TY  - JOUR
A1  - Reibis, Rona Katharina
A1  - Huber, Matthias
A1  - Karoff, Marthin
A1  - Kamke, Wolfram
A1  - Kreutz, Reinhold
A1  - Wegscheider, Karl
A1  - Völler, Heinz
T1  - Target organ damage and control of cardiovascular risk factors in hypertensive patients Evidence from the multicenter ESTher registry
JF  - Herz : cardiovascular diseases
N2  - This study investigated the incidence of hypertensive target organ damage (TOD), control of cardiovascular risk factors, and the short-term prognosis in hypertensive patients under contemporary guideline-oriented therapy.
 A total of 1,377 consecutive patients (mean age 58.2 +/- 9.9 years, 82.2 % male) with arterial hypertension were included in the ESTher (Endorganschaden, Therapie und Verlauf - target organ damage, therapy, and course) registry at 15 rehabilitation clinics within the framework of the National Genome Research Network. Cardiovascular risk factors, medication, comorbidities, and glomerular filtration rate (GFR) were assessed. Left ventricular hypertrophy (LVH), left ventricular mass (LVM), left ventricular mass index (LVMI), and left ventricular ejection fraction (LVEF) were determined by two-dimensional echocardiography. The mean follow-up was 513 +/- 159 days. Changes in continuous parameters were tested by the t test, changes in discrete characteristics are presented by means of transition tables and tested with the McNemar test.
 The mean LVEF was 59.3 +/- 9.9 %, both mean LVM (238.6 +/- 101.5 g) and LVMI (54.0 +/- 23.6 g/m(2.7)) were increased while relative wall thickness (RWT, 0.46 +/- 0.18) indicated the presence of concentric LVH. Of the patients, 10.2 % displayed renal dysfunction (estimated GFR < 60 ml/min/1.73 m(2)). The 1.5-year overall mortality was 1.2 %. Compared with discharge, at follow-up the proportion of patients with blood pressure (BP) values < 140/90 mmHg decreased from 68.7 % to 55.0 % (p < 0.001) and with low-density lipoprotein (LDL) values < 100 mg/dl from 62.6 % to 38.1 % (p < 0.001). At follow-up significantly more patients displayed a GFR value of < 60 ml/min/1.73 m(2) (10.2 % vs. 16.0 %, p < 0.001).
 A significant proportion of hypertensive rehabilitation participants displayed TOD including LVH and renal dysfunction. Even after stringent BP reduction, a considerable increase in nephropathy could be found after 18 months.
KW  - Arterial hypertension
KW  - Prospective study
KW  - Left ventricular hypertrophy
KW  - Glomerular filtration rate
KW  - Cardiac rehabilitation
Y1  - 2015
U6  - https://doi.org/10.1007/s00059-014-4189-8
SN  - 0340-9937
SN  - 1615-6692
VL  - 40
SP  - 209
EP  - 216
PB  - Urban & Vogel
CY  - München
ER  - 
TY  - JOUR
A1  - Salzwedel, Annett
A1  - Rieck, Angelika
A1  - Reibis, Rona Katharina
A1  - Völler, Heinz
T1  - Routine initial exercise stress testing for treatment stratification in comprehensive cardiac rehabilitation
JF  - International journal of rehabilitation research
N2  - There is evidence of substantial benefit of cardiac rehabilitation (CR) for patients with low exercise capacity at admission. Nevertheless, some patients are not able to perform an initial exercise stress test (EST). We aimed to describe this group using data of 1094 consecutive patients after a cardiac event (71 +/- 7 years, 78% men) enrolled in nine centres for inpatient CR. We analysed sociodemographic and clinical variables (e.g. cardiovascular risk factors, comorbidities, complications at admission), amount of therapy (e.g. exercise training, nursing care) and the results of the initial and the final 6-min walking test (6MWT) with respect to the application of an EST. Fifteen per cent of patients did not undergo an EST (non-EST group). In multivariable analysis, the probability of obtaining an EST was higher for men [odds ratio (OR) 1.89, P=0.01], a 6MWT (per 10 m, OR 1.07, P<0.01) and lower for patients with diabetes mellitus (OR 0.48, P<0.01), NYHA-class III/IV (OR 0.27, P<0.01), osteoarthritis (OR 0.39, P<0.01) and a longer hospital stay (per 5 days, OR 0.87, P=0.02). The non-EST group received fewer therapy units of exercise training, but more units of nursing care and physiotherapy than the EST group. However, there were no significant differences between both groups in the increase of the 6MWT during CR (123 vs. 108 m, P=0.122). The present study confirms the feasibility of an EST at the start of CR as an indicator of disease severity. Nevertheless, patients without EST benefit from CR even if exercising less. Thus, there is a justified need for individualized, comprehensive and interdisciplinary CR.
KW  - disease severity
KW  - exercise stress test
KW  - multimodal cardiac rehabilitation
KW  - rehabilitation outcome
KW  - therapy volume
Y1  - 2015
U6  - https://doi.org/10.1097/MRR.0000000000000133
SN  - 0342-5282
SN  - 1473-5660
VL  - 38
IS  - 4
SP  - 344
EP  - 349
PB  - Lippincott Williams & Wilkins
CY  - Philadelphia
ER  - 
TY  - JOUR
A1  - Reibis, Rona Katharina
A1  - Jannowitz, Christina
A1  - Halle, Martin
A1  - Pittrow, David
A1  - Gitt, Anselm
A1  - Völler, Heinz
T1  - Management and outcomes of patients with reduced ejection fraction after acute myocardial infarction in cardiac rehabilitation centers
JF  - Current medical research and opinion
N2  - Background:
 We aimed to describe the contemporary management of patients with systolic chronic heart failure (CHF) during a cardiac rehabilitation (CR) stay and present outcomes with focus on lipids, blood pressure, exercise capacity, and clinical events.
