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Journal: Herz


BACKGROUND: Atrial fibrillation (AF) recurrence after ablation is difficult to predict. The development of AF is associated with inflammation, and inflammatory markers such as big endothelin-1 (big ET-1) reflect inflammatory status. It is unknown, however, whether big ET-1 can be used as a predictor for AF recurrence. The aim of this study was to investigate the relationship between plasma levels of big ET-1 and AF recurrence. METHODS: A total of 158 patients who had undergone primary ablation for symptomatic and/or drug-refractory AF, including 103 with paroxysmal and 55 with persistent AF, were included in this study. Left atrial diameter was measured with echocardiography and plasma big ET-1 levels with ELISA. All patients were followed up for at least 12 months and AF recurrence defined as an episode of AF lasting ≥ 30 s, with or without atrial flutter or atrial tachycardia. RESULTS: The AF recurrence rate was 44.9% (71/158) during the median follow-up period of 22 (13, 40) months. Plasma levels of big ET-1 in the recurrence group were higher than those in the non-recurrence group in all patients [0.80 (0.54, 1.30) vs. 0.57 (0.48, 0.72) fmol·L(-) (1), p  = 0.001], in patients with paroxysmal AF [0.81 (0.46, 1.30) vs. 0.57 (0.48, 0.70) fmol·L(-) (1), p  = 0.009] as well as in patients with persistent AF [0.77 (0.57, 1.28) vs. 0.57 (0.49, 0.89) fmol·L(-) (1), p = 0.034]. Multiple logistic regression analyses showed that plasma levels of big ET-1 were associated with AF recurrence in patients with paroxysmal AF (p  = 0.037). Kaplan-Meier analysis demonstrated that the sinus rhythm maintenance rate was lower in patients with higher big ET-1 levels than those with lower levels (p  < 0.05). CONCLUSIONS: Baseline plasma big ET-1 levels are associated with AF recurrence after primary ablation procedure in patients with paroxysmal AF, and may be used in the prediction of AF recurrence in these patients.

Concepts: Regression analysis, Logistic regression, Atrial fibrillation, Cardiac electrophysiology, Supraventricular tachycardia, Atrial flutter, Tachycardia, Left atrial appendage


Due to the increased life expectancy and continual improvements in cardiological treatment options, diseases of the tricuspid valve, in particular tricuspid valve insufficiency will become increasingly more recognized as an interventional target. While tricuspid stenosis is rare and can be effectively treated with balloon valvuloplasty, no effective transcatheter approach to tricuspid regurgitation (TR) has yet been established. As the tricuspid annulus is a complex and highly dynamic structure that offers little resistance, orthotopic long-term fixation of transcatheter valves with the current techniques is challenging and has not yet been performed in human patients. Alternative treatment concepts include transcatheter caval valve implantation (CAVI) to address the regurgitation of blood into the caval veins, which has resulted in hemodynamic improvement and is currently undergoing further clinical investigation. Other interventional treatment concepts are aimed at tricuspid valve repair, e.g. by annular plication with the Mitralign™ device or the TriCinch™ system. In the medium-term it can be assumed that percutaneous systems and therapy options will become available for these indications whereby the functional and prognostic effects of these treatment procedures will be corroborated in the appropriate patient groups by corresponding studies.

Concepts: Heart, Right atrium, Tricuspid valve, Annulus, Abstraction, Tricuspid insufficiency, Regurgitation, Valvular heart disease


The individual amount of alcohol consumed acutely or chronically decides on harm or benefit to a person’s health. Available data suggest that one to two drinks in men and one drink in women will benefit the cardiovascular system over time, one drink being 17.6 ml 100 % alcohol. Moderate drinking can reduce the incidence and mortality of coronary artery disease, heart failure, diabetes, ischemic and hemorrhagic stroke. More than this amount can lead to alcoholic cardiomyopathy, which is defined as alcohol toxicity to the heart muscle itself by ethanol and its metabolites. Historical examples of interest are the Munich beer heart and the Tübingen wine heart. Associated with chronic alcohol abuse but having different etiologies are beriberi heart disease (vitamin B1 deficiency) and cardiac cirrhosis as hyperdynamic cardiomyopathies, arsenic poising in the Manchester beer epidemic, and cobalt intoxication in Quebec beer drinker’s disease. Chronic heavy alcohol abuse will also increase blood pressure and cause a downregulation of the immune system that could lead to increased susceptibility to infections, which in turn could add to the development of heart failure. Myocardial tissue analysis resembles idiopathic cardiomyopathy or chronic myocarditis. In the diagnostic work-up of alcoholic cardiomyopathy, the confirmation of alcohol abuse by carbohydrate deficient transferrin (CDT) and increased liver enzymes, and the involvement of the heart by markers of heart failure (e.g., NT-proBNP) and of necrosis (e.g., troponins or CKMb) is mandatory. Treatment of alcoholic cardiomyopathy consists of alcohol abstinence and heart failure medication.

