Splenic rupture and fungal endocarditis in a pediatric patient with invasive fusariosis after allogeneic hematopoietic stem cell transplantation for aplastic anemia: A case report.

Background: Invasive mold infections are a well-known and life-threatening condition after allogeneic hematopoietic stem cell transplantation (HSCT). While Aspergillus species are recognized as predominant pathogens, Fusarium species should also be considered due to their broad environmental distribution and the expected poor outcome of invasive fusariosis. Particularly, splenic rupture as a complication of disseminated disease has not been reported yet. Case presentation: Two weeks after allogeneic HSCT for severe aplastic anemia, a 16-year-old boy presented with painful, erythematous skin nodules affecting the entire integument. As disseminated mycosis was considered, treatment with liposomal amphotericin B and voriconazole (VCZ) was initiated. Invasive fusariosis was diagnosed after histological and previously unpublished polymerase chain reaction-based examination of skin biopsies. Microbiological tests revealed Fusarium solani species. Despite stable neutrophil engraftment and uninterrupted treatment with VCZ, he developed mold disease-associated splenic rupture with hypovolemic shock and fungal endocarditis. The latter induced a cardiac thrombus and subsequent embolic cerebral infarctions with unilateral hemiparesis. Following cardiac surgery, the patient did not regain consciousness because of diffuse cerebral ischemia, and he died on day +92 after HSCT. Conclusion: Invasive fusariosis in immunocompromised patients is a life-threatening condition. Despite antimycotic treatment adapted to antifungal susceptibility testing, the patient reported here developed uncommon manifestations such as splenic rupture and fungal endocarditis.

Invasive Validation of Antares, a New Algorithm to Calculate Central Blood Pressure from Oscillometric Upper Arm Pulse Waves.

Background: Antares is an algorithm for pulse wave analysis (PWA) by oscillometric blood pressure (BP) monitors in order to estimate central (aortic) blood pressure (cBP). Antares aims to enable brachial cuff-based BP monitors to be type II-devices, determining absolute cBP values independently of potential peripheral BP inaccuracies. The present study is an invasive validation of the Antares algorithm in the custo screen 400. Methods: We followed entirely the 2017 ARTERY protocol for validation of non-invasive cBP devices, the 2013 American National Standards Institute, Inc./Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2 and 2018 AAMI/European Society of Hypertension (ESH)/ISO validation standard protocols. In total, 191 patients undergoing cardiac catheterization were included, of which 145 patients entered analysis. Invasive cBP recordings were compared to simultaneous non-invasive cBP estimations using the Antares algorithm, integrated into an oscillometric BP monitor. Results: Mean difference between invasive and non-invasively estimated systolic cBP was 0.71 mmHg with standard deviation of 5.95 mmHg, fulfilling highest validation criteria. Conclusion: Antares is the first algorithm for estimation of cBP that entirely fulfills the 2017 ARTERY and AAMI/ESH/ISO validation protocols. The Antares algorithm turns the custo screen 400 BP monitor into a type II-device. Integration of Antares into commercially available BP monitors could make it possible to measure PWA parameters in virtually every practice in future.

Diabetes and outcomes following guided de-escalation of antiplatelet treatment in acute coronary syndrome patients undergoing percutaneous coronary intervention: a pre-specified analysis from the randomised TROPICAL-ACS trial.

AIMS: A guided de-escalation of P2Y12 inhibitor treatment is considered an alternative treatment strategy in ACS patients undergoing PCI. However, the safety and efficacy of this strategy may differ in diabetic vs non-diabetic patients. The aim of this study was to compare the outcomes of platelet function testing (PFT)-guided de-escalation of dual antiplatelet therapy (DAPT) in ACS patients with and without diabetes mellitus. METHODS AND RESULTS: The TROPICAL-ACS trial randomised 2,610 biomarker-positive ACS patients 1:1 to either standard treatment with prasugrel for 12 months (control group) or PFT-guided DAPT de-escalation. The association and interaction of diabetes on clinical endpoints across treatment groups and on platelet reactivity was investigated. In diabetic patients (n=527, 20.2%), the overall event rates were high and the one-year incidence of the primary endpoint (cardiovascular death, myocardial infarction, stroke or bleeding ≥grade 2) did not differ between guided de-escalation and control group patients (12.5% vs 10.8%; HR 1.17, 95% CI: 0.71-1.93, p=0.55). In non-diabetic patients (n=2,083, 79.8%), the one-year incidence of the primary endpoint was lower in the guided de-escalation vs control group (6.1% vs 8.5%; HR 0.71, 95% CI: 0.52-0.99, p=0.04, pint=0.10). Diabetic patients showed higher platelet reactivity levels in both control (=on prasugrel, p=0.01) and guided de-escalation group (=on clopidogrel, p=0.005) patients. CONCLUSIONS: Although diabetic status did not significantly interfere with the treatment effects of guided DAPT de-escalation, our results suggest that this approach might be safe and effective in non-diabetic patients. Further investigation is definitely warranted in diabetic patients.

