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Showing papers in "Clinical Research in Cardiology in 2006"


Journal ArticleDOI
TL;DR: The presently available data suggest that the pathophysiology of the metabolic syndrome and its contribution to the relative risk of cardiovascular events and heart failure show gender differences, which might be of potential relevance for prevention, diagnostics, and therapy of the syndrome.
Abstract: Women live longer than men and develop cardiovascular disease (CVD) at an older age. The metabolic syndrome represents a major risk factor for the development of CVD, and gender1 differences in this syndrome may contribute to gender differences in CVD.

437 citations


Book ChapterDOI
TL;DR: In this paper, the vorliegenden Leitlinien zur Implantation von Defibrillatoren wurden in Uberarbeitung der Deutschen Gesellschaft fur Kardiologie, Herz and Kreislaufforschung, erstellt, basierend auf einer sorgfaltigen Analyse der wissenschaftlichen Daten zur aktuellen Therapie ventrikularer Tachyarrhythmien.
Abstract: Die vorliegenden Leitlinien zur Implantation von Defibrillatoren wurden in Uberarbeitung der Leitlinien der Deutschen Gesellschaft fur Kardiologie, Herz und Kreislaufforschung, wie sie 1993 publiziert worden sind, erstellt, basierend auf einer sorgfaltigen Analyse der wissenschaftlichen Daten zur aktuellen Therapie ventrikularer Tachyarrhythmien. Auch in Zukunft sollen diese Leitlinien in regelmasigen Abstanden revidiert werden, wenn der wissenschaftliche Erkenntnisstand dies erforderlich macht.

109 citations


Journal ArticleDOI
TL;DR: The retrospective analysis showed, that if the patients had been managed using this scheme, 503 of 1079 routine FU could have been skipped with only one safety concern, a three month delay in the detection of silent paroxysmal atrial fibrillation in one patient.
Abstract: Due to the increasing number of patients with an implantable cardioverter defibrillator (ICD), new options for ICD patient follow-up management are required. Patients with ICD indication according to the guidelines received an ICD with Home Monitoring technology. The devices enabled the transmission of the relevant episode, therapy, and system integrity data. Patients were followed for 12 months with routine controls every 3 months. The physician analyzed the Home Monitoring data before the routine follow-up visit (FU) and gave a forecast on the necessity of the pending FU, which was compared with the evaluation after the FU. Based on the derived forecast reliability, a patient management scheme was developed and its impact on patient safety was assessed retrospectively. A total of 271 patients were enrolled (40 f, mean age 62±12 years, mean LVEF 39±15%, 65% ischemic heart disease, 20% cardiomyopathy) and followed for 339±109 days. Of 908 pairs of Home Monitoring data and FU data evaluation, 129 there were false negative results for 92 patients. Safety concerns from false negative forecasts can be minimized with a patient management scheme containing the following elements: 1) never skip the first routine FU; 2) never skip a routine FU for a patient having already shown pacing threshold problems; 3) perform FU following hospitalizations; 4) perform FU following episode detection by the ICD; and 5) perform a routine FU if the patient reports symptoms. The retrospective analysis showed, that if the patients had been managed using this scheme, 503 of 1079 routine FU could have been skipped with only one safety concern, a three month delay in the detection of silent paroxysmal atrial fibrillation in one patient. Home Monitoring in ICD therapy over 12 months is feasible. The data transmitted relevantly contribute to a remarkable reduction of follow-up burden and enable the individualization of routine follow-up.

91 citations


Journal ArticleDOI
TL;DR: Die vorliegenden Leitlinien zur Implantation of Defibrillatoren wurden in Uberarbeitung der Leit Linien der Deutschen Gesellschaft fur Kardiologie, Herz and Kreislaufforschung erstellt.
Abstract: Die vorliegenden Leitlinien zur Implantation von Defibrillatoren wurden in Uberarbeitung der Leitlinien der Deutschen Gesellschaft fur Kardiologie, Herz und Kreislaufforschung, wie sie 1993 publiziert worden sind, erstellt, basierend auf einer sorgfaltigen Analyse der wissenschaftlichen Daten zur aktuellen Therapie ventrikularer Tachyarrhythmien. Auch in Zukunft sollen diese Leitlinien in regelmasigen Abstanden revidiert werden, wenn der wissenschaftliche Erkenntnisstand dies erforderlich macht.

