[Show abstract][Hide abstract] ABSTRACT: The coxsackie and adenovirus receptor (CAR) mediates the entry of coxsackievirus B (CVB) and adenovirus into host cells and is, therefore, a key determinant for the molecular pathogenesis of viral diseases such as myocarditis. The aim was to investigate the influence of HMG-CoA reductase inhibitor lovastatin on CAR expression in endothelial cells.
Human umbilical vein endothelial cells (HUVECs) were exposed to different concentrations of lovastatin (0.05-5 μmol/l) for up to 48 h. Alterations in CAR expression were examined by quantitative real-time PCR (qRT-PCR) and flow cytometry. In addition, after treatment with 1 μmol/l lovastatin for 48 h, HUVECs were infected for 8 h with CVB3 and virus replication was detected by qRT-PCR using viral-specific TaqMan probes.
We found that lovastatin decreases CAR mRNA expression by up to 80 % (p < 0.01) and CAR protein expression by up to 19 % (p < 0.01), in a concentration-dependent manner. Moreover, virus replication of CVB3 was significantly inhibited after lovastatin treatment (p < 0.05). The signaling mechanism of CAR down-regulation by lovastatin depends on the Rac1/Cdc42 pathway.
This study shows for the first time that lovastatin reduces the expression of CAR and subsequently the replication of CVB3 in HUVECs.
Full paper here: http://link.springer.com/article/10.1007/s00011-013-0695-z
[Show abstract][Hide abstract] ABSTRACT: We examined the prevalence of sleep-disordered breathing (SDB) in patients with severe aortic valve stenosis (AS) and the impact of transfemoral aortic valve implantation (TAVI) on SDB.
79 patients underwent cardiorespiratory polygraphy (PG) before TAVI (CoreValve™), 62 of them a second PG after the procedure.
Forty-nine (62 %) patients had obstructive sleep apnea (OSA), 25 (32 %) central sleep apnea (CSA), and 5 (6 %) presented without significant SDB (apnea-hypopnea index (AHI) < 5/h). Among the 62 patients evaluated before and after TAVI, 36 (58 %) had OSA, 22 (36 %) CSA, and 4 patients (7 %) no SDB. AHI was significantly higher in CSA patients than in OSA patients (34.5 ± 18.3 vs. 18.0 ± 12.6/h, p < 0.001). Successful TAVI had a significant impact on CSA but not on OSA: CSA patients with optimal TAVI results experienced a significant reduction in central respiratory events (AHI 39.6 ± 19.6-23.1 ± 16.0/h, p = 0.035), while no changes were detected in OSA patients (AHI 18.8 ± 13.0-20.25 ± 13.4/h, p = 0.376). In contrast, in patients who developed at least moderate periprosthetic aortic regurgitation (AR > I), CSA increased significantly (AHI 26.3 ± 13.2-39.2 ± 18.4/h, p = 0.036), whereas no acute change was seen in patients with OSA (AHI 10.5 ± 7.8-12.5 ± 5.0/h, p = 0.5).
OSA and CSA are prevalent in more than 90 % of patients undergoing TAVI for severe aortic valve stenosis. Successful TAVI had no significant impact on OSA but improved CSA. In case of an acute change from pressure overload (aortic stenosis) to acute volume overload (aortic regurgitation after TAVI), central, but not obstructive, sleep apnea deteriorated.
Clinical Research in Cardiology 08/2013; · 3.67 Impact Factor
[Show abstract][Hide abstract] 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.
[Show abstract][Hide abstract] ABSTRACT: Psychological symptoms are common in patients with heart disease. Objective of this study was to analyse the effects of somatic factors on anxiety and depression in hospitalised patients with heart failure. We examined 150 patients by short-term interview and standardized questionaire (HADS-D) and performed a written survey 3 months later. In 47% of the patients signs of anxiety and in 30% signs of depression were present. Increased heart failures severity was associated with increased rates of anxiety and depression. 3 months after hospital discharge the percentage of patients who reported symptoms of anxiety had decreased, the percentage of depressive female patients had increased. The course of anxiety and depression was not affected by cardiologic treatment. Patients with severe signs of anxiety and/or depression should receive specific diagnostics and therapy.
