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ZusammenfassungDie Deutsche Gesellschaft für Pneumologie hat die AWMFS1-Leitlinie Post-COVID/Long-COVID initiiert. In einem breiten interdisziplinären Ansatz wurde diese S1-Leitlinie basierend auf dem aktuellen Wissensstand gestaltet.Die klinische Empfehlung beschreibt die aktuellen Post-COVID/Long-COVID-Symptome, diagnostische Ansätze und Therapien.Neben der allgemeinen und konsentierten Einführung wurde ein fachspezifischer Zugang gewählt, der den aktuellen Wissensstand zusammenfasst.Die Leitlinie hat einen expilzit praktischen Anspruch und wird basierend auf dem aktuellen Wissenszugewinn vom Autorenteam stetig weiterentwickelt und adaptiert.

ZusammenfassungAsthma und COPD sind die häufigsten obstruktiven Atemwegserkrankungen. Die chronische Inflammation bedingt eine Induktion von proinflammatorischen Zytokinkaskaden. Neben der systemischen Inflammation tragen Hypoxämie, Hyperkapnie, eine katabole Stoffwechsellage, eine gonadale oder eine Schilddrüsendysfunktion, eine muskuloskelettale Dysfunktion und Inaktivität sowie Vitamin D‑Mangel zu einem erhöhten Knochenbruchrisiko bei. Iatrogene Ursachen der Osteoporose sind die zum Teil langjährigen Anwendungen von inhalativen oder systemischen Glukokortikoiden (GC). Die inhalative GC Applikation bei Asthma ist oft schon im Kindes- und Jugendalter indiziert, aber auch interstitielle Lungenerkrankungen wie die chronisch organisierende Pneumonie, die Sarkoidose oder rheumatische Erkrankungen mit Lungenbeteiligung werden mit inhalativen oder oralen GC behandelt. Bei PatientInnen mit zystischer Fibrose kommt es durch die Malabsorption im Rahmen der Pankreasinsuffizienz, durch Hypogonadismus und chronische Inflammation mit erhöhter Knochenresorption zu einer Abnahme der Knochenstruktur. Nach Lungentransplantation ist die Immunsuppression mit GC ein Risikofaktor.Die pneumologischen Grunderkrankungen führen zu einer Veränderung der trabekulären und kortikalen Mikroarchitektur des Knochens und zu einer Verminderung von osteologischen Formations- und Resorptionsmarkern. Hyperkapnie, Azidose und Vitamin D‑Mangel können diesen Prozess beschleunigen und somit das individuelle Risiko für osteoporotische Fragilitätsfrakturen erhöhen.Eine Knochendichtemessung mit einem T‑Score −2,5 auf. Eine niedrig-traumatische Fraktur in der Anamnese indiziert eine osteologische Therapie.Neben der Optimierung des Vitamin D‑Spiegels sind sämtliche in Österreich zur Behandlung der Osteoporose zugelassenen antiresorptiv oder anabol wirksamen Medikamente auch bei pneumologischen PatientInnen mit einem erhöhten Knochenbruchrisiko entsprechend der nationalen Erstattungskriterien indiziert.

Background Training intensities in pulmonary rehabilitation are commonly based on fixed percentages of peak heart rate (HRpeak), heart rate reserve (HRR), or peak work load (Wpeak). For patients suffering from interstitial lung disease (ILD) it is unknown, whether those intensities are appropriate when compared to individual ventilatory thresholds (VT1 and VT2) derived from cardiopulmonary exercise testing (CPET). The aim of this study was to compare fixed HR percentages with HRs at VT1 and VT2. Study Design and Methods A total of 120 subjects, 80 ILD patients and 40 healthy controls, underwent a symptom-limited CPET. From the ILD patient, 32 suffered from idiopathic pulmonary fibrosis (IPF), 37 from connective tissue disease (CTD) and 11 from sarcoidosis. Results HRs at fixed percentages, i.e., at 70%HRpeak, at 70%Wpeak and at 60%HRR were significantly lower in the ILD patients compared to the control group. Large percentages of HR values at 70%Wpeak and 60%HRR ranged between the HRs at VT1 and VT2 in ILD subgroups and controls as well. HRs at 70%HRpeak were lower than HRs at VT1 in 66% of the IPF patients, 54% of the CTD patients and 55% of patients with sarcoidosis compared to 18% in the control group. Discussion Our findings demonstrate a considerable scattering of fixed HR percentages compared to HRs at the individual VTs derived from CPET in ILD patients. Thus, the use of HRs at the individual VTs is recommended for appropriate prescription of exercise intensity in pulmonary rehabilitation of ILD patients.

