Publications by authors named "Westenfeld R"
Aims: Ischaemic mitral regurgitation (MR) is a dynamic condition influenced by global and regional left ventricular remodelling as well as mitral valvular deformation. Exercise testing plays a substantial role in assessing the haemodynamic relevance of MR and is recommended by current guidelines. We aimed to assess the prevalence, haemodynamic consequences, and prognostic impact of dynamic MR using isometric handgrip exercise.
View Article and Find Full Text PDFAims: Myocardial inflammation and impaired mitochondrial oxidative capacity are hallmarks of heart failure (HF) pathophysiology. The extent of myocardial inflammation in patients suffering from ischaemic cardiomyopathy (ICM) or dilated cardiomyopathy (DCM) and its association with mitochondrial energy metabolism are unknown. We aimed at establishing a relevant role of cardiac inflammation in the impairment of mitochondrial energy production in advanced ischaemic and non-ischaemic HF.
View Article and Find Full Text PDFBackground: In DanGer Shock (the Danish-German Cardiogenic Shock trial), use of a microaxial flow pump (mAFP) in patients with ST-segment-elevation myocardial infarction-related cardiogenic shock led to lower all-cause mortality but higher rates of renal replacement therapy (RRT). In this prespecified analysis, rates and predictors of acute kidney injury (AKI) and RRT were assessed.
Methods: In this international, randomized, open-label, multicenter trial, 355 adult patients with ST-segment-elevation myocardial infarction-related cardiogenic shock were randomized to mAFP (n=179) or standard care alone (n=176).
Background: Heart failure is a substantial global health concern that severely affects patients' quality of life. We aimed to compare the effects of early integration of palliative care (EIPC) and standard cardiac care on health status and mood of patients with non-terminal heart failure.
Methods: EPCHF was a multicentre, parallel, two-arm, open-label, randomised controlled trial carried out at University Hospital Bonn and University Hospital Düsseldorf in Germany.
Aims: Cancer therapy-related cardiac dysfunction (CTRCD) is a dreaded complication of anthracycline therapy. CTRCD most frequently appears in patients with cardiovascular risk factors (CVR) or known cardiovascular disease. However, limited data exist on incidence and course of anthracycline-induced CTRCD in patients without preexisting risk factors.
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- A study examined the impact of using a microaxial flow pump alongside standard care for patients with STEMI and cardiogenic shock, focusing on mortality and safety outcomes.
- In a trial with 360 patients, those using the pump had a lower death rate (45.8%) compared to those receiving only standard care (58.5%).
- However, the pump group experienced a higher rate of adverse events (24.0% vs. 6.2%) and significantly more patients required renal-replacement therapy (41.9% vs. 26.7%).
Background: Absolute treatment benefits-expressed as numbers needed to treat-of the glucose lowering and cardiovascular drugs, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose transporter 2 (SGLT2) inhibitors on renal outcomes remain uncertain. With the present meta-analysis of digitalized individual patient data, we aimed to display and compare numbers needed to treat of both drugs on a composite renal outcome.
Methods: From Kaplan-Meier plots of major cardiovascular outcome trials of GLP-1 receptor agonists and SGLT2 inhibitors vs.
Background: Impella™ is increasingly used in cardiogenic shock. However, thromboembolic and bleeding events are frequent during percutaneous mechanical circulatory support (pMCS).
Objective: Therefore, we aimed to explore the optimal anticoagulation regime for pMCS to prevent thromboembolism and bleedings.
Background: The recommended chronic kidney disease (CKD) first-line diagnostic test is based on the creatinine-derived (estimated) glomerular filtration rate (eGFR). Cystatin C use may provide a better assessment.
Methods: We compared creatinine- and cystatin C-derived eGFR determination as the first-line diagnostic test for 112 hospital patients aged > 60 years (median = 76 years).
Article Synopsis
- The study investigates how exercise affects mitral regurgitation (MR) severity in patients with atrial functional mitral regurgitation (aFMR), highlighting discrepancies between symptoms and echocardiographic findings at rest.
- Conducting handgrip exercise echocardiography on 80 patients, it was found that a significant number showed changes in MR severity during exercise, with 35% being reclassified based on their exercise response.
- The follow-up revealed that patients with severe MR at rest and those whose MR became severe during exercise experienced higher rates of adverse events, suggesting exercise testing may influence treatment decisions for those with mild aFMR at rest.
Background: Out-of-hospital cardiac arrest (OHCA) remains a frequent medical emergency with low survival rates even after a return of spontaneous circulation (ROSC). Growing evidence supports formation of dedicated teams in scenarios like cardiogenic shock to improve prognosis. Thus, the European Resuscitation Council (ERC) recommended introduction of Cardiac Arrest Centers (CAC) in their 2015 guidelines.
