Karl Werdan

University of Leipzig, Leipzig, Saxony, Germany

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Publications (568)1679.68 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: The European ST-elevated myocardial infarction (STEMI) guideline suggested the intra-aortic balloon pump (IABP) with a recommendation level I and a level of evidence C as an effective measure in combination with balloon angioplasty in patients with cardiogenic shock (CS), stent implantation, and inotropic and vasopressor support. Similarly, upon mechanical complication due to myocardial infarction (MI), the guideline suggests that in patients with a ventricular septal defect or in most patients with acute mitral regurgitation, preoperative IABP implantation is indicated for circulatory support. The American College of Cardiology/American Heart Association STEMI guideline recommends the use of the IABP with a recommendation level I and a level of evidence B if CS does not respond rapidly to pharmacological treatment. The guideline notes that the IABP is a stabilizing measure for angiography and early revascularization. Even in MI complications, the use of preoperative IABP is recommended before surgery. Within this overview, we summarize the current evidence on IABP use in patients with CS complicated by MI. From our Cochrane data analysis, we conclude that in CS due to acute MI (AMI) treated with adjuvant systemic fibrinolysis, the IABP should be implanted. In patients with CS following AMI, treated with primary percutaneous coronary intervention (PCI), the IABP can be implanted, although data are not distinctive (i.e., indicating positive and negative effects). In the future, randomized controlled trials are needed to determine the use of IABP in CS patients treated with PCI. When patients with CS are transferred to a PCI center with or without thrombolysis, patients should receive mechanical support with an IABP. To treat mechanical MI complications-in particular ventricular septal defect-patients should be treated with an IABP to stabilize their hemodynamic situation prior to cardiac surgery. Similar recommendations are given in the German Austrian guidelines on treatment of infarction-related CS patients (http://www.awmf.org/leitlinien/detail/ll/019-013.html).
    Artificial Organs 05/2012; 36(6):505-11. DOI:10.1111/j.1525-1594.2011.01408.x · 1.87 Impact Factor
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    ABSTRACT: The aim of this analysis was to evaluate the importance of genetic variants of TNFα for the severity of periodontal disease and periodontal risk factors with respect to periodontal risk factors in a cohort of coronary patients. A total of 942 consecutive patients with angiographic proven coronary heart disease were prospectively included in the study entitled "Periodontitis and Its Microbiological Agents as Prognostic Factors in Patients With Coronary Heart Disease" (ClinicalTrials.gov identifier:NCT01045070). After including of patients, an extensive periodontal examination also involving PCR-sampling for 11 periodontal bacteria was performed. In this subanalysis, single nucleotide polymorphisms (SNPs) c.-308G>A, c.-238G>A and haplotypes for TNFα were analysed by CTS-PCR-SSP Tray kit (Heidelberg, Germany). The AG+AA genotype of SNP c.-238G>A of TNFα gene was associated with the amount of clinical attachment loss in patients with coronary heart disease in multivariate regression analysis. Moreover, Prevotella intermedia occurred more frequently in carriers who were positive for the AG+AA genotype and A-allele of SNP c.-308G>A in bivariate and multivariate analyses. Furthermore, only in bivariate analyses significant associations of genetic variants of TNFα with intensified bleeding on probing and with higher plasma level of interleukin 6 could be shown. Genetic variants of TNFα gene, namely c.-308G>A and c.-238G>A, are associated with periodontal conditions in patients with coronary heart disease.
