P Christian Schulze

Publication Details
Article Title: Transthyretin Val30Met mutation in an African American with cardiac amyloidosis.

First Author: P Christian Schulze

All Authors: Schulze PC, Maurer MS

Journal Title: Congestive heart failure (Greenwich, Conn.)


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Interactive cardiovascular and thoracic surgery
Brain natriuretic peptide--a reliable parameter for the effectiveness of cardiac resynchronization therapy after coronary artery bypass grafting.

Authors: Raab S, Oertel F, Weimann T, Danov V, Beyer M

Abstract: Brain natriuretic peptide (BNP) is a valuable marker in heart failure and its therapy, for example cardiac resynchronization therapy (CRT). So far, one finding which is indicative for CRT is dyssynchrony of ventricular contraction obtained by echocardiography. The aim of this study was to show that BNP is also a helpful marker to help decide whether CRT is useful for patients after CABG.Forty-two patients with a poor ejection fraction (<35%) underwent elective CABG. Twenty-eight of them received permanent biventricular stimulation for seven days after surgery. Before and on the first, third, seventh and tenth day after surgical treatment, the following parameters were established: left ventricular function obtained by transthoracic echocardiography, myocardium-specific enzymes (such as CK and CKMB), ECG and BNP.There was a very good correlation between the preoperative ejection fraction and BNP (r2=0.98, P<0.005). Patients who had received CRT after CABG had BNP levels similar to preoperative data on postoperative day 7. This decrease of the BNP values in the CRT-group is in accord with an increased left ventricular function as obtained by echocardiography. The control group, which had not received CRT, showed significantly higher BNP levels.Therefore, we conclude that BNP is a good marker to evaluate CRT in patients undergoing CABG. An extraordinary rise of the BNP level should lead to early therapeutic consequences like CRT. The significantly lower BNP level of the patients with heart failure who received CRT indicates a better prognosis.

Interactive cardiovascular and thoracic surgery
Early and intensive continuous veno-venous hemofiltration for acute renal failure after cardiac surgery.

Authors: Bapat V, Sabetai M, Roxburgh J, Young C, Venn G

Abstract: Various forms of renal replacement therapies are available to treat acute renal failure (ARF) after cardiac surgery. The objective of this study was to assess the incidence of ARF developing postoperatively necessitating continuous veno-venous hemofiltration (CVVH) in adult patients requiring cardiopulmonary bypass (CPB), to determine the factors which influence the outcome in these patients and to assess the outcome following the use of early and intensive CVVH. During the study period, i.e. August 2000 to July 2002, 2355 adult patients underwent surgery under CPB, of whom 159 (6.7%) developed renal failure (creatinine >200 micromol/l) and 116 (5%) needed CVVH. Patients excluded were those who died within 24 h and those who underwent coronary artery bypass grafting without utilising CPB, thoracoabdominal aneurysm operations and pericardial surgery. Average age, Parsonnet score and Euroscore in the study population were 69.9 years, 21 and 7.70, respectively. Of the 116, 45 died in the intensive care unit (38.8% mortality). Relatively more non-survivors suffered from diabetes and preoperative renal dysfunction (P<0.05). Adverse outcome was also more likely if patient suffered from postoperative cardiac failure or had gastrointestinal complications or had more than two organ systems failing (P<0.05). Mortality was 100% if hepatic failure ensued.

Journal of gastroenterology and hepatology
Role of clinical presentation in diagnosing reflux-related non-cardiac chest pain.

Authors: Mousavi S, Tosi J, Eskandarian R, Zahmatkesh M

Abstract: Non-cardiac chest pain (NCCP) presents as a frequent diagnostic challenge, with patients tending to use a disproportionate level of health-care resources. Gastroesophageal reflux disease (GERD) is the most frequent cause of NCCP. Thus the typical symptoms of reflux, such as heartburn and regurgitation, when present as predominant symptoms are quite specific for diagnosing GERD but in patients with NCCP the clinical diagnosis of reflux is difficult, and invasive methods or the omeprazole test are required for its detection. The aim of the present study was to evaluate the role of clinical presentation when diagnosing GERD among patients with NCCP.Patients with NCCP underwent upper endoscopy, Bernstein and omeprazole tests. The patients were divided into two groups based on GER- or non-GER-related chest pain, and clinical presentation was compared between these two groups. Gastroesophageal reflux disease was considered positive when at least two methods were positive.From 78 NCCP patients (41 male; mean age 50.4 +/- 2.3 years), the chest pain was related to GERD in 35 patients (44.8%). The two groups were the same based on sex and age. The chest pain severity, site, radiation and relation to food, exercise, and sleep were equal in the two groups, except for two symptoms: pain that was relieved by antacid (P < 0.031) and presence of classical reflux symptoms (P < 0.009), seen in the GERD patients. With regard to recent patient history, heartburn and regurgitation symptoms were seen more frequently in GERD patients (P < 0.036 and P < 0.002, respectively).Clinical presentation is important in diagnosing GERD in NCCP. Although the chest pain is the same in reflux- and non-reflux-related NCCP, the symptoms of heartburn or regurgitation in the present or recent patient history are diagnostic for GERD-related chest pain.

