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Shost MD, Barksdale E, Huerta M, Seals K, Rabah N, Butt B, Steinmetz M. A retrospective analysis of perioperative complications of lateral approach lumbar interbody fusion in patients with prior abdominal surgery or a history of colonic inflammatory disease. Spine J 2024:S1529-9430(24)00110-4. [PMID: 38518920 DOI: 10.1016/j.spinee.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 09/20/2023] [Revised: 01/25/2024] [Accepted: 03/12/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND CONTEXT Lateral approaches for lumbar interbody fusion (LIF) allow for access to the lumbar spine and disk space by passing through a retroperitoneal corridor either pre- or trans-psoas. A contraindication for this approach is the presence of retroperitoneal scarring that may occur from prior surgical intervention in the retroperitoneal space or from inflammatory conditions with fibrotic changes and pose challenges for the mobilization and visualization needed in this approach. However, there is a paucity of evidence on the prevalence of surgical complications following lateral fusion surgery in patients with a history of abdominal surgery. PURPOSE The primary aim of this study is to describe the association between surgical complications following lateral interbody fusion surgery and prior abdominal surgical. STUDY DESIGN Retrospective study. PATIENT SAMPLE Patients over the age of 18 who underwent lateral lumbar interbody fusion at a large, tertiary care center between 2011 and 2019 were included in the study. OUTCOME MEASURES The primary outcome included medical, surgical, and thigh-related complications either in the intraoperative or 90-day postoperative periods. Additional outcome metrics included readmission rates, length of stay, and operative duration. METHODS The electronic health records of 250 patients were reviewed for demographic information, surgical data, complications, and readmission following surgery. The association of patient and surgical factors to complication rate was analyzed using multivariable logistic regression. Statistical analysis was performed using R statistical software (R, Vienna, Austria). RESULTS Of 250 lateral interbody fusion patients, 62.8% had a prior abdominal surgery and 13.8% had a history of colonic disease. The most common perioperative complication was transient thigh or groin pain/sensory changes (n=62, 24.8%). A multivariable logistic regression considering prior abdominal surgery, age, BMI, history of colonic disease, multilevel surgery, and the approach relative to psoas found no significant association between surgical complication rates and colonic disease (OR 0.40, 95% CI 0.02-2.22) or a history of prior abdominal surgeries (OR 0.56, 95% CI 0.20-1.55). Further, the invasiveness of prior abdominal surgeries showed no association with overall spine complication rate, lateral-specific complications, or readmission rates (p>.05). CONCLUSION Though retroperitoneal scarring is an important consideration for lateral approaches to the lumbar spine, this study found no association between lateral lumbar approach complication rates and prior abdominal surgery. Further study is needed to determine the impact of inflammatory colonic disease on lateral approach spine surgery.
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Affiliation(s)
- Michael D Shost
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Edward Barksdale
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Mina Huerta
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Karrington Seals
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, USA
| | - Nicholas Rabah
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA
| | - Bilal Butt
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA
| | - Michael Steinmetz
- Center for Spine Health, Neurologic Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, USA; Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, 9501 Euclid Ave, Cleveland, OH, USA.
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Ulrich S, Balmer C, Becker K, Bruhs J, Danne F, Debus V, Dewein L, Di-Bernardo S, Doll U, Fleck T, Tirilomis T, Glöckler M, Grafmann M, Greil S, Grosser U, Saur P, Skrzypek S, Steinmetz M. COVID-19 infection in patients with history of pediatric heart transplant in Germany, Austria, and Switzerland. Clin Transplant 2024; 38:e15272. [PMID: 38445550 DOI: 10.1111/ctr.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
COVID-19 is a heterogenous infection-asymptomatic to fatal. While the course of pediatric COVID-19 infections is usually mild or even asymptomatic, individuals after adult heart transplantation are at high risk of a severe infection. We conducted a retrospective, multicenter survey of 16 pediatric heart transplant centers in Germany, Austria and Switzerland to evaluate the risk of a severe COVID-19 infection after pediatric heart transplantation between 02/2020 and 06/2021. Twenty-six subjects (11 male) with a median age of 9.77 years at time of transplantation and a median of 4.65 years after transplantation suffered from COVID-19 infection. The median age at time of COVID-10 infection was 17.20 years. Fourteen subjects had an asymptomatic COVID-19 infection. The most frequent symptoms were myalgia/fatigue (n = 6), cough (n = 5), rhinitis (n = 5), and loss of taste (n = 5). Only one subject showed dyspnea. Eleven individuals needed therapy in an outpatient setting, four subjects were hospitalized. One person needed oxygen supply, none of the subjects needed non-invasive or invasive mechanical ventilation. No specific signs for graft dysfunction were found by non-invasive testing. In pediatric heart transplant subjects, COVID-19 infection was mostly asymptomatic or mild. There were no SARS-CoV-2 associated myocardial dysfunction in heart transplant individuals.
