Publications by authors named "Flammer A"

Tricuspid regurgitation (TR) is a common valvular dysfunction following heart transplantation (HT), with reported prevalence rates ranging from 19 to 84%, primarily depending on the duration of follow-up. Its etiology is multifactorial and includes surgical technique, ischemic time, primary graft dysfunction, pulmonary hypertension, pacemaker leads, and endomyocardial biopsies. Severe TR can significantly impair graft function, exercise capacity, and patient survival.

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Background: Cardiac sarcoidosis (CS) is a chronic inflammatory disease characterised by non-caseating granulomas, while arrhythmogenic cardiomyopathy (ACM) is a genetic condition mainly affecting desmosomal proteins. The coexistence of CS and genetic variants associated with ACM is not well understood, creating challenges in diagnosis and management. This study aimed to describe the clinical, imaging and genetic features of patients with both conditions.

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Cardiac allograft vasculopathy (CAV) is a major prognosis-limiting factor in patients undergoing orthotopic heart transplantation (HT). Due to the diffuse involvement of the coronary tree, CAV lesions are often not amenable to percutaneous coronary intervention (PCI), leaving coronary artery bypass grafting (CABG) and retransplantation as primary revascularization options. : The latest guidelines from the International Society for Heart and Lung Transplantation (ISHLT) recognize CABG as a viable option but with a downgraded strength of recommendation.

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Background And Aims: Systemic sclerosis (SSc) is a systemic autoimmune disease, characterized by widespread microvasculopathy and fibrosis. Vascular and endothelial cell changes appear to precede other features of SSc. Retinal vascular analysis is a new, easy-to-use tool for the assessment of retinal microvascular function.

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Background: The mechanism of how sacubitril/valsartan improves outcomes in heart failure with reduced ejection fraction (HFrEF) is still incompletely understood.

Objectives: The aim of this trial was to delineate the effects of sacubitril/valsartan on endothelial function, retinal microvascular function, and arterial stiffness in HFrEF.

Methods: This double-blind controlled trial randomized 79 stable HFrEF patients with NYHA class II-IV on guideline-recommended therapy (mean age: 59.

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Article Synopsis
  • * Symptoms resemble heart failure, and diagnosis relies on imaging tests like echocardiography and tissue biopsies to detect amyloid deposits.
  • * Treatment varies based on the type and severity, requiring a team of specialists for effective management and improved patient outcomes.
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In recent years, sodium-glucose co-transporter 2 inhibitors (SGLT2i) emerged as promising therapeutic agents in managing heart failure (HF). They demonstrated a significant impact on reducing HF hospitalizations and related mortality in patients with reduced and preserved ejection fraction. However, evidence supporting their use in patients with left ventricular assist device (LVAD) and heart transplant (HT) recipients is still limited.

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Background: Cardiac resynchronization therapy (CRT) is a cornerstone in the treatment of selected heart failure patients. However, a relevant proportion of patients do not show beneficial response. Identification of simple, additive, and outcome-relevant selection criteria may improve selection of patients.

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Article Synopsis
  • * The study revealed that bone morphogenic protein-4 (BMP4) gradients play a crucial role in maintaining cardiac tissue health in both mice and humans with myocarditis.
  • * Enhancing BMP signaling by targeting inhibitors gremlin-1 and gremlin-2 reduced inflammation and fibrosis in mouse models, suggesting that this BMP4-gremlin pathway could be a potential treatment for myocardial inflammation.
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  • A significant number of heart failure patients progress to advanced stages, which heightens health risks, and some may qualify for advanced treatments like ventricular assist devices (VAD).
  • This study assessed vascular function in 34 patients with VAD compared to 34 patients with advanced heart failure, finding that those with VAD showed improved endothelial function in larger arteries but not in microcirculation.
  • The findings suggest that while VAD implantation benefits endothelial function at the arterial level, it does not enhance microvascular function in advanced heart failure patients.
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Background: Light chain cardiac amyloidosis (AL-CA) is associated with a high incidence of mortality. Big endothelin-1 (ET-1), the precursor of endothelial-vasoconstrictive ET-1, is closely related to the concentration of bioactive ET-1. Association between big ET-1 and prognosis of AL-CA has not yet been documented.

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Further line treatment of patients with advanced stage AL amyloidosis with cardiac involvement is challenging. Venetoclax is a promising option, especially in t(11;14) and BCL2 expression.In our multicentre observational study, we report the 3-year follow-up of Venetoclax treatment in 9 patients with advanced, relapsed or refractory AL amyloidosis with t(11;14) and BCL-2 expression in > 50% of plasma cells.