Endonuclease G is a novel determinant of cardiac hypertrophy and mitochondrial function.

Authors: McDermott-Roe C, Ye J, Ahmed R, Sun XM, Serafín A, Ware J, Bottolo L, Muckett P, Cañas X, Zhang J, Rowe GC, Buchan R, Lu H, Braithwaite A, Mancini M, Hauton D, Martí R, García-Arumí E, Hubner N, Jacob H, Serikawa T, Zidek V, Papousek F, Kolar F, Cardona M, Ruiz-Meana M, García-Dorado D, Comella JX, Felkin LE, Barton PJ, Arany Z, Pravenec M, Petretto E, Sanchis D, Cook SA

Abstract: Left ventricular mass (LVM) is a highly heritable trait and an independent risk factor for all-cause mortality. So far, genome-wide association studies have not identified the genetic factors that underlie LVM variation, and the regulatory mechanisms for blood-pressure-independent cardiac hypertrophy remain poorly understood. Unbiased systems genetics approaches in the rat now provide a powerful complementary tool to genome-wide association studies, and we applied integrative genomics to dissect a highly replicated, blood-pressure-independent LVM locus on rat chromosome 3p. Here we identified endonuclease G (Endog), which previously was implicated in apoptosis but not hypertrophy, as the gene at the locus, and we found a loss-of-function mutation in Endog that is associated with increased LVM and impaired cardiac function. Inhibition of Endog in cultured cardiomyocytes resulted in an increase in cell size and hypertrophic biomarkers in the absence of pro-hypertrophic stimulation. Genome-wide network analysis unexpectedly implicated ENDOG in fundamental mitochondrial processes that are unrelated to apoptosis. We showed direct regulation of ENDOG by ERR-? and PGC1? (which are master regulators of mitochondrial and cardiac function), interaction of ENDOG with the mitochondrial genome and ENDOG-mediated regulation of mitochondrial mass. At baseline, the Endog-deleted mouse heart had depleted mitochondria, mitochondrial dysfunction and elevated levels of reactive oxygen species, which were associated with enlarged and steatotic cardiomyocytes. Our study has further established the link between mitochondrial dysfunction, reactive oxygen species and heart disease and has uncovered a role for Endog in maladaptive cardiac hypertrophy.

Congenital heart disease
Utility of preprocedure checklists in the congenital cardiac catheterization laboratory.

Authors: Gordon BM, Lam TS, Bahjri K, Hashmi A, Kuhn MA

Abstract: Preprocedure meetings have become more commonplace in medicine but are not performed routinely in the cardiac catheterization laboratory. We sought to create, implement, and evaluate a preprocedural meeting in the form of a checklist for the cardiac catheterization laboratory. Staff attitudes and perceptions toward safety and sense of teamwork were also analyzed.All procedures performed in the cardiac catheterization laboratory on patients with structural heart disease from January 2010 to February 2012 were retrospectively reviewed for demographics, procedural details, and reported complications. A checklist was introduced to the preprocedure protocol at the halfway point, and patients were divided into pre- and postchecklist cohorts. Anesthesia and cardiac catheterization laboratory staff were surveyed at the beginning and end of the study period regarding attitude toward safety, team climate, and the impact of errors.Total number of procedures (prechecklist, n = 371; postchecklist, n = 370) and demographics were similar among groups. Complication rates were equivalent pre- and postchecklist, but there was a greater proportion of interventional cases and higher median complication level in the postchecklist group. Cardiac catheterization laboratory staff reported improved awareness of being briefed with the checklist. Anesthesia differed from cardiac catheterization staff in perception of communication as well as team and safety climate.A preprocedure checklist for congenital cardiac catheterization cases is easy to perform and serves to update cardiac catheterization laboratory staff. Anesthesia and cardiac catheterization staff had different perceptions of safety and teamwork climate. Further studies are needed to determine if this briefing could lead to better communication among services and ultimately reduce complications.