Die pneumologische Rehabilitation ist ein wesentlicher Bestandteil der Therapie bei Patienten mit chronischen Lungenerkrankungen. Sie fuhrt zu einer Verbesserung der Leistungsfahigkeit und der Lebensqualitat, sowie zu einer Abnahme der Anzahl und Dauer der Spitalsaufenthalte bei Patienten mit COPD und Reduktion der Gesundheitskosten.

Chronic obstructive pulmonary disease (COPD) represents a major global health problem; however, there are no data regarding clinical phenotypes of these patients in Austria. This was an analysis from the Austrian cohort of the cross-sectional Phenotypes of COPD in Central and Eastern Europe (POPE) study, which was offered to patients with stable COPD in a real-life setting. Patients were recruited at 5 different outpatient facilities in 3 different provinces in Austria. All consecutive patients aged ≥40 years with a diagnosis of COPD confirmed by a post-bronchodilator forced expired volume in 1 s/forced vital capacity (FEV1/FVC) ratio

HINTERGRUND: Ziel unserer Studie war es, den Effekt von einem Jahr ambulanter wohnortnaher Rehabilitation auf funktionelle Parameter sowie auf die Lebensqualitat und Exazerbationsrate bei Patienten mit COPD zu untersuchen. METHODIK: Wir inkludierten 100 Patienten in ein multidisziplinares Rehabilitationsprogramm, welches sowohl Ausdauer-, Kraft- und inspiratorisches Atemmuskeltraining beinhaltet. Wir fuhrten folgende Messungen vor der Rehabilitation sowie nach sechs und 12 Monaten durch: Spiroergometrie, modifizierter Bruce Test, Kraft der Arme und Beine sowie inspiratorische Atemmuskelkraft. Zusatzlich wurde der Saint Georges Respiratory Questionnaire und die Exazerbationstage ein Jahr vor sowie wahrend der Rehabilitation erhoben. ERGEBNISSE: 100 Patienten (42 f/58 m) mit COPD (COPD IV – N = 36, COPD III – N = 42, COPD II – N = 22), einem mittleren Alter von 60,5 ± 9,6 Jahren, einem BMI von 25,8 ± 6,0 begannen ein pneumologisches Rehabilitationsprogramm uber einen Zeitraum von einem Jahr. Die Spiroergometrie (VO2max von 1,1 auf 1,3 l/Min, P < 0.05), der modifizierte Bruce Test (von 13 ± 7 Min auf 18 ± 9 Min; P < 0.001), die Kraft der Arme (von 39,9 ± 3 auf 52,9 ± 8 kg; P < 0.001) und Beine verbesserten sich (von 85,3 ± 45 auf 131,5 ± 57 kg; P < 0.001). Der Maximal inspiratorische Druck stieg von 81,1 auf 108,8 mbar (P < 0.0001). Es kam zu keinen Veranderungen in der FEV1 oder FEV1/FVC, jedoch der Saint Georges Respiratory Questionnaire (Gesamtscore) verbesserte sich von 37,2 ± 3,6 auf 26,5 ± 2,8; P < 0.001. Auch kam es zu einer Reduktion der Exazerbationsraten von 2,8 im Jahr vor der Rehabilitation auf 0,8; P = 0.006) sowie der Hospitalisationstage (von 27,3 auf 3,3, P < 0.001). FOLGERUNGEN: Ein Jahr ambulanter pneumologischer Rehabilitation fuhrt zu einer deutlichen Verbesserung der korperlichen Leistungsfahigkeit und der gesundheitsbezogenen Lebensqualitat, weiters konnen die Anzahl der Exazerbationen sowie die Hospitalisationstage reduziert werden.

