Cardiac Implantable Electronic Devices (CIED) and Heart Failure

(PD Dr. med. Dr. sc. nat. Stephan H. Winnik)

The research focus of the Winnik Lab is to identify prognostic markers of outcome in patients with heart failure undergoing device therapy with a focus on cardiac resynchronization therapy. A core element is the identification of both clinical and molecular markers to enhance risk stratification and patient selection for distinct therapeutic strategies.

Heart failure (HF) remains a leading cause of morbidity and mortality worldwide, with cardiac resynchronization therapy (CRT) being one of the therapeutic cornerstones for patients with HF, a reduced left ventricular ejection fraction and electrical ventricular dyssynchrony. CRT has shown significant benefits in improving cardiac function and reducing mortality in certain subsets of HF patients. However, a persistent challenge in clinical practice is the variability in patient response to CRT. Therefore, the need for reliable parameters remains critical to better predict which patients will benefit most from CRT. Currently, robust clinical- and biomarkers beyond QRS duration to reliably predict outcomes in CRT patients are lacking. Proteomics and multiomics approaches show promise in identifying novel biomarkers to improve patient selection and forecast CRT response and overall morbidity and mortality in HF patients. Therefore, our research group focuses on the identification of clinical and molecular biomarkers and their interplay in the prediction of outcome in patients with Heart Failure.

Figure 1. The effect of Diabetes mellitus on CRT outcome. Data stratified for diabetes mellitus (DM) vs. no DM: (A) Kaplan–Meier survival curves for the composite endpoint of all-cause death, heart transplantation, or ventricular assist device implantation

Figure 2. Protein expression and distribution of phospholamban (PLN), PERP, and CPT1B in the right ventricular myocardium of patients with ARVC compared with patients with DCM and healthy controls. Representative immunohistochemistry of PLN, PERP, and CPT1B.

Ongoing research lines:

  • Building a comprehensive biobank of heart failure patients with and without cardiac implantable electronic devices for a comprehensive mutliomics approach to identify disease and therapy-modifying biomarkers in heart failure.

  • Sex-specific proteome analyses for the identification of prognostic biomarkers in personalized treatment of heart failure and cardiac resynchronization therapy.

  • Identification of the role of different etiologies of heart failure, including rare causes such as noncompaction and arrhythmogenic cardiomyopathy, in the context of their response to established therapeutic strategies and personalize therapeutic options.

  • Investigation of the impact of novel device therapies, including conduction system pacing and leadless pacing, on predictive biomarkers of disease progression and outcome.

Collaborations:

 

  • Herzzentrum, Luzerner Kantonsspital, Klinik für Rhythmologie

  • Department of Cardiovascular Sciences, University Hospital Leuven, Belgium

  • Department of Cardiology, AZ Sint-Jan Bruges, Bruges, Belgium

  • Department of Cardiovascular Diseases, Faculty of Medicine, Suez Canal, University, Egypt

  • Department for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Med. Fakultät OWL (Universität Bielefeld), Bad Oeynhausen, 32545, Germany

 

Research Team

  • Deniz Akdis, MD

  • Felix Neugebauer, MD

  • Mustapha El Hamriti, MD

  • Stefan Wyden, MD

  • Sander Trenson, MD, PhD

  • Pascal Betschart, MD, PhD candidate

  • Joël Kuster, MD, PhD candidate