Per Otto Schueller

RWTH Aachen University, Aachen, North Rhine-Westphalia, Germany

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Publications (31)56.32 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Atrial fibrillation (AF) is the most common heart rhythm disorder, with increasing prevalence in the aging population. The clinical presentation and evolution of AF can be highly variable. Therefore, treatment of AF can be challenging in some patients. This review summarizes recent developments in both prevention of thromboembolic events and rate/rhythm control highlighting the possibilities of behavioral, pharmacological, and catheter-based perspectives.
    Praxis 11/2010; 99(22):1343-51.
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    ABSTRACT: Cardiovascular mortality is markedly increased in chronic kidney disease (CKD) and may be explained in part by sympathetic hyperactivity. Impaired hyperoxic chemoreflex sensitivity (CHRS) has been attributed to an increased sympathetic tone. The aim of the present study was to examine whether chemosensor function is altered in patients with CKD. We assessed CHRS in 20 patients with stage 3 CKD [glomerular filtration rate (GFR) 30-59 ml/min/1.73 m(2)], in 15 patients with stage 4 CKD [GFR 15-29 ml/min/1.73 m(2)], as well as in 35 age and gender matched patients without any evidence of CKD. The difference in the R-R intervals divided by the difference in the oxygen pressures before and after deactivation of the chemoreceptors by inhalation of pure oxygen was calculated as the CHRS. A CHRS below 3.0 ms/mmHg was defined as pathological. CHRS was significantly depressed in patients with stage 3 CKD (2.9 ± 0.9 ms/mmHg, P=0.005) and in patients with stage 4 CKD (2.1 ± 0.6 ms/mmHg, P<0.001), as compared with patients without CKD (6.7 ± 0.9 ms/mmHg). There was a negative correlation between serum creatinine and CHRS (r=-0.51; P<0.001). In patients with CKD, chemosensor deactivation decreased mean arterial pressure from 91 ± 4 mmHg to 87 ± 3 mmHg (P=0.03). Multivariate analysis showed that GFR (P=0.001) was the only independent predictor of a pathological CHRS. Using a relatively non-invasive bedside test we provide evidence for a blunted peripheral chemosensor function in chronic kidney disease. We thereby lay the basis for interventional studies assessing chemosensor function in chronic kidney disease.
    International journal of cardiology 10/2010; 155(2):201-5. · 6.18 Impact Factor
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    ABSTRACT: Growing evidence suggests that there may be a strong pathophysiologic link between congestive heart failure (CHF) and nocturnal breathing disorders due to nocturnal oxygen desaturation, intrathoracic pressure swings and sympathetic activation. It seems that sleep apnea contributes to systolic and diastolic heart failure, reduced left and right ventricular function and arrhythmia (e.g. atrial fibrillation). Therefore treatment of sleep apnea might alleviate cardiac symptoms and improve cardiac function. Nevertheless, the exact role of long term treatment of sleep apnea in heart failure patients remains to be elucidated.
    Panminerva medica 03/2010; 52(1):79-89. · 2.28 Impact Factor
  • P Schueller, J Winter, M Kelm, S Steiner
    Pneumologie 01/2010; 64.
  • Pneumologie 01/2010; 64.
  • S Steiner, V Schulze, PO Schüller
    Pneumologie 01/2010; 64.
  • P Schüller, T Zeus, M Kelm, S Steiner
    Pneumologie 01/2010; 64.
