Cardiovascular Research Institute Basel

Basel, Switzerland

Cardiovascular Research Institute Basel

Basel, Switzerland
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Schoen T.,University of Basel | Schoen T.,Cardiovascular Research Institute Basel | Aeschbacher S.,Cardiovascular Research Institute Basel | Aeschbacher S.,University of Basel | And 13 more authors.
Open Heart | Year: 2017

Objective Obstructive sleep apnoea (OSA) is a risk factor for vascular disease and other adverse outcomes. These associations may be at least partly due to early endothelin-1 (ET-1)-mediated endothelial dysfunction (ED). Therefore, we assessed the relationships between subclinical sleep apnoea and plasma levels of ET-1. Methods We performed a population-based study among 1255 young and healthy adults aged 25-41 €...years. Cardiovascular disease, diabetes or a body mass index >35 €...kg/m 2 were exclusion criteria. Plasma levels of ET-1 were measured using a high-sensitivity, single-molecule counting technology. The relationships between subclinical sleep apnoea (OSA indices: respiratory event index (REI), oxygen desaturation index (ODI), mean night-time blood oxygen saturation (SpO 2)) and ET-1 levels were assessed by multivariable linear regression analysis. Results Median age of the cohort was 35 €...years. Median ET-1 levels were 2.9 (IQR 2.4-3.6) and 2.5 €...pg/mL (IQR 2.1-3.0) among patients with (n=105; 8%) and without subclinical sleep apnoea (REI 5-14), respectively. After multivariable adjustment, subclinical sleep apnoea remained significantly associated with plasma levels of ET-1 (β=0.13 (95% CI 0.06 to 0.20) p=0.0002 for a REI 5-14; β=0.10 (95% CI 0.03 to 0.16) p=0.003 for an ODI≥5). Every 1% decrease in mean night-time SpO 2 increased ET-1 levels by 0.1 €...pg/mL, an association that remained significant after multivariable adjustment (β=0.02 (95% CI 0.003 to 0.033) p=0.02). Conclusions In this study of young and healthy adults, we found that participants with subclinical sleep apnoea had elevated plasma ET-1 levels, an association that was due to night-time hypoxaemia. Our results suggest that ED may already be an important consequence of subclinical sleep apnoea. © Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.


Wildi K.,Cardiovascular Research Institute Basel | Gimenez M.R.,Cardiovascular Research Institute Basel | Gimenez M.R.,Hospital Del Mar Institute Municipal dInvestigacio Medica | Twerenbold R.,Cardiovascular Research Institute Basel | And 19 more authors.
Circulation | Year: 2015

Misdiagnosis of acute myocardial infarction (AMI) may significantly harm patients and may result from inappropriate clinical decision values (CDVs) for cardiac troponin (cTn) owing to limitations in the current regulatory process. Methods and Results-In an international, prospective, multicenter study, we quantified the incidence of inconsistencies in the diagnosis of AMI using fully characterized and clinically available high-sensitivity (hs) cTn assays (hs-cTnI, Abbott; hs-cTnT, Roche) among 2300 consecutive patients with suspected AMI. We hypothesized that the approved CDVs for the 2 assays are not biologically equivalent and might therefore contribute to inconsistencies in the diagnosis of AMI. Findings were validated by use of sex-specific CDVs and parallel measurements of other hs-cTnI assays. AMI was the adjudicated diagnosis in 473 patients (21%). Among these, 86 patients (18.2%) had inconsistent diagnoses when the approved uniform CDV was used. When sex-specific CDVs were used, 14.1% of female and 22.7% of male AMI patients had inconsistent diagnoses. Using biologically equivalent CDV reduced inconsistencies to 10% (P<0.001). These findings were confirmed with parallel measurements of other hs-cTn assays. The incidence of inconsistencies was only 7.0% for assays with CDVs that were nearly biologically equivalent. Patients with inconsistent AMI had long-term mortality comparable to that of patients with consistent diagnoses (P=NS) and a trend toward higher long-term mortality than patients diagnosed with unstable angina (P=0.05). Conclusions-Currently approved CDVs are not biologically equivalent and contribute to major inconsistencies in the diagnosis of AMI. One of 5 AMI patients will receive a diagnosis other than AMI if managed with the alternative hs-cTn assay. © 2014 Macmillan Publishers Limited. All rights reserved.


Schoen T.,University of Basel | Schoen T.,Cardiovascular Research Institute Basel | Schoen T.,Albert Ludwigs University of Freiburg | Hohmann E.-M.,University of Basel | And 12 more authors.
Journal of Hypertension | Year: 2015