Conference proceedings : ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Annual Conference
Coi-wiz: An interactive computer wizard for analyzing cardiac optical signals.

Authors: Yuan X, Uyanik I, Situ N, Xi Y, Cheng J

Abstract: A number of revolutionary techniques have been developed for cardiac electrophysiology research to better study the various arrhythmia mechanisms that can enhance ablating strategies for cardiac arrhythmias. Once the three-dimensional high resolution cardiac optical imaging data is acquired, it is time consuming to manually go through them and try to identify the patterns associated with various arrhythmia symptoms. In this paper, we present an interactive computer wizard that helps cardiac electrophysiology researchers to visualize and analyze the high resolution cardiac optical imaging data. The wizard provides a file interface that accommodates different file formats. A series of analysis algorithms output waveforms, activation and action potential maps after spatial and temporal filtering, velocity field and heterogeneity measure. The interactive GUI allows the researcher to identify the region of interest in both the spatial and temporal domain, thus enabling them to study different heart chamber at their choice.

Acta anaesthesiologica Scandinavica
Choice Reaction Time and cognitive dysfunction following cardiac surgery.

Authors: Steinmetz J, Rasmussen LS


International orthopaedics
The measurement of cardiac troponins in patients undergoing major orthopaedic surgery.

Authors: Lippi G, Cervellin G, Plebani M


Bioengineered cardiac patch constructed from multilayered mesenchymal stem cells for myocardial repair.

Authors: Wei HJ, Chen CH, Lee WY, Chiu I, Hwang SM, Lin WW, Huang CC, Yeh YC, Chang Y, Sung HW

Abstract: Growing three-dimensional scaffolds that contain more than a few layers of seeded cells is crucial for the creation of thick and viable cardiac tissues. To achieve this goal, a bioengineered cardiac patch (the MSC patch) composed of a sliced porous biological scaffold inserted with multilayered mesenchymal stem cells (MSCs) was developed for myocardial repair in a syngeneic rat model. After culture, sliced layers of the scaffold were stuck together and seeded MSCs were redistributed throughout the scaffold. Immunofluorescence analyses indicated that cells were viable and tightly adhered to a robust fibronectin meshwork within the scaffold. Results of echocardiography and heart catheterization revealed that the MSC-patch group had a superior heart function to the infarct group. Cells together with neo-muscle fibers and neo-microvessels were clearly observed in the entire MSC patch to fill its original pores, indicating that the implanted patch became well integrated into the host. The thickness of the retrieved MSC patch increased significantly as compared to that before implantation. When compared with the infarct group, expressions of angiogenic cytokines (bFGF, vWF and PDGF-B) and cardioprotective factors (IGF-1 and HGF) were significantly increased in the MSC-patch group. The aforementioned results indicated that transplantation of the MSC patch could restore the dilated LV and preserve cardiac functions after infarction.

Preoperative and perioperative predictors of reactive and persistent depression after cardiac surgery: a three-month follow-up study.

Authors: Patron E, Messerotti Benvenuti S, Palomba D

Abstract: Depression is commonly reported in patients after cardiac surgery and increases the risk of postoperative cardiac morbidity or mortality or both. Although preoperative depression has been implicated as the strongest predictor of depression after surgery, the characteristics thought to influence reactive or persistent depression have been poorly investigated in cardiac surgery patients.Therefore, the main aim of this study was to examine whether pre-existing depression rather than perioperative variables may predict postoperative reactive or persistent depression.Overall, 96 patients completed a psychologic evaluation, including the Center for Epidemiologic Studies of Depression scale and the State and Trait Anxiety Inventory for depression and anxiety, respectively, before surgery and at 3-month follow-up.A total of 27 (28%) and 24 (25%) patients had depression preoperatively and at 3-month follow-up, respectively. Postoperative depression was predicted by preoperative scores in Center for Epidemiologic Studies of Depression scale (? = 0.29, p < 0.05) and European System for Cardiac Operative Risk Evaluation (? = 0.22, p < 0.04), but not by procedure-related variables (p > 0.75). Specifically, patients with reactive depression showed greater European System for Cardiac Operative Risk Evaluation than those without depression (p < 0.05), whereas patients with persistent depression had greater preoperative Center for Epidemiologic Studies of Depression scores than those whose depression improved after surgery (p < 0.01).The severity of pre-existing depression and biomedical risk factors can be markers of depression-related risk 3 months after cardiac surgery in patients with persistent and reactive depression, respectively. An integrated psychologic and biomedical evaluation is essential to anticipate which patients are likely to show depression after cardiac surgery.

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