TY - JOUR A1 - Eichler, Sarah A1 - Salzwedel, Annett A1 - Harnath, Axel A1 - Butter, Christian A1 - Wegscheider, Karl A1 - Chiorean, Mihai A1 - Völler, Heinz A1 - Reibis, Rona Katharina T1 - Nutrition and mobility predict all-cause mortality in patients 12 months after transcatheter aortic valve implantation JF - Clinical research in cardiology : official journal of the German Cardiac Society. N2 - The aim of the study was to determine pre-interventional predictors for all-cause mortality in patients after transcatheter aortic valve implantation (TAVI) with a 12-month follow-up. From 10/2013 to 07/2015, 344 patients (80.9 +/- 5.0 years, 44.5% male) with an elective TAVI were consecutively enrolled prospectively in a multicentre cohort study. Prior to the intervention, sociodemographic parameters, echocardiographic data and comorbidities were documented. All patients performed a 6-min walk test, Short Form 12 and a Frailty Index (score consisting of activities of daily living, cognition, nutrition and mobility). Peri-interventional complications were documented. Vital status was assessed over telephone 12 months after TAVI. Predictors for all-cause mortality were identified using a multivariate regression model. At discharge, 333 patients were alive (in-hospital mortality 3.2%; n = 11). During a follow-up of 381.0 +/- 41.9 days, 46 patients (13.8%) died. The non-survivors were older (82.3 +/- 5.0 vs. 80.6 +/- 5.1 years; p = 0.035), had a higher number of comorbidities (2.6 +/- 1.3 vs. 2.1 +/- 1.3; p = 0.026) and a lower left ventricular ejection fraction (51.0 +/- 13.6 vs. 54.6 +/- 10.6%; p = 0.048). Additionally, more suffered from diabetes mellitus (60.9 vs. 44.6%; p = 0.040). While the global Frailty Index had no predictive power, its individual components, particularly nutrition (OR 0.83 per 1 pt., CI 0.72-0.95; p = 0.006) and mobility (OR 5.12, CI 1.64-16.01; p = 0.005) had a prognostic impact. Likewise, diabetes mellitus (OR 2.18, CI 1.10-4.32; p = 0.026) and EuroSCORE (OR 1.21 per 5%, CI 1.07-1.36; p = 0.002) were associated with a higher risk of all-cause mortality. Besides EuroSCORE and diabetes mellitus, nutrition status and mobility of patients scheduled for TAVI offer prognostic information for 1-year all-cause mortality and should be advocated in the creation of contemporary TAVI risk scores. KW - TAVI KW - Frailty KW - Mortality KW - Malnutrition KW - Mobility Y1 - 2018 U6 - https://doi.org/10.1007/s00392-017-1183-1 SN - 1861-0684 SN - 1861-0692 VL - 107 IS - 4 SP - 304 EP - 311 PB - Springer CY - Heidelberg ER - TY - GEN A1 - Eichler, Sarah A1 - Völler, Heinz A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Butter, Christian A1 - Harnath, Axel A1 - Salzwedel, Annett T1 - Geriatric or cardiac rehabilitation? BT - Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation T2 - Postprints der Universität Potsdam : Mathematisch-Naturwissenschaftliche Reihe N2 - Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p <  0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings. T3 - Zweitveröffentlichungen der Universität Potsdam : Humanwissenschaftliche Reihe - 647 KW - TAVI KW - Treatment pathways KW - Frailty KW - Geriatric rehabilitation Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-473958 SN - 1866-8364 ER - TY - JOUR A1 - Eichler, Sarah A1 - Völler, Heinz A1 - Reibis, Rona Katharina A1 - Wegscheider, Karl A1 - Butter, Christian A1 - Harnath, Axel A1 - Salzwedel, Annett T1 - Geriatric or cardiac rehabilitation? BT - Predictors of treatment pathways in advanced age patients after transcatheter aortic valve implantation JF - BMC Cardiovascular Disorders N2 - Background Aim of the study was to find predictors of allocating patients after transcatheter aortic valve implantation (TAVI) to geriatric (GR) or cardiac rehabilitation (CR) and describe this new patient group based on a differentiated characterization. Methods From 10/2013 to 07/2015, 344 patients with an elective TAVI were consecutively enrolled in this prospective multicentric cohort study. Before intervention, sociodemographic parameters, echocardiographic data, comorbidities, 6-min walk distance (6MWD), quality of