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Moutzoukis G, Lorenz MK, Schroeder T, Schulte-Steinberg B, Chow K, Kellman P, Bekeredjian R, Schmid N, Mahrholdt H, Seitz A. Systematic underestimation of myocardial perfusion reserve by regadenoson stress perfusion CMR-when haste makes waste. Clin Res Cardiol 2024:10.1007/s00392-024-02405-6. [PMID: 38466348 DOI: 10.1007/s00392-024-02405-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 03/13/2024]
Affiliation(s)
- Georgios Moutzoukis
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Marie K Lorenz
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Thomas Schroeder
- Department of Medical Informatics, Bosch Health Campus, Stuttgart, Germany
| | - Benedict Schulte-Steinberg
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Kelvin Chow
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | - Peter Kellman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
| | - Nico Schmid
- Department of Medical Informatics, Bosch Health Campus, Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
| | - Andreas Seitz
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany
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Oberli L, Moutzoukis G, Bekeredjian R, Mahrholdt H, Seitz A. Mitral annular disjunction, mitral valve disease, and excessive trabeculation: an overlooked trio associated with arrhythmia? Eur Heart J Cardiovasc Imaging 2023; 24:e282. [PMID: 37409609 DOI: 10.1093/ehjci/jead155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
- Lisa Oberli
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Georgios Moutzoukis
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Andreas Seitz
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
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Mahrholdt H, Seitz A. Refining the Prognostic Value of LGE in Hypertrophic Cardiomyopathy: Presence, Extent, and Location-What's Next? JACC Cardiovasc Imaging 2023; 16:1178-1180. [PMID: 37204387 DOI: 10.1016/j.jcmg.2023.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023]
Affiliation(s)
- Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Stuttgart, Germany.
| | - Andreas Seitz
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Stuttgart, Germany
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Moutzoukis G, Oberli L, Bekeredjian R, Mahrholdt H, Seitz A. Timing of LGE imaging in patients undergoing CMR for suspected pericarditis: the later the better? Eur Heart J Cardiovasc Imaging 2023:7113772. [PMID: 37039733 DOI: 10.1093/ehjci/jead059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Affiliation(s)
- Georgios Moutzoukis
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Lisa Oberli
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Andreas Seitz
- Department of Cardiology and Angiology, Robert Bosch Hospital, Auerbachstr. 110, 70376 Stuttgart, Germany
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Seitz A, Wachter K, Cani E, Burgstahler C, Spaich S, Mahrholdt H. CMR tissue characterization and course of acute SARS-CoV-2 type B.1.1.529-associated myocarditis in a professional soccer player. Dtsch Z Sportmed 2023. [DOI: 10.5960/dzsm.2022.551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
We report the case of a young professional soccer player who underwent cardiac MRI (CMR) for work-up of discrete intermittent chest pain and subtle ST segment elevations in the ECG after having been tested positive for SARS-CoV-2 type B.1.1.529 despite full vaccination including recent mRNA booster. Troponin levels were significantly increased and myocarditis was suspected. Comprehensive CMR including CINE and late gadolinium enhancement as well as multi-parametric T1/T2 mapping techniques revealed local hypokinesia and swelling of the posterolateral wall with non-ischemic late gadolinium enhancement and increased T2 relaxation time compatible with acute viral myocarditis. The patient was admitted to a cardiology ward for rhythm and troponin monitoring and was discharged after two days of uneventful rhythm monitoring and with decreased troponin levels. Adhering to current recommendations the patient was advised to abstain from moderate- to high-intensity sports and exercise for 3-6 months. After 6 months of exercise avoidance, follow-up ECG showed regression of prior ST segment elevations, and Holter ECG as well as a treadmill exercise stress test did not reveal any abnormalities. Follow-up CMR was performed before return-to-sports which revealed persisting myocardial fibrosis but complete regression of myocardial edemam and excluded ongoing inflammation. This example underscores the value of multi-parametric CMR tissue characterization for the work-up of suspected SARS-CoV-2 associated myocarditis, as well as for follow-up before return-to-sports.
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Kettler L, Nikolai P, Mahrholdt H, Ong P, Bekeredjian R. Early experience of fluid management and clinical benefit after transcatheter edge-to-edge repair in severe tricuspid regurgitation. AsiaIntervention 2023; 9:95-96. [PMID: 36936087 PMCID: PMC10015486 DOI: 10.4244/aij-d-22-00052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/19/2022] [Indexed: 03/14/2023]
Affiliation(s)
- Lisa Kettler
- Department of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Philipp Nikolai
- Department of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany
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Seitz A, Rogers C, Moutzoukis G, Oberli L, Ong P, Bekeredjian R, Mahrholdt H. CMR findings in patients referred for suspected myocarditis following mRNA-based COVID vaccination compared with pre-COVID myocarditis referrals: A single-centre observational study. IJC Heart & Vasculature 2022; 43:101142. [PMID: 36389264 PMCID: PMC9643878 DOI: 10.1016/j.ijcha.2022.101142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/15/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
Background Vaccination is considered the key to overcome the COVID pandemic. For the first time mRNA-based vaccinations are used in humans. Case series suggested an increased risk of myocarditis after vaccination. This study sought to describe CMR findings in patients with suspected mRNA-vaccine associated myocarditis. Methods A total of 33 consecutive patients referred for CMR work-up of suspected myocarditis associated with mRNA-based vaccination were included. A historical cohort of 135 consecutive patients referred for suspected myocarditis in the pre-COVID era served as control group. All patients underwent multi-parametric CMR including CINE and late gadolinium enhancement (LGE) imaging as well as parametric T1/T2 mapping of the left ventricular myocardium. Results Patients referred for suspected vaccination-related myocarditis were more often female (55 % vs 32 %, p = 0.015) and demonstrated smaller LV dimensions as well as a better LV function compared to patients of the control group. CMR revealed a lower prevalence of non-ischemic LGE in patients with suspected vaccination-myocarditis (6 % vs 22 %, p = 0.04). However, among patients without LGE we observed a higher prevalence of an abnormal T1/T2 mapping result in patients with suspected vaccination-myocarditis compared to the control group (45 % vs 18 %, p = 0.010). Conclusion In this small single-centre study, compared to myocarditis referrals in the pre-COVID era, patients currently referred for CMR work-up of suspected mRNA-vaccination-associated myocarditis demonstrated lower prevalence of LGE but higher prevalence of abnormal T1/T2 mapping. These hypothesis-generating observations may point towards a rather subtle myocardial damage and support the routine use of T1/T2 mapping in this indication.
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Mengel A, Nenova L, Müller KAL, Poli S, Kowarik MC, Feil K, Mizera L, Geisler T, Kübler J, Mahrholdt H, Ernemann U, Hennersdorf F, Ziemann U, Nikolaou K, Gawaz M, Krumm P, Greulich S. TRoponin of Unknown origin in STroke evaluated by multi-component cardiac Magnetic resonance Imaging – The TRUST-MI study. Front Cardiovasc Med 2022; 9:989376. [PMID: 36247463 PMCID: PMC9561415 DOI: 10.3389/fcvm.2022.989376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/13/2022] [Indexed: 01/01/2023] Open
Abstract
AimsIncreased high-sensitive cardiac troponin I (hs-cTnI) levels are common in patients with acute ischemic stroke. However, only a minority demonstrates culprit lesions on coronary angiography, suggesting other mechanisms, e.g., inflammation, as underlying cause of myocardial damage. Late Gadolinium Enhancement (LGE)-cardiac magnetic resonance (CMR) with mapping techniques [T1, T2, extracellular volume (ECV)] allow the detection of both focal and diffuse myocardial abnormalities. We investigated the prevalence of culprit lesions by coronary angiography and myocardial tissue abnormalities by a comprehensive CMR protocol in troponin-positive stroke patients.Methods and resultsPatients with troponin-positive acute ischemic stroke and no history of coronary artery disease were prospectively enrolled. Coronary angiography and CMR (LGE, T1 + T2 mapping, ECV) were performed within the first days of the acute stroke. Twenty-five troponin-positive patients (mean age 62 years, 44% females) were included. 2 patients (8%) had culprit lesions on coronary angiography and underwent percutaneous coronary intervention. 13 patients (52%) demonstrated LGE: (i) n = 4 ischemic, (ii) n = 4 non-ischemic, and (iii) n = 5 ischemic AND non-ischemic. In the 12 LGE-negative patients, mapping revealed diffuse myocardial damage in additional 9 (75%) patients, with a high prevalence of increased T2 values.ConclusionsOur data show a low prevalence of culprit lesions in troponin-positive stroke patients. However, > 50% of the patients demonstrated myocardial scars (ischemic + non-ischemic) by LGE-CMR. Mapping revealed additional myocardial abnormalities (mostly inflammatory) in the majority of LGE-negative patients. Therefore, a comprehensive CMR protocol gives important insights in the etiology of troponin which might have implications for the further work-up of troponin-positive stroke patients.
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Affiliation(s)
- Annerose Mengel
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lilyana Nenova
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Karin A. L. Müller
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Markus C. Kowarik
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Katharina Feil
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Lars Mizera
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Tobias Geisler
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Jens Kübler
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Ulrike Ernemann
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
- *Correspondence: Simon Greulich,
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Moutzoukis G, Mahrholdt H, Seitz A. Cardiac manifestation of giant cell arteritis as a rare cause of severe coronary triple vessel disease. J Cardiovasc Comput Tomogr 2022; 17:e5-e6. [PMID: 36192327 DOI: 10.1016/j.jcct.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022]
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Ochs A, Riffel J, Ochs MM, Arenja N, Fritz T, Galuschky C, Schuster A, Bruder O, Mahrholdt H, Giannitsis E, Frey N, Katus HA, Buss SJ, André F. Myocardial mechanics in dilated cardiomyopathy: prognostic value of left ventricular torsion and strain. J Cardiovasc Magn Reson 2021; 23:136. [PMID: 34852822 PMCID: PMC8638178 DOI: 10.1186/s12968-021-00829-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 11/16/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Data on the prognostic value of left ventricular (LV) morphological and functional parameters including LV rotation in patients with dilated cardiomyopathy (DCM) using cardiovascular magnetic resonance (CMR) are currently scarce. In this study, we assessed the prognostic value of global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and LV torsion using CMR feature tracking (FT). METHODS CMR was performed in 350 DCM patients and 70 healthy subjects across 5 different European CMR Centers. Myocardial strain parameters were retrospectively assessed from conventional balanced steady-state free precession cine images applying FT. A combined primary endpoint (cardiac death, heart transplantation, aborted sudden cardiac death) was defined for the assessment of clinical outcome. RESULTS GLS, GCS, GRS and LV torsion were significantly lower in DCM patients than in healthy subjects (all p < 0.001). The primary endpoint occurred in 59 (18.7%) patients [median follow-up 4.2 (2.0-5.6) years]. In the univariate analyses all strain parameters showed a significant prognostic value (p < 0.05). In the multivariate model, LV strain parameters, particularly GLS provided an incremental prognostic value compared to established CMR parameters like LV ejection fraction and late gadolinium enhancement. A scoring model including six categorical variables of standard CMR and strain parameters differentiated further risk subgroups. CONCLUSION LV strain assessed with CMR FT has a high prognostic value in patients with DCM, surpassing routine and dedicated functional parameters. Thus, CMR strain imaging may contribute to the improvement of risk stratification in DCM.
