Clinical research in cardiology : official journal of the German Cardiac Society最新文献

{"title":"Medical and cardio-vascular emergency department visits during the COVID-19 pandemic in 2020: is there a collateral damage? A retrospective routine data analysis.","authors":"Anna Slagman,&nbsp;Mareen Pigorsch,&nbsp;Felix Greiner,&nbsp;Wilhelm Behringer,&nbsp;Michael Bernhard,&nbsp;Jonas Bienzeisler,&nbsp;Sabine Blaschke,&nbsp;Volker Burst,&nbsp;Katharina Dechant,&nbsp;Michael Dommasch,&nbsp;Sebastian Ewen,&nbsp;André Gries,&nbsp;Felix Patricius Hans,&nbsp;Karl-Georg Kanz,&nbsp;Matthias Klein,&nbsp;Philipp Kümpers,&nbsp;Matthias Napp,&nbsp;Christopher Plata,&nbsp;Alexandra Ramshorn-Zimmer,&nbsp;Joachim Risse,&nbsp;Rainer Röhrig,&nbsp;Rajan Somasundaram,&nbsp;Domagoj Schunk,&nbsp;Felix Walcher,&nbsp;Thomas Walter,&nbsp;Dirk Weismann,&nbsp;Sebastian Wolfrum,&nbsp;Markus Wörnle,&nbsp;Yves Noel Wu,&nbsp;Martin Möckel","doi":"10.1007/s00392-022-02074-3","DOIUrl":"https://doi.org/10.1007/s00392-022-02074-3","url":null,"abstract":"<p><strong>Background: </strong>In this retrospective routine data analysis, we investigate the number of emergency department (ED) consultations during the COVID-19 pandemic of 2020 in Germany compared to the previous year with a special focus on numbers of myocardial infarction and acute heart failure.</p><p><strong>Methods: </strong>Aggregated case numbers for the two consecutive years 2019 and 2020 were obtained from 24 university hospitals and 9 non-university hospitals in Germany and assessed by age, gender, triage scores, disposition, care level and by ICD-10 codes including the tracer diagnoses myocardial infarction (I21) and heart failure (I50).</p><p><strong>Results: </strong>A total of 2,216,627 ED consultations were analyzed, of which 1,178,470 occurred in 2019 and 1,038,157 in 2020. The median deviation in case numbers between 2019 and 2020 was - 14% [CI (- 11)-(- 16)]. After a marked drop in all cases in the first COVID-19 wave in spring 2020, case numbers normalized during the summer. Thereafter starting in calendar week 39 case numbers constantly declined until the end of the year 2020. The decline in case numbers predominantly concerned younger [- 16%; CI (- 13)-(- 19)], less urgent [- 18%; CI (- 12)-(- 22)] and non-admitted cases [- 17%; CI (- 13)-(- 20)] in particular during the second wave. During the entire observation period admissions for chest pain [- 13%; CI (- 21)-2], myocardial infarction [- 2%; CI (- 9)-11] and heart failure [- 2%; CI (- 10)-6] were less affected and remained comparable to the previous year.</p><p><strong>Conclusions: </strong>ED visits were noticeably reduced during both SARS-CoV-2 pandemic waves in Germany but cardiovascular diagnoses were less affected and no refractory increase was noted. However, long-term effects cannot be ruled out and need to be analysed in future studies.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"1174-1182"},"PeriodicalIF":5.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9362706/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40587741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparisons of the risk of myopericarditis between COVID-19 patients and individuals receiving COVID-19 vaccines: a population-based study.","authors":"Oscar Hou In Chou,&nbsp;Jiandong Zhou,&nbsp;Teddy Tai Loy Lee,&nbsp;Thompson Kot,&nbsp;Sharen Lee,&nbsp;Abraham Ka Chung Wai,&nbsp;Wing Tak Wong,&nbsp;Qingpeng Zhang,&nbsp;Shuk Han Cheng,&nbsp;Tong Liu,&nbsp;Vassilios S Vassiliou,&nbsp;Bernard Man Yung Cheung,&nbsp;Gary Tse","doi":"10.1007/s00392-022-02007-0","DOIUrl":"https://doi.org/10.1007/s00392-022-02007-0","url":null,"abstract":"<p><strong>Background: </strong>Both COVID-19 infection and COVID-19 vaccines have been associated with the development of myopericarditis. The objective of this study is to (1) analyse the rates of myopericarditis after COVID-19 infection and COVID-19 vaccination in Hong Kong, (2) compared to the background rates, and (3) compare the rates of myopericarditis after COVID-19 vaccination to those reported in other countries.