life and frailty (score indexing activities of daily living [ADL], cognition, nutrition and mobility) were documented. Out of these, predictors for assignment to CR or GR after TAVI were identified using a multivariable regression model. Results After TAVI, 249 patients (80.7 ± 5.1 years, 59.0% female) underwent CR (n = 198) or GR (n = 51). GR patients were older, less physically active and more often had a level of care, peripheral artery disease as well as a lower left ventricular ejection fraction. The groups also varied in 6MWD. Furthermore, individual components of frailty revealed prognostic impact: higher values in instrumental ADL reduced the probability for referral to GR (OR:0.49, p <  0.001), while an impaired mobility was positively associated with referral to GR (OR:3.97, p = 0.046). Clinical parameters like stroke (OR:0.19 of GR, p = 0.038) and the EuroSCORE (OR:1.04 of GR, p = 0.026) were also predictive. Conclusion Advanced age patients after TAVI referred to CR or GR differ in several parameters and seem to be different patient groups with specific needs, e.g. regarding activities of daily living and mobility. Thus, our data prove the eligibility of both CR and GR settings. KW - TAVI KW - Treatment pathways KW - Frailty KW - Geriatric rehabilitation Y1 - 2019 U6 - https://doi.org/10.1186/s12872-020-01452-x SN - 1471-2261 VL - 20 PB - BioMed Central CY - London ER - TY - THES A1 - Kochlik, Bastian Max T1 - Relevance of biomarkers for the diagnosis of the frailty syndrome T1 - Die Bedeutung von Biomarkern für die Diagnose des Frailty-Syndroms BT - focus on parameters of muscle protein turnover, micronutrients and oxidative stress BT - 3-Methylhistidine, Mikronährstoffe und oxidativer Stress im Fokus N2 - Frailty and sarcopenia share some underlying characteristics like loss of muscle mass, low muscle strength, and low physical performance. Imaging parameters and functional examinations mainly assess frailty and sarcopenia criteria; however, these measures can have limitations in clinical settings. Therefore, finding suitable biomarkers that reflect a catabolic muscle state e.g. an elevated muscle protein turnover as suggested in frailty, are becoming more relevant concerning frailty diagnosis and risk assessment. 3-Methylhistidine (3-MH) and its ratios 3-MH-to-creatinine (3-MH/Crea) and 3 MH-to-estimated glomerular filtration rate (3-MH/eGFR) are under discussion as possible biomarkers for muscle protein turnover and might support the diagnosis of frailty. However, there is some skepticism about the reliability of 3-MH measures since confounders such as meat and fish intake might influence 3-MH plasma concentrations. Therefore, the influence of dietary habits and an intervention with white meat on plasma 3-MH was determined in young and healthy individuals. In another study, the cross-sectional associations of plasma 3-MH, 3-MH/Crea and 3-MH/eGFR with the frailty status (robust, pre-frail and frail) were investigated. Oxidative stress (OS) is a possible contributor to frailty development, and high OS levels as well as low micronutrient levels are associated with the frailty syndrome. However, data on simultaneous measures of OS biomarkers together with micronutrients are lacking in studies including frail, pre-frail and robust individuals. Therefore, cross-sectional associations of protein carbonyls (PrCarb), 3-nitrotyrosine (3-NT) and several micronutrients with the frailty status were determined. A validated UPLC-MS/MS (ultra-performance liquid chromatography tandem mass spectrometry) method for the simultaneous quantification of 3-MH and 1-MH (1 methylhistidine, as marker for meat and fish consumption) was presented and used for further analyses. Omnivores showed higher plasma 3-MH and 1-MH concentrations than vegetarians and a white meat intervention resulted in an increase in plasma 3-MH, 3 MH/Crea, 1-MH and 1-MH/Crea in omnivores. Elevated 3-MH and 3-MH/Crea levels declined significantly within 24 hours after this white meat intervention. Thus, 3-MH and 3-MH/Crea might be used as biomarker for muscle protein turnover when subjects did not consume meat 24 hours prior to blood