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Affiliation(s)
- Andreas Ochs
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Johannes Riffel
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Marco M. Ochs
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Nisha Arenja
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- Department of Cardiology, Solothurner Spitäler AG, Kantonsspital Olten, Olten, Switzerland
| | - Thomas Fritz
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | | | | | | | | | - Evangelos Giannitsis
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Hugo A. Katus
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Sebastian J. Buss
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
| | - Florian André
- Department of Cardiology, Angiology and Pneumology, University of Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Heidelberg, Heidelberg, Germany
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Greulich S, Gatidis S, Gräni C, Blankstein R, Glatthaar A, Mezger K, Müller KAL, Castor T, Mahrholdt H, Häntschel M, Hetzel J, Dittmann H, Nikolaou K, Gawaz M, la Fougère C, Krumm P. Hybrid Cardiac Magnetic Resonance/Fluorodeoxyglucose Positron Emission Tomography to Differentiate Active From Chronic Cardiac Sarcoidosis. JACC Cardiovasc Imaging 2021; 15:445-456. [PMID: 34656480 DOI: 10.1016/j.jcmg.2021.08.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 08/06/2021] [Accepted: 08/26/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The purpose of this study was to investigate the diagnostic value of simultaneous hybrid cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for detection and differentiation of active (aCS) from chronic (cCS) cardiac sarcoidosis. BACKGROUND Late gadolinium enhancement (LGE) CMR and FDG-PET are both established imaging techniques for the detection of CS. However, there are limited data regarding the value of a comprehensive simultaneous hybrid CMR/FDG-PET imaging approach that includes CMR mapping techniques. METHODS Forty-three patients with biopsy-proven extracardiac sarcoidosis (median age: 48 years, interquartile range: 37-57 years, 65% male) were prospectively enrolled for evaluation of suspected CS. After dietary preparation for suppression of myocardial glucose metabolism, patients were evaluated on a 3-T hybrid PET/MR scanner. The CMR protocol included T1 and T2 mapping, myocardial function, and LGE imaging. We assumed aCS if PET and CMR (ie, LGE or T1/T2 mapping) were both positive (PET+/CMR+), cCS if PET was negative but CMR was positive (PET-/CMR+), and no CS if patients were CMR negative regardless of PET findings. RESULTS Among the 43 patients, myocardial glucose uptake was suppressed successfully in 36 (84%). Hybrid CMR/FDG-PET revealed aCS in 13 patients (36%), cCS in 5 (14%), and no CS in 18 (50%). LGE was present in 14 patients (39%); T1 mapping was abnormal in 10 (27%) and T2 mapping abnormal in 2 (6%). CS was diagnosed based on abnormal T1 mapping in 4 out of 18 CS patients (22%) who were LGE negative. PET FDG uptake was present in 17 (47%) patients. CONCLUSIONS Comprehensive simultaneous hybrid CMR/FDG-PET imaging is useful for the detection of CS and provides additional value for identifying active disease. Our results may have implications for enhanced diagnosis as well as improved identification of patients with aCS in whom anti-inflammatory therapy may be most beneficial.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Sergios Gatidis
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ron Blankstein
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andreas Glatthaar
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Katharina Mezger
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Karin A L Müller
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Tatsiana Castor
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Maik Häntschel
- Department of Medical Oncology and Pneumology, University of Tübingen, Tübingen, Germany; Division of Pulmonology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Jürgen Hetzel
- Department of Medical Oncology and Pneumology, University of Tübingen, Tübingen, Germany; Division of Pulmonology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Helmut Dittmann
- Department of Nuclear Medicine and Clinical Molecular Imaging, University of Tübingen, Tübingen, Germany
| | - Konstantin Nikolaou
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, University of Tübingen, Tübingen, Germany
| | - Christian la Fougère
- Department of Nuclear Medicine and Clinical Molecular Imaging, University of Tübingen, Tübingen, Germany.
| | - Patrick Krumm
- Department of Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
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Guenther F, Bekeredjian R, Mahrholdt H, Seitz A. Balanced myocardial ischaemia in non-calcified triple-vessel disease caused by Takayasu arteritis. Eur Heart J Cardiovasc Imaging 2021:jeab172. [PMID: 34435624 DOI: 10.1093/ehjci/jeab172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/12/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Fabian Guenther
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Andreas Seitz
- Department of Cardiology and Angiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
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13
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Greulich S, Seitz A, Herter D, Günther F, Probst S, Bekeredjian R, Gawaz M, Sechtem U, Mahrholdt H. Long-term risk of sudden cardiac death in hypertrophic cardiomyopathy: a cardiac magnetic resonance outcome study. Eur Heart J Cardiovasc Imaging 2021; 22:732-741. [PMID: 33458753 PMCID: PMC8219365 DOI: 10.1093/ehjci/jeaa423] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 12/29/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Sudden cardiac death (SCD) is an appalling complication of hypertrophic cardiomyopathy (HCM). There is an ongoing discussion about the optimal SCD risk stratification strategy since established SCD risk models have suboptimal discriminative power. The aim of this study was to evaluate the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for SCD risk stratification compared to the European Society of Cardiology (ESC) SCD risk score and traditional risk factors in an >10-year follow-up. METHODS AND RESULTS Two hundred and twenty consecutive patients with HCM and LGE-CMR were enrolled. Follow-up data were available in 203 patients (median age 58 years, 61% male) after a median follow-up period of 10.4 years. LGE was present in 70% of patients with a median LGE amount of 1.6%, the median ESC 5-year SCD risk score was 1.84. In the overall cohort, SCD rates were 2.3% at 5 years, 4.8% at 10 years, and 15.7% at 15 years, independent from established risk models. An LGE amount of >5% left ventricular (LV) mass portends the highest risk for SCD with SCD prevalences of 5.5% at 5 years, 13.0% at 10 years, and 33.3% at 15 years. Conversely, patients with no or ≤5% LGE of LV mass have favourable prognosis. CONCLUSIONS LGE-CMR in HCM patients allows effective 10-year SCD risk stratification beyond established risk factors. LGE amount might be added to established risk models to improve its discriminatory power. Specifically, patients with >5% LGE should be carefully monitored and might be adequate candidates for primary prevention implantable cardioverter-defibrillator during the clinical long-term course.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology and Angiology, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany
| | - Andreas Seitz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Diana Herter
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Fabian Günther
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Sabine Probst
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
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14
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Seitz A, Greulich S, Herter D, Guenther F, Probst S, Bekeredjian R, Gawaz M, Sechtem U, Mahrholdt H. Long-term risk of sudden cardiac death in hypertrophic cardiomyopathy - a cardiac magnetic resonance outcome study. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): Robert Bosch Stiftung; Deutsche Forschungsgemeinschaft
Background
Sudden cardiac death (SCD) is an appalling complication of hypertrophic cardiomyopathy (HCM). There is an ongoing discussion about the optimal SCD risk stratification strategy in HCM since established SCD risk models have suboptimal discriminative power.
Objective
To evaluate the prognostic value of late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) for SCD risk stratification compared to the ESC SCD risk score and traditional SCD risk factors in an >10-year follow-up study.
Methods
220 consecutive patients with HCM and LGE-CMR were enrolled. Follow-up data was available in 203 patients (median age 58 years, 61% male) after a median follow-up period of 10.4 years.
Results
LGE was present in 70% of patients with a median LGE amount of 1.6%, the median ESC 5-year SCD risk score was 1.84. In the overall cohort, SCD rates were 2.3% at 5 years, 4.8% at 10 years, and 15.7% at 15 years, independent from established risk models. A LGE amount of >5% (LV mass) portends the highest risk for SCD with SCD prevalences of 5.5% at 5 years, 13.0% at 10 years and 33.3% at 15 years. Conversely, patients with no or ≤5% LGE amount (of LV mass) have favorable prognosis.
Conclusions
LGE-CMR in HCM patients allows effective 10-year SCD risk stratification beyond established risk factors. LGE amount might be added to established risk models to improve its discriminatory power. Specifically, patients with >5% amount of LGE should be carefully monitored and might be adequate candidates for primary prevention ICD during the clinical long-term course.
Abstract Figure.
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Affiliation(s)
- A Seitz
- Robert Bosch Hospital, Stuttgart, Germany
| | - S Greulich
- University of Tübingen, Tübingen, Germany
| | - D Herter
- Robert Bosch Hospital, Stuttgart, Germany
| | - F Guenther
- Robert Bosch Hospital, Stuttgart, Germany
| | - S Probst
- Robert Bosch Hospital, Stuttgart, Germany
| | | | - M Gawaz
- University of Tübingen, Tübingen, Germany
| | - U Sechtem
- Robert Bosch Hospital, Stuttgart, Germany
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15
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Zhang Q, Werys K, Popescu IA, Biasiolli L, Ntusi NAB, Desai M, Zimmerman SL, Shah DJ, Autry K, Kim B, Kim HW, Jenista ER, Huber S, White JA, McCann GP, Mohiddin SA, Boubertakh R, Chiribiri A, Newby D, Prasad S, Radjenovic A, Dawson D, Schulz-Menger J, Mahrholdt H, Carbone I, Rimoldi O, Colagrande S, Calistri L, Michels M, Hofman MBM, Anderson L, Broberg C, Andrew F, Sanz J, Bucciarelli-Ducci C, Chow K, Higgins D, Broadbent DA, Semple S, Hafyane T, Wormleighton J, Salerno M, He T, Plein S, Kwong RY, Jerosch-Herold M, Kramer CM, Neubauer S, Ferreira VM, Piechnik SK. Quality assurance of quantitative cardiac T1-mapping in multicenter clinical trials - A T1 phantom program from the hypertrophic cardiomyopathy registry (HCMR) study. Int J Cardiol 2021; 330:251-258. [PMID: 33535074 PMCID: PMC7994017 DOI: 10.1016/j.ijcard.2021.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/07/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Quantitative cardiovascular magnetic resonance T1-mapping is increasingly used for myocardial tissue characterization. However, the lack of standardization limits direct comparability between centers and wider roll-out for clinical use or trials. PURPOSE To develop a quality assurance (QA) program assuring standardized T1 measurements for clinical use. METHODS MR phantoms manufactured in 2013 were distributed, including ShMOLLI T1-mapping and reference T1 and T2 protocols. We first studied the T1 and T2 dependency on temperature and phantom aging using phantom datasets from a single site over 4 years. Based on this, we developed a multiparametric QA model, which was then applied to 78 scans from 28 other multi-national sites. RESULTS T1 temperature sensitivity followed a second-order polynomial to baseline T1 values (R2 > 0.996). Some phantoms showed aging effects, where T1 drifted up to 49% over 40 months. The correlation model based on reference T1 and T2, developed on 1004 dedicated phantom scans, predicted ShMOLLI-T1 with high consistency (coefficient of variation 1.54%), and was robust to temperature variations and phantom aging. Using the 95% confidence interval of the correlation model residuals as the tolerance range, we analyzed 390 ShMOLLI T1-maps and confirmed accurate sequence deployment in 90%(70/78) of QA scans across 28 multiple centers, and categorized the rest with specific remedial actions. CONCLUSIONS The proposed phantom QA for T1-mapping can assure correct method implementation and protocol adherence, and is robust to temperature variation and phantom aging. This QA program circumvents the need of frequent phantom replacements, and can be readily deployed in multicenter trials.
