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Herz
Journal Prestige (SJR): 0.322
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Number of Followers: 2  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 1615-6692 - ISSN (Online) 0340-9937
Published by Springer-Verlag Homepage  [2658 journals]
  • First experiences with a new balloon-expandable Myval transcatheter
           aortic valve: a preliminary study

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      Abstract: Background In the present article, we present our first experiences with a new type of balloon-expandable Myval valve (Meril Life Sciences, Gujarat, India). Materials and methods A total of 25 consecutive patients who underwent transcatheter aortic valve implantation (TAVI) from June 2020 to November 2020 were included in the study. Results The mean age of the study population was 83 (75–87) years; 17 (68%) were female, and 20 (80%) had hypertension. The Society of Thoracic Surgeons (STS) score of the group was 5.4% ± 3.5%. TAVI was performed via the transfemoral route on all patients. In 19 (76%) cases, we started the procedure without predilation. In two (10.5%) cases performed without predilation, the prosthesis did not pass the native valve. We had to implant the valve from the descending aorta in one (4%) patient. We used Prostar XL (Abbott Vascular, Santa Clara, CA, USA) for six (24%) patients and ProGlide (Abbott Vascular) for 19 (76%) patients for vascular closure. Two (8%) in-hospital deaths occurred in our study but there were no deaths in the 30-day and 90-day follow-up. Vascular complications were observed in one (4%) patient. None of the patients in our study had severe paravalvular leak (PVL), while two (8%) patients had moderate PVL. A permanent pacemaker (PPM) was required in two (8%) patients for the indication of complete atrioventricular block. The mean hospital stay for the whole group was 4 (3–7) days. Conclusion Based on our experiences, the new balloon-expandable valve Myval is easy to use, efficient, and has only a few negligible drawbacks such as the need for predilation of the sheath. While shaft flexibility may have advantages in some situations including in very tortuous arteries, it may cause some difficulties in alignment of the valves.
      PubDate: 2021-10-13
       
  • ESC/EACTS-Leitlinien 2021 zum Management von Herzklappenerkrankungen

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      Abstract: Zusammenfassung Im August 2021 haben die European Society of Cardiology (ESC) und die European Association for Cardio-Thoracic Surgery (EACTS) ihre Leitlinien zum Management von Herzklappenerkrankungen aktualisiert. Seit der Veröffentlichung der vorherigen Version im Jahr 2017 haben sich einige neue Erkenntnisse zur Epidemiologie, Diagnose und Behandlung von Herzklappenerkrankungen ergeben, die zu einer Neubewertung mehrerer Empfehlungen geführt haben. Dabei wurden insbesondere die kritische Rolle des Herzteams bei Therapieentscheidungen erneut hervorgehoben, die Kriterien für die Auswahl der Behandlungsmodalität der Aortenklappenstenose präzisiert, die Definition der schweren sekundären Mitralklappeninsuffizienz revidiert und die Empfehlung für eine katheterbasierte Edge-to-edge-Rekonstruktion der Mitralklappe bei Patienten mit dieser Erkrankung aufgewertet. Weiterhin wurden die antithrombotischen Therapieschemata bei Patienten mit nativen Herzklappenerkrankungen und Bioprothesen neu bewertet, die Indikationen für eine frühzeitige Operation bei ausgewählten asymptomatischen Patientengruppen erweitert sowie das Potenzial von kathetergestützten Trikuspidalklappeneingriffen bei inoperablen und Hochrisikopatienten anerkannt, auch wenn Letztere noch weiter evaluiert werden müssen. Dieser Übersichtsartikel fasst die wichtigsten Empfehlungen der neuen Leitlinien zusammen.
      PubDate: 2021-10-05
       
  • Association of CHA2DS2-VASc score with thrombus burden in patients with
           acute myocardial infarction undergoing SVG-PCI

