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Now showing items 1 - 16 of 19

  • Oxidative Stress in Cardiovascular Diseases: Still a Therapeutic Target?

    Senoner, Thomas   Dichtl, Wolfgang  

    Cardiovascular diseases (CVD) are complex entities with heterogenous pathophysiologic mechanisms and increased oxidative stress has been viewed as one of the potential common etiologies. A fine balance between the presence of reactive oxygen species (ROS) and antioxidants is essential for the proper normal functioning of the cell. A basal concentration of ROS is indispensable for the manifestation of cellular functions, whereas excessive levels of ROS cause damage to cellular macromolecules such as DNA, lipids and proteins, eventually leading to necrosis and apoptotic cell death. CVD is the main cause of death worldwide with several conditions being affected by oxidative stress. Increased ROS lead to decreased nitric oxide availability and vasoconstriction, promoting arterial hypertension. ROS also negatively influence myocardial calcium handling, causing arrhythmia, and augment cardiac remodeling by inducing hypertrophic signaling and apoptosis. Finally, ROS have also been shown to promote atherosclerotic plaque formation. This review aims at giving an introduction into oxidative stress in CVD, with special focus on endothelial dysfunction, and then examining in detail the role of oxidative stress in the most prevalent of these diseases. Finally, potential nutraceuticals and diets that might be beneficial in diminishing the burden of oxidative stress in CVD are presented.
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  • Left Atrial Appendage Morphology Is Associated With Cryptogenic Stroke A CTA Study

    Adukauskaite, Agne   Barbieri, Fabian   Senoner, Thomas   Plank, Fabian   Beyer, Christoph   Knoflach, Michael   Boehme, Christian   Hintringer, Florian   Mueller, Silvana   Cartes-Zumelzu, Fabiola   Dichtl, Wolfgang   Feuchtner, Gudrun  

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  • Intracavitary right coronary artery - Or just a wrap? A cardiac CT imaging series

    Zujs, Vitalijs   Chevtchik, Orest   Schachner, Thomas   Senoner, Thomas   Feuchtner, Gudrun M.  

    Intracavitary right coronary artery (RCA) is a very rare anomaly occurring in less than 0.1%1 and up to 0.4% reported by coronary computed tomography angiography (CTA).(2) Literature is scarce, however its recognition is crucial, especially prior to surgical or interventional procedures such as coronary artery bypass graft (CABG) surgery, right heart catheterization or device implantation: Hereby the RCA is at risk of injury with fatal bleeding, or suturing a CABG anastomosis may be difficult or impossible.
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  • Intracavitary right coronary artery - Or just a wrap? A cardiac CT imaging series

    Zujs, Vitalijs   Chevtchik, Orest   Schachner, Thomas   Senoner, Thomas   Feuchtner, Gudrun M.  

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  • Added value of high-risk plaque criteria by coronary CTA for prediction of long-term outcomes

    Senoner, Thomas   Plank, Fabian   Barbieri, Fabian   Beyer, Christoph   Birkl, Katharina   Widmann, Gerlig   Adukauskaite, Agne   Friedrich, Guy   Dichtl, Wolfgang   Feuchtner, Gudrun M.  

    Background and aims: Long-term data relating coronary computed tomography angiography (CTA) to coronary artery disease (CAD) prognosis including novel CTA-biomarkers ("high-risk plaque criteria") is scarce. The aim of this study was to define predictors of long-term outcomes. Methods: 1430 low-to-intermediate risk patients (57.9 +/- 11.1 years; 44.4% females) who underwent CTA and coronary calcium scoring (CCS) were prospectively enrolled. CTAs were evaluated for (1) stenosis severity CADRADS 0-4 (minimal < 25%, mild 25-50%, moderate 50-70%, severe > 70%), (2) mixed plaque burden weighted for non-calcified plaque (NCP), and (3) high-risk-plaque (HRP) criteria: low-attenuation-plaque (LAP), napkin-ring-sign, spotty calcifications < 3 mm or remodeling index > 1.1. Endpoints were all-cause and cardiovascular mortality, composite fatal and nonfatal major adverse cardiovascular events (MACE). Results: Over a mean follow-up of 10.55 years +/- 1.98, 106 patients (7.4%) died, 25 from cardiovascular events (1.75%). Composite MACE occurred in 57 (3.9%) patients. In patients with negative CTA, cardiovascular mortality and MACE rates were 0% and 0.2%. Stenosis severity by CTA predicted all 3 endpoints (p < 0.001) while CCS > 100 AU predicted only all-cause mortality (p =3D 0.045) but not MACE. The high risk plaque criteria LAP < 60HU (HR: 4.00, 95%CI 95% 1.52-10.52, p =3D 0.005) and napkin-ring (HR 4.11, CI 95% 1.77-9.52, p =3D 0.001) predicted MACE but not all-cause-mortality, after adjusting for risk factors, while spotty calcification and remodeling index did not. Similarly, mixed plaque burden predicted MACE (p < 0.0001). HRP criteria, if added to CADRADS + CCS for prediction of MACE, were superior to CCS (c =3D 0.816 vs 0.716, p < 0.001). In 33.5% of CCS zero patients, non-calcified fibroatheroma were found. Conclusions: Long-term prognosis is excellent if CTA is negative for CAD. The high-risk plaque criteria LAP < 60HU and napkin-ring-sign were independent predictors of MACE while HRP criteria added incremental prognostic value.
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  • The challenge of imaging congenital heart disease in neonates: How to minimize radiation exposure with advanced CT technology