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Affiliation(s)
- Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Christian Balmer
- Department of Pediatric Cardiology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Kolja Becker
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Josefin Bruhs
- Center of Congenital Heart Disease/Pediatric Cardiology, HDZ-NRW, Ruhr-University, Bad Oeynhausen, Germany
| | - Friederike Danne
- Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Volker Debus
- Department of Pediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Leonie Dewein
- Department of Pediatrics, University Hospital Ulm, Ulm, Germany
| | - Stefano Di-Bernardo
- Department of Pediatric Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Ulrike Doll
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theodor Tirilomis
- Department of Pediatric Cardiac Surgery, Georg-August-University-Goettingen, Gottingen, Germany
| | - Martin Glöckler
- Center for Congenital Heart Disease, University Hospital for Cardiology, Bern, Switzerland
| | - Maria Grafmann
- Department of Pediatric Cardiology, UKE Hamburg, Hamburg, Germany
| | - Sabine Greil
- Department of Pediatric Cardiology, University Hospital Wien, Wien, Austria
| | - Urte Grosser
- Department of Pediatric Cardiology, University Hospital Hannover, Hannover, Germany
| | - Patrick Saur
- Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Susanne Skrzypek
- Department of Pediatric Cardiology, University Hospital Giessen, Giessen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine University Medical Center, Georg-August-University-Goettingen, Germany and German Center for Cardiovasvular Research (DZHK), Gottingen, Germany
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Soschynski M, Bunck AC, Beer M, Kloempken S, Schlett CL, Baeßler B, Kröger JR, Persigehl T, Pinto Dos Santos D, Steinmetz M, Niehaus A, Bamberg F, Ley S, Tiemann K, Beerbaum P, Lotz J, Maintz D, Kloth C, Brunner H, Ritter CO. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning. ROFO-FORTSCHR RONTG 2023; 195:293-296. [PMID: 36796410 DOI: 10.1055/a-1981-1196] [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: 02/18/2023]
Abstract
BACKGROUND Structured reporting allows a high grade of standardization and thus a safe and unequivocal report communication. In the past years, the radiological societies have started several initiatives to base radiological reports on structured reporting rather than free text reporting. METHODS Upon invitation of the working group for Cardiovascular Imaging of the German Society of Radiology, in 2018 an interdisciplinary group of Radiologists, Cardiologists, Pediatric Cardiologists and Cardiothoracic surgeons -all experts on the field of cardiovascular MR and CT imaging- met for interdisciplinary consensus meetings at the University Hospital Cologne. The aim of these meetings was to develop and consent templates for structured reporting in cardiac MR and CT of various cardiovascular diseases. RESULTS Two templates for structured reporting of CMR in ischemia imaging and vitality imaging and two templates for structured reporting of CT imaging for planning Transcatheter Aortic Valve Implantation (TAVI; pre-TAVI-CT) and coronary CT were discussed, consented and transferred to a HTML 5/IHR MRRT compatible format. The templates were made available for free use on the website www.befundung.drg.de. CONCLUSION This paper suggests consented templates in German language for the structured reporting of cross-sectional CMR imaging of ischemia and vitality as well as reporting of CT imaging pre-TAVI and coronary CT. The implementation of these templates is aimed at providing a constant level of high reporting quality and increasing the efficiency of report generation as well as a clinically based communication of imaging results. KEY POINTS · Structured reporting offers a constant level of high reporting quality and increases the efficiency of report generation as well as a clinically based communication of imaging results.. · For the first time templates in German language for the structured reporting of CMR imaging of ischemia and vitality and CT imaging pre-TAVI and coronary CT are reported.. · These templates will be made available on the website www.befundung.drg.de and can be commented via strukturierte-befundung@drg.de.. ZITIERWEISE · Soschynski M, Bunck AC, Beer M et al. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Ischemia and Myocardial Viability and for Cardiac CT Imaging of Coronary Heart Disease and TAVI Planning. Fortschr Röntgenstr 2023; DOI: 10.1055/a-1981-1196.
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Affiliation(s)
- Martin Soschynski
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Meinrad Beer
- Abteilung für Diagnostische und Interventionelle Radiologie, University Hospital Ulm, Germany
| | - Steffen Kloempken
- Abteilung für Diagnostische und Interventionelle Radiologie, University Hospital Ulm, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University Hospital Wurzburg, Germany
| | - Jan Robert Kröger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling Hospital Minden, Germany
| | | | - Daniel Pinto Dos Santos
- Institut für Diagnostische und Interventionelle Radiologie, University Hospital Cologne, Koln, Germany.,Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Johannes Gutenberg Universitat Universitatsmedizin, Mainz, Germany
| | - Michael Steinmetz
- Klinik für Pädiatrische Kardiologie und Intensivmedizin, University Medical Center Göttingen, Gottingen, Germany
| | - Adelheid Niehaus
- Klinik für Herz-, Thorax-, Transplantations- und Gefäßchirurgie, Hannover Medical School, Hannover, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Sebastian Ley
- Diagnostic and Interventional Radiology, Artemed SE, Tutzing, Germany
| | - Klaus Tiemann
- Department of Cardiology and Intensive Care, Peter Osypka Heart Center Munich, Hospital Munich South, Munchen, Germany
| | - Philipp Beerbaum
- Clinic for Paediatric Cardiology and Paediatric Critical Care Medicine, Hannover Medical School, Hannover, Germany
| | - Joachim Lotz
- Diagnostic Radiology, University Medical Center Göttingen, Germany
| | | | - Christopher Kloth
- Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Horst Brunner
- Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Christian O Ritter
- Diagnostic and Interventional Radiology, University Medical Center Göttingen, Gottingen, Germany
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Greenberg JK, Javeed S, Zhang JK, Benedict B, Frumkin MR, Xu Z, Zhang J, Rodebaugh TL, Lu C, Piccirillo JF, Steinmetz M, Ghogawala Z, Bydon M, Ray WZ. Current and future applications of mobile health technology for evaluating spine surgery patients: a review. J Neurosurg Spine 2023; 38:617-626. [PMID: 36670535 DOI: 10.3171/2022.12.spine221302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 11/30/2022] [Accepted: 12/27/2022] [Indexed: 01/22/2023]
Abstract
Mobile health (mHealth) technology has assumed a pervasive role in healthcare and society. By capturing real-time features related to spine health, mHealth assessments have the potential to transform multiple aspects of spine care. Yet mHealth applications may not be familiar to many spine surgeons and other spine clinicians. Consequently, the objective of this narrative review is to provide an overview of the technology, analytical considerations, and applications of mHealth tools for evaluating spine surgery patients. Reflecting their near-ubiquitous role in society, smartphones are the most commonly available form of mHealth technology and can provide measures related to activity, sleep, and even social interaction. By comparison, wearable devices can provide more detailed mobility and physiological measures, although capabilities vary substantially by device. To date, mHealth evaluations in spine surgery patients have focused on the use of activity measures, particularly step counts, in an attempt to objectively quantify spine health. However, the correlation between step counts and patient-reported disease severity is inconsistent, and further work is needed to define the mobility metrics most relevant to spine surgery patients. mHealth assessments may also support a variety of other applications that have been studied less frequently, including those that prevent postoperative complications, predict surgical outcomes, and serve as motivational aids to patients. These areas represent key opportunities for future investigations. To maximize the potential of mHealth evaluations, several barriers must be overcome, including technical challenges, privacy and regulatory concerns, and questions related to reimbursement. Despite those obstacles, mHealth technology has the potential to transform many aspects of spine surgery research and practice, and its applications will only continue to grow in the years ahead.