Takayasu's arteritis: a case with relapse after urgent coronary revascularization.

BACKGROUND: Vasculitides are commonly unrecognized causes of coronary stenosis and myocardial ischemia. We report on a 24-year old patient with Takayasu's arteritis who underwent urgent percutaneous coronary intervention, suffered from symptomatic restenosis of the left main coronary artery during standard immunosuppressive therapy. CASE PRESENTATION: A 24-year old woman was referred for coronary angiography because of typical progressive angina pectoris. On bicycle ergometry, there were both reproducible symptoms and deep ST segment depressions on precordial leads. Semi-selective angiography of the left coronary artery revealed high-grade ostial stenosis. Because of persistent angina pectoris and electrocardiographic signs of acute myocardial ischemia, immediate percutaneous coronary angioplasty with subsequent implantation of an everolimus-eluting stent was performed. This intervention was performed with excellent angiographic results. Because of several concomitant criteria including hypoechogenicity on postprocedural intravascular ultrasonography, the diagnosis of Takayasu's disease was made. The patient was treated with prednisolone and cyclophosphamide for 5 months. Because of recurrent angina pectoris, another coronary angiography was performed, which revealed high-grade in-stent-restenosis. Immunomodulatory therapy was switched to high-dose prednisolone and the anti-IL-6 receptor antagonist tocilizumab. The high-grade in-stent-restenosis persisted, and aortocoronary bypass graft surgery was performed with two saphenous vein grafts to the left anterior descending and circumflex artery. Since then, the patient has been doing well for 2 years. CONCLUSION: In cases of treatment refractoriness during standard immunosuppressive therapy, more recently developed biological compounds may offer an alternative strategy.

De novo acute heart failure and acutely decompensated chronic heart failure.

BACKGROUND: Heart failure is one of the most common diseases of adults in Europe, with an overall prevalence of 1-2%. Among persons aged 60 and above, its prevalence is above 10% in men and 8% in women. Acute heart failure has a poor prognosis; it is associated with a high rate of rehospitalization and a 1-year mortality of 20-30%. METHODS: This review is based on pertinent literature, including guidelines, retrieved by a selective search in PubMed. RESULTS: There are different types of acute heart failure; the basic diagnostic assessment is performed at once and consists of ECG, echocardiography, and the measurement of N-terminal pro-brain natriuretic peptide (NTproBNP) and troponin levels. The most common causes of decompensation are arrhythmia, valvular dysfunction, and acute cardiac ischemia, each of which accounts for 30% of cases. The potential indication for immediate revascularization should be carefully considered in cases where acute heart failure is due to coronary heart disease. The basic treatment of acute heart failure is symptomatic, with the administration of oxygen, diuretics, and vasodilators. Ino-tropic agents, vasopressors, and temporary mechanical support for the circulatory system are only used to treat cardiogenic shock. CONCLUSION: The treatment of acute heart failure is markedly less evidence-based than that of chronic heart failure. Newer treatment approaches that are intended to improve outcomes still need to be tested in multicenter trials.

Multicenter long-term validation of a minicourse in radiation-reducing techniques in the catheterization laboratory.

