Publications by authors named "Fastner C"
Intertwined destinies - Acute ischemic stroke and neurogenic stress cardiomyopathy.
J Stroke Cerebrovasc Dis
January 2025
Article Synopsis
- Atrial fibrillation (AF) significantly increases the risk of stroke, and identifying risk factors for strokes in AF patients remains complicated, suggesting that existing scoring systems don't capture all relevant details.
- In a study analyzing patients from the ARENA project, it was found that those with a history of cerebrovascular events (CVE) were generally older, had higher CHADS-VASc scores, and larger left atrial diameters compared to those without CVE.
- The prognosis for AF patients with CVE was notably worse; they had higher mortality rates and higher stroke occurrences within a year, indicating that factors like atrial remodeling and underlying heart disease may contribute to their increased risk.
Article Synopsis
- A significant portion of heart failure patients (around 30%) do not respond to cardiac resynchronization therapy (CRT), especially those with QRS durations between 120-149 ms who receive inconsistent benefits.
- A study evaluated the effectiveness of cardiac contractility modulation (CCM) in improving heart failure-related hospitalizations, left ventricular ejection fraction (LVEF), and quality of life in patients with this specific QRS duration.
- Results showed that CCM reduced hospitalizations by 72%, improved LVEF by 7%, and positively affected quality of life, with outcomes similar to those seen in patients with shorter QRS durations; mortality within the first year was not significantly different from predictions.
Introduction: Cardiac implantable electrical devices are able to affect kidney function through hemodynamic improvements. The cardiac contractility modulation (CCM) is a device-based therapy option for patients with symptomatic chronic heart failure (HF) despite optimized medical treatment. The long-term cardiorenal interactions for CCM treated patients are yet to be described.
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- * Collaboration between cardiologists and neurologists is essential since the causes for elevated hs-cTn can be diverse, sometimes presenting atypically or silently, and some may be life-threatening, such as myocardial infarction.
- * The majority of hs-cTn increases in AIS patients result from non-ischemic myocardial injury, and the paper provides an updated clinical algorithm to assist in differential diagnosis for these cases.
Article Synopsis
- - Pre-therapeutic histologic diagnosis for suspicious breast issues typically uses image-guided biopsies, but patients on anti-coagulation therapy face potential bleeding risks, and there's no standardized management protocol.
- - A survey conducted among breast health experts revealed that over half believe there’s no standard approach for managing breast biopsies in patients on anti-coagulation or anti-platelet therapy, with differing views on when to discontinue medications.
- - Experts generally consider breast biopsies safe for patients on aspirin or prophylactic heparin, but there’s hesitation around performing them on other medications like DOACs or phenprocoumon, suggesting a need for further guidelines.
Background: Various professional groups are involved in the daily work of the central operating room with the aim of providing the best possible treatment for each individual using modern medical technology (sociotechnical system) in a cost-effective manner. Ensuring perioperative patient safety is of particular importance. At the same time, the efficient use of the central operating room is essential for the economic success of a hospital.
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- Interventional left atrial appendage occlusion (LAAO) is effective for patients with nonvalvular atrial fibrillation (AF) who can't use long-term blood thinners, especially those with a history of stroke.
- A study from the LAARGE registry found that LAAO was similarly effective and safe for stroke patients compared to those without a stroke history, with high success rates and low complication rates in both groups.
- The results suggest that LAAO could be a viable option for secondary prevention in high-risk AF patients, showing no significant differences in risk of death or stroke between those with and without prior strokes.
Background And Aims: Left atrial (LA) enlargement has been repeatedly shown to be associated with the diagnosis of atrial fibrillation (AF). In clinical practice, several parameters are available to determine LA enlargement: LA diameter index (LADI), LA area index (LAAI), or LA volume index (LAVI). We investigated the predictive power of these individual LA parameters for AF in patients with acute ischemic stroke or transient ischemic attack (TIA).
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- Interventional left atrial appendage occlusion (LAAO) is a treatment option that replaces long-term oral anticoagulation for patients with nonvalvular atrial fibrillation, particularly those with a high risk of bleeding.
- A study examined the impact of spontaneous echo contrast (SEC) on the risk of device-related thrombus (DRT) and thromboembolic events (TEs) in two groups of patients: those with SEC and those without it.
- The results showed that while procedural success was high in both SEC groups, DRT was only noted in the SEC- group and TEs were rare in both, suggesting that SEC presence might not significantly affect post-LAAO outcomes.
We hypothesized that myocardial septal scarring, assessed by cardiac magnetic resonance (CMR) using late gadolinium enhancement (LGE), at the site of cardiac contractility modulation (CCM) lead placement may predict treatment response. Eligible heart failure (HF) patients underwent LGE CMR imaging before CCM device implantation. The response to CCM therapy at follow-up was determined by a change in NYHA class and echocardiographic left ventricular ejection fraction (LVEF) assessment.
View Article and Find Full Text PDFThe healthcare system is an example of a complex sociotechnical system where the goal is the best possible individual treatment together with the cost-effective use of modern technology. Working in anesthesia requires medical knowledge as well as manual skills and the use of specialized technical equipment in an interdisciplinary and interprofessional setting. The susceptibility to errors and adverse events, especially in the care of critically ill patients, is high.
View Article and Find Full Text PDFBackground: Cardiac contractility modulation (CCM) is an FDA-approved device therapy for patients with refractory systolic heart failure and normal QRS width. Randomized trials demonstrated benefits of CCM primarily for patients with severe heart failure (> NYHA class II).
Purpose: To better understand individualized indication in clinical practice, we compared the effect of CCM in patients with baseline NYHA class II vs.
Article Synopsis
- Interventional left atrial appendage occlusion (LAAO) is a procedure used for patients with nonvalvular atrial fibrillation who cannot take standard blood thinners, and this study looks at its effects on patients with low versus high stroke risk.