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Affiliation(s)
- Jacob K Greenberg
- Departments of1Neurological Surgery.,5Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | | | | | | | | | - Ziqi Xu
- 3Computer Science and Engineering, and
| | | | | | | | | | - Michael Steinmetz
- 5Department of Neurological Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Zoher Ghogawala
- 6Department of Neurological Surgery, Lahey Clinic, Burlington, Massachusetts; and
| | - Mohamad Bydon
- 7Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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5
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Wottrich S, Kha S, Thompson N, Bakar D, Yee P, Melillo A, Nash C, Healy AT, Steinmetz M, Mroz T. The Effect of Cervical and Lumbar Decompression Surgery for Spinal Stenosis on Erectile Dysfunction. Global Spine J 2022:21925682221136493. [PMID: 36281560 DOI: 10.1177/21925682221136493] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Observational study. OBJECTIVES To evaluate the prevalence of erectile dysfunction and evaluate the effects of decompressive surgery on erectile dysfunction in cervical spinal stenosis and lumbar canal stenosis patients. METHODS This observational, prospective analysis enrolled patients aged 18-80 with cervical spinal stenosis and/or lumbar canal stenosis that underwent respective decompressive surgery. The IIEF-5 questionnaire was administered preoperatively, and at 6- and 12-months postoperatively to assess erectile dysfunction severity. The EPIC database was queried to determine any postoperative complications and document prominent erectile dysfunction risk factors. RESULTS Of 79 patients included in the analysis, 42 (53.2%) completed the IIEF-5 at 6 months, and 62 (78.5%) completed it at 12 months. Eighteen had cervical stenosis only, 54 had lumbar stenosis only, and 7 had both. 72% (18/25) of cervical stenosis patients and 83.6% (51/61) of lumbar stenosis patients had erectile dysfunction preoperatively according to IIEF-5 responses. The average preoperative IIEF-5 score indicated significant presence of erectile dysfunction for both the cervical and lumbar stenosis groups. No significant differences were identified in IIEF-5 score deltas from pre- to both postoperative periods. The presence of erectile dysfunction in both the cervical and lumbar stenosis groups was not significantly associated with the presence of any documented risk factors. CONCLUSIONS Our results suggest no significant improvement in overall erectile function postoperatively for patients with preoperative erectile dysfunction. This is important to address during patient counseling for decompression surgery candidates with cervical spinal stenosis and/or lumbar canal stenosis to manage expectations.
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Affiliation(s)
- Stephanie Wottrich
- Dell Seton Medical Center at the University of Texas at Austin, Austin, TX, USA
| | - Stephanie Kha
- The Cleveland Clinic Foundation, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Dara Bakar
- The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Philina Yee
- The Cleveland Clinic Foundation, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | | | - Andrew T Healy
- Carolina Neurosurgery and Spine Associates, Charlotte, NC, USA
| | | | - Thomas Mroz
- The Cleveland Clinic Foundation, Cleveland, OH, USA
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Radecke T, Nashtar MA, Korste S, Hendgen-Cotta UB, Rassaf T, Rammos C, Gunzer M, Steinmetz M. A critical review of wire injury induced aortic valve stenosis in mice. J Mol Cell Cardiol 2022; 169:71-73. [PMID: 35598534 DOI: 10.1016/j.yjmcc.2022.05.004] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/30/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Affiliation(s)
- T Radecke
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - M A Nashtar
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - S Korste
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - U B Hendgen-Cotta
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - T Rassaf
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - C Rammos
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany
| | - M Gunzer
- Institute for Experimental Immunology and Imaging, University of Duisburg-Essen, Germany
| | - M Steinmetz
- West German Heart and Vascular Center Essen, Department of Cardiology and Vascular Medicine, University Hospital Essen, Germany.
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7
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Ravishankar P, Winkleman R, Rabah N, Steinmetz M, Mroz T. Analysis of Patient-reported Outcomes Measures Used in Lumbar Fusion Surgery Research for Degenerative Spondylolisthesis. Clin Spine Surg 2022; 35:287-294. [PMID: 34724455 DOI: 10.1097/bsd.0000000000001272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/15/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Meta-analyses. OBJECTIVE This study aims to document the most common Patient-reported Outcome Measures (PROMs) used to assess lumbar fusion surgery outcomes and provide an estimate of the average improvement following surgical treatment. SUMMARY OF BACKGROUND DATA As health care institutions place more emphasis on quality of care, accurately quantifying patient perceptions has become a valued tool in measuring outcomes. To this end, greater importance has been placed on the use of PROMs. This is a systemic review and meta-analysis of randomly controlled trials published between 2014 and 2019 assessing surgical treatment of degenerative spondylolisthesis. METHODS A fixed effect size model was used to calculate mean difference and a 95% confidence interval (95% CI). Linear regression was used to calculate average expected improvement, adjusted for preoperative scores. RESULTS A total of 4 articles (7 study groups) were found for a total of 444 patients. The 3 most common PROMs were Oswestry Disability Index (ODI) (n=7, 100%), Short-Form-12 or Short-Form-36 (SF-12/36) (n=4, 57.1%), and visual analog scale-back pain (n=3, 42.8%). Pooled average improvement was 24.12 (95% CI: 22.49-25.76) for ODI, 21.90 (95% CI: 19.71-24.08) for SF-12/36 mental component score, 22.74 (95% CI: 20.77-24.71) for SF-12/36 physical component score, and 30.87 (95% CI: 43.79-47.97) for visual analog scale-back pain. After adjusting for preoperative scores, patients with the mean preoperative ODI (40.47) would be expected to improve by 22.83 points postoperatively. CONCLUSIONS This study provides a range of expected improvement for common PROMs used to evaluate degenerative spondylolisthesis with the goal of equipping clinicians with a benchmark value to use when counseling patients regarding surgery. In doing so, it hopes to provide a comparison point by which to judge individual patient improvement. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Pavitra Ravishankar
- Department of School of Medicine, Case Western Reserve University School of Medicine, Health Education Campus
| | | | - Nicholas Rabah
- Center for Spine Health, Cleveland Clinic, Cleveland, OH
| | | | - Thomas Mroz
- Center for Spine Health, Cleveland Clinic, Cleveland, OH
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8
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Backhaus SJ, Rösel SF, Schulz A, Lange T, Hellenkamp K, Gertz RJ, Wachter R, Steinmetz M, Kutty S, Raaz U, Friede T, Seidler T, Uecker M, Hasenfuß G, Schuster A. RT-CMR Imaging for Noninvasive Characterization of HFpEF: Medium-Term Outcomes of the HFpEF Stress Trial. JACC Cardiovasc Imaging 2022; 15:943-945. [PMID: 35512961 DOI: 10.1016/j.jcmg.2021.11.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/03/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023]