[Show abstract][Hide abstract] ABSTRACT: An intervention for chronic acquired valvular heart disease may either be indicated in symptomatic patients to relieve symptoms and improve quality of life or in asymptomatic patients to improve long-term prognosis, e.g., by preventing disease-related complications like chronic heart failure or arrhythmias. For proper action according to current guidelines, the systematic evaluation of symptoms related to the underlying valve disease is of utmost importance. If a discrepancy between symptoms reported or not reported by the patients and the severity of the valve disease is supposed, true absence of symptoms and exercise tolerance should be verified by spiroergometry. In the truly asymptomatic patient with a severe valvular lesion, preservation of myocardial adaption to the chronic volume or pressure overload should be tested utilizing appropriate imaging techniques like radionuclide ventriculography under exercise conditions. The proper evaluation of the functional status is of growing importance in our aging population with its sedentary lifestyle. In this context, the results of a survey should be kept in mind, which indicated that a significant proportion of patients still have interventions too late during the natural history of their valve disease with symptoms of congestive heart failure, arrhythmias, and the risk of sudden cardiac death persisting after a primarily successful valve repair or replacement.
[Show abstract][Hide abstract] ABSTRACT: Fragestellung: Veränderungen der Na+Ca2+-Exchanger (EXCH)-Expression werden als Ausdruck einer gestörten Calciumhomöostase angesehen. Da sich diastolische und systolische
Funktionsstörungen lange vor Manifestation einer terminalen Herzinsuffizienz einstellen, untersuchten wir bei 22 Patienten
mit chronischen Herzklappenfehlern (HKF), in welchem Stadium der myokardialen Funktionsstörung eine Hochregulation des EXCH
erfolgt und ob diese ggf. frühzeitig eine Erschöpfung der myokardialen Adaptationsmechanismen an chronische Druck- und/oder
Volumenbelastung anzeigt.¶ Methoden: Mittels quantitativer RT-PCR wurde die Transkriptionshöhe des EXCH in endomyokardialen Biopsien von 11 Patienten mit Aortenstenosen
(AS), 5 mit Aorteninsuffizienzen (AI) und 6 mit primären Mitralinsuffizienzen (MI) unterschiedlicher hämodynamischer Schweregrade
bestimmt. Zusätzlich wurde endomyokardiales Gewebe von 13 explantierten, terminal insufffizienten Herzen untersucht. Als Kontrollgruppe
diente endomyokardiales Gewebe von sieben Individuen bei denen letztlich eine Herzerkrankung ausgeschlossen werden konnte.¶ Ergebnisse: Die Menge an EXCH mRNA betrug im Myokard der Kontrollgruppe 2,6±1,2amol/ng totaler RNA und unterschied sich nicht von der
Menge an EXCH mRNA bei AS (1,8±1,4amol/ng totaler RNA), AI (1,9±0,8amol/ng) oder MI (2,2±2,1amol/ng). Im Myokard explantierter
terminal insuffizienter Herzen fand sich dagegen eine deutlich erhöhte Menge an EXCH mRNA (8,9±1,9amol/ng).¶Zwischen der EXCH-Transkription
und dem Schweregrad des Vitiums oder der konsekutiven Einschränkung der linksventrikulären Pumpfunktion bestand kein Zusammenhang:
Cardiac Index (CI) >3,5l/min/m2 (EXCH 1,4±1,1amol/ng totaler RNA); CI 3,5–2,4 (EXCH 2,5±1,8); CI <2,4 (EXCH 1,8±1,0); EF-angio >50% (EXCH 1,9±1,8), EF-angio
≤50% (EXCH 1,9±0,9); EF-RNV >50% (EXCH 2,4±1,8), EF-RNV ≤50% (EXCH 1,7±1,0).¶ Schlussfolgerung: Die myokardialen EXCH-Transkriptionsmengen ändern sich bei HKF nicht parallel zur Ausbildung einer myokardialen Pumpfunktionsstörung.
EXCH scheint daher nicht geeignet, eine beginnende Erschöpfung der myokardialen Adaptation an chronische Volumen- und/oder
Druckbelastungen zu detektieren.