- The study included 638 patients divided into low-risk (CHA DS -VASc score ≤2) and high-risk (score >2) groups, finding that while implantation success was high, low-risk patients experienced more moderate complications despite having no major strokes or bleeds within a year.
- The authors suggest that the need for LAAO in low-risk patients should be carefully evaluated to weigh potential benefits against risks.
Article Synopsis
- - The study investigates how pre-implantation left ventricular ejection fraction (LVEF) influences long-term outcomes in cardiac contractility modulation (CCM) therapy for patients with chronic heart failure.
- - It compares two groups of patients: those with LVEF ≤ 30% and those with LVEF ≥ 31%, analyzing survival rates and various health measurements over a follow-up period of up to 5 years.
- - Results show that lower LVEF (≤30%) leads to significantly better improvements in echocardiographic measures, while overall clinical improvements, like NYHA classification, occur similarly across both groups regardless of initial LVEF levels.
Background: Acute ischemic stroke (AIS) in patients with non-valvular atrial fibrillation (AF) despite oral anticoagulation (OAC) is a complex and insufficiently investigated setting. Potential strategies range from maintaining the current OAC to changing the substance class. We have queried the specific treatment standards on German stroke units (SUs).
View Article and Find Full Text PDFThere is little information concerning the invasive coronary angiography (ICA) findings of patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA) with elevated troponin levels and suspected myocardial infarction (MI). This study analyzed patient characteristics associated with ICA outcomes. A total of 8,322 patients with AIS or TIA, treated between March 2010 and May 2020, were retrospectively screened for elevated serum troponin I at hospital admission.
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- Cardiac contractility modulation (CCM) is a therapy approved by the FDA for patients with systolic heart failure who still show symptoms despite optimal medication, aimed at comparing its effects on ischemic versus non-ischemic cardiomyopathy.
- The study analyzed 174 heart failure patients with CCM devices, finding that after 3 years, non-ischemic cardiomyopathy patients had a significantly higher left ventricular ejection fraction (LVEF), and after 5 years, they also showed better tricuspid annular plane systolic excursion (TAPSE) compared to ischemic patients.
- Overall mortality rates at 1 and 3 years were similar between both groups,
Article Synopsis
- - Elevated troponin levels are often found in patients experiencing acute ischemic stroke, which indicates a need for thorough diagnostic evaluations due to increased risk of heart-related deaths post-stroke.
- - The use of dual platelet inhibition therapy can result in secondary brain bleeding, making it essential to weigh the risks before performing any invasive heart procedures.
- - This review discusses a diagnostic algorithm derived from recent literature, supported by three individual case reports, to guide medical professionals in managing these complex cases.
[Delayed Takotsubo syndrome - A critical perioperative incident].
Dtsch Med Wochenschr
September 2020
Introduction: The term Takotsubo syndrome (TTS) describes a transient ventricular dysfunction. Symptoms and complication rate are similar to those of a myocardial infarction.
Medical History: An 81-year-old female patient was admitted for thrombendarterectomy of the left femoral artery.
Introduction: The catheter-based left atrial appendage closure (LAAC) has evolved as an alternative to oral anticoagulation (OAC) among non-valvular atrial fibrillation (AF) patients in whom long-term OAC is contraindicated. In daily practice, however, a sizeable number of patients who have been referred for an LAAC do not receive this intervention. This study aimed primarily to investigate the factors deterring the practice of an LAAC in referred AF patients, and secondarily to compare the complication rates of intervened patients with those who had refused the intervention within 1 year.
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- Inherited arrhythmia syndromes and genetic cardiomyopathies significantly contribute to sudden cardiac death, leading to the use of implantable cardioverter defibrillators (ICDs) in high-risk patients.
- A study involving 183 patients compared two ICD technologies—transvenous (TV-ICD) and subcutaneous (S-ICD)—over an average follow-up of 4.3 years, highlighting their performance in preventing adverse events.
- Results showed that the S-ICD group experienced fewer lead failures and adverse defibrillator events, as well as a significantly lower rate of any shocks, suggesting it may be the preferable option for these patients.
Routine determination of troponin levels is recommended for all patients with acute ischemic stroke. In 20-55% of these patients the troponin levels are elevated, which may be caused by ischemic as well as non-ischemic myocardial damage and particularly neurocardiogenic myocardial damage. In patients with acute ischemic stroke, the prevalence of previously unknown coronary heart disease is reported to be up to 27% and is prognostically relevant for these patients; however, relevant coronary stenoses are less frequently detected in stroke patients with troponin elevation compared to patients with non-ST elevation myocardial infarction.
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- The study explores the impact of chronic kidney disease (CKD) on complications and outcomes following left atrial appendage closure (LAAC) in patients with atrial fibrillation.
- About 48% of the 623 participants had CKD, showing higher cardiovascular risks but similar success rates for the procedure across different kidney function levels.
- Although CKD patients faced a lower survival rate free of stroke within a year, LAAC proved safe and effective for stroke prevention, regardless of the severity of kidney impairment.
Article Synopsis
- - The study investigates the effectiveness of left atrial appendage closure (LAAC) in patients with atrial fibrillation and varying levels of left ventricular ejection fraction (LVEF), revealing that LVEF reduction does not significantly affect procedural success or safety during the procedure.
- - A total of 619 patients from 37 centers were analyzed, showing that lower LVEF correlates with increased cardiovascular comorbidity but similar rates of procedural complications across all LVEF categories.
- - Despite a trend towards reduced stroke-free survival associated with lower LVEF, the findings suggest that the LAAC procedure remains effective and safe, regardless of LVEF levels, emphasizing its utility in high-risk patient populations.