    Senoner, Thomas   Geiger, Ralf   Rivard, Andrew L.   Feuchtner, Gudrun M.  

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  • Associations of Oxidative Stress and Postoperative Outcome in Liver Surgery with an Outlook to Future Potential Therapeutic Options

    Senoner, Thomas   Schindler, Sophie   Stättner, Stefan   Öfner, Dietmar   Troppmair, Jakob   Primavesi, Florian  

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  • Associations of Oxidative Stress and Postoperative Outcome in Liver Surgery with an Outlook to Future Potential Therapeutic Options.

    Senoner, Thomas   Schindler, Sophie   Stattner, Stefan   Ofner, Dietmar   Troppmair, Jakob   Primavesi, Florian  

    Several types of surgical procedures have shown to elicit an inflammatory stress response, leading to substantial cytokine production and formation of oxygen-based or nitrogen-based free radicals. Chronic liver diseases including cancers are almost always characterized by increased oxidative stress, in which hepatic surgery is likely to potentiate at least in the short term and hereby furthermore impair the hepatic redox state. During liver resection, intermittent inflow occlusion is commonly applied to prevent excessive blood loss but resulting ischemia and reperfusion of the liver have been linked to increased oxidative stress, leading to impairment of cell functions and subsequent cell death. In the field of liver transplantation, ischemia/reperfusion injury has extensively been investigated in the last decades and has recently been in the scientific focus again due to increased use of marginal donor organs and new machine perfusion concepts. Therefore, given the intriguing role of oxidative stress in the pathogenesis of numerous diseases and in the perioperative setting, the interest for a therapeutic antioxidative agent has been present for several years. This review is aimed at giving an introduction to oxidative stress in surgical procedures in general and then examines the role of oxidative stress in liver surgery in particular, discussing both transplantation and resection. Results from studies in the animal and human settings are included. Finally, potential therapeutic agents that might be beneficial in reducing the burden of oxidative stress in hepatic diseases and during surgery are presented. While there is compelling evidence from animal models and a limited number of clinical studies showing that oxidative stress plays a major role in both liver resection and transplantation and several recent studies have suggested a potential for antioxidative treatment in chronic liver disease (e.g., steatosis), the search for effective antioxidants in the field of liver surgery is still ongoing.=20
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  • Relationship of exercise to coronary artery disease extent,severity and plaque type:A coronary computed tomography angiography study

    Feuchtner, Gudrun   Langer, Christian   Barbieri, Fabian   Beyer, Christoph   Dichtl, Wolfgang   Bonaros, Nikolaos   Cartes-Zumelzu, Fabiola   Klauser, Andrea   Schachner, Thomas   Friedrich, Guy   Plank, Fabian   Senoner, Thomas  