Background: Na+-Ca2+ exchanger (EXCH) is an important regulator of intracellular calcium homeostasis. To maintain a normal intracellular Ca2+ concentration, EXCH expression may be upregulated before the onset of end-stage heart failure. We tested for a correlation
between the EXCH transcription level and the degree of myocardial dysfunction as well as the suitability of EXCH transcription
as a molecular marker for early detection of a transition from adequate to inadequate myocardial adaptation to chronic pressure
and/or volume overload in valvular heart disease (VHD).¶ Methods: The level of EXCH transcription was analyzed in myocardial biopsies from eleven patients with aortic stenosis (AS), five
with aortic regurgitation (AR) and six with primary mitral regurgitation (MR) of different hemodynamic severity and myocardial
impairment using the quantitative rt-PCR technique. In addition, endomyocardial tissue from thirteen explanted hearts with
end-stage heart failure and biopsies from seven individuals without heart disease were investigated.¶ Results: The mean level of EXCH transcription in patients with AS was: 1.8±1.4amol/ng total RNA, with AR: 1.9±0.8amol/ng and with
MR: 2.2±+2.1 amol/ng. This was not from different controls (2.6±1.2 amol/ng total RNA). However, in myocardium from end-stage
heart failure, EXCH transcription was increased fourfold amounting to 8.9±1.9amol/ng total RNA. No difference in the EXCH
transcription was found in VHD with respect to the degree of myocardial dysfunction: cardiac index (CI) >3.5l/min/m2 (EXCH 1.4±1.1amol/ng total RNA); CI 3.5–2.4 (EXCH 2.5±1.8); CI <2.4 (EXCH 1.8±1.0); EF-angio >50% (EXCH 1.9±1.8); EF-angio
≤50% (EXCH 1.9±0.9); EF-RNV >50% (EXCH 2.4±1.8), EF-RNV ≤50% (EXCH 1.7±1.0).¶ Conclusion: Myocardial EXCH transcription does not change parallel to the degree of myocardial dysfunction in VHD. Consequently, myocardial
EXCH transcription does not appear to be suitable as a parameter indicating the transition from adequate to inadequate myocardial
adaptation to chronic volume and/or pressure overload.
Schlüsselwörter Natrium-Calcium-Exchanger – Herzklappenfehler – myokardiale Adaptation – endomyokardiale Biopsie – terminale
Key words Sodium-calcium exchanger – heart valve disease – endomyocardial biopsy – myocardial adaptation – end-stage heart
Zeitschrift für Kardiologie 04/2012; 89(8):682-690. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Die supravalvuläre Aortenstenose ist im Erwachsenenalter seltene Ursache einer Behinderung des linksventrikulären Blutausstroms.
Sie tritt zum einen als isolierter Defekt sporadisch oder familiär mit autosomal-dominantem Erbgang ohne weitere phänotypische
Anomalien und zum anderen im Rahmen des Williams-Syndroms mit geistiger Retardierung und multiplen weiteren Anomalien auf.
Als Ursache ist ein Defekt des Elastin kodierenden Gens nachgewiesen.
Die supravalvuläre Aortenstenose ist häufig mit kardiovaskulären Defekten assoziiert, insbesondere Anomalien der peripheren
Pulmonalarterien, der thorakalen Aorta, der Carotiden, der Aa. subclaviae, der Koronarien und der Aortenklappe. Die Koronararterien
sind einem erhöhten Perfusionsdruck ausgesetzt, was zu deren Dilatation, Schlängelung und beschleunigter Arteriosklerose beiträgt.
Es wird über einen 35-jährigen Patienten berichtet, bei dem eine bisher asymptomatische supravalvuläre Aortenstenose mit einer
exzessiven Dilatation von rechter Koronararterie und Ramus descendens anterior der linken Koronararterie sowie einer Ostiumstenose
der linken A. carotis communis vergesellschaftet ist. Phänotypische Anomalien des Williams-Syndroms fanden sich bei dem Patienten
Supravalvular aortic stenosis is a rare cause of left ventricular outflow obstruction in adults. It occurs as an isolated
defect sporadically or on a hereditary basis with an autosomal dominant trait without further phenotypical anomalies, or as
part of the Williams syndrome with mental retardation and multiple other anomalies. This lesion was proved to result from
a defect of the elastin coding gene.
