C A Nienaber

University of Rostock, Rostock, Mecklenburg-Vorpommern, Germany

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Publications (224)559.17 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Representative data on the current management of patients with acute coronary syndromes (ACS) are of high interest. The EPICOR registry aimed to prospectively collect such real-life data with particular focus on antithrombotic drug utilization and outcomes.
    Herz 11/2014; · 0.78 Impact Factor
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    ABSTRACT: Optical coherence tomography (OCT) is the latest intravascular imaging modality for the investigation of coronary arteries. It can be used in patients with stable coronary artery disease as well as in patients with acute coronary syndrome. Its almost microscope-like resolution of 10-20 μm (10-times greater than intravascular ultrasound) gives us the most detailed insight into the coronary artery wall in vivo so far.Optical coherence tomography can be used for accurate qualitative and quantitative assessment of stenoses in stable coronary artery disease and accurate guidance of percutaneous coronary interventions as well as accurate postprocedural control. In patients with acute coronary syndrome it can be used for the detection of culprit of the culprit lesion (vulnerable plaque) which allows the operator to cover not only angiographically tightest stenosis (angiographic culprit lesion, caused in most cases by thrombus only) but most importantly the vulnerable plaque, which led to the acute event, as well. Furthermore, optical coherence tomography allows accurate assessment of thrombotic burden, stent apposition/malapposition, edge dissections and tissue prolaps or thrombus protrusions throught stent struts, etc.
    Deutsche medizinische Wochenschrift (1946). 09/2014; 139(39):1941-1946.
  • I Akin, C A Nienaber
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    ABSTRACT: Chronic and acute diseases of the thoracic aorta, including aortic dissection and aortic aneurysm 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 classical surgical strategies still dominate the care for acute and chronic 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 aortic pathology in suitable patients constituting the majority of cases. Additionally, aortic arch pathologies are becoming the target of hybrid approaches combining surgical head-vessel debranching and interventional stent-graft implantation in the 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, every patient should be discussed in a team consisting of cardiologists, cardiac surgeons, anaesthesiologists and radiologists and an individualized therapeutic strategy should be carried out in a center with experience in both endovascular and surgical procedures.
    European review for medical and pharmacological sciences. 09/2014; 18(17):2562-2574.
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    ABSTRACT: Acute aortic syndrome (AAS) is a modern term used to describe interrelated emergency aortic conditions with similar clinical characteristics and challenges including aortic dissection, intramural hematoma (IMH) and penetrating aortic ulcer (PAU). Population-based studies suggest that the incidence of aortic dissection ranges from 2.6 to 3.5 cases per 100,000 inhabitants per year; hypertension and a variety of genetic disorders with altered connective tissue are the most prevalent risk conditions. In general, open surgical repair is recommended when dissection involves the ascending aorta, whereas medical management and endovascular stent graft repair is the best option when the ascending aorta is spared. Pathological conditions involving the aortic arch may be treated using a hybrid approach combining debranching of supra-aortic vessels and stent graft placement. Stent graft-induced remodeling of a dissected aorta seems to have long-term benefits in complicated and so-called uncomplicated type B dissections as almost every case reveals a risk profile and one in eight patients diagnosed with acute type B aortic dissection has either an IMH or a PAU. Pain is the most commonly presenting symptom of AAS and should prompt immediate attention including diagnostic imaging modalities, such as multislice computed tomography, transesophageal ultrasound and magnetic resonance imaging. A specific therapeutic approach is necessary for IMH and PAU because without treatment they have a very poor outcome, are unpredictable in evolution and can be more severe 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 monitored without interventions. 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 such patients. Irrespective of the treatment modality close surveillance is mandatory in order to monitor disease progression.
    09/2014; 85(9):774-81.
  • P Schmidt, T C Rehders, A Kaminski, C A Nienaber
    Deutsche medizinische Wochenschrift (1946). 09/2014; 139(39):1937-1938.
  • Deutsche medizinische Wochenschrift (1946). 09/2014; 139(39):1947-51.