    Journal Of Clinical Periodontology 05/2012; 39(8):699-706. DOI:10.1111/j.1600-051X.2012.01909.x · 3.61 Impact Factor
  • Karl Werdan
    Critical care medicine 05/2012; 40(5):1669-70. DOI:10.1097/CCM.0b013e3182474c20 · 6.15 Impact Factor
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    ABSTRACT: Infarction-related cardiogenic shock (ICS) is usually due to left-ventricular pump failure. With a mortality of 30% to 80%, ICS is the most common cause of death from acute myocardial infarction. The S3 guideline presented here characterizes the current evidence-based treatment of ICS: early revascularization, treatment of shock, and intensive care treatment of multi-organ dysfunction syndrome (MODS) if it arises. The success or failure of treatment for MODS determines the outcome in ICS. Experts from eight German and Austrian specialty societies analyzed approximately 3600 publications that had been retrieved by a systematic literature search. Three interdisciplinary consensus conferences were held, resulting in the issuing of 111 recommendations and algorithms for this S3 guideline. Early revascularization of the occluded vessel, usually with a percutaneous coronary intervention (PCI), is of paramount importance. The medical treatment of shock consists of dobutamine as the inotropic agent and norepinephrine as the vasopressor of choice and is guided by a combination of pressure and flow values, or by the cardiac power index. Levosimendan can be given in addition to treat catecholamine-resistant shock. For patients with ICS who are treated with PCI, the current S3 guideline differs from the European and American myocardial infarction guidelines with respect to the recommendation for intra-aortic balloon pulsation (IABP): Whereas the former guidelines give a class I recommendation for IABP, this S3 guideline states only that IABP "can" be used in this situation, in view of the poor state of the evidence. Only for patients being treated with systemic fibrinolysis is IABP weakly recommended (IABP "should" be used in such cases). With regard to the optimal intensive-care interventions for the prevention and treatment of MODS, recommendations are given concerning ventilation, nutrition, erythrocyte-concentrate transfusion, prevention of thrombosis and stress ulcers, follow-up care, and rehabilitation. The goal of this S3 guideline is to bring together the types of treatment for ICS that lie in the disciplines of cardiology and intensive-care medicine, as patients with ICS die not only of pump failure, but also (and even more frequently) of MODS. This is the first guideline that adequately emphasizes the significance of MODS as a determinant of the outcome of ICS.
    Deutsches Ärzteblatt International 05/2012; 109(19):343-51. DOI:10.3238/arztebl.2012.0343 · 3.61 Impact Factor
  • K.M. Heinroth, K. Werdan
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    ABSTRACT: In der Notfallsituation kann der Einsatz eines passageren Herzschrittmachers bei symptomatischen, medikamentös nicht beherrschbaren Bradykardien notwendig werden, oft zur Überbrückung bis zur definitiven Schrittmacherversorgung. Dabei stehen 3 Stimulationsverfahren zur Verfügung: die transkutane, die transgastrale und die transvenöse Stimulation. Spezifische Vor- und Nachteile der einzelnen Methoden werden in diesem Beitrag ebenso dargestellt wie das praktische Vorgehen bei der Platzierung und Einstellung der verschiedenen passageren Schrittmachersysteme.
    Der Internist 04/2012; 41(10):1019-1030. DOI:10.1007/s001080050661 · 0.27 Impact Factor
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    ABSTRACT: BACKGROUND: The aim of this study was to investigate factors influencing mortality after percutaneous coronary intervention (PCI) in patients aged ≥ 75 years compared to younger patients. PATIENTS AND METHODS: A total of 1,809 coronary heart disease (CHD) patients after PCI with stent implantation in our hospital were assessed. Kaplan-Meier analyses with log-rank test and Cox regression analyses were performed on three predefined models concerning primary endpoint of all-cause mortality. Model 1 was a univariate analysis of the influence of age dichotomized by age 75 years on the primary endpoint. Model 2 included age and classical cardiovascular risk factors (CVRFs, e.g., body mass index (BMI), smoking, diabetes, and hypertension). Model 3 consisted of age, classical CVRFs, and additional factors (e.g., medication; hemoglobin, peripheral arterial disease (PAD), low-density lipoprotein cholesterol (LDL-C) and creatinine levels, and left ventricular ejection fraction (LVEF)). RESULTS: In the mean follow-up of 137 ± 61 weeks 375 patients died. Age ≥ 75 years was significantly related to mortality in all models. In model 3, previous stroke, PAD, diabetes, elevated levels of serum creatinine, and increased LDL-C were related to elevated mortality, higher hemoglobin levels, and LVEF > 50% were associated with decreased mortality in all patients and in patients < 75 years. In patients ≥ 75 years arterial hypertension was associated with poor outcome (hazard ratio (HR) 7.989, p = 0.040), previous antiplatelet therapy showed reduced mortality (HR 0.098, p = 0.039). CONCLUSION: Although risk factors such as previous stroke, PAD, diabetes, renal insufficiency, and anemia were predictors for death in all patients and patients < 75 years, in the elderly only arterial hypertension increased, whereas treatment with platelet inhibitors decreased mortality.