84 citations


Journal ArticleDOI
TL;DR: Intracoronary progenitor cell therapy after AMI is associated with complete restoration of coronary flow reserve due to a substantial improvement of maximal coronary vascular conductance capacity.
Abstract: Coronary microvascular dysfunction contributes to infarct extension and poor prognosis after an acute myocardial infarction (AMI). Recently, progenitor cell application has been demonstrated to improve neovascularization and myocardial function after experimental myocardial infarction. Therefore, we investigate coronary blood flow regulation in patients after AMI treated with intracoronary progenitor cell therapy. In the TOPCARE-AMI trial, patients received either bone marrow-derived or circulating progenitor cells into the infarct-related artery 3–7 days after AMI. The present substudy investigates in 40 patients coronary blood flow regulation at the time of progenitor cell therapy and at 4-month follow-up by i.c. Doppler in the infarct artery as well as a reference vessel. At the initial measurement, coronary flow reserve (CFR) was reduced in the infarct artery compared to the reference vessel (median 2.5 vs. 3.4, p<0.001). At 4-month follow-up, intracoronary progenitor cell therapy was associated with a normalization of CFR in the infarct artery (median 3.9 vs. reference vessel 3.8, p=0.15). CFR also improved in the reference vessel, but mechanisms were different: reference vessel increase in CFR was secondary to an increased basal vascular resistance, probably due to reduced need for hypercontractility. In contrast, in the infarct artery, adenosine-induced minimal vascular resistance profoundly decreased, indicating an increased maximal coronary vascular conductance capacity. In addition, in a non-randomized matched control group (n=8), minimal vascular resistance in the infarct artery was significantly elevated compared to progenitor cell treated patients 4 months after AMI (p=0.012). Intracoronary progenitor cell therapy after AMI is associated with complete restoration of coronary flow reserve due to a substantial improvement of maximal coronary vascular conductance capacity. The clinical importance of improved microcirculation by progenitor cell therapy in patients after AMI has to be established in further randomized trials.

76 citations


Journal ArticleDOI
Reinhold Kreutz1
TL;DR: The treatment and management of patients with arterial hypertension depends on the global cardiovascular risk of the individual patient, and the presence of target organ damage, cardiovascular or renal disease determine not only the initiation of therapy but also the choice of drug(s).
Abstract: The treatment and management of patients with arterial hypertension depends on the global cardiovascular risk of the individual patient. Thus, additional cardiovascular risk factors, the presence of target organ damage, cardiovascular or renal disease determine not only the initiation of therapy but also the choice of drug(s). Drug treatment is usually started with one compound, which is selected from 5 drug classes recommended for first-line therapy including ACE-inhibitors, AT1-antagonists, betablockers, calcium channel blockers, and diuretics. Depending on risk and additional disease individual target blood pressures are 140/90, 130/80 or 125/75 mmHg, respectively. If blood pressures at baseline exceeds target values more than 20/10 mmHg treatment may be started with initial or early combination therapy of two drugs. Overall, approximately two-thirds of patients require treatment with at least two drugs to achieve target blood pressure values.

69 citations


Journal ArticleDOI
TL;DR: In this paper, the authors present interim results of the prospective, longitudinal, multicenter Home CARE Phase 0 study, conducted in 123 patients (age: 67±9 years, 83% male) with clinical indication for CRT.
Abstract: The increasing worldwide prevalence of heart failure is associated with numerous and protracted hospital admissions. The multidisciplinary team approach together with telemonitoring aims at reducing the number of rehospitalizations, length of hospital stay, and mortality rates. Novel cardiac resynchonization therapy (CRT) devices have a Home Monitoring capability, offering wireless, everyday transfer of the essential status and therapy data to the attending physician. The transmitted data include potential predictors of death or hospitalization, such as the onset of atrial and ventricular arrhythmias, duration of physical activity, mean heart rates over 24 h and at rest, percentage of CRT delivered, and lead impedances. We present here interim results of the prospective, longitudinal, multicenter Home CARE Phase 0 study, conducted in 123 patients (age: 67±9 years, 83% male) with clinical indication for CRT. Twenty-nine patients (24%) received a CRT pacemaker, 52 (42%) a prophylactic implantable cardioverter defibrillator (ICD), and 42 (34%) had other ICD indications. All devices have an integrated Home Monitoring feature. In a mean (interim) follow-up period of 3 months (9194 observational days), 11 unplanned rehospitalizations of cardiovascular etiology and 9 deaths occurred. In 70% of the rehospitalization events, the retrospective analysis of transmitted data via Home Monitoring revealed an increase in mean heart rate at rest and in mean heart rate over 24 h within 7 days preceding hospitalization. A decrease in the percentage of CRT was observed in 43% and a reduction in the patients’ daily activity in 30% of rehospitalized patients. These interim findings suggest that Home Monitoring data may predict events leading to hospitalization and encourage further research.

67 citations


Journal ArticleDOI
TL;DR: It is concluded that the extent to which statins lower LDL–C is strongly related to the improvement of clinical outcomes achieved by this class of drugs.
Abstract: A recent meta–analysis of the Cholesterol Treatment Trialists’ (CTT) Collaboration comes to the clear conclusion that a reduction in LDL–C using statins of 1 mmol/l (39 mg/dl) leads to a decrease in overall mortality by 12%, in coronary mortality by 19% and in the incidence of strokes by 17%, independent of the LDL–C level prior to the start of treatment. We conducted a systematic review retrieving 18 studies with a total of 97 861 participants. Differences in average LDL–C reductions between the intervention and control groups during the follow–up and relative risks according to different clinical endpoints were extracted from the original publications. Metaregression analyses showed that reduction in LDL–C accounted for more than 75% of the variance in risk reductions for overall mortality and cardiovascular endpoints. On the basis of our estimates, a reduction in LDL–C of 1 mmol/l (39 mg/dl) leads to reductions in overall mortality, coronary mortality, incidence of non–fatal myocardial infarction, the combination of coronary mortality and non–fatal myocardial infarction, stroke and any vascular event by 15% (95% CI: 11–20%), 24% (95% CI: 20–28%), 27% (95% CI: 20–32%), 25% (95% CI: 22–29%), 24% (18–29%) and 22% (95% CI: 19–26%), respectively. We conclude that the extent to which statins lower LDL–C is strongly related to the improvement of clinical outcomes achieved by this class of drugs.