Supravalvular aortic stenosis is frequently associated with cardiovascular defects, particularly of the peripheral pulmonary
arteries, thoracic aorta, carotid, subclavian, and coronary arteries and the aortic valve. The coronary arteries are subject
to an increased perfusion pressure leading to dilatation, tortuosity and acelerated arteriosclerosis.
We give details of a 35-year-old patient in whom a previously asymptomatic supravalvular aortic stenosis is associated with
an excessive dilatation of the right coronary artery and the left anterior descending coronary artery as well as an ostium
stenosis of the left common carotid artery. The patient did not present any phenotypical anomalies of the Williams syndrome.
Schlüsselwörter Supravalvuläre Aortenstenose – Williams-SyndromKey words Supravalvular aortic stenosis – Williams syndrome
Zeitschrift für Kardiologie 04/2012; 89(3):199-205. · 0.97 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Dysfunction of heart valve prostheses (VP) is a life-threatening complication and the diagnosis remains difficult. The motivation for this study was to improve the detection of dysfunctional VP by optimizing application of the prosthetic effective orifice area (VA). For this reason the minimal expected normal VA (VA(expected)) was introduced.
We investigated echocardiographically 1,369 normally functioning aortic valve prostheses (AVP). Mean VA, transprosthetic peak (PPG) and mean pressure gradients (MPG) were evaluated to gain reference values depending on prosthetic size and construction principle. Mean VA(expected) was calculated by applying a simple formula that was developed empirically using statistical analyses. The results were compared with those of 65 dysfunctional AVPs.
VA(expected) can be applied as a threshold between normal and dysfunctional stenotic AVP and showed a correct estimation in 87% of all normally functioning and 100% of dysfunctional stenotic VPs. The sensitivity for all prosthetic sizes is 1.0, independently of the constructional principle of the VP. Specificity ranged between 0.8 and 1.0, dependent on VP size. The formula representing VA(expected) is simple and can be executed easily.
As nearly independent of stroke volume and in consideration of VA(expected), VA seems to have become one of the preferable parameters for detecting pathological stenotic AVPs echocardiographically. The additional application of PPG/MPG and other parameters permits prostheses with relevant isolated regurgitation and patient-prosthesis-mismatch to be distinguished.
[Show abstract][Hide abstract] ABSTRACT: The Coxsackievirus and Adenovirus Receptor (CAR) is a transmembrane protein of the immunoglobulin superfamily and plays a physiological role in cellular adhesion on various cell types. Moreover, CAR mediates the entry of Coxsackievirus B (CVB) and Adenovirus (Ad) in host cells and is therefore a key determinant for the molecular pathogenesis of viral diseases like myocarditis. A down regulation of CAR expression could potentially affect the virus entry and subsequent the replication. Therefore we investigated in cultured human umbilical vein endothelial cells (HUVEC) whether CAR expression is influenced by the 3‑hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitor Lovastatin and, if so, by which mechanisms. We could demonstrate for the first time that pre-incubation of HUVEC with Lovastatin dose-dependently decreases the mRNA and protein level of CAR resulting in a remarkable reduction of Coxsackievirus B3 replication. Moreover, the signalling mechanism of CAR down regulation by statins depends on the Rac1/Cdc42 pathway. Through the statin-mediated inhibition of G protein isoprenylation Rac1 and Cdc42 remain inactive and the gene expression is therefore down regulated.
In summary, these results indicate potentially beneficial antiviral effects of Lovastatin which could be the basis for a new therapeutic strategy in viral myocarditis.
Herbsttagung und Jahrestagung der Arbeitsgruppe Rhythmologie, Deutsche Gesellschaft für Kardiologie; 10/2011
[Show abstract][Hide abstract] ABSTRACT: There are as yet no data on the prevalence of sleep apnoea in patients with severe aortic stenosis (AS).
