Christian Prinz

Predictors of recurrence in patients undergoing cryoballoon ablation for treatment of atrial fibrillation: the independent role of sleep-disordered breathing.

Predictors of AF Recurrence After Cryoballoon PVI.u2002Introduction: In patients with atrial fibrillation (AF) undergoing pulmonary vein isolation, cryoballoon technique (cryoPVI) has been adopted in many centers. This study aimed to evaluate predictors of AF recurrence including impact of sleep‐disordered breathing (SDB).

Sleep apnea is common in patients with coronary artery disease

ZusammenfassungSchlafapnoe hat eine prognostisch ungünstige Bedeutung für Herzpatienten. Wir schlossen 257 konsekutive Patienten mit erhaltener linksventrikulärer Pumpfunktion und angiographisch gesicherter koronarer Herzerkrankung (KHK) in unsere Studie ein. Alle Patienten erhielten eine kardiorespiratorische Polygraphie. Bei 251 Patienten wurde hochsensitives C-reaktives Protein (hsCRP) und Fibrinogen bestimmt. 188 Patienten demonstrierten eine Schlafapnoe (Apnoe-Hypopnoe-Index [AHI] 16,4±1,9/h): 58 Patienten präsentierten eine zentrale (CSA) und 130 Patienten eine obstruktive Schlafapnoe (OSA). Alle Schlafapnoeiker (73 %) zeigten höhere Fibrinogenspiegel als die Patienten ohne Schlafapnoe (p = 0,01). Wir fanden 197 Patienten mit CRP-Werten unter einem cut-off von 0,5 mg/dl (Gruppe 1) und 54 Patienten ohne aktive Infektion, aber mit CRP-Werten >0,5 mg/dl (Gruppe 2). Die Gruppe 2 wies eine deutlich schwerere Schlafapnoe auf (p = 0,01). Schlafapnoe hatte eine hohe Prävalenz bei unseren KHK-Patienten und scheint mit chronischer Inflammation assoziiert zu sein, die wiederum eine Progression der KHK oder akute koronare Ereignisse triggern könnte.SummarySleep-disordered breathing (SDB) has a prognostic impact in patients with cardiac diseases. We included 257 patients with preserved left ventricular function and angiographically proven coronary artery disease (CAD). All patients underwent cardiorespiratory polygraphy. In 251 patients high-sensitive C-reactive protein and fibrinogen were measured. SDB was documented in 188 patients (apnea-hypopnea-index [AHI] 16.4± 1.9/h): 58 patients presented central sleep apnea (CSA) and 130 patients obstructive sleep apnea (OSA). All patients (73%) with SDB had higher blood fibrinogen levels than those without SDB (p = 0.01). We found 197 patients with CRP-values below the cut-off of 0.5 mg/dl (group 1) and 54 patients with no active infection but CRP>0.5 mg/dl (group 2). Severity of SDB was significantly higher in group 2 (p = 0.01). SDB has a high prevalence in CAD patients and seems to be associated with chronic inflammation, which may be linked to CAD progression and/or acute coronary events.

Left Ventricular Mass and Oxygen Uptake in Top Handball Athletes

The key challenge in athletes screening is the distinction between abnormal and normal which is hindered by the fact that the adaptation to sports activity in endurance athletes is different to that in power athletes. Especially cardiomyopathies provoke changes in ECG and echocardiography (echo) at an early stage when clinical symptoms are absent. ECG and echo data and their relationship to fitness peculiar to top handball players have never been described. We studied 291 male first league handball players (32 Olympians/47 national players) (25.3±4.4 years). Check up consisted of ECG, spiroergometry and echocardiography. None had T-wave inversions, 3.1% showed early repolarisation abnormalities in the precordial leads. Sokolow-Lyon voltage criterion for left ventricular hypertrophy was positive in 19.3%. Spiroergometry showed a maximum oxygen uptake (peakVO₂) of 50.3±7.7 ml/min/kg body weight. LVmass was increased in comparison to normal values. There was a correlation between peakVO₂ and LVindex (p<0.001, r=0.341), (LVmass/peak VO₂ p=0.053, r=0.125). A relationship between cardiac dimensions and peakVO₂ could not be confirmed. In professional handball players early repolarisation abnormalities were less frequent and LVmass was increased when compared with soccer players. The need for normal values for different types of sports is crucial to guarantee a proper evaluation of athletes.