66 citations


Journal ArticleDOI
TL;DR: In this paper, the clinical implication of a Cardiac MR (CMR) protocol including adenosine stress perfusion in this patient population was analyzed and the relative impact of CMR exam components (perfusion, function and viability assessment) in achieving this target was compared.
Abstract: Background Real world cardiology is faced with a low diagnostic yield of coronary angiography (CXA) in patients presenting with ACC/AHA class II CXA indication. Our aim was to analyze the clinical implication of a Cardiac MR (CMR) protocol including adenosine stress perfusion in this patient population. We examined whether CMR could enhance appropriate CXA indication and thus reduce the rate of pure diagnostic CXA. In addition, we compared the relative impact of CMR exam components (perfusion, function and viability assessment) in achieving this target.

61 citations


Journal ArticleDOI
TL;DR: Diese Endotheldysfunktion führt zu einer deutlichen Reduktion der endothelvermittelten Vasodilatation für Patienten mit chronischer Herzinsuffizienz als auch bei Patienten with insulinpflichtigem Diabetes mellitus gefunden.
Abstract: Endothelial dysfunction is found both in patients with chronic heart failure and in patients with insulin-treated type 2 diabetes mellitus This endothelial dysfunction leads to a significant reduction in endothelium-derived vasodilation Physical exercise can have a positive effect on endothelial dysfunction in patients with coronary artery disease, chronic heart failure and diabetes mellitus It is not clear, however, whether an exercise program influences endothelial function in diabetics with chronic heart failure Our study was thus aimed at investigating whether a special exercise program would affect endothelial function Comparisons were made with insulintreated type 2 diabetics and with non-diabetics suffering from chronic heart failure 42 patients with severe chronic heart failure (LVEF≤30%), insulin-dependent diabetics (n=20, mean age 67±6 yrs, 16 male, 4 female), non-diabetics (n=22, mean age 68±10 yrs, 20 male, 2 female) participated in a 4-week exercise program consisting of ergometer and special muscle strength training Before (T1) and at the end (T2) of the training program endothelium-dependent and endothelium-independent vasodilatory capacity were assessed by brachial artery diameter measurement At the end of the training program, there were no significant results within the two groups The endothelium-dependent vasodilation changed between T1 and T2 as follows: In the diabetic group, the endothelium-dependent vasodilation at T1 and T2 was 51±36 and 49±25%, respectively For the non-diabetics, the endothelium-dependent vasodilation was 68±45 and 76±40% at T1 and T2, respectively The endotheliumindependent vasodilation in the diabetics was 105±56 at T1 and dropped to 87±41% at T2 The results for the non-diabetics were 132±58 and 123±63% at T1 and T2, respectively The LVEF in the diabetics was 242±34% at T1, increasing to 278±58% at T2 In the non-diabetics, the LVEF was 229±38 at T1 vs 286±69% at T2 In the groups of diabetics, the maximum oxygen uptake (VO2-max) was 103±39 at T1 vs 114±28 ml/kg/min at T2 and in the group of non-diabetics 100±31 vs 135±50 ml/kg/min No correlations were found between the change in endothelium-dependent vasodilation and the increase in oxygen uptake In our study, a program of physical exercise had no influence on endothelium-dependent or endothelium-independent vasodilation in insulin-treated type 2 diabetics or in non-diabetics with considerably reduced ejection fraction In both groups, however, an exercise-related influence on medical parameters and physical performance could be observed

60 citations


Journal ArticleDOI
TL;DR: The use of music stimulation during the catheterization has a relaxing and calming effect on patients, and seems to be especially beneficial in a subgroup of patients with higher-than-average psychological strains.
Abstract: Background Intracardiac catheterization is a routine physical examination. Due to psychological strains, several psychosocial interventions, including music therapy, have been proposed. The aim of the present study was to examine whether the preventive or adjuvant use of music therapy results in a reduction in both subjective and objective anxiety and thus leads to a reduction in sedative medication.