To assess the occurrence, severity and clinical correlates of sleep apnoea in patients with AS.
During a 4-month period in 2010, 67 patients were consecutively included in this study, 42 of which (19 men; mean±SD age 72±9 years) had severe AS (aortic valve opening area≤1.0 cm2); all were investigated with cardiorespiratory polygraphy. Sleep apnoea was diagnosed if the apnoea-hypopnoea index (AHI) (median (lower quartile, upper quartile)) was ≥5/h. The control group of 25 patients matched for age, body mass index and sex had angiographic exclusion of coronary artery disease, regular left ventricular ejection fraction, and no valve disease.
Sleep apnoea was found in 30/42 patients with AS (71%; AHI=23/h (14/h, 36/h)). The severity was significantly greater in patients with severe AS than in the control group (AHI=12/h (8/h, 17/h)) (p<0.01). Half of the patients with sleep apnoea had obstructive sleep apnoea (OSA) (AHI=15/h (9/h, 28/h)), and half had central sleep apnoea (CSA) (AHI=25/h (18/h, 45/h)). New York Heart Association classification and severity of sleep apnoea correlated with η=0.5 (η2=0.3). The severity of CSA correlated with pulmonary artery pressure (r=0.7, p<0.01) and pulmonary capillary wedge pressure (r=0.7, p<0.01). Patients with AS and CSA had a lower PCO2 than those with OSA and those without sleep apnoea (p<0.01).
Sleep apnoea is common in patients with severe AS. The severity of CSA correlates with pulmonary hypertension, which may suggest that myocardial adaptation is exhausting.
Postgraduate medical journal 03/2011; 87(1029):458-62. · 1.38 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In viral myocarditis, adeno- and enteroviruses have most commonly been implicated as causes of infection. Both viruses require the human coxsackie-adenovirus receptor (CAR) to infect the myocardium. Due to its crucial role for viral entry, CAR-downregulation may lead to novel approaches for treatment for viral myocarditis. In this study, we report on pharmaceutical drug influences on CAR levels in human umbilical vein endothelial cells (HUVEC) and cervical carcinoma cells (HeLa) detected by immunoblotting, quantitative real time-PCR and cellular susceptibility to the cardiotropic coxsackie-B3 virus strain Nancy (CVB3). Our results indicate, for the first time, a dose-dependent CAR mRNA and protein downregulation upon Valsartan and Bosentan treatment. Most interestingly, drug-induced CAR diminution significantly reduced the viral load in CVB3-infected HUVEC. In order to assess the regulatory effects of both drugs in detail, we knocked down their protein targets, the G-protein coupled receptors angiotensin-II type-1 receptor (AT(1)R) and endothelin-1 type-A and -B receptors (ET(A)R/ET(B)R) in HUVEC. Receptor-specific gene silencing indicates that CAR gene expression is regulated by agonistic and antagonistic binding to ET(B)R, but not ET(A)R. In addition, neither stimulation nor inhibition of AT(1)R seemed to be involved in CAR gene regulatory processes. Our study indicates that Valsartan and Bosentan protected human endothelial cells from CVB3-infection. Therefore, besides their well-known anti-hypertensive effects these drugs may also protect the myocardium and other tissues from coxsackie- and adenoviral infection.
Journal of General Virology 08/2010; 91(Pt 8):1959-70. · 3.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Sleep-disordered breathing (SDB) has a prognostic impact in patients with cardiac diseases. We included 257 patients with preserved left ventricular function and angiographically proven coronary artery disease (CAD). All patients underwent cardiorespiratory polygraphy. In 251 patients high-sensitive C-reactive protein and fibrinogen were measured. SDB was documented in 188 patients (apnea-hypopnea-index [AHI] 16.4+/- 1.9/h): 58 patients presented central sleep apnea (CSA) and 130 patients obstructive sleep apnea (OSA). All patients (73%) with SDB had higher blood fibrinogen levels than those without SDB (p = 0.01). We found 197 patients with CRP-values below the cut-off of 0.5 mg/dl (group 1) and 54 patients with no active infection but CRP>0.5 mg/dl (group 2). Severity of SDB was significantly higher in group 2 (p = 0.01). SDB has a high prevalence in CAD patients and seems to be associated with chronic inflammation, which may be linked to CAD progression and/or acute coronary events.
