Publications by authors named "Michael Metze"
Total Thrombus-Formation System in Patients with Peripheral Artery Disease.
Clin Appl Thromb Hemost
November 2024
Article Synopsis
- The Total Thrombus-formation Analysis System (T-TAS) is an automated tool designed to evaluate thrombus (blood clot) formation under simulated blood flow conditions, particularly in patients receiving antiplatelet therapy.
- This study examined T-TAS's effectiveness in detecting responses to dual antiplatelet therapy (DAPT) among 60 patients with peripheral artery disease (PAD) after a surgical procedure.
- Findings indicated that the platelet-chip (PL-chip) of T-TAS was able to identify low responders to DAPT more effectively than traditional aggregation tests, suggesting it could be a useful tool for monitoring treatment responses in PAD patients.
Article Synopsis
- Acute coronary syndrome (ACS) can occur without obstructive coronary artery disease in 1-14% of cases, with coronary artery spasm being a rare cause that requires specialized diagnosis and treatment.
- A 67-year-old patient experienced severe ACS with cardiogenic shock during hip surgery; despite initial resuscitation and use of ECMO, he was stabilized with nitrates and other therapies after identifying coronary vasospasm.
- This case underscores the need for awareness of non-obstructive causes of ACS, suggesting that vasodilators can be effective in treatment, and emphasizing the importance of ongoing preventive care to avoid future cardiac events.
The Effect of Upright Posture on Left Atrial Strain in Competitive Athletes.
J Cardiovasc Dev Dis
September 2024
Article Synopsis
- Left atrial strain (LAS) assessment via speckle tracking echocardiography (STE) is useful for detecting left ventricular (LV) issues, particularly in athletes during treadmill exercise tests.
- A study involving 50 male athletes examined LAS in both upright and left lateral positions, measuring various echocardiographic parameters.
- Results showed that LAS metrics and maximum left atrial volume were significantly lower in the upright position compared to the left lateral position, suggesting that posture impacts LA function and should be considered in echocardiography for athletes.
Article Synopsis
- A study was conducted on trauma patients requiring emergency intubation and ventilation to explore the role of epicardial adipose tissue (EAT) in predicting short-term health outcomes.
- The research analyzed 455 trauma patients, finding that EAT was initially linked to higher mortality rates and longer ICU stays, but these associations didn't hold up after adjusting for other risk factors like age and injury severity.
- The conclusion indicates that while EAT shows some correlation with outcomes in severely injured trauma patients, its usefulness as a prognostic tool is limited when accounting for other significant predictors.
Article Synopsis
- The study investigates how well the diluted Russel's Viper Venom Time (dRVVT) tests can detect leftover activity from direct oral anticoagulants (DOAC) in patients, aiming to find an efficient screening method for this purpose.
- A total of 80 patients received one of four DOAC medications, and their blood was tested at various times to measure dRVVT alongside DOAC plasma levels.
- Results show that while dRVVT is very effective at indicating significant levels of DOAC, especially with the LA2 assay, it can help in emergency settings to quickly assess anticoagulant effects and make treatment decisions.
Objectives: Coronary artery calcifications detected by computed tomography (CT) provide prognostic relevance for vascular disorders and coronary heart disease, whereas their prognostic relevance in severely injured trauma patients remains unclear.
Material And Methods: All consecutive trauma patients requiring emergency tracheal intubation before initial CT at a level-1 trauma center and admission to the intensive care unit (ICU) over a 12-year period (2008-2019) were reanalyzed. The Weston score, a semiquantitative method to quantify coronary calcifications, was evaluated as a prognostic variable based upon whole-body trauma CT analysis.
Article Synopsis
- A study assessed the prognostic value of the global myocardial work index (GWI) in 103 patients with moderate aortic valve stenosis (AS), finding that a GWI ≤ 1951 mmHg% did not predict outcomes like the need for aortic valve replacement (AVR).
- Over a follow-up period of about 30 months, survival without AVR was high but did not significantly differ between patients with GWI above or below the 1951 mmHg% threshold.