    Zeitschrift für Gerontologie + Geriatrie 04/2012; DOI:10.1007/s00391-012-0338-y · 1.02 Impact Factor
  • M. Krivokuca, K. Werdan
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    ABSTRACT: Die vorliegende Übersicht über die Notfalltherapie der akuten Links- und Rechtsherzinsuffizienz sowie des kardiogenen Lungenödems und Schocks macht klar, wie viele wichtige ärztliche und organisatorische Aspekte in dieser Notfallsituation zu beachten sind. All dies muß ständig vorgehalten werden: spezialisiertes, hochmotiviertes ärztliches und Hilfspersonal, ein beachtliches medikamentöses Arsenal, zahlreiche Geräte zu supportiven Zwecken, ein großer diagnostischer Apparat und schließlich die Möglichkeit zu interventionellen koronaren Maßnahmen. Die im Text dieser Arbeit erklärten und diskutierten Empfehlungen zur Behandlung der akuten Herzinsuffienz sind in tabellarisch einprägsamer Form dargestellt, worauf besonders hingewiesen sei. Überblickt man die Entwicklung der kardiologischen Notfalltherapie in der letzten Dekade, besonders die überzeugenden Resultate von Notfall-PTCA’s drängen sich natürlich Fragen mit weit reichenden ökonomischen Konsequenzen auf: (1.) Wohin sollen die erstbehandelnden Ärzte ihre kardiologischen Notfälle schicken bzw. begleiten, in die nächste Klinik (wie man so leicht sagt, immer die beste) oder nicht doch lieber gleich in eine (meist wesentlich weiter entfernte) Spezialabteilung mit interventionellen Möglichkeiten? (2.) Wie steht es mit der flächendeckenden Versorgung kardiologischer Notfälle hierzulande?
    Der Internist 04/2012; 41(2):127-136. DOI:10.1007/s001080050016 · 0.27 Impact Factor
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    ABSTRACT: Thyroid hormones play key roles in cellular growth, development and metabolism. Although there is a strong genetic influence on thyroid hormone levels, the genes involved are widely unknown. The levels of circulating thyroid hormones are tightly regulated by thyrotropin (TSH), which also represents the most important diagnostic marker for thyroid function. Therefore, in order to identify genetic loci associated with TSH levels, we performed a discovery meta-analysis of two genome-wide association studies including two cohorts from Germany, KORA (n = 1287) and SHIP (n = 2449), resulting in a total sample size of 3736. Four genetic loci at 5q13.3, 1p36, 16q23 and 4q31 were associated with serum TSH levels. The lead single-nucleotide polymorphisms of these four loci were located within PDE8B encoding phosphodiesterase 8B, upstream of CAPZB that encodes the β-subunit of the barbed-end F-actin-binding protein, in a former 'gene desert' that was recently demonstrated to encode a functional gene (LOC440389) associated with thyroid volume, and upstream of NR3C2 encoding the mineralocorticoid receptor. The latter association for the first time suggests the modulation of thyroid function by mineral corticoids. All four loci were replicated in three additional cohorts: the HUNT study from Norway (n = 1487) and the two German studies CARLA (CARLA, n = 1357) and SHIP-TREND (n = 883). Together, these four quantitative trait loci accounted for ∼3.3% of the variance in TSH serum levels. These results contribute to our understanding of genetic factors and physiological mechanisms mediating thyroid function.
    Human Molecular Genetics 04/2012; 21(14):3275-82. DOI:10.1093/hmg/dds136 · 6.68 Impact Factor
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    ABSTRACT: Die infektiöse Endokarditis ist eine seltene Erkrankung mit hohem Mortalitätsrisiko. In den letzten Jahren haben epidemiologische Verschiebungen im Altersgefälle der betroffenen Patienten, das Auftreten neuer Risikofaktoren sowie die zunehmende Verwendung intravasaler prothetischer Materialien zu Veränderungen im klinischen Erscheinungsbild sowie in Diagnostik und Therapie der Endokarditis geführt. Von herausragender Bedeutung ist eine frühzeitige Diagnosestellung. Die unspezifischen Symptome, aber auch das zunehmend häufigere Auftreten „nosokomialer“ Endokarditiden, oft bei schwerkranken Patienten auf Intensivstationen, fordern die diagnostische Kompetenz des behandelnden Arztes. Hierbei stehen diagnostische und therapeutische Algorithmen zur Verfügung, die von einer zügigen Diagnose zur adäquaten Therapie der Erkrankung leiten sollen. Es kann gerade auf der Intensivstation wichtig sein, zum richtigen Zeitpunkt die Indikation zu einer chirurgischen Sanierung der Infektion zu stellen. Entsprechend den aktuellen Leitlinien wird in dieser Übersicht die gängige Praxis in der Diagnostik und Therapie der infektiösen Endokarditis dargestellt und für Intensivpatienten kommentiert.
