H Ince

University of Rostock, Rostock, Mecklenburg-Vorpommern, Germany

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Publications (64)79.22 Total impact

  • [show abstract] [hide abstract]
    ABSTRACT: In this study, we present and discuss our institutionalized and standardized computed tomography (CT) morphological criteria for the treatment of patients with a PARACHUTE device. After clinical and echocardiographic screening of 79 patients with ischemic heart failure, 28 were examined with multidetector computed tomography (MDCT) to assess their suitability for treatment with a PARACHUTE implant. From the 28 examined patients, 9 were suitable for parachute implantation. Within the group of excluded patients, the cardiac diameters of one-third of the patients were too large, whereas for another third they were too small. Approximately 20% of the patients were rejected because of a deep insertion of the papillary muscles. Further reasons included left ventricular bands as well as mismatches between CT and echocardiographic measurements of left ventricular ejection fraction (EF). To ensure a safe PARACHUTE device implantation in patients with ischemic heart failure, only the CT at present offers the capability to obtain complete and dynamic three-dimensional (3D) measurements of the cardiac dimensions. This article is protected by copyright. All rights reserved.
    Cardiovascular Therapeutics 11/2013; · 2.85 Impact Factor
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    ABSTRACT: Considering the demographic changes in our society and the proliferation of imaging-based improved diagnostics, both acute and chronic aortic diseases attract increasing attention and require dedicated care. Cardiac as well as vascular surgery used to represent the gold standards for therapeutic management of pathologies of the ascending aorta and the arch; however, the technological evolution of endoluminal strategies has had a serious impact on the treatment of the descending aorta, the aortic arch in combination with vascular debranching or bypass, and in selected cases even on managing pathologies of the ascending aorta. Although several case series and meta-analyses of published observations hint towards superiority of endografting in comparison to open surgical repair, the affected usually multimorbid patients with highly complex aortic disease should be subjected to an individual evaluation by a team of cardiologists, cardiac and vascular surgeons as well as imaging specialists; a dedicated individualized treatment concept in highly experienced centers of excellence is likely to provide the best results for such challenging patients.
    Der Internist 04/2013; · 0.33 Impact Factor
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    ABSTRACT: BACKGROUND: A novel percutaneous ventricular restoration therapy (PVRT) has been recently proposed to treat patients with ischemic heart failure (IHF) and antero-apical regional wall motion abnormalities after myocardial infarction (MI). In this a prospective, single center, non-randomized study we herein propose safety and feasibility evaluation of the device, in which a different patient selection strategy was used MATERIAL AND METHODS: A three-stage evaluation was adopted in a series of patients referred for a Parachute Ventricular Partitioning Device (Parachute(TM) ). After an initial clinical evaluation, a secondary screening step was performed according to echocardiographic functional (LVEF<40%, apical/anterior akinesia/dyskinesia) and anatomical criteria (diameter of LV-apex (LVAD) =4.0x5.0cm, left ventricular end diastolic diameter (LVEDD)>56mm, left ventricular end systolic diameter (LVESD)>38mm). Patients encountering the echocardiographic criteria were selected for 3D cardiac CT (architecture, geometry and trabeculation of the left ventricle) and eventually treated with the Parachute(TM) . Fifty patients were screened according to the echocardiographic criteria. Twenty-seven of those that met the echo inclusion criteria underwent further cardiac CT imaging. After CT imaging, 8 patients were scheduled for Parachute(TM) implantation. The device was successfully implanted in all 8 patients with no in-hospital mortality. A 3-month follow-up echocardiography showed LV-volume reduction (95% CI; LVEDV: -76.5 (-116; -36.8), p=0.002 and LVESV: -47.4 (-63.8; -30.9), p=0.003) and improvement of global EF (95% CI; global EF: 6,87 (5,36; 8,39), p=0.008). CONCLUSION: Selection criteria for Parachute™ placement should include left ventricular functional and anatomical parameters. When preprocedural echocardiography and cardiac CT are adequately implemented, satisfactory periprocedural and short term follow-up results may be achieved after Parachute(TM) implantation. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 04/2013; · 2.51 Impact Factor
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    International journal of cardiology 07/2012; · 7.08 Impact Factor
  • Clinical Research in Cardiology 06/2012; · 3.67 Impact Factor
  • Clinical Research in Cardiology 03/2012; 101(10):847-9. · 3.67 Impact Factor
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    ABSTRACT: Left ventricular hypertrophy, dehydration, sepsis, vasodilatation, excessive sympathetic stimulation, pericardial tamponade and surgical treatment of the atrioventricular valve are known causes of left ventricular outflow tract (LVOT) obstruction. We report the rare case of a patient who developed dynamic LVOT obstruction as a complication of acute pulmonary embolism.