Wiener Medizinische Wochenschrift 07/2010; 160(13-14):349-55.
[Show abstract][Hide abstract] ABSTRACT: A new diagnostic strategy to improve the detection of pathogens in heart valves (HVs) from patients with infective endocarditis (IE) was evaluated.
Three hundred and fifty seven HVs surgically removed from 326 patients with proven IE or suspicious intra-operative findings, examined by 16S rDNA polymerase chain reaction (PCR) and culture were retrospectively analysed according to the predictive value of various PCR methods. Patients were classified into four categories: active IE, IE with ambiguous infective status, healed IE, and valve diseases but no IE. Retained samples of 200 HVs were analysed by real-time PCR targeting bacterial 23S rDNA, fungal 28S rDNA, and mycoplasmal tuf gene. 16S rDNA PCR revealed 80.6% sensitivity, 100% specificity, 100% positive predictive value, and 71% negative predictive value (NPV), compared with cultivation with 33.4, 96.6, 95.5, and 40.9%, respectively. The use of real-time PCR increased diagnostic sensitivity to 96.4%, and NPV to 92.5%. Bacterial load, C-reactive protein, and white blood cell counts (WBCs) decreased during antibiotic treatment. Bacterial load showed no correlation to C-reactive protein or WBCs, whereas C-reactive protein and WBCs were significantly correlated.
23S rDNA real-time PCR of surgically removed HVs improves the diagnosis of IE. Polymerase chain reaction analysis of explanted HVs allow the optimization of the antimicrobial therapy, especially in patients with culture-negative IE.
European Heart Journal 05/2010; 31(9):1105-13. · 14.10 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Echocardiographic tissue Doppler imaging (TDI) has been proposed as diagnostic tool for the differentiation between constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). The aim of this study was a comprehensive TDI analysis of systolic (S') and early diastolic (E') velocities of the septal and lateral mitral annulus (MA) in patients (pts) with severe diastolic dysfunction caused either by CP or RCM.
Sixty consecutive pts (34 men, mean age 61 +/- 11 years), 34 pts with proven CP and 26 pts with RCM due to cardiac amyloidosis, were included in the study. Forty-two of the 60 pts were in NYHA class III (70%). In pts with RCM systolic longitudinal velocity (S') was significantly decreased when compared to CP (septal MA 4.1 +/- 1.5 vs. 7.3 +/- 2.1 cm/s, p < 0.001; lateral MA 4.3 +/- 1.9 vs. 7.0 +/- 1.9 cm/s, p < 0.001). In addition, the RCM group showed a significantly decreased early diastolic longitudinal velocity (E'), both on the septal (4.1 +/- 1.6 vs. 12.9 +/- 4.9 cm/s, p < 0.001) and lateral side (4.8 +/- 1.9 vs. 11.3 +/- 3.7 cm/s; p < 0.001) of the mitral annulus. ROC analysis demonstrated an area under the curve of 0.889 (S' septal), 0.823 (S' lateral), 0.974 (E' septal), and 0.915 (E' lateral) for the differentiation of RCM and CP with a cutoff value of <8 cm/s. The combined use of an averaged S' cutoff value <8 cm/s as well as an E' cutoff value <8 at the lateral and septal MA demonstrated 93% sensitivity and 88% specificity for the diagnosis of RCM.
TDI provides a diagnostic superiority and an accurate discrimination between RCM and CP by using the combined cutoff value of <8 cm/s for S' and E' at both sides of the MA.
Clinical Research in Cardiology 04/2010; 99(4):207-15. · 3.67 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To detect cardiac amyloidosis (CA) earlier, it is inevitable to improve diagnostic strategies.