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      Abstract: Background The rate of saphenous vein graft (SVG) occlusion within the first year of bypass graft surgery is 15%. The CHA2DS2-VASc score is used to predict the risk of thromboembolic events in patients with nonvalvular atrial fibrillation. We aimed to evaluate the predictive role of the CHA2DS2-VASc score in the estimation of intracoronary thrombus burden in patients with acute myocardial infarction (AMI) who underwent SVG-PCI. Methods We retrospectively evaluated 221 patients who were admitted with AMI and underwent PCI of SVGs at the Department of Cardiology in the Turkiye Yuksek Ihtisas Education and Research Hospital between 2012 and 2018. The study population was divided into two groups according to their Thrombolysis in Myocardial Infarction (TIMI) thrombus grade: low thrombus burden (LTB; TIMI 0–3) and high thrombus burden (HTB; TIMI 4 and 5). Results The study included 221 patients with a mean age of 63.3 ± 6.7 years. The patients with HTB had significantly higher CHA2DS2-VASc scores (p < 0.001) compared with LTB patients. Univariate and multivariate regression analysis demonstrated that both CHA2DS2-VASc score (OR: 1.573, 95% CI: 1.153–2.147, p = 0.004) as a continuous variable and a binary cut-off level of the CHA2DS2-VASc score > 3 (OR: 3.876, 95% CI: 1.705–8.808, p = 0.001) were significantly associated with HTB. The ability of the CHA2DS2-VASc score to predict HTB burden was evaluated by receiver-operating characteristics analysis curve analysis. The optimum cut-off value of the CHA2DS2-VASc score for predicting HTB was 3 (with a sensitivity of 67.9% and a specificity of 69.3%) according to the Youden index. Conclusion The CHA2DS2-VASc score can be used as an easy practical tool to predict HTB in AMI patients undergoing SVG-PCI.
      PubDate: 2021-10-04
       
  • Kardiovaskuläre Interventionen

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      PubDate: 2021-10-01
       
  • “Virtual” heart team through a secure instant messenger
           smartphone app

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      PubDate: 2021-10-01
       
  • Predictors of adequate intraprocedural premature ventricular complex (PVC)
           frequency during idiopathic PVC ablation

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      Abstract: Background The aim of the present study was to determine the predictors of adequate intraprocedural premature ventricular complex (PVC) frequency for successful mapping and ablation of idiopathic PVCs. Methods A total of 101 consecutive patients (45 men; age: 47.9 ± 14.2 years) who had undergone idiopathic PVC ablation between 01 November 2018 and 24 June 2020 constituted our study population. Clinical and demographic data, procedural details and 24 h rhythm recordings that had been recorded before the procedure were retrospectively evaluated. Total PVC burden and diurnal variability assessed by the ratio of night time (22:00–06:00) over day time (06:00–22:00) PVC burden was calculated. The relationship between hourly PVC number and heart rate was also evaluated for each patient. Clinical characteristics and Holter parameters were compared between groups with and without adequate intraprocedural frequency of PVCs that permitted activation mapping. Results In all, 27 patients (26.7%) had infrequent intraprocedural PVCs which necessitated isoproterenol infusion or cancellation of ablation procedure due to inability of activation mapping. PVC burden was significantly higher in the group with frequent intraprocedural PVCs (26.1 ± 9.4% vs 21.2 ± 10.3%; p: 0.026). There were no significant differences between groups regarding the relationship between hourly PVC number and heart rate or the ratio of night/day PVC burden. Binary logistic regression analysis revealed the 24 h Holter PVC burden as the sole parameter that is significant predictor of frequent intraprocedural PVCs permitting activation mapping. Conclusion The 24 h PVC burden was the only predictor of adequate intraprocedural PVC frequency permitting activation mapping during idiopathic PVC ablation.
      PubDate: 2021-10-01
       
  • Technisches Rüstzeug für chronisch verschlossene
           Gefäße

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      Abstract: Zusammenfassung Die perkutane Revaskularisation von chronisch verschlossenen Koronarien stellt seit jeher eine große Herausforderung für die interventionelle Kardiologie dar. In den letzten Jahrzenten wurde eine Vielzahl an Anstrengungen unternommen, um die Revaskularisationsstrategien für chronisch verschlossene Koronarien zu standardisieren. Diese Bestrebungen sind v. a. in dem steigenden Interesse der verschiedenen kardiologischen Fachgesellschaften an dieser Patientengruppe, in der zunehmenden Erfahrung der Interventionalisten und in der fortwährenden Entwicklung des technischen Instrumentariums und von endovaskulären Unterstützungstechnologien begründet. Diese Übersichtsarbeit beleuchtet die aktuell zur Verfügung stehenden Hilfsmittel sowie Technologien, Techniken und Strategien zur perkutanen Rekanalisation von chronisch verschlossenen Koronarien.
      PubDate: 2021-10-01
       
