Lothar Faber

Publications (127) View all

• Article: Alcohol septal ablation in patients with hypertrophic obstructive cardiomyopathy: low incidence of sudden cardiac death and reduced risk profile.

  Morten K Jensen, Christian Prinz, Dieter Horstkotte, Frank van Buuren, Thomas Bitter, Lothar Faber, Henning Bundgaard
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  ABSTRACT: BACKGROUND: The infarction induced by alcohol septal ablation (ASA) may predispose to arrhythmia and sudden cardiac death (SCD). OBJECTIVE: To assess survival, incidence of SCD after ASA and effects of ASA on the traditional risk factors (RFs) for SCD. DESIGN: An observational cohort-study (follow-up 8.4±4 years). SETTING: A dual-centre cohort. PATIENTS: 470 consecutive patients (age 56±14 years) with obstructive hypertrophic cardiomyopathy (HCM) (1996-2010). INTERVENTIONS: Clinically applied echo-contrast-guided ASA treatments. MAIN OUTCOME MEASURES: All-cause mortality, SCD and RFs for SCD before and after ASA. RESULTS: The 10-year survival was 88% (annual all-cause death rate 1.2%) after ASA compared with 84% (p=0.06) in a matched background population. The 10-year survival free of SCD was 95% (annual SCD rate 0.5%). ASA reduced the prevalence of abnormal blood pressure response (from 23% to 9%, p<0.001), syncope (26% to 2%, p<0.001), non-sustained ventricular tachycardia (NSVT) (23% to 17%, p<0.05) and maximal wall thickness ≥30 mm (7% to 2%, p<0.001). There was a family history of SCD in 19% of the patients. The proportion of patients at high risk-that is, two or more RFs (n=89), was reduced from 25% to 8% (p<0.001). A RF score ≥2 before ASA was not associated with SCD (n=361, p=0.31). CONCLUSIONS: Survival in ASA-treated patients was similar to that in the background population. The number of RFs, including the prevalence of NSVT, was markedly reduced by ASA and the incidence of SCD was correspondingly low. Thus, clinically applied ASA was safe.
  Heart (British Cardiac Society) 05/2013; · 4.22 Impact Factor
• Article: Electrical myostimulation improves left ventricular function and peak oxygen consumption in patients with chronic heart failure: results from the exEMS study comparing different stimulation strategies.

  Frank van Buuren, Klaus Peter Mellwig, Christian Prinz, Britta Körber, Andreas Fründ, Dirk Fritzsche, Lothar Faber, Tanja Kottmann, Nicola Bogunovic, Johannes Dahm, Dieter Horstkotte
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  ABSTRACT: AIMS: Electromyostimulation (EMS) of thigh and gluteal muscles is a strategy to increase exercise capacity in patients with chronic heart failure (CHF). The aim of this non-randomised pilot study was to investigate the effects of different stimulation strategies in CHF patients using a newly developed stimulation suit also involving trunk and arm muscles [extended electromyostimulation (exEMS)] in comparison with EMS therapy limited to gluteal and leg muscles (limEMS). METHODS: 60 individuals joined the EMS training programme. Stable CHF patients (NYHA class II-III) received either exEMS (22 patients, 15 males, mean age 59.95 ± 13.16 years) or limEMS (12 patients, 9 males, 62.75 ± 8.77 years). 26 participants served as healthy control group (CG) receiving exEMS. Training was performed for 10 weeks twice weekly for 20 min, and the level of daily activity remained unchanged. Effects on exercise capacity, oxygen uptake, left ventricular function (EF) and biomarkers were evaluated. RESULTS: There was a significant increase of oxygen uptake at aerobic threshold in all groups (exEMS: 13.7 ± 3.9-17.6 ± 5.1 ml/kg/min (+28.46 %, p < 0.001); limEMS 13.6 ± 3.0-16.0 ± 3.8 ml/kg/min (+17.6 %, p = 0.003); CG 15.0 ± 4.9-17.0 ± 6.4 ml/kg/min (+13.3 %, p = 0.005). LVEF increased from 38.3 ± 8.4 to 43.4 ± 8.8 % (+13.3 %, p = 0.001) (limEMS 37.1 ± 3.0-39.5 ± 5.3 % (+6.5 %, p = 0.27); CG 53.9 ± 6.7-53.7 ± 3.9 % (-0.4 %, p = 0.18). In CHF patients changes in oxygen consumption and LVEF were higher in the exEMS group than in limEMS (not significant). Maximal workload improved in healthy controls (p = 0.002) but not in CHF patients. CONCLUSION: Extended EMS can improve oxygen uptake and EF in CHF. In patients with limited EMS and in control patients without heart failure but extended EMS, oxygen uptake can be improved but EF is unaltered. For all groups, NT proBNP is unaffected by EMS.
  Clinical Research in Cardiology 04/2013; · 2.95 Impact Factor
• Article: Determining the role of fibrosis in hypertrophic cardiomyopathy.