- The results indicate that, unlike in severe AS cases, GWI may not be a useful indicator for guiding treatment decisions in patients with moderate AS, prompting a call for more research to improve risk assessment in this group.
Article Synopsis
- The study investigates how concomitant aortic regurgitation (AR) affects the diagnosis of severe aortic stenosis (AS), focusing on Doppler-derived criteria like flow velocity and pressure gradients.
- Researchers analyzed data from 238 patients with severe AS, classifying them based on AR severity and assessing various hemodynamic parameters.
- Results revealed that while maxV and mean pressure gradient increased with AR severity, the effective orifice area (EOA) and geometric orifice area (GOA) remained unchanged, indicating that AR impacts certain measurements but not others in AS assessment.
Article Synopsis
- The study compares a new method called Quantitative Flow Ratio (QFR) with traditional measurements (instantaneous wave-free ratio - iFR and resting full-cycle ratio - RFR) in evaluating coronary artery health.
- Results showed that QFR correlates well with iFR and RFR, indicating it is a valid alternative for assessing blood flow in patients with coronary artery disease.
- QFR was found to be more efficient, requiring less time and radiation exposure compared to iFR and RFR, making it a potentially better option for daily clinical use.
The case of a 71-year-old male with end stage heart failure and severe mitral regurgitation is presented, where percutaneous indirect mitral annuloplasty was performed. During device implantation in the coronary sinus the circumflex artery was compromised at two anatomic locations, while the mitral regurgitation was efficiently reduced. After weighing risks and alternative therapeutic options, stent implantation was chosen as bailout strategy to leave the device in place and retain the efficient MR reduction.
View Article and Find Full Text PDFArticle Synopsis
- The assessment of left ventricular function primarily relies on measuring left ventricular volume, which is crucial in valvular heart diseases for evaluating stroke and regurgitant volumes.
- There is an ongoing debate about the accuracy of cardiac volume measurements from echocardiography compared to cardiac magnetic resonance tomography, highlighting concerns over echocardiography's underestimation due to its technical limitations.
- The authors call for a reevaluation of echocardiographic methods in diagnosing valvular heart diseases, advocating for a more reliable quantitative approach, although they acknowledge practical challenges in implementing this in everyday clinical settings.
Weight-adjusted dosing of tinzaparin for thromboprophylaxis in obese medical patients.
Res Pract Thromb Haemost
February 2023
Background: The optimal dose of tinzaparin for prophylaxis in obese medical patients is not well defined.
Objectives: To evaluate the anti-Xa activity in obese medical patients on tinzaparin prophylaxis adjusted for actual bodyweight.
Methods: Patients with a body mass index of ≥30 kg/m treated with 50 IU/kg tinzaparin once daily were prospectively included.
Article Synopsis
- The study aimed to understand what factors help predict the progression of moderate aortic valve stenosis (AS) by focusing on left ventricular hypertrophy (LVH), diastolic dysfunction, and right ventricular (RV) load.
- Researchers divided 131 patients into two groups based on the number of pathophysiological changes, finding that those with two or more changes had worse outcomes, including lower survival rates without needing aortic valve replacement (AVR).
- The conclusion highlighted that having two or more pathophysiological changes is a significant predictor of outcomes in moderate AS, which can aid in planning patient follow-ups and determining when AVR is needed.
Article Synopsis
- In emergency medicine, unconscious patients present unique challenges since they can't communicate or express symptoms.
- Early identification of life-threatening conditions is crucial for effective treatment.
- The ABCDE scheme is a structured approach that helps emergency physicians quickly assess and identify critical issues in a matter of minutes.
Monitoring of vitamin K antagonist treatment with the international normalized ratio (INR) is obligatory, whereas this only applies to direct oral anticoagulants (DOAC) or low molecular weight heparin in the context of selected clinical scenarios. For DOAC the focus is on the determination of trough and peak plasma levels of the drug but for low molecular weight heparins the focus is on anti-Xa activity. The timing of blood sampling in relation to drug intake is essential for the interpretation of the results.
