Cornelia Piper

Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, Germany

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Publications (149)396.27 Total impact

  • Cornelia Piper · Dieter Horstkotte
    No preview · Article · May 2016 · Der Klinikarzt
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Chronic viral infections of the heart are considered one antecedent event leading to progressive dysfunction of the myocardium, often with an impaired prognosis due to a virus- or immune-mediated myocardial injury. Symptomatic treatment does not influence the viral cause of heart failure, and the effect of antiviral treatment has not been determined, yet. Methods and results: In this phase II study 143 patients with symptoms of heart failure and biopsy-based confirmation of the enterovirus (EV), adenovirus, and/or parvovirus B19 genomes in their myocardial tissue were randomly assigned to double-blind treatment, and received either placebo (n = 48) or 4 × 10(6) (n = 49) and 8 × 10(6) IU (n = 46) interferon beta-1b (IFN-β-1b) for 24 weeks, in addition to standard heart failure treatment. Patients with active myocarditis or other specific causes of heart failure were excluded. Compared to placebo, virus elimination and/or virus load reduction was higher in the IFN-β-1b groups (odds ratio 2.33, p = 0.048), similarly in both interferon groups and both strata. IFN-β-1b treatment was associated with favourable effects on NYHA functional class (p = 0.013 at follow-up week 12), improvement in quality of life (Minnesota Heart Failure score; p = 0.032 at follow-up week 24) and patient global assessment (follow-up week 12 to follow-up week 24; p = 0.039). The frequency of adverse cardiac events was not higher in the IFN-β-1b groups compared to the placebo group. Conclusions: Immunomodulatory IFN-β-1b treatment is a well-tolerated and safe treatment option, leading to effective virus clearance or reduction of the virus load in patients with chronic viral cardiomyopathy. Favourable clinical effects assess quality of life, NYHA functional class, and patient global assessment. ClinicalTrials.gov identifier: NCT001185250.
    No preview · Article · Apr 2016 · Clinical Research in Cardiology
  • No preview · Article · Apr 2016 · Journal of the American College of Cardiology
  • No preview · Article · Oct 2015 · Journal of the American College of Cardiology
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    No preview · Dataset · Sep 2015
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    [Show abstract] [Hide abstract] ABSTRACT: The European Cubicin(®) Outcomes Registry and Experience (EU-CORE(SM)) was a retrospective, non-interventional, multicenter study which evaluated the safety and effectiveness of daptomycin therapy in patients with Gram-positive infections including infective endocarditis (IE). Data from the EU-CORE registry were collected for patients with IE who had received at least one dose of daptomycin between January 2006 and April 2012, across 18 countries in Europe (12), Latin America (5) and Asia (1). Clinical outcomes were assessed as success (cured or improved), failure or non-evaluable. Adverse events (AEs) were recorded during treatment and for up to 30 days post-treatment; follow-up data were collected for 2 years. Of 6075 patients included in the EU-CORE registry, 610 were diagnosed with IE as primary infection; 149 (24.4%) right-sided IE (RIE), 414 (67.9%) left-sided IE (LIE), and 47 (7.7%) with both right- and left-sided IE (BRLIE). Overall clinical success was achieved in 80.0% of patients (RIE 88.6%, LIE 76.6% and BRLIE 82.9%). Success rates for methicillin-resistant Staphylococcus aureus (MRSA) infections were 90.9%, 71.7% and 66.6% in patients with RIE, LIE and BRLIE, respectively. The overall sustained clinical success rate in patients followed for up to 2 years was 86.7% (RIE 93.5%, LIE 88.3% and BRLIE 77.8%). AEs deemed possibly related to daptomycin in the investigator's opinion were reported in 2 (1.3%) RIE, 18 (4.3%) LIE and 1 (2.1%) BRLIE patients. There were 11 (1.8%) patients (2 with RIE, 8 with LIE and 1 with BRLIE) with AEs of creatine phosphokinase elevation reported as possibly related to daptomycin. Data from this real-world clinical setting showed that daptomycin was well tolerated and effective for the treatment of LIE and BRLIE in addition to RIE caused by Gram-positive bacteria, including MRSA. Two-year follow-up data showed that a high proportion of patients had a sustained response.