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Affiliation(s)
- Qiang Zhang
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK.
| | - Konrad Werys
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Iulia A Popescu
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Luca Biasiolli
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Ntobeko A B Ntusi
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | | | | | - Dipan J Shah
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Kyle Autry
- Houston Methodist DeBakey Heart & Vascular Center, USA
| | - Bette Kim
- Mount Sinai West Hospital; Icahn School of Medicine at Mount Sinai, USA
| | - Han W Kim
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Elizabeth R Jenista
- Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, USA
| | - Steffen Huber
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, USA
| | - James A White
- Stephenson Cardiac Imaging Centre, Libin Cardiovascular Institute, University of Calgary, Canada
| | - Gerry P McCann
- Department of cardiovascular sciences, University of Leicester and NIHR Leicester Biomedical Research Centre, UK
| | - Saidi A Mohiddin
- Inherited Cardiovascular Diseases, Barts Heart Centre, London, UK
| | - Redha Boubertakh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Amedeo Chiribiri
- King's College London and Guy's and St Thomas' NHS Foundation Trust, UK
| | - David Newby
- Centre for Cardiovascular Science, University of Edinburgh, UK
| | - Sanjay Prasad
- National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK
| | - Aleksandra Radjenovic
- Institute of Cardiovascular & Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Dana Dawson
- Aberdeen Cardiovascular and Diabetes Centre, College of Life Sciences and Medicine, University of Aberdeen, UK
| | | | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Italy
| | | | - Stefano Colagrande
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Linda Calistri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Italy
| | - Michelle Michels
- Erasmus MC, department of cardiology, Rotterdam, the Netherlands
| | - Mark B M Hofman
- dept. Radiology and Nuclear Medicine, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
| | - Lisa Anderson
- Cardiology Clinical Academic Group, St George's University of London, UK
| | - Craig Broberg
- Knight Cardiovascular Institute, Oregon Health and Science University, USA
| | | | | | | | - Kelvin Chow
- Siemens Medical Solutions USA, Inc., Chicago, IL, USA
| | | | - David A Broadbent
- Biomedical Imaging Sciences Department, University of Leeds, Leeds, UK
| | - Scott Semple
- Edinburgh Imaging, Centre for Cardiovascular Science, University of Edinburgh, UK
| | | | | | | | - Taigang He
- The Cardiology Clinical Academic Group (CAG), St George's University of London, St George's University Hospitals NHS Foundation Trust, UK
| | - Sven Plein
- Department of Biomedical Imaging Science, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, UK
| | - Raymond Y Kwong
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, USA
| | | | | | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Vanessa M Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
| | - Stefan K Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research, Oxford BRC NIHR, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, UK
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16
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Martínez Pereyra V, Seitz A, Mahrholdt H, Bekeredjian R, Sechtem U, Ong P. Coronary microvascular dysfunction in patients with mild-to-moderate aortic stenosis – Insights from intracoronary acetylcholine testing. IJC Heart & Vasculature 2020; 31:100658. [PMID: 33145392 PMCID: PMC7591340 DOI: 10.1016/j.ijcha.2020.100658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/17/2020] [Accepted: 10/03/2020] [Indexed: 12/04/2022]
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17
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Zemrak F, Raisi-Estabragh Z, Khanji MY, Mohiddin SA, Bruder O, Wagner A, Lombardi M, Schwitter J, van Rossum AC, Pilz G, Nothnagel D, Steen H, Nagel E, Prasad SK, Deluigi CC, Dill T, Frank H, Schneider S, Mahrholdt H, Petersen SE. Left Ventricular Hypertrabeculation Is Not Associated With Cardiovascular Morbity or Mortality: Insights From the Eurocmr Registry. Front Cardiovasc Med 2020; 7:158. [PMID: 33195445 PMCID: PMC7536335 DOI: 10.3389/fcvm.2020.00158] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/28/2020] [Indexed: 11/27/2022] Open
Abstract
Aim: Left ventricular non-compaction (LVNC) is perceived as a rare high-risk cardiomyopathy characterized by excess left ventricular (LV) trabeculation. However, there is increasing evidence contesting the clinical significance of LV hyper-trabeculation and the existence of LVNC as a distinct cardiomyopathy. The aim of this study is to assess the association of LV trabeculation extent with cardiovascular morbidity and all-cause mortality in patients undergoing clinical cardiac magnetic resonance (CMR) scans across 57 European centers from the EuroCMR registry. Methods and Results: We studied 822 randomly selected cases from the EuroCMR registry. Image acquisition was according to international guidelines. We manually segmented images for LV chamber quantification and measurement of LV trabeculation (as per Petersen criteria). We report the association between LV trabeculation extent and important cardiovascular morbidities (stroke, atrial fibrillation, heart failure) and all-cause mortality prospectively recorded over 404 ± 82 days of follow-up. Maximal non-compaction to compaction ratio (NC/C) was mean (standard deviation) 1.81 ± 0.67, from these, 17% were above the threshold for hyper-trabeculation (NC/C > 2.3). LV trabeculation extent was not associated with increased risk of the defined outcomes (morbidities, mortality, LV CMR indices) in the whole cohort, or in sub-analyses of individuals without ischaemic heart disease, or those with NC/C > 2.3. Conclusion: Among 882 patients undergoing clinical CMR, excess LV trabeculation was not associated with a range of important cardiovascular morbidities or all-cause mortality over ~12 months of prospective follow-up. These findings suggest that LV hyper-trabeculation alone is not an indicator for worse cardiovascular prognosis.
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Affiliation(s)
- Filip Zemrak
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Mohammed Y Khanji
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Saidi A Mohiddin
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Oliver Bruder
- Department of Cardiology and Angiology, Elisabeth-Krankenhaus Essen, Ruhr University Bochum, Bochum, Germany
| | - Anja Wagner
- Department of Cardiology, St. Vincent's Medical Centre, Bridgeport, CT, United States
| | - Massimo Lombardi
- I.R.C.C.S. Multimodality Cardiac Imaging, Policlinico San Donato, Milan, Italy
| | - Juerg Schwitter
- Cardiac MR Centre, University Hospital (CHUV), Switzerland and Lausanne University, Lausanne, Switzerland
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam University Centres, Amsterdam, Netherlands
| | - Günter Pilz
- Department of Cardiology, Clinic Agatharied, University of Munich, Munich, Germany
| | - Detlev Nothnagel
- Department of Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | | | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging DZHK (German Centre for Cardiovascular Research) Centre for Cardiovascular Imaging, Partner Site RheinMain, University Hospital, Goethe University, Frankfurt, Germany
| | - Sanjay K Prasad
- CMR Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute, London, United Kingdom
| | - Christina C Deluigi
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thorsten Dill
- Department of Internal Medicine, Krankenhaus Benrath, Düsseldorf, Germany
| | - Herbert Frank
- Department of Internal Medicine, University Hospital Tulln, Tulln, Austria
| | | | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Centre, Stuttgart, Germany
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom.,Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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18
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Arai AE, Schulz-Menger J, Berman D, Mahrholdt H, Han Y, Bandettini WP, Gutberlet M, Abraham A, Woodard PK, Selvanayagam JB, McCann GP, Hamilton-Craig C, Schoepf UJ, San Tan R, Kramer CM, Friedrich MG, Haverstock D, Liu Z, Brueggenwerth G, Bacher-Stier C, Santiuste M, Pennell DJ, Pennell D, Schulz-Menger J, Mahrholdt H, Gutberlet M, Kramer U, von der Recke G, Nassenstein K, Tillmanns C, Taupitz M, Pache G, Mohrs O, Lotz J, Ko SM, Choo KS, Sung YM, Kang JW, Muzzarelli S, Valeti U, McCann G, Binukrishnam S, Croisille P, Jacquier A, Cowan B, Arai A, Berman D, Shah D, Bandettini WP, Han Y, Woodard P, Avery R, Schoepf J, Carr J, Kramer C, Flamm S, Harsinghani M, Lerakis S, Kim R, Raman S, Marcotte F, Islam A, Friedrich M, Abraham A, Selvanayagam J, Hamilton-Craig C, Chong WK, San Lynette Teo L, San Tan R. Gadobutrol-Enhanced Cardiac Magnetic Resonance Imaging for Detection of Coronary Artery Disease. J Am Coll Cardiol 2020; 76:1536-1547. [DOI: 10.1016/j.jacc.2020.07.060] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/20/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022]
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19
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Greulich S, Seitz A, Müller KAL, Grün S, Ong P, Ebadi N, Kreisselmeier KP, Seizer P, Bekeredjian R, Zwadlo C, Gräni C, Klingel K, Gawaz M, Sechtem U, Mahrholdt H. Predictors of Mortality in Patients With Biopsy-Proven Viral Myocarditis: 10-Year Outcome Data. J Am Heart Assoc 2020; 9:e015351. [PMID: 32787653 PMCID: PMC7660832 DOI: 10.1161/jaha.119.015351] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background There is scarce data about the long‐term mortality as well as the prognostic value of cardiovascular magnetic resonance and late gadolinium enhancement (LGE) in patients with biopsy‐proven viral myocarditis. We sought to investigate: (1) mortality and (2) prognostic value of LGEcardiovascular magnetic resonance (location, pattern, extent, and distribution) in a >10‐year follow‐up in patients with biopsy‐proven myocarditis. Methods and Results Two‐hundred three consecutive patients with biopsy‐proven viral myocarditis and cardiovascular magnetic resonance were enrolled; 183 patients were eligible for standardized follow‐up. The median follow‐up was 10.1 years. End points were all‐cause death, cardiac death, and sudden cardiac death (SCD). We found substantial long‐term mortality in patients with biopsy‐proven myocarditis (39.3% all cause, 27.3% cardiac, and 10.9% SCD); 101 patients (55.2%) demonstrated LGE. The presence of LGE was associated with a more than a doubled risk of death (hazard ratio [HR], 2.40; 95% CI], 1.30–4.43), escalating to a HR of 3.00 (95% CI, 1.41–6.42) for cardiac death, and a HR of 14.79 (95% CI, 1.95–112.00) for SCD; all P≤0.009. Specifically, midwall, (antero‐) septal LGE, and extent of LGE were highly associated with death, all P<0.001. Septal LGE was the best independent predictor for SCD (HR, 4.59; 95% CI, 1.38–15.24; P=0.01). Conclusions In patients with biopsy‐proven viral myocarditis, the presence of midwall LGE in the (antero‐) septal segments is associated with a higher rate of mortality (including SCD) compared with absent LGE or other LGE patterns, underlining the prognostic benefit of a distinct LGE analysis in these patients.