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- Researchers studied the use of mechanical circulatory support (MCS) in patients with non-ischaemic cardiogenic shock (CS), focusing on how left ventricular ejection fraction (LVEF) could influence patient outcomes.
- An analysis of 807 patients showed that while lower LVEF was linked to more severe shock, it didn't correlate with overall 30-day mortality risk; however, MCS appeared to reduce mortality in those with severely reduced LVEF (≤20%).
- The study suggests that incorporating LVEF into decision-making for MCS in non-ischaemic CS patients could improve patient outcomes by optimizing the benefit-risk ratio.
Article Synopsis
- The study investigates how exercise affects mitral regurgitation (MR) in patients with degenerative MR (DegMR) and functional MR (FMR), highlighting that exercise testing reveals important changes in MR severity and impacts patient outcomes.
- Out of 367 patients, 19% of those with DegMR and 28% with FMR experienced an increase in MR severity during handgrip exercise, which was linked to changes in heart function and pulmonary pressure.
- Findings suggest that handgrip exercise echocardiography can help assess MR's dynamic nature and may inform treatment strategies, especially for patients with non-severe MR who show significant changes during exercise.
Real-time fusion imaging for guiding transcatheter tricuspid valve repair.
Int J Cardiovasc Imaging
October 2022
Aims: Small studies and observations suggested that exercise training may improve peak oxygen consumption (peakVO ) in patients with advanced heart failure and left ventricular assist device (LVAD). We investigated whether in this patient group a supervised exercise training can improve exercise capacity.
Methods And Results: In this multicentre, prospective, randomized, controlled trial, patients with stable heart failure and LVAD were randomly assigned (2:1) to 12 weeks of supervised exercise training or usual care, with 12 weeks of follow-up.
Article Synopsis
- About 20-40% of heart failure patients experience depression, which increases the risk of mortality and hospitalizations compared to the general population.
- This study investigates the effectiveness of cognitive behavioral therapy (CBT) in improving self-care and reducing depression and anxiety symptoms among heart failure patients.
- Results indicate that while CBT significantly reduces depression and anxiety after 4-9 months, it doesn't show meaningful short-term benefits (under 3 months) for self-care or mental health.
Article Synopsis
- Neurologic events during heart transplant recovery can lead to significantly worse outcomes and lower survival rates for patients.
- A study of 268 heart transplant recipients showed that those experiencing neurologic issues had longer ICU stays, more extensive mechanical ventilation, and increased needs for interventions like blood transfusions and dialysis compared to those without such events.
- Statistical analysis indicated that neurologic complications were linked to a higher risk of mortality at 30 days, 1 year, and overall, along with a notable decline in survival rates over a five-year period.
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View Article and Find Full Text PDFBackground: Cardiogenic shock (CS) patients remain at 30% to 60% in-hospital mortality despite therapeutic innovations. Heterogeneity of CS has complicated clinical trial design. Recently, 3 distinct CS phenotypes were identified in the CSWG (Cardiogenic Shock Working Group) registry version 1 (V1) and external cohorts: I, "noncongested;" II, "cardiorenal;" and III, "cardiometabolic" shock.
View Article and Find Full Text PDFBackground: Cardiovascular calcifications are prevented by matrix Gla protein (MGP), a vitamin K-dependent protein. Haemodialysis patients exhibit marked vitamin K deficiency. The randomized, prospective, open-label, multicentre VitaVasK trial analysed whether vitamin K1 supplementation reduces progression of coronary artery calcifications (CACs) and thoracic aortic calcifications (TACs).
View Article and Find Full Text PDFAims: Identifying patients who may benefit from mechanical circulatory support (MCS) after out-of-hospital cardiac arrest (OHCA) and return of spontaneous circulation (ROSC) remains challenging; thus, a search for helpful biomarkers is warranted. We aimed to evaluate phosphate and lactate levels on admission regarding their associations with survival with and without MCS.
Methods: In 224 OHCA patients who achieved ROSC, the initial phosphate and lactate levels were investigated to discriminate in-hospital mortality by receiver operating characteristic (ROC) curves.
Background: The present study aimed to develop a simple dosing score when starting the cardiac glycoside digitoxin in heart failure with reduced ejection fraction (HFrEF) employing first data from the randomized, double-blinded DIGIT-HF trial.
Methods And Results: In DIGIT-HF, digitoxin was started with a dose of 0.07 mg once daily (o.