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    ABSTRACT: Autonomic neuropathy is common in patients suffering from end-stage renal disease (ESRD). This may in part explain the high cardiovascular mortality in these patients. Chemosensory function is involved in autonomic cardiovascular control and is mechanistically linked to the sympathetic tone. The aim of the present study was to assess whether sympathetic hyperactivity contributes to an altered chemosensory function in ESRD. In a randomized, double-masked, placebo controlled crossover design we studied the impact of chemosensory deactivation on heart rate, blood pressure and oxygen saturation in 10 ESRD patients and 10 age and gender matched controls. The difference in the R-R intervals divided by the difference in the oxygen pressures before and after deactivation of the chemoreceptors by 5-min inhalation of 7 L oxygen was calculated as the hyperoxic chemoreflex sensitivity (CHRS). Placebo consisted of breathing room air. Baseline sympathetic activity was characterized by plasma catecholamine levels and 24-h time-domain heart rate variability (HRV) parameters. Plasma norepinephrine levels were increased (1.6 +/- 0.4 vs. 5.8 +/- 0.6; P<0.05) while the SDNN (standard deviation of all normal R-R intervals: 126.4 +/- 19 vs. 100.2 +/- 12 ms), the RMSSD (square root of the mean of the squared differences between adjacent normal R-R intervals: 27.1 +/- 8 vs. 15.7 +/- 2 ms), and the 24-h triangular index (33.6 +/- 4 vs. 25.7 +/- 3; each P<0.05) were decreased in ESRD patients as compared to controls. CHRS was impaired in ESRD patients (2.9 +/- 0.9 ms/mmHg, P<0.05) as compared to controls (7.9 +/- 1.4 ms/mmHg). On multiple regression analysis 24 h-Triangular index, RMSSD, and plasma norepinephrine levels were independent predictors of an impaired hyperoxic CHRS. Sympathetic hyperactivity influences chemosensory function in ESRD resulting in an impaired hyperoxic CHRS.
    European journal of medical research 12/2009; 14 Suppl 4:151-5. · 1.10 Impact Factor
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    ABSTRACT: The occurrence of ventricular arrhythmias in patients with idiopathic dilated cardiomyopathy (DCM) who are treated with an implantable cardioverter-defibrillator (ICD) for primary or secondary prevention is not fully understood. In this nonrandomized, two-centre, observational study we analyzed the occurrence of ventricular arrhythmias in a total of 105 DCM patients (age, 53 +/- 13 years) treated with an ICD. Fifty-one patients with a left ventricular ejection fraction <or= 35% did not have prior sustained ventricular arrhythmias (primary prevention). The secondary prevention group consisted of 54 patients with documented sustained ventricular tachycardia (n = 25) or aborted sudden cardiac death (n = 29). During 32 +/- 7 months follow-up the number of patients with appropriate defibrillator therapies (n = 51) was comparable between the two groups (HR 0.79, 95% CI 0.454 to 1.361, P = 0.389). Importantly, less primary prevention patients experienced appropriate ICD shocks for any arrhythmic event (HR 0.35, 95% CI 0.186 to 0.777, P = 0.008), as well as appropriate ICD shocks for ventricular fibrillation (HR 0.31, 95% CI 0.167 to 0.737, P = 0.006). In contrast, antitachycardia pacing was more often observed in the primary prevention group (HR 2.75, 95% CI 1.031 to 6.238, P = 0.043). Two primary prevention and 6 secondary prevention patients received multiple ICD therapies in consequence of incessant ventricular tachycardia. The characteristics of ventricular arrhythmias in patients with DCM who are treated with an ICD for primary or secondary prevention vary according to the underlying indication. Therefore, different device programming according to the patient's history might improve ventricular tachyarrhythmia management.
    International Heart Journal 11/2009; 50(6):741-51. · 1.23 Impact Factor
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    ABSTRACT: Obstructive sleep apnea (OSA) is thought to act as a coronary risk factor. There is emerging evidence that intermittent phases of hypoxia might contribute to alterations of the cardiovascular system. We hypothesized that OSA syndrome (OSAS) might be accompanied by an increased coronary collateral vessel (CCV) development in patients with total coronary occlusion. Thirty-four patients with total coronary occlusions were classified according to the apnea-hypopnea index (AHI) (OSAS: AHI > 10/h; non-OSAS: AHI < 10/h). CCVs were scored by visual analysis and were analyzed according to the Cohen and Rentrop grading system. There was no significant discrepancy between the groups concerning the prevalence of age, gender, the presence of hypertension, smoking, or diabetes mellitus. There was no difference in left ventricular systolic function (ejection fraction 53% +/- 20% vs 61% +/- 20%, P = .29) or left ventricular end-diastolic pressure (22.6 +/- 8.5 mm Hg vs 18.5 +/- 7.7 mm Hg, P = .41). OSAS showed a higher Rentrop score compared with non-OSAS (1.61 +/- 1.2 vs 2.4 +/- 0.7, P = .02). These findings suggest that CCV development is augmented in patients with OSA.