</p><p><strong>Methods: </strong>This was a population-based cohort study from Hong Kong, China. Patients with positive RT-PCR test for COVID-19 between 1st January 2020 and 30th June 2021 or individuals who received COVID-19 vaccination until 31st August were included. The main exposures were COVID-19 positivity or COVID-19 vaccination. The primary outcome was myopericarditis.</p><p><strong>Results: </strong>This study included 11,441 COVID-19 patients from Hong Kong, four of whom suffered from myopericarditis (rate per million: 326; 95% confidence interval [CI] 127-838). The rate was higher than the pre-COVID-19 background rate in 2019 (rate per million: 5.5, 95% CI 4.1-7.4) with a rate ratio of 55.0 (95% CI 21.4-141). Compared to the background rate, the rate of myopericarditis among vaccinated subjects in Hong Kong was similar (rate per million: 5.5; 95% CI 4.1-7.4) with a rate ratio of 0.93 (95% CI 0.69-1.26). The rates of myocarditis after vaccination in Hong Kong were comparable to those vaccinated in the United States, Israel, and the United Kingdom.</p><p><strong>Conclusions: </strong>COVID-19 infection was associated with significantly higher rate of myopericarditis compared to the vaccine-associated myopericarditis.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"1098-1103"},"PeriodicalIF":5.0,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8951670/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40327736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence and clinical relevance of upper gastrointestinal pathology during preprocedural endoscopy in patients undergoing pulmonary vein isolation.","authors":"Dirk Grosse Meininghaus, Robert Freund, Lukas Heimbaecher, Tobias Kleemann, Anton Kushnir, J Christoph Geller","doi":"10.1007/s00392-022-02050-x","DOIUrl":"10.1007/s00392-022-02050-x","url":null,"abstract":"<p><strong>Background: </strong>Reflux-induced esophagitis might facilitate ablation-induced esophageal lesions (ELs) following pulmonary vein isolation (PVI), and these may progress to atrio-esophageal fistula (AEF). In contrast, preexisting ELs are not prone to progression but may affect procedure planning.</p><p><strong>Objective: </strong>To study the incidence of preexisting esophageal and upper gastrointestinal (UGI) pathology in patients undergoing PVI, and the relation to ablation-induced ELs.</p><p><strong>Methods: </strong>From 08/2018 to 09/2021, consecutive patients undergoing (radiofrequency [RF] or cryoballoon [CB]) PVI were examined by esophagogastroscopy (EGD) before and following ablation. Postprocedural endoscopic ultrasound (EUS) was added in 2021.</p><p><strong>Results: </strong>412 patients (median age 67.5 [IQR 61.3-75.0] years, 56.1% male) were studied. Preprocedural EGD showed abnormalities in 226/399 patients, 15% in the lower third of the esophagus. Half (99/226) were relevant for PVI, 13 procedures were postponed, 6 due to pathological EGD results. A third of the patients with new esophageal injury following ablation had preexisting esophagitis which was associated with a trend for a higher incidence of ELs after RF ablation (12.5 vs. 6.9%, p = 0.232), and a six- and two-fold higher rate of food retention after CB-PVI (28.6 vs. 4.5%, p = 0.008) and RF ablation (8.3 vs. 4.4%, p = 0.279), respectively.</p><p><strong>Conclusion: </strong>(1) EGD before PVI showed UGI abnormalities in > 50% of patients, one-fourth of these relevant for PVI. (2) Esophageal inflammation was associated with a higher incidence of post-ablation (peri)-esophageal injury. Whether having this information before ablation is able to reduce ELs or AEF remains to be shown.