Journal: ESC Heart Failure

Abbreviation

ESC Heart Fail

Publisher

Wiley

Journal Volumes

ISSN

2055-5822

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2019 - 201912020 - 20257
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Publications 1 - 8 of 8
  • Movement therapy in advanced heart failure assisted by a lightweight wearable robot: a feasibility pilot study
    Item type: Journal Article
    Just, Isabell Anna; Fries, Denis; Loewe, Sina; et al. (2022)
    ESC Heart Failure
    Aims The aim of this pilot study was to investigate the safety, feasibility, tolerability, and acceptability of an assisted mobilization of advanced heart failure patients, using a lightweight, exoskeleton-type robot (Myosuit, MyoSwiss AG, Zurich, Switzerland). Methods and results Twenty patients in functional NYHA class III performed activities of daily life (ADL, n = 10) or participated in a single, standardized, 60 min rehabilitation exercise unit (REU, n = 10) with and without the Myosuit. The outcome assessment included the evaluation of vital signs, adverse events, rates of perceived exertion and dyspnoea (RPE, RPD), the ability to perform ADL or REU, and the individual acceptability. The mean age of the subjects was 49.4 (±11.0) years; 80% were male. The mean left ventricular ejection fraction was 22.1% (±7.4%) and the median NT-proBNP 2054 pg/mL (IQR 677, 3270 pg/mL). In all patients, mobilization with the Myosuit was feasible independently or with minor support. The mean individual difference in the total walking distance of the patients without and with robotic assistance was −26.5 m (95% confidence interval (CI) −142 to 78 m, P = 0.241). No adverse events occurred. RPE and RPD showed no significant difference with or without the device (ADL: RPE −0.1 m, 95% CI −1.42 to 1.62, P = 0.932 and RPD −0.95 m, 95% CI −0.38 to 2.28, P = 0.141; REU: RPE 1.1 m, 95% CI −2.90 to 0.70, P = 0.201 and RPD 0.5 m, 95% CI −2.02 to 1.02, P = 0.435). All median responses in the acceptability questionnaire were positive. The patients felt safe and enjoyed the experience; 85% would be interested in participating in robot-assisted training on a regular basis. Conclusion This feasibility pilot trial provides first indications that a robotic exoskeleton-assisted mobilization of patients with advanced heart failure is safe, feasible, well-tolerated, and well-accepted. The results are highly encouraging to further pursue this innovative approach in rehabilitation programmes. This trial was registered at ClinicalTrials.gov: NCT04839133.
  • Comparison of feasibility and results of frailty assessment methods prior to left ventricular assist device implantation
    Item type: Journal Article
    Roehrich, Luise; Sündermann, Simon H.; Just, Isabell A.; et al. (2022)
    ESC Heart Failure
    Aims Assessing frailty and sarcopenia is considered a valuable cornerstone of perioperative risk stratification in advanced heart failure patients. The lack of an international consensus on a diagnostic standard impedes its implementation in the clinical routine. This study aimed to compare the feasibility and prognostic impact of different assessment tools in patients undergoing continuous-flow left ventricular assist device (cf-LVAD) implantation. Methods and results We prospectively compared feasibility and prognostic values of six frailty/sarcopenia assessment methods in 94 patients prior to cf-LVAD implantation: bioelectrical impedance analysis (BIA), computed tomography (CT)-based measurement of two muscle areas/body surface area [erector spinae muscle (TMESA/BSA) and iliopsoas muscle (TPA/BSA)], physical performance tests [grip strength, 6 min walk test (6MWT)] and Rockwood Clinical Frailty Scale (RCFS). Six-month mortality and/or prolonged ventilation time >95 h was defined as the primary endpoint. BIA and CT showed full feasibility (100%); physical performance and RCFS was limited due to patients' clinical status (feasibility: 87% grip strength, 62% 6MWT, 88% RCFS). Phase angle derived by BIA showed the best results regarding the prognostic value for 6 month mortality and/or prolonged ventilation time >95 h (odds ratio (OR) 0.66 [95% confidence interval (CI): 0.46–0.92], P = 0.019; area under the curve (AUC) 0.65). It provided incremental value to the clinical risk assessment of EuroSCORE II: C-index of the combined model was 0.75 [95% CI; 0.651–0.848] compared with C-index of EuroSCORE II alone, which was 0.73 (95% CI: 0.633–0.835). Six-month survival was decreased in patients with reduced body cell mass derived by BIA or reduced muscle area in the CT scan compared with patients with normal values: body cell mass 65% (95% CI: 51.8–81.6%) vs. 83% (95% CI: 74.0–93.9%); P = 0.03, TMESA/BSA 65% (95% CI: 51.2–82.2%) vs. 82% (95% CI: 73.2–93.0%); P = 0.032 and TPA/BSA 66% (95% CI: 53.7–81.0%) vs. 85% (95% CI: 75.0–95.8%); P = 0.035. Conclusions Bioelectrical impedance analysis parameters and CT measurements were shown to be suitable to predict 6-month mortality and/or prolonged ventilation time >95 h in patients with advanced heart failure prior to cf-LVAD implantation. Phase angle had the best predictive capacity and sarcopenia diagnosed by reduced body cell mass in BIA or muscle area in CT was associated with a decreased 6 month survival.