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Affiliation(s)
- Simon Greulich
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Andreas Seitz
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Karin A L Müller
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Stefan Grün
- Department of Cardiology Rems-Murr-Klinikum Winnenden Winnenden Germany
| | - Peter Ong
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Nawid Ebadi
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | | | - Peter Seizer
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Raffi Bekeredjian
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Carolin Zwadlo
- Department of Cardiology and Angiology Hannover Medical School Hannover Germany
| | - Christoph Gräni
- Department of Cardiology Bern University Hospital Bern Switzerland.,Department of Nuclear Medicine University Hospital Zurich Zurich Switzerland
| | - Karin Klingel
- Cardiopathology Institute for Pathology and Neuropathology University of Tübingen Germany
| | - Meinrad Gawaz
- Department of Cardiology and Angiology University of Tübingen Germany
| | - Udo Sechtem
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Heiko Mahrholdt
- Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
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20
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Seitz A, Gardezy J, Pirozzolo G, Probst S, Athanasiadis A, Hill S, Mahrholdt H, Bekeredjian R, Sechtem U, Ong P. Long-Term Follow-Up in Patients With Stable Angina and Unobstructed Coronary Arteries Undergoing Intracoronary Acetylcholine Testing. JACC Cardiovasc Interv 2020; 13:1865-1876. [DOI: 10.1016/j.jcin.2020.05.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/26/2020] [Accepted: 05/05/2020] [Indexed: 01/10/2023]
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21
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Löbig S, Seitz A, Feuerstein M, Bekeredjian R, Mahrholdt H. Varicose cardiac veins in a case of persistent left superior vena cava and stenosis of the coronary sinus ostium. Eur Heart J Cardiovasc Imaging 2020; 21:786. [DOI: 10.1093/ehjci/jeaa029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephanie Löbig
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Andreas Seitz
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Markus Feuerstein
- Department of Radiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany
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22
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Halle M, Binzenhöfer L, Mahrholdt H, Johannes Schindler M, Esefeld K, Tschöpe C. Myocarditis in athletes: A clinical perspective. Eur J Prev Cardiol 2020; 28:1050-1057. [PMID: 33611403 DOI: 10.1177/2047487320909670] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 02/08/2020] [Indexed: 12/12/2022]
Abstract
Myocarditis is an important cause of arrhythmias and sudden cardiac death (SCD) in both physically active individuals and athletes. Elite athletes seem to have an increased risk for viral infection and subsequent myocarditis due to increased exposure to pathogens (worldwide traveling/international competition) or impaired immune system (continuing training during infections/resuming training early thereafter, strenuous exercise training or competition, and exercising in extreme weather conditions). Initial clinical presentation is variable, but athletes characteristically express non-specific symptoms of fatigue, muscle soreness, increased heart rate at rest, as well as during exercise and reduced overall exercise capacity. Beyond resting electrocardiogram (ECG), cardiac biomarkers, echocardiography, and 24-hour Holter ECG, diagnostic work-up should include cardiac magnetic resonance imaging (CMR) assessing inflammation, oedema, and fibrosis by late gadolinium enhancement (LGE), respectively, as these measures are crucial for prognosis and sports eligibility. For patients with insufficient cardiac recovery, endomyocardial biopsy is recommended to clarify differential diagnoses and initiate specific treatment options. In uncomplicated cases with normal left ventricular function during acute phase and absent LGE, eligibility for sports can be attested to three months after clinical recovery. In those with persistent pathological findings, even after six months, the risk for SCD remains increased and resuming exercise beyond recreational activities can only be recommended individually based on course of disease, left ventricular function, arrhythmias, pattern of LGE in CMR, as well as intensity and volume of exercise performed during training and competition. For all athletes, follow-up examination should be performed yearly.
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Affiliation(s)
- Martin Halle
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Leonhard Binzenhöfer
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | | | - Katrin Esefeld
- Department of Preventive Sports Medicine and Sports Cardiology, Technical University of Munich, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Campus Virchow (CVK), Charité Universitätsmedizin Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.,Berlin Institute of Health/Center for Regenerative Therapy (BCRT), Germany
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23
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Martínez Pereyra V, Seitz A, Hubert A, Mahrholdt H, Bekeredjian R, Sechtem U, Ong P. Coronary Microvascular Spasm as the Underlying Cause of the Angiographic Slow Flow Phenomenon. JACC Case Rep 2020; 2:35-39. [PMID: 34316961 PMCID: PMC8301693 DOI: 10.1016/j.jaccas.2019.11.059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 11/27/2019] [Indexed: 05/04/2023]
Abstract
Slow coronary flow is frequently seen during angiography in patients with angina and unobstructed coronary arteries. However, the pathophysiology of this finding remains largely unclear. We report a case of a 52-year-old woman with slow coronary flow caused by acetylcholine-induced microvascular spasm, as confirmed by intracoronary flow measurements. (Level of Difficulty: Beginner.).
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Affiliation(s)
| | - Andreas Seitz
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Astrid Hubert
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
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24
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Pirozzolo G, Seitz A, Becker A, Schaeufele T, Mahrholdt H, Bekeredjian R, Sechtem U, Ong P. P875Myocardial perfusion reserve assessment in patients with angina pectoris and suspected coronary spasm. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries represent a diagnostic and therapeutic challenge. Coronary vasomotor disorders such as coronary epicardial or microvascular spasm are frequently found among these patients. They can be diagnosed using intracoronary acetylcholine testing (ACH-test). It has been shown that patients with epicardial spasm have a worse prognosis compared to patients with microvascular spasm. The reasons for this finding are however not apparent. We speculated in this study that patients with epicardial spasm have a worse vasomotor dysfunction compared to patients with microvascular spasm or normal ACH-test. To assess this hypothesis all patients in this study not only underwent ACH-testing but in addition also adenosine stress perfusion cardiac MRI (CMR) with calculation of the myocardial perfusion reserve index (MPRI). The latter method allows for assessment of vasodilatory function compared to the vasoconstrictor assessment using acetylcholine.
Methods
Between 2012 and 2016, 129 consecutive patients (mean age 64±13 years, 46% female) with signs and symptoms of myocardial ischemia yet unobstructed coronary arteries were enrolled in this study. All patients underwent ACH-testing as well as adenosine stress perfusion CMR. According to the results of the acetylcholine test, patients were allocated to 3 groups: a) epicardial spasm (angina, ischemic ECG changes and >75% coronary diameter reduction), b) microvascular spasm (angina, ischemic ECG changes and <75% coronary diameter reduction) and c) no evidence of coronary artery spasm. CMR-derived MPRI was calculated semiquantitatively from myocardial signal intensity-over-time curves of adenosine stress and rest perfusion.
Results
Epicardial and microvascular spasm was found in 31 (24%) and 69 (53%) patients, respectively, while 29 (22%) patients had no evidence of coronary spasm on ACH-testing. Women were more likely to have microvascular spasm than men (68% vs. 36%, p<0.001). The prevalence of epicardial spasm did not significantly differ between female and male patients (18% vs. 31%, p=0.08). MPRI was similar in patients with microvascular spasm compared to patients without spasm (1.30 vs. 1.27, p=0.43). However, patients with epicardial spasm had significantly lower MPRI than patients without spasm (1.16 vs. 1.30, p<0.05) or those with microvascular spasm (1.16 vs. 1.27, p<0.05).
Conclusion
MPRI determined by stress perfusion CMR was significantly reduced in patients with epicardial spasm compared to those with microvascular spasm or normal ACH-test. This could indicate that patients with epicardial spasm have a more generalized coronary vasomotor disorder compared to other patients. This may be the reason for the worse outcome observed and could lead to more aggressive medical therapy and closer follow-up.
Acknowledgement/Funding
This work was funded by the Robert-Bosch-Stiftung, Stuttgart, Germany and the Berthold-Leibinger-Stiftung, Ditzingen, Germany.
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Affiliation(s)
| | - A Seitz
- Robert Bosch Hospital, Stuttgart, Germany
| | - A Becker
- Robert Bosch Hospital, Stuttgart, Germany
| | | | | | | | - U Sechtem
- Robert Bosch Hospital, Stuttgart, Germany
| | - P Ong
- Robert Bosch Hospital, Stuttgart, Germany
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25
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Greulich S, Mayr A, Gloekler S, Seitz A, Birkmeier S, Schaeufele T, Bekeredjian R, Zuern CS, Geisler T, Klug G, Wahl A, Metzler B, Gawaz M, Windecker S, Mahrholdt H. P2714Time-dependent myocardial necrosis in patients suffering from ST-elevation myocardial infarction without angiographic collateral flow visualized by cardiac magnetic resonance imaging. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Acute complete occlusion of a coronary artery results in progressive ischemia, moving from the endocardium to the epicardium (“wavefront”). Dependent on time-to-reperfusion and collateral flow, myocardial infarction (MI) will manifest, with transmural MI portending poor prognosis. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) imaging can detect MI with high diagnostic accuracy. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients with STEMI <12 hours of symptom onset.
Purpose
We sought to visualize time-dependent necrosis in a ST-segment elevation myocardial infarction (STEMI) population by LGE-CMR.
Methods
STEMI patients with: single-vessel disease, complete occlusion with Thrombolysis in Myocardial Infarction (TIMI) score 0, absence of collateral flow (Rentrop score 0) and symptom onset <12 hours were consecutively enrolled. By LGE-CMR, area at risk (AAR) and infarct size (IS), myocardial salvage index (MSI), transmurality index, and transmurality grade (0–50%, 51–75%, 76–100%) were determined.
Results
164 patients (54±11 years, 80% male) were included. Receiver-operating-characteristic (ROC)-curve (area under the curve [AUC] = 0.81) indicating transmural necrosis revealed the best diagnostic cut-off for a symptom-to-balloon time of 121 minutes, i.e. patients with >121 minutes demonstrated increased IS, transmurality index, transmurality grade (all p-values <0.01), and decreased MSI (p<0.001) vs. patients with symptom-to-balloon times ≤121 minutes.
Conclusions
In myocardial infarction with no residual antegrade, and no collateral flow, immediate reperfusion is vital. A symptom-to-balloon time of >121 minutes causes a high grade of transmural necrosis. In the present, pure STEMI population, time to reperfusion to salvage myocardium was less than suggested by current guidelines.
