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Wolfram Grimm

Publications and source records attributed to Wolfram Grimm.

At least 19 recordsLinked to original sources
PubMed2006

B-type natriuretic peptide levels predict event-free survival in patients with implantable cardioverter defibrillators.

INTRODUCTION: We examined whether B-type natriuretic peptide (BNP) levels predict outcome in heart failure patients with implantable cardioverter defibrillators (ICD) using a combined endpoint of malignant tachyarrhythmias, death or heart transplantation. METHODS AND RESULTS: BNP levels were measured in 123 ICD patients with chronic heart failure (age: 63+/-12 years, ejection fraction: 29+/-10%). After a median follow-up of 25 months, the combined endpoint was reached in 28 patients (first tachyarrhythmic event, n=16; death, n=11; heart transplantation, n=1). BNP levels were significantly lower in patients with event-free survival compared to patients reaching the combined endpoint of this study (median: 140 vs. 373 pg/ml; p<0.001). Multivariable Cox regression analysis revealed that BNP levels predict adverse outcome (RR 1.002 per pg/ml increment; 95% CI: 1.001-1.003; p<0.001) and use of beta-blockers was associated with favourable outcome (RR 0.319; 95% CI 0.151-0.670; p=0.004). LV ejection fraction (p=0.66) did not significantly predict event-free survival in multivariable analysis. CONCLUSIONS: BNP plasma levels are useful markers to predict event-free survival in ICD patients with heart failure. Of note, malignant tachyarrhythmias appear responsible for about 50% of fatal outcomes. Our findings suggest that determination of BNP plasma levels is more valuable than determining LV ejection fraction to anticipate event-free survival in this population.

Aged↗
PubMed2006

Brain natriuretic peptide for prediction of Cheyne-Stokes respiration in heart failure patients.

Cheyne-Stokes respiration (CSR) is indicative of adverse outcome in patients with chronic heart failure (CHF). We evaluated the use of brain natriuretic peptide (BNP) plasma levels to predict CSR in CHF patients. In this cross-sectional study, overnight polygraphy and cardiac work-up were performed and neurohumoral activation was determined in 102 consecutive CHF patients (25-82 years). Demographic characteristics did not significantly differ among patients with (n=38) or without CSR (n=64); BNP (median: 377 vs. 142 pg/ml, p<0.001) and norepinephrine levels (459+/-283 vs. 346+/-204 pg/ml, p=0.02) were significantly increased in patients with CSR. BNP concentrations were significantly associated with the central apnoea/hypopnoea index (y=253+/-5.3x; r=0.26, p=0.01). The area under the ROC curve that used BNP to predict CSR was 0.780 (95% CI: 0.688 to 0.873). Using established cut-off limits of BNP plasma levels, heart failure patients with BNP levels >500 pg/ml displayed a 13 fold increased risk of CSR (95% CI: 2.34-73.50; p=0.03) compared to patients with BNP levels <100 pg/ml. In multiple logistic regression analysis p(a)CO2 (point estimate 0.84, 95% CI: 0.72 to 0.98; p=0.02) and higher BNP class (point estimate 3.14, 95% CI: 1.38-7.144; p=0.006) emerged as parameters independently predicting the presence of CSR in our cohort of CHF patients. In conclusion, CSR is associated with neurohumoral activation in CHF patients. Specifically, BNP levels are associated with the severity of cardiac and sleep-related disease, and may be helpful in the diagnosis of CSR and more appropriate use of polysomnography in CHF patients.

Adult↗
PubMed2006

Obesity, sleep apnea syndrome, and rhythmogenic risk.

Obstructive sleep apnea is a common disorder and affects approximately 4% of middle-aged men and 2% of middle-aged women. Obstructive sleep apnea is clearly associated with obesity, with more than 50% of patients having a body mass index>30 kg/m2. Substantial evidence identified obstructive sleep apnea as risk factor not only for excessive daytime sleepiness and road traffic accidents, but also for increased cardiovascular morbidity and mortality. In addition, all kinds of arrhythmias have been observed in patients with sleep apnea ranging from asymptomatic sinus bradycardia to sudden cardiac death. Approximately 5-10% of patients with obstructive sleep apnea show marked apnea-related bradyarrhythmias due to enhanced vagal tone and pronounced hypoxia. Therapeutic options in obese patients with obstructive sleep apnea include consequent weight loss and nasal continuous positive airway pressure (CPAP) ventilation as the therapy of first choice. Weight reduction and effective nasal CPAP therapy significantly decrease cardiovascular morbidity and mortality and eliminate sleep-related bradyarrhythmias in 80-90% of patients obviating the need for pacemaker implantation in these patients.