The impact of ECG, echocardiography including tissue Doppler imaging (TDI) and strain, and myocardial biopsies was evaluated in 30 patients (63% (n = 19) men, mean age 66 +/- 8 years, NYHA 3.0 +/- 0.5, 73% with prior myocardial decompensation), in whom we proved CA. Amyloid was confirmed by apple-green birefringence under polarised light, and the causing protein by immunohistochemical examinations. Genetic analyses excluded familial CA. All patients (AL-lambda (n = 22), AL-kappa (n = 3), senile amyloidosis (n = 5)) had echocardiographic signs of restrictive cardiomyopathy (RCM), typical TDI and strain parameters (E'septal; E' lateral < 8 cm/s; E/E' > 8; S' < or =9 cm/s; global longitudinal strain (GLS) -7.9 +/- 3.8%). Pericardial effusions were present in 63% of patients. ECGs were suspicious in many patients: 19 (63%) had low-voltage, 23 (77%) reduced R waves in V(1)-V(4), and 57% both. Abnormalities, retrospectively had been present for 0.5-4 years. Twenty (67%) patients died 232 +/- 268 [2-1020] days after CA was diagnosed, but 502 +/- 333 [30-1440] days after the first symptom.
Accurate ECG evaluations, careful echocardiographic search for RCM, reduced strain/strain rates, and general indications to myocardial biopsies with correct analyses are needed to diagnose CA.
Amyloid: the international journal of experimental and clinical investigation: the official journal of the International Society of Amyloidosis 03/2010; 17(1):1-9. · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: History. We report about the course of central sleep apnea (CSA) in 3 patients (70.3 +/- 15.2 years) with severe aortic stenosis (AS) (AVA </= 1.0 cm(2), NYHA 2.7 +/- 1.4). Investigations. Every patient received echocardiography, left/right-heart catheterization, and cardiorespiratory polygraphy before and 6 months after surgical aortic valve replacement (without right-heart catheterization during follow up). Course. Preoperatively all patients demonstrated reduced systolic left ventricular function (EF <55%). They had elevated pulmoraryarterialy pressures and severe CSA. After valve replacement left ventricular function and exercise capacity improved, as well as the severity of CSA. Conclusion. Patients with severe AS can develop CSA, which seems to improve after surgery. Patients with severe AS should be screened for CSA, because CSA might be an additional risk factor and hint that myocardial adaptation is exhausting.
[Show abstract][Hide abstract] ABSTRACT: In octogenarians with symptomatic aortic valve stenosis (AS), aortic valve replacement (AVR) is frequently not performed in due time, because the prognostic benefit is underestimated, while perioperative morbidity and mortality are overestimated. The severely impaired prognosis and quality of life after myocardial decompensation then urges AVR with a significantly increased perioperative risk.
Between 2003 and 2006, all octogenarians with isolated symptomatic AS (indexed aortic valve opening area <0.5 cm2/m2) referred to the authors' unit were prospectively included in the survey. Among the 83 patients enrolled (51 women, 32 men; mean age 84 +/- 5.1 years), 38 patients (26 women, 12 men; mean age 84 +/- 2.3 years) had signs of chronic myocardial decompensation (dilated left ventricle and/or reduced left ventricular function; left ventricular ejection fraction (LVEF) 43 +/- 18% (range: 25-53%). These patients comprised group A. All other patients (group B) had normal left ventricular dimensions, a normal LVEF (>55%), and no clinical episodes of myocardial decompensation. All patients underwent AVR, while 23 (28%) underwent simultaneous coronary revascularization.
In group A, the 30-day mortality rate was 5.3% (n = 2). Octogenarians without chronic myocardial decompensation had a lower 30-day mortality (1/45; 2.2%). The incidences of major postoperative complications (reversible acute renal failure, stroke, mechanical circulatory support) were significantly higher in group A (26.3% versus 8.9%, p < 0.05). During late follow up (mean 24.2 +/- 12.8 months), another four patients in group A (11.1%) and five in group B (11.4%) died. Octogenarians in group B had a significantly (p < 0.01) more favorable cumulative survival rate (87% versus 78% after 24 months; 81% versus 68% after 46 months).
AVR can be performed in octogenarians with a low mortality and morbidity, but should not be postponed. The decision to perform for AVR may take into consideration any life-limiting comorbidities, but should be made independent of the patient's age.
The Journal of heart valve disease 05/2009; 18(3):239-44. · 1.07 Impact Factor