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Affiliation(s)
- S Greulich
- University of Tuebingen, Tuebingen, Germany
| | - A Mayr
- University of Innsbruck, Radiology, Innsbruck, Austria
| | - S Gloekler
- Schwarzwald-Baar Hospital, Cardiology, Villingen-Schwenningen, Germany
| | - A Seitz
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - S Birkmeier
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - T Schaeufele
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - R Bekeredjian
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
| | - C S Zuern
- University Hospital Basel, Cardiology, Basel, Switzerland
| | - T Geisler
- University of Tuebingen, Tuebingen, Germany
| | - G Klug
- University of Innsbruck, Cardiology, Innsbruck, Austria
| | - A Wahl
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Metzler
- University of Innsbruck, Cardiology, Innsbruck, Austria
| | - M Gawaz
- University of Tuebingen, Tuebingen, Germany
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - H Mahrholdt
- Robert Bosch Hospital, Department of Cardiology, Stuttgart, Germany
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26
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Seitz A, Greulich S, Ebadi N, Gruen S, Klingel K, Gawaz MP, Sechtem U, Bekeredjian R, Mahrholdt H. 2424Long-term outcome of patients with biopsy-proven viral myocarditis: 12-year results from a late gadolinium enhancement cardiac magnetic resonance study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Purpose
Myocarditis is a common cardiac disease that is associated with significant mortality as demonstrated by several studies. Late gadolinium enhancement (LGE) by cardiac magnetic resonance imaging (CMR) is a valuable tool for risk stratification of patients with suspected myocarditis. Previous studies using CMR-LGE have reported a good negative predictive value over follow-up periods of 4–6 years, while its positive predictive value was only modest. However, there is a lack of data regarding the long-term prognosis (>10 years) of these patients. This study reports an extended long-term follow-up of a large cohort of patients with biopsy-proven viral myocarditis.
Methods
At initial presentation, all patients underwent endomyocardial biopsy and CMR for the work-up of suspected myocarditis or unclear cardiomyopathy and had evidence of virus in PCR analyses. The primary endpoints were: all-cause death, cardiac death, and the occurrence of sudden cardiac death (SCD).
Results
183 patients with biopsy-proven viral myocarditis were followed for a median of 11.5 years. At baseline, patients were 52 years old, 31% were females, and the median ejection fraction was moderately reduced (44%). Initial CMR assessment revealed LGE in 101 (55%) patients, while 82 (45%) patients had LGE-negative CMR. During the follow-up period, the following endpoints occurred in the overall cohort: all-cause death (n=71, 39%), cardiac death (n=50, 27%) and SCD (n=20, 11%). Most importantly, only a single LGE-negative patient experienced a SCD during this 12-year follow-up, while all other SCDs occurred in patients with LGE-positive CMR (1% vs. 19%, p<0.001). Consequently, the negative predictive value (NPV) of normal CMR-LGE regarding SCD was 98%. In addition, cardiac mortality (12% vs. 40%, p<0.001, NPV=88%) and all-cause mortality (20% vs. 54%, p<0.001, NPV=79%) were significantly lower in patients without LGE.
Conclusion
This cohort of biopsy-proven viral myocarditis demonstrates substantial mortality (39% in 11.5 years). However, absence of LGE on CMR was associated with favorable prognosis. This was applicable regarding all-cause and cardiac mortality, but most importantly with regard to SCD with a NPV of 98% over almost 12 years median follow-up.
Acknowledgement/Funding
This work was funded by the Robert-Bosch-Stiftung, Stuttgart, Germany and the Berthold-Leibinger-Stiftung, Ditzingen, Germany.
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Affiliation(s)
- A Seitz
- Robert Bosch Hospital, Stuttgart, Germany
| | - S Greulich
- University of Tübingen, Tübingen, Germany
| | - N Ebadi
- Robert Bosch Hospital, Stuttgart, Germany
| | - S Gruen
- Rems-Murr-Klinikum, Winnenden, Germany
| | - K Klingel
- University of Tübingen, Tübingen, Germany
| | - M P Gawaz
- University of Tübingen, Tübingen, Germany
| | - U Sechtem
- Robert Bosch Hospital, Stuttgart, Germany
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27
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Seitz A, Schäfer S, Backes M, Mahrholdt H, Ong P. Giant Aneurysm of a Coronary-Pulmonary Artery Fistula: A Rare Cause of a Diastolic Murmur. Cardiovascular Innovations and Applications 2019. [DOI: 10.15212/cvia.2019.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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28
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Seitz A, Kaesemann P, Chatzitofi M, Löbig S, Tauscher G, Bekeredjian R, Sechtem U, Mahrholdt H, Greulich S. Impact of caffeine on myocardial perfusion reserve assessed by semiquantitative adenosine stress perfusion cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2019; 21:33. [PMID: 31230593 PMCID: PMC6589875 DOI: 10.1186/s12968-019-0542-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/20/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Adenosine is used in stress perfusion cardiac imaging to reveal myocardial ischemia by its vasodilator effects. Caffeine is a competitive antagonist of adenosine. However, previous studies reported inconsistent results about the influence of caffeine on adenosine's vasodilator effect. This study assessed the impact of caffeine on the myocardial perfusion reserve index (MPRI) using adenosine stress cardiovascular magnetic resonance imaging (CMR). Moreover, we sought to evaluate if the splenic switch-off sign might be indicative of prior caffeine consumption. METHODS Semiquantitative perfusion analysis was performed in 25 patients who underwent: 1) caffeine-naïve adenosine stress CMR demonstrating myocardial ischemia and, 2) repeat adenosine stress CMR after intake of caffeine. MPRI (global; remote and ischemic segments), and splenic perfusion ratio (SPR) were assessed and compared between both exams. RESULTS Global MPRI after caffeine was lower vs. caffeine-naïve conditions (1.09 ± 0.19 vs. 1.24 ± 0.19; p < 0.01). MPRI in remote myocardium decreased by caffeine (1.24 ± 0.19 vs. 1.49 ± 0.19; p < 0.001) whereas MPRI in ischemic segments (0.89 ± 0.18 vs. 0.95 ± 0.23; p = 0.23) was similar, resulting in a lower MPRI ratio (=remote/ischemic segments) after caffeine consumption vs. caffeine-naïve conditions (1.41 ± 0.19 vs. 1.64 ± 0.35, p = 0.01). The SPR was unaffected by caffeine (SPR 0.38 ± 0.19 vs. 0.38 ± 0.18; p = 0.92). CONCLUSION Caffeine consumption prior to adenosine stress CMR results in a lower global MPRI, which is driven by the decreased MPRI in remote myocardium and underlines the need of abstinence from caffeine. The splenic switch-off sign is not affected by prior caffeine intake.
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Affiliation(s)
- Andreas Seitz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Philipp Kaesemann
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Maria Chatzitofi
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Stephanie Löbig
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Gloria Tauscher
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Raffi Bekeredjian
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Udo Sechtem
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstraße 110, 70376 Stuttgart, Germany
| | - Simon Greulich
- Department of Cardiology and Angiology, University Hospital Tübingen, Tübingen, Germany
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29
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Greulich S, Mayr A, Gloekler S, Seitz A, Birkmeier S, Schäufele T, Bekeredjian R, Zuern CS, Seizer P, Geisler T, Müller KAL, Krumm P, Nikolaou K, Klug G, Reinstadler S, Pamminger M, Reindl M, Wahl A, Traupe T, Seiler C, Metzler B, Gawaz M, Windecker S, Mahrholdt H. Time-Dependent Myocardial Necrosis in Patients With ST-Segment-Elevation Myocardial Infarction Without Angiographic Collateral Flow Visualized by Cardiac Magnetic Resonance Imaging: Results From the Multicenter STEMI-SCAR Project. J Am Heart Assoc 2019; 8:e012429. [PMID: 31181983 PMCID: PMC6645633 DOI: 10.1161/jaha.119.012429] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Acute complete occlusion of a coronary artery results in progressive ischemia, moving from the endocardium to the epicardium (ie, wavefront). Dependent on time to reperfusion and collateral flow, myocardial infarction (MI) will manifest, with transmural MI portending poor prognosis. Late gadolinium enhancement cardiac magnetic resonance imaging can detect MI with high diagnostic accuracy. Primary percutaneous coronary intervention is the preferred reperfusion strategy in patients with ST‐segment–elevation MI with <12 hours of symptom onset. We sought to visualize time‐dependent necrosis in a population with ST‐segment–elevation MI by using late gadolinium enhancement cardiac magnetic resonance imaging (STEMI‐SCAR project). Methods and Results ST‐segment–elevation MI patients with single‐vessel disease, complete occlusion with TIMI (Thrombolysis in Myocardial Infarction) score 0, absence of collateral flow (Rentrop score 0), and symptom onset <12 hours were consecutively enrolled. Using late gadolinium enhancement cardiac magnetic resonance imaging, the area at risk and infarct size, myocardial salvage index, transmurality index, and transmurality grade (0–50%, 51–75%, 76–100%) were determined. In total, 164 patients (aged 54±11 years, 80% male) were included. A receiver operating characteristic curve (area under the curve: 0.81) indicating transmural necrosis revealed the best diagnostic cutoff for a symptom‐to‐balloon time of 121 minutes: patients with >121 minutes demonstrated increased infarct size, transmurality index, and transmurality grade (all P<0.01) and decreased myocardial salvage index (P<0.001) versus patients with symptom‐to‐balloon times ≤121 minutes. Conclusions In MI with no residual antegrade and no collateral flow, immediate reperfusion is vital. A symptom‐to‐balloon time of >121 minutes causes a high grade of transmural necrosis. In this pure ST‐segment–elevation MI population, time to reperfusion to salvage myocardium was less than suggested by current guidelines.
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Affiliation(s)
- Simon Greulich
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Agnes Mayr
- 2 Department of Radiology University of Innsbruck Austria
| | - Steffen Gloekler
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland.,4 Department of Cardiology Schwarzwald-Baar Klinikum Villingen-Schwenningen Germany
| | - Andreas Seitz
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Stefan Birkmeier
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Tim Schäufele
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | - Raffi Bekeredjian
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
| | | | - Peter Seizer
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Tobias Geisler
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Karin A L Müller
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Patrick Krumm
- 7 Department of Radiology University of Tübingen Germany
| | | | - Gert Klug
- 8 Department of Cardiology University of Innsbruck Austria
| | | | | | - Martin Reindl
- 8 Department of Cardiology University of Innsbruck Austria
| | - Andreas Wahl
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | - Tobias Traupe
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | - Christian Seiler
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | | | - Meinrad Gawaz
- 1 Department of Cardiology and Cardiovascular Diseases University of Tübingen Germany
| | - Stephan Windecker
- 3 Department of Cardiology, Inselspital Bern University Hospital University of Bern Switzerland
| | - Heiko Mahrholdt
- 5 Department of Cardiology Robert Bosch Medical Center Stuttgart Germany
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30
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Mahrholdt H, Klingel K, Sechtem U. [The Changing Appearance of Cardiac Amyloidosis]. Dtsch Med Wochenschr 2018; 143:1335-1343. [PMID: 30199915 DOI: 10.1055/s-0043-109420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A fast and reliable diagnosis of cardiac amyloidosis requires a significant amount of clinical awareness. It is especially important to come to an early diagnosis in patients with cardiac AL amyloidosis in order to improve the otherwise unfavourable clinical course in these patients. There is a significant increase in the number of patients with cardiac amyloidosis of the ATTR wild-type variety. These patients are often elderly males presenting with predominantly right sided heart failure. We present a diagnostic pathway enabling a structured approach to these patients using multimodality cardiac imaging and endomyocardial biopsy. Early chemotherapy is the key to improving symptoms in patients with AL amyloidosis. In contrast, pharmacologic approaches for treating cardiac ATTR amyloidosis need further research and clinical trials.