Patient radiation exposure in invasive cardiology is considerable. We aimed to investigate, in a multicenter field study, the long-term efficacy of an educational 90-minute workshop in cardiac invasive techniques with reduced irradiation. Before and at a median period of 2.5 months and 2.0 years after the minicourse (periods I, II, and III, respectively) at 5 German cardiac centers, 18 interventionalists documented various radiation parameters for 10 coronary angiographies. The median patient dose area product (DAP) for periods I, II, and III amounted to 26.6, 12.2, and 9.6 Gy × cm(2), respectively. The short-term and long-term effects were related to shorter median fluoroscopy times (180, 138, and 114 seconds), fewer radiographic frames (745, 553, and 417) because of fewer (11, 11, and 10) and shorter (64, 52, and 44 frames/run) runs, consistent collimation, and restriction to an adequate image quality; both radiographic DAP/frame (27.7, 17.3, and 18.4 mGy × cm(2)) and fluoroscopic DAP/second (26.6, 12.9, and 14.9 mGy × cm(2)) decreased significantly. Multivariate analysis over time indicated increasing efficacy of the minicourse itself (-55% and -64%) and minor influence of interventionist experience (-4% and -3% per 1,000 coronary angiographies, performed lifelong until the minicourse and until period III). In conclusion, autonomous self-surveillance of various dose parameters and feedback on individual radiation safety efforts supported the efficacy of a 90-minute course program toward long-lasting and ongoing patient dose reduction.

Efficacy of a minicourse in radiation-reducing techniques in invasive cardiology: a multicenter field study.

OBJECTIVES: Our goal was to validate an educational 90-min minicourse in lower-irradiating cardiac invasive techniques. BACKGROUND: Despite comprehensive radiation safety programs, patient radiation exposure in invasive cardiology remains considerable. METHODS: Before and at a median period of 3.7 months after the minicourse at 32 German cardiac centers, 177 interventionalists consistently documented radiation parameters for 10 coronary angiographies: dose area product (DAP), radiographic and fluoroscopic fractions, fluoroscopy time, and number of radiographic frames and runs. RESULTS: A total of 154 cardiologists attended the minicourse and achieved significant (p < 0.001) decrease in patients' median overall DAP (-48.4%), from baseline 26.5 to 13.7 Gy × cm(2). They reduced fluoroscopy times (-20.8%), radiographic runs (-9.1%), frames/run (-18.6%) and frames (-29.6%), and both radiographic DAP/frame (-27.4%) and fluoroscopic DAP/s (-39.3%), which indicate improved collimation, reduced-irradiation angulations, or adequate image quality. Dose-related parameters for the remaining 23 invited cardiologists unable to attend the workshop did not change significantly in univariate comparison. Multilevel analysis (p < 0.001) confirmed the efficacy of the minicourse itself (-14.7 Gy × cm(2)) and revealed higher DAP for increasing body mass index (+1.5 Gy × cm(2) per kg/m(2)), male sex (+5.8 Gy × cm(2)), age (+1.5 Gy × cm(2)/decade), and-owing to different settings during image acquisition-for advanced flat-panel detector systems (+9.0 Gy × cm(2)) versus older, traditional image intensifier systems. CONCLUSIONS: Despite significant required training in radiation safety for all interventional cardiologists, the presented additional 90-min minicourse significantly reduced patient dose.

Variants of Toll-like receptor 4 predict cardiac recovery in patients with dilated cardiomyopathy.

The clinical course of patients with dilated cardiomyopathy (DCM) varies from cardiac recovery to end stage heart failure. The etiology of this variability is largely unknown. In this study, we investigated the impact of coding polymorphisms of the innate immune protein Toll-like receptor 4 (TLR4) on left ventricular performance in patients with DCM. Two variants of TLR4 (rs4986790, TLR4 c.1187A→G, p.299D→G and rs4986791,TLR4 c.1487C→T, p.T399I) were investigated in 158 patients with DCM. Other reasons for heart failure were excluded by coronary angiography, myocardial biopsy, and echocardiography. Risk factors, age, gender, or treatment did not differ among the groups. At the follow-up evaluation (median 4.0-5.4 months), patients carrying the TLR4 wild type gene displayed cardiac recovery under intense medical heart failure therapy indexed by reduced left ventricular dilation, improved left ventricular ejection fraction, and reduced NT-probrain natriuretic peptide blood level when compared with the initial evaluation. In contrast, patients carrying both the rs4986790 and the rs4986791 variant showed significantly reduced improvement of left ventricular ejection fraction (p = 0.006) and left ventricular dilation (p = 0.015) at the follow-up evaluation when compared with carriers of the wild type gene under the same treatment conditions. In addition, NT-probrain natriuretic peptide level in carriers of both TLR4 variants did not change significantly at the follow up when compared with the first evaluation. Among patients with DCM, the presence of the TLR4 variants rs4986790 and rs4986791 predicts impaired cardiac recovery independently of medical treatment or cardiac risk factors.