Arrhythmias, Cardiac↗
PubMed2006

What is evidence-based, what is new in medical therapy of acute heart failure?

Acute decompensated heart failure (ADHF) has become the leading cause of hospitalization in patients > 65 years of age. Traditional drug therapy for ADHF has remained unchanged for many years including morphine, diuretics, nitrates and inotropic agents in addition to oxygen supplementation and mechanical ventilatory support, if necessary. In the year 2005, the European Society of Cardiology published new guidelines for diagnosis and treatment of ADHF. These guidelines emphasize that ADHF is not a disease entity but a complex syndrome with various etiologies and several distinct clinical conditions as a result of systolic and/or diastolic left and/or right ventricular dysfunction. This review article describes the current role of traditional drugs for ADHF as well as the role of newer concepts including vasodilators like the recombinant human brain peptide nesiritide, endothelin antagonists or vasopressin antagonists and newer inotropic agents like the calcium sensitizer levosimendan.

Anti-Arrhythmia Agents↗
PubMed2006

Heart rate variability in patients with cardiac hypertrophy--relation to left ventricular mass and etiology.

BACKGROUND: Decreased heart rate variability (HRV) has been shown to reflect disturbances of the autonomic nervous system that is related to increased cardiovascular mortality. Most studies investigated HRV in patients with systolic left ventricular dysfunction due to remote myocardial infarction or dilated cardiomyopathy. To date, only few data are available on HRV in patients with predominant diastolic dysfunction in the presence of cardiac hypertrophy of different etiologies. METHODS: Time domain analysis of HRV was performed from digital 24-hour Holter electrocardiogram recordings in 86 patients with sinus rhythm and cardiac hypertrophy, which was due to aortic valve stenosis in 33 patients, hypertrophic cardiomyopathy in 29 patients, and hypertensive heart disease in 24 patients. Heart rate variability analysis was compared with 91 healthy controls. RESULTS: The SD of all normal-to-normal R-R intervals (SDNN) was reduced in patients with aortic valve stenosis, hypertrophic cardiomyopathy, and hypertensive heart disease when compared with controls (SDNN 119 +/- 42 vs 154 +/- 36 milliseconds, P < .001). The extent of cardiac hypertrophy indexed by echocardiography based left ventricular mass calculation and increased patient age were independent predictors for depression of SDNN. CONCLUSIONS: Cardiac hypertrophy of various etiologies is related to decreased HRV on 24-hour Holter electrocardiogram. Both the patient age and the extent of left ventricular hypertrophy are independently associated with depression of HRV. These findings are independent of the cause of cardiac hypertrophy. The significance of these findings remains to be determined by future studies.

Aged↗
PubMed2006

Antitachycardia pacing for spontaneous rapid ventricular tachycardia in patients with prophylactic cardioverter-defibrillator therapy.

AIMS: Antitachycardia pacing (ATP) has not routinely been used in patients who received implantable cardioverter defibrillators (ICDs) for primary prevention of sudden death. This study investigated the efficacy of empirical ATP to terminate rapid ventricular tachycardia (VT) in heart failure patients with prophylactic ICD therapy. METHODS AND RESULTS: Ninety-three patients with a mean left ventricular ejection fraction of 22 +/- 7% (range: 9-35%) due to nonischemic or ischemic cardiomyopathy received prophylactic ICDs with empiric ATP. At least 2 ATP sequences with 6-pulse burst pacing trains at 81% of VT cycle length (CL) were programmed in one or two VT zones for CL below 335 +/- 23 ms and above 253 +/- 18 ms. Ventricular flutter and fibrillation (VF) with CL below 253 +/- 18 ms were treated in a separate VF zone with ICD shocks without preceding ATP attempts. During 38 +/- 27 months follow-up, 339 spontaneous ventricular tachyarrhythmias occurred in 36 of 93 study patients (39%). A total of 232 VT episodes, mean CL 293 +/- 22 ms, triggered ATP in 25 of 36 patients with ICD interventions (69%). ATP terminated 199 of 232 VT episodes (86%) with a mean CL of 294 +/- 23 ms in 23 of 25 patients (88%) who received ATP therapy. ATP failed to terminate or accelerated 33 of 232 VT episodes (14%) with a mean CL of 287 +/- 19 ms in 12 of 25 patients (48%) who received ATP therapy. CONCLUSIONS: Painfree termination of rapid VT with empirical ATP is common in heart failure patients with prophylactic ICD therapy. The occasional inability of empiric ATP to terminate rapid VT in almost 50% of patients who receive ATP for rapid VT warrants restrictive ICD programming with regard to the number of ATP attempts in order to avoid syncope before VT termination occurs.