  • B M Richartz, C A Nienaber
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    ABSTRACT: All women of child-bearing age suffering from congenital cardiac valve malformations or acquired valvular disease, pulmonary hypertension or arterial hypertension and who are at risk for coronary heart disease should receive early counseling and optimal treatment before pregnancy. They should be treated by an interdisciplinary team composed of gynecologists, cardiologists, geneticists and, if necessary, cardiac surgeons. This interdisciplinary approach should be used for all pregnant women with cardiac disease in order to minimize maternal and fetal mortality. As physicians will only rarely be confronted with such critically ill patients, guidelines and access to worldwide information from databanks are particularly important (http://www.safetus.com und http://www.emryotox.de).
    Herz 07/2014; · 0.78 Impact Factor
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    ABSTRACT: Drug-eluting stents (DES) have substantially reduced target vessel revascularization (TVR) after percutaneous coronary interventions. Risk factors for clinical events need to be redefined with this treatment option. In the prospective DES.DE registry, baseline clinical and angiographic characteristics as well as in-hospital and follow-up events were recorded for all enrolled patients. Between October 2005 and May 2009, 21,774 patients receiving DES were enrolled at 98 DES.DE sites. The composite of death, myocardial infarction (MI) and stroke defined as major adverse cardiac and cerebrovascular events (MACCE) and TVR were predefined as primary endpoints. At 1-year follow-up rates for overall death, MI, stroke, MACCE, TVR and definite stent thrombosis were 2.7, 3.1, 1.4, 7.1, 11.5 and 0.6 %, respectively. Aside from well-known risk factors like age, diabetes mellitus and triple-vessel disease, stratification in patients with or without MACCE revealed atrial fibrillation, non-ST-segment elevation myocardial infarction, renal failure, impaired ejection fraction and peripheral vascular disease as strong predictors of MACCE at 1 year. Data collected in the DES.DE registry, reflecting the clinical practice in Germany, revealed favorable clinical outcomes after DES implantation in a real world setting but also identifying several high-risk populations.
    Clinical Research in Cardiology 01/2014; · 3.67 Impact Factor
  • DMW - Deutsche Medizinische Wochenschrift 01/2014; · 0.65 Impact Factor
  • C A Nienaber, I Akin, S Kische, H Ince, T Chatterjee
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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
  • K Rotter, K Kroll, C A Nienaber, B Ismer
    Biomedizinische Technik/Biomedical Engineering 09/2012; · 1.16 Impact Factor
  • Biomedizinische Technik/Biomedical Engineering 08/2012; · 1.16 Impact Factor
  • Source
    International journal of cardiology 07/2012; · 6.18 Impact Factor
  • In Percutaneous Interventional Cardiovascular Medicine., 07/2012: chapter Thoracic and Abdominal Aortic Disease and Aortic Trauma.: pages 317-365; PCR Publishing., ISBN: 978-2-913628-57-1.
  • L Paranskaya, G D Ancona, C A Nienaber, H Ince
    Clinical Research in Cardiology 06/2012; · 3.67 Impact Factor
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    ABSTRACT: Das Marfan-Syndrom ist eine autosomal-dominant vererbte Bindegewebserkrankung mit Beteiligung des skelettalen, okulären und kardiovaskulären Systems. Die Erkrankung wird durch Mutationen im FBN1-Gen verursacht, das für das Glykoprotein Fibrillin, eine elementare Strukturkomponente der elastischen Fasern kodiert. Die Diagnose des Marfan-Syndroms basiert auf zwei Säulen, erstens der klinischen Evaluierung der Patienten, zweitens dem direkten Mutationsnachweis im FBN1-Gen. Inter- und intrafamiliäre Unterschiede im klinischen Erscheinungsbild erschweren die phänotypische Diagnostik. In dieser Arbeit wird die indirekte Genotypanalyse, in welcher die Segregation von allelischen DNA-Polymorphismen verfolgt wird, als ein zusätzliches Verfahren für die Diagnose vorgestellt. Mittels indirekter Genotypdiagnostik und in Kombination mit den klinischen Untersuchungsbefunden kann die Diagnose oder der Ausschluss des Marfan-Syndroms noch sicherer gestellt werden, insbesondere bei klinischen Grenzfällen. Marfan syndrome (MFS) is an autosomal dominant disorder of connective tissue characterized by skeletal, ocular and cardiovascular manifestations. The disease is caused by mutations in the FBN1 gene, encoding fibrillin, an important component of elastic fibers. Diagnosis of Marfan syndrome is currently based on detailed clinical examination and/or mutation analysis in the fibrillin gene. Clinical expression varies widely both among and within families, rendering clinical diagnosis extremely difficult. In this study, we performed segregation analysis of allelic DNA polymorphisms to support diagnosis of Marfan syndrome. This type of genotype analysis is a useful, additional diagnostic tool for families with Marfan syndrome and provides incremental information of diagnosis or exclusion of Marfan syndrome based on clinical findings. Schlüsselwörter–Marfan-Syndrom–Fibrillin 1-Gen–klinische Variabilität–indirekte GenotypdiagnostikKey words Marfan syndrome–fibrillin-1 gene–clinical variability–haplotype segregation analysis