    02/2012; 107(1). DOI:10.1007/s00063-011-0006-9
  • K Werdan, H Ebelt
    02/2012; 107(1):6. DOI:10.1007/s00063-011-0027-4
  • H Ebelt, K Werdan
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    ABSTRACT: Patients suffering from septic shock often present with not only severe reduction of afterload induced by vasodilation but are also affected by sepsis-induced cardiac dysfunction. Elevated troponin levels, which are typically not caused by coronary ischemia, may indicate septic cardiomyopathy which is characterized both by altered systolic function as well as by disturbances in the regulation of heart rate and heart rate variability. The latter findings are based not only on the dysfunction of the autonomous nervous system but are also the result of the direct interaction of endotoxins with cardiac pacemaker cells. In order to quantify the extent of septic cardiomyopathy, cardiac output has to be considered in the light of the existing afterload, i.e., by the parameter 'afterload-related cardiac performance' (ACP). Therapy of septic shock (and thereby septic cardiomyopathy) is based on the well-known causative, supportive, and adjunctive strategies. Stabilization of cardiac function is assured by volume resuscitation (including blood transfusion) and inotropic support (dobutamine). Further specific therapeutic approaches have not yet been established.
    02/2012; 107(1):24-8.
  • S Dietz, H Lemm, U Raaz, K Werdan, M Buerke
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    ABSTRACT: Infectious endocarditis is a rare disease with high mortality. Epidemiological changes in recent years, the emergence of new risk factors, and the increasing use of intravasal prosthetic materials has led to changes in not only the clinical appearance of this disease but also in its diagnosis and treatment. Early diagnosis of infectious endocarditis is crucial. However, the often unspecific symptoms and the changes in its epidemiologic profile pose a challenge for the treating physician. This is especially true since the incidence of hospital-acquired, "nosocomial" cases of infectious endocarditis is increasing and often affects severely ill patients in intensive care units (ICU). There are diagnostic and therapeutic algorithms to guide the physician from an early diagnosis to an adequate treatment of the disease. In some critically ill patients, only surgery in combination with antimicrobial treatment may lead to complete eradication of the infectious disease. This review aims to subsume the guidelines, paying special attention to aspects that are important for intensive care and emergency doctors.
    02/2012; 107(1):39-52.
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    ABSTRACT: Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test.Methods. At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (≥2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. Results of the BC were available in 200 patients (94.8%) and PCR were available in 119 patients (56.3%), respectively. In total, 87 BC (43.5%) were positive and identified 94 pathogens. In 45 positive PCRs, 47 pathogens (37.8%) were found. Identical results were obtained in 81.4%. In addition, BC identified 9 Gram-positive and 3 Gram-negative bacteria, while PCR added 5 Gram-negative pathogens. Coagulase-negative staphylococci were detected in blood cultures only (n=20, 21.3%), whereas PCR identified significantly more Gram-negative bacteria than BC. In patients with positive PCR results, the PCT level was significantly higher than in patients with negative PCR (15.0±23.3 vs. 8.8±32.8 ng/ml, p<0.001). This difference was not observed for BC (10.6±25.7 vs. 11.6±44.9 ng/ml, p=0.075). The APACHE II score correlated with PCR (19.2±9.1 vs. 15.8±8.9, p<0.05) and was also higher in positive BC (18.7±8.7 vs. 14.4±8.0, p<0.01). Positive PCR and BC were correlated with negative clinical outcomes (e.g., transfer to ICU, mechanical ventilation, renal replacement therapy, death). In patients admitted with suspected severe infection, a high percentage of positive BC and PCR were observed. Positive findings in the PCR correlate with elevated levels of PCT and high APACHE II scores.