Cardiac Pacing, Artificial↗
PubMed2005

Effects of synthetic progestagens on autonomic tone, neurohormones and C-reactive protein levels in young healthy females in reproductive age.

BACKGROUND: Heart rate variability and baroreceptor sensitivity are measures of autonomic control. While progestagen-containing replacement therapy in postmenopausal women adversely affects autonomic balance, the impact of hormonal contraceptives with synthetic progestagens on autonomic activity, neurohormones and C-reactive protein levels is not well characterized. METHODS AND RESULTS: We analyzed parameters of heart rate variability and baroreceptor sensitivity in young healthy females without (n = 27) or on oral contraceptives with synthetic progestagens (n = 31). Demographic characteristics were not different among the examined groups. Total power (controls: 5682+/-3618 vs. hormones: 4800+/-2957 ms2; NS), standard deviation of beat-to-beat intervals (SDNN; 66+/-24 vs. 63+/-20 ms; p = 0.74), other time- and frequency-dependent parameters of heart rate variability and baroreceptor sensitivity (6.0+/-3.2 vs. 6.5+/-2.7 ms/mm Hg; NS) were not significantly different among the groups. Total cholesterol and triglyceride as well as C-reactive protein (CRP) levels were significantly higher in users of hormonal contraceptives than in non-users (cholesterol: 187+/-37 vs. 166+/-28 mg/dL; p = 0.05; triglycerides: 110+/-35 vs. 68+/-30 mg/dL; p = 0.01; CRP: 2.7+/-2.1 vs. 1.0+/-1.4 mg/L; p < 0.001). Heart rate variability, baroreceptor sensitivity, lipid parameters and CRP levels were not affected during the ovarian cycle in non-users of hormonal contraception. CONCLUSIONS: The use of oral contraceptives containing synthetic progestagens was not associated with a modulation of autonomic tone, while lipid parameters and CRP levels were adversely affected. These data suggest that synthetic progestagens in modern oral contraceptives do not modulate the autonomic balance, but probably affect the atherogenic risk profile of young females in reproductive age.

Adult↗
PubMed2005

Prognostic significance of serum cholesterol levels in patients with idiopathic dilated cardiomyopathy.

AIMS: Previous studies indicate that low cholesterol levels are associated with adverse prognosis in heart failure patients, because elevated lipoprotein levels may negate bacterial endotoxin load induced by gastrointestinal congestion. METHODS AND RESULTS: We examined the prognostic significance of lipid levels in a cohort of 422 patients with idiopathic dilated cardiomyopathy (iDCM) [50+/-12 years, 342 males, 80 females, left ventricular ejection fraction (LV-EF): 31.6+/-10.6%]. During 42 months of follow-up, 86 patients (20.3%) died or received a heart transplant. In univariate Cox regression analysis, reduced LV-EF, high New York Heart Association (NYHA) class, and increased LV end-diastolic diameter (LVEDD) were strong risk factors associated with that endpoint, whereas decreased total cholesterol, HDL-cholesterol, and apoprotein I levels were identified as weak risk predictors. After step-wise multivariable analysis, only LVEDD, NYHA class, and LV-EF emerged as parameters independently contributing to the model predicting risk for death or heart transplantation (P<0.05). Cholesterol levels were positively associated with LV-EF and negatively associated with LVEDD (P<0.05). Circulating sCD14 levels, a marker of endotoxin exposure, were related to cholesterol levels (P<0.05) and LV-EF (P<0.05). CONCLUSION: Decreased cholesterol levels do not independently predict adverse prognosis in patients with iDCM. Our findings indicate that low cholesterol levels are dependent on the severity of cardiac disease.

Adult↗
PubMed2005

Right ventricular cardiac myxoma. Diagnostic usefulness of cardiac magnetic resonance imaging.

BACKGROUND: Cardiac myxomas are the most common type of cardiac tumors. About 75-85% of cardiac myxomas originate in the left atrium, 15-20% in the right atrium. Most myxomas arise from the interatrial septum adjacent to the fossa ovalis. Only 3-4% are found in the left and right ventricle each. Although myxomas are histologically benign, they may be fatal because of their strategic position. CASE STUDY: The authors report on a 24-year-old patient with stabbing thoracic pain and dyspnea due to pulmonary thromboembolism that was caused by an atypically localized myxoma at the right ventricular apex originating from the interventricular septum. The diagnosis was based on cardiac magnetic resonance (CMR) imaging. Superior to echocardiography, CMR could strengthen the diagnostic accuracy by additional information on tissue characterization using different imaging sequences. Typically for cardiac myxomas, contrast enhancement was moderate and delayed enhancement was found in the outer circumferential tumor margins only. CONCLUSION: High spatial resolution and multiplane imaging combined with different acquisition patterns of CMR achieve a global view of the heart that seems to be useful for diagnosing cardiac tumorous masses.