Journal ArticleDOI
TL;DR: In this paper, van Buuren et al. analyse the jährlichen Leistungszahlen deutscher Herzkatheterlabore seit 1985 and find that the stieg bezogen auf die Anzahl der PCIs von 68,35% in Jahr 2000 auf 80,45% in 2004 wobei sich zuletzt eine Stagnation dieser Quote abzeichnete.
Abstract: Dr. F. van Buuren ()) · Prof. Dr. D. Horstkotte Kardiologische Klinik Herzund Diabeteszentrum NRW Universitätsklinik der Ruhr-Universität Bochum Georgstr. 11 32545 Bad Oeynhausen, Germany E-Mail: fvbuuren@hdz-nrw.de Gesundheitspolitische Umstrukturierungsprozesse und die damit verbundene Diskussion machen statistische Erhebungen zur zwingenden Voraussetzung für eine fundierte Einschätzung der medizinischen Versorgung in Deutschland. Auch für die invasive Kardiologie muss weiter eine Analyse des Leistungsspektrums gefordert werden. Dieser Beitrag schreibt die jährlichen Leistungszahlen deutscher Herzkatheterlabore seit 1985 fort [1–5]. Die Statistik basiert auf den Angaben von 470 invasiv tätigen Kliniken und Praxen (Vorjahr 432 Einrichtungen). Von 19 der 470 Einrichtungen (3,9%) wurden keine aktuellen Daten gemeldet; in diesen Fällen wurden die Vorjahreszahlen für die statistische Auswertung herangezogen. Die Entwicklung der Leistungszahlen zwischen 1984 und 2004 ist in der Tabelle 1 a dargestellt. Für 2004 wurden 711 607 (Vorjahr: n = 652 781; + 9,01%) diagnostische Herzkatheteruntersuchungen und 248 909 (Vorjahr: n = 221 867; + 12,18%) Koronarinterventionen gemeldet. Erstmals wird in Tabelle 1 b ein Überblick über die Stentquote im Verlauf der letzten Jahre gegeben. Diese stieg bezogen auf die Anzahl der PCIs von 68,35% in Jahr 2000 auf 80,45% in 2004 wobei sich zuletzt eine Stagnation dieser Quote abzeichnete. Be-

Journal ArticleDOI
TL;DR: Tako–tsubo cardiomyopathy is not exclusively a Japanese or Northern American phenomenon and despite increased patient reports the exact underlying cause and pathophysiology of this syndrome remain unclear.
Abstract: A peculiar type of an acute coronary syndrome is characterised by acute onset of chest pain, STsegment changes, elevated troponin I levels and a transient balloon–like apical left ventricular dysfunction, but without significant coronary artery disease. We sought to assess this syndrome in German patients. A total of 22 females and 1 male with acute transient left ventricular dysfunction were identified during an interval of 2 years and were investigated clinically and angiographically. All patients presented without obstructive coronary artery disease. In 16 patients (70%) ST–segment elevations were observed mimicking acute myocardial infarction, whereas the remaining patients (30%) revealed only negative T waves. Deep negative Twaves were characteristically seen during the course of recovery in all patients. Elevated troponin I levels > 2.0 µg/l (upper level of normal) were measured in all patients (mean 18 ± 26.5 µg/l, range from 2.2–135.7 µg/l). Creatine kinase rose up to a mean of 282 ± 236 IU/l (upper level of normal 180 U/l). Emotional or physical stress situations associated with the onset of the symptoms were observed in 16 patients (70%). Other suspected trigger factors were gastrointestinal infection and in one case a surgical intervention. In four patients a trigger factor could not be identified. Left ventriculography showed an ejection fraction of 53 ± 15%. After an interval of 7 ± 2 days after the first angiogram, ejection fraction had increased from 48 ± 11% to 64 ± 11% in eight controlled patients by repeated ventriculography. Coronary spasm with a lumen reduction > 75% could be provoked using acetylcholine in 10 of 17 tested patients (59%) with reproduction of the symptoms. Within 14 days the LV dysfunction returned to normal in all patients. The ECG abnormalities disappeared completely as early as 3 months (74%) and were not seen in any patient after 6 months. Tako–tsubo cardiomyopathy is not exclusively a Japanese or Northern American phenomenon. Despite increased patient reports the exact underlying cause and pathophysiology of this syndrome remain unclear. However, despite the initial dramatic presentation of this disease the prognosis is good.

Journal ArticleDOI
TL;DR: Implantable cardioverter defibrillators with the integrated Home Monitoring feature use dedicated mobile phone and internet links to provide the physicians and technicians in the ICD clinic with the essential device- and arrhythmia-related data stored in theICD diagnostic memory.
Abstract: Implantable cardioverter defibrillators (ICDs) with the integrated Home Monitoring feature use dedicated mobile phone and internet links to provide the physicians and technicians in the ICD clinic with the essential device- and arrhythmia-related data stored in the ICD diagnostic memory. Various counters, graphs and intracardiac electrograms are automatically transmitted via Home Monitoring each day to allow prompt, remote presentation of arrhythmias or detection of technical problems. One of the most inconvenient side-effects of the ICD therapy is inappropriate intervention of the device. Home Monitoring data can help the physician to identify and subsequently reduce the incidence of inappropriate ICD therapy.