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  • Iron deficiency (ID) is prevalent in heart failure (HF) patients and negatively impacts their health, even if they aren't anemic; iron supplementation can improve exercise and quality of life in these individuals.
  • An online survey of 256 cardiologists revealed that most defined ID correctly and screened more than half of their patients, but only 54.3% did periodic screenings; intravenous iron was the most commonly prescribed treatment.
  • The survey results point to a need for better, standardized practices for ID screening and management in HF patients, as many physicians view ID as an overlooked issue in this group.
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  • The study investigates how machine learning (ML) can classify patients with cardiovascular disease or risk factors who are hospitalized with COVID-19, aiming to better predict patient outcomes.
  • A total of 458 patients were analyzed, revealing three distinct clusters: one with mostly women and fewer comorbidities, another mainly with men and less severe symptoms, and a third group of men with severe cardiovascular issues and higher mortality risk.
  • The findings highlight the importance of personalized approaches in treating high-risk COVID-19 patients, particularly identifying those likely to face poorer outcomes due to their cardiovascular conditions.
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Article Synopsis
  • * Recent evidence suggests that such restrictions may not significantly benefit HF patients, leading to changes in recommendations over time.
  • * The European Society of Cardiology now advises limiting salt intake to a maximum of 5g/day and recommends fluid restrictions of 1.5-2L/day only for specific patients, based on current research and expert consensus.
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Aims Of The Study: Systemic amyloidoses are rare protein-folding diseases with heterogeneous, often nonspecific clinical presentations. To better understand systemic amyloidoses and to apply state-of-the-art diagnostic pathways and treatment, the interdisciplinary Amyloidosis Network was founded in 2013 at University Hospital Zurich. In this respect, a registry was implemented to study the characteristics and life expectancy of patients with amyloidosis within the area covered by the network.

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Background: Medication non-adherence in heart failure (HF) leads to increased mortality, morbidity and healthcare costs. However, no study has investigated HF patients' post-hospitalization medication non-adherence in Switzerland.

Objectives: Our primary aim was to assess the prevalence of post-discharge medication non-adherence in patients with HF.

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Background: Cardiovascular (CV) risk factors and CV diseases, in particular heart failure, are strongly associated with impaired microvascular retinal endothelial function. Whether atrial fibrillation (AF) contributes to vascular dysfunction is not clear. Therefore, the aim of this study was to investigate the impact of AF on retinal microvascular function.

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Aims: Mineralocorticoid receptor antagonists (MRAs) improve outcomes in heart failure with reduced ejection fraction (HFrEF) but remain underused and are often discontinued especially in patients with chronic kidney disease (CKD) due to concerns on renal safety. Therefore, in a real-world HFrEF population we investigated the safety of MRA use, in terms of risk of renal events, any mortality and any hospitalization, across the estimated glomerular filtration rate (eGFR) spectrum including severe CKD.

Methods And Results: We analysed patients with HFrEF (ejection fraction <40%), not on dialysis, from the Swedish Heart Failure Registry.

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Aims: Epicardial adipose tissue (EAT) is a metabolically highly active tissue modulating numerous pathophysiological processes. The aim of this study was to investigate the association between EAT thickness and endothelial function in patients with heart failure (HF) across the entire ejection fraction spectrum.

Methods And Results: A total of 258 patients with HF with an ejection fraction across the entire spectrum [HF with reduced ejection fraction (HFrEF), n = 168, age 60.

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Article Synopsis
  • Homograft heart valves are often better for fixing heart problems in young women, athletes, and patients with active infections.
  • There is a shortage of donated tissues for these valves, so a new program is being started to help collect more tissue donations.
  • Between 2020 and 2022, doctors at the hospital collected several heart and lung parts for transplant, but some were discarded due to issues like contamination or damage.
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Amyloidosis is a systemic disease characterized by extracellular deposits of insoluble amyloid in various tissues and organs. Cardiac amyloidosis is a frequent feature of the disease, causing a progressive, restrictive type of cardiomyopathy, and is associated with adverse clinical outcomes and increased mortality. The typical clinical presentation in patients with cardiac amyloidosis is heart failure (HF) with preserved ejection fraction.

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Introduction: Heart Failure (HF) is a major health and economic issue worldwide. HF-related expenses are largely driven by hospital admissions and re-admissions, many of which are potentially preventable. Current self-management programs, however, have failed to reduce hospital admissions.

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The global lack of donor shortage poses a major limitation for heart transplantation. New concepts with expanded donor inclusion criteria comprise extended transport distances and prolonged ischemic times with the aim of reaching a larger number of potential donors. Recent developments in cold storage solutions may allow more donor hearts with prolonged ischemic times to be use for transplantation in the future.

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