Adult↗
PubMed2005

Arrhythmia risk prediction in idiopathic dilated cardiomyopathy based on heart rate variability and baroreflex sensitivity.

UNLABELLED: This study examined the relation between heart rate variability (HRV) and baroreflex sensitivity (BRS) and subsequent major arrhythmic events (MAE), defined as sustained VT, VF or sudden death, in 263 patients with idiopathic dilated cardiomyopathy (IDC) in sinus rhythm. The predefined measure of HRV was the standard deviation of all normal-to-normal RR intervals (SDNN) on baseline 24-hour ambulatory ECG. BRS was determined by the phenylephrine method. Over 52 +/- 21 months of follow-up, MAE occurred in 38 patients (14%). SDNN at baseline 24-hour ambulatory ECG (106 +/- 46 vs 109 +/- 45, ns) and BRS (7.9 +/- 5.5 vs 7.7 +/- 5.3 ms/mmHg, ns) were both similar in patients with versus without MAE during follow-up. In contrast, left ventricular ejection fraction was significantly lower in patients with versus without MAE (24%+/- 7% vs 31%+/- 10%, P < 0.019. CONCLUSIONS: Neither HRV nor BRS predicted MAE in patients with IDC.

Arrhythmias, Cardiac↗
PubMed2005

Predictive value of high-sensitivity C-reactive protein in patients with idiopathic dilated cardiomyopathy.

We analyzed the serum concentrations of high-sensitivity C-reactive protein (hsCRP) at the time of diagnostic cardiac catheterization in 198 patients with idiopathic dilated cardiomyopathy (IDC) to evaluate its prognostic value. Patients were dichotomized according to a median value of hsCRP of 2 mg/dL. Predefined study endpoints over 69 +/- 33 months of follow-up included major arrhythmic events and transplant-free survival. Major arrhythmic events during follow-up occurred in 20 of 98 patients (20%) with low, compared to 22 of 100 patients (22%) with high hsCRP (ns). By multivariate analysis, a depressed left ventricular ejection fraction (LVEF) was the only significant predictor of arrhythmic risk. Death or cardiac transplantation was observed in 36% of patients with high, versus 22% of patients with low hsCRP (P < 0.05). By multivariate analysis, hsCRP and LVEF were independent predictors of transplant-free survival. Thus, in this patient population with IDC, hsCRP had independent prognostic value with regard to transplant-free survival, but did not contribute in the stratification with regard to arrhythmic risk.

Arrhythmias, Cardiac↗
PubMed2005

Long runs of non-sustained ventricular tachycardia on 24-hour ambulatory electrocardiogram predict major arrhythmic events in patients with idiopathic dilated cardiomyopathy.

This study examined the prognostic significance of the rate and length of non-sustained (NS) ventricular tachycardia (VT) on 24-hour ambulatory electrocardiograms (ECG) recorded in 343 patients with idiopathic dilated cardiomyopathy (IDC) in the prospective Marburg Cardiomyopathy study. NSVT was defined as >/=3 consecutive ventricular premature beats at >120 bpm. During 52 +/- 21 months of follow-up, major arrhythmic events defined as sustained VT, VF, or sudden cardiac death occurred in 46 of 343 patients (13%). Patients with 3-4 beat runs of NSVT had a similar arrhythmia-free survival as patients without NSVT on baseline 24-hour ambulatory ECG. The incidence of major arrhythmic events during follow-up increased significantly from 2% per year in patients without NSVT, to 5% per year in patients with 5-9 beat runs of NSVT, to 10% per year in patients with >/=10 beat runs of NSVT (P < 0.05). Unlike the length, the rate of NSVT was similar in patients with versus without subsequent major arrhythmic events (163 +/- 23 vs 160 +/- 24 bpm). Thus, the length but not the rate of NSVT on 24-hour ambulatory ECG was a predictor of major arrhythmic events in patients with IDC. The presence of NSVT with >/=10 beat runs on ambulatory ECG was associated with a particularly high risk of major arrhythmic events.