Journal ArticleDOI
TL;DR: A patient with a recurrent tako–tsubo phenomenon, who at work–up proved to have a pheochromocytoma as the most likely underlying disease, is described.
Abstract: Primarily described in Japan, tako-tsubo-like left ventricular dysfunction is a phenomenon characterized by transient apical ballooning in the absence of significant coronary artery disease. The clinical presentation includes symptoms like chest pain, dyspnea, syncope, electrocardiographic changes and elevated myocardial markers, all compatible with the diagnosis of an acute coronary syndrome. The underlying mechanism is supposed to be a catecholamine excess caused by various triggers. We describe a patient with a recurrent tako-tsubo phenomenon, who at work-up proved to have a pheochromocytoma as the most likely underlying disease.

Journal ArticleDOI
TL;DR: Normotensive and hypertensive OSAS was not associated with a significant elevation of NT-pro-BNP and the potential for nCPAP to improve cardiovascular comorbidity and co-mortality in OSAS and sleep disordered breathing, in general.
Abstract: The aim of this study was to evaluate the impact of obstructive sleep apnea syndrome (OSAS) on B-type natriuretic peptide (BNP) and to determine the effect of nasal continuous positive airway pressure (nCPAP) treatment on BNP levels. Increased sympathetic activity, repetitive rises in blood pressure, and apnea-induced wall stress may contribute as a trigger to release BNP in OSAS. However, there is uncertainty about whether OSAS affects BNP and whether application of nasal continuous positive airway pressure (nCPAP) ventilation affects release of BNP. A prospective study in 69 consecutive patients with suspected sleep disordered breathing referred to our sleep laboratory was conducted. OSAS was confirmed in 26 normotensive and 34 hypertensive patients and ruled out in nine normotensive patients (controls) by polysomnography (PSG). Baseline N-terminal fragment of BNP prohormone (NT-pro-BNP) did not differ significantly between OSAS patients (hypertensive: mean ±SEM 60.8±9.9 pg/ml, normotensive: 43.2±6.8 pg/ml) and controls (36.5±8.5 pg/ml). Application of CPAP resulted in a significant decrease of NT-pro-BNP in hypertensive (60.8±9.9 pg/ml to 47.6±7.4 pg/ml, p=0.023) and normotensive OSAS (43.2±6.8 pg/ml to 29.6±5.3 pg/ml, p=0.0002). In contrast, controls showed no significant differences in NT-pro-BNP after a second PSG (36.5±8.5 pg/ml to 40.7±12.3 pg/ml, p=0.597). Normotensive and hypertensive OSAS was not associated with a significant elevation of NT-pro-BNP. Application of nCPAP decreased NT-pro-BNP levels significantly in normotensive and, in particular, hypertensive OSAS. These findings may provide further evidence of the potential for nCPAP to improve cardiovascular comorbidity and co-mortality in OSAS and sleep disordered breathing, in general.

Journal ArticleDOI
TL;DR: The goal in the present paper was to analyse the present treatment of AMI patients over 75 years of age in the city of Berlin, Germany, with data gained from the Berlin Myocardial Infarction Registry (BHIR).
Abstract: Aims Guidelines issued by European and German cardiology societies clearly define procedures for treatment of acute myocardial infarction (AMI). These guidelines, however, are based on clinical studies in which older patients are underrepresented. Older patients, on the other hand, represent a large and growing portion of the infarction population. It was our goal in the present paper to analyse the present treatment of AMI patients over 75 years of age in the city of Berlin, Germany, with data gained from the Berlin Myocardial Infarction Registry (BHIR).

Journal ArticleDOI
TL;DR: Prevalences of DM and IGR are higher than expected in patients with CHD, and an OGTT should be considered for all patients with a fasting plasma glucose ≥ 90 mg/dl undergoing a coronary angiography.
Abstract: Impaired glucose regulation (IGR) and diabetes mellitus (DM) are amongst the main risk factors for developing coronary heart disease (CHD). The aim of this study was to investigate previously unknown glucose metabolism disorder in patients scheduled for an elective coronary angiography. A total of 141 patients scheduled for coronary angiography without signs of acute myocardial ischemia or previous history of a glucose metabolism disorder were prospectively included in the study. An oral glucose tolerance test (OGTT) was performed in each patient. IGR was diagnosed in 40.4% (95% confidence interval 32.3–49.0) and undetected DM in 22.7% (16.1–30.5) of patients undergoing an elective coronary angiography. Depending on the severity of CHD, the percentage of IGR and DM increased up to 45.3% (34.6–56.5) and 26.7% (17.8–37.4) in the subgroup with the need of percutaneous angioplasty, while the corresponding proportions in the group without CHD were 30.3% (15.6–48.7) and 12.1% (3.4–28.2). The percentage of undiagnosed DM increased with the number of epicardial vessels involved. Using the recommended fasting plasma glucose value of ≥ 126 mg/dl for the diagnosis of DM, we would have missed 71.9% of the patients with undiagnosed DM. If all patients with a fasting plasma glucose of ≥ 90 mg/dl had been subjected to OGTT, 93.8% of DM would have been identified. Prevalences of DM and IGR are higher than expected in patients with CHD. An OGTT should be considered for all patients with a fasting plasma glucose ≥ 90 mg/dl undergoing a coronary angiography.