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31
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Ong PE, Gardezy J, Hill S, Mahrholdt H, Schaeufele T, Athanasiadis A, Sechtem U. P6431Long-term prognosis of patients with coronary vasomotor disorders and unobstructed coronary arteries. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- P E Ong
- Robert Bosch Hospital, Cardiology, Stuttgart, Germany
| | - J Gardezy
- Robert Bosch Hospital, Cardiology, Stuttgart, Germany
| | - S Hill
- Robert Bosch Hospital, Cardiology, Stuttgart, Germany
| | - H Mahrholdt
- Robert Bosch Hospital, Cardiology, Stuttgart, Germany
| | - T Schaeufele
- Robert Bosch Hospital, Cardiology, Stuttgart, Germany
| | | | - U Sechtem
- Robert Bosch Hospital, Cardiology, Stuttgart, Germany
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32
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Seitz A, Ong P, Backes M, Mahrholdt H. Chronic pericardial effusion in the setting of pericardial capillary haemangioma: a case report and review of the literature. Eur Heart J Case Rep 2018; 2:yty024. [PMID: 31020103 PMCID: PMC6426034 DOI: 10.1093/ehjcr/yty024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 01/30/2018] [Indexed: 11/18/2022]
Abstract
Introduction Cardiac haemangiomas are rare vascular tumours of the heart accounting for less than 5% of benign primary cardiac neoplasms. They are sometimes diagnosed incidentally, since patients can be asymptomatic. The clinical presentation in symptomatic patients, however, is variable, depending on size and exact localization of the tumour. Although cardiac haemangiomas have been reported everywhere in the heart, those localized in the pericardium are extremely rare. Case presentation A 48-year-old female patient with a history of pericardial effusion and pneumonia was admitted to our hospital with progressive dyspnoea on exertion. Echocardiography demonstrated recurrence of pericardial effusion with ‘swinging heart’. Further investigation by computed tomography, cardiac magnetic resonance imaging and coronary angiography revealed a hypervascular pericardial mass with typical ‘tumour blush’ after contrast injection. The tumour could be resected in toto by open heart surgery, and histological evaluation confirmed the diagnosis of a pericardial capillary haemangioma. There were no signs of recurrence of neither the pericardial effusion nor the tumour during follow-up. Discussion We here report a very rare case of a pericardial haemangioma in the adult which was diagnosed by multi-modality workup of recurrent pericardial effusion. This case illustrates that in the setting of chronic pericardial effusion non-inflammatory and non-malignant causes should be taken into account.
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Affiliation(s)
- Andreas Seitz
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Peter Ong
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Maik Backes
- Department of Radiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Medical Center, Auerbachstr. 110, 70376 Stuttgart, Germany
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Greulich S, Kaesemann P, Seitz A, Birkmeier S, Abu-Zaid E, Vecchio F, Sechtem U, Mahrholdt H. Effects of caffeine on the detection of ischemia in patients undergoing adenosine stress cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2017; 19:103. [PMID: 29254482 PMCID: PMC5735931 DOI: 10.1186/s12968-017-0412-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adenosine stress cardiovascular magnetic resonance (CMR) can detect significant coronary artery stenoses with high diagnostic accuracy. Caffeine is a nonselective competitive inhibitor of adenosine2A-receptors, which might hamper the vasodilator effect of adenosine stress, potentially yielding false-negative results. Much controversy exists about the influence of caffeine on adenosine myocardial perfusion imaging. Our study sought to investigate the effects of caffeine on ischemia detection in patients with suspected or known coronary artery disease (CAD) undergoing adenosine stress CMR. METHODS Thirty patients with evidence of myocardial ischemia on caffeine-naïve adenosine stress CMR were prospectively enrolled and underwent repeat adenosine stress CMR after intake of 200 mg caffeine. Both CMR exams were then compared for evaluation of ischemic burden. RESULTS Despite intake of caffeine, no conversion of a positive to a negative stress study occurred on a per patient basis. Although we found significant lower ischemic burden in CMR exams with caffeine compared to caffeine-naïve CMR exams, absolute differences varied only slightly (1 segment based on a 16-segment model, 3 segments on a 60-segment model, and 1 ml in total ischemic myocardial volume, p < 0.001 each). Moreover, no relevant ischemia (≥2 segments in a 16-segment model) was missed by prior ingestion of caffeine. CONCLUSIONS Although differences were small and no relevant myocardial ischemia had been missed, prior consumption of caffeine led to significant reduction of ischemic burden, and might lower the high diagnostic and prognostic value of adenosine stress CMR. Therefore, we suggest that patients should still refrain from caffeine prior adenosine stress CMR tests.
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Affiliation(s)
- Simon Greulich
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
- Department of Cardiology and Cardiovascular Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Philipp Kaesemann
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Andreas Seitz
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | | | - Eed Abu-Zaid
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Francesco Vecchio
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
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Allgäuer S, Pieper F, Mahrholdt H. Schwere akzidentelle Hypothermie. Med Klin Intensivmed Notfmed 2017; 112:731-736. [DOI: 10.1007/s00063-017-0291-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/04/2017] [Accepted: 01/13/2017] [Indexed: 10/19/2022]
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Ong P, Odaka Y, Athanasiadis A, Suda A, Komatsu M, Nishimiya K, Hao K, Tsuburaya R, Ito K, Mahrholdt H, Schaeufele T, Hill S, Takahashi J, Sechtem U, Shimokawa H. P882Comparison of epicardial coronary artery spasm during intracoronary acetylcholine testing between German and Japanese patients with unobstructed coronaries. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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van den Bos EJ, Wagner A, Mahrholdt H, Thompson RB, Morimoto Y, Sutton BS, Judd RM, Taylor DA. Improved Efficacy of Stem Cell Labeling for Magnetic Resonance Imaging Studies by the Use of Cationic Liposomes. Cell Transplant 2017; 12:743-56. [PMID: 14653621 DOI: 10.3727/000000003108747352] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Labeling stem cells with FDA-approved superparamagnetic iron oxide particles makes it possible to track cells in vivo with magnetic resonance imaging (MRI), but high intracellular levels of iron can cause free radical formation and cytotoxicity. We hypothesized that the use of cationic liposomes would increase labeling efficiency without toxic effects. Rabbit skeletal myoblasts were labeled with iron oxide by: 1) uptake of iron oxide incorporated into cationic transfection liposomes (group I) or 2) customary endocytosis (group II). In both groups, cell proliferation and differentiation were measured and toxicity was assayed using trypan blue and ratio fluorescence microscopy with BODIPY® 581/591 C11. The effects of the intracellular iron oxide on magnetic resonance image intensities were assessed in vitro and in vivo. Both methods resulted in uptake of iron intracellularly, yielding contrast-inducing properties on MRI images. In group II, however, incubation with iron oxide at high concentrations required for endocytosis caused generation of free radicals, a decrease in proliferation, and cell death. Cytotoxic effects in the remaining cells were still visible 24 h after incubation. Conversely, in group I, sufficient intracellular uptake for detection in vivo by MRI could be achieved at 100-fold lower concentrations of iron oxide, which resulted in a high percentage of labeled cells, high retention of the label, and no cytotoxic effects even after stressing the cells with a hypoxia–reoxygenation insult. The use of cationic liposomes for iron oxide stem cell labeling increases labeling efficiency approximately 100-fold without toxic effects. This technique results in high-contrast-inducing properties on MRI images both in vitro and in vivo and could thus be a valuable tool for tracking stem cells noninvasively.
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Affiliation(s)
- Ewout J van den Bos
- Division of Cardiology, Duke University Medical Center, Durham, NC 27710, USA
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Greulich S, Kitterer D, Latus J, Aguor E, Steubing H, Kaesemann P, Patrascu A, Greiser A, Groeninger S, Mayr A, Braun N, Alscher MD, Sechtem U, Mahrholdt H. Comprehensive Cardiovascular Magnetic Resonance Assessment in Patients With Sarcoidosis and Preserved Left Ventricular Ejection Fraction. Circ Cardiovasc Imaging 2017; 9:CIRCIMAGING.116.005022. [PMID: 27903537 DOI: 10.1161/circimaging.116.005022] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Accepted: 08/29/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cardiac sarcoidosis (CS) may manifest as arrhythmia or even sudden cardiac death. Because patients with CS often present with nonspecific symptoms, normal electrocardiography, and preserved left ventricular ejection fraction, a reliable diagnostic tool for the work-up of CS is needed. Late gadolinium enhancement-cardiovascular magnetic resonance has proven diagnostic value in CS but has some limitations that may be overcome by adding newer cardiovascular magnetic resonance mapping techniques. The aim of our study was to evaluate a comprehensive cardiovascular magnetic resonance protocol, including late gadolinium enhancement and mapping sequences in sarcoid patients with no symptoms or unspecific symptoms and preserved left ventricular ejection fraction. METHODS AND RESULTS Sixty-one sarcoid patients were prospectively enrolled and underwent comprehensive cardiovascular magnetic resonance imaging. Twenty-six healthy volunteers served as control group. Mean left ventricular ejection fraction was 65%; late gadolinium enhancement was only present in sarcoid patients (n=15). Sarcoid patients had a higher median native T1 (994 versus 960 ms; P<0.001), lower post contrast T1 (491 versus 526 ms; P=0.001), expanded extracellular volume (28 versus 25%; P=0.001), and higher T2 values (52 versus 49 ms; P<0.001) compared with controls. Among patients with values higher than the 95% percentile of healthy controls, most significant differences were observed for native T1 and T2 values. Most of these patients were late gadolinium enhancement negative. CONCLUSIONS Patients with sarcoidosis demonstrate higher T1, extracellular volume, and T2 values compared with healthy controls, with most significant differences for native T1 and T2. While promising, the clinical significance of the newer mapping techniques with respect to early diagnosis and therapy of CS will have to be determined in future studies.
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Affiliation(s)
- Simon Greulich
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Daniel Kitterer
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Joerg Latus
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Eissa Aguor
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Hannah Steubing
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Philipp Kaesemann
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Alexandru Patrascu
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Andreas Greiser
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Stefan Groeninger
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Agnes Mayr
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Niko Braun
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - M Dominik Alscher
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Udo Sechtem
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.)
| | - Heiko Mahrholdt
- From the Division of Cardiology (S.G., H.S., P.K., A.P., U.S., H.M.) and Division of Nephrology, Department of Internal Medicine (D.K., J.L., N.B., M.D.A.), Robert-Bosch-Medical Center Stuttgart, Germany; Philips Medical Solutions, Best, The Netherlands (E.A.); Siemens Healthcare GmbH, Erlangen, Germany (A.G., S.G.); and Division of Radiology, University Hospital Innsbruck, Austria (A.M.).
