K Werdan

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (543)1622.37 Total impact

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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. · 6.68 Impact Factor
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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.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2012; 107(1):53-62.
  • 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.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2012; 107(1):24-8.
  • K Werdan, H Ebelt
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2012; 107(1):6.
  • 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.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 02/2012; 107(1):39-52.
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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.
    Medizinische Klinik - Intensivmedizin und Notfallmedizin. 02/2012; 107(1).
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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. · 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. · 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. · 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
  • Source
    Karl Werdan
    Deutsches Ärzteblatt International 12/2011; 108(50):854. · 3.61 Impact Factor
  • Journal of clinical psychopharmacology 12/2011; 31(6):783-5. · 5.09 Impact Factor
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    ABSTRACT: To study the association between baseline heart rate and outcome in patients with multiple organ dysfunction (MODS) as well as the course of heart rate over the first 4 days during MODS. Prospective observational study in 89 patients with MODS, defined as an APACHE-II score ≥20. Baseline heart rate (HR(0)) was determined over a 60-minute period at the time of MODS diagnosis. 28-day all-cause mortality was the primary endpoint of the study, a fall of the APACHE-II score by 4 points or more from day 0 to day 4 constituted the secondary endpoint. Hazard ratios for heart rate of 90 beats per minute (bpm) or greater relative to less than 90 bpm were calculated using Cox proportional hazards model and adjusted for confounding variables. Median baseline heart rate was 83 bpm in survivors and 92 bpm in non-survivors (p = 0.048). 28-day mortality was 32 and 61% in patients with HR(0) < 90 bpm and HR(0) ≥ 90 bpm, respectively. The adjusted hazard ratio for 28-day mortality was 2.30 (95% confidence interval 1.21-4.36, p = 0.001) for HR(0) ≥ 90 bpm relative to HR(0) < 90 bpm. No correlation was found between baseline heart rate and the secondary endpoint. From day 0 to day 4, heart rate remained elevated in all patients, as well as in survivors and non-survivors. A heart rate ≥90 bpm at the time of MODS diagnosis is an independent risk factor for increased 28-day mortality. As in patients with cardiovascular conditions such as coronary heart disease or chronic heart failure, heart rate might constitute a target for heart rate-lowering therapy in the narrow initial treatment window of MODS.
    Clinical Research in Cardiology 11/2011; 101(2):139-47. · 4.17 Impact Factor
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    ABSTRACT: An immunocompetent Nigerian developed a fulminant hemophagocytic lymphohistiocytosis due to Epstein-Barr virus reactivation. The patient initially presented with fever, hepatosplenomegaly and pancytopenia. The clinical status of our patient deteriorated quickly despite treatment with corticoids. Escalation of immunosuppressive treatment was not possible. He died of lung, liver and circulatory failure in our intensive care unit.Hemophagocytic lymphohistiocytosis is a rare disease characterized by inflammation due to prolonged and excessive activation of antigen-presenting cells. High plasma ferritin levels and phagocytosis of hematopoetic cells in bone marrow, spleen and liver lead to the diagnosis. Hemophagocytic lymphohistiocytosis should therefore be included in the differential diagnosis in patients with persistent fever, hepatosplenomegaly and cytopenia.
    Der Internist 09/2011; 53(1):93-8. · 0.27 Impact Factor
  • M Reincke, K Werdan
    Der Internist 09/2011; 52(10):1147-8. · 0.27 Impact Factor
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    ABSTRACT: Dual antiplatelet therapy using aspirin and a thienopyridine (e.g. clopidogrel) is known to be essential in patients in whom percutaneous coronary intervention with stent implantation has been performed in order to prevent stent thrombosis and its fatal consequences. On the other hand dual antiplatelet therapy increases the incidence of perioperative bleeding complications. In case of urgent or emergency surgery the risk of perioperative stent thrombosis on the one hand and the perioperative bleeding risk on the other has to be evaluated carefully in order to keep time period without sufficient platelet inhibition as short as possible. The presented case offers a strategy for managing perioperative administration of antiplatelet agents.
    Medizinische Klinik, Intensivmedizin und Notfallmedizin. 09/2011; 106(1):48-51.
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    ABSTRACT: IntroductionSepsis 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. MethodsAt total of 211patients 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 (≥2positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. ResultsResults of the BC were available in 200patients (94.8%) and PCR were available in 119patients (56.3%), respectively. In total, 87 BC (43.5%) were positive and identified 94 pathogens. In 45 positive PCRs, 47pathogens (37.8%) were found. Identical results were obtained in 81.4%. In addition, BC identified 9Gram-positive and 3Gram-negative bacteria, while PCR added 5Gram-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±32.8ng/ml, p<0.001). This difference was not observed for BC (10.6±25.7 vs. 11.6±44.9ng/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). ConclusionIn 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 APACHEII scores. EinleitungDie Sepsis im frühen Stadium ist eine häufige Erkrankung in der Notaufnahme, eine rasche Diagnosestellung ist essenziell. Ziel dieser Studie war der Vergleich der Erregerdiagnostik mittels Blutkultur (BC) und Polymerasekettenreaktion (PCR). MethodenWir untersuchten 211Patienten, die zwischen 2006 und 2009 mit Verdacht auf eine