  • Linksatrialer Vorhofohrverschluss

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      Abstract: Zusammenfassung Der katheterbasierte Verschluss des linken Vorhofohrs („left atrial appendage closure“, LAAC) stellt bei Patienten mit Vorhofflimmern und hohem Schlaganfall- sowie hohem Blutungsrisiko eine potenzielle Therapieoption zur Reduktion des Schlaganfallrisikos dar. Aufgrund der Weiterentwicklung der Implantationstechnik sowie der Einführung neuer bzw. optimierter Devices hat sich das Sicherheitsprofil der perkutanen LAAC in den letzten Jahren verbessert. Diese Beobachtungen sind auch der Ausgangspunkt für eine aktuell umfangreiche weitere Prüfung der Behandlungsmethode für neue Einsatzgebiete, wie beispielsweise bei Vorhofflimmerpatienten mit niedrigem Blutungsrisiko bzw. nach Pulmonalvenenisolation (PVI) oder bei Patienten nach elektrischer Isolation des linken Vorhofohrs. Das Therapieprinzip des Herzohrverschlusses wird durch neuere Daten unterstützt, die die Wirksamkeit des operativen Verschlusses des linken Vorhofohrs bezüglich einer Reduktion des Schlaganfallrisikos z. T. auch zusätzlich zur Antikoagulation im Rahmen von kardiochirurgischen Eingriffen zeigen. Aktuell wird die Anwendung in der klinischen Praxis durch eine hohe Studienaktivität begleitet. Diese randomisierten Studien werden den Einsatz des LAAC in neuen Indikationsfeldern prüfen und sollen zusammen mit neuen Entwicklungen bei der Implantationstechnik den optimalen zukünftigen Einsatz der Methode für die klinische Praxis weiter definieren. Die aktuell möglichen Indikationen zum LAAC, laufende randomisierte Studien sowie Fortschritte bei der Device-Entwicklung, der Implantationsplanung- und -technik sowie zukünftige Entwicklungen auf dem Gebiet der LAA-Verschluss-Therapie sollen in der vorliegenden Übersichtsarbeit zusammengefasst und diskutiert werden.
      PubDate: 2021-10-01
       
  • Aktuelle Technologien zur interventionellen Therapie der
           Trikuspidalklappeninsuffizienz

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      Abstract: Zusammenfassung Die schwere Trikuspidalklappeninsuffizienz (TI) ist insbesondere in der älteren Bevölkerung eine lange Zeit unterschätzte Erkrankung mit hoher assoziierter Morbidität und Mortalität. Aufgrund der hohen perioperativen Mortalität der Trikuspidalklappenchirurgie stellte lange nur die medikamentöse Therapie eine praktikable Behandlungsoption dar. Interventionelle Herangehensweisen konnten in ersten Studien aussichtsreiche Ergebnisse mit effektiver Reduktion der TI bei gleichzeitigem Nachweis einer sicheren Intervention erzielen. Grundsätzlich können die aktuell verfügbaren interventionellen Behandlungsoptionen in 3 Therapiekonzepte (Koaptationsysteme [„edge-to-edge repair“], Annuloplastie und interventioneller Klappenersatz) eingeteilt werden. Die größte klinische Erfahrung und beste wissenschaftliche Datenlage konnten bislang im Bereich der Koaptationssysteme generiert werden. Sehr aussichtsreiche erste Ergebnisse mit effektiver Reduktion der TI und Verbesserung der klinischen Beschwerdesymptomatik liegen jedoch auch zum interventionellen Klappenersatz vor. Eckpfeiler einer erfolgreichen Behandlung der TI in diesem komplex kranken Patientenkollektiv stellt die umfangreiche präinterventionelle Diagnostik mit Auswahl des für den Patienten individuell am besten geeigneten Therapiekonzepts dar. Studien im prospektiv randomisierten Design werden zukünftig den Nutzen der interventionellen Behandlung der TI gegenüber einem rein konservativen Therapiekonzept untersuchen.
      PubDate: 2021-10-01
       