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9
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Caruso JP, Singh R, Mazzola C, Eldridge CM, Chilakapati S, Deme P, Swartz K, Schirmer CM, Huntoon K, Cheng J, Steinmetz M, Adogwa O. Trends in Racial and Ethnic Representation Among Neurosurgery Applicants and Residents: A Comparative Analysis of Procedural Specialties. World Neurosurg 2022; 163:e177-e186. [DOI: 10.1016/j.wneu.2022.03.145] [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: 12/10/2021] [Revised: 03/18/2022] [Accepted: 03/20/2022] [Indexed: 11/28/2022]
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10
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Seidel F, Opgen-Rhein B, Rentzsch A, Boehne M, Wannenmacher B, Boecker D, Reineker K, Grafmann M, Wiegand G, Hecht T, Kiski D, Fischer M, Papakostas K, Ruf B, Kramp J, Khalil M, Kaestner M, Steinmetz M, Fischer G, Özcan S, Freudenthal N, Schweigmann U, Hellwig R, Pickardt T, Klingel K, Messroghli D, Schubert S. Clinical characteristics and outcome of biopsy-proven myocarditis in children - Results of the German prospective multicentre registry "MYKKE". Int J Cardiol 2022; 357:95-104. [PMID: 35304189 DOI: 10.1016/j.ijcard.2022.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/22/2021] [Revised: 02/08/2022] [Accepted: 03/11/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Heart failure (HF) due to myocarditis might not respond in the same way to standard therapy as HF due to other aetiologies. The aim of this study was to investigate the value of endomyocardial biopsies (EMB) for clinical decision-making and its relation to the outcome of paediatric patients with myocarditis. METHODS Clinical and EMB data of children with myocarditis collected for the MYKKE-registry between 2013 and 2020 from 23 centres were analysed. EMB studies included histology, immunohistology, and molecular pathology. The occurrence of major adverse cardiac events (MACE) including mechanical circulatory support (MCS), heart transplantation, and/or death was defined as a combined endpoint. RESULTS Myocarditis was diagnosed in 209/260 patients: 64% healing/chronic lymphocytic myocarditis, 23% acute lymphocytic myocarditis (AM), 14% healed myocarditis, no giant cell myocarditis. The median age was 12.8 (1.4-15.9) years. Time from symptom-onset to EMB was 11.0 (4.0-29.0) days. Children with AM and high amounts of mononuclear cell infiltrates were significantly younger with signs of HF compared to those with healing/chronic or healed myocarditis. Myocardial viral DNA/RNA detection had no significant effect on outcome. The worst event-free survival was seen in patients with healing/chronic myocarditis (24%), followed by acute (31%) and healed myocarditis (58%, p = 0.294). A weaning rate of 64% from MCS was found in AM. CONCLUSIONS EMB provides important information on the type and stage of myocardial inflammation and supports further decision-making. Children with fulminant clinical presentation, high amounts of mononuclear cell infiltrates or healing/chronic inflammation and young age have the highest risk for MACE.
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Affiliation(s)
- Franziska Seidel
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany; Charité-Universitätsmedizin Berlin, Department of Pediatric Cardiology, Berlin, Germany; Experimental and Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, Germany; Charité-Universitätsmedizin Berlin, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany.
| | - Bernd Opgen-Rhein
- Charité-Universitätsmedizin Berlin, Department of Pediatric Cardiology, Berlin, Germany
| | - Axel Rentzsch
- Department for Paediatric Cardiology, Saarland University Medical Center, Homburg, Germany
| | - Martin Boehne
- Department of Paediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Bardo Wannenmacher
- Clinic for Paediatric Cardiology, Heart Centre, University of Leipzig, Leipzig, Germany
| | - Dorotheé Boecker
- Department for Paediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Katja Reineker
- Department for Paediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Maria Grafmann
- Department for Paediatric Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Gesa Wiegand
- Department for Paediatric Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Hecht
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart- and Diabetescenter NRW, University Clinic of Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Daniela Kiski
- Department for Paediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Marcus Fischer
- Department of Paediatric Cardiology and Paediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | | | - Bettina Ruf
- Department for Paediatric Cardiology, German Heart Centre Munich, Munich, Germany
| | - Jennifer Kramp
- Department for Paediatric Cardiology, University Hospital Cologne, Cologne, Germany
| | - Marcus Khalil
- Department for Paediatric Cardiology, University Hospital Giessen, Giessen, Germany
| | | | - Michael Steinmetz
- Department for Paediatric Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Gunther Fischer
- Department for Paediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sevinc Özcan
- Pediatric Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Noa Freudenthal
- Pediatric Cardiology, University Hospital Bonn, Bonn, Germany
| | | | - Regina Hellwig
- Pediatric Cardiology and Congenital Heart Defects, Center for Pediatrics, University Hospital Heidelberg, Heidelberg. Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Messroghli
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Internal Medicine-Cardiology, German Heart Center, Germany; Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Schubert
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin, Germany; Department for Paediatric Cardiology, University Heart & Vascular Center Hamburg, Hamburg, Germany
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11
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McGrath K, Lee J, Steinmetz M. Degenerative Spine Disorders and Multiple Sclerosis. Neurol Clin 2022; 40:249-259. [DOI: 10.1016/j.ncl.2021.11.004] [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: 10/18/2022]
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12
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Ulrich S, Balmer C, Becker K, Bruhs J, Danne F, Debus V, Dewein L, Doll U, Fleck T, Grafmann M, Greil S, Grosser U, Saur P, Skrzypek S, Steinmetz M. COVID-19 Infection after Pediatric Heart Transplantation in Germany, Austria, and Switzerland. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742987] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S. Ulrich
- Department of Pediatric Cardiology and Intensive Care Medicine, Chairwoman of the Working Group Thoracic Organ Transplantation DGPK, LMU, München, Deutschland
| | - C. Balmer
- Children's Hospital Zurich, Zürich, Switzerland
| | - K. Becker
- Department of Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Deutschland
| | - J. Bruhs
- Center of Congential Heart Disease, HDZ-NRW, Ruhr-University, Bad Oeynhausen, Bad Oeynhausen, Deutschland
| | - F. Danne
- Department of Pediatric Cardiology, DHZ Berlin, Berlin, Deutschland
| | - V. Debus
- Department of Pediatric Cardiology, University Hospital Münster, Münster, Deutschland
| | - L. Dewein
- Department of Pediatrics, University Hospital Ulm, Ulm, Deutschland
| | - U. Doll
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Deutschland
| | - T. Fleck
- Department of Pediatric Cardiology, University Hospital Freiburg, Freiburg, Deutschland
| | - M. Grafmann
- Department of Pediatric Cardiology, UKE Hamburg, Hamburg, Deutschland