  Christian Prinz, Martin Farr, Kai Thorsten Laser, Helmut Esdorn, Cornelia Piper, Dieter Horstkotte, Lothar Faber
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  ABSTRACT: Fibroblast activity within the heart may be considered a basically constructive process. Hyperactivity of fibroblasts, however, may result in the accumulation of extracellular matrix proteins with adverse effects on cardiac structure and function including electrical instability and increased risk of arrhythmogenic cardiac death. The detection of cardiac fibrosis by dedicated imaging techniques, mainly gadolinium-enhanced MRI, holds promise to refine patient management in a variety of cardiac conditions. This review aims to summarize the current knowledge regarding fibrosis in hypertrophic cardiomyopathy.
  Expert Review of Cardiovascular Therapy 04/2013; 11(4):495-504.
• Article: Left Ventricular Dyssynchrony Predicts Clinical Response to CRT - A Long-Term Follow-Up Single-Center Prospective Observational Cohort Study.

  Christian Prinz, Roman Lehmann, Maria Schwarz, Eva-Maria Prinz, Thomas Bitter, Jürgen Vogt, Frank van Buuren, Nikola Bogunovic, Barbara Lamp, Dieter Horstkotte, Lothar Faber
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  ABSTRACT: BACKGROUND: Until now, there is no consensus regarding the definition of a clinical response to cardiac resynchronization therapy (CRT) in patients with chronic heart failure (CHF) and systolic left ventricular (LV) dysfunction. The aim of this study was to evaluate if echocardiography is predictive for an objective improvement in exercise capacity during long-term follow-up of CRT. METHODS: Each patient underwent echocardiography and spiroergometry both at baseline and at last follow-up. Left ventricular dyssynchrony (LVD) before CRT was defined by tissue Doppler imaging (TDI) as intra-LV delay ≥40 msec (septal-lateral or anterior-posterior). Clinical response to CRT was defined as increase of peakVO2 or as increase of maximal workload >10% as compared to baseline. RESULTS: Mean follow-up was 69 ± 37 months. From the 238 consecutive patients included in the study, 141 (59%) were classified as clinical responders and 97 (41%) as nonresponders. Baseline data of responders and nonresponders were comparable. However, clinical responders showed more often LVD (64%) than nonresponders (42%, P = 0.004). On multivariate regression analysis, nonischemic origin of CHF (β-coefficient in the final model 0.1, P = 0.04) and LVD at baseline (β-coefficient in the final model 0.2, P < 0.001) were independently associated with clinical response during long-term follow-up. Patients with LVD at baseline had significant more often an improvement of left ventricular ejection fraction >10% (P = 0.02) and a reduction of left ventricular end-diastolic diameter (LVEDD) >10% (P < 0.01) than patients without LVD at baseline. CONCLUSIONS: LVD at baseline as assessed by a straightforward echocardiographic approach predicts the long-term clinical response to CRT and is associated with a more pronounced reverse LV remodeling.
  Echocardiography 03/2013; · 1.24 Impact Factor
• Article: Evaluation of left ventricular torsion in children with hypertrophic cardiomyopathy.

  Christian Prinz, Lothar Faber, Dieter Horstkotte, Hermann Körperich, Axel Moysich, Nikolaus Haas, Deniz Kececioglu, Kai Thorsten Laser
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  ABSTRACT: Aims To evaluate the role of torsion in hypertrophic cardiomyopathy in children. METHODS: A total of 88 children with idiopathic hypertrophic cardiomyopathy (n = 24) and concentric hypertrophy (n = 20) were investigated with speckle-tracking echocardiography and compared with age- and gender-matched healthy controls (n = 44). RESULTS: In hypertrophic cardiomyopathy, we found increased torsion (2.8 ± 1.6 versus 1.9 ± 1.0°/cm [controls], p < 0.05) because of an increase in clockwise basal rotation (-8.7 ± 4.3° versus -4.9 ± 2.5° [controls], p < 0.001) and prolonged time to peak diastolic untwisting (3.7 ± 2.4% versus 1.7 ± 0.6% [controls] of cardiac cycle, p < 0.01), but no differences in peak untwisting velocities. Hypertrophic cardiomyopathy patients demonstrated a negative correlation between left ventricular muscle mass and torsion (r = -0.7, p < 0.001). In concentric hypertrophy, torsion was elevated because of increased apical rotation (15.1 ± 6.4° versus 10.5 ± 5.5° [controls], p < 0.05) without correlation with muscle mass. Peak untwisting velocities (- 202 ± 88 versus -145 ± 67°/s [controls], p < 0.05) were higher in concentric hypertrophy and time to peak diastolic untwisting was delayed (1.8 ± 0.8% versus 1.2 ± 0.6% [controls], p < 0.05). CONCLUSIONS: In contrast to an increased counterclockwise apical rotation in concentric hypertrophy, hypertrophic cardiomyopathy is characterised by predominantly enhanced systolic basal clockwise rotation. Diastolic untwisting is delayed in both groups. Torsion may be an interesting marker to guide patients with hypertrophic cardiomyopathy.
  Cardiology in the Young 02/2013; · 0.76 Impact Factor