  • Heart rate kinetics during standard cardiopulmonary exercise testing in heart transplant recipients: a longitudinal study
    Item type: Journal Article
    Schumacher, Oliver; Trachsel, Lukas D.; Herzig, David; et al. (2021)
    ESC Heart Failure
    Aims Heart transplantation (HTx) results in complete autonomic denervation of the donor heart, causing resting tachycardia and abnormal heart rate (HR) responses to exercise. We determined the time course of suggestive cardiac reinnervation post HTx and investigated its clinical significance. Methods and results Heart rate kinetics during standard cardiopulmonary exercise testing at 2.5–5 years after HTx was assessed in 58 patients. According to their HR increase 30 s after exercise onset, HTx recipients were classified as denervated (slow responders: <5 beats per minute [b.p.m.]) or potentially reinnervated (fast responders: ≥5 b.p.m.). Additionally, in 30 patients, longitudinal changes of maximal oxygen consumption and HR kinetics were assessed during the first 15 post‐operative years. At 2.5–5 years post HTx, 38% of our study population was potentially reinnervated. Fast responders were significantly younger (41 ± 15 years) than slow responders (53 ± 13 years, P = 0.003) but did not differ with regard to donor age, immunosuppressive regime, cardiovascular risk factors, endomyocardial biopsy, or vasculopathy parameters. While HR reserve (56 ± 20 vs. 39 ± 15 b.p.m., P = 0.002) and HR recovery after 60 s (15 ± 11 vs. 5 ± 6 b.p.m., P < 0.001) were greater in fast responders, resting HR, peak HR of predicted, and peak oxygen consumption of predicted were comparable. Conclusions Signs of reinnervation occurred mainly in younger patients. Maximal oxygen consumption was independent of HR kinetics.
  • Presence of active myocarditis at the 6 month follow-up appointment for a severe form of COVID-19: a case report
    Item type: Journal Article
    Vogel, Thomas; Meyer, Anita; Constancias, Florentin; et al. (2021)
    ESC Heart Failure
    Here, we present the case of an 81-year-old male patient, who was hospitalized for a severe form of COVID-19. Transthoracic echocardiogram (TTE) performed 1 month after symptom onset was normal. Respiratory evolution was favourable, and the patient was discharged at Day 78. At 6 months, despite a good functional recovery, he presented pulmonary sequelae, and the TTE revealed a clear reduction of left ventricular ejection fraction (LVEF) and mild LV dilatation without cardiac symptoms. The cardiac magnetic resonance (CMR) using Lake Louise Criteria (LLC), T1 and T2 mapping showed focal infero-basal LV wall oedema, elevated T1 and T2 myocardial relaxation times especially in basal inferior and infero-lateral LV walls, and sub-epicardial late gadolinium enhancement in those LV walls. The diagnosis of active myocarditis was raised especially based on TTE abnormalities and CMR LLC, T1 and T2 mapping. Currently, we are not aware of published reports of a 6 month post-COVID-19 active myocarditis.
  • Unveiling the invisible: Is there a role of CMR in biopsy-negative graft dysfunction post-heart transplantation?
    Item type: Other Journal Item
    Sokolska, Justyna M.; Manka, Robert (2024)
    ESC Heart Failure
  • Rationale and design of the randomized 'early ventricular assist device'-Trial (VAD-DZHK3)
    Item type: Journal Article
    Knosalla, Christoph; Färber, Gloria; Rieth, Andreas J.; et al. (2025)
    ESC Heart Failure