| | - S. Greil
- Department of Pediatric Cardiology, University Hospital Wien, Vienna, Austria
| | - U. Grosser
- Department of Pediatric Cardiology, University Hospital Hannover, Hanover, Deutschland
| | - P. Saur
- Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Deutschland
| | - S. Skrzypek
- Kinderherzzentrum Giessen, Gießen, Deutschland
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13
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Uden T, Seidel F, Opgen-Rhein B, Boecker D, Wannenmacher B, Rentzsch A, Reineker K, Böhne M, Wiegand G, Hecht T, Blank AE, Fischer M, Kaestner M, Steinmetz M, Freudenthal N, Fischer G, Ruf B, Boethig D, Pickardt T, Beerbaum P, Schubert S, Messroghli D. Scar and Edema Imaging by CMR in Pediatric Myocarditis—Preliminary Results from the MYKKE-Registry. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742958] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- T. Uden
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - F. Seidel
- German Heart Institute Berlin, Berlin, Deutschland
| | - B. Opgen-Rhein
- Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - D. Boecker
- University Hospital Erlangen, Erlangen, Deutschland
| | - B. Wannenmacher
- Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - A. Rentzsch
- Saarland University Medical Center, Homburg an der Saar, Deutschland
| | - K. Reineker
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Centre Freiburg - Bad Krozingen, Medical Centre-University of Freiburg, Freiburg, Deutschland
| | - M. Böhne
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - G. Wiegand
- Department of Pediatric Cardiology, University of Tuebingen, Tübingen, Deutschland
| | - T. Hecht
- HDZ NRW, Bad Oeynhausen, Deutschland
| | - A.-E. Blank
- Pediatric Heart Center, Giessen, Deutschland
| | - M. Fischer
- Klinikum der Universität München, München, Deutschland
| | | | - M. Steinmetz
- University Medicine Göttingen, Göttingen, Deutschland
| | - N. Freudenthal
- Pediatric Cardiology, Universitätsklinikum Bonn, Bonn, Deutschland
| | - G. Fischer
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - B. Ruf
- Pediatric Cardiology, Deutsches Herzzentrum München, Munich, Deutschland
| | - D. Boethig
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - T. Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Deutschland
| | - P. Beerbaum
- Medizinische Hochschule Hannover, Hannover, Deutschland
| | - S. Schubert
- German Heart Institute Berlin, Berlin, Deutschland
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14
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Laubrock K, von Loesch T, Steinmetz M, Lotz J, Frahm J, Uecker M, Unterberg-Buchwald C. Imaging of arrhythmia: Real-time cardiac magnetic resonance imaging in atrial fibrillation. Eur J Radiol Open 2022; 9:100404. [PMID: 35265735 PMCID: PMC8899235 DOI: 10.1016/j.ejro.2022.100404] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [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: 12/13/2021] [Revised: 02/01/2022] [Accepted: 02/09/2022] [Indexed: 01/02/2023] Open
Abstract
Objectives Quantitative evaluations of function, volume and mass are fundamental in the diagnostic workup of different cardiovascular diseases and can be exactly determined by CMRI in sinus rhythm. This does not hold true in arrhythmia as CMR is hampered by reconstruction artifacts caused by inconsistent data from multiple heartbeats. Real-time (RT) MRI at high temporal resolution might reduce these problems. Methods Consecutive patients with atrial fibrillation were prospectively included and underwent RT and conventional CINE CMR in randomized order. 29 patients were studied at 1.5 T and 30 patients at 3 T. At 3 T a group of 20 subjects in sinus rhythm served as controls. RT and CINE image quality was evaluated in different planes and for different wall sections using a Likert scale (from zero to four). Volumetric analysis was performed using two types of software and differences between RT and CINE CMR were evaluated. Results In patients with atrial fibrillation RT CMR short axis (SA) resulted in a significantly higher image quality compared to CINE imaging both at 1.5 T and 3 T (1.5 T: mid SA: 3.55 ± 0.5 RT vs 2.6 ± 0.9 CINE, p = 0.0001; 3 T: mid SA: 3.15 ± 0.9 RT vs 2.6 ±1.0 CINE, p = 0.03); This qualitative difference was more marked and significant for the long axis views (2CV and 4CV) at 1.5 T (1.5 T: 2CV: 3.2 ± 0.6 RT vs 2.65 ± 1.1 CINE; p = 0.011; 4CV: 2.9 ± 0.69 RT vs 2.4 ± 0.9 CINE; p = 0.0044). During sinus rhythm CINE images were superior concerning diagnostic quality (3 T mid SA: 3.35 ± 0.45 RT vs 3.8 ± 0.5 CINE, p = 0.008). Quantitative analysis was successful with both software packages and the results showed a good correlation (Pearson correlation between 0.679 and 0.921 for patients). RT CMR resulted in slightly lower functional volumes than CINE CMR (3 T: patients: EDVI 86 ± 29 ml/m2 RT vs 93 29 ml/m2± 29 CINE, Pearson r = 0.902) but similar ejection fractions (3 T: patients: EF 47 ± 16% RT vs 45 ± 13% CINE, Pearson r = 0679; controls: EF 63 ± 6 RT vs 63 ± 3 CINE, Pearson r = 0.695). Conclusion RT CMR improves image quality in arrhythmic patients and renders studies more comfortable. Volumetric analysis is feasible with slightly lower values relative to CINE CMR, while ejection fractions are comparable. Real time cardiac magnetic imaging is superior to conventional CINE in arrhythmias: concerning image quality. Volumetric and functional analysis of real time is comparable to CINE. Acquistion time is reduced in real time. Improvement of postprocessing software of real time imaging is mandatory.
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Affiliation(s)
- Kerstin Laubrock
- Departmentof Medicine II, St. Joseph Hospital, Wüsthoffstraße 15, 12101 Berlin, Germany
- Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-AugustUniversity, Robert-Koch-Str.40, 37075 Goettingen, Germany
- Corresponding author at: Departmentof Medicine II, St. Joseph Hospital, Wüsthoffstraße 15, 12101 Berlin, Germany
| | - Thassilo von Loesch
- Institute for Diagnostic and Interventional Radiology, Georg-AugustUniversity, Robert-Koch-Str.40, 37075 Goettingen, Germany
- Doctor of Internal Medicine, Elise-Averdieck-Str. 17, 27356 Rotenburg,Wuemme Germany
| | - Michael Steinmetz
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Robert-Koch-Str.40, 37075 Goettingen, Germany
- Department of Pediatric Cardiology and Intensive Care Medicine,Georg-August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Georg-AugustUniversity, Robert-Koch-Str.40, 37075 Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Robert-Koch-Str.40, 37075 Goettingen, Germany
| | - Jens Frahm
- Biomedizinische NMR, Max-Planck-Institute for Biophysical Chemistry, Am Faßberg 11, 37077 Goettingen, Germany
| | - Martin Uecker
- Institute for Diagnostic and Interventional Radiology, Georg-AugustUniversity, Robert-Koch-Str.40, 37075 Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Robert-Koch-Str.40, 37075 Goettingen, Germany
- 7170 Institute of Biomedical Imaging, GrazUniversity of Technology, Stremayrgasse16/III, 8010 Graz, Austria
- Cluster of Excellence “Multiscale Bioimaging:from Molecular Machines to Networks of Excitable Cells” (MBExC) University ofGöttingen, Germany
| | - Christina Unterberg-Buchwald
- Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37075 Goettingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-AugustUniversity, Robert-Koch-Str.40, 37075 Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Robert-Koch-Str.40, 37075 Goettingen, Germany
- Correspondence to: Christina Unterberg-Buchwald, MD, Department of Cardiology and Pneumology, University Clinic Goettingen,Robert-Koch-Str. 40, 37075 Goettingen, Germany.