    Zeitschrift für Kardiologie 04/2012; 89(10):939-948. · 0.97 Impact Factor
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    ABSTRACT: In-hospital outcome of acute type B dissection (ABAD) is strongly related to preoperative aortic conditions. In order to clarify the influence of the clinical presentation on the outcome, we analyzed the patients of the International Registry of Acute Aortic Dissection (IRAD). All patients affected by complicated ABAD, enrolled in the IRAD from 1996-2004, were included. Complications were defined as the presence of shock, periaortic hematoma, spinal cord ischemia, preoperative mesenteric ischemia/infarction, acute renal failure, limb ischemia, recurrent pain, refractory pain or refractory hypertension (group I). All other patients were categorized as uncomplicated (group II). A comprehensive analysis was performed of all clinical variables in relation to in-hospital outcome. The overall in-hospital mortality among 550 patients was 12.4%. Mortality in group I (250 patients) was 20.0 %, compared to 6.1% in group II (300 patients) (P<0.001). Univariate predictors of ABAD complications were Marfan syndrome, abrupt onset of pain, migrating pain, any focal neurological deficits, need for higher number of diagnostic examinations and use of magnetic resonance and/or aortogram, abdominal vessels involvement at aortogram, larger descending aortic diameter, especially >6 cm, pleural effusion, and widened mediastinum on chest X-ray. Univariate predictors of a non complicated status were normal chest X-ray and medical management. In group I, in-hospital mortality following surgical and endovascular intervention were 28.6% and 10.1% (P=0.006), respectively. Independent predictors of overall in-hospital mortality included age >70 years, female gender, ECG showing ischemia, preoperative acute renal failure, preoperative limb ischemia, periaortic hematoma, and surgical management. The only independent variable protective for mortality was magnetic resonance as diagnostic test. ABAD is a heterogeneous disease that produces dissimilar clinical subsets, each of which can have specific clinical signs, management and in-hospital results. In IRAD ABAD uncomplicated patients, medical therapy was associated with best hospital outcome, while endovascular interventions were associated with better results than surgery when invasive treatments were required. Although selection bias may be possible, and irrespective of treatments, knowledge of significant risk factors for mortality may contribute to a better management and a more defined risk-assessment in patients affected by ABAD.
    The Journal of cardiovascular surgery 04/2012; 53(2):161-8. · 1.51 Impact Factor
  • D Bänsch, R Schneider, I Akin, C A Nienaber
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    ABSTRACT: Ventricular tachycardias (VT), shocks, and clusters of shock are ominous signs in patients with implantable cardioverter-defibrillators and herald an increased risk of hospitalization and mortality. VT clusters have been associated with aggravation of heart failure (19%), acute coronary events (14%), and electrolyte imbalance (10%). Yet, any association of potential causative factors and aggravation of VT is vague. Maybe, in patients with any substrate for re-entry, progressive aggravation of ventricular dysrhythmias is to be expected. The high recurrence rate of electrical storm despite antiarrhythmic drug therapy supports this view. The optimal timing of VT ablation is unknown, but current convention is to perform VT ablation after shock clusters or incessant VT has occurred. Preemptive VT ablation before VT has occurred is rarely performed (only in 15% of active centers) and the majority of centers never perform VT ablation even after the first shock. Such practice is within guidelines that recommend VT ablation only in ICD patients with recurrent or incessant VT. However, there is strong data in support of preemptive VT ablation.
    Herzschrittmachertherapie & Elektrophysiologie 03/2012; 23(1):38-44.