Journal ArticleDOI
TL;DR: In this paper, a task force for Klinische kardiologie is established, with the aim to find a solution to the problem of Herz-and Kreislaufforschung in Klinisch Kardiologien.
Abstract: Herausgegeben vom Vorstand der Deutschen Gesellschaft furKardiologie – Herz- und Kreislaufforschung e.V.Bearbeitet im Auftrag der Kommission fur Klinische KardiologieG. Ertl, D. Andresen, M. Bohm, M. Borggrefe, J. Brachmann,F. de Haan, S. Silber, H.J. Trappe, A. Osterspeyauserdem G. Arnold, H. M. Hoffmeister, E. Fleckvon H. Kaemmerer (Vorsitzender der Ad-hoc-Gruppe),U. Bauer, F. de Haan, J. Flesch, C. Gohlke-Barwolf, S. Hagl,J. Hess, M. Hofbeck, H.C. Kallfelz, P.E. Lange, H. Nock,K.R. Schirmer, A.A. Schmaltz, U. Tebbe, M. Weyand undG. Breithardt (Vorsitzender der Task Force)Gemeinsam erarbeitet mit dem Kompetenznetz Angeborene Herz-fehler von einer interdisziplinarenTask Force:– der Deutschen Gesellschaft fur Kardiologie (DGK)– der Deutschen Gesellschaft fur Padiatrische Kardiologie(DGPK)– der Deutschen Gesellschaft fur Thorax-, Herz- und Gefas-chirurgie (DGTHG)– der Arbeitsgemeinschaft Leitender Kardiologischer Kranken-hausarzte e. V. (ALKK)– dem Bundesverband Niedergelassener Kardiologen e.V. (BNK)– der Arbeitsgemeinschaft Niedergelassener Kinderkardiologene.V. (ANKK)unter Mitarbeit der AG „Kongenitale Herzfehler im Erwachsenen-alter“ der DGK,dem Bundesverband Herzkranke Kinder e.V. (BVHK)sowie der Bundesvereinigung Jugendliche und Erwachsene mitangeborenen Herzfehlern e.V. (JEMAH).

Journal ArticleDOI
TL;DR: Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.
Abstract: The DETECT study was performed to obtain representative data about the frequency, distribution, and treatment of patients with coronary artery disease (CAD) in the primary care setting in Germany. The DETECT study was a cross–sectional clinical– epidemiological survey of a nationally representative sample of 3795 primary care offices and 55 518 patients. Overall, 12.4% of patients were diagnosed with CAD. Stable angina pectoris and myocardial infarction were the most frequent (4.2%) subgroups, followed by status post (s/p) percutaneous coronary interventions (PCI, 3.0%) and s/p coronary bypass surgery (2.2%). Patients with CAD were prescribed AT1 receptor antagonists (in 19.4% of cases), beta blockers (57.2%), ACE inhibitors (49.9%), antiplatelet agents (52.7%), statins (43.0%), and long–term nitrates (24.5%). When comparing all CAD patients with social health care insurance to those who had private insurance, private patients had significantly higher rates of revascularisation procedures and use of preventive medications. Great potential remains for improving secondary prevention in primary care in Germany to reduce the risk of further coronary or vascular events, especially in patients with social health care insurance.

Journal ArticleDOI
TL;DR: The time interval from onset of symptoms to first blood collection is an important determinant for NT–proBNP values on admission in patients with an ACS and needs to be considered in clinical practice.
Abstract: Recently it has been found that BNP and NT–proBNP provide independent prognostic information in patients with acute coronary syndromes (ACS). However, little data are available on the time course of NT–proBNP levels in relation to onset of symptoms. We included 765 patients (236 females, aged 64 ± 11 years) with an ACS (STEMI 42%, NSTEMI 41%, UAP 17%), who were referred for coronary angiography. NT–proBNP was assessed on admission and the next day. NT–proBNP values were related to the time duration from onset of symptoms until blood drawing with lowest values within 3 h and highest values 24–36 h after onset of symptoms (147 (64–436) pg/ml and 1099 (293–3795) pg/ml, respectively, p < 0.001). Highest values for NT–proBNP on admission were found in patients with NSTEMI compared to patients with STEMI and UAP (912 (310–2258) pg/ml) vs 262 (85–1282) pg/ml) vs 182 (74– 410) pg/ml; p < 0.001), but no difference was present between STEMI and NSTEMI the day after admission (1325 (532–2974) pg/ ml vs 1169 (555–3413) pg/ml; p = 0.676). In contrast NT–proBNP values remained unchanged in UAP (182 (74–410) pg/ml) vs 171 (53–474) pg/ml). The time interval from onset of symptoms to first blood collection is an important determinant for NT–proBNP values on admission in patients with an ACS and needs to be considered in clinical practice.

Journal ArticleDOI
TL;DR: Two patients in whom deterioration of left ventricular function could be avoided by implantation of self–fabricated fenestrated Amplatzer Septal Occluders (ASO) in patients with ongoing restrictiveleft ventricular physiology are reported.
Abstract: To avoid left ventricular failure after transcatheter closure of atrial septal defects in elderly patients with restrictive left ventricular physiology, partial occlusion by fenestrated devices may be an option. If complete defect closure is not possible in these patients, significant reduction of left to right shunting usually results in clinical benefit. We report two patients in whom deterioration of left ventricular function could be avoided by implantation of self-fabricated fenestrated Amplatzer Septal Occluders (ASO) in patients with ongoing restrictive left ventricular physiology. We describe technical preparation of the standard occluder, the specific implantation technique, and the initial and the intermediate term results up to 24 months.

