Publications by authors named "Dirk Von Lewinski"
Background: Invasive pulmonary aspergillosis (IPA), once limited to immunocompromised patients, is now a severe complication in critically ill ICU patients without classic risk factors. Due to the difficulty of obtaining histological evidence, its diagnosis relies on poorly tested algorithms in real-world settings.
Methods: We conducted a retrospective multicenter (n=9) cohort study including 202 patients with IPA.
Ambient air pollution is a significant public health concern, known to affect cardiovascular health adversely. Research has identified both long-term and short-term cardiovascular risks associated with various air pollutants, including those linked to acute coronary syndromes. However, the observed effects are rather small, with most data sourced from highly polluted regions.
View Article and Find Full Text PDFSodium-glucose cotransporter 2 (SGLT2, SLC5A2) is a promising target for a new class of drug primarily established as kidney-targeting as well as emerging class of glucose-lowering drugs in diabetes. Studies showed that SGLT2 inhibitors also have a systemic impact via indirectly targeting the heart and kidneys which exerts broad cardio- and nephroprotective effects. Additionally, as cancer cells tightly require glucose supply, studies also questioned how SGLT2 inhibitors impact molecular pathology and cellular metabolism in cancer hallmarks.
View Article and Find Full Text PDFAims: The optimal timing for implementing mechanical circulatory support (MCS) in cardiogenic shock (CS) remains indeterminate. This study aims to evaluate patient characteristics and outcome associated with the time interval between CS onset and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implementation.
Methods And Results: In this study, patients with CS treated with MCS at 15 tertiary care centres in three countries were enrolled.
Patients with transthyretin amyloid cardiomyopathy (ATTR-CM) represent a high-risk heart failure population with continued unmet therapeutic needs. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) improve cardiovascular outcomes in patients with heart failure across the whole spectrum of ejection fraction, and first evidence regarding their safety and effectiveness in patients with ATTR-CM is arising. This study investigates the association between SGLT2i therapy and clinical outcomes in these patients.
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- The study investigates the significance of cardiac troponin (cTn) levels in predicting mortality in patients with Takotsubo syndrome (TTS), analyzing data from the International Takotsubo Registry.
- It identifies that a cTn increase greater than 28.8 times the upper reference limit signals clinically relevant myocardial injury, correlating with a higher risk of mortality over 5 years (adjusted HR 1.58).
- The findings enhance understanding of patient risk profiles in TTS, emphasizing the need for increased monitoring and follow-up for those with significant troponin elevations.
Background: Empagliflozin administered after acute myocardial infarction proofed to improve cardiometabolic parameters and biomarkers, but the impact on cardiac function is still largely unknown. The aim of this post-hoc echocardiographic sub-analysis of the EMMY trial was to provide in-depth echocardiographic analysis on the effects of empagliflozin versus placebo on standard and novel echocardiographic structural and functional parameters after acute myocardial infarction.
Methods: In this post-hoc analysis of the EMMY trial a subset of 313 patients (157 empagliflozin vs.
Article Synopsis
- Steroidal mineralocorticoid receptor antagonists help patients with heart failure and reduced ejection fraction, but their effectiveness in those with mildly reduced or preserved ejection fraction is unclear, indicating a need for further research on finerenone.
- In a double-blind study, patients with heart failure (ejection fraction 40% or greater) were assigned to receive either finerenone or a placebo to assess its impact on heart failure events and cardiovascular death.
- Results showed that finerenone led to fewer worsening heart failure events and a lower overall rate of primary outcome events compared to placebo, although it also carried a higher risk of hyperkalemia.
Article Synopsis
- Inflammation plays a key role in obesity-related heart failure with preserved ejection fraction (HFpEF), and semaglutide treatment improves symptoms and reduces inflammation as measured by C-reactive protein (CRP) levels in patients with this condition.
- The study aims to evaluate characteristics of patients with different inflammation levels, assess if semaglutide's effects on health outcomes vary with CRP levels, and explore the link between weight loss and changes in CRP.
- This secondary analysis uses data from two international trials to analyze changes in health status, body weight, and exercise performance, focusing on how these changes correlate with baseline inflammation levels.
Article Synopsis
- The study investigated changes in demographics, risk factors, clinical presentations, and outcomes of takotsubo syndrome (TTS) patients from 2004 to 2021, using data from the InterTAK registry.
- Over the years, the proportion of male patients increased, and there was a rise in cases of midventricular TTS as well as significant growth in the incidence of physical triggers.
- There was also a notable increase in 60-day mortality rates, although no significant change in 1-year mortality when excluding early deaths was observed, indicating a complex evolution of TTS and its management in recent years.
Background: Sodium-glucose cotransporter 2 inhibitors (SGLT2is) have beneficial pleiotropic effects, contributing to improved cardiovascular and renal outcomes for patients with and without diabetes. The impact of SGLT2is on arrhythmic burden remains largely unexplored through randomized trials.
Methods: In this multicenter, double-blind, randomized, placebo-controlled trial, we investigated the effects of ertugliflozin on arrhythmic burden among patients with heart failure with an ejection fraction less than 50%.