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"1069-1076"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39986736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement.","authors":"Jasmin Shamekhi,&nbsp;Thi Quynh Anh Nguyen,&nbsp;Helen Sigel,&nbsp;Oliver Maier,&nbsp;Kerstin Piayda,&nbsp;Tobias Zeus,&nbsp;Baravan Al-Kassou,&nbsp;Marcel Weber,&nbsp;Sebastian Zimmer,&nbsp;Atsushi Sugiura,&nbsp;Nihal Wilde,&nbsp;Malte Kelm,&nbsp;Georg Nickenig,&nbsp;Verena Veulemans,&nbsp;Alexander Sedaghat","doi":"10.1007/s00392-022-02010-5","DOIUrl":"https://doi.org/10.1007/s00392-022-02010-5","url":null,"abstract":"<p><strong>Background: </strong>Clinical data regarding the association between the left atrial function index (LAFI) and outcome in patients undergoing transcatheter aortic valve replacement (TAVR) are limited.</p><p><strong>Objectives: </strong>We aimed to investigate the association between the left atrial function index (LAFI) and outcome in patients undergoing TAVR.</p><p><strong>Methods: </strong>In this retrospective multicenter study, we assessed baseline LAFI in 733 patients undergoing TAVR for severe aortic stenosis in two German high-volume centers between 2008 and 2019. Based on receiver operating characteristic curves, patients were stratified according to their baseline LAFI into two groups (LAFI ≤ 13.5 vs. LAFI > 13.5) and assessed for post-procedural outcome. The primary endpoint of our study was the 1-year all-cause mortality.</p><p><strong>Results: </strong>Patients with a LAFI ≤ 13.5 had significantly more often atrial fibrillation (p < 0.001), lower LVEF (p < 0.001) and higher levels of NT-proBNP (p < 0.001). After TAVR, a significant improvement in the LAFI as compared to baseline was observed at 12 months after the procedure (28.4 vs. 32.9; p = 0.001). Compared to patients with a LAFI > 13.5, those with a LAFI ≤ 13.5 showed significantly higher rate of 1-year mortality (7.9% vs. 4.0%; p = 0.03). A lower LAFI has been identified as independent predictor of mortality in multivariate analysis (HR (95% CI) 2.0 (1.1-3.9); p = 0.03).</p><p><strong>Conclusion: </strong>A reduced LAFI is associated with adverse outcome and an independent predictor of mortality in TAVR patients. TAVR improves LAFI within 12 months after the procedure. Left Atrial Function Index (LAFI) in Patients undergoing Transcatheter Aortic Valve Implantation. A Kaplan-Meier survival analysis of 1-year all-cause mortality in patients with LAFI ≤ 13.5 compared with patients with LAFI > 13.5. Comparing rates of 1-year all-cause mortality between the different LAFI groups, we found a significant association between left atrial function and mortality. LAFI Left atrial function index. B Comparison of the mean LAFI before and after TAVR. After long-term follow-up the LAFI improved significantly. LAFI Left atrial function index; FU follow-up. C Assessment of the left atrial function index using the pre-procedural transthoracic echocardiography. A Measurement of the minimal left atrial volume (LAEDV). B Assessment of the maximal left atrial volume (LAESV).</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"944-954"},"PeriodicalIF":5.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40317021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk-related short-term clinical outcomes after transcatheter aortic valve implantation and their impact on early mortality: an analysis of claims-based data from Germany.","authors":"Niklas Schofer,&nbsp;Elke Jeschke,&nbsp;Janine Kröger,&nbsp;Henning Baberg,&nbsp;Volkmar Falk,&nbsp;Jan F Gummert,&nbsp;Christian W Hamm,&nbsp;Martin Möckel,&nbsp;Alina Goßling,&nbsp;Jürgen Malzahn,&nbsp;Christian Günster,&nbsp;Stefan Blankenberg","doi":"10.1007/s00392-022-02009-y","DOIUrl":"https://doi.org/10.1007/s00392-022-02009-y","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to define and assess risk-specific adverse outcomes after transcatheter aortic valve implantation (TAVI) in an all-comers patient population based on German administrative claims data.