    Background: While exercise has been associated with favorable coronary artery disease (CAD) outcomes, the relationship between endurance exercise levels and CAD findings has not been well explored. Purpose: To evaluate the relationship of endurance exercise to CAD findings by coronary computed tomographic angiography (CCTA). Methods: We evaluated consecutive patients referred to CCTA who filled out a survey instrument between 2015 and 2017, and who graded their level of weekly endurance exercise as: none, low (1-2 times per week), moderate (3-5 times per week) or high (5-7 times per week); along with the number of hours per week engaged in exercise as: low (< 30 min), moderate (1 h) or high (> 1-3 h). CCTA: analysis included measurement of maximum per-patient, per-vessel and per-segment stenosis severity, which was judged as minimal (< 25%), mild (< 50%), moderate (50-70%), and severe (> 70%). CAD extent and severity was also summated CADRADS score, plaque burden by segment involvement score (SIS), and non-calcified plaque score (G-score). High-risk plaque (HRP), as defined by the presence of low attenuation plaque, positive arterial remodelling, spotty calcifications and napkin ring signs, was assessed. Finally, coronary artery calcium scores (CCS), as determined by Agatston units, were quantified. Results: The study cohort comprised 252 patients (55.3y +/- 10.1, 39.7% females) with 97 inactives, 87 with low and 68 with moderate-to-high recreational endurance exercise levels ( > =3D3x/week >=3D 1 h) included. Prevalence of subclinical CAD was 57.4%. Prevalence of > 50% stenosis was with 13.2% lower at moderate-to-high exercise levels as compared to inactives (p =3D 0.04). Stenosis severity score (p =3D 0.04), total (p =3D 0.036) non-calcified plaque burden were lower (p =3D 0.026) in athletes, and in the absence of confounding risk factors, the effect strenghtened (SIS and G-score, p =3D 0.012 and 0.008). There was no difference in the CCS. High-risk plaque prevalence was higher in controls as compared to athletes with moderate-to-high exercise levels (13.4% vs 0%, p =3D 0.002), and HDL was lower (p < 0.001), respectively. MACE rate was 0%, and ICA rate of > 50% stenosis 3.5% at 1 year follow-up. Conclusion: Regular moderate-to-high endurance exercise results in lower total and non-calcified plaque burden and less high-risk plaque.
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  • Relationship of exercise to coronary artery disease extent, severity and plaque type: A coronary computed tomography angiography study

    Feuchtner, Gudrun   Langer, Christian   Barbieri, Fabian   Beyer, Christoph   Dichtl, Wolfgang   Bonaros, Nikolaos   Cartes-Zumelzu, Fabiola   Klauser, Andrea   Schachner, Thomas   Friedrich, Guy   Plank, Fabian   Senoner, Thomas  

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  • Establishing a new water tariff method that complies with european principles and respects statutory autonomy:The case of South Tyrol

    Romano, Giulia   Guerrini, Andrea   Senoner, Thomas  

    This paper describes a path-dependent regulatory process to define a new water-tariff calculation method for European regions and provinces requiring context-specific regulation. In 2017, South Tyrol, an autonomous province in north Italy, decided to design a new water tariff-setting method. The case of South Tyrol illustrates the application of the action research method. It offers insights on the regulatory tools available to define new water-tariff methods that comply with national and international frameworks, while considering contextual specificities that require simplicity (i.e., clarity and administrative ease). The results encourage using different regulatory instruments, following a contingency approach, to create diverse tariff structures.
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  • Does coronary calcium score zero reliably rule out coronary artery disease in low-to-intermediate risk patients? A coronary CTA study

    Senoner, Thomas   Plank, Fabian   Beyer, Christoph   Langer, Christian   Birkl, Katharina   Steinkohl, Fabian   Widmann, Gerlig   Barbieri, Fabian   Adukauskaite, Agne   Friedrich, Guy   Dichtl, Wolfgang   Feuchtner, Gudrun M.  

    Background: Objective was to assess if coronary calcium score (CCS) zero (<1.0AU) reliably rules out coronary artery disease (CAD) by coronary CTA; and if a difference between CCS zero and ultralow CCS (0.1-0.9AU) exists. Methods: 6439 low-to-intermediate ASCVD-risk patients (57.9 +/- 11.1 years; 44.4% females) who underwent CTA and CCS were enrolled. Coronary CTAs were evaluated for: (1) stenosis severity (CADRADS: <25%, 25-49%, 50-69%, 70-99%, and 100%), (2) mixed-plaque burden, and (3) high-risk-plaque-(HRP)-criteria. Primary endpoints were all-cause and cardiovascular (CV) mortality, secondary endpoint MACE. Results: Overall 1451 (22.5%) had CCS<1.0 AU. Among them, 1289 had CCS zero and 162 ultralow CCS (0.1-0.9AU). In CCS zero patients, 25.9% had CAD, 5.1% > 50% and 20.8% less than 50% stenosis, 6.8% had HRP with min 2 criteria, respectively. LAP<30HU, LAP<60HU, Napkin-Ring-Sign, Spotty calcification and PR were found in 1.3%, 3.7%, 2.8%, 2.3% and 8.2%. CAD prevalence was with 87.7% markedly higher in the ultralow CCS (p < 0.001) group, >50% stenosis (16.6%), total plaque burden (p < 0.001) and HRP-criteria rates were higher (up to 19.1%) (p < 0.001, respectively).All-cause mortality was similar (2.7% and 1.9%) in CCS 0 and ultralow patients (mean follow-up 6.6 +/- 4.2 years). Composite MACE (n =3D 7, 0.48%) was higher than CV-mortality (n =3D 1, 0.06%, p =3D 0.038, OR 1.08-1.6). More HRP were found on 128-slice-dual-source-CTA compared to 64-slice (p < 0.001). There were no differences in CTA findings between patients with and without chest pain, but more females were symptomatic. Conclusion: Early signs of CAD on CTA are frequent in CCS zero and even present in the majority of ultralow CCS (0.1-0.9AU) patients, who should not be downgraded to CCS zero patients. High-risk plaque and >50% stenosis rate is low but not negligible; and MACE rate very low.
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  • Authors reply to Power of zero stronger than "soft" plaque by Budoff et al. The undeniable impact of statins on favorable outcomes