Objective: We investigated whether copeptin - a well characterized vasopressin-related stress hormone - is associated with circadian ambulatory blood pressure (BP) variability and/or mean BP levels in young adults. Method and results: We studied a population-based sample of healthy adults aged 25-41 years. Individuals with diabetes, treated hypertension, and cardiovascular disease were excluded. Ambulatory 24-h BP monitoring was performed using validated devices. To evaluate the relationships of copeptin with mean ambulatory BP levels and BP variability during daytime and night-time, multivariable adjusted regression models were constructed. BP variability was defined as SD of all intraindividual BP values. Of the 2012 individuals included in this study, 53% were women and the median age was 37 years. Median plasma copeptin levels were 3.9 (interquartile range 2.7, 5.8) in men and 2.3pmol/l (interquartile range 1.6, 3.6) in women (P<0.0001). In multivariable linear regression models, log-transformed copeptin was significantly associated with systolic and diastolic night-time BP levels among men [β=1.9, 95% confidence interval (CI) 0.6, 3.1, P=0.003; and β=1.4, 95% CI 0.6, 2.3, P=0.001, respectively], but not among women. In addition, copeptin was strongly associated with an increased systolic and diastolic daytime (β=0.5, 95% CI 0.2, 0.7, P=0.001; β=0.5, 95% CI 0.3, 0.8, P<0.0001, respectively) and night-time BP variability (β=0.6, 95% CI 0.3, 0.9, P=0.0002; β=0.4, 95% CI 0.2, 0.7, P=0.002, respectively). Conclusion: In this large population-based study of young and healthy adults, plasma levels of copeptin were significantly associated with an increased BP variability in both sexes and an elevated night-time BP among men. © 2015 Wolters Kluwer Health, Inc.


Knecht S.,University of Basel | Knecht S.,Cardiovascular Research Institute Basel | Sticherling C.,University of Basel | Sticherling C.,Cardiovascular Research Institute Basel | And 11 more authors.
Europace | Year: 2015

Aims: It is recommended to keep exposure to ionizing radiation as low as reasonably achievable. The aim of this study was to determine whether fluoroscopy-free mapping and ablation using a standardized procedural protocol is feasible in patients undergoing pulmonary vein isolation (PVI). Methods and results: Sixty consecutive patients were analysed: Thirty consecutive patients undergoing PVI using Carto3 were treated using a standardized procedural fluoroscopy protocol with X-ray being disabled after transseptal puncture (Group 1) and compared with a set of previous 30 consecutive patients undergoing PVI without a specific recommendation regarding the use of fluoroscopy (Group 2). The main outcome measures were the feasibility of fluoroscopy-free mapping and ablation, total fluoroscopy time, total dose area product (DAP), and procedure time. Sixty patients (age 60 ± 10 years, 73% male, ejection fraction 0.55 ± 0.09, left atrium 42 ± 8 mm) were included. In Group 1, total fluoroscopy time was 4.2 (2.6-5.6) min and mapping and ablation during PVI without using fluoroscopy was feasible in 29 of 30 patients (97%). In Group 2, total fluoroscopy time was 9.3 (6.4-13.9) min (P < 0.001). Total DAP was 13.2 (6.2-22.2) Gy∗cm2 in Group 1 compared with 17.5 (11.7-29.7) Gy∗cm2 in Group 2 (P = 0.036). Total procedure time did not differ between Groups 1 (133 ± 37 min) and 2 (134 ± 37 min, P = 0.884). Conclusion: Performing mapping and ablation guided by an electroanatomic-mapping system during PVI without using fluoroscopy after transseptal puncture using a standardized procedural protocol is feasible in almost all patients and is associated with markedly decreased total fluoroscopy duration and DAP. © The Author 2015. Published on behalf of the European Society of Cardiology. All rights reserved.


Knecht S.,University of Basel | Knecht S.,Cardiovascular Research Institute Basel | Reichlin T.,University of Basel | Reichlin T.,Cardiovascular Research Institute Basel | And 9 more authors.
Journal of Interventional Cardiac Electrophysiology | Year: 2015

Purpose: Contact force (CF) sensing during radiofrequency (RF) ablation allows controlling lesion size. The aim of this study was to analyze the impact of catheter tip location and orientation on the association of CF and impedance decrease. Methods: We retrospectively analyzed RF applications from 32 patients undergoing catheter ablation for paroxysmal atrial fibrillation using a force-sensing catheter and 3D mapping system. CF, catheter location and orientation relative to the tissue during ablation as well as the absolute impedance decrease during the first 20 s of ablation as a surrogate for lesion effectiveness were analyzed for 791 RF applications. Results: While a higher CF was achieved around the right pulmonary veins (12.5 vs. 11.4 g, p = 0.045), a lower median absolute impedance decrease within the first 20 s was seen around the right veins compared to the left veins (9.3 vs. 10.2 Ω, p = 0.02). With different catheter orientations relative to the tissue, higher CF and impedance decrease was seen when the catheter was orientated parallel or oblique to the tissue (30°–145°) as compared perpendicularly (0–30°) with a median CF of 13.2 vs. 8.0 g (p < 0.001) and a median impedance decrease during the first 20 s of 11 vs. 7 Ω (p < 0.001). Importantly, achieved CF, baseline impedance, catheter orientation and location all independently predicted the initial absolute and relative impedance decrease in a multivariable linear regression model (p < 0.05). Conclusions: The effectiveness of RF ablation lesions, as assessed by the initial impedance decrease, is not only dependent on the achieved catheter CF but also on catheter orientation and location. © 2015, Springer Science+Business Media New York.

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