    Chest 10/2009; 137(3):516-20. · 7.13 Impact Factor
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    ABSTRACT: The aim of the present study was to determine whether regular exercise training (ET) is effective at promoting the mobilization of CPCs and improving their functional activity in patients with recently acquired myocardial infarction (STEMI). Regular physical training has been shown to improve myocardial perfusion and cardiovascular function. This may be related in part to a mobilization of bone marrow-derived circulating progenitor cells (CPCs) as well as an enhanced vascularisation. 37 patients with STEMI were randomly assigned to an ET group or a non-ET group (controls). Two weeks after STEMI, three weeks after regular ET and three months after ET, BNP levels, exercise echocardiography and exercise spiroergometry were evaluated. The number of CD34+/CD45+ and CD133+/CD45+ CPCs was measured by flow cytometry analysis. The migration capacity of the CPCs was determined with a boyden chamber and the clonogenic capacity by CFU-assay. In the ET-group the number and migration capacity of CPCs increased significantly after regular exercise training. The BNP level decreased significantly from 121 +/- 94 to 75 +/- 47 pg/ml (p<0.001) after the ET period, the left ventricular ejection fraction raised in parallel at peak exercise, and the cardiorespiratory condition improved as demonstrated by an increase of VO2max (from 1641 +/- 522 to 1842 +/- 724 ml/min, p<0.02). These three effects persist till three months after the ET period. Regular physical activity appears to predispose the mobilization and enhanced functional activity of CPCs, a phenomenon which might lead to an improved cardiac function in patients with recently acquired acute myocardial infarction.
    European journal of medical research 09/2009; 14(9):393-405. · 1.10 Impact Factor
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    ABSTRACT: Atrial fibrillation is the arrhythmia that most frequently leads to hospital admission. As prevalence of atrial fibrillation increases with age, its epidemiological relevance will increase due to the well-known changes in life expectancy. In the presence of atrial fibrillation the cardiovascular mortality and the risk for a stroke are considerably elevated. Interventional treatment, such as catheter ablation or special pacemaker algorithms, have been improved extensively in the last years as a therapeutic option. Nevertheless drug therapy is still the first choice of treating atrial fibrillation.
    Medizinische Monatsschrift für Pharmazeuten 07/2009; 32(6):204-10; quiz 211-2.
  • International Heart Journal - INT HEART J. 01/2009; 50(6):741-751.
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    ABSTRACT: Chemoreflexes are important mechanisms for regulating ventilatory and cardiovascular function. The aim of this study was to determine the meaning of autonomic dysfunction for the pathophysiology and outcome in critical ill patients. For the determination of the chemoreflex sensitivity (ChRS), the ratio of the RR interval shift and the shift of oxygen partial pressure during a 5-min inhalation of oxygen with a nose mask was formed. Pathological chemoreflex sensitivity was predefined as a ChRS below 3.0 ms/mmHg. Out of the 27 critical ill patients included into the study, 17 had a sepsis and 10 a cardiogenic shock. In these patients, chemoreflex sensitivity was significantly reduced compared with a control group (sepsis: 2.1 +/- 1.68, cardiogenic shock: 0.4 +/- 0.27, controls: 5.0 +/- 2.8 ms/mmHg; P<0.05 vs. sepsis or cardiogenic shock). There was a significant negative correlation (r=-0.6; P<0.01) between the chemoreflex sensitivity and the severity of illness described by the SOFA-score. We conclude that cardiac reflex mechanisms are changed toward increased sympathetic activity reflected by reduced chemoreflex sensitivity in critical ill patients. Moreover, there is a close negative correlation between the ChRS and the SOFA-score.