samplings. Plasma 3-MH, 3-MH/Crea and 3-MH/eGFR were higher in frail individuals than in robust individuals. Additionally, these biomarkers were positively associated with frailty in linear regression models, and higher odds to be frail were found for every increase in 3 MH and 3-MH/eGFR quintile in multivariable logistic regression models adjusted for several confounders. This was the first study using 3-MH/eGFR and it is concluded that plasma 3-MH, 3-MH/Crea and 3-MH/eGFR might be used to identify frail individuals or individuals at higher risk to be frail, and that there might be threshold concentrations or ratios to support these diagnoses. Higher vitamin D3, lutein/zeaxanthin, γ-tocopherol, α-carotene, β-carotene, lycopene and β-cryptoxanthin concentrations and additionally lower PrCarb concentrations were found in robust compared to frail individuals in multivariate linear models. Frail subjects had higher odds to be in the lowest than in the highest tertile for vitamin D3 α-tocopherol, α-carotene, β-carotene, lycopene, lutein/zeaxanthin, and β cryptoxanthin, and had higher odds to be in the highest than in the lowest tertile for PrCarb than robust individuals in multivariate logistic regression models. Thus, a low micronutrient together with a high PrCarb status is associated with pre-frailty and frailty. N2 - Gebrechlichkeit (englisch: frailty) und Sarkopenie teilen einige zugrundeliegende Merkmale wie einen Verlust von Muskelmasse, eine geringe Muskelkraft und eine geringe körperliche Leistungsfähigkeit, welche durch einen erhöhten Muskelproteinumsatz entstehen können. Kriterien der Gebrechlichkeit und Sarkopenie werden hauptsächlich durch bildgebende Verfahren sowie funktionelle Untersuchungen gemessen, die in ihrer Durchführbarkeit im klinischen Alltag jedoch eingeschränkt sein können. Daher gewinnt das Finden geeigneter Biomarker zur Anzeige eines erhöhten Muskelproteinumsatzes (kataboler Muskelzustand) in Bezug auf Diagnose und Risikobewertung der Gebrechlichkeit zunehmend an Bedeutung. 3-Methylhistidin (3-MH) und die Verhältnisse 3-MH zu Kreatinin (3-MH/Crea) und 3-MH zu geschätzter glomerulärer Filtrationsrate (3-MH/eGFR) werden als solche möglichen Biomarker diskutiert und könnten folglich die Diagnose und Risikobewertung von Gebrechlichkeit unterstützen. Es herrscht jedoch eine gewisse Skepsis hinsichtlich der Zuverlässigkeit von 3-MH-Messungen, da 3-MH-Plasmakonzentrationen durch Fleisch- und Fischaufnahme beeinflusst werden können. Daher wurde der Einfluss von Ernährungsgewohnheiten (Mischkost oder vegetarisch) und einer Intervention mit Hähnchenfleisch auf Plasma-3-MH bei jungen und gesunden Personen untersucht. In einer weiteren Studie wurden die Querschnittsassoziationen von 3-MH, 3-MH/Crea und 3-MH/eGFR im Plasma mit dem Frailty-Status (robust, pre-frail und frail) untersucht. Oxidativer Stress (OS) ist ein potentieller Faktor der zur Entwicklung von Gebrechlichkeit beiträgt, und sowohl hohe OS-Konzentrationen als auch niedrige Mikronährstoffkonzentrationen sind mit Gebrechlichkeit assoziiert. Daten zu simultanen Messungen von OS und Mikronährstoffen in Personen aller drei Frailty-Kategorien (robust, pre-frail und frail) fehlen jedoch. Aus diesem Grund wurden Querschnittsassoziationen von Proteincarbonylen (PrCarb), 3-Nitrotyrosin (3-NT) und mehrerer fettlöslicher Mikronährstoffe mit dem Frailty-Status bestimmt. Eine validierte UPLC-MS/MS-Methode (ultra-performance liquid chromatography tandem mass spectrometry) zur simultanen Bestimmung von 3-MH und 1-MH (1 Methylhistidin als Marker für den Fleisch- und Fischkonsum) in Plasma wurde beschrieben und für die weiteren Analysen verwendet. Mischköstler wiesen höhere 3 MH- und 1-MH-Konzentrationen in Plasma auf als Vegetarier. Die Intervention mit Hähnchenfleisch führte zu einem Anstieg von Plasma 3-MH, 3-MH/Crea, 1-MH und 1 MH/Crea bei Mischköstlern. Diese erhöhten 3-MH- und 3-MH/Crea-Spiegel sanken innerhalb von 24 Stunden nach der Intervention signifikant ab. Folglich stellen 3-MH und 3-MH/Crea potentielle Biomarker für den Muskelproteinumsatz dar, wenn Personen für 24 Stunden vor der Blutentnahme kein Fleisch verzehrt haben. Gebrechliche