Comparison of rotational with conventional coronary angiography.

BACKGROUND: Patient radiation exposure and consumption of contrast medium are considered major risks of diagnostic coronary angiography (CA). Rotation of the C-arm during CA could provide similar diagnostic accuracy and lower radiation exposure and contrast medium consumption. METHODS: To compare feasibility, safety, diagnostic accuracy, patient radiation exposure, and consumption of contrast medium of rotational CA with the invasive standard technique, intraindividual comparisons of the results obtained by both techniques were performed in 235 patients with an indication for first-time elective CA. In addition to conventional angiography, we performed 2 isocentric radiographic coronary spins with cranial and caudal tilts by 20 degrees around the left coronary artery and 1 strict posteroanterior rotational spin around the right coronary artery. RESULTS: In 16 patients, rotational CA was not performed because of safety concerns. In a further 12 patients, image quality of rotational scans was considered inadequate. In the remaining 207 patients, both modes of CA were proven suitable for anonymized, separate analysis by 3 independent cardiologists. Intraindividual comparison of both CA modes revealed a high degree of diagnostic agreement (Cohen (K) >0.8 for all cardiologists and for each coronary segment). Contrast medium volume during rotational CA and conventional CA amounted to 31.9 +/- 4.5 mL versus 52.2 +/- 8.0 mL (P < .001) and patient radiation exposure amounted to 5.0 +/- 2.6 Gy × cm(2) versus 11.5 +/- 5.5 Gy × cm(2) (P < .001), respectively. CONCLUSIONS: Rotational CA represents a safe and feasible method in clinical routine. Whereas diagnostic accuracy is similar to the usual conventional mode, consumption of contrast medium and patient radiation exposure are significantly reduced.

Effects of immunoadsorption and subsequent immunoglobulin G substitution on cardiopulmonary exercise capacity in patients with dilated cardiomyopathy.

BACKGROUND: Recent data indicate that cardiac antibodies play an active role in the pathogenesis of dilated cardiomyopathy (DCM) and may contribute to cardiac dysfunction in patients with DCM. The present study investigated the influence of immunoadsorption with subsequent immunoglobulin G substitution (IA/IgG) on cardiopulmonary exercise capacity in patients with DCM. METHODS: Sixty patients with DCM (New York Heart Association II-IV, left ventricular ejection fraction < or =45%) were included in this single-center university hospital-based case-control study. Patients either were treated with IA/IgG (n = 30) or were followed without IA/IgG (n = 30). At baseline and after 3 months, we compared echocardiographic assessment of left ventricular function and spiroergometric exercise parameters. RESULTS: In contrast to controls, left ventricular ejection fraction improved significantly in the IA/IgG group from 33.0% +/- 1.2% to 40.1% +/- 1.5% (P < .001). In the control group, spiroergometric exercise parameters did not change during follow-up. After 3 months, maximum achieved power increased in the treatment group from 114.2 +/- 7.4 to 141.9 +/- 7.9 W (P = .02). Total exercise time increased in the treatment group from 812 +/- 29 to 919 +/- 30 seconds (P < .05). Peak oxygen uptake (Vo(2)) increased from 17.3 +/- 0.9 to 21.8 +/- 1.0 mL min(-1) kg(-1) after IA/IgG (P < .01). Oxygen pulse (peak Vo(2)/maximum heart rate) increased in the treatment group (10.7 +/- 0.7 vs 13.6 +/- 0.7 mL beat(-1) min(-1), P < .01). The Vo(2) at the gas exchange anaerobic threshold increased after 3 months in the treatment group from 10.3 +/- 0.5 to 13.2 +/- 0.5 mL min(-1) kg(-1) (P < .001). The ventilatory response to exercise (V(E)/Vco(2) slope) decreased after IA/IgG therapy from 32.3 +/- 1.5 to 28.7 +/- 0.9 (P = .02). CONCLUSIONS: In patients with DCM, IA/IgG therapy may induce improvement in echocardiographic and cardiopulmonary exercise parameters.