Objectives: There is still little information about the cardiorespiratory effects of cardiac resynchronization therapy (CRT) in patients undergoing all-day physical activity. This study aimed to assess the effects of CRT on ventilatory perfusion coupling during submaximal exercise. Methods: Metabolic and hemodynamic parameters were obtained during treadmill exercise testing as well as during rest for each single-right (RV), -left (LV) and biventricular (BiV) pacing mode as well as during intrinsic conduction (VVI 30) in 37 patients. Only responders to CRT (>10% increase in cardiac output (CO) during BiV pacing; n = 27) were included into the evaluation. Results: LV and BiV pacing increased systolic (144 ± 25 and 142 ± 28 vs. 118 ± 29 mm Hg, p < 0.05) and mean blood pressure (108 ± 19 and 109 ± 19 vs. 94 ± 25 mm Hg, p < 0.05) as well as CO (7.0 ± 0.6 and 7.2 ± 0.8 vs. 6.0 ± 0.6 l/min, p < 0.05 and p < 0.01) during exercise as compared to VVI 30. Simultaneously, LV and BiV pacing decreased dead space ventilation (18 ± 3 and 17 ± 3 vs. 20 ± 4, p < 0.01) and the ventilatory equivalent for oxygen (31 ± 4 and 31 ± 5 vs. 36 ± 6; p < 0.05) compared to intrinsic conduction. Conclusion: The improvement in ventilatory efficacy during CRT, which is demonstrated by the decrease in the ventilatory equivalent for oxygen, results from an increase in CO and thus from a reduction in the ventilatory perfusion mismatch.

31-Phosphorous magnetic resonance spectroscopy (31P MRS) is a unique tool to investigate IN VIVO high-energy phosphates (HEP) in the human heart. We hypothesized that physical capacity may be associated with myocardial HEP status. Healthy, male volunteers (n = 105, mean age 51 +/- 7 years) underwent bicycle ergometry with a stepwise increasing workload to determine maximal working capacity (MWC). Heart rate (HR) and blood pressure (BP) were measured continuously during exercise and 4 minutes of recovery. Further 31-Phosphorous 2-dimensional chemical shift imaging (31P 2D CSI) MRS was performed to assess myocardial HEP metabolism by determining phosphocreatinine to beta-ATP ratios (PCr/b-ATP) using a 1.5 tesla scanner. Volunteers with MWC230 Watt had significantly higher PCr/b-ATP ratios than those with MWC200 Watt (1.93 +/- 0.36 vs. 1.59 +/- 0.35; p0.001). Additionally, those with a recovery systolic (S)BP195 mmHg had significantly higher ratios than those with a recovery SBP195 mmHg (1.74 +/- 0.3 vs. 1.51 +/- 0.2; p0.05). We observed a linear correlation between the PCr/b-ATP ratio and MWC (r = 0.411; p0.001) and recovery SBP (r = - 0.290; p0.01). After statistical correction for age, these correlations remained significant. In this study, we observed a correlation of parameters of physical fitness determined by bicycle exercise testing and cardiac PCr/b-ATP ratios.

Analysis of shape began to emerge as a useful method in medical image computing with the potential to improve the accuracy of medical diagnosis as well as the understanding of processes behind growth and disease. Our work aims at investigating the suitability of the medial representation method (m-reps) to model and analyze shape and shape differences between healthy and diseased hearts. For this experimental study we used MRI short axis scans of 16 male subjects, 11 healthy volunteers (age: 50 ± 10) and 5 patients (age: 57 ± 11) with dilatative cardiomyopathy (CMP, EF: 22 ± 10%). Controlled semi-automated segmentation using the level set method provided labels, which were used for the modeling process. To evaluate the model to image quality the similarity index (SI) was calculated. The SI for the left ventricle was 0.93, and for the right ventricle SI = 0.9. Applying extended Principal Component Analysis (PCA) on all 16 subjects revealed the distribution of the individual shapes, showing discrimination between healthy and diseased ventricles. The first two main components of the PCA, mainly responsible for discrimination, cover more than 40% of the whole shape space. Applying the medial based approach and using shape statistics using component analysis for the left and right ventricle is feasible. This preliminary work promises to discriminate at least globally based on shape differences between healthy and diseased hearts. The resulting question however is, if this approach is good enough to detect early structural changes leading to diseased hearts.

Acute myocarditis may result in severe hemodynamic compromise with fatal outcome. Furthermore, recent studies suggest myocarditis as a major cause of sudden unexpected death. A variety of cardiotropic viral, rickettsial, and bacterial infectious agents have been identified to date. Parvovirus B19 (PVB19) is usually benign in childhood, but it may also cause death due to myocarditis. We present here the case of an adult female who presented with fatigue, dyspnea on exertion, and orthostatic dizziness 8 months after successful liver transplantation. Cardiologic work-up, including left ventricular endomyocardial biopsy, revealed acute myocarditis secondary to PVB19. Since no specific therapy for this virus is available, the patient was treated symptomatically with an angiotensin-converting enzyme inhibitor plus beta-blocker and diuretics. After a period of stabilization, new-onset rapid atrial fibrillation caused acute low-output syndrome within 14 days after hospital admission. The patient eventually died because of refractory cardiogenic shock. In conclusion, to our knowledge this is the first report of PVB19-induced myocarditis confirmed by detection of viral genome in myocardium in a liver transplant recipient.