    Full-text · Article · Jul 2015
  • Cornelia Piper · Dieter Horstkotte
    No preview · Article · Jun 2015 · Frauenheilkunde up2date
  • Cornelia Piper · Lothar Faber · Dieter Horstkotte
    No preview · Article · Jun 2015 · DMW - Deutsche Medizinische Wochenschrift
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    D Horstkotte · C Piper
    Preview · Article · Jun 2015 · Herz
  • D Horstkotte · C Piper
    [Show abstract] [Hide abstract] ABSTRACT: Die mikrobielle Besiedelung kann native Herzklappenstrukturen oder intrakardial implantiertes Fremdmaterial (Herzklappenprothesen oder Elektroden = polymerassoziierte Endokarditis, PIE) betreffen. Allgemeine Krankheitssymptome bestehen bei nahezu allen, kontinuierliches oder remittierendes Fieber bei rund 90% der Patienten. Ein bei etwas mehr als der Hälfte der Betroffenen vorhandenes, neu aufgetretenes Herzklappeninsuffizienzgeräusch ist diagnostisch wegweisend. Regelhaft finden sich Leukozytose, BSG- und CRP-Erhöhungen. Unabhängig vom Fieberverlauf sind vor einer Antibiotikabehandlung mindestens drei Blutkulturpaare zu entnehmen. Die Erregeridentifikation bis zur Spezies und die Testung der minimalen Hemmkonzentration im quantitativen Reihenverdünnungstest sind obligat. Grampositive Erregerspezies (Streptokokken, Staphylokokken, Enterokokken) dominieren wegen ihrer besonderen Adhäsionsfähigkeit an endokardständigen Thromben. Eine transthorakale Echokardiographie ist bei jedem Endokarditisverdacht dringlich durchzuführen. Bei möglicher Beteiligung intrakardialer Implantate, unzureichender Bildqualität oder unbestätigtem Endokarditisverdacht ist eine transösophageale Echokardiographie unverzichtbar. Eine unzureichende Therapiedauer bedingt die Gefahr der Rezidivinfektion, sodass eine 4-wöchige, bei Beteiligung von Polymermaterial 6-wöchige intravenöse Therapie die Regel ist. Treten typische Komplikationen wie lokal unkontrolliert verlaufende Infektionen (z. B. Abszessnachweis), systemische Thromboembolien, ZNS-Beteiligung, schwere akute Klappeninsuffizienzen und/oder mitrale Abklatschvegetationen bei primärer Aortenklappenendokarditis hinzu, verbessert eine dringliche Operation die Prognose. Bei PIE erschwert die Interaktion von Polymermaterial, Biofilmen und Bakterienoberflächen die antibiotische Sanierung, sodass eine unverzügliche komplette Entfernung allen Polymermaterials bzw. des gesamten Implantats therapeutischer Standard ist.
    No preview · Article · Apr 2015 · Herz
  • Cornelia Piper · Lothar Faber · Dieter Horstkotte
    No preview · Article · Mar 2015 · DMW - Deutsche Medizinische Wochenschrift
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Constrictive pericarditis (CP) is challenging in diagnosis and treatment. Echocardiographic characteristics of consctrictio has been studied, however little is known about the reversibility of the characteristics during short and long term follow-up after surgical pericardiectomy. Method and Results: A retrospective review found 46 patients (56.5 ± 14.9 yrs) with the diagnosis of CP confirmed by echocardiography and right-sided heart catherization. Echocardiographic exams were available at time of diagnosis and in 22 patients at short and long term follow-up. Most prevalent etiology was rheumatic/inflammatory disease. At time of diagnosis the most significant features were: dilated inferior vena cava (IVC) in 100% (mean 25 ± 4mm), diastolic retrograde liver vein flow (rLVF) in 90%, abnormal presenting pericardium in 98%, septal bounce (SB) in 98%, high for age diastolic septal tissue doppler velocity (septal e') of 13.2 ± 3.9cm/s with a ratio of septal to medial e' of 1.01 ± 0.33. Mitral inflow deceleration time MvDT was general low with a mean of 135 ± 31 msec (range 90-230), but in 29% of patients the MvDT was normal (>140msec) and abnormal respiratory mitral inflow variation (resp. Mvvar) (>25%) was only present in 53%. Early after pericardiectomy (mean 8.8 ± 8 days) the only echocardiographic parameters that was significantly changed was: increased MvDT (22.1 ± 30.7msec, p=0.003), decreased septal e' (3.9 ± 2.8 cm/sec, p=0.006), reduced proportion of patients with abnormal resp. Mvvar (53% vs. 6%,p=0.003). All other of the above mentioned characteristics of CP remained unchanged. At late follow-up (mean 32 ± 27 months) many of the echocardiographic CP characteristics was changed towards normal: decreased IVC diameter (-4.3 ± 4.9mm, p=0.016) but still dilated in 82%, increased MvDT (35.9 ± 47.3 ms, p=0.007), decreased septal e' (-7.0 ± 3.6cm/s, p=0.0004) and decreased lateral e' (-4.5 ± 4.1, p=0.004) with a concomitant normalization of the ratio of septal to lateral e' to 1.44 ± 0.21. The proportion of patients with abnormal resp. Mvvar was reduced to zero and the presence of SB was significantly reduced from 98% to 70% (p=0.009), the rLVF was unchanged present in 44% (NS) as well as the presence of abnormal pericardium in 95%(NS). Conclusions. Specific echocardiographic parameters can be pointed out as characteristic at the time of CP diagnosis like: dilated IVC, SB, rLVF, high septal e' with an abnormal ratio of septal to lateral e'. Many parameters return towards normal at late follow-up but SB and dilated IVC, rLVF as well as an abnormal presenting pericardium remains abnormal in a high proportion of patients.