Mild renal dysfunction as a non-traditional cardiovascular risk factor?-Association of cystatin C-based glomerular filtration rate with flow-mediated vasodilation.

OBJECTIVE: Chronic kidney disease, at least in its advanced stages, can be regarded as a non-traditional cardiovascular risk factor. The purpose of this study was to evaluate whether early stages of renal dysfunction are associated with flow-mediated vasodilatation, as an early marker of the atherosclerotic disease process. METHODS: In 1515 subjects (753 females) from the population-based Study of Health in Pomerania, the relationship between flow-mediated vasodilatation of the brachial artery (cuff occlusion of the forearm for 5 min) and glomerular filtration rate, estimated on the basis of serum cystatin C levels, was analyzed under consideration of various cardiovascular risk factors. RESULTS: Flow-mediated vasodilatation was 5.75 + or - 0.16% in women and 4.29+/-0.12% in men (mean + or - SEM). Glomerular filtration rate amounted to 94.2 + or - 0.7 ml/min/1.73 m(2), with 8.1% subjects with glomerular filtration rate < or = 60 ml/min/1.73 m(2). Flow-mediated vasodilatation significantly correlated with glomerular filtration rate in the entire population (r=0.237, p<0.001), in women (r=0.224, p<0.001) and in men (r=0.168, p<0.001). Adjusting for age and multiple cardiovascular risk factors and also for high-sensitive C-reactive protein levels revealed a significant association of flow-mediated vasodilatation and glomerular filtration rate in women (p=0.01), but not in men, with similar results when the analyses were restricted to individuals with glomerular filtration rate >60 ml/min/1.73 m(2). CONCLUSION: Mild reduction in renal function is associated with alterations in endothelial function in females. Hence, very mild alterations in kidney function may also be regarded as a cardiovascular risk factor at least in women.

Early detection and efficient therapy of cardiac angiosarcoma due to routine transesophageal echocardiography after cerebrovascular stroke.

Primary malignant cardiac tumors (cardiac angiosarcomas) are exceedingly rare. Since there are initially nonspecific or missing symptoms, these tumors are usually diagnosed only in an advanced, often incurable stage, after the large tumor mass elicits hemodynamic obstructive symptoms. A 59-year-old female presented with symptoms of cerebral ischemia. A computed tomography (CT) scan showed changes suggestive of stroke. Transesophageal echocardiography revealed an inhomogeneous, medium-echogenic, floating mass at the roof of the left atrium near the mouth of the right upper pulmonary vein, indicative of a thrombus. At surgery, a solitary tumor was completely enucleated. Histologically, cardiac angiosarcoma was diagnosed. The patient received adjuvant chemotherapy and was free of symptoms and recurrence of disease at 14 months follow-up. Due to the fortuitous appearance of clinical signs indicative of stroke, cardiac angiosarcoma was diagnosed and effectively treated at an early, nonmetastatic, and therefore potentially curable stage. Although cardiac angiosarcoma is a rare disease, it should be taken into consideration as a potential cause of cerebral embolic disease.

Unintentional extraction of a coronary stent deployed 4 months earlier during cutting-balloon angioplasty for in-stent restenosis.

In general, coronary stents, when deployed in a coronary artery by conventional balloon expansion, appear to be tightly forced into the vessel wall, virtually precluding intentional or unintentional removal of the stents. Here, we present a case of unintended coronary stent extraction during cutting balloon angioplasty for high-grade in-stent restenosis of a stent successfully deployed 4 months earlier. The blades of the cutting balloon became stuck in the stent struts. Retrieval of the cutting balloon was only possible in conjunction with the stent using increased traction. Subsequent vessel closure was recanalized and a paclitaxel-eluting stent was implanted, covering the entire region of the previous stent and rendering an excellent angiographic result. Careful inspection of the extracted stent demonstrated complete removal. Retrospective analysis of the stent implantation procedure 4 months prior revealed complete stent expansion and closely matched stent and vessel dimensions as assessed by angiographic criteria.