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Wollert KC, Meyer GP, Müller-Ehmsen J, Tschöpe C, Bonarjee V, Larsen AI, May AE, Empen K, Chorianopoulos E, Tebbe U, Waltenberger J, Mahrholdt H, Ritter B, Pirr J, Fischer D, Korf-Klingebiel M, Arseniev L, Heuft HG, Brinchmann JE, Messinger D, Hertenstein B, Ganser A, Katus HA, Felix SB, Gawaz MP, Dickstein K, Schultheiss HP, Ladage D, Greulich S, Bauersachs J. Intracoronary autologous bone marrow cell transfer after myocardial infarction: the BOOST-2 randomised placebo-controlled clinical trial. Eur Heart J 2017; 38:2936-2943. [DOI: 10.1093/eurheartj/ehx188] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/23/2017] [Indexed: 01/21/2023] Open
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Greulich S, Mayr A, Kitterer D, Latus J, Henes J, Steubing H, Kaesemann P, Patrascu A, Greiser A, Groeninger S, Braun N, Alscher MD, Sechtem U, Mahrholdt H. T1 and T2 mapping for evaluation of myocardial involvement in patients with ANCA-associated vasculitides. J Cardiovasc Magn Reson 2017; 19:6. [PMID: 28077133 PMCID: PMC5225624 DOI: 10.1186/s12968-016-0315-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/09/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Myocardial involvement in AAV patients might be silent, presenting with no or nonspecific symptoms, normal ECG, and preserved left-ventricular ejection fraction (LV-EF). Since up to 50% of deaths in these patients may be due to myocardial involvement, a reliable diagnostic tool is warranted. In contrast to LGE-CMR, which has its strengths in detecting focal inflammatory or fibrotic processes, recent mapping techniques are able to detect even subtle, diffuse inflammatory or fibrotic processes. Our study sought to investigate ANCA (antineutrophil cytoplasmic antibody) associated vasculitides (AAV) patients for myocardial involvement by a cardiovascular magnetic resonance (CMR) protocol, including late gadolinium enhancement (LGE) and mapping sequences. METHODS Thirty seven AAV patients were prospectively enrolled and underwent CMR imaging. Twenty healthy volunteers served as controls. RESULTS Mean LV-EF was 64%; LGE prevalence of the AAV patients was 43%. AAV patients had higher median native T1 (988 vs. 952 ms, p < 0.001), lower post-contrast T1 (488 vs. 524 ms, p = 0.03), expanded extracellular volume (ECV) (27.5 vs. 24.5%, p < 0.001), and higher T2 (53 vs. 49 ms, p < 0.001) compared to controls, with most parameters independent of the LGE status. Native T1 and T2 in AAV patients showed the highest prevalence of abnormally increased values beyond the 95% percentile of controls. CONCLUSION AAV patients demonstrated increased T1, ECV, and T2 values, with native T1 and T2 showing the highest prevalence of values beyond the 95% percentile of normal. Since these findings seem to be independent of LGE, mapping techniques may provide complementary information to LGE-CMR in the assessment of myocardial involvement in patients with AAV.
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Affiliation(s)
- Simon Greulich
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Agnes Mayr
- Division of Radiology, University Hospital Innsbruck, Innsbruck, Austria
| | - Daniel Kitterer
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - Joerg Latus
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - Joerg Henes
- Center for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases, University Hospital Tuebingen, Tuebingen, Germany
| | - Hannah Steubing
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Philipp Kaesemann
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Alexandru Patrascu
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | | | | | - Niko Braun
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - M. Dominik Alscher
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center, Stuttgart, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376 Stuttgart, Germany
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Abstract
The major guidelines on stable coronary artery disease recommend revascularizing patients with large areas of myocardium at risk. The algorithms on how to prove that such high risk is present differ considerably. The opinions on the use of coronary CT (calcium scoring and angiography) vary widely. This review aims to summarize the recommendations of the major guidelines, commenting on differences between the guidelines and discussing whether extending the role of coronary CT angiography should be considered in the light of new CT data.
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Greulich S, Kitterer D, Kurmann R, Henes J, Latus J, Gloekler S, Wahl A, Buss SJ, Katus HA, Bobbo M, Lombardi M, Backes M, Steubing H, Schepat P, Braun N, Alscher MD, Sechtem U, Mahrholdt H. Cardiac involvement in patients with rheumatic disorders: Data of the RHEU-M(A)R study. Int J Cardiol 2016; 224:37-49. [DOI: 10.1016/j.ijcard.2016.08.298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 08/19/2016] [Indexed: 01/08/2023]
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Mayr A, Kitterer D, Latus J, Steubing H, Henes J, Vecchio F, Kaesemann P, Patrascu A, Greiser A, Groeninger S, Braun N, Alscher MD, Sechtem U, Mahrholdt H, Greulich S. Evaluation of myocardial involvement in patients with connective tissue disorders: a multi-parametric cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2016; 18:67. [PMID: 27733210 PMCID: PMC5062828 DOI: 10.1186/s12968-016-0288-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/29/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Severe arrhythmias or heart failure may be surrogates of myocardial involvement in patients with connective tissue disorders (CTD). However, most patients present with unspecific symptoms, normal ECG, and preserved left ventricular ejection fraction (LV-EF). Therefore, timely diagnosis by an accurate technique is crucial. Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) has proven value for the detection of focal processes, but due to the often diffuse character of fibrosis/inflammation in CTD patients, CMR mapping techniques might be of incremental value for the assessment of myocardial involvement. Purpose of this study was to evaluate a multi-parametric CMR protocol as a screening tool for myocardial involvement in CTD patients. METHODS Forty CTD patients were prospectively enrolled and underwent CMR, twenty healthy volunteers served as control group. RESULTS Mean LV-EF was 62 %; LGE prevalence was low (18 %). CTD patients had higher native T1 (1008 vs. 962 ms, p = 0.001), lower post contrast T1 (494 vs. 526 ms, p = 0.008), expanded extracellular volume (ECV) (28 vs. 25 %, p = 0.001), and higher T2 values (53 vs. 49 ms, p < 0.001) compared to controls. Among patients with values higher than the 95 % percentile of healthy controls, native T1 and T2 values seem to be the most promising discriminators. CONCLUSION CTD patients showed higher T1, ECV, and T2 values compared to controls, with most significant differences for native T1 and T2, which seem to be independent of the presence of LGE. Our data suggest that CMR mapping techniques are of incremental value in the detection of myocardial involvement in CTD patients.
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Affiliation(s)
- Agnes Mayr
- Division of Radiology, University Hospital Innsbruck, Innsbruck, Austria
| | - Daniel Kitterer
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany
| | - Joerg Latus
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany
| | - Hannah Steubing
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Joerg Henes
- Centre for Interdisciplinary Clinical Immunology, Rheumatology and Auto-inflammatory Diseases and Department of Internal Medicine II (Oncology, Haematology, Immunology, Rheumatology, Pulmology), University Hospital Tuebingen, Tuebingen, Germany
| | - Francesco Vecchio
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Philipp Kaesemann
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Alexandru Patrascu
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | | | | | - Niko Braun
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany
| | - M. Dominik Alscher
- Division of Nephrology, Department of Internal Medicine, Robert-Bosch-Medical Center Stuttgart, Stuttgart, Germany
| | - Udo Sechtem
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Heiko Mahrholdt
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
| | - Simon Greulich
- Division of Cardiology, Robert-Bosch-Medical Center Stuttgart, Auerbachstrasse 110, 70376 Stuttgart, Germany
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Abstract
Cardiac magnetic resonance (CMR) is a non-invasive imaging modality that has rapidly emerged during the last few years and has become a valuable, well-established clinical tool. Beside the evaluation of anatomy and function, CMR has its strengths in providing detailed non-invasive myocardial tissue characterization, for which it is considered the current diagnostic gold standard. Late gadolinium enhancement (LGE), with its capability to detect necrosis and to separate ischemic from non-ischemic cardiomyopathies by distinct LGE patterns, offers unique clinical possibilities. The presence of LGE has also proven to be a good predictor of an adverse outcome in various studies. T2-weighted (T2w) images, which are supposed to identify areas of edema and inflammation, are another CMR approach to tissue characterization. However, T2w images have not held their promise owing to several technical limitations and potential physiological concerns. Newer mapping techniques may overcome some of these limitations: they assess quantitatively myocardial tissue properties in absolute terms and show promising results in studies for characterization of diffuse fibrosis (T1 mapping) and/or inflammatory processes (T2 mapping). However, these techniques are still research tools and are not part of the clinical routine yet. T2* CMR has had significant impact in the management of thalassemia because it is possible to image the amount of iron in the heart and the liver, improving both diagnostic imaging and the management of patients with thalassemia. CMR findings frequently have clinical impact on further patient management, and CMR seems to be cost effective in the clinical routine.
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Affiliation(s)
- Simon Greulich
- Division of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Andrew E Arai
- National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, MD, USA
| | - Udo Sechtem
- Division of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
| | - Heiko Mahrholdt
- Division of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
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Greulich S, Mahrholdt H. Prognosis of Myocardial Damage in Sarcoidosis Patients With Preserved Left Ventricular Ejection Fraction: Always Look at the Bright Side of Cardiovascular Magnetic Resonance. Circ Cardiovasc Imaging 2016; 9:e004417. [PMID: 26763282 DOI: 10.1161/circimaging.115.004417] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Simon Greulich
- From the Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany.