Teilnehmer wiesen höhere Plasma 3-MH-, 3-MH/Crea- und 3 MH/eGFR-Werte auf als robuste Teilnehmer und zusätzlich waren diese Biomarker in linearen Regressionsmodellen positiv mit Gebrechlichkeit assoziiert. In multivariablen logistischen Regressionsmodellen (adjustiert für mehrere Confounder) waren gebrechliche Personen im Vergleich zu robusten Personen mit einer höheren Wahrscheinlichkeit in einer höheren 3-MH- und 3-MH/eGFR-Quintile. Diese erste Studie, die 3-MH/eGFR als Biomarker für Gebrechlichkeit untersucht hat, erlaubt die Schlussfolgerung, dass Plasma-3-MH, -3-MH/Crea und -3-MH/eGFR verwendet werden könnte, um gebrechliche Personen oder Personen mit einem erhöhten Frailty-Risiko zu identifizieren. Möglicherweise gibt es auch Schwellenwerte, die diese Diagnosen unterstützen können. In multivariaten Regressionsanalysen wiesen robuste Personen höhere Vitamin D3-, Lutein/Zeaxanthin-, γ-Tocopherol-, α-Carotin-, β-Carotin-, Lycopin- und β Cryptoxanthin-Konzentrationen sowie niedrigere PrCarb-Konzentrationen auf als gebrechliche Personen. Zudem waren in multinomialen logistischen Regressionsanalysen gebrechliche Personen mit einer höheren Wahrscheinlichkeit sowohl in der niedrigsten Vitamin D3-, α-Tocopherol-, α-Carotin-, β-Carotin-, Lycopin-, Lutein/Zeaxanthin- und β Cryptoxanthin-Tertil als auch im höchsten PrCarb-Tertil zu finden als robuste Personen. Es wird daher geschlussfolgert, dass niedrige Mikronährstoffkonzentrationen zusammen mit hohen PrCarb-Konzentrationen mit Gebrechlichkeit und dessen Vorstufe (pre-frailty) assoziiert sind. KW - biomarker KW - Biomarker KW - frailty KW - Frailty KW - micronutrients KW - Mikronährstoffe KW - oxidative stress KW - oxidativer Stress KW - 3-methylhistidine KW - 3-Methylhistidin KW - muscle protein turnover KW - Muskelproteinumsatz Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:kobv:517-opus4-441186 ER - TY - JOUR A1 - Vigorito, Carlo A1 - Abreu, Ana A1 - Ambrosetti, Marco A1 - Belardinelli, Romualdo A1 - Corra, Ugo A1 - Cupples, Margaret A1 - Davos, Constantinos H. A1 - Hoefer, Stefan A1 - Iliou, Marie-Christine A1 - Schmid, Jean-Paul A1 - Völler, Heinz A1 - Doherty, Patrick T1 - Frailty and cardiac rehabilitation: A call to action from the EAPC Cardiac Rehabilitation Section JF - European journal of preventive cardiology : the official ESC journal for primary & secondary cardiovascular prevention, rehabilitation and sports cardiology N2 - Frailty is a geriatric syndrome characterised by a vulnerability status associated with declining function of multiple physiological systems and loss of physiological reserves. Two main models of frailty have been advanced: the phenotypic model (primary frailty) or deficits accumulation model (secondary frailty), and different instruments have been proposed and validated to measure frailty. However measured, frailty correlates to medical outcomes in the elderly, and has been shown to have prognostic value for patients in different clinical settings, such as in patients with coronary artery disease, after cardiac surgery or transvalvular aortic valve replacement, in patients with chronic heart failure or after left ventricular assist device implantation. The prevalence, clinical and prognostic relevance of frailty in a cardiac rehabilitation setting has not yet been well characterised, despite the increasing frequency of elderly patients in cardiac rehabilitation, where frailty is likely to influence the onset, type and intensity of the exercise training programme and the design of tailored rehabilitative interventions for these patients. Therefore, we need to start looking for frailty in elderly patients entering cardiac rehabilitation programmes and become more familiar with some of the tools to recognise and evaluate the severity of this condition. Furthermore, we need to better understand whether exercise-based cardiac rehabilitation may change the course and the prognosis of frailty in cardiovascular patients. KW - Frailty KW - cardiac rehabilitation KW - elderly Y1 - 2017 U6 - https://doi.org/10.1177/2047487316682579 SN - 2047-4873 SN - 2047-4881 VL - 24 SP - 577 EP - 590 PB - Sage Publ. CY - London ER -