Cutting-balloon angioplasty effectively facilitates the interventional procedure and leads to a low rate of recurrent stenosis in ostial bifurcation coronary lesions: A subgroup analysis of the NICECUT multicenter registry.

BACKGROUND: Displacement of plaque is a major concern during coronary intervention of ostial bifurcation lesions. For this reason, angioplasty involves complex stenting procedures, which may trigger development of restenosis in a previously non-diseased parent vessel. OBJECTIVES: To examine, whether plaque displacement may be prevented by scoring atherosclerotic plaque with a cutting-balloon (CB) stand-alone procedure. METHODS: Data of patients with Duke E and B type ostial bifurcation lesions (>/=70% stenosis involving a diagonal and/or marginal branch >2 mm deriving from a non-diseased parent vessel), who were treated with CB as stand-alone procedure within the prospective NICECUT multicenter trial were analyzed. Primary endpoint was the rate of binary stenosis and target lesion revascularization (TLR). Secondary endpoints were procedural success and major adverse cardiac events (MACE) at 6-months follow-up. RESULTS: 63 out of 65 lesions (56 patients) were successfully amenable to treatment with CB (96.4% procedural success). 76.9% of patients were successfully treated with CB as a stand-alone procedure, while provisional stenting was necessary in 23.1%. At follow-up, binary stenosis was found in 23.2%, among the total population. Total rate of TLR and MACE were 7.7% and 3.6%, respectively, compared to 4.0% and 2.0% in patients for whom CB stand-alone procedure was feasible, while it was 20.0% and 6.7% for stented lesions. CONCLUSIONS: CB angioplasty as a stand-alone procedure may facilitate interventional treatment of ostial bifurcation lesions and may help to avoid complex stenting procedures. It is associated with a low rate of binary stenosis and TLR.

Excimer laser thrombus elimination for prevention of distal embolization and no-reflow in patients with acute ST elevation myocardial infarction: results from the randomized LaserAMI study.

BACKGROUND: Results for standard revascularization therapies in acute myocardial infarction (AMI) have been limited in part by distal embolization, a process which might be reduced by the application of ultraviolet laser light. The aim was to assess feasibility and safety of excimer laser coronary angioplasty (ELCA) in a randomized study in AMI. METHODS: Twenty-seven consecutive patients with ST-segment elevation AMI (aged 57.8+/-9.2 years) were randomized either to balloon angioplasty and stent implantation alone (n=13) or adjunct ELCA (n=14). Quantitative coronary angiography was analyzed by an independent core laboratory. RESULTS: ELCA was feasible and safe in all cases. No procedure-associated complications were observed. Similar results were found for main parameters in laser (L) and control (C) patients: diameter stenosis decreased from 94.3+/-9.6 to 20.7+/-10.3% (L) and from 82.7+/-16.8 to 18.9+/-5.5% (C) (p=ns; L vs. C). TIMI flow increased from 0.7+/-1.2 to 2.8+/-0.4 and from 1.7+/-1.5 to 3.0+/-0 (p=ns; L vs. C), respectively. The post-procedural myocardial blush score did not differ between the groups (2.1+/-1.3 and 2.7+/-1.0; p=ns; L vs. C) and the final corrected TIMI frame count (cTFC) was also similar in both groups (23+/-7 and 22+/-4; p=ns; L vs. C), but the cTFC gain was higher in the laser group (53+/-14% and 35+/-20%; p<0.05; L vs. C). CONCLUSIONS: Laser angioplasty is feasible and safe for the treatment of patients with ST elevation AMI. Procedural results were at least on par with conventional treatment. Further randomized controlled trials are needed to assess the benefit of laser angioplasty in AMI.

Immunoadsorption in dilated cardiomyopathy: 6-month results from a randomized study.