View Article and Find Full Text PDFArticle Synopsis
- The article is divided into two parts and explores coagulation diagnostics through five common clinical scenarios, focusing on the need for accurate bleeding assessments before invasive procedures.
- Part 1 highlights that traditional tests like Quick and activated partial thromboplastin time are not reliable indicators of bleeding risk for elective interventions, as they often miss primary hemostasis disorders.
- Acquired causes, such as the use of anticoagulants and certain diseases, are typically responsible for most clinical bleeding tendencies, making accurate preanalytical processing and contextual interpretation of test results crucial.
Article Synopsis
- * It included plasma samples from 703 patients on rivaroxaban and 252 on apixaban, revealing significant correlations between DOAC levels and TG parameters, except for lag time with apixaban.
- * The findings indicate that rivaroxaban has a stronger impact on TG compared to apixaban, particularly at higher plasma levels, with over 85% accuracy in predicting low DOAC levels based on normal TG parameters.
Article Synopsis
- The study evaluated how direct oral anticoagulants (DOACs) affect thrombin generation (TG) in blood, focusing on their plasma levels in newly anticoagulated patients.
- It included 80 patients, monitoring TG and plasma levels of different DOACs (apixaban, edoxaban, rivaroxaban, and dabigatran) over time.
- Results showed that while all DOACs prolonged certain TG parameters, the effects were influenced by patient-specific baseline levels, suggesting that TG tests might provide a better measure of anticoagulation intensity than just measuring drug levels in plasma.
Article Synopsis
- Isolated pulmonary valve endocarditis is a rare type of right-sided infective endocarditis, often challenging to diagnose due to vague symptoms and limited echocardiographic detection, with risk factors including intravenous drug use and certain health issues.
- A case study of a 39-year-old homeless man with a history of IV drug use highlighted how he presented with common symptoms and was later diagnosed with isolated pulmonary valve endocarditis after detecting septic embolism in his lungs.
- Treatment typically involves antibiotics, and while most patients recover, careful monitoring and repeated echocardiograms may be needed in cases with atypical presentations, especially to avoid surgery in high-risk patients like IV drug users.
Loeffler's Endocarditis: An Integrated Multimodality Approach.
Maria Vincenza Polito Andreas Hagendorff Rodolfo Citro Costantina Prota Angelo Silverio Michael Metze
J Am Soc Echocardiogr
December 2020
Loeffler's endocarditis (LE) is the cardiac manifestation of hypereosinophilic syndrome, a rare systemic disease characterized by the sustained production of eosinophils leading to organ damage. Few data, principally by case reports, are available regarding the diagnostic workup in patients with suspected LE. Thus, we have performed a systematic search of the literature dealing with imaging in LE and propose an integrated multimodality imaging approach in the cardiac diagnostics of LE patients.
View Article and Find Full Text PDFArticle Synopsis
- The study investigates the relationship between the plasma levels of direct oral anticoagulants (DOACs) and thrombin generation (TG) parameters, which offers a more comprehensive understanding of a patient's coagulation status despite variability in drug levels.
- A total of 380 blood samples were analyzed from patients taking different DOACs, and results indicated significant correlations between DOAC drug levels and certain TG parameters, especially for anti-Xa DOACs like apixaban, edoxaban, and rivaroxaban.
- The findings suggest that TG parameters, particularly peak thrombin and velocity index, can be useful in assessing the anticoagulant effects of anti-Xa DOACs, while for
Article Synopsis
- The study investigates the residual effects of direct oral anticoagulants (DOACs) on thrombin generation 12 hours post-intake, which is crucial during emergencies like bleeding or surgery.
- Four types of DOACs (apixaban, edoxaban, rivaroxaban, and dabigatran) were tested on 80 patients, comparing their blood samples before and after medication, and against a control group of blood donors.
- Results showed that all DOACs significantly decreased thrombin generation parameters and prolonged lag time compared to baseline and the healthy control, indicating ongoing antithrombotic activity that may impact clinical decisions in urgent situations.