    Feuchtner, Gudrun M.   Senoner, Thomas   Beyer, Christoph   Friedrich, Guy   Plank, Fabian  

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  • Does a Coronary Calcium Score Zero Reliably Rule Out Coronary Artery Disease in Low-to-Intermediate Risk Patients? A Coronary CTA Study

    Feuchtner, Gudrun   Senoner, Thomas   Plank, Fabian   Beyer, Christoph   Steinkohl, Fabian   Barbieri, Fabian   Friedrich, Guy   Dichtl, Wolfgang  

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  • Dataset on the prognostic value of cardiac biomarkers used in clinical routine in patients with severe aortic stenosis undergoing valve replacement

    Senoner, Thomas   Adukauskaite, Agne   Dobner, Stephan   Holfeld, Johannes   Semsroth, Severin   Lambert, Thomas   Zweiker, David   Theurl, Thomas   Rainer, Peter   Schmidt, Albrecht   Feuchtner, Gudrun   Steinwender, Clemens   Hoppe, Uta   Hintringer, Florian   Bauer, Axel   Mueller, Silvana   Grimm, Michael   Pfeifer, Bernhard   Dichtl, Wolfgang  

    Hereby, the supplemental data of the research article "Long-Term Prognostic Value of High-Sensitivity Troponin T added to N-Terminal Pro Brain Natriuretic Peptide Plasma Levels before Valve Replacement for Severe Aortic Stenosis" are presented [1]. It offers enhanced input on the predictive value of these biomarkers considering the influence of the presence of concomitant coronary artery disease (CAD) in various severities as well as an additional cox proportional hazard model on cardiovascular mortality. Furthermore, the receiver operating characteristic (ROC) curves are shown as figures. The material described increases therefore the understanding of the predictive value of these already routinely available biomarkers and reduces the risk of potential bias due to possible confounding factors. It also underlines the urge for a multi-factorial approach in diagnostics to detect the optimal point for referral to valve replacement other than just symptomatic status, an observed reduction in left ventricular ejection fraction or the presence of CAD with the necessity for coronary artery bypass grafting (CABG) [2]. The data of the 3595 patients were gathered retrospectively at a consortium of four university hospital centers in Austria and combined with prospectively collected data on cardiovascular and all-cause mortality. (C) 2020 The Authors. Published by Elsevier Inc.
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  • Sleep apnea detection by a cardiac resynchronization device integrated thoracic impedance sensor: A validation study against the gold standard polysomnography.

    Barbieri, Fabian   Dichtl, Wolfgang   Heidbreder, Anna   Brandauer, Elisabeth   Stefani, Ambra   Adukauskaite, Agne   Senoner, Thomas   Schgor, Wilfried   Hintringer, Florian   Hogl, Birgit  

    BACKGROUND: Sleep disordered breathing is a common but often undiagnosed comorbidity in heart failure patients. Cardiac implantable electronic devices used for cardiac resynchronization therapy (CRT) may detect sleep apnea by use of a transthoracic impedance sensor. Validation of the AP scan algorithm (Boston Scientific) was performed by using the diagnostic gold standard polysomnography (PSG).; METHODS: Forty-one patients with impaired left ventricular ejection fraction, frequent right ventricular pacing due to atrioventricular block and heart failure symptoms despite optimal medical therapy underwent upgrading to biventricular pacing. Within one month after left ventricular lead implantation, sleep apnea was assessed by single-night PSG and AP scan measurements.; RESULTS: AP scan measurements were valid in only 21 of 41 (51.2%) patients in the index night of the PSG. The PSG determined apnea-hypopnea index did not correlate statistically significant with the AP scan measurements (r =3D 0.41, 95% confidence interval -0.05-0.72, p =3D 0.07). The degree of overestimation is displayed by using the Bland-Altman method: mean difference -12.4, standard deviation =C2=B1 15.8, 95% confidence interval -43.3-18.6.; CONCLUSIONS: In heart failure patients receiving CRT upgrading, the AP scan algorithm may need further improvement before it can be recommended for sleep apnea detection.=20
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