BACKGROUND: Various randomized studies evidenced that immunoadsorption (IA) repeated at monthly intervals induced acute and prolonged hemodynamic benefit in patients with severe heart failure due to dilated cardiomyopathy. Some findings indicate that the use of only one course of IA therapy may also induce prolonged beneficial effects. METHODS: This randomized study included 22 patients suffering from severe heart failure (left ventricular ejection fraction [LVEF] <35%) due to dilated cardiomyopathy. The first group (11 patients) was treated with four IA courses at monthly intervals. The second group (11 patients) received one IA course only without repetition. In all patients of the 2 groups, each course was performed in one IA session on 5 consecutive days. At 3 and 6 months after the beginning of this study, left ventricular function and hemodynamics were reevaluated in both groups. RESULTS: Immunoadsorption treatment repeated at monthly intervals induced improvement in LVEF after 6 months, that is, from 28.1% +/- 1.5% to 37.0% +/- 1.6% (+/-SEM; P < .01 vs baseline). Patients treated in only one IA course experienced comparable improvement of LVEF after 6 months, that is, from 26.5% +/- 2.2% to 34.8% +/- 2.9% (P < .01 vs baseline). In the group with repeated IA courses, cardiac index increased from baseline 2.2 +/- 0.1 to 2.8 +/- 0.2 L min(-1) m(-2) after 6 months (P < .01 vs baseline). In comparison, during the 6 months of this study in the group with one IA course, cardiac index increased from 2.1 +/- 0.1 to 2.7 +/- 0.2 L min(-1) m(-2). After 3 and 6 months, there were no significant differences between the 2 groups with respect to LVEF and all measured hemodynamic parameters. CONCLUSIONS: One course of IA treatment may induce improvement of left ventricular function over a period of 6 months, with results comparable to those received by IA treatment repeated at monthly intervals.

Effects of immunoadsorption on the nt-BNP and nt-ANP plasma levels of patients suffering from dilated cardiomyopathy.

Immunoadsorption (IA) represents an additional therapeutic approach in patients with severe heart failure due to dilated cardiomyopathy (DCM). nt-BNP and nt-ANP plasma levels are prognostic markers in patients with heart failure. The effect of IA on nt-BNP and nt-ANP plasma levels is unknown. In this case control study, 30 patients suffering from severe heart failure (LVEF < 35%) due to DCM were included. In 15 patients, IA was carried out in four courses of monthly intervals until month 3. For analysis of the acute and prolonged effects, the plasma levels of nt-BNP and nt-ANP were determined before and after each IA course. In 15 comparable DCM patients (controls), plasma levels of nt-BNP and nt-ANP were determined at baseline and after 3 months. LVEF remained stable during this study in the control group. In contrast, in the IA group after 3 months, LVEF increased from 29.7 +/- 1 to 38.6 +/- 2%, P < 0.001. In the control group, the nt-BNP and nt-ANP plasma levels remained stable during the 3 months of the study. In the IA group after the first IA course, the level of nt-BNP was acutely reduced from 1501 +/- 328 to 925 +/- 151 fmol/mL, P < 0.01. In addition, the nt-ANP level was reduced from 4439 +/- 1271 to 2897 +/- 825 fmol/mL, P < 0.01. In the IA group, the reduction of these two parameters remained detectable after 3 months before the last course: nt-BNP: 714 +/- 119 fmol/mL, nt-ANP: 2227 +/- 427 fmol/mL, P < 0.05. The improvement of left ventricular function during IA is accompanied by a reduction of nt-BNP and nt-ANP plasma levels in patients with DCM.

Tooth loss is independently associated with the risk of acquired aortic valve sclerosis.

BACKGROUND: Several studies have shown that periodontal disease and atherosclerosis are associated. Aortic valve sclerosis (AVS) represents the sum of processes that are similar to the development of atherosclerosis. The present analysis was performed to investigate associations between periodontal disease, tooth loss, and AVS. METHODS: The population-based SHIP was conducted in northeast Germany. A study population of 2341 individuals aged > or =45 years was available for the present analysis. Aortic valve sclerosis was determined by echocardiography. Periodontal status was assessed by attachment loss and tooth loss. RESULTS: The prevalence of AVS was 29.9%. Logistic regression analyses did not reveal attachment loss as an independent risk factor for AVS. However, a reduced number of teeth was independently associated with AVS. Other risk factors for AVS were age, history of myocardial infarction, body mass index, pulse pressure, plasma fibrinogen and lipoprotein (a) levels, and the use of drugs that act on the renin-angiotensin system. CONCLUSION: A reduced number of teeth was independently associated with the risk of AVS. This finding further strengthens the link between oral health and cardiovascular disorders.