  • Patent foramen ovale—When to close and how'

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      Abstract: Closure of a patent foramen ovale (PFO) in patients after cryptogenic/cardioembolic stroke is recommended by current guidelines for patients who are 16–60 years of age with a high-risk PFO (class of recommendation A, level of evidence I). The use of double-disk occlusion devices followed by antiplatelet therapy is recommended. The procedure of interventional PFO closure compared with other interventions in cardiology is rather easy to learn. However, it should be performed carefully to avoid postinterventional complications. The number needed to treat (NNT) to avoid one stroke in 5 years in the RESPECT trial was 42, in the CLOSE trial even lower with 20. In the REDUCE trial, the NNT was 28 at 2 years. This can be reduced by longer follow-up, e.g., at 10 years the NNT is 18. While other conditions such as migraine are currently under investigation with respect to the impact of PFO closure, sufficiently powered trials are lacking so that closure in diseases other than stroke should always be individualized.
      PubDate: 2021-10-01
       
  • Pushing the limits for interventional treatment of aortic valve stenosis

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      Abstract: As we approach 20 years of clinical experience with transcatheter aortic valve replacement (TAVR), a vast portfolio of high-quality clinical data has accumulated, confirming the safety and efficacy of TAVR across the entire spectrum of surgical risk. Although many aspects of this innovative therapy have been thoroughly studied, several challenges remain. As TAVR is expanding to include younger low-risk patients, with longer life expectancy, one major unsolved issue is represented by transcatheter heart valve (THV) durability, since robust THV durability data are currently limited to approximately 5–6 years. Additionally, steric interactions between THV components and coronary ostia may render coronary access particularly difficult, and thus personalized decisions regarding THV type and implanting techniques are of paramount importance to secure future coronary access. Since bicuspid aortic valve (BAV) stenosis may be associated with unfavorable anatomic factors, it has represented an exclusion criterion in major randomized TAVR trials. Albeit promising data are available from multicenter registries, results of specifically designed randomized trials are eagerly needed to inform use of TAVR for BAV stenosis. Although valve-in-valve (ViV) TAVR has emerged as an effective treatment option for degenerated aortic bioprostheses, ViV procedures are associated with specific risks, which mandated the development of specific techniques aimed at reducing the occurrence of periprocedural adverse events. Despite the transfemoral approach represents the access of choice for TAVR, a significant proportion of patients have significant peripheral artery disease and alternative vascular access routes have been increasingly evaluated with encouraging data regarding their safety and feasibility.
      PubDate: 2021-10-01
       
  • Current devices and interventions in mitral regurgitation

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      Abstract: Mitral regurgitation (MR) is the most common valvular disease. With a rising incidence in older age, the prevalence of relevant comorbidities inevitably increases. Considering the constantly aging population with high surgical risk, transcatheter therapy of MR is gaining increasing importance. Interventional therapy of either primary or secondary MR represents an alternative to pure drug or surgical therapy. With mitral valve transcatheter edge-to-edge repair, a well-established treatment has evolved in the past two decades. In addition, direct or indirect annuloplasty and ultimately transcatheter mitral valve implantation further expand the armamentarium. The current broad spectrum of interventional therapy options allows for patient-oriented therapy individually targeting different MR pathologies. This review discusses the current landscape of transcatheter therapies for relevant MR.
      PubDate: 2021-10-01
       
  • Echocardiographic assessment in cardiogenic shock

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      Abstract: Echocardiography is the most helpful diagnostic modality in cardiogenic shock, the management of which still remains challenging despite advances in therapeutic options. The presence of cardiogenic shock portends high mortality rates. Therefore, rapid recognition, identification of the underlying cause, and evaluation of the severity of hemodynamic dysfunction are vital for correct management. Whether the cause of shock is unknown, suspected, or established, echocardiography is utilized in its diagnosis and management as well as to monitor progress. It is recommended as the modality of first choice. No other investigative bedside tool can offer comparable diagnostic capability, allowing for exact targeting of the underlying cardiac and hemodynamic problems. Echocardiography can promptly provide an impression of the etiology of shock and the potential line of treatment. Normal left ventricular and right ventricular systolic function, normal cardiac chamber dimensions, absence of any significant valvular pathology, and absence of any pericardial effusion virtually rule out a cardiac cause of shock. This review discusses the role of echocardiography as a decision-making tool in the evaluation and management of cardiogenic shock.
      PubDate: 2021-10-01
       