    Der Internist 03/2012; 53(6):751-5. · 0.33 Impact Factor
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    ABSTRACT: Acute aortic syndrome (AAS) is a modern term to describe interrelated emergency aortic conditions with similar clinical characteristics and challenges. These conditions include aortic dissection, intramural hematoma (IMH), and penetrating aortic ulcer (PAU). Population-based studies suggest that the incidence of aortic dissection ranges from 2.6-3.5 cases per 100,000 person/year; hypertension and a variety of genetic disorders with altered connective tissue are the most prevalent risk conditions. One in eight patients diagnosed with acute aortic dissection has either an IMH or a PAU. Pain is the most commonly presenting symptom of acute aortic syndrome and should prompt immediate attention including diagnostic imaging modalities (such as multislice computed tomography, transesophageal ultrasound, or magnetic resonance imaging). IMH and PAU need a specific therapeutic approach, because without treatment they have a very poor evolution, are unpredictable and can be worse than acute aortic dissection. All patients must receive the best medical treatment available at admission. High-risk but asymptomatic patients with IMH and PAU can probably be followed-up without intervention. All symptomatic patients will need treatment. In many of these patients, a direct surgical approach is often prohibitive, due to age and multiple comorbidities. Endovascular treatment offers superior results and is becoming a recognized indication for patients. Irrespective of treatment modality, a close follow-up is mandatory in order to detect disease progression.
    The Journal of cardiovascular surgery 02/2012; 53(1 Suppl 1):83-90. · 1.51 Impact Factor
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    ABSTRACT: Transcatheter aortic valve implantation (TAVI) has been developed to minimize operative morbidity and mortality in high-risk symptomatic patients unfit for open surgery. With the proximity of the aortic valve annulus to the conduction system there is, however, an unknown risk of conduction disturbances necessitating monitoring and often cardiac pacing. We enrolled 50 consecutive patients from January 2007 to 2008 in our prospective evaluation of conduction disturbances measured by surface and intracardiac ECG recordings. Baseline parameters, procedural characteristics as well as twelve-lead surface ECG and intracardiac conduction times were revealed pre-interventionally, after TAVI and at 7-day follow-up. TAVI was performed successfully in all patients. During 7 days of follow-up the rate for first-degree AV block raised from 14% at baseline to 44% at day 7 (p < 0.001), while rates for type II second- and third-degree were 0 versus 8% (p < 0.001) and 0 versus 12% (p < 0.001), respectively. Similarly, the prevalence of new left bundle branch block (LBBB) rose from 2 to 54% (p < 0.001). Intracardiac measurements revealed a prolongation of both AH and HV interval from 123.7 ± 41.6 to 136.6 ± 40.5 ms (p < 0.001) and from 54.8 ± 11.7 to 71.4 ± 20.0 ms (p < 0.001), respectively. Pacemaker implantation at a mean follow-up of 4.8 ± 1.2 days was subsequently performed in 23 patients (46%) due to complete AV block (12%) and type II second-degree AV block (8%) while another 13 patients (26%) received a pacemaker for the combination of new LBBB with marked HV prolongation. The high rate of first-degree AV block was primarily driven by an increase in HV interval. Cardiac conduction disturbances were common in the early experience with CoreValve implantation necessitating close surveillance for at least 1 week.