 Methods:
 Comparison of 3199 patients with moderately or severely impaired left ventricular ejection fraction (low EF, 13.3%) and 20,913 patients with slightly reduced or normal LVEF (normal EF, 86.7%) who underwent an inpatient CR period of about 3 weeks in 2009-2010.
 Results:
 Patients with low EF compared to those with normal EF were somewhat older (65.1 vs. 63.0 years, p<0.0001), and more often had risk factors such as diabetes mellitus (39.7% vs. 32.0%, p<0.0001) or other comorbidities. The overall rate of patients with regular physical activity of at least 90 minutes per week prior to CR was low overall (54.4%), and reduced in patients with low EF compared to those with normal EF (47.7% vs. 55.5%, p<0.0001). The rate of patients that achieved lower LDL cholesterol (5100 mg/dl), total cholesterol (<200 mg/dl) and triglyceride (<150 mg/dl) values at discharge increased compared to baseline. Mean blood pressure was substantially lower in the low EF group compared to the normal EF group both at baseline (124/75 vs. 130/78 mmHg, p<0.0001) and at discharge (119/72 vs. 124/74 mmHg, p<0.0001). Maximum exercise improved substantially in both groups (at baseline 71 vs. 91 Watts, p<0.0001; at discharge 85 vs. 105 Watts, p<0.0001). Event rates during CR were low, and only 0.3% in the low EF group died. As limitations to this study, information on brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro BNP) and/or cardiac troponin were not documented, and no long-term information was collected beyond the 3-week CR stay.
 Conclusions:
 Patients with CHF account for a considerable proportion of patients in CR. Also patients with moderate/severe EF benefited from participation in CR, as their lipid profile and physical fitness improved.
KW  - Acute myocardial infarction
KW  - Cardiac rehabilitation Chronic heart failure
KW  - Control rates
KW  - Dyslipidemia
KW  - Lipid profile
KW  - Observational
KW  - Risk factor
Y1  - 2015
U6  - https://doi.org/10.1185/03007995.2014.977854
SN  - 0300-7995
SN  - 1473-4877
VL  - 31
IS  - 2
SP  - 211
EP  - 219
PB  - Taylor & Francis Group
CY  - London
ER  - 
TY  - JOUR
A1  - Huber, Matthias
A1  - Lezius, Susanne
A1  - Reibis, Rona Katharina
A1  - Treszl, Andras
A1  - Kujawinska, Dorota
A1  - Jakob, Stefanie
A1  - Wegscheider, Karl
A1  - Völler, Heinz
A1  - Kreutz, Reinhold
T1  - A Single Nucleotide Polymorphism near the CYP17A1 Gene Is Associated with Left Ventricular Mass in Hypertensive Patients under Pharmacotherapy
JF  - International journal of molecular sciences
N2  - Cytochrome P450 17A1 (CYP17A1) catalyses the formation and metabolism of steroid hormones. They are involved in blood pressure (BP) regulation and in the pathogenesis of left ventricular hypertrophy. Therefore, altered function of CYP17A1 due to genetic variants may influence BP and left ventricular mass. Notably, genome wide association studies supported the role of this enzyme in BP control. Against this background, we investigated associations between single nucleotide polymorphisms (SNPs) in or nearby the CYP17A1 gene with BP and left ventricular mass in patients with arterial hypertension and associated cardiovascular organ damage treated according to guidelines. Patients (n = 1007, mean age 58.0 +/- 9.8 years, 83% men) with arterial hypertension and cardiac left ventricular ejection fraction (LVEF) 40% were enrolled in the study. Cardiac parameters of left ventricular mass, geometry and function were determined by echocardiography. The cohort comprised patients with coronary heart disease (n = 823; 81.7%) and myocardial infarction (n = 545; 54.1%) with a mean LVEF of 59.9% +/- 9.3%. The mean left ventricular mass index (LVMI) was 52.1 +/- 21.2 g/m(2.7) and 485 (48.2%) patients had left ventricular hypertrophy. There was no significant association of any investigated SNP (rs619824, rs743572, rs1004467, rs11191548, rs17115100) with mean 24 h systolic or diastolic BP. However, carriers of the rs11191548 C allele demonstrated a 7% increase in LVMI (95% CI: 1%-12%, p = 0.017) compared to non-carriers. The CYP17A1 polymorphism rs11191548 demonstrated a significant association with LVMI in patients with arterial hypertension and preserved LVEF. Thus, CYP17A1 may contribute to cardiac hypertrophy in this clinical condition.
KW  - clinical study
KW  - genetics
KW  - heart
KW  - hypertension
KW  - cytochrome P450 17A1 (Cyp17A1)
Y1  - 2015
U6  - https://doi.org/10.3390/ijms160817456
SN  - 1422-0067
VL  - 16
IS  - 8
SP  - 17456
EP  - 17468
PB  - MDPI
CY  - Basel
ER  -