death plays a pathogenic role in a rat model of heart failure. Int J Cardiol 2009;134:82–90. [6] Matsui Y, Takagi H, Qu X, et al. Distinct roles of autophagy in the heart during ischemia and reperfusion: roles of AMP-activated protein kinase and Beclin 1 in mediating autophagy. Circ Res 2007;100:914–22. [7] Asanuma K, Tanida I, Shirato I, et al. MAP-LC3, a promising autophagosomal marker, is processed during the differentiation and recovery of podocytes from PAN nephrosis. FASEB J 2003;17:1165–7. [8] Shewan LG, Coats AJ. Ethics in the authorship and publishing of scientific articles. Int J Cardiol 2010;144:1–2.

Cardiac resynchronization therapy (CRT) is limited by the high numbers of nonresponders. This study analyzed the impact of the cardiorespiratory functional reserve to predict the response to CRT.Twenty-eight patients (age 67 ± 9 years, LVEF35%, NYHA class III, QRS 158 ± 25 ms) underwent submaximal cardiopulmonary treadmill exercise testing prior and 6 months after implantation of a CRT device. Breath-to-breath gas analysis was used for calculation of the oxygen uptake efficiency slope (OUES = non-effort-dependent index of cardiorespiratory functional reserve) in the responder and nonresponder group. Responders to CRT [defined by a decrease in left ventricular end-systolic volume (LVESV)15%] showed a significant lower cardiorespiratory reserve at baseline (prior CRT) as compared to the nonresponders (OUES 1,235 ± 651 vs. 2,480 ± 590; p0.01). Responders showed an increase in OUES during CRT at the 6 months follow-up (1,879 ± 663; p0.05) whereas nonresponders showed no significant changes from baseline (2,194 ± 422; ns). Both responders and nonresponders showed an improvement in LVEF at the 6 months follow-up (23 ± 5 vs. 31 ± 9% and 26 ± 7 vs. 32 ± 3%; p0.05). Responders to CRT showed a decrease in NYHA classification (3.0 vs. 2.6 ± 0.5; p0.05) and a decrease in LVESV (175 ± 58 vs. 128 ± 40 ml; p0.05).Nonresponders to CRT showed a more preserved cardiorespiratory functional reserve as compared to responders despite similar NYHA classification. Evaluation of the OUES by submaximal exercise testing improves identification of responders to CRT.

The aim of our study was to determine the effect of one year of pulmonary rehabilitation (PR) on functional parameters and exacerbation rates in patients with chronic obstructive pulmonary disease (COPD).A total of 100 patients were enrolled in a multidisciplinary PR program. PR included endurance, resistance and respiratory muscle training. We performed spiroergometry, a modified Bruce Test and measurements of upper and lower limb contractility as well as inspiratory muscle strength before, six and 12 months after beginning rehabilitation. Additionally, we assessed the quality of life and the number of exacerbations and exacerbation days one year before and after starting rehabilitation.100 patients (42 female/58 male) with COPD (COPD IV-N=36, COPD III-N=42, COPD II-N=22), a mean age of 60.5+/-9.6 years, BMI 25.8+/-6.0 attended a rehabilitation training program over a time period of one year. Spiroergometry (VO2max from 1.1 to 1.3 l/min, P0.05), modified Bruce Test (from 13+/-7 Min to 18+/-9 Min; P0.001), upper limb (from 39.9+/-3 to 52.9+/-8 kg; P0.001) and lower limb strength increased significantly (from 85.3+/-45 to 131.5+/-57 kg; P0.001). The maximal inspiratory pressure rose from 81.1 mbar to 108.8 mbar (p0.001). There was no improvement in FEV1 or FEV1/FVC but Saint Georges Respiratory Questionnaire (total score) improved from 37.2+/-3.6 to 26.5+/-2.8; P0.001. The same was true for exacerbation rates (they dropped from 2.8 to 0.8; P=0.006) and the number of hospitalization days (from 27.3 to 3.3, P0.001).One year of outpatient pulmonary rehabilitation is an effective intervention leading to a significant improvement in exercise tolerance and quality of life in patients with COPD also reducing COPD exacerbation rates and hospitalizations.