    Clinical Research in Cardiology 12/2011; 101(5):357-64. · 3.67 Impact Factor
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    ABSTRACT: Current approaches to coronary artery disease (CAD) and acute myocardial infarction (MI) may not be well represented in most primary prevention trials of sudden cardiac death (SCD). The contemporary and ongoing registry of the Rostock infarction network (Drip & Ship) represents a well-defined cohort of patients subjected to percutaneous coronary intervention (PCI) for ST-elevation infarction (STEMI) and served as the database for both candidates for an ICD for primary prevention of SCD and for sudden death (SCD) or ventricular tachycardia (VT) during follow-up. A total of 855 consecutive patients were treated with PCI for STEMI or NSTEMI in the region of Rostock (Germany) between 2001 and 2004. While all cause mortality was still 17.2%, the SCD rate was low at 1.3% during 728 ± 366 days of follow-up. Within that time 85 patients (9.9%) developed an indication for ICD therapy due to an impaired LV function (LVEF ≤ 35%) and heart failure. Univariate predictors of an ICD indication were delayed reperfusion (p = 0.001), a high creatine kinase (CK) max (p = 0.009), a persistent wide QRS complex (p = 0.001), previous cerebrovascular events (p = 0.033), and chronic renal failure (p = 0. 001). However, only 16.5% of these patients qualifying for an ICD actually received an ICD; nevertheless, the actual SCD rate was only 3.5%, while 5.4% (46 patients) suffered VTs or ventricular fibrillation (VF). The SCD/VT rate in the entire infarct population was associated with time to reperfusion (0.032), left bundle-branch block (0.002), a longer history of CAD (0.032), and VT during follow-up. While mortality in patients with STEMI is still alarming even with PCI, the risk of SCD may be considerably decreased even in patients with an LVEF below 35%. With the current approach to primary prevention of sudden cardiac death, approximately 10% of postinfarction patients qualify for ICD therapy; however this may only reach a quarter of patients prone to SCD.
    Herzschrittmachertherapie & Elektrophysiologie 11/2011; 22(4):243-8.
  • Clinical Research in Cardiology 11/2011; 101(1):69-71. · 3.67 Impact Factor
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    ABSTRACT: There is ongoing development of new therapeutic regimens in the use of antithrombotic agents and anticoagulants focussing on acute coronary syndrome (ACS) with an increasing impact on current guidelines over the last years. This was especially accompanied by an increase in innovative percutaneous coronary interventional (PCI) methods in patients with ACS, non-ST-segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI) with a need for therapeutics with more sufficient and effective antiplatelet action. On the other hand, newer direct and indirect thrombin inhibitors with primary use in prevention and therapy of thromboembolic events have been shown to have beneficial and even superior effects in ACS with or without PCI. The current review aims to report on the evidence-based use of approved antithrombotic agents and anticoagulants in ACS with special focus on PCI according to the actualized European guidelines.
    Der Internist 09/2011; 52(11):1292-300. · 0.33 Impact Factor
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    ABSTRACT: Chronic as well as acute diseases of the thoracic aorta are attracting increasing attention, both in the light of an ageing Western and Oriental population and with the proliferation of modern diagnostic imaging modalities. While classic surgical strategies still dominate the treatment of pathology of the ascending aorta and the proximal arch region, new endovascular concepts are emerging and are likely to evolve as primary treatment strategies for descending and abdominal aortic pathology. Additionally, aortic arch pathologies are becoming the target of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in an attempt to improve outcome by avoiding the high risk of open arch repair or complete replacement. Nonetheless, due to the complexity of the underlying vascular disease, each patient should be discussed in a team consisting of cardiologists, cardiac surgeons, and an imaging specialist in order to design an individualized therapeutic strategy carried out best in a center with experience in both endovascular and surgical procedures.
