Stefan Brunner’s research while affiliated with German Centre for Cardiovascular Research and other places

Heart failure and cardiac decompensation, often leading to recurrent hospitalizations, significantly impair quality of life and life expectancy. Monitoring hydration status is crucial in managing these patients. Although body impedance analysis (BIA) is a simple, cost-effective, and noninvasive method, its clinical application remains underutilized worldwide. Given its potential to improve therapy management, this study aimed to evaluate the feasibility of repetitive BIA measurements in patients hospitalized for acute heart failure in a real-world clinical setting. Thirty two patients hospitalized for acute heart failure were enrolled in this prospective cohort study between June 8, 2021, and May 16, 2022. Repetitive measurements of body weight and composition were performed on admission, day 3, and day 6. All measurements were performed by previously untrained medical staff after a 10-minute introduction. We observed a significant decrease in body weight by 2.02 kg ( P < .001) within the first 3 days under diuretic therapy, which corresponded to a significant loss of body water (−1.51 kg; P = .013) and a slight loss of body fat (−1.41 kg; P = .002). Subsequent measurements on day 6 showed variable results. An additional loss of body weight (−1.63 kg; P ≤ 0.001) was mainly driven by a reduction of fat (−1.01 kg; P = .040) and body cell mass (−1.91 kg; P = .027). Only few patients benefited from further intensified diuretic therapy with a subsequent loss of body water (−0.51 kg; P = .580). BIA provides essential data on body composition, which cannot be assessed by simple weight measurements as these may be altered by simultaneous changes in fat or body cell mass. BIA measurements are feasible and easy to learn and should be implemented in routine cardiovascular care.

In den letzten Jahren erfreut sich der alpine Freizeitsport wachsender Beliebtheit, nicht nur unter Freizeitsportlern, sondern zunehmend auch bei Personen mit Herz-Kreislauf-Erkrankungen. Die Thrombozytenaktivierung spielt eine zentrale Rolle beim Auftreten von kardiovaskulären Ereignissen wie Myokardinfarkt oder Schlaganfall. Die Kenntnis der physiologischen Veränderungen der Thrombozytenaktivierung unter alpiner sportlicher Betätigung hat deshalb eine maßgebliche Bedeutung, um das Risiko für dieses Patientenkollektiv besser einschätzen und dementsprechend präventiv Einfluss nehmen zu können.

Background In a recent meta-analysis of randomized controlled trials routine use of venous-arterial ECMO (VA-ECMO) did not improve outcome in patients with infarct related cardiogenic shock (CS). Since the rate of patients with cardiac arrest and the need for cardio-pulmonary resuscitation was over 75 %, it has been speculated that a more selective approach might improve the effectiveness of VA-ECMO. Methods Patients included in four randomized clinical trials investigating the routine use of VA-ECMO in CS were centrally analysed. For the purpose of this sub-analysis only patients who would have been eligible for inclusion into the Dan-Ger SHOCK trial were analyzed (STEMI only, exclusion of comatose patients after out-of hospital cardiac arrest). The primary endpoint was 180-day total mortality. Results A total of 202 patients (106 randomised to VA-ECMO and 96 to control) were included into this analysis. There were no differences in baseline characteristics, angiographic and interventional features between the two groups. The table summarizes the results and revealed non-significant trends towards a reduced mortality with VA-ECMO. Conclusions In non-comatose patients with CS and STEMI the routine use of VA-ECMO is associated with a numerically lower mortality after 6 months. However, as indicated by the large confidence intervals the statistical power was limited, to draw definite conclusions. Therefore, a prospective trial with VA-ECMO in these patients seems warranted.Table

Background and Aims Acute excessive alcohol intake may cause the holiday heart syndrome, characterized by cardiac arrhythmias including atrial fibrillation. Since underlying data are scarce, the study aimed to prospectively investigate the temporal course of occurring cardiac arrhythmias following binge drinking in young adults. Methods A total of 202 volunteers planning acute alcohol consumption with expected peak breath alcohol concentrations (BACs) of ≥1.2 g/kg were enrolled. The study comprised 48 h electrocardiogram monitoring covering baseline (Hour 0), ‘drinking period’ (Hours 1–5), ‘recovery period’ (Hours 6–19), and two control periods corresponding to 24 h after the ‘drinking’ and ‘recovery periods’, respectively. Acute alcohol intake was monitored by BAC measurements during the ‘drinking period’. Electrocardiograms were analysed for mean heart rate, atrial tachycardia, premature atrial complexes, premature ventricular complexes (PVCs), and heart rate variability measures. Results Data revealed an increase in heart rate and an excess of atrial tachycardias with increasing alcohol intake. Heart rate variability analysis indicated an autonomic modulation with sympathetic activation during alcohol consumption and the subsequent ‘recovery period’, followed by parasympathetic predominance thereafter. Premature atrial complexes occurred significantly more frequently in the ‘control periods’, whereas PVCs were more frequent in the ‘drinking period’. Ten participants experienced notable arrhythmic episodes, including atrial fibrillation and ventricular tachycardias, primarily during the ‘recovery period’. Conclusions The study demonstrates the impact of binge drinking on heart rate alterations and increased atrial tachycardias during ‘drinking period’, and the occurrence of clinically relevant arrhythmias during the ‘recovery period’, emphasizing the holiday heart syndrome as a health concern.