  • Gesättigte Fettsäuren und kardiovaskuläres Risiko

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      Abstract: Zusammenfassung Die „Fetthypothese der koronaren Herzkrankheit“, derzufolge „gesättigte Fettsäuren“ („saturated fatty acids“, SFA) die LDL(„low-density lipoprotein“)-Cholesterin-Konzentration (LDL-C) steigern und folglich das Risiko für kardiovaskuläre Erkrankungen erhöhen, prägte die Ernährungsempfehlungen der letzten 60 Jahre, zunächst in den USA und später auch in Europa. Über die Jahre mehrte sich Evidenz aus Epidemiologie und kontrollierten klinischen Studien, dass der Konsum von SFA per se nicht mit einem erhöhten kardiovaskulären Risiko einhergeht bzw. die Einschränkung des Konsums von SFA keine präventive Wirkung zeigt. Die Fokussierung auf den SFA-Gehalt negiert die biologisch heterogenen und zum Teil biologisch günstigen Wirkungen unterschiedlicher SFA. Zudem wird hierbei außer Acht gelassen, dass SFA in intakten Lebensmitteln in unterschiedliche komplexe Matrizes eingebunden sind, die aus Dutzenden Nährstoffen mit unterschiedlicher Struktur und Begleitstoffen bestehen und damit jeweils unterschiedliche biologische Antworten und metabolische Effekte auslösen. Entsprechend sind solche nährstoffbasierten Empfehlungen prinzipiell wenig zielführend und zudem schlecht umsetzbar. Hinzu kommt, dass LDL‑C kein geeigneter Marker ist, um den Effekt von Lebensstilintervention wie der Ernährung oder aber der körperlichen Aktivität auf das globale kardiovaskuläre Risiko zu beurteilen.
      PubDate: 2021-09-23
       
  • Kardiale Amyloidose und Aortenklappenstenose

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      Abstract: Zusammenfassung Die Aortenklappenstenose im höheren Alter ist in den Blickpunkt der Kardiologie und Herzchirurgie gerückt, nachdem transvaskuläre und transluminale minimal-invasive Verfahren zur Klappenimplantation entwickelt worden waren. Die Beobachtung von Amyloidablagerungen in operativ entfernten Klappen führte zur Diagnostik der Amyloidose des Myokards, die bei bis zu 20 % der Patienten, die zur Klappenimplantation kommen, aufgedeckt wurde. Klinische Zeichen wie Karpaltunnelsyndrom oder Bizepssehnenruptur sind zu beachten. Eine wichtige diagnostische Rolle spielt neben EKG, Echokardiogramm und Magnetresonanztomographie die 99mTechnetium-Knochenszintigraphie. Das Zusammentreffen von Aortenklappenstenose und Amyloidose erklärt die besondere hämodynamische Situation eines niedrigen Gradienten, mit niedrigem Blutfluss bei hochgradiger Klappeneinengung. Die interventionelle oder chirurgische Klappenimplantation verbessert die Prognose dieser Patienten ähnlich wie bei reiner Aortenklappenstenose, gefolgt von einer spezifischen medikamentösen Therapie in Abhängigkeit vom Amyloidosetyp.
      PubDate: 2021-09-06
      DOI: 10.1007/s00059-021-05054-x
       
  • Genetic association between eNOS gene polymorphisms and risk of carotid
           atherosclerosis