    No preview · Article · Dec 2014 · European Heart Journal – Cardiovascular Imaging
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    No preview · Dataset · Apr 2014
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    [Show abstract] [Hide abstract] ABSTRACT: The coxsackie and adenovirus receptor (CAR) mediates the entry of coxsackievirus B (CVB) and adenovirus into host cells and is, therefore, a key determinant for the molecular pathogenesis of viral diseases such as myocarditis. The aim was to investigate the influence of HMG-CoA reductase inhibitor lovastatin on CAR expression in endothelial cells. Human umbilical vein endothelial cells (HUVECs) were exposed to different concentrations of lovastatin (0.05-5 μmol/l) for up to 48 h. Alterations in CAR expression were examined by quantitative real-time PCR (qRT-PCR) and flow cytometry. In addition, after treatment with 1 μmol/l lovastatin for 48 h, HUVECs were infected for 8 h with CVB3 and virus replication was detected by qRT-PCR using viral-specific TaqMan probes. We found that lovastatin decreases CAR mRNA expression by up to 80 % (p < 0.01) and CAR protein expression by up to 19 % (p < 0.01), in a concentration-dependent manner. Moreover, virus replication of CVB3 was significantly inhibited after lovastatin treatment (p < 0.05). The signaling mechanism of CAR down-regulation by lovastatin depends on the Rac1/Cdc42 pathway. This study shows for the first time that lovastatin reduces the expression of CAR and subsequently the replication of CVB3 in HUVECs. Full paper here: http://link.springer.com/article/10.1007/s00011-013-0695-z
    Full-text · Article · Dec 2013 · Agents and Actions
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    [Show abstract] [Hide abstract] ABSTRACT: We examined the prevalence of sleep-disordered breathing (SDB) in patients with severe aortic valve stenosis (AS) and the impact of transfemoral aortic valve implantation (TAVI) on SDB. 79 patients underwent cardiorespiratory polygraphy (PG) before TAVI (CoreValve™), 62 of them a second PG after the procedure. Forty-nine (62 %) patients had obstructive sleep apnea (OSA), 25 (32 %) central sleep apnea (CSA), and 5 (6 %) presented without significant SDB (apnea-hypopnea index (AHI) < 5/h). Among the 62 patients evaluated before and after TAVI, 36 (58 %) had OSA, 22 (36 %) CSA, and 4 patients (7 %) no SDB. AHI was significantly higher in CSA patients than in OSA patients (34.5 ± 18.3 vs. 18.0 ± 12.6/h, p < 0.001). Successful TAVI had a significant impact on CSA but not on OSA: CSA patients with optimal TAVI results experienced a significant reduction in central respiratory events (AHI 39.6 ± 19.6-23.1 ± 16.0/h, p = 0.035), while no changes were detected in OSA patients (AHI 18.8 ± 13.0-20.25 ± 13.4/h, p = 0.376). In contrast, in patients who developed at least moderate periprosthetic aortic regurgitation (AR > I), CSA increased significantly (AHI 26.3 ± 13.2-39.2 ± 18.4/h, p = 0.036), whereas no acute change was seen in patients with OSA (AHI 10.5 ± 7.8-12.5 ± 5.0/h, p = 0.5). OSA and CSA are prevalent in more than 90 % of patients undergoing TAVI for severe aortic valve stenosis. Successful TAVI had no significant impact on OSA but improved CSA. In case of an acute change from pressure overload (aortic stenosis) to acute volume overload (aortic regurgitation after TAVI), central, but not obstructive, sleep apnea deteriorated.