    02/2012; 107(1):53-62. DOI:10.1007/s00063-011-0051-4
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    ABSTRACT: We conducted the IABP Cardiogenic Shock Trial (ClinicalTrials.gov ID NCT00469248) as a prospective, randomized, monocentric clinical trial to determine the hemodynamic effects of additional intra-aortic balloon pump (IABP) treatment and its effects on severity of disease in patients with acute myocardial infarction complicated by cardiogenic shock (CS). Intra-aortic balloon pump counterpulsation is recommended in patients with CS complicating myocardial infarction. However, there are only limited randomized controlled trial data available supporting the efficacy of IABP following percutaneous coronary intervention (PCI) and its impact on hemodynamic parameters in patients with CS. Percutaneous coronary intervention of infarct-related artery was performed in 40 patients with acute myocardial infarction complicated by CS, within 12 h of onset of hemodynamic instability. Serial hemodynamic parameters were determined over the next 4 days and compared in patients receiving medical treatment alone with those treated with additional intra-aortic balloon counterpulsation. There were no significant differences among severity of disease (i.e., Acute Physiology and Chronic Health Evaluation II score) initially and no differences among both groups for disease improvement. We observed significant temporal improvements of cardiac output (4.8 ± 0.5 to 6.0 ± 0.5 L/min), systemic vascular resistance (926 ± 73 to 769 ± 101 dyn · s(-1) · cm(-5)), and the prognosis-validated cardiac power output (0.78 ± 0.06 to 1.01 ± 0.2 W) within the IABP group. However, there were no significant differences between the IABP group and the medical-alone group. Additional IABP treatment did not result in a significant hemodynamic improvement compared with medical therapy alone in a randomized prospective trial in patients with CS following PCI. Therefore, the use and recommendation for IABP treatment in CS remain unclear.
    Shock (Augusta, Ga.) 01/2012; 37(4):378-84. DOI:10.1097/SHK.0b013e31824a67af · 2.87 Impact Factor
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    ABSTRACT: Several clinical trials have demonstrated the antianginal and anti-ischemic efficacy of ivabradine in combination with beta-blocker in patients with stable angina pectoris. The ADDITIONS (PrActical Daily efficacy anD safety of Procoralan(®) In combinaTION with betablockerS) study evaluated the efficacy, safety, and tolerability of ivabradine added to beta-blocker, and its effect on angina symptoms and quality of life in routine clinical practice. This non-interventional, multicenter, prospective study included 2,330 patients with stable angina pectoris treated with a flexible dose of ivabradine twice daily in addition to beta-blocker for 4 months. The parameters recorded included heart rate, number of angina attacks, nitrate consumption, tolerance, and quality of life. After 4 months ivabradine (mean dose 12.37 ± 2.95 mg/day) reduced heart rate by 19.4 ± 11.4 to 65.6 ± 8.2 bpm (p < 0.0001). The number of angina attacks was reduced by 1.4 ± 1.9 per week (p < 0.0001), and nitrate consumption by 1.9 ± 2.9 U per week (p < 0.0001). At baseline (i.e., on beta-blocker), half of the patients (51%) were classified as Canadian Cardiovascular Society (CCS) grade II; 29% were CCS grade I. After 4 months' treatment with ivabradine, most of the patients were CCS grade I (68%). The EQ-5D index improved by 0.17 ± 0.23 (p < 0.0001). The overall efficacy of ivabradine was considered by the physicians as "very good" (61%) or "good" (36%) in most patients. Suspected adverse drug reactions were documented in 14 patients; none were severe. In daily clinical practice, combining ivabradine with beta-blocker not only reduces heart rate, number of angina attacks, and nitrate consumption, but also improves the quality of life in patients with stable angina pectoris.
    Clinical Research in Cardiology 01/2012; 101(5):365-73. DOI:10.1007/s00392-011-0402-4 · 4.17 Impact Factor
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    ABSTRACT: The IABP-SHOCK-trial was a morbidity-based randomized controlled trial in patients with infarction-related cardiogenic shock (CS), which used the change of the quantified degree of multiorgan failure as determined by APACHE II score over a 4-day period as primary outcome measure. The prospective hypothesis was that adding IABP therapy to "standard care" would improve CS-triggered multi organ dysfunction syndrome (MODS). The primary endpoint showed no difference between conventionally managed cardiogenic shock patients and those with IABP support. In an inflammatory marker substudy, we analysed the prognostic value of interleukin (IL)-1β, -6, -7, -8, and -10 in patients with acute myocardial infarction complicated by cardiogenic shock. Inflammatory marker substudy of the prospective, randomized, controlled, open label IABP-SHOCK-trial (Clinical-Trials-gov-ID-NCT00469248). A single-center study was performed in a 12-bed Intensive-Care-Unit in an university hospital in which 40 consecutive patients were enrolled with an observational period of 96 h. The pro- and anti-inflammatory markers IL-6, -7, -8 and -10 showed a predictive power for mortality of infarct-related CS patients, while IL-1β did not discriminate. The maximal values during the observational period, in case of IL-7 the minimal value, showed the best power to predict mortality. Both, ROC and multivariate analyses confirmed these suggestions (area under the curve: IL-8, 0.80 ± 0.08; IL-6, 0.79 ± 0.08; IL-10, 0.76 ± 0.08; IL-7, 0.69 ± 0.08). Inflammatory markers were not affected by the presence of IABP support. The inflammatory response in patients with myocardial infarction complicated by cardiogenic shock, as reflected by the inflammatory markers IL-6, IL-7, IL-8 and IL-10, demonstrates a clinically relevant prognostic contribution to clinical outcome.