</p><p><strong>Methods: </strong>Administrative claims data of patients undergoing transvascular TAVI between 2017 and 2019 derived from the largest provider of statutory health-care insurance in Germany were used. Patients' risk profile was assessed using the established Hospital Frailty Risk (HFR) score and 30-day adverse events were evaluated. Multivariable logistic regression models were applied to investigate the relation of patients' risk factors to clinical outcomes and, subsequently, of clinical outcomes to mortality.</p><p><strong>Results: </strong>A total of 21,430 patients were included in the analysis. Of those, 51% were categorized as low-, 37% as intermediate-, and 12% as high-risk TAVI patients according to HFR score. Whereas low-risk TAVI patients showed low rates of periprocedural adverse events, TAVI patients at intermediate or high risk suffered from worse outcomes. An increase in HFR score was associated with an increased risk for all adverse outcome measures. The strongest association of patients' risk profile and outcome was present for cerebrovascular events and acute renal failure after TAVI. Independent of patients' risk, the latter showed the strongest relation with early mortality after TAVI.</p><p><strong>Conclusions: </strong>Differentiated outcomes after TAVI can be assessed using claims-based data and are highly dependent on patients' risk profile. The present study might be of use to define risk-adjusted outcome margins for TAVI patients in Germany on the basis of health-insurance data.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"934-943"},"PeriodicalIF":5.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40319775","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early response of right-ventricular function to percutaneous mitral valve repair.","authors":"Atsushi Sugiura,&nbsp;Jasmin Shamekhi,&nbsp;Tadahiro Goto,&nbsp;Maximilian Spieker,&nbsp;Christos Iliadis,&nbsp;Refik Kavsur,&nbsp;Victor Mauri,&nbsp;Malte Kelm,&nbsp;Stephan Baldus,&nbsp;Tetsu Tanaka,&nbsp;Noriaki Tabata,&nbsp;Jan-Malte Sinning,&nbsp;Marcel Weber,&nbsp;Sebastian Zimmer,&nbsp;Georg Nickenig,&nbsp;Ralf Westenfeld,&nbsp;Roman Pfister,&nbsp;Marc Ulrich Becher","doi":"10.1007/s00392-021-01951-7","DOIUrl":"https://doi.org/10.1007/s00392-021-01951-7","url":null,"abstract":"<p><strong>Background: </strong>The change in right-ventricular function (RVF) after transcatheter mitral valve repair is still poorly understood. We assessed the early response of RVF to the MitraClip procedure and its clinical relevance.</p><p><strong>Methods: </strong>We analyzed consecutive patients who underwent a MitraClip procedure to treat MR between August 2010 and March 2019 in the Heart Failure Network Rhineland registry. RVF was assessed before and after the procedure. Impaired RVF was defined as an RV fractional area change (RVFAC) < 35% or tricuspid annular plane systolic excursion (TAPSE) < 16 mm.</p><p><strong>Results: </strong>816 eligible patients (77 ± 9 years, 58.5% male) were included in the analysis. Baseline values of RVF were: RVFAC 38.6 (IQR 29.7-46.7) % and TAPSE 17.0 (IQR 14.0-21.0) mm. At a median time of 3 (IQR 2-5) days after the procedure, the RVF remained normal in 34% (n = 274), normalized in 17% (n = 140), deteriorated in 15% (n = 125), and was persistently impaired in 34% (n = 277) of patients. The RVF response was significantly associated with a composite outcome of all-cause mortality and hospitalization due to heart failure within a 2-year follow-up. Compared to stable/normal RVF, the adjusted hazard ratios for the outcome were 1.78 (95% CI 1.10-2.86) for normalized RVF, 1.89 (95% CI 1.34-3.15) for deteriorated RVF, and 2.25 (95% CI 1.47-3.44) for persistently impaired RVF. Changes in TAPSE and RVFAC as continuous variables were significantly correlated with the outcome.</p><p><strong>Conclusion: </strong>An early change in RVF following transcatheter mitral valve repair is predictive of mortality and hospitalization due to heart failure during follow-up. Early response of RVF after MitraClip and its clinical significance. An acute, early change in RVF can be observed following the MitraClip procedure, which is associated with the risk of mortality and hospitalization for HF.