    Herz 09/2011; 36(6):539-47. · 0.78 Impact Factor
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    ABSTRACT: Autologous bone marrow cell transplantation (BMCs-Tx) is a promising novel option for treatment of cardiovascular disease. We analysed in a randomized controlled study the influence of the intracoronary autologous freshly isolated BMCs-Tx on the mobilization of bone marrow-derived circulating progenitor cells (BM-CPCs) in patients with acute myocardial infarction (AMI). Sixty-two patients with AMI were randomized to either freshly isolated BMCs-Tx or to a control group without cell therapy. Peripheral blood (PB) concentrations of CD34/45(+) - and CD133/45(+)-circulating progenitor cells were measured by flow cytometry in 42 AMI patients with cell therapy as well as in 20 AMI patients without cell therapy as a control group on days 1, 3, 5, 7, 8 and 3, 6 as well as 12 months after AMI. Global ejection fraction (EF) and the size of infarct area were determined by left ventriculography. We observed in patients with freshly isolated BMCs-Tx at 3 and 12 months follow up a significant reduction of infarct size and increase of global EF as well as infarct wall movement velocity. The mobilization of CD34/45(+) and CD133/45(+) BM-CPCs significantly increased with a peak on day 7 as compared to baseline after AMI in both groups (CD34/45(+): P < 0.001, CD133/45(+): P < 0.001). Moreover, this significant mobilization of BM-CPCs existed 3, 6 and 12 months after cell therapy compared to day 1 after AMI. In control group, there were no significant differences of CD34/45(+) and CD133/45(+) BM-CPCs mobilization between day 1 and 3, 6 and 12 months after AMI. Intracoronary transplantation of autologous freshly isolated BMCs by use of point of care system in patients with AMI may enhance and prolong the mobilization of CD34/45(+) and CD133/45(+) BM-CPCs in PB and this might increase the regenerative potency after AMI.
    Journal of Cellular and Molecular Medicine 06/2011; 16(4):852-64. · 4.75 Impact Factor
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    ABSTRACT: Drug-eluting stents (DES) have revolutionized the treatment of coronary artery disease by reducing the rate of in-stent restenosis from 20-40% with bare-metal stent (BMS) to 6-8% with DES. However, with widespread use of DES, safety concerns have risen due to the observation of late stent thrombosis. With this in mind and better understanding of mechanism and pathophysiology of stent thrombosis, the technological platform, especially innovative anti-restenotic agents, polymeric coatings, and stent platforms, improved with newer DES. Two second-generation DES, the Endeavor zotarolimus-eluting stent (ZES) and the Xience-V everolimus-eluting stent (EES), have provided promising results in both randomized controlled trials (SPIRIT and ENDEAVOR) and registries (E-Five, COMPARE) compared with bare-metal stents (BMS) and first-generation DES. Newer third-generation stent technology, especially biodegradable polymers, polymer-free stents, and biodegradable stents on the basis of poly-L-lactide (PLLA) or magnesium, has been evaluated in preclinical and initial clinical trials. However, despite encouraging initial results, long-term data of large-scale randomized trials as well as registries comparing them to currently approved first- and second-generation DES are still lacking.
    Herz 05/2011; 36(3):190-6. · 0.78 Impact Factor
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    ABSTRACT: In den Therapieschemata zur Thrombozytenaggregationshemmung und Antikoagulation beim akuten Koronarsyndrom (ACS) kam es in den vergangenen Jahren zur Einführung einiger neuer Substanzen, die bereits in verstärktem Ausmaß Eingang in die aktuellen Leitlinien gefunden haben. Diese Entwicklung hat sich insbesondere auf dem Gebiet der Antiaggregation bei Patienten mit ACS, Nicht-ST-Hebungs-Myokardinfarkten (NSTEMI) und mit ST-Hebungs-Myokardinfarkten (STEMI) parallel mit der Ausweitung des Spektrums der Koronarinterventionen vollzogen. Auf der anderen Seite hat der Wunsch nach einem besseren und effizienteren Management der Antikoagulation in der Thombembolieprophylaxe und -therapie zur Entwicklung von neueren Substanzen auf dem Gebiet der direkten und indirekten Thrombinhemmung geführt. Hier ist eine vielversprechende Erweiterung ihres Einsatzspektrums bei ACS-Patienten mit oder ohne perkutane Koronarintervention (PCI) erfolgt. Die vorliegende Übersichtsarbeit stellt ausgehend von den Substanzklassen und dem Wirkmechanismus anhand der Studienlage die Einsatzgebiete der zugelassenen Präparate vor. Hierbei wird deren Rolle beim ACS mit Betonung auf dem Aspekt der PCI in Anlehnung an die kürzlich erschienenen aktuellen europäischen Leitlinien (Wijns et al., Eur Heart