Effective valve opening area in the detection of dysfunctional aortic valve prostheses: a differentiated statistical analysis of this parameter including the introduction of minimal expected normal values as borderline to dysfunctional stenotic prostheses.

Background: Dysfunction of heart valve prostheses (VP) is a life‐threatening complication and the diagnosis remains difficult. The motivation for this study was to improve the detection of dysfunctional VP by optimizing application of the prosthetic effective orifice area (VA). For this reason the minimal expected normal VA (VAexpected) was introduced. Methods: We investigated echocardiographically 1,369 normally functioning aortic valve prostheses (AVP). Mean VA, transprosthetic peak (PPG) and mean pressure gradients (MPG) were evaluated to gain reference values depending on prosthetic size and construction principle. Mean VAexpected was calculated by applying a simple formula that was developed empirically using statistical analyses. The results were compared with those of 65 dysfunctional AVPs. Results: VAexpected can be applied as a threshold between normal and dysfunctional stenotic AVP and showed a correct estimation in 87% of all normally functioning and 100% of dysfunctional stenotic VPs. The sensitivity for all prosthetic sizes is 1.0, independently of the constructional principle of the VP. Specificity ranged between 0.8 and 1.0, dependent on VP size. The formula representing VAexpected is simple and can be executed easily. Conclusion: As nearly independent of stroke volume and in consideration of VAexpected, VA seems to have become one of the preferable parameters for detecting pathological stenotic AVPs echocardiographically. The additional application of PPG/MPG and other parameters permits prostheses with relevant isolated regurgitation and patient‐prosthesis‐mismatch to be distinguished. (Echocardiography 2012;29:713‐719)

GENDER-RELATED ASSOCIATION BETWEEN RESPIRATORY STABILITY AND CHEYNE-STOKES RESPIRATION IN CHRONIC HEART FAILURE: A MATCHED CONTROL STUDY

Introduction: Hypersensitive ventilatory feedback loop has major impact on the manifestation of Cheyne-Stokes respiration (CSA) in chronic heart failure (CHF). As CSA mainly affects male CHF patients (pts), this study aims to clarify the role of respiratory stability in the evolution of CSA in men and women. Methods: We investigated 563 pts with CHF (91 female, LVEF ≤45%, NYHA-class ≥2) using echocardiography, cardiopulmonary exercise testing (CPX), cardiorespiratory polygraphy, measurement of hyperoxic, hypercapnic ventilatory response (HCVR), and standard laboratory. Adjusted for age (±2 years), body mass index (BMI; ± 2), and LVEF (± 3%) 79 matched pairs (male/female) were eligible for analysis. Results: Obstructive sleep apnoea (AHI ≥5/h) was present in 12 female (15.2%) and 13 male (16.4%) pts (p=n.s.), CSA (AHI ≥5/h) in 30 (37.9%) female and 54 (68.4%) male pts (p 2 36.7 (interquartile range (IQR) 34.4-39.4) vs. 36.7 (IQR 34.8-38.7), VE/VCO 2 slope during CPX 34 (IQR 30-40) vs. 35 (IQR 31-40), HCVR 2.32 (IQR 1.71-3.49) vs. 2.69 (IQR 2.01-4.45) did not show a significant difference. Adjusted for age, NYHA-class, BMI, heart rate, LVEF, CRP, creatinine, NT-proBNP stepwise regression analysis revealed HCVR (p=0.03) an independent predictor for CSA in male pts while NYHA-class (p=0.04) was the only independent predictor for CSA in female pts. Conclusion: These data suggest gender-related differences in the evolution of CSA. Additional studies are warranted to figure out a more sophisticated pathophysiological concept that may elucidate these findings.