Journal ArticleDOI
TL;DR: A novel NKX2.5 mutation is reported in a small family where progressive AV block and congenital heart disease was identified in two generations and is important to pediatricians, cardiologists and surgeons who diagnose, treat and provide longterm follow-up to these patients.
Abstract: D. Woodrow Benson Cincinnati Children’s Hospital Medical Center Cincinnati, OH, USA Sirs: Congenital heart disease has the highest incidence of all birth defects affecting about 6–8/1000 live births. These heart malformations are believed to arise during cardiac development, but there is little known about the underlying mechanisms of disease [12]. Cardiac development is a complex process, and in recent years, the role of transcription factors as possible navigators of development has been frequently investigated [7, 10, 19]. The cardiac transcription factor NKX2.5 was identified as the first genetic cause of nonsyndromic congenital heart disease [22]. A total of 33 heterozygous mutations in NKX2.5 have been reported in individuals with a variety of congenital heart malformations, including atrial septal defect, ventricular septal defect, tetralogy of Fallot and abnormalities of the tricuspid valve [2, 6, 8, 9, 11, 13, 14, 16, 18, 21–23]. Specific types of mutations result in progressive atrioventricular (AV) conduction disturbance, requiring pacemaker implantation. These studies have provided important insight into the genetic origins of cardiac malformations and, by providing tools for the developmental biologist, have contributed to improved insights into the pathogenesis of congenital heart disease [3, 5]. As such, these results are important to pediatricians, cardiologists and surgeons who diagnose, treat and provide longterm follow-up to these patients. Here we report a novel NKX2.5 mutation in a small family where progressive AV block and congenital heart disease was identified in two generations.

Journal ArticleDOI
TL;DR: Herausgegeben vom Vorstand der Deutschen Gesellschaft für Kardiologie – Herzund Kreislaufforschung e.V.
Abstract: Prof. Dr. W. G. Daniel ()) · H. Baumgartner · C. Gohlke-Bärwolf P. Hanrath · D. Horstkotte · K. C. Koch · A. Mügge · H. J. Schäfers F. A. Flachskampf Med. Klinik 2 Universitätsklinikum Erlangen Ulmenweg 18 91054 Erlangen, Germany Tel.: 0 91 31 / 8 53 53 01 Fax: 0 91 31 / 8 53 53 03 E-Mail: werner.g.daniel@rzmail.uni-erlangen.de Herausgegeben vom Vorstand der Deutschen Gesellschaft für Kardiologie – Herzund Kreislaufforschung e.V. Bearbeitet im Auftrag der Kommission für Klinische Kardiologie G. Ertl, D. Andresen, M. Böhm, M. Borggrefe, J. Brachmann, F. de Haan, A. Osterspey, S. Silber, H. J. Trappe außerdem G. Arnold, H. M. Hoffmeister, E. Fleck


Journal ArticleDOI
TL;DR: The overexpression of MMP–1, which is associated with an increased ratio of M MP–1/TIMP–1 in DCM, indicates an activated collagenolytic system while replacement fibrosis is accumulating.
Abstract: Left ventricular dilation and myocardial remodeling are hallmarks of dilated cardiomyopathy (DCM). It is assumed that left ventricular dilation is caused by the disintegration of the collagenous network by increased collagenolytic activity of matrix metalloproteinases (MMPs) and their adequate tissue inhibitors (TIMPs). In this study the myocardial MMP–1 and TIMP–1 mRNA expressions were investigated by using real–time quantitative PCR analysis from right septal endomyocardial biopsies of patients with dilated cardiomyopathy (n = 46) and control subjects (n = 11). The volume density (Vv%) of collagen was measured morphometrically. Classification was done according to LV diameters [left ventricular enddiastolic diameter (LVEDD, cm) calculated to body surface area (BSA, m2)] into three DCM groups: group I (LVEDD–BSA > 2.7–3.0 cm/m2), group II ( > 3.0–3.6 cm/m2), group III ( > 3.6 cm/m2), controls (< 2.7 cm/m2). Compared with controls, the MMP–1 expression in patients with DCM was significantly increased (119.2 ± 45.2 vs. 1.3 ± 0.4; p < 0.001) as was TIMP–1 expression (9.6 ± 1.2 vs. 1.3 ± 0.4; p < 0.01). Moreover the MMP–1 and TIMP–1 expression varied according to LV diameter: group I (MMP–1: 8.7 ± 3.5; p = 0.33; TIMP– 1: 4.5 ± 1.2; p < 0.01); group II (MMP–1: 211.4 ± 86.0; p < 0.001; TIMP–1: 12.5 ± 1.9 ; p < 0.001); group III (MMP–1: 38.8 ± 22.6; p < 0.01; TIMP–1: 8.1 ± 1.7; p < 0.001). Compared with controls, the collagen level in DCMPt. was significantly increased: 5.0 ± 0.6 vol% vs 1.2 ± 0.2 vol% p < 0.001 and correlates with LV diameter. This study reveals that the overexpression of MMP–1, which is associated with an increased ratio of MMP–1/TIMP–1 in DCM, indicates an activated collagenolytic system while replacement fibrosis is accumulating. The MMP–1 overexpression is mainly found in moderately dilated DCM hearts (group II) indicating the dynamic process of LV dilation and the importance of collagenases in the early phase of LV remodeling.