    Clinical Research in Cardiology 01/2012; 101(5):375-84. DOI:10.1007/s00392-011-0403-3 · 4.17 Impact Factor
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    ABSTRACT: We report the case of a 47-year-old man who was admitted because of syncope. Upon hospital admission, he rapidly developed circulatory shock with generalized edema and a severe hemoconcentration with a hematocrit of 70%. The condition was stabilized with infusion of 17 l of cristalloid fluids over a period of 24 h. After ruling out possible secondary causes, the diagnosis of a systemic capillary leak syndrome--a severe transient endothelial barrier dysfunction of unknown origin--was made. A triad of hypotension, hemoconcentration (hematocrit  >60%) and macromolecular extravasation is the typical finding; furthermore, a strong association with monoclonal gammopathy of unknown significance (MGUS) is described.
    Der Internist 12/2011; 53(3):341-4. · 0.27 Impact Factor
  • Journal of clinical psychopharmacology 12/2011; 31(6):783-5. DOI:10.1097/JCP.0b013e318236bfa6 · 5.09 Impact Factor
  • P Wacker, K Werdan
    DMW - Deutsche Medizinische Wochenschrift 12/2011; 136(48):2474-7. DOI:10.1055/s-0031-1297270 · 0.65 Impact Factor
  • Source
    Karl Werdan
    Deutsches Ärzteblatt International 12/2011; 108(50):854. DOI:10.3238/arztebl.2011.0854 · 3.61 Impact Factor

Publication Stats

7k Citations
1,679.68 Total Impact Points

Institutions

  • 2015
    • University of Leipzig
      • Department of Cardiac Surgery
      Leipzig, Saxony, Germany
  • 1970–2015
    • Martin Luther University Halle-Wittenberg
      • • Institute for Pharmacology and Toxicology
      • • Clinic for Internal Medicine III
      • • Institute of Medical Epidemiology, Biostatistics, and Computer Science
      • • Institut für Humangenetik und Medizinische Biologie
      • • Poliklinik für Herz- und Thoraxchirurgie
      • • Institute for Pathology
      Halle-on-the-Saale, Saxony-Anhalt, Germany
  • 2014
    • Erasmus MC
      • Department of Medical Informatics
      Rotterdam, South Holland, Netherlands
  • 2004–2014
    • Universitätsklinikum Halle (Saale)
      Halle-on-the-Saale, Saxony-Anhalt, Germany
  • 2011
    • Carl-von-Basedow Hospital
      Merseburg, Saxony-Anhalt, Germany
  • 2010
    • Friedrich-Schiller-University Jena
      • Department of Anaesthesiology and Intensive Care Medicine
      Jena, Thuringia, Germany
  • 2003–2008
    • Ruhr-Universität Bochum
      • • Medizinische Klinik I
      • • Medizinische Klinik II - Kardiologie und Angiologie
      Bochum, North Rhine-Westphalia, Germany
    • University of Tartu
      Dorpat, Tartu County, Estonia
    • University Hospital RWTH Aachen
      Aachen, North Rhine-Westphalia, Germany
  • 2005
    • University Hospital Essen
      • Klinik für Kardiologie
      Essen, North Rhine-Westphalia, Germany
  • 2001
    • Georg-August-Universität Göttingen
      Göttingen, Lower Saxony, Germany
  • 2000
    • Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia
      Reggio nell'Emilia, Emilia-Romagna, Italy
  • 1990–1998
    • Ludwig-Maximilian-University of Munich
      • Department of Internal Medicine I
      München, Bavaria, Germany
  • 1995
    • Deutsches Herzzentrum München
      München, Bavaria, Germany
  • 1972–1995
    • University Hospital München
      München, Bavaria, Germany
  • 1991
    • University of Tuebingen
      • Institute for Physiology
      Tübingen, Baden-Wuerttemberg, Germany
    • Ludwig Boltzmann Institute for Experimental and Clinical Traumatology
      Wien, Vienna, Austria
  • 1990–1991
    • Universität Heidelberg
      • Institute of Pharmacology
      Heidelberg, Baden-Wuerttemberg, Germany