| | - Heiko Mahrholdt
- From the Department of Cardiology, Robert Bosch Medical Center, Stuttgart, Germany
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Greulich S, Meloni A, Nazir SA, Stefan Biesbroek P, Arenja N, Kammerlander AA, Sayeed A, Ricci F, Bernhardt P, Meierhofer C, Devos DG, Ruecker B, Burkhardt B, Kamphuis VP, De Lazzari M, Nederend I, Dux-Santoy L, Cavalcante JL, Rosmini S, Liu B, Fent G, Claessen G, Behar J, Oebel S, Baritussio A, Ranjit Arnold J, Kitterer D, Latus J, Henes J, Kurmann R, Gloekler S, Wahl A, Buss S, Katus H, Bobbo M, Lombardi M, Braun N, Alscher M, Sechtem U, Mahrholdt H, Neri M, Preziosi P, Grassedonio E, Schicchi N, Keilberg P, Pulini S, Facchini E, Positano V, Pepe A, Shetye A, Khan JN, Singh A, Kanagala P, Swarbrick D, Gulsin G, Graham-Brown M, Squire I, Gershlick A, McCann GP, Amier RP, Teunissen PF, Robbers LF, Beek AM, van Rossum AC, Hofman MB, van Royen N, Nijveldt R, Riffel JH, Djiokou CN, Andre F, Fritz T, Halder M, Thomas Z, Korosoglou G, Katus HA, Buss SJ, Schwaiger ML, Duca F, Aschauer S, Marzluf BA, Zotter-Tufaro C, Dalos D, Pfaffenberger S, Bonderman D, Mascherbauer J, Fridman Y, Hackman B, Kadakkal A, Maanja M, Daya HA, Wong TC, Schelbert EB, Barison A, Todiere G, Gaeta R, Galllina S, Emdin M, De Caterina R, Aquaro G, Buckert D, Dyckmanns N, Rottbauer W, Kühn A, Shehu N, Müller J, Stern H, Ewert P, Fratz S, Vogt M, De Groote K, Babin D, Demulier L, Taeymans Y, Westenberg JJ, Van Bortel L, Segers P, Achten E, De Schepper J, Rietzschel E, Geiger J, Makki M, Burkhardt B, Kellenberger CJ, Buechel ERV, Kellenberger C, Geiger J, Ruecker B, Buechel EV, Elbaz MS, Kroft LJ, van der Geest RJ, de Roos A, Blom NA, Westenberg JJ, Roest AA, Cipriani A, Susana A, Rizzo S, Giorgi B, Carmelo L, Bertaglia E, Bauce B, Corrado D, Thiene G, Marra MP, Basso C, Iliceto S, Roest A, van den Boogaard P, ten Harkel A, de Geus J, Kroft L, de Roos A, Westenberg J, Kale R, Teixido-Tura G, Maldonado G, Huguet M, Garcia-Dorado D, Evangelista A, Rodriguez-Palomares J, Rijal S, Schindler JT, Gleason TG, Lee JS, Schelbert EB, Bulluck H, Treibel TA, Bhuva A, Abdel-Gadir A, Culotta V, Merghani A, Maestrini V, Herrey AS, Kellman P, Manisty C, Moon JC, Hayer M, Baig S, Shah T, Rooney S, Edwards N, Steeds R, Garg P, Swoboda P, Dobson L, Musa T, Foley J, Haaf P, Greenwood J, Plein S, Schnell F, Bogaert J, Dymarkowski S, Pattyn N, Claus P, Van Cleemput J, Gerche AL, Heidbuchel H, Toth D, Reiml S, Panayiotou M, Claridge S, Jackson T, Sohal M, Webb J, O'Neill M, Brost A, Mountney P, Razavi R, Rhode K, Rinaldi CA, Arya A, Hilbert S, Bollmann A, Hindricks G, Jahnke C, Paetsch I, Dinov B, Perazzolo Marra M, Ghosh Dastidar A, Rodrigues J, Zorzi A, Susana A, Scatteia A, De Garate E, Mattesi G, Strange J, Corrado D, Bucciarelli-Ducci C, Jerosch-Herold M, Karamitsos TD, Francis JM, Bhamra-Ariza P, Sarwar R, Choudhury R, Selvanayagam JB, Neubauer S. ORAL AB AGORA1362Cardiac Involvement in Patients With Different Rheumatic Disorders1366Gender differences in the development of cardiac complications: a multicentric prospective study in a large cohort of thalassemia major patients1646Comparison of T1-mapping, T2-weighted and contrast-enhanced cine imaging at 3.0T CMR for diagnostic oedema assessment in ST-segment elevation myocardial infarction1375Evaluation of Tissue Changes in Remote Noninfarcted Myocardium after Acute Myocardial Infarction using T1-mapping1377Right ventricular long axis strain – The prognostic value of a novel parameter in non-ischemic dilated cardiomyopathy using standard cardiac magnetic resonance imaging1389The role of the right ventricular insertion point in heart failure patients with preserved ejection fraction: Insights from a cardiovascular magnetic resonance study1398Myocardial fibrosis associates with B-type natriuretic peptide levels and outcomes more than wall stress1478Prognostic Value of Pulmonary Blood Volume by Contrast-Enhanced Magnetic Resonance Imaging in Heart Failure Outpatients – The PROVE-HF Study1370Magnetic Resonance Adenosine Perfusion Imaging as Gatekeeper of Invasive Coronary1509Influence of non-invasive hemodynamic CMR parameters on maximal exercise capacity in surgically untreated patients with Ebstein's anomaly1356Proximal aortic stiffening in Turner patients is more pronounced in the presence of a bicuspid valve. A segmental functional MRI study1503Flow pattern and vascular distensibility of the pulmonary arteries in patients after repair of tetralogy of Fallot. Insights from 4D flow CMR1516Myocardial deformation characteristics of the systemic right ventricle after atrial switch operation for transposition of the great arteries1633Three-dimensional vortex formation in patients with a Fontan circulation: evaluation with 4D flow CMR1483Mitral valve prolapse: arrhythmogenic substrates by cardiac magnetic imaging1596Increased local wall shear stress after coarctation repair is associated with descending aorta pulse wave velocity: evaluation with CMR and 4D flow1636Three-dimensional wall shear stress assessed by 4Dflow CMR in bicuspid aortic valve disease1464Cardiac Amyloidosis and Aortic Stenosis – The Convergence of Two Aging Processes1630Blood T1 variability explained in healthy volunteers: an analysis on MOLLI, ShMOLLI and SASHA1408Myocardial deformation on CMR predicts adverse outcomes in carcinoid heart disease - a new marker of risk1492Myocardial Perfusion Reserve and Global Longitudinal Strain in Early Rheumatoid Arthritis1500Exercise CMR to differentiate athlete's heart from patients with early dilated cardiomyopathy1559Real-Time, x-mri guidance to optimise left ventricular lead placement for delivery of cardiac resynchronisation therapy1560The role of Cardiac magnetic resonance imaging in patients undergoing ablation for ventricular tachycardia- Defining the substrate and visualizing the outcome1590Impact of cardiovascular magnetic resonance on clinical management and decision-making of out of hospital cardiac arrest survivors with inconclusive coronary angiogram1561Detection of coronary stenosis at rest using Oxygenation-Sensitive Magnetic Resonance Imaging. Eur Heart J Cardiovasc Imaging 2016. [DOI: 10.1093/ehjci/jew181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Mahrholdt H, Sechtem U. Bildgebende Verfahren bei Myokarditis und Kardiomyopathie. Dtsch Med Wochenschr 2016; 141:310. [DOI: 10.1055/s-0042-101888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Mahrholdt H, Sechtem U. [Imaging procedures for myocarditis and cardiomyopathy]. Dtsch Med Wochenschr 2016; 141:89-94. [PMID: 26800068 DOI: 10.1055/s-0041-108365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This manuscript gives a comprehensive overview with regard to cardiac imaging techniques for work-up and management of patients with myocarditis or cardiomyopathies.
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Affiliation(s)
- Heiko Mahrholdt
- Klinik für Kardiologie am Robert-Bosch-Krankenhaus, Stuttgart
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Moschetti K, Petersen SE, Pilz G, Kwong RY, Wasserfallen JB, Lombardi M, Korosoglou G, Van Rossum AC, Bruder O, Mahrholdt H, Schwitter J. Cost-minimization analysis of three decision strategies for cardiac revascularization: results of the "suspected CAD" cohort of the european cardiovascular magnetic resonance registry. J Cardiovasc Magn Reson 2016; 18:3. [PMID: 26754743 PMCID: PMC4709988 DOI: 10.1186/s12968-015-0222-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 12/22/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Coronary artery disease (CAD) continues to be one of the top public health burden. Perfusion cardiovascular magnetic resonance (CMR) is generally accepted to detect CAD, while data on its cost effectiveness are scarce. Therefore, the goal of the study was to compare the costs of a CMR-guided strategy vs two invasive strategies in a large CMR registry. METHODS In 3'647 patients with suspected CAD of the EuroCMR-registry (59 centers/18 countries) costs were calculated for diagnostic examinations (CMR, X-ray coronary angiography (CXA) with/without FFR), revascularizations, and complications during a 1-year follow-up. Patients with ischemia-positive CMR underwent an invasive CXA and revascularization at the discretion of the treating physician (=CMR + CXA-strategy). In the hypothetical invasive arm, costs were calculated for an initial CXA and a FFR in vessels with ≥50% stenoses (=CXA + FFR-strategy) and the same proportion of revascularizations and complications were applied as in the CMR + CXA-strategy. In the CXA-only strategy, costs included those for CXA and for revascularizations of all ≥50% stenoses. To calculate the proportion of patients with ≥50% stenoses, the stenosis-FFR relationship from the literature was used. Costs of the three strategies were determined based on a third payer perspective in 4 healthcare systems. RESULTS Revascularizations were performed in 6.2%, 4.5%, and 12.9% of all patients, patients with atypical chest pain (n = 1'786), and typical angina (n = 582), respectively; whereas complications (=all-cause death and non-fatal infarction) occurred in 1.3%, 1.1%, and 1.5%, respectively. The CMR + CXA-strategy reduced costs by 14%, 34%, 27%, and 24% in the German, UK, Swiss, and US context, respectively, when compared to the CXA + FFR-strategy; and by 59%, 52%, 61% and 71%, respectively, versus the CXA-only strategy. In patients with typical angina, cost savings by CMR + CXA vs CXA + FFR were minimal in the German (2.3%), intermediate in the US and Swiss (11.6% and 12.8%, respectively), and remained substantial in the UK (18.9%) systems. Sensitivity analyses proved the robustness of results. CONCLUSIONS A CMR + CXA-strategy for patients with suspected CAD provides substantial cost reduction compared to a hypothetical CXA + FFR-strategy in patients with low to intermediate disease prevalence. However, in the subgroup of patients with typical angina, cost savings were only minimal to moderate.
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Affiliation(s)
- Karine Moschetti
- Healthcare Evaluation Unit, Institute of Social and Preventive Medicine (IUMSP), Lausanne, Switzerland.
- Technology Assessment Unit, University Hospital of Lausanne, Lausanne, Switzerland.
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Cardiovascular Biomedical Research Unit at Barts, Queen Mary University of London, London, UK.
| | - Guenter Pilz
- Clinic Agatharied, Academic Teaching Hospital, University of Munich, Munich, Germany.
| | - Raymond Y Kwong
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
| | | | - Massimo Lombardi
- Policlinics of San Donato, Italian Research Hospital, Milano, Italy.
| | | | | | - Oliver Bruder
- Elisabeth Hospital, Department of Cardiology and Angiology, Elisabeth Hospital Essen, Essen, Germany.
| | - Heiko Mahrholdt
- Department of Cardiology, Robert Bosch Hospital, Stuttgart, Germany.
| | - Juerg Schwitter
- Division of Cardiology, Director Cardiac MR Center, University Hospital Lausanne - CHUV, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
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Ochs A, Schuster A, Riffel J, Düchting J, Thome S, Andre F, Seitz SA, Galuschky C, Mahrholdt H, Bruder O, Korosoglou G, Katus HA, Buss S. LV rotational mechanics in patients with dilated cardiomyopathy compared to healthy individuals: Experience from the European CMR Registry. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328563 DOI: 10.1186/1532-429x-17-s1-q69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Greulich S, Kindermann I, Schumm J, Perne A, Birkmeier S, Grün S, Ong P, Schäufele T, Schneider S, Böhm M, Sechtem U, Mahrholdt H. Predictors of outcome in patients with parvovirus B19 positive endomyocardial biopsy. J Cardiovasc Magn Reson 2015. [PMCID: PMC4328219 DOI: 10.1186/1532-429x-17-s1-o80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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