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15
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Sinning C, Zengin E, Diller GP, Onorati F, Castel MA, Petit T, Chen YS, Lo Rito M, Chiarello C, Guillemain R, Coniat KNL, Magnussen C, Knappe D, Becher PM, Schrage B, Smits JM, Metzner A, Knosalla C, Schoenrath F, Miera O, Cho MY, Bernhardt A, Weimann J, Goßling A, Terzi A, Amodeo A, Alfieri S, Angeli E, Ragni L, Napoleone CP, Gerosa G, Pradegan N, Rodrigus I, Dumfarth J, de Pauw M, François K, Van Caenegem O, Ancion A, Van Cleemput J, Miličić D, Moza A, Schenker P, Thul J, Steinmetz M, Warnecke G, Ius F, Freyt S, Avsar M, Sandhaus T, Haneya A, Eifert S, Saeed D, Borger M, Welp H, Ablonczy L, Schmack B, Ruhparwar A, Naito S, Hua X, Fluschnik N, Nies M, Keil L, Senftinger J, Ismaili D, Kany S, Csengeri D, Cardillo M, Oliveti A, Faggian G, Dorent R, Jasseron C, Blanco AP, Márquez JMS, López-Vilella R, García-Álvarez A, López MLP, Rocafort AG, Fernández ÓG, Prieto-Arevalo R, Zatarain-Nicolás E, Blanchart K, Boignard A, Battistella P, Guendouz S, Houyel L, Para M, Flecher E, Gay A, Épailly É, Dambrin C, Lam K, Ka-Lai CH, Cho YH, Choi JO, Kim JJ, Coats L, Crossland DS, Mumford L, Hakmi S, Sivathasan C, Fabritz L, Schubert S, Gummert J, Hübler M, Jacksch P, Zuckermann A, Laufer G, Baumgartner H, Giamberti A, Reichenspurner H, Kirchhof P. Study design and rationale of the pAtients pResenTing with cOngenital heaRt dIseAse Register (ARTORIA-R). ESC Heart Fail 2021; 8:5542-5550. [PMID: 34510806 PMCID: PMC8712832 DOI: 10.1002/ehf2.13574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 01/03/2023] Open
Abstract
Aim Due to improved therapy in childhood, many patients with congenital heart disease reach adulthood and are termed adults with congenital heart disease (ACHD). ACHD often develop heart failure (HF) as a consequence of initial palliative surgery or complex anatomy and subsequently require advanced HF therapy. ACHD are usually excluded from trials evaluating heart failure therapies, and in this context, more data about heart failure trajectories in ACHD are needed to guide the management of ACHD suffering from HF. Methods and results The pAtients pResenTing with cOngenital heaRt dIseAse Register (ARTORIA‐R) will collect data from ACHD evaluated or listed for heart or heart‐combined organ transplantation from 16 countries in Europe and the Asia/Pacific region. We plan retrospective collection of data from 1989–2020 and will include patients prospectively. Additional organizations and hospitals in charge of transplantation of ACHD will be asked in the future to contribute data to the register. The primary outcome is the combined endpoint of delisting due to clinical worsening or death on the waiting list. The secondary outcome is delisting due to clinical improvement while on the waiting list. All‐cause mortality following transplantation will also be assessed. The data will be entered into an electronic database with access to the investigators participating in the register. All variables of the register reflect key components important for listing of the patients or assessing current HF treatment. Conclusion The ARTORIA‐R will provide robust information on current management and outcomes of adults with congenital heart disease suffering from advanced heart failure.
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Affiliation(s)
- Christoph Sinning
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Elvin Zengin
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Francesco Onorati
- Divisione Ospedaliero Universitaria Cardiochirurgia Verona, Verona, Italy
| | - María-Angeles Castel
- Heart Failure and Heart Transplantation Unit, Cardiology Department, ICCV, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - Thibault Petit
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK
| | - Yih-Sharng Chen
- Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Mauro Lo Rito
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Carmelina Chiarello
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Romain Guillemain
- Chirurgie cardio vasculaire, Hôpital Européen Georges-Pompidou HEGP, Paris, France
| | - Karine Nubret-Le Coniat
- Programme de transplantation et d'assistance cardiaque adulte et pédiatrique au CHU de Bordeaux, Haut Lévêque Hospital, Pessac, France
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Dorit Knappe
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Andreas Metzner
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Christoph Knosalla
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Centre of Cardiovascular Research DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Charité University Medicine Berlin, Corporate Member of Freie University Berlin, Humboldt-University Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Centre of Cardiovascular Research DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Oliver Miera
- Department of Congenital Heart Disease/Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Mi-Young Cho
- Department of Congenital Heart Surgery/Pediatric Heart Surgery German Heart Center Berlin, Berlin, Germany
| | - Alexander Bernhardt
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | - Antonio Amodeo
- Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Sara Alfieri
- Bambino Gesù Pediatric Hospital and Research Institute, Rome, Italy
| | - Emanuela Angeli
- Pediatric Cardiac Surgery and Adult Congenital Heart Disease Program, Department of Cardio - Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero - Universitaria di Bologna, Bologna, Italy
| | - Luca Ragni
- Pediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio-Thoracic and Vascular Medicine, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Gino Gerosa
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, University of Padova, Padova, Italy
| | - Nicola Pradegan
- Cardiac Surgery Unit, Cardio-Thoraco-Vascular and Public Health Department, Padova University Hospital, University of Padova, Padova, Italy
| | - Inez Rodrigus
- Department of Cardiac Surgery, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Julia Dumfarth
- Department of Cardiac Surgery, University of Innsbruck, Innsbruck, Austria
| | - Michel de Pauw
- Department of Cardiology, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Katrien François
- Department of Cardiovascular Surgery, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Olivier Van Caenegem
- Division of Cardiovascular Intensive Care and Heart Transplantation, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Arnaut Ancion
- Department of Cardiology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Davor Miličić
- Department of Cardiology, Medical Faculty University of Zagreb, Zagreb, Croatia
| | - Ajay Moza
- Department of Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Bochum, Bochum, Germany
| | - Josef Thul
- Department of Pediatric Cardiology, University Hospital Giessen/Marburg, Giessen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology, University Hospital Göttingen, Göttingen, Germany.,German Center of Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gregor Warnecke
- Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabio Ius
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Susanne Freyt
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Murat Avsar
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Tim Sandhaus
- Department of Cardiovascular Surgery, University Hospital Jena, Jena, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sandra Eifert
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Diyar Saeed