Background Sports-related physical activity is associated with an increased risk of ventricular dysfunction and arrhythmias in patients with arrhythmogenic right ventricular cardiomyopathy (ARVC). However, there are currently no standardized strategies for activity assessment. Thresholds for harmful levels of physical activity suggested by previous studies vary substantially and neither life-time activity burden nor continuous modelling approaches were considered. Methods For this single-center retrospective study, ARVC patients were interviewed to assess sports-related and non-sports-related physical activity between the age of 10 years and last follow-up. Activity data were aggregated to median metabolic equivalent of task - hours (METh) per week for each year. The association between cumulative physical activity burden and clinical study endpoints was investigated using Cox regression models. Results 124 patients (median age: 39.5 years, 48% male) were included in the analysis, of whom 93 had been diagnosed with definite ARVC. Study participants reported a median overall activity of 202.3 METh/week, with 38.7 METh/week attributed to sports-related activity. In the continuous model, cumulative overall activity burden was associated with the occurrence of symptomatic heart failure (hazard ratio [HR] per 100 METh/week: 1.017, 95%CI [1.003, 1.032], p=0.015), sustained ventricular tachycardia (HR: 1.021, 95%CI [1.006, 1.037], p=0.007), and implantable cardioverter-defibrillator interventions (HR: 1.017, 95%CI [1.000, 1.034], p=0.048). This finding was consistent when considering sports-related activity separately as a predictor variable, whereas the resulting hazard ratios did not show a significant association for non-sports-related physical activity. Conclusion This study demonstrates for the first time that cumulative physical activity as a continuous predictor variable is associated with symptomatic heart failure and arrhythmic risk in ARVC patients. Collaborative research is required in larger cohorts to investigate the influence of potential confounders on event occurrence and to develop threshold recommendations for clinical practice.

Introduction Hypertension is a major cause of premature death worldwide as it is an important risk factor for coronary artery disease, myocardial infarction, heart failure and stroke. Although an estimated 1.3 billion adults suffer from hypertension, less than half of them are diagnosed correctly and therefore receive sufficient treatment. Furthermore, only one fifth of those treated reach the therapy target of normotension. This significant deficit underlines the need for new therapy concepts to improve long-term health outcomes. Several studies have shown positive effects of digital health programmes in the disease management of ambulatory, long-term hypertension treatment. More research is needed to explore the abilities of digital health programmes as an innovative pathway in ambulatory healthcare. The eXPLORE study aims to evaluate the feasibility of a clinical trial on the impact of a supplementary digital therapy programme for the treatment of primary arterial hypertension. Methods and analyses The eXPLORE study collects data in the setting of a prospective randomised controlled trial to evaluate methodological feasibility for larger-scaled follow-up research. The study compares a digital therapy programme using a smartphone application that is based on functions and algorithms creating tasks and recommendations based on individual health data to standard care for the treatment of primary arterial hypertension. The study period is 180 days, with a 90-day in-life phase followed by a 90-day follow-up phase. Baseline and follow-up data (3 months, 6 months follow-up) of all participants included is collected via questionnaire surveys as well as self-administered blood pressure monitoring. Patient inclusion, initial data acquisition and follow-up were carried out in an innovative remote setting. The study was initiated in November 2022 and is currently ongoing. Study outcome measures are changes in mean blood pressure, health literacy and self-sufficient health behaviour. Ethics and dissemination The eXPLORE study is carried out in accordance with all applicable legal regulations. Cost-effectiveness is assured by continuous evaluation and documentation over the course of the study. All health-relevant data from the eXPLORE study will be provided for analyses and publication to the investigators of LMU Hospital. The study was approved by the local ethics committee of LMU Munich (project nr.: 22–0115). Trial registration NCT05580068 . Protocol Version: 1.5, 28.08.2023.