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"859-868"},"PeriodicalIF":5.0,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9334433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39533575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Activity of the adrenomedullin system to personalise post-discharge diuretic treatment in acute heart failure.","authors":"Nikola Kozhuharov,&nbsp;Leong Ng,&nbsp;Desiree Wussler,&nbsp;Ivo Strebel,&nbsp;Zaid Sabti,&nbsp;Oliver Hartmann,&nbsp;Mohamed Eltayeb,&nbsp;Iain Squire,&nbsp;Albina Nowak,&nbsp;Max Rieger,&nbsp;Jasmin Martin,&nbsp;Eleni Michou,&nbsp;Sabrina Stefanelli,&nbsp;Christian Puelacher,&nbsp;Samyut Shrestha,&nbsp;Maria Belkin,&nbsp;Tobias Zimmermann,&nbsp;Pedro Lopez-Ayala,&nbsp;Joachim Struck,&nbsp;Andreas Bergmann,&nbsp;Alexandre Mebazaa,&nbsp;Alice Blet,&nbsp;Danielle Menosi Gualandro,&nbsp;Tobias Breidthardt,&nbsp;Christian Mueller","doi":"10.1007/s00392-021-01909-9","DOIUrl":"https://doi.org/10.1007/s00392-021-01909-9","url":null,"abstract":"<p><strong>Background: </strong>Quantifying the activity of the adrenomedullin system might help to monitor and guide treatment in acute heart failure (AHF) patients. The aims were to (1) identify AHF patients with marked benefit or harm from specific treatments at hospital discharge and (2) predict mortality by quantifying the adrenomedullin system activity.</p><p><strong>Methods: </strong>This was a prospective multicentre study. AHF diagnosis and phenotype were centrally adjudicated by two independent cardiologists among patients presenting to the emergency department with acute dyspnoea. Adrenomedullin system activity was quantified using the biologically active component, bioactive adrenomedullin (bio-ADM), and a prohormone fragment, midregional proadrenomedullin (MR-proADM). Bio-ADM and MR-proADM concentrations were measured in a blinded fashion at presentation and at discharge. Interaction with specific treatments at discharge and the utility of these biomarkers on predicting outcomes during 365-day follow-up were assessed.</p><p><strong>Results: </strong>Among 1886 patients with adjudicated AHF, 514 patients (27.3%) died during 365-day follow-up. After adjusting for age, creatinine, and treatment at discharge, patients with bio-ADM plasma concentrations above the median (> 44.6 pg/mL) derived disproportional benefit if treated with diuretics (interaction p values < 0.001). These findings were confirmed when quantifying adrenomedullin system activity using MR-proADM (n = 764) (interaction p values < 0.001). Patients with bio-ADM plasma concentrations above the median were at increased risk of death (hazard ratio 1.87, 95% CI 1.57-2.24; p < 0.001). For predicting 365-day all-cause mortality, both biomarkers performed well, with MR-proADM presenting an even higher predictive accuracy compared to bio-ADM (p < 0.001).</p><p><strong>Conclusions: </strong>Quantifying the adrenomedullin's system activity may help to personalise post-discharge diuretic treatment and enable accurate risk-prediction in AHF.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"627-637"},"PeriodicalIF":5.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-021-01909-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39216454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomarkers as predictors of recurrence of atrial fibrillation post ablation: an updated and expanded systematic review and meta-analysis.","authors":"Vennela Boyalla,&nbsp;Leanne Harling,&nbsp;Alice Snell,&nbsp;Ines Kralj-Hans,&nbsp;Ana Barradas-Pires,&nbsp;Shouvik Haldar,&nbsp;Habib R Khan,&nbsp;John G F Cleland,&nbsp;Thanos Athanasiou,&nbsp;Sian E Harding,&nbsp;Tom Wong","doi":"10.1007/s00392-021-01978-w","DOIUrl":"https://doi.org/10.1007/s00392-021-01978-w","url":null,"abstract":"<p><strong>Background: </strong>A high proportion of patients undergoing catheter ablation (CA) for atrial fibrillation (AF) experience recurrence of arrhythmia. This meta-analysis aims to identify pre-ablation serum biomarker(s) associated with arrhythmia recurrence to improve patient selection before CA.