J 2010;31:2501–2555) diskutiert. Aufgrund ihres vornehmlichen Einsatzes im Herzkatheterlabor wird in diesem Rahmen auf eine separate Darstellung der Glykoprotein(GP)-IIb/IIIa-Inhibitoren verzichtet. Eine „Hands-on“-Sektion gibt abschließend zu jedem Präparat einen praxisnahen Einsatzleitfaden. There is ongoing development of new therapeutic regimens in the use of antithrombotic agents and anticoagulants focussing on acute coronary syndrome (ACS) with an increasing impact on current guidelines over the last years. This was especially accompanied by an increase in innovative percutaneous coronary interventional (PCI) methods in patients with ACS, non-ST-segment elevation myocardial infarction (NSTEMI) or ST-segment elevation myocardial infarction (STEMI) with a need for therapeutics with more sufficient and effective antiplatelet action. On the other hand, newer direct and indirect thrombin inhibitors with primary use in prevention and therapy of thromboembolic events have been shown to have beneficial and even superior effects in ACS with or without PCI. The current review aims to report on the evidence-based use of approved antithrombotic agents and anticoagulants in ACS with special focus on PCI according to the actualized European guidelines (Wijns et al., Eur Heart J 2010;31:2501–2555). SchlüsselwörterMyokardischämie–Antithrombozytenagenzien–Antikoagulanzien–Leitlinien–Behandlungsergebnis KeywordsMyocardial ischemia–Antiplatelet agents–Anticoagulants–Guidelines–Treatment outcome
    Der Internist 01/2011; 52(11):1292-1300. · 0.33 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2011; 57(14).
  • International journal of cardiology 12/2010; 148(3):373-5. · 7.08 Impact Factor
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    ABSTRACT: There is growing evidence that intracoronary autologous bone marrow cells transplantation (BMCs-Tx) in patients with chronic myocardial infarction beneficially affects postinfarction remodelling. In this randomized controlled study we analyzed the influence of intracoronary autologous freshly isolated bone marrow cells transplantation by use of point of care system on cardiac function and on the functional activity of bone marrow derived circulating progenitor cells (BM-CPCs) in patients with ischemic heart disease (IHD). 56 patients with IHD were randomized to either received freshly isolated BMC-Tx or a control group that did not receive cell therapy. The functional activity of BM-CPCs in peripheral blood (PB) was measured by migration assay and colony forming unit assay pre- and 3, 6 as well as 12 months after procedure. Global ejection fraction (EF) and infarct size area were determined by left ventriculography. Intracoronary transplantation of autologous freshly isolated BMCs led to a significant reduction of infarct size and an increase of global EF as well as infarct wall movement velocity after 3 and 12 months follow-up compared to control group. The colony-forming capacity of BM-CPCs significantly increased 3, 6 and 12 months after cell therapy compared to pre BMCs-Tx and control group (CFU-E: p < 0.001, CFU-GM: p < 0.001). Likewise, we found significant increase of migratory response to stromal cell-derived factor 1 (SDF-1) and vascular endothelial growth factor (VEGF) after cell therapy compared to pre BMCs-Tx (SDF-1: p < 0.001, VEGF: p < 0.001) and to control (SDF-1: p < 0.001, VEGF: p < 0.001). There was no significant difference of migratory- and colony forming capacity between pre- and 3, 6, 12 months after coronary angiography in control group without cell therapy. Intracoronary transplantation of autologous freshly isolated BMCs by use of point of care system may lead to improvement of BM-CPCs functional activity in peripheral blood, which might increase the regenerative potency in patients with IHD.
    Stem cell reviews 12/2010; 7(3):646-56. · 5.08 Impact Factor
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    ABSTRACT: A persistent foramen ovale can be a possible cause of paradoxical cerebral embolism. Thranscatheter closure by transcatheter technique has a high success rate and is a recurrence prevention measure. This paper reviews of patent foramen ovale anatomy, pathophysiology, and clinical impact and discusses current therapeutic options.
    Praxis 10/2010; 99(20):1203-15.

Publication Stats

198 Citations
47 Downloads
79.22 Total Impact Points

Institutions

  • 2005–2013
    • University of Rostock
      • • Institut für Medizinische Genetik
      • • Abteilung Kardiologie
      Rostock, Mecklenburg-Vorpommern, Germany
  • 2009
    • Klinik Hirslanden
      Zürich, Zurich, Switzerland
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
  • 2001
    • University Medical Center Hamburg - Eppendorf
      Hamburg, Hamburg, Germany