[Lifelong learning in cardiology: success through innovation : Use of e-learning in further education and training]. / Lebenslanges Lernen in der Kardiologie: Durch Innovation erfolgreich : Einsatz von E-Learning in Fort- und Weiterbildung.

Lifelong learning in cardiology is essential, as treatment standards, technologies and drug treatment are constantly evolving. In this respect e­learning plays a central role, enabling doctors to flexibly and efficiently expand their knowledge. There are various offerings, from medical students and specialist training to highly specialised expert knowledge. The e­learning platforms have become an indispensable tool in specialist training. Another concept is the combination of face-to-face teaching and e­learning, known as blended learning. This is particularly effective in medical training. These models enable flexible preparation and follow-up and appeal to different types of learners. Overall, e­learning offers a valuable resource for flexibly and efficiently acquiring knowledge and keeping up to date.

Recurrence of atrial fibrillation after pulmonary vein isolation in dependence of arterial stiffness.

BACKGROUND: Arterial stiffness (AS) has emerged as a strong predictor of cardiovascular (CV) diseases. Although increased AS has been described as a predictor of atrial fibrillation (AF), its role as a risk marker for AF recurrence has not yet been elucidated. METHODS: Patients with AF who underwent pulmonary vein isolation (PVI) were included in this study. Presence of AS was evaluated by measuring aortic distensibility (AD) of the descending aorta by transoesophageal echocardiography. RESULTS: In total, 151 patients (mean ± standard deviation (SD) age 71.9 ± 9.8 years) were enrolled and followed for a median duration of 21 months (interquartile range 15.0-31.0). During follow-up, AF recurred in 94 (62.3%) patients. AF recurrence was seen more frequently in patients with permanent AF (27% vs 46%, p = 0.03) and in those who had undergone prior PVI (9% vs 23%, p = 0.02). AD was significantly reduced in patients with AF recurrence (mean ± SD 2.6 ± 2.3 vs 1.5 ± 0.7â€¯× 10-3 mm Hg-1, p < 0.0001), as well as left atrial volume index (LAVI) (mean ± SD 29 ± 12 vs 44 ± 15 ml/m2, p < 0.0001). Multivariable analysis revealed LAVI (odds ratio (OR) 2.9, 95% confidence interval (CI) 1.2-3.4) and AS (OR 3.6, 95% CI 2.8-4.1) as independent risk factors of AF recurrence. CONCLUSION: Increased AS and left atrial size were independent predictors of AF recurrence after PVI. AD as surrogate marker of AS seemed to reflect the overall CV risk. In addition, AD was significantly correlated with left atrial size, which suggests that increased AS leads to atrial remodelling and thus to AF recurrence. TRIAL REGISTRATION: German registry for clinical studies (DRKS), DRKS00019007.

[Diabetic foot syndrome-Part 2 : Revascularization, treatment alternatives, care structures, recurrency prophylaxis]. / Diabetisches Fußsyndrom ­ Teil 2 : Revaskularisation, Behandlungsalternativen, Versorgungsstrukturen, Rezidivprophylaxe.

Diabetic foot syndrome (DFS) is the most frequent reason for major amputations in Germany. The majority of foot lesions are triggered by repetitive pressure in diabetic polyneuropathy. Peripheral arterial occlusive disease (PAOD) impairs wound healing and is the main risk factor for amputations. The treatment of wounds and infections as well as timely revascularization are decisive. The use of endovascular and vascular surgical methods depends on the distribution pattern and length of the occlusion processes. Both procedures are complementary. Bypass surgery is of great importance for neuroischemic DFS. Multidisciplinary centers that provide revascularization in DFS can achieve an improvement of arterial blood flow in 90% of the cases and reduce the amputation rate by up to 80%. Due to the high recurrence rate of diabetic foot lesions, measures for secondary prophylaxis are of exceptional importance (podological and orthopedic technical care, foot surgery).

[Instantaneous wave-free ratio (iFR®) in patients with coronary artery disease]. / "Instantaneous wave-free ratio" (iFR®) bei Patienten mit koronarer Herzkrankheit.

Coronary angiography is considered as the gold standard in the morphological representation of coronary artery stenosis. Coronary angiography is often performed without preprocedural non-invasive proof of ischemia and the assessment of the severity of a coronary lesion by morphology is very subjective. Thus, invasive fractional flow reserve (FFR) measurement represents the current standard for estimation of the hemodynamic relevance of coronary artery stenosis and facilitates decision making for percutaneous coronary intervention (PCI) and stenting. The FFR-guided revascularization strategy has been classified as a class IA recommendation in the 2014 ESC/EACTS guidelines on myocardial revascularization. Both the DEFER and the FAME studies showed no treatment advantage of hemodynamically irrelevant stenosis. By use of FFR (and targeted interventions), clinical results could be improved as well as the procedure costs were reduced; however, the use in clinical practice is still limited due to the need of adenosine administration and a significant prolongation of the procedure. Instantaneous wave-free ratio (iFR®) is a new innovative approach for the determination of the hemodynamic relevance of coronary stenosis which can be obtained at rest without the use of vasodilators. Regarding periprocedural complications as well as prognosis, iFR® showed non-inferiority compared to FFR in the SWEDEHEART and DEFINE-FLAIR trials.

[Frequency and distribution of types of hyperlipoproteinemia with life-shortening risk factors among ambulant patients (author's transl)]. / Häufigkeit und Typenverteilung von Hyperlipoproteinämien unter ambulanten Patienten mit lebensverkürzenden Risikofaktoren

It is reported of 726 patients incidentally elected and mainly with life-shortening risk factors. 341 (47.1p.c.) showed an increased concentration of neutral fats and/or total cholesterol in the serum. Type IV (49.8 p.c.) according to Fredrickson was observed most frequently, followed by type IIb (31.1 p.c.) and by type IIa (19.1 p.c.). Most of the patients with hyperlipoproteinemia were overweight (53.1 p.c.), 33.6 p.c. suffered from arterial hypertension, 25.3 p.c. from diseases of the liver, 10.9 p.c. from coronary heart diseases, and 8.7 p.c. from manifest diabetes mellitus. The distribution of different types of hyperlipoproteinemia among the various diseases deviates from that of the total number of patients observed in this study. Cases of hyperlipoproteinemia were observed most frequently in diseases of the kidney with arterial hypertension (62.7 p.c.), coronary heart diseases (60.8 p.c.), manifest gout (60.0 p.c.), manifest diabetes mellitus (58.7 p.c.), and hyperuricemia without symptoms (55.8 p.c.). Type-IV-hyperlipoproteinemia was observed most frequently within the different groups of patients with life-shortening risk factors. An exception was the group of patients suffering from malignancies. Type IIb was found most frequently within the group of patients suffering from malignancies.