Vascular endothelial growth factor (VEGF) has been associated with atherosclerosis progression and lesion destabilisation. Despite a beneficial effect of local VEGF administration in myocardial and peripheral ischaemia,1 recent evidence suggests a pro-atherosclerotic role of VEGF2 through its ability to enhance plaque inflammatory infiltration and neovascularisation. Despite these results, coming mostly from animal studies, there have been few investigations on the relation between VEGF and human coronary artery disease (CAD). These studies yielded conflicting results regarding VEGF concentrations and gene expression in CAD patients compared to controls.3,4 To elucidate the association of VEGF and CAD further, we performed a prospective study in consecutive patients with chest pain undergoing coronary angiography to compare the coronary status with VEGF plasma concentrations. Written informed consent was obtained from 178 patients. Plasma was collected from a femoral artery access immediately before diagnostic coronary angiography. Exclusion criteria were prior myocardial infarction (< 1 month before inclusion), tumour disease, peripheral arterial occlusive disease, ejection fraction < 30%, acute infections, chronic rheumatoid diseases, and chronic obstructive pulmonary disease. Prior statin use was defined as statin treatment for more than 10 days. VEGF plasma concentrations were determined by enzyme linked immunosorbent assay (ELISA, R&D System, Abingdon, UK). Coronary angiograms were scored visually by a blinded observer: a severity score (0–3) defined the number of vessels with a luminal stenosis ⩾ 50% (for right, left anterior descending, and …

Enhancement of the generation of nitric oxide (NO) and vascular endothelial growth factor (VEGF) are suggested to prevent restenosis after angioplasty. Accordingly, we tested whether the local delivery of L-arginine (L-Arg), a substrate for NO generation and the VEGF gene, alone or in combination, can influence neointima formation in hypercholesterolemic rabbits. Balloon injury of the iliac arteries was performed in 24 New Zealand White rabbits fed a 1% cholesterol diet for 3 weeks followed by a local infusion of: (1) pSG5VEGF165 plasmid alone (1000 μg); (2) pSG5VEGF165 (1000 μg) with L-Arg (800 mg); (3) L-Arg (800 mg) alone; and (4) L-Arg (800 mg) with naked pSVβ-gal plasmid (1000 μg). The animals were kept on the hypercholesterolemic diets for a further 28 days, when vessels were taken for morphometric analysis and immunocytochemistry. Endogenous rabbit VEGF concentration in the plasma increased significantly at 7 days after injury (17.06 ± 1.57 vs 23.01 ± 1.9 pg/ml; p < 0.02) and remained elevated for up to 28 days (28.46 ± 5.24; p < 0.01). Injured arteries exhibited strong immunocytochemical staining for rabbit VEGF. Rabbits that received a VEGF gene transfer revealed more prominent neointima formation, whereas treatment with L-Arg was associated with significantly less intimal thickness ( p < 0.05). Local transfer of the VEGF gene does not inhibit neointima formation in hypercholesterolemic rabbits. Our results suggest that VEGF gene therapy applied locally in atherosclerotic arteries may not be beneficial.

Objectives: HMG-CoA reductase inhibitors (statins) can modulate the formation of new blood vessels, but the reports on their contribution to angiogenesis are contradictory. Therefore, we investigated whether the effect of statins is dependent either on the concentration of the drug or on the cell type. Methods and results: Under basal conditions human vascular smooth muscle cells (HVSMC) and microvascular endothelial cells (HMEC-1) constitutively generate and release vascular endothelial growth factor (VEGF). In contrast, primary macrovascular endothelial cells (HUVEC) produce minute amounts of VEGF. Different statins (atorvastatin, simvastatin and lovastatin, 1–10 μmol/l) significantly reduced basal and cytokine-, nitric oxide- or lysophosphatidylcholine (LPC)-induced VEGF synthesis in HMEC-1 and HVSMC. Interestingly, at the same concentrations statins upregulated VEGF generation in HUVEC. Furthermore, statins exerted dual, concentration-dependent influence on angiogenic activities of HUVEC as determined by tube formation assay. At low concentrations (0.03–1 μmol/l) the pro-angiogenic activity of statins is prevalent, whereas at higher concentrations statins inhibit angiogenesis, despite increasing VEGF synthesis. Conclusion: Our data show that statins exert concentration- and cell type-dependent effects on angiogenic activity of endothelial cells and on VEGF synthesis. The data are of relevance for elucidating the differential activity of statins on angiogenesis in cardiovascular diseases and cancer.