schwere Infektion in die Notaufnahme unseres Klinikums eingewiesen wurden. Blutproben für BC und Multiplex-PCR zur Identifikation infektiöser Mikroorgansimen wurden unmittelbar nach Aufnahme entnommen. Ferner wurden Procalcitonin (PCT) bestimmt, die klinische Diagnose einer Sepsis, die Schwere der Infektion und das klinische Outcome erhoben. ErgebnisseErgebnisse der BC waren bei 200 (94,8%) und der PCR bei 119 (56,3%) Patienten verfügbar. Insgesamt waren 87 der BC (43,5%) positiv und identifizierten 94Erreger. In 45 positiven PCRs (37,8%) wurden 47Erreger gefunden. Identische Ergebnisse wurden in 81,4% erzielt. Durch die BC wurden 9 zusätzliche grampositive und 3 gramnegative Bakterien identifiziert. Die PCR fand 5 zusätzliche gramnegative Bakterien. Koagulasenegative Staphylokokken wurden nur in Blutkulturen gefunden (n=20, 21,3%); die PCR identifizierte signifikant mehr gramnegative Bakterien als die BC. Bei Patienten mit positiver PCR war der PCT-Spiegel signifikant höher als bei Patienten mit negativer PCR (15,0±23,3 vs. 8,8±32,8ng/ml, p<0,001). Diese Differenz konnte nicht für die BC beobachtet werden (10,6±25,7 vs. 11,6±44,9ng/ml, p=0,075). Der APACHE-II-Score war bei positiver PCR (19,2±9,1 vs. 15,8±8,9, p<0,05) und positiver BC (18,7±8,7 vs. 14,4±8,0, p<0,01) erhöht. Positive PCR und BC korrelierten mit schlechtem klinischem Outcome (z.B. Verlegung auf ITS, mechanische Beatmung, Nierenersatztherapie oder Tod). SchlussfolgerungBei Patienten mit Verdacht auf eine schwere Infektion kann ein hoher Prozentsatz positiver BC und PCR gefunden werden. Positive Ergebnisse in der PCR korrelieren mit erhöhten PCT-Spiegeln und hohen APACHE-II-Scores. KeywordsSepsis–Polymerase chain reaction–Blood culture–Emergency service, hospital–Procalcitonin SchlüsselwörterSepsis–Polymerasekettenreaktion–Blutkultur–Notaufnahme–Procalcitonin
    Intensivmedizin + Notfallmedizin 09/2011; 48(6):517-526.
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    ABSTRACT: Die duale thrombozytenaggregationshemmende Therapie – bestehend aus Acetylsalicylsäure und einem Thienopyridin (meist Clopidogrel) – ist essenziell bei Patienten nach perkutaner Koronarintervention mit Stentimplantation. Hiermit kann eine Stentthrombose und ihre in einer Vielzahl der Fälle tödlichen Folgen effektiv vermieden werden. Auf der anderen Seite geht diese Therapie mit einer erhöhten Rate von Blutungskomplikationen einher. Im Falle notwendiger dringlicher oder notfallmäßiger Operationen muss daher das Risiko einer perioperativen Stentthrombose gegen das operationsassoziierte Blutungsrisiko abgewogen und die Zeit ohne suffiziente Thrombozytenaggregation so kurz wie möglich gehalten werden. Der vorliegende Fall beschreibt eine Strategie zum perioperativen Management thrombozytenaggregationshemmender Medikamente. Dual antiplatelet therapy using aspirin and a thienopyridine (e.g. clopidogrel) is known to be essential in patients in whom percutaneous coronary intervention with stent implantation has been performed in order to prevent stent thrombosis and its fatal consequences. On the other hand dual antiplatelet therapy increases the incidence of perioperative bleeding complications. In case of urgent or emergency surgery the risk of perioperative stent thrombosis on the one hand and the perioperative bleeding risk on the other has to be evaluated carefully in order to keep time period without sufficient platelet inhibition as short as possible. The presented case offers a strategy for managing perioperative administration of antiplatelet agents. SchlüsselwörterAcetylsalicylsäure–Clopidogrel–„Drug-eluting“-Stents–Stentthrombose KeywordsAspirin–Clopidogrel–Drug-eluting stents–Stent thrombosis
    09/2011; 106(1):48-52.
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    ABSTRACT: Recently it was shown that lipopolysaccharide (LPS) impairs the pacemaker current in human atrial myocytes. It was speculated that reduced heart rate variability (HRV), typical of patients with severe sepsis, may partially be explained by this impairment. We evaluated the effect of various types of LPS on the activity of human hyperpolarization-activated cyclic nucleotide-gated channel 2 (hHCN2) expressed in HEK293 cells, and on pacemaker channels in native murine sino-atrial node (SAN) cells, in order to determine the structure of LPS necessary to modulate pacemaker channel function. Application of LPS caused a robust inhibition of hHCN2-mediated current (I(hHCN2)) owing to a negative shift of the voltage dependence of current activation and to a reduced maximal conductance. In addition, kinetics of channel gating were modulated by LPS. Pro-inflammatory LPS-types lacking the O-chain did not reduce I(hHCN2), whereas pro-inflammatory LPS-types containing the O-chain reduced I(hHCN2). On the other hand, a detoxified LPS without inflammatory activity, but containing the O-chain reduced I(hHCN2). Similar observations were made in HEK293 cells expressing hHCN4 and in murine SAN cells. This mechanistic analysis showed the novel finding that the O-chain of LPS is required for reduction of HCN channel activity. In the clinical situation the observed modulation of HCN channels may slow down diastolic depolarization of pacemaker cells and, hence, influence heart rate variability and heart rate.
    Journal of Molecular and Cellular Cardiology 08/2011; 51(2):226-35. · 5.15 Impact Factor
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    ABSTRACT: Perioperative detection of cardiac biomarkers may help to identify patients at risk. Whether detection of these markers will be recommended in the preoperative setting for patients with cardiac diseases in the future has to be discussed as large prospective trials on this topic are missing. For preoperative evaluation of cardiac insufficiency quantification of brain natriuretic peptide (BNP) and amino-terminal pro-brain natriuretic peptide (NT-proBNP) are useful markers. Troponin is the marker of choice for detection of myocardial ischemia/infarction in the postoperative setting. In unstable patients coronary angiography and/or percutaneous coronary intervention (PCI) are indicated. However, in stable patients the decision for coronary angiography and/or PCI has to be made in each patient individually after interdisciplinary discussion between anesthesiologists, cardiologists and surgeons.
    Der Anaesthesist 08/2011; 60(8):709-16. · 0.74 Impact Factor