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      Abstract: Background Endothelial nitric oxide synthase (eNOS) has been reported to be involved in the atherosclerotic process. A number of studies have investigated the association between eNOS gene polymorphisms and the risk of carotid atherosclerosis (CAS). However, the results are conflicting and inconclusive. The aim of this study was to evaluate precisely the association between the eNOS T786C, G894T, and 4a/4b polymorphisms and CAS risk. Material and methods A meta-analysis was carried out by retrieving relevant studies from PubMed, Embase, China National Knowledge Infrastructure (CNKI), and Cochrane databases without a restriction on publication year. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe the strength of the association with CAS. Results Data were obtained from eight case-control studies comprising 2975 cases and 2624 controls. Significant associations were detected between the allelic and recessive models of the eNOS T786C polymorphism (allelic: p = 0.04; OR, 95% CI = 1.57 [1.01, 2.44]; recessive: p = 0.03; OR, 95% CI = 1.53 [1.04, 2.24]), as well as the allelic and dominant models of the eNOS 4a/4b polymorphism, and CAS risk in an Asian subgroup (allelic: p = 0.02; OR, 95% CI = 1.49 [1.07, 2.07]; dominant: p = 0.01; OR, 95% CI = 1.50 [1.09, 2.05]), but not in a Caucasian subgroup (p > 0.05). No association was observed between the eNOS G894T polymorphism and CAS risk (p > 0.05). Conclusion Our study provides evidence that the allelic and recessive models of the eNOS T786C polymorphism and the allelic and dominant models of the eNOS 4a/4b polymorphism may increase the risk of CAS in Asian populations.
      PubDate: 2021-09-01
      DOI: 10.1007/s00059-020-04995-z
       
  • Outcomes after transcatheter aortic valve replacement in older patients

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      Abstract: Background The prevalence of aortic valve stenosis is increasing due to the continuously growing geriatric population. Data on procedural success and mortality of very old patients are sparse, raising the question of when this population may be deemed as “too old even for transcatheter aortic valve replacement (TAVR).” We, therefore, sought to evaluate the influence of age on outcome after TAVR and the impact of direct implantation. Methods The data of 394 consecutive patients undergoing TF-TAVR were analyzed. Patients were divided into four age groups: ≤75 (group 1, n = 28), 76–80 (group 2, n = 107), 81–85 (group 3, n = 148), and >85 (group 4, n = 111) years. Direct implantation was performed when possible according to current recommendations. Survival was evaluated by Kaplan–Meier analysis. Results Mortality at 30 days and 1 year was not significantly different between the four age groups (3.6 vs. 6.7 vs. 5.4 vs. 2.7% and 7.6 vs. 17 vs. 14.5 vs. 13%m respectively, log-rank p = 0.59). Direct implantation without balloon aortic valvuloplasty was more frequently performed on patients aged >85 vs. ≤85 years (33.3 vs. 14.1%, p < 0.001). the incidence of procedural complications frequently associated with advanced age (stroke, vascular complications) was not significantly increased in group 4. Conclusion Outcome after TF-TAVR is comparable among different age cohorts, even in very old patients. Direct implantation simplifies the procedure and could therefore play a role in reducing the incidence of peri-interventional complications in patients of advanced age.
      PubDate: 2021-09-01
      DOI: 10.1007/s00059-020-04986-0
       
  • Prognostic value of DCTA scoring system in heart failure

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      Abstract: Objective The aim of this study was to evaluate the prognostic value of a novel scoring system, based on D‑dimer, total cholesterol, high-sensitivity cardiac troponin T (hs-cTnT), and serum albumin levels, in patients with heart failure. Methods A total of 221 patients diagnosed with heart failure between May 2016 to January 2020 were enrolled in this retrospective study. The prognostic significance of the biomarkers D‑dimer, total cholesterol, hs-cTnT, and serum albumin was determined with univariate and multivariate Cox proportional hazard models. A novel prognostic score based on these predictors was established. The Kaplan–Meier method and log-rank test were used to compare the adverse outcomes of patients in different risk groups. Result Results from univariate and multivariate analyses showed that high D‑dimer, low serum albumin, high hs-cTnT, and low total cholesterol levels were independent prognostic factors for adverse outcomes (D-dimer >0.63 mg/l, HR = 1.84, 95% CI = 1.16–2.94, p = 0.010; serum albumin >34 g/l, HR = 0.67, 95% CI = 0.45–0.99, p = 0.046; hs-cTnT >24.06 pg/ml, HR = 1.65, 95% CI = 1.08–2.53, p = 0.020; total cholesterol >3.68 mmol/l, HR = 0.63, 95% CI = 0.43–0.92, p = 0.017). Moreover, all the patients were stratified into low-risk or high-risk group according to a scoring system based on these four markers. Kaplan–Meier analyses demonstrated that patients in the high-risk group were more prone to having adverse outcomes compared with patients in the low-risk group. Conclusion D‑dimer, total cholesterol, hs-cTnT, and serum albumin levels were independent prognostic factors in the setting of heart failure. A novel and comprehensive scoring system based on these biomarkers is an easily available and effective tool for predicting the adverse outcomes of patients with heart failure.
      PubDate: 2021-09-01
      DOI: 10.1007/s00059-020-04993-1
       