</p><p><strong>Methods: </strong>A systematic approach following PRISMA reporting guidelines was utilised in libraries (Pubmed/Medline, Embase, Web of Science, Scopus) and supplemented by scanning through bibliographies of articles. Biomarker levels were compared using a random-effects model and presented as odds ratio (OR). Heterogeneity was examined by meta-regression and subgroup analysis.</p><p><strong>Results: </strong>In total, 73 studies were identified after inclusion and exclusion criteria were applied. Nine out of 22 biomarkers showed association with recurrence of AF after CA. High levels of N-Terminal-pro-B-type-Natriuretic Peptide [OR (95% CI), 3.11 (1.80-5.36)], B-type Natriuretic Peptide [BNP, 2.91 (1.74-4.88)], high-sensitivity C-Reactive Protein [2.04 (1.28-3.23)], Carboxy-terminal telopeptide of collagen type I [1.89 (1.16-3.08)] and Interleukin-6 [1.83 (1.18-2.84)] were strongly associated with identifying patients with AF recurrence. Meta-regression highlighted that AF type had a significant impact on BNP levels (heterogeneity R² = 55%). Subgroup analysis showed that high BNP levels were more strongly associated with AF recurrence in paroxysmal AF (PAF) cohorts compared to the addition of non-PAF patients. Egger's test ruled out the presence of publication bias from small-study effects.</p><p><strong>Conclusion: </strong>Ranking biomarkers based on the strength of association with outcome provides each biomarker relative capacity to predict AF recurrence. This will provide randomised controlled trials, a guide to choosing a priori tool for identifying patients likely to revert to AF, which are required to substantiate these findings.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"680-691"},"PeriodicalIF":5.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9151522/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39658413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Controlling my genome with my smartphone: first clinical experiences of the PROMISE system.","authors":"Ali Amr,&nbsp;Marc Hinderer,&nbsp;Lena Griebel,&nbsp;Dominic Deuber,&nbsp;Christoph Egger,&nbsp;Farbod Sedaghat-Hamedani,&nbsp;Elham Kayvanpour,&nbsp;Daniel Huhn,&nbsp;Jan Haas,&nbsp;Karen Frese,&nbsp;Marc Schweig,&nbsp;Ninja Marnau,&nbsp;Annika Krämer,&nbsp;Claudia Durand,&nbsp;Florian Battke,&nbsp;Hans-Ulrich Prokosch,&nbsp;Michael Backes,&nbsp;Andreas Keller,&nbsp;Dominique Schröder,&nbsp;Hugo A Katus,&nbsp;Norbert Frey,&nbsp;Benjamin Meder","doi":"10.1007/s00392-021-01942-8","DOIUrl":"https://doi.org/10.1007/s00392-021-01942-8","url":null,"abstract":"<p><strong>Background: </strong>The development of Precision Medicine strategies requires high-dimensional phenotypic and genomic data, both of which are highly privacy-sensitive data types. Conventional data management systems lack the capabilities to sufficiently handle the expected large quantities of such sensitive data in a secure manner. PROMISE is a genetic data management concept that implements a highly secure platform for data exchange while preserving patient interests, privacy, and autonomy.</p><p><strong>Methods: </strong>The concept of PROMISE to democratize genetic data was developed by an interdisciplinary team. It integrates a sophisticated cryptographic concept that allows only the patient to grant selective access to defined parts of his genetic information with single DNA base-pair resolution cryptography. The PROMISE system was developed for research purposes to evaluate the concept in a pilot study with nineteen cardiomyopathy patients undergoing genotyping, questionnaires, and longitudinal follow-up.