    Journal of physiology and pharmacology: an official journal of the Polish Physiological Society 12/2008; 59 Suppl 6:623-7. · 2.48 Impact Factor
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    ABSTRACT: Bradycardia is a common finding in patients with obstructive sleep apnea and might be pronounced in heart failure patients. The aim of the present study was to determine the relationship between nocturnal hypoxemia, apnea-hypopnea index, and electrophysiological parameters of sinus node and atrioventricular conduction properties. Electrophysiological studies were performed in 12 patients with heart failure. Polygraphic studies were done in all of the patients. Patients with an AHI >10/h were classified as sleep apnea patients. Mild sleep apnea was diagnosed in 50% of the patients (AHI 17.8 +/- 4.4 vs. 5.1 +/- 3.6/h). There were no differences with respect to the resting heart rate, PQ interval, or QRS duration between the two groups. Sinus node recovery time was normal in all of the patients (993 +/-291 vs. 1099 +/-62 ms, P=0.45). There was no abnormal atrioventricular conduction. Nevertheless, sleep apnea patients showed decreased atrioventricular conduction time (AH) intervals (134 +/- 42 vs. 102 +/- 25 ms, P=0.1) and infranodal conduction time (HV) intervals (59 +/- 9 vs. 43 +/- 7 ms, P=0.01). We conclude that mild sleep apnea was not associated with abnormal findings in sinus node function or AV conduction properties in patients with heart failure. Decreased AH/HV intervals might be a consequence of apnea associated sympathetic activation.
    Journal of physiology and pharmacology: an official journal of the Polish Physiological Society 12/2008; 59 Suppl 6:669-74. · 2.48 Impact Factor
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    ABSTRACT: At least half of patients with heart failure (HF) suffer from sleep apnea. Growing evidence suggests that there may be a strong pathophysiological link between chronic HF and sleep apnea due to nocturnal oxygen desaturation and sympathetic activation. It seems that sleep apnea contributes to systolic and diastolic HF, reduced left and right ventricular function, and arrhythmia (e.g. atrial fibrillation, bradycardia, or ventricular ectopy). Therefore, treatment of sleep apnea might alleviate cardiac symptoms and improve cardiac function. Nevertheless, the exact role of long-term treatment of sleep apnea in HF patients remains to be elucidated, as important clinical endpoints (e.g mortality) have been assessed in only a few studies. Heart Fail Monit 2008;5(4):106-11.
    Heart failure monitor 02/2008; 5(4):106-11.
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    ABSTRACT: There is growing evidence that obstructive sleep apnea is associated with coronary artery disease. However, there are no data on the course of coronary stenosis after percutaneous coronary intervention in patients with obstructive sleep apnea. To determine whether sleep apnea is associated with increased late lumen loss and restenosis after percutaneous coronary intervention. 78 patients with coronary artery disease who underwent elective percutaneous coronary intervention were divided in 2 groups: 43 patients with an apnea hypopnea - Index < 10/h (group I) and 35 pt. with obstructive sleep apnea and an AHI > 10/h (group II). Late lumen loss, a marker of restenosis, was determined using quantitative coronary angiography after 6.9 +/- 3.1 months. Angiographic restenosis (>50% luminal diameter), was present in 6 (14%) of group I and in 9 (25%) of group II (p = 0.11). Late lumen loss was significant higher in pt. with an AHI > 10/h (0.7 +/- 0.69 mm vs. 0.38 +/- 0.37 mm, p = 0.01). Among these 35 patients, 21(60%) used their CPAP devices regularly. There was a marginally lower late lumen loss in treated patients, nevertheless, this difference did not reach statistical significance (0.57 +/- 0.47 mm vs. 0.99 +/- 0.86 mm, p = 0.08). There was no difference in late lumen loss between treated patients and the group I (p = 0.206). In summary, patients with OSA and coronary artery disease have a higher degree of late lumen loss, which is a marker of restenosis and vessel remodeling after elective percutaneous intervention.
    Respiratory research 01/2008; 9:50. · 3.64 Impact Factor
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    ABSTRACT: Severe pulmonary hypertension (PAH) leads to right ventricular dysfunction and is associated with different atrial arrhythmias. In PAH patients, the echocardiographic Tei-index is used for monitoring right heart function. The P-wave signal-averaged ECG (SA-ECG) has been shown to have a potential role in identifying patients at risk of developing paroxysmal atrial fibrillation and those likely to change from paroxysmal to chronic atrial fibrillation. The aim of the present study was to define the correlation of the Tei-Index with parameters of P-wave triggered and bidirectional P-wave SA-ECG. A total of 18 patients (14 men, 4 women) with normal sinus rhythm and a mean age of 67+/-10 years (BMI 27.6+/-5.1 kg/m2) were included into the study. Right ventricular (RV) Tei-index was calculated from the sum of isovolumetric contraction time and relaxation time divided by ejection time. Furthermore, P-wave triggered P-wave signal averaged ECG was performed from an X, Y, and Z lead system. The results show that there was a statistically significant correlation between Tei-index and filtered P-wave duration (r=0.53; P=0.023). Teiindex did not correlate with the root mean square voltage of the last 20 ms of the P wave (r=-0.16; P=0.52). In conclusion, a correlation of RV Tei index with P-wave duration indicates that this echocardiographic measurement is not only a marker of right heart function, but also an indicator of electrical instability that could be useful to detect patients at risk for atrial arrhythmias.