Journal ArticleDOI
TL;DR: This Critical Perspective will deal with the question, which patient should undergo endomyocardial biopsy investigations for an etiopathogenic differentiation of the disease and for the possible choice of immunomodulatory treatment strategies.
Abstract: The role of endomyocardial biopsies in patients with clinically suspected acute myocarditis, myocarditis in the past, and dilated cardiomyopathy is discussed controversially. In fact, it is still under discussion whether information obtained from endomyocardial biopsies is relevant for further clinical decisions. Therefore this Critical Perspective will deal with the question, which patient should undergo endomyocardial biopsy investigations for an etiopathogenic differentiation of the disease and for the possible choice of immunomodulatory treatment strategies.

Journal ArticleDOI
TL;DR: Transhepatic access for catheter intervention can easily be achieved in selected pediatric patients, and in one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion.
Abstract: We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months–9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore–Tex® tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the transseptal needle to the atrial baffle, allowing puncture of the Gore–Tex® membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression.

Journal ArticleDOI
TL;DR: This article reports on two patients with inappropriate detection of ventricular tachycardia, recognized immediately by IEGMs that were transmitted via Home Monitoring services (“IEGM Online”).
Abstract: Oliver Ritter, MD ()) · Wolfgang R. Bauer Department of Medicine I Cardiovascular Center University of Wuerzburg Josef Schneider Str. 2 97080 Wuerzburg, Germany Tel.: +49-9 31 / 2 01-3 61 12 Fax: +49-9 31 / 2 91-3 62 12 E-Mail: ritter_o@klinik.uni-wuerzburg.de Sirs: Therapy of life-threatening tachycardias with an implantable cardioverter defibrillator (ICD) is safe and effective as demonstrated in many randomized trials [1–3]. However, inappropriate therapies remain a major problem in patients with ICDs. Therefore, decreasing the number of inappropriate therapies is a major objective. Programming of detection criteria based on stability, onset, and atrial fibrillation rate threshold increase specificity in ICD therapy. However, discrimination of supraventricular tachycardia (SVT) with a 1 : 1 atrioventricular relationship still remains a challenge [4]. Inadequate therapies for supraventricular tachycardia by ICDs are potentially arrhythmogenic [5] and impair the patient’s quality of life. To maintain the patient’s safety and comfort, patients need rigid follow-ups for assessment of clinical status or adaptation of ICD therapy. The current follow-up interval for ICD patients is three to six months [6]. To increase patient safety and to reduce follow-up visits at the same time, Home Monitoring therapy has been suggested for close remote followup of patients with implanted electronic devices. To date, this technology allows transmission of event data within 24 hours. For exact verification of the events and for testing of device integrity, the patient still has to be referred to the attending physician. Recently, an additional feature was offered by the manufacturer. The Home Monitoring devices are now capable of transmitting IEGMs of the tachycardia episode to be evaluated. This article reports on two patients with inappropriate detection of ventricular tachycardia, recognized immediately by IEGMs that were transmitted via Home Monitoring services (“IEGM Online”).

Journal ArticleDOI
TL;DR: German guidelines for the diagnosis and therapy of severe sepsis did not exist and were developed based on international recommendations by the International Sepsis Forum and the Surviving Sepsis Campaign and take into account the structure and organisation of the German health care system.
Abstract: A recent survey conducted by the publicly funded Competence Network Sepsis (Sep- Net) reveals that severe sepsis and/or septic shock occurs in 75,000 inhabitants (110 out of 100,000) and sepsis in 79,000 inhabitants (116 out of 100,000) in Germany annually. This illness is responsible for approx. 60,000 deaths and ranges as the third most frequent cause of death after acute myocardial infarction. Direct costs for the intensive care of patients with severe sepsis alone amount to approx. 1.77 billion euros, which means that about 30% of the budget in intensive care is used to treat severe sepsis. However, until now German guidelines for the diagnosis and therapy of severe sepsis did not exist. Therefore, the German Sepsis Society initiated the development of guidelines which are based on international recommendations by the International Sepsis Forum (ISF) and the Surviving Sepsis Campaign (SSC) and take into account the structure and organisation of the German health care system. Priority was given to the following guideline topics: a) diagnosis, b) prevention, c) causative therapy, d) supportive therapy, e) adjunctive therapy. The guidelines development process was carefully planned and strictly adhered to according to the requirements of the Working Group of Scientific Medical Societies (AWMF).