Die Eindämmung des lokalen Infektionsgeschehens in der Stadt Jena unter Einsatz eines Maßnahmenbündels während der COVID-19- Pandemie

Seit Beginn der CO¬VID-19-Pandemie in Deutschland verfolgte die Stadt Jena ein fortlaufend angepasstes Bündel synergistisch wirkender Maßnahmen, um Infektionsketten frühzeitig zu un-terbrechen und Neuinfektionen zu verhindern. Der Erfahrungsbericht der Stadt zeigt, dass sich das Jenaer Maßnahmenbündel als ein sehr wirksames Contain¬ment-Werkzeug bewährt hat.Peer Reviewe

Clinical predictors of outcome in patients with inflammatory dilated cardiomyopathy

Objectives The study objectives were to identify predictors of outcome in patients with inflammatory dilated cardiomyopathy (DCMi). Methods From 2004 to 2008, 55 patients with biopsy-proven DCMi were identified and followed up for 58.2 +/- 19.8 months. Predictors of outcome were identified in a multivariable analysis with a Cox proportional hazards analysis. The primary endpoint was a composite of death, heart transplantation and hospitalization for heart failure or ventricular arrhythmias. Results For the primary endpoint, a QTc interval > 440msec (HR 2.84; 95% CI 1.03-7.87; p = 0.044), a glomerular filtration rate (GFR) <60ml/min/1.73m(2) (HR 3.19; 95% CI 1.35-7.51; p = 0.008) and worsening of NYHA classification during follow-up (HR 2.48; 95% CI 1.01-6.10; p = 0.048) were univariate predictors, whereas left ventricular ejection fraction at baseline, NYHA class at entry, atrial fibrillation, treatment with digitalis or viral genome detection were not significantly related to outcome. After multivariable analysis, a GFR < 60ml/min/1.73m(2) (HR 3.04; 95% CI 1.21-7.66; p = 0.018) remained a predictor of adverse outcome. Conclusions In patients with DCMi, a prolonged QTc interval > 440msec, a GFR <60ml/min/1.73m(2) and worsening of NYHA classification during follow-up were univariate predictors of adverse prognosis. In contrast, NYHA classification at baseline, left ventricular ejection fraction, atrial fibrillation, treatment with digitalis or viral genome detection were not related to outcome. After multivariable analysis, a GFR < 60ml/min/1.73m(2) remained independently associated with adverse outcome

Galectin-3 as a Predictor of Left Ventricular Reverse Remodeling in Recent-Onset Dilated Cardiomyopathy

Objectives. Studies have evaluated the association of galectin-3 and outcome in patients with heart failure. However, there is still scarce evidence concerning the clinical usefulness and predictive value of galectin-3 for left ventricular reverse remodeling (LVRR) in patients with recent-onset dilated cardiomyopathy (RODCM). Patients and Methods. Baseline galectin-3 was measured in 57 patients with RODCM. All patients were followed for at least 12 months. The study end point was LVRR at 12 months, defined as an absolute improvement of the left ventricular ejection fraction of ≥10% to a final value of ≥35%, accompanied by a decrease in the left ventricular end diastolic diameter of at least 10%, as assessed by echocardiography. In receiver operating characteristic curve analysis, the optimum cut-off value for baseline galectin-3 with the highest Youden index was 59 ng/ml. Results. Overall, LVRR at 12 months was observed in 38 patients (66%). In a univariate analysis, NYHA functional class and baseline galectin-3 levels were associated with LVRR. After adjustment for covariates, galectin-3 remained an independent predictor for LVRR. Conclusions. Our study suggests that baseline galectin-3 is an independent predictor of LVRR. Low levels of galectin-3 may be regarded a useful biomarker of favorable ventricular remodeling in patients with RODCM

Clinical predictors of outcome in patients with inflammatory dilated cardiomyopathy

<div><p>Objectives</p><p>The study objectives were to identify predictors of outcome in patients with inflammatory dilated cardiomyopathy (DCMi).</p><p>Methods</p><p>From 2004 to 2008, 55 patients with biopsy-proven DCMi were identified and followed up for 58.2±19.8 months. Predictors of outcome were identified in a multivariable analysis with a Cox proportional hazards analysis. The primary endpoint was a composite of death, heart transplantation and hospitalization for heart failure or ventricular arrhythmias.</p><p>Results</p><p>For the primary endpoint, a QTc interval >440msec (HR 2.84; 95% CI 1.03–7.87; p = 0.044), a glomerular filtration rate (GFR) <60ml/min/1.73m² (HR 3.19; 95% CI 1.35–7.51; p = 0.008) and worsening of NYHA classification during follow-up (HR 2.48; 95% CI 1.01–6.10; p = 0.048) were univariate predictors, whereas left ventricular ejection fraction at baseline, NYHA class at entry, atrial fibrillation, treatment with digitalis or viral genome detection were not significantly related to outcome. After multivariable analysis, a GFR <60ml/min/1.73m² (HR 3.04; 95% CI 1.21–7.66; p = 0.018) remained a predictor of adverse outcome.</p><p>Conclusions</p><p>In patients with DCMi, a prolonged QTc interval >440msec, a GFR<60ml/min/1.73m² and worsening of NYHA classification during follow-up were univariate predictors of adverse prognosis. In contrast, NYHA classification at baseline, left ventricular ejection fraction, atrial fibrillation, treatment with digitalis or viral genome detection were not related to outcome. After multivariable analysis, a GFR <60ml/min/1.73m² remained independently associated with adverse outcome.</p></div

Economic impact of heart failure with preserved ejection fraction: insights from the ALDO‐DHF trial

Aims Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care-related costs of ambulatory HFpEF patients and the effect of spironolactone. Methods and results The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double-blind, placebo-controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow-up. We used a single-patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities. The average annual costs per patient in this cohort came up to euro1, 118 (± 2,475), and the median costs were euro332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO(2)max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs. Conclusions In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system

Baseline characteristics of study patients (N = 55).

<p>Baseline characteristics of study patients (N = 55).</p

Hazard ratio for the composite end-point all-cause mortality, heart transplantation and hospitalization for heart failure or ventricular arrhythmias.

<p>Hazard ratio for the composite end-point all-cause mortality, heart transplantation and hospitalization for heart failure or ventricular arrhythmias.</p

Characteristics of patients with or without LVEF improvement^*.

<p>Characteristics of patients with or without LVEF improvement^{<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0188491#t002fn002" target="_blank">*</a>}.</p

(a-k). Unadjusted survival free from death, heart transplantation and hospitalization for heart failure or ventricular arrhythmias in relation to clinical, laboratory, electrocardiographic, echocardiographic parameters and immunohistochemical parameters.

<p>a: gender; b: NYHA functional class; c: left ventricular ejection fraction (LVEF); d: QTc interval; e: treatment with digitalis; f: atrial fibrillation; g: mitral regurgitation; h: glomerular filtration rate (GFR), i: myocardial fibrosis, j: inflammatory cell count on endomyocardial biopsy, k: viral genome detection.</p