Publication Stats

6k Citations
1,622.37 Total Impact Points

Institutions

  • 2014
    • Erasmus MC
      • Department of Medical Informatics
      Rotterdam, South Holland, Netherlands
  • 1970–2014
    • Martin Luther University of Halle-Wittenberg
      • • 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
  • 2013
    • Max Planck Institute for Heart and Lung Research
      Stadt Bad Nauheim, Hesse, Germany
  • 2009–2013
    • Universitätsklinikum Halle (Saale)
      Halle-on-the-Saale, Saxony-Anhalt, Germany
  • 2011
    • Carl-von-Basedow Hospital
      Merseburg, Saxony-Anhalt, Germany
  • 2010
    • Universitätsklinikum Jena
      Jena, Thuringia, Germany
    • Friedrich-Schiller-University Jena
      • Department of Anaesthesiology and Intensive Care Medicine
      Jena, Thuringia, Germany
  • 2008
    • Medical University of Graz
      • Institut für Biophysik
      Graz, Styria, Austria
    • Hannover Medical School
      Hanover, Lower Saxony, 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
  • 2006
    • St.-Antonius-Hospital Eschweiler
      Eschweiler, North Rhine-Westphalia, Germany
    • State University of New York Downstate Medical Center
      • SUNY Downstate Medical Center
      Brooklyn, NY, United States
  • 2005
    • University Hospital Essen
      • Klinik für Kardiologie
      Essen, North Rhine-Westphalia, Germany
  • 2001
    • Universitätsmedizin Göttingen
      • Department of Pediatric Cardiology and Intensive Care Medicine
      Göttingen, Lower Saxony, Germany
  • 2000
    • Azienda Ospedaliera Santa Maria Nuova di Reggio Emilia
      Reggio nell'Emilia, Emilia-Romagna, Italy
  • 1999
    • Martin University
      Indianapolis, Indiana, United States
  • 1990–1998
    • Ludwig-Maximilian-University of Munich
      • Department of Internal Medicine I
      München, Bavaria, Germany
  • 1983–1997
    • Technische Universität München
      • Medizinische Klinik und Poliklinik I
      München, Bavaria, Germany
  • 1995
    • Deutsches Herzzentrum München
      München, Bavaria, Germany
  • 1972–1995
    • University Hospital München
      München, Bavaria, Germany
  • 1991
    • Ludwig Boltzmann Institute for Experimental and Clinical Traumatology
      Wien, Vienna, Austria
    • University of Tuebingen
      • Institute for Physiology
      Tübingen, Baden-Wuerttemberg, Germany
  • 1989–1991
    • Universität Heidelberg
      • Institute of Pharmacology
      Heidelberg, Baden-Wuerttemberg, Germany