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Michael Borger
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Henryk Welp
- Department of Cardiac Surgery, University Hospital Münster, Münster, Germany
| | - László Ablonczy
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Bastian Schmack
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany
| | - Shiho Naito
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Xiaoqin Hua
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Moritz Nies
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Laura Keil
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Juliana Senftinger
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Djemail Ismaili
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Shinwan Kany
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | - Dora Csengeri
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany
| | | | | | - Giuseppe Faggian
- Divisione Ospedaliero Universitaria Cardiochirurgia Verona, Verona, Italy
| | | | | | | | | | - Raquel López-Vilella
- Heart Failure and Transplantation Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ana García-Álvarez
- Heart Failure and Heart Transplantation Unit, Cardiology Department, ICCV, Hospital Clinic Barcelona, IDIBAPS, Barcelona, Spain
| | - María Luz Polo López
- Cirugia Cardiovascular, Servicio de Cirugia Cardiovascular Infantil y de Cardiopatías Congénitas, Hospital Universitario La Paz, Madrid, Spain
| | - Alvaro Gonzalez Rocafort
- Cirugia Cardiovascular, Servicio de Cirugia Cardiovascular Infantil y de Cardiopatías Congénitas, Hospital Universitario La Paz, Madrid, Spain
| | - Óscar González Fernández
- Heart Failure and Transplant Unit, Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raquel Prieto-Arevalo
- Department of Cardiology, Gregorio Marañon University Hospital CIBER-CV, Madrid, Spain
| | | | | | - Aude Boignard
- Department of Cardiology and Cardiovascular Surgery, CHU Michallon, Grenoble, France
| | - Pascal Battistella
- Department of Cardiology, Montpellier University Hospital, Montpellier Cedex 5, France
| | - Soulef Guendouz
- Département de Cardiologie, Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Lucile Houyel
- M3C-Necker Enfants malades, AP-HP, Université de Paris, Paris, France
| | - Marylou Para
- Department of Cardiovascular Surgery and Transplantation, Bichat Hospital, AP-HP, Paris, France
| | - Erwan Flecher
- Division of Thoracic and Cardiovascular Surgery, Rennes University Hospital, Rennes, France
| | - Arnaud Gay
- Thoracic and Cardiovascular Surgery Department, Rouen University Hospital, Rouen, France
| | - Éric Épailly
- Department of Cardiac Surgery, Strasbourg University Hospital, Strasbourg, France
| | - Camille Dambrin
- Service de Cardiologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Kaitlyn Lam
- Department of Cardiology, Fiona Stanly Hospital, Perth, Australia
| | - Cally Ho Ka-Lai
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China
| | - Yang Hyun Cho
- Department of Thoracic and Cardiovascular Surgery, Sungkyunkwan University, Seoul, South Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Jae-Joong Kim
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Louise Coats
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,Congenital Heart Disease Research Group, Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | - David Steven Crossland
- Adult Congenital and Pediatric Heart Unit, Freeman Hospital Newcastle Upon Tyne, Newcastle Upon Tyne, UK.,Congenital Heart Disease Research Group, Population Health Sciences Institute Newcastle University, Newcastle upon Tyne, UK
| | | | - Samer Hakmi
- Department of Cardiology & Critical Care Medicine, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Cumaraswamy Sivathasan
- Department of Cardiothoracic Surgery, Mount Elizabeth Medical Centre, Singapore, Singapore
| | - Larissa Fabritz
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,Institute of Cardiovacsular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK.,Department of Cardiology, University Hospital Birmingham, Birmingham, UK
| | - Stephan Schubert
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Jan Gummert
- Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Michael Hübler
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Pediatric Cardiac Surgery, University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - Peter Jacksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Helmut Baumgartner
- Department of Cardiology III, University Hospital Münster, Münster, Germany
| | - Alessandro Giamberti
- Department of Congenital Cardiac Surgery, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Hermann Reichenspurner
- German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany.,German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany.,Institute of Cardiovacsular Sciences and SWBH and UHB NHS Trusts, Birmingham, UK
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16
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Steinmetz M, Stümpfig T, Seehase M, Schuster A, Kowallick J, Müller M, Unterberg-Buchwald C, Kutty S, Lotz J, Uecker M, Paul T. Impaired Exercise Tolerance in Repaired Tetralogy of Fallot Is Associated With Impaired Biventricular Contractile Reserve: An Exercise-Stress Real-Time Cardiovascular Magnetic Resonance Study. Circ Cardiovasc Imaging 2021; 14:e011823. [PMID: 34384226 DOI: 10.1161/circimaging.120.011823] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Correction of tetralogy of Fallot (cTOF) often results in pulmonary valve pathology and right ventricular (RV) dysfunction. Reduced exercise capacity in cTOF patients cannot be explained by these findings alone. We aimed to explore why cTOF patients exhibit impaired exercise capacity with the aid of a comprehensive cardiopulmonary exercise testing (CPET) and real-time cardiovascular magnetic resonance exercise testing (CMR-ET) protocol. METHODS Thirty three cTOF patients and 35 matched healthy controls underwent CPET and CMR-ET in a prospective case-control study. Real-time steady-state free precession cine and phase-contrast sequences were obtained during incremental supine in-scanner cycling at 50, 70, and 90 W. RV and left ventricle (LV) volumes and pulmonary blood flow (Qp) were calculated. Differences of CPET and CMR-ET between cTOF versus controls and correlations between CPET and CMR-ET parameters in cTOF were evaluated statistically for all CMR exercise levels using Mann-Whitney U and Spearman rank-order correlation tests. RESULTS CPET capacity was significantly lower in cTOF than in controls. cTOF patients exhibited not only significantly reduced Qp and RV function but also lower LV function on CMR-ET. Higher CPET values in cTOF correlated with higher Qp (Qp 90 W versus carbon dioxide ventilatory equivalent %: R=-0.519, P<0.05), higher LV-end-diastolic volume indexed to body surface area (LV-end-diastolic volume indexed to body surface area at 50 W versus oxygen uptake in % at maximum exercise on CPET R=0.452, P<0.05), and change in LV ejection fraction (EF; LV-EF at 90 W versus Watt %: r=-0.463, P<0.05). No correlation was found with regard to RV-EF. Significant RV-LV interaction was observed during CMR-ET (RV-EF versus LV-EF at 50 W and 70 W: r=0.66, P<0.02 and r=0.52, P<0.05, respectively). CONCLUSIONS Impaired exercise capacity in cTOF resulted from a reduction in not only RV, but also LV function. cTOF with good exercise capacity on CPET demonstrated higher LV reserve and pulmonary blood flow during incremental CMR-ET. Apart from RV parameters, CMR-ET-derived LV function could be a valuable tool to stratify cTOF patients for pulmonary valve replacement.