    Aims: Bridge to transplantation (BTT) with durable, continuous-flow left ventricular assist devices (LVAD) of patients is a well-established treatment concept in patients awaiting heart transplantation (HTx). However, the role of elective LVAD implantation in patients with less advanced HF, but increased risk of decompensation remains uncertain. Methods and results: The VAD-DZHK3 trial is an investigator-initiated, randomized controlled trial designed to assess whether an early strategy of elective LVAD implantation improves outcomes compared with a conventional approach involving optimal medical therapy and delayed device implantation only after clinical deterioration. Eligible patients are those with end-stage HF listed for cardiac transplantation. This is an event-driven study, that is, the study is completed once 120 events of the primary composite endpoint have been observed and all patients have at least 1 year of follow-up unless they died earlier. Patients meeting inclusion criteria who decline randomization are enrolled in a parallel observational registry reflecting standard care. The primary efficacy endpoint is survival free from high urgent cardiac transplantation, disabling stroke and HF hospitalizations (including emergency room HF visits >6 h). Conclusions: The VAD-DZHK3 trial will provide guidance on the optimal timing and patient selection for LVAD implantation in heart transplant candidates, potentially redefining current standards of care.
  • Echocardiographic assessment of functional mitral regurgitation: opening Pandora's box?
    Item type: Journal Article
    Falk V; Hagendorff, Andreas; Doenst, Torsten; et al. (2019)
    ESC Heart Failure
    Two recent trials of transcatheter mitral‐valve repair in patients with functional mitral regurgitation (FMR) presented opposing results for the MitraClip® compared to medical therapy alone. The conflicting results gave rise to intensive discussions about assessment of mitral valve regurgitation (MR). A recent editorial viewpoint provided a potential explanation presenting a new pathophysiologic concept. However, the echocardiographic characterization of both trials' patients is inconsistent and the discussed concepts appear to suffer from plausibility weaknesses. It is well conceivable that limitations in the echocardiographic assessment of the trial patients introduced a bias regarding the selection of patients with severe (or less severe) MR that may be a more plausible explanation for the differences in outcome. We here illustrate our viewpoint regarding the two MitraClip trials and also illustrate the difficulties in assessing functional MR properly. It may indeed be “opening Pandora's box”, but we will also make an attempt to provide a solution.
  • Transcriptomic and proteomic profiling shows dysregulated immune and metabolic pathways in arrhythmogenic cardiomyopathy
    Item type: Journal Article
    Akdis, Deniz; Weidmann, Lukas; Nanni, Paolo; et al. (2025)
    ESC Heart Failure
    Aims: Arrhythmogenic cardiomyopathy (ACM) is a hereditary heart disease characterized by fibrofatty myocardial replacement and a predisposition to malignant ventricular arrhythmias. The underlying pathomechanisms remain incompletely understood, and specific disease markers are sparse. This study aimed to characterize the myocardial transcriptome and proteome in ACM patients and assess whether key identified molecules were also detectable in plasma and tissue samples. Methods and results: Myocardial tissues were obtained from ACM and dilated cardiomyopathy (DCM) patients as well as healthy controls (n = 10/group). Transcriptomic profiling was performed by RNA sequencing and proteomic profiling by label-free liquid chromatography–tandem mass spectrometry. Differential expression and pathway enrichment analyses were performed to identify key biological processes. Selected targets were validated by tissue immunofluorescence and plasma ELISA. Transcriptomic analysis revealed 3030 dysregulated mRNAs in ACM versus healthy controls and 120 versus DCM. Enriched clusters in ACM versus healthy controls were related to immune activation, inflammation, extracellular matrix remodelling and mitochondrial stress; redox and metabolic processes, cell junction regulation and immune responses were enriched clusters in ACM versus DCM. Proteomics identified 206 and 65 differentially expressed proteins, respectively. Three novel proteins, UCHL1, OCIAD1 and desmoyokin, were consistently up-regulated at transcript and protein levels. The latter two were confirmed in myocardial tissue staining and showed elevated plasma levels in ACM compared with DCM and controls. Conclusion: This integrated transcriptomic and proteomic study of myocardial tissue and plasma from patients with ACM compared with those with DCM and healthy controls, identified key dysregulated pathways, involving immune response, inflammation and oxidative and mitochondrial stress. Desmoyokin and OCIAD1, in particular, may represent specific candidate biomarkers for ACM.
Publications 1 - 8 of 8