    Full-text · Article · Aug 2013 · Clinical Research in Cardiology
  • [Show abstract] [Hide abstract] ABSTRACT: Fibroblast activity within the heart may be considered a basically constructive process. Hyperactivity of fibroblasts, however, may result in the accumulation of extracellular matrix proteins with adverse effects on cardiac structure and function including electrical instability and increased risk of arrhythmogenic cardiac death. The detection of cardiac fibrosis by dedicated imaging techniques, mainly gadolinium-enhanced MRI, holds promise to refine patient management in a variety of cardiac conditions. This review aims to summarize the current knowledge regarding fibrosis in hypertrophic cardiomyopathy.
    No preview · Article · Apr 2013 · Expert Review of Cardiovascular Therapy
  • Patrick Schöner · Dieter Horstkotte · Cornelia Piper
    [Show abstract] [Hide abstract] ABSTRACT: Psychological symptoms are common in patients with heart disease. Objective of this study was to analyse the effects of somatic factors on anxiety and depression in hospitalised patients with heart failure. We examined 150 patients by short-term interview and standardized questionaire (HADS-D) and performed a written survey 3 months later. In 47% of the patients signs of anxiety and in 30% signs of depression were present. Increased heart failures severity was associated with increased rates of anxiety and depression. 3 months after hospital discharge the percentage of patients who reported symptoms of anxiety had decreased, the percentage of depressive female patients had increased. The course of anxiety and depression was not affected by cardiologic treatment. Patients with severe signs of anxiety and/or depression should receive specific diagnostics and therapy.
    No preview · Article · Mar 2013 · PPmP - Psychotherapie · Psychosomatik · Medizinische Psychologie
  • D Horstkotte · C Prinz · C Piper
    [Show abstract] [Hide abstract] ABSTRACT: An intervention for chronic acquired valvular heart disease may either be indicated in symptomatic patients to relieve symptoms and improve quality of life or in asymptomatic patients to improve long-term prognosis, e.g., by preventing disease-related complications like chronic heart failure or arrhythmias. For proper action according to current guidelines, the systematic evaluation of symptoms related to the underlying valve disease is of utmost importance. If a discrepancy between symptoms reported or not reported by the patients and the severity of the valve disease is supposed, true absence of symptoms and exercise tolerance should be verified by spiroergometry. In the truly asymptomatic patient with a severe valvular lesion, preservation of myocardial adaption to the chronic volume or pressure overload should be tested utilizing appropriate imaging techniques like radionuclide ventriculography under exercise conditions. The proper evaluation of the functional status is of growing importance in our aging population with its sedentary lifestyle. In this context, the results of a survey should be kept in mind, which indicated that a significant proportion of patients still have interventions too late during the natural history of their valve disease with symptoms of congestive heart failure, arrhythmias, and the risk of sudden cardiac death persisting after a primarily successful valve repair or replacement.
    No preview · Article · Jan 2013 · Der Internist
  • No preview · Article · Nov 2012 · Circulation
  • [Show abstract] [Hide abstract] ABSTRACT: Fragestellung: Veränderungen der Na+Ca2+-Exchanger (EXCH)-Expression werden als Ausdruck einer gestörten Calciumhomöostase angesehen. Da sich diastolische und systolische Funktionsstörungen lange vor Manifestation einer terminalen Herzinsuffizienz einstellen, untersuchten wir bei 22 Patienten mit chronischen Herzklappenfehlern (HKF), in welchem Stadium der myokardialen Funktionsstörung eine Hochregulation des EXCH erfolgt und ob diese ggf. frühzeitig eine Erschöpfung der myokardialen Adaptationsmechanismen an chronische Druck- und/oder Volumenbelastung anzeigt.