</p><p><strong>Results: </strong>The safety of genetic data was very important to 79%, and patients generally regarded the data as highly sensitive. More than half the patients reported that their attitude towards the handling of genetic data has changed after using the PROMISE app for 4 months (median). The patients reported higher confidence in data security and willingness to share their data with commercial third parties, including pharmaceutical companies (increase from 5 to 32%).</p><p><strong>Conclusion: </strong>PROMISE democratizes genomic data by a transparent, secure, and patient-centric approach. This clinical pilot study evaluating a genetic data infrastructure is unique and shows that patient's acceptance of data sharing can be increased by patient-centric decision-making.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"638-650"},"PeriodicalIF":5.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9151530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39569293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Serum markers of fibrosis, cardiovascular and all-cause mortality in hemodialysis patients: the AURORA trial.","authors":"Madonna Salib,&nbsp;Sophie Girerd,&nbsp;Nicolas Girerd,&nbsp;Winfried März,&nbsp;Hubert Scharnagl,&nbsp;Ziad A Massy,&nbsp;Céline Leroy,&nbsp;Kévin Duarte,&nbsp;Hallvard Holdaas,&nbsp;Alan G Jardine,&nbsp;Roland E Schmieder,&nbsp;Bengt Fellström,&nbsp;Natalia López-Andrés,&nbsp;Patrick Rossignol,&nbsp;Faiez Zannad","doi":"10.1007/s00392-021-01898-9","DOIUrl":"https://doi.org/10.1007/s00392-021-01898-9","url":null,"abstract":"<p><strong>Background: </strong>Biomarkers of fibrosis are associated with outcome in several cardiovascular diseases. However, their relevance to chronic kidney disease and dialysis is uncertain, as it remains unclear how the kidneys and the dialysis procedure itself affect their elimination and degradation. We aimed to investigate the relationship of the blood levels of two markers associated with fibrosis: procollagen type I C-terminal pro-peptide (PICP) and galectin-3 (Gal-3) with mortality in dialysis patients.</p><p><strong>Methods: </strong>Procollagen type I C-terminal pro-peptide and galectin-3 were measured at baseline in 2773 patients enrolled in the AURORA trial, investigating the effect of rosuvastatin on cardiovascular outcomes, in patients on hemodialysis, and their interaction with CV death or all-cause mortality using survival models. The added prognostic value of these biomarkers was assessed by the net reclassification improvement (NRI).</p><p><strong>Results: </strong>The median follow-up period was 3.8 years. Blood concentrations of PICP and Gal-3 were significantly associated with CV death [adjusted HR per 1 SD = 1.11 (1.02-1.20) and SD = 1.20 (1.10-1.31), respectively] and all-cause mortality (all adjusted p < 0.001). PICP and Gal-3 had a synergistic effect with regard to CV death and all-cause mortality (interaction p = 0.04 and 0.01, respectively). Adding PICP, Gal-3 and their interaction on top of clinical and biological covariates, resulted in significantly improved prognostic accuracy NRI = 0.080 (0.019-0.143) for CV death.</p><p><strong>Conclusion: </strong>In dialysis patients, concomitant increase in PICP and Gal-3 concentrations are associated with higher rates of CV death. These results suggest that concomitantly raised PICP and Gal-3 may reflect an activated fibrogenesis relevant to risk stratification in dialysis, raising the hypothesis that anti-fibrotic therapy may be beneficial for cardiovascular protection in such patients.</p>","PeriodicalId":401855,"journal":{"name":"Clinical research in cardiology : official journal of the German Cardiac Society","volume":" ","pages":"614-626"},"PeriodicalIF":5.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-021-01898-9","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39038601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}