  • Medikamentöse Sekundärprävention bei Patienten mit peripherer
           arterieller Verschlusskrankheit

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      Abstract: Zusammenfassung Hintergrund Die periphere arterielle Verschlusskrankheit (pAVK) ist eine atherosklerotische Gefäßerkrankung mit hoher Morbidität und Mortalität. Eine konsequente medikamentöse Sekundärprävention gehört zur essenziellen und evidenzbasierten Therapie der pAVK. Das Ziel der vorliegenden Studie war es, den Status quo der medikamentösen Sekundärprävention anhand von Rezepteinlösungen zu ermitteln. Methoden Basierend auf Sekundärdaten der Kassenärztlichen Vereinigung Westfalen-Lippe (KVWL), wurden im Zeitraum von 2014 bis 2017 Patienten mit einer gesicherten pAVK-Kodierung (I70.2-/I73.9-) identifiziert und deren Rezepteinlösung bezüglich Thrombozytenaggregationshemmern (TAH), oralen Antikoagulanzien, lipidmodifizierender Medikation (LLT) sowie ACE(„angiotensin-converting enzyme“)-Hemmer im 4. Quartal nach der Diagnosekodierung erfasst. Ergebnisse Im Diagnosezeitraum 2014/2015 hatten im Einzugsgebiet KVWL 238.397 Patienten eine pAVK. Der Anteil an eingelösten Rezepten betrug im 4. Quartal nach der Diagnosestellung 25,9 % für LLT, 13,6 % für Acetylsalicylsäure, 4,5 % für Clopidogrel, 5,5 % für Vitamin-K-Antagonisten (VKA), 3,5 % für nicht-Vitamin-K-abhängige orale Antikoagulanzien (NOAK) und 26,8 % für ACE-Hemmer. Im Verlauf von 3 Jahren (n = 241.375 Patienten mit pAVK 2016/2017) stieg der Anteil an eingelösten Rezepten bis auf VKA für alle anderen Substanzen an (p < 0,001), wobei der größte relative Anstieg bei NOAK zu verzeichnen war (relativer Anstieg um 81,7 %). Schlussfolgerung Die leitliniengerechte medikamentöse Sekundärprävention bei pAVK-Patienten in Deutschland ist weiterhin verbesserungswürdig. Eine konsequente Umsetzung evidenzbasierter medikamentöser Sekundärprävention beherbergt ein großes Potenzial zur Verbesserung der Gesamtprognose der pAVK-Patienten.
      PubDate: 2021-09-01
      DOI: 10.1007/s00059-020-04998-w
       
  • Catheter-directed therapy in pulmonary embolism

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      Abstract: Acute pulmonary embolism (PE) is a life-threatening condition with high mortality rates and potential long-term sequelae. Systemic thrombolysis has been virtually the only therapeutic option available for patients with hemodynamic instability over decades. Recently, interventional therapy of PE has gained increasing interest. Multiple devices were developed; these include devices for local thrombolysis, thrombus fragmentation, thrombus aspiration, and combined approaches. However, the available evidence is limited to mostly small, nonrandomized studies. In these studies, safety and efficacy data from patients with intermediate or high-risk PE are promising. However, due to the lack of adequately powered randomized trials, interventional treatment of intermediate or high-risk PE cannot be recommended as standard-of-care. The decision on whether and how to perform a catheter-based intervention should therefore be left to the discretion of the local team, depending on the patients’ clinical status, bleeding risk, local expertise, and available devices. The implementation of local multidisciplinary PE response teams is recommended by international guidelines to provide the best possible treatment.
      PubDate: 2021-09-01
      DOI: 10.1007/s00059-021-05059-6
       
 
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