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    ABSTRACT: OBJECTIVE: The purpose of the economic evaluation of the German Drug-Eluting Stent (DES) registry includes the investigation of the economic impact and cost-effectiveness of DES compared to bare-metal stents (BMS) and between paclitaxel-eluting (PES) and sirolimus-eluting stents (SES). Here, methodology and initial results are presented. METHODS: Patients were recruited in 2005 and 2006 in 87 centres across Germany. Selection of PES, SES, or BMS was made at the discretion of the cardiologists in charge. Clinical, economic, and quality of life (QoL) data were collected at baseline and up to 12 months. Group comparisons were conducted using Fisher's exact and t test. RESULTS: Overall, 3,930 patients were enrolled: 3,471 (75% male, 65 ± 11 years) received DES and 458 (74% male, 67 ± 11 years) BMS. Among the DES patients, 1,821 received PES (75% male, 65 ± 10 years) and 1,600 SES (76% male, 65 ± 11 years). There were baseline differences in clinical and procedural characteristics but not in QoL. During the hospital stay, major adverse cardiac and cerebrovascular events occurred in 1.6% of DES (PES 1.9%, SES 1.1%) and 2.2% of BMS patients (BMS vs. DES, PES, and SES p = 0.327, 0.706, and 0.098, respectively). Hospital treatment costs were 4,989 ± 1,284 and 3,609 ± 924 , respectively, in DES and BMS patients (p < 0.001) with no significant difference between PES and SES. CONCLUSION: The economic evaluation of the large DES registry demonstrates increased initial hospitalisation costs associated with DES compared to BMS. Further analysis of the economic impact and cost-effectiveness of DES will provide estimates on large "real world" patient populations for decision makers and aid in reimbursement decisions of DES within the German and other health care systems.
    Herz 02/2012; · 0.78 Impact Factor
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    ABSTRACT: Implantable cardioverter-defibrillators (ICDs) terminate ventricular tachycardia (VT) and ventricular fibrillation (VF) with high efficacy and can protect patients from sudden cardiac death (SCD). However, inappropriate shocks may occur if tachycardias are misdiagnosed. Inappropriate shocks are harmful and impair patient quality of life. The risk of inappropriate therapy increases with lower detection rates programmed in the ICD. Single-chamber detection poses greater risks for misdiagnosis when compared with dual-chamber devices that have the benefit of additional atrial information. However, using a dual-chamber device merely for the sake of detection is generally not accepted, since the risks associated with the second electrode may outweigh the benefits of detection. Therefore, BIOTRONIK developed a ventricular lead called the Linox(SMART) S DX, which allows for the detection of atrial signals from two electrodes positioned at the atrial part of the ventricular electrode. This device contains two ring electrodes; one that contacts the atrial wall at the junction of the superior vena cava (SVC) and one positioned at the free floating part of the electrode in the atrium. The excellent signal quality can only be achieved by a special filter setting in the ICD (Lumax 540 and 740 VR-T DX, BIOTRONIK). Here, the ease of implantation of the system will be demonstrated.
    Journal of Visualized Experiments 01/2012;

Publication Stats

3k Citations
559.17 Total Impact Points

Institutions

  • 2003–2013
    • University of Rostock
      • • Institut für Medizinische Genetik
      • • Abteilung Kardiologie
      Rostock, Mecklenburg-Vorpommern, Germany
  • 1987–2012
    • Universität Hamburg
      • • Department of Human Genetics
      • • University Heart Center
      • • Department of Cardiovascular Surgery
      • • Department of Nuclear Medicine
      • • Paediatric Cardiology / Paediatric Cardiac Surgery
      Hamburg, Hamburg, Germany
  • 2011
    • Asklepios Klinik St. Georg
      Hamburg, Hamburg, Germany
  • 2009
    • Klinik Hirslanden
      Zürich, Zurich, Switzerland
    • Charité Universitätsmedizin Berlin
      Berlín, Berlin, Germany
    • University of Colorado
      • Division of General Internal Medicine
      Denver, CO, United States
  • 1988–2001
    • University Medical Center Hamburg - Eppendorf
      • Department of Nuclear Medicine
      Hamburg, Hamburg, Germany