Aim: The decline in estimated glomerular filtration rate (eGFR), a significant predictor of cardiovascular disease (CVD), occurs heterogeneously in people with diabetes because of various risk factors. We investigated the role of eGFR decline in predicting CVD events in people with type 2 diabetes in both primary and secondary CVD prevention settings.
Materials And Methods: Bayesian joint modelling of repeated measures of eGFR and time to CVD event was applied to the Exenatide Study of Cardiovascular Event Lowering (EXSCEL) trial to examine the association between the eGFR slope and the incidence of major adverse CV event/hospitalization for heart failure (MACE/hHF) (non-fatal myocardial infarction, non-fatal stroke, CV death, or hospitalization for heart failure).
Background: Affective disorders (AD) have been linked to inflammatory processes, although the underlying mechanisms of this relationship are still not fully elucidated. It is hypothesized that demographic, somatic, lifestyle, and personality variables predict inflammatory parameters in AD.
Aim: To identify biopsychosocial factors contributing to inflammation in AD measured with two parameters, C-reactive protein (CRP) and leukocytes.
Article Synopsis
- * A post-hoc analysis focused on 181 patients from the trial examined the relationship between baseline ECG metrics and the cardiac improvements observed with empagliflozin treatment.
- * The analysis revealed that while certain ECG metrics like QRS width and heart rate showed correlations with cardiac parameters, baseline ECG characteristics did not predict the benefits of empagliflozin on NT-proBNP levels or changes in heart function/structure within 26 weeks post-AMI.
Aims: To describe the baseline characteristics of participants in the FINEARTS-HF trial, contextualized with prior trials including patients with heart failure (HF) with mildly reduced and preserved ejection fraction (HFmrEF/HFpEF). The FINEARTS-HF trial is comparing the effects of the non-steroidal mineralocorticoid receptor antagonist finerenone with placebo in reducing cardiovascular death and total worsening HF events in patients with HFmrEF/HFpEF.
Methods And Results: Patients with symptomatic HF, left ventricular ejection fraction (LVEF) ≥40%, estimated glomerular filtration rate ≥ 25 ml/min/1.
Background: Sodium-glucose co-transporter 2 inhibitors (SGLT2i) have been suggested to exert cardioprotective effects in patients with heart failure, possibly by improving the metabolism of ketone bodies in the myocardium.
Methods: This post hoc analysis of the EMMY trial investigated the changes in serum β-hydroxybutyrate (3-βOHB) levels after acute myocardial infarction (AMI) in response to 26-week of Empagliflozin therapy compared to the usual post-MI treatment. In addition, the association of baseline and repeated measurements of 3-βOHB with cardiac parameters and the interaction effects of Empagliflozin were investigated.
In patients with stable chronic heart failure with a reduced ejection fraction (HFrEF), left ventricular ejection fraction (LVEF) provides limited prognostic value, especially in patients with moderately to severely reduced LVEF. Echocardiographic parameters of right ventricular function may be associated with adverse clinical events in these patients. Therefore, we analyzed 164 patients with HFrEF in a prospective single-center cohort study to evaluate whether the parameters of right ventricular function are associated with worsening heart failure (WHF) hospitalizations, cardiovascular and all-cause deaths and combined endpoints.
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- The STEP-HFpEF and STEP-HFpEF DM trials investigated the effects of the GLP-1 receptor agonist semaglutide on individuals with obesity-related heart failure, showing improvements in symptoms, physical limitations, body weight, and exercise function.
- A pooled analysis was conducted to assess the effects of semaglutide across various outcomes and determine consistency among different patient subgroups, utilizing data from randomized, double-blind, placebo-controlled trials.
- Participants were assigned to receive either semaglutide or a placebo for 52 weeks, with primary endpoints focusing on changes in heart failure-related symptoms and body weight, and secondary endpoints assessing physical activity and inflammation markers.
Article Synopsis
- Obesity and type 2 diabetes are common in patients with heart failure with preserved ejection fraction, leading to significant symptoms, and there's a lack of approved treatments targeting this condition.
- A study assigned 616 patients with heart failure, obesity, and type 2 diabetes to receive either once-weekly semaglutide or a placebo for one year, measuring improvements in symptoms and weight.
- Results showed that those on semaglutide had significantly better improvements in symptom scores (KCCQ-CSS) and lost more body weight compared to the placebo group, along with other beneficial outcomes in physical activity and inflammation markers.
(1) : Mechanical circulatory support (MCS) in myocardial infarction-associated cardiogenic shock is subject to debate. This analysis aims to elucidate the impact of MCS's timing on patient outcomes, based on data from the PREPARE CS registry. (2) : The PREPARE CS prospective registry includes patients who experienced cardiogenic shock (SCAI classes C-E) and were subsequently referred for cardiac catheterization.
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- Chronic heart failure (HFrEF) can lead to osteoporosis and vertebral fractures, increasing the risk of fractures and poor clinical outcomes.
- In this study of 205 outpatients with HFrEF, 15% had osteoporosis and 14% had vertebral fractures, with 27% showing either condition.
- Vertebral fractures were significantly linked to higher risks of cardiovascular death and worsening heart failure, while osteoporosis alone did not show a strong association with negative cardiovascular events.
The treatment and burden of patients with severe ischemic heart disease, whether acute or chronic, remain some of the greatest challenges in cardiology [...
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