    Journal of physiology and pharmacology: an official journal of the Polish Physiological Society 12/2007; 58 Suppl 5(Pt 2):627-32. · 2.48 Impact Factor
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    ABSTRACT: Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnea. It is known, that there are beneficial effects on cardiac function, which might be explained by suppression of apnea and specific hemodynamic effects of CPAP. Therefore, CPAP might act as an adjunct therapy in heart failure, even in the absence of sleep apnea. In the present study, 11 patients with congestive heart failure (EF=23.1+/-6.9%) without sleep apnea (AHI 3.0+/-1.2/h) were treated with nocturnal CPAP. Cardiopulmonary exercise testing was performed at baseline and after 8.6 +/-1.3 months. All patients underwent heart catheterization and myocardial biopsy to exclude myocarditis at baseline. Five (46%) of the 11 patients did not complete the study because of poor compliance and irregular use of the CPAP device. Six (54%) of the patients used CPAP regularly (>6 h/night) and completed the study. Cardiopulmonary exercise testing showed an improvement of work load (96+/-36 Watt vs. 112+/-34 Watt; P=0.025) and VO2 peak (1227+/-443 ml vs. 1525+/-470 ml; P=0.01). Oxygen-pulse was increased, although that did not reach significance (11.2+/-4.8 ml/beat vs. 12.6+/-3.9 ml/beat). In conclusion, CPAP might have beneficial effects on exercise capacity in patients with congestive heart failure even in the absence of sleep apnea. Nevertheless, poor compliance seems to be a limiting factor.
    Journal of physiology and pharmacology: an official journal of the Polish Physiological Society 12/2007; 58 Suppl 5(Pt 2):665-72. · 2.48 Impact Factor
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    ABSTRACT: With reference to the EU-Council Directive (1999/30/EC) a discussion in the European Union between basic science, epidemiologic knowledge, and regulatory policies has become of growing public interest. The consequences following particulate matter (PM) exposure on the cardiovascular system, are actually not fully understood. This work reviews latest developments as regards the realization of the mentioned Council Directive and emphasizes the cardiovascular health impairment in this context. PM is assumed to increase the risk for arrhythmia, ischemic cardiovascular events, and worsens heart failure. The importance of the risk factor PM is due to the number of people who are affected, if consequent actions for air pollution prevention are not adequately transposed. Health-care providers can protect especially patients at high risk by informing them about behavior modification to prevent PM exposure and its possible consequences. To promote public health on the health-policy level, several action plans have been established. Forthcoming challenge for PM-associated cardiovascular health promotion remains an interdisciplinary approach to create synergistic effects of several sanctions, which primarily concerns scientific and political decision makers and public consciousness. In conclusion, further investigations are necessary to deepen the understanding of PM exposure and its consequences for the cardiovascular system and evaluate the success of preventive strategies.
    Medizinische Klinik 12/2007; 102(11):899-903. · 0.34 Impact Factor

Publication Stats

159 Citations
56.32 Total Impact Points

Institutions

  • 2010
    • RWTH Aachen University
      Aachen, North Rhine-Westphalia, Germany
  • 2006–2009
    • Heinrich-Heine-Universität Düsseldorf
      • • Klinik für Kardiologie, Pneumologie und Angiologie
      • • Medizinische Fakultät
      Düsseldorf, North Rhine-Westphalia, Germany
  • 2007–2008
    • Universitätsklinikum Düsseldorf
      • Klinik für Kardiologie, Pneumologie und Angiologie
      Düsseldorf, North Rhine-Westphalia, Germany