Concepts: Immune system, Blood, Myocardial infarction, Cardiology, Heart, Alcoholism, Circulatory system, Alcoholic beverage


Several recent small studies have suggested a causal link between Lyme disease and dilated cardiomyopathy (DCM) by demonstrating the presence of the Borrelia burgdorferi (Bb) genome in the myocardium of patients with recent-onset DCM. The aim of this study was to further investigate the effect of targeted antibiotic treatment of Bb-related recent-onset DCM in a larger cohort of patients.

Concepts: Bacteria, Lyme disease, Borrelia burgdorferi, Borrelia, Allen Steere


The current European Society of Cardiology (ESC) guidelines on peripheral arterial diseases include recommendations on diagnostics and treatment of atherosclerotic manifestations in peripheral arteries. Because of the high coincidence of atherosclerosis in different arterial territories, screening for other atherosclerotic lesions is necessary in patients with clinical symptoms in one vascular bed. Consistent treatment of cardiovascular risk factors is important in all patients with peripheral atherosclerosis. This includes smoking cessation, statin therapy and control of blood pressure and blood glucose. All patients with carotid artery stenosis should be treated with antiplatelet drugs. In patients with symptomatic carotid artery stenosis and low periprocedural risk, early revascularization is recommended when the degree of stenosis is more than 50%. In asymptomatic carotid artery stenosis revascularization should only be considered if the risk for cerebral embolization is high and the periprocedural risk is low. Patients with peripheral arterial occlusive disease should only be treated with an antiplatelet drug if they are symptomatic. In cases of intermittent claudication supervised exercise training is strongly recommended. When activities of daily life are compromised despite training, revascularization by endovascular therapy first should be considered. In chronic limb-threatening ischemia early revascularization should be considered, preferably by venous bypass surgery. In patients with arterial hypertension and specific risk factors screening for renal artery stenosis is recommended. Particularly in patients with atherosclerotic renal artery stenosis, the indications for revascularization should be assessed very carefully.

Concepts: Blood, Myocardial infarction, Atherosclerosis, Blood vessel, Blood pressure, Artery, Cardiovascular system, Coronary artery bypass surgery


This article gives an update on the management of acute ST-segment elevation myocardial infarction (STEMI) according to the recently released European Society of Cardiology guidelines 2017 and the modifications are compared to the previous STEMI guidelines from 2012. Primary percutaneous coronary intervention (PCI) remains the preferred reperfusion strategy. New guideline recommendations relate to the access site with a clear preference for the radial artery, use of drug-eluting stents over bare metal stents, complete revascularization during the index hospitalization, and avoidance of routine thrombus aspiration. For periprocedural anticoagulation during PCI, bivalirudin has been downgraded. Oxygen treatment should be administered only if oxygen saturation is <90%. In cardiogenic shock, intra-aortic balloon pumps should no longer be used. New recommendations are in place with respect to the duration of dual antiplatelet therapy for patients without bleeding events during the first 12 months. Newly introduced sections cover myocardial infarction with no relevant stenosis of the coronary arteries (MINOCA), the introduction of new indicators for quality of care for myocardial infarction networks and new definitions for the time to reperfusion.

Concepts: Myocardial infarction, Atherosclerosis, Angina pectoris, Cardiology, Heart, Percutaneous coronary intervention, Atheroma, Artery


The present meta-analysis was designed to improve statistical power and review the effects of monoclonal antibodies against PCSK9 on clinical cardiovascular events.

Concepts: Immune system, Epidemiology, The Canon of Medicine, Randomized controlled trial, Evaluation methods, Pharmaceutical industry, Clinical research, Effect size


We investigated the effects and underlying mechanisms of genistein on pathological cardiac hypertrophy in vivo and in vitro.

Concepts: In vivo, In vitro fertilisation, In vitro


We previously showed that using the radial artery access site as opposed to the femoral artery site decreases the radiation exposure of patients during coronary artery interventions. The objective of this study was to compare radiation exposure levels of the operating physician during coronary interventions when incorporating both radial and femoral artery approaches.

Concepts: Artery, Coronary circulation, Pulse


Ventricular assist device (VAD) implantation has developed into a well-established option when conservative treatment of terminal heart failure has been exhausted. Figures from 2015 make this clear: only 283 heart transplantations were performed nationwide but 959 VAD systems were implanted. It is noteworthy that the survival times with a VAD are approaching the survival times after heart transplantation. Patients with VADs have a life-long dependency on their proximity to specialists. So far, the requirements for outpatient care have not been systematically recorded from the perspective of VAD patients and their relatives. In September 2016, VAD patients (n = 30) and their relatives (n = 25) were anonymously questioned about their views on postoperative outpatient care. For this purpose, the VAD Patient Satisfaction Survey was adapted to the needs of this study. Patients with VADs and their relatives were found to experience their daily life with a VAD in a positive manner. Information, training, accessibility and regular contacts with the implantation clinic and the VAD coordinator are important pillars of outpatient care after VAD implantation. Almost 95% of surveyed patients regarded good home support as an important factor that makes life with a VAD easier. These aspects should be taken into account in the care of patients living with a VAD.

Concepts: Patient, Cardiology, Cardiomyopathy, Organ transplant, Ventricular assist device, Surveying, 2016, 2015