Arrhythmias, Cardiac↗
PubMed2005

Marked improvement in left ventricular function and significant reverse left ventricular remodeling within 3 months of cardiac resynchronization therapy in patients with dilated cardiomyopathy.

We monitored reverse left ventricular (LV) remodeling and LV function during the first 6 months of cardiac resynchronization therapy (CRT) in 34 patients (mean age = 55.3 +/- 13.6 years, 28 men) with dilated cardiomyopathy (DCM), left bundle branch block, in stable New York Heart Association class III, and on fixed drug regimen who underwent implantation of CRT systems with or without cardioverter defibrillator back-up. QRS-complex duration was reduced from 169.69 +/- 19.6 ms (SD) to 144.1 +/- 23.4 ms during CRT. Parasternal M-mode and apical 2D-echocardiography was performed before and 3 and 6 months after device implantation. LV enddiastolic (EDD) and endsystolic (ESD) diameters were measured, and biplane LV enddiastolic (EDV), and endsystolic (ESV) volumes and ejection fractions (EF) were calculated using a modified Simpson formula. Significant decreases in LVEDD (P = 0.0064 at 3 months and P = 0.021 at 6 months), LVESD (P = 0.023 at 3 months, and P = 0.003 at 6 months), and LVESV (P = 0.006 resp. P = 0.007), and increases in LVEF (P = 0.003 at 3 months and P < 0.001 at 6 months) were observed. Mean LVEF increased from 23% at baseline to 39% at 6 months. CRT induced prominent reverse LV remodeling and significantly increased LVEF within a few months in patients with DCM.

Cardiac Pacing, Artificial↗
PubMed2005

Complications of implantable cardioverter defibrillator therapy in 440 consecutive patients.

BACKGROUND: Although more than 150,000 implantable cardioverter defibrillators (ICDs) are implanted yearly worldwide, only few studies systematically examined complications of ICD therapy in large patient cohorts. METHODS: We prospectively analyzed ICD-related complications in 440 consecutive patients who underwent first implantation of an ICD system for primary or secondary prevention of sudden cardiac death within the last 10 years at our institution. All study patients received pectoral nonthoracotomy ICD lead systems with the exception of one patient who had an artificial tricuspid valve. RESULTS: During 46 +/- 37 months follow-up, 136 of 440 patients (31%) experienced at least one complication including implant procedure-related complications in 43 patients (10%), ICD generator-related complications in 28 patients (6%), lead-related complications in 52 patients (12%), and inappropriate shocks in 54 patients (12%). The most serious complications included one perioperative death due to heart failure (0.2%), two ICD system infections necessitating device removal (0.5%) and two perioperative cerebrovascular strokes (0.5%). CONCLUSIONS: We conclude that more than one quarter of ICD patients experience complications during a mean follow-up of almost 4 years, although serious complications such as intraoperative death or ICD system infections are rare in patients with nonthoracotomy ICD systems. Recognition of these complications is the prerequisite for advances in ICD technology and management strategies to avoid their recurrence.

Death, Sudden, Cardiac↗
PubMed2004

Arrhythmia risk stratification with regard to prophylactic implantable defibrillator therapy in patients with dilated cardiomyopathy. Results of MACAS, DEFINITE, and SCD-HeFT.

To date, generally accepted indications for prophylactic defibrillator implantation in patients with dilated cardiomyopathy do not exist. Recently, the Marburg Cardiomyopathy Study (MACAS) revealed left ventricular ejection fraction to be the only significant arrhythmia risk predictor in a relatively large patient population with dilated cardiomyopathy. Meanwhile, the preliminary results of two prospective randomized trials evaluating prophylactic defibrillator therapy in dilated cardiomyopathy have been reported. The Defibrillators in Nonischemic Cardiomyopathy Treatment Evaluation study (DEFINITE) randomized 458 patients with a history of symptomatic heart failure, a left ventricular ejection fraction < or = 35% and arrhythmias on Holter to an ICD versus no ICD. As a result, ICD therapy was associated with a significant reduction of arrhythmic deaths, which failed to result in a significant decrease in total mortality due to an insufficient number of patients in DEFINITE. The Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) was a three-arm study comparing placebo to amiodarone to prophylactic ICD therapy in a total of 2,521 patients with ischemic cardiomyopathy (51%) or nonischemic dilated cardiomyopathy (49%). All patients in SCD-HeFT had a left ventricular ejection fraction inverted exclamation mark U 35% despite optimized medical heart failure therapy. SCD-HeFT showed a significant reduction of total mortality in the ICD group, whereas amiodarone did not improve survival.

Arrhythmias, Cardiac↗