¶   Methoden: Mittels quantitativer RT-PCR wurde die Transkriptionshöhe des EXCH in endomyokardialen Biopsien von 11 Patienten mit Aortenstenosen (AS), 5 mit Aorteninsuffizienzen (AI) und 6 mit primären Mitralinsuffizienzen (MI) unterschiedlicher hämodynamischer Schweregrade bestimmt. Zusätzlich wurde endomyokardiales Gewebe von 13 explantierten, terminal insufffizienten Herzen untersucht. Als Kontrollgruppe diente endomyokardiales Gewebe von sieben Individuen bei denen letztlich eine Herzerkrankung ausgeschlossen werden konnte.¶   Ergebnisse: Die Menge an EXCH mRNA betrug im Myokard der Kontrollgruppe 2,6±1,2amol/ng totaler RNA und unterschied sich nicht von der Menge an EXCH mRNA bei AS (1,8±1,4amol/ng totaler RNA), AI (1,9±0,8amol/ng) oder MI (2,2±2,1amol/ng). Im Myokard explantierter terminal insuffizienter Herzen fand sich dagegen eine deutlich erhöhte Menge an EXCH mRNA (8,9±1,9amol/ng).¶Zwischen der EXCH-Transkription und dem Schweregrad des Vitiums oder der konsekutiven Einschränkung der linksventrikulären Pumpfunktion bestand kein Zusammenhang: Cardiac Index (CI) >3,5l/min/m2 (EXCH 1,4±1,1amol/ng totaler RNA); CI 3,5–2,4 (EXCH 2,5±1,8); CI <2,4 (EXCH 1,8±1,0); EF-angio >50% (EXCH 1,9±1,8), EF-angio ≤50% (EXCH 1,9±0,9); EF-RNV >50% (EXCH 2,4±1,8), EF-RNV ≤50% (EXCH 1,7±1,0).¶   Schlussfolgerung: Die myokardialen EXCH-Transkriptionsmengen ändern sich bei HKF nicht parallel zur Ausbildung einer myokardialen Pumpfunktionsstörung. EXCH scheint daher nicht geeignet, eine beginnende Erschöpfung der myokardialen Adaptation an chronische Volumen- und/oder Druckbelastungen zu detektieren. Background: Na+-Ca2+ exchanger (EXCH) is an important regulator of intracellular calcium homeostasis. To maintain a normal intracellular Ca2+ concentration, EXCH expression may be upregulated before the onset of end-stage heart failure. We tested for a correlation between the EXCH transcription level and the degree of myocardial dysfunction as well as the suitability of EXCH transcription as a molecular marker for early detection of a transition from adequate to inadequate myocardial adaptation to chronic pressure and/or volume overload in valvular heart disease (VHD).¶   Methods: The level of EXCH transcription was analyzed in myocardial biopsies from eleven patients with aortic stenosis (AS), five with aortic regurgitation (AR) and six with primary mitral regurgitation (MR) of different hemodynamic severity and myocardial impairment using the quantitative rt-PCR technique. In addition, endomyocardial tissue from thirteen explanted hearts with end-stage heart failure and biopsies from seven individuals without heart disease were investigated.¶   Results: The mean level of EXCH transcription in patients with AS was: 1.8±1.4amol/ng total RNA, with AR: 1.9±0.8amol/ng and with MR: 2.2±+2.1 amol/ng. This was not from different controls (2.6±1.2 amol/ng total RNA). However, in myocardium from end-stage heart failure, EXCH transcription was increased fourfold amounting to 8.9±1.9amol/ng total RNA. No difference in the EXCH transcription was found in VHD with respect to the degree of myocardial dysfunction: cardiac index (CI) >3.5l/min/m2 (EXCH 1.4±1.1amol/ng total RNA); CI 3.5–2.4 (EXCH 2.5±1.8); CI <2.4 (EXCH 1.8±1.0); EF-angio >50% (EXCH 1.9±1.8); EF-angio ≤50% (EXCH 1.9±0.9); EF-RNV >50% (EXCH 2.4±1.8), EF-RNV ≤50% (EXCH 1.7±1.0).¶   Conclusion: Myocardial EXCH transcription does not change parallel to the degree of myocardial dysfunction in VHD. Consequently, myocardial EXCH transcription does not appear to be suitable as a parameter indicating the transition from adequate to inadequate myocardial adaptation to chronic volume and/or pressure overload. Schlüsselwörter Natrium-Calcium-Exchanger – Herzklappenfehler – myokardiale Adaptation – endomyokardiale Biopsie – terminale Herzinsuffizienz Key words Sodium-calcium exchanger – heart valve disease – endomyocardial biopsy – myocardial adaptation – end-stage heart failure
    No preview · Article · Apr 2012 · Zeitschrift für Kardiologie

Publication Stats

1k Citations
396.27 Total Impact Points

Institutions

  • 1999-2014
    • Ruhr-Universität Bochum
      Bochum, North Rhine-Westphalia, Germany
  • 2012
    • Franziskus Hospital Bielefeld
      Bielefeld, North Rhine-Westphalia, Germany
  • 2007-2009
    • Herz- und Diabeteszentrum Nordrhein-Westfalen
      • Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia
      Bad Oeyhausen, North Rhine-Westphalia, Germany
  • 2003
    • Krankenhaus Bad Oeynhausen
      Bad Oeyhausen, North Rhine-Westphalia, Germany
  • 1997-2000
    • Freie Universität Berlin
      Berlín, Berlin, Germany