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Affiliation(s)
- Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Thomas Stümpfig
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Matthias Seehase
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)
| | - Andreas Schuster
- Department of Cardiology and Pneumology (A.S., C.U.-B.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Johannes Kowallick
- Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Matthias Müller
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.)
| | - Christina Unterberg-Buchwald
- Department of Cardiology and Pneumology (A.S., C.U.-B.).,Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Shelby Kutty
- University Medical Center, Georg-August-University, Goettingen, Germany. The Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
| | - Martin Uecker
- Institute for Diagnostic and Interventional Radiology (J.K., C.U.-B., J.L., M.U.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.).,Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Goettingen, Germany (M.U.)
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine (M. Steinmetz, T.S., M. Seehase, M.M., T.P.).,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M. Steinmetz, T.S., A.S., J.K., C.U.-B., J.L., M.U., T.P.)
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17
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McGrath K, Schmidt E, Rabah N, Abubakr M, Steinmetz M. Clinical assessment and management of Bertolotti Syndrome: a review of the literature. Spine J 2021; 21:1286-1296. [PMID: 33676018 DOI: 10.1016/j.spinee.2021.02.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 11/06/2020] [Revised: 02/10/2021] [Accepted: 02/27/2021] [Indexed: 02/03/2023]
Abstract
Bertolotti Syndrome is a diagnosis given to patients experiencing pain caused by the presence of a lumbosacral transitional vertebra (LSTV), which is characterized by enlargement of the L5 transverse process(es), with potential pseudoarticulation or fusion with the sacrum. The Castellvi classification system is commonly utilized to grade LSTVs based on the degree of contact between the L5 transverse process(es) and the sacrum. LSTVs present a diagnostic dilemma to the treating clinician, as they may remain unidentified on plain x-rays and even advanced imaging; additionally, even if the malformation is identified, patients with a LSTV may be asymptomatic or have nonspecific symptoms, such as low back pain with or without radicular symptoms. With low back pain being extremely prevalent in the general population; it can be difficult to implicate the LSTV as the source of this pain. Care should be taken however, to exclude Bertolotti Syndrome in patients under 30 years old presenting with persisting low back pain given its congenital origin. If a LSTV is identified, typically with acquisition of a MRI or CT scan of the lumbosacral spine, and there is an absence of a more compelling or obvious source for the patient's symptoms, a conservative, step-wise management plan is recommended. This may include assessing for improvement in symptoms with injections prior to proceeding with surgical intervention. Additional concerns arise from the biomechanical alterations that a LSTV induces in adjacent spinal levels, predisposing this patient population to a more rapid-onset of adjacent segment disease, raising the question as to the most appropriate surgery (resection of LSTV pseudoarticulation with or without fusion). Postoperative outcome data for patients undergoing surgical treatment is limited in the literature with promising, but variable, results. More large-scale, controlled studies must be performed to gain further insight into the ideal work-up and management of this pathology.
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Affiliation(s)
- Kyle McGrath
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Eric Schmidt
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Nicholas Rabah
- Case Western Reserve College of Medicine, Cleveland, OH, USA
| | | | - Michael Steinmetz
- Center for Spine Health, Department of Neurosurgery, Neurologic Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
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18
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Schirmer CM, Cozzens JW, Steinmetz M. A Primer in Socioeconomics for Neurosurgeons with a Global Perspective. World Neurosurg 2021; 151:340. [PMID: 34243666 DOI: 10.1016/j.wneu.2021.05.001] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
| | - Jeffrey W Cozzens
- Division of Neurosurgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Michael Steinmetz
- Department of Neurosurgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
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19
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Kashkoush A, Chakravarthy V, Bain M, Kalfas I, Steinmetz M. Two cases of supratentorial lobar intracranial hemorrhage following lumbar decompression and stabilization. Surg Neurol Int 2021; 12:221. [PMID: 34084648 PMCID: PMC8168694 DOI: 10.25259/sni_271_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 04/07/2021] [Indexed: 11/04/2022] Open
Abstract
Background Lumbar spine surgery with or without intraoperative dural tear (DT) may contribute to postoperative subdural hematomas and/or cerebellar intracranial hemorrhages (ICHs). Here, we present two patients, one with and one without an intraoperative DT occurring during lumbar surgery, both of whom developed acute postoperative supratentorial ICHs. Case Description Two patients developed supratentorial lobar ICH following lumbar decompressions and fusion. The first patient, without an intraoperative DT, developed multiple ICHs involving the left cerebellum and left temporal lobe. The second patient, following an L4-5 decompression/instrumented fusion involving a DT, postoperatively developed a large right frontal ICH. Conclusion Here, two patients undergoing lumbar spine surgery with/without DT subsequently developed significant ICH.
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Affiliation(s)
- Ahmed Kashkoush
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Vikram Chakravarthy
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Mark Bain
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Iain Kalfas
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Michael Steinmetz
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, United States
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20
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Caruso JP, Swartz K, Mazzola C, Ban VS, Singh R, Eldridge C, Schirmer C, Cheng J, Bauer AM, Steinmetz M, Adogwa O. The Financial Impact of the COVID-19 Pandemic on Neurosurgery Practice in Spring 2020. World Neurosurg 2021; 153:e1-e10. [PMID: 33964499 DOI: 10.1016/j.wneu.2021.04.120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 03/10/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has changed health care delivery across the United States. Few analyses have specifically looked at quantifying the financial impact of the pandemic on practicing neurosurgeons. A survey analysis was performed to address this need. METHODS A 19-question survey was distributed to practicing neurosurgeons in the United States and its territories. The questions evaluated respondents' assessments of changes in patient and procedural volume, salary and benefits, practice expenses, staffing, applications for government assistance, and stroke management. Responses were stratified by geographic region. RESULTS The response rate was 5.1% (267/5224). Most respondents from each region noted a >50% decrease in clinic volume. Respondents from the Northeast observed a 76% decrease in procedure volume, which was significantly greater than that of other regions (P = 0.003). Northeast respondents were also significantly more likely to have been reassigned to nonneurosurgical clinical duties during the pandemic (P < 0.001). Most respondents also noted decreased salary and benefits but experienced no changes in overall practice expenses. Most respondents did not experience significant reductions in nursing or midlevel staffing. These trends were not significantly different between regions. CONCLUSIONS The COVID-19 pandemic has led to decreases in patient and procedural volume and physician compensation despite stable practice expenses. Significantly more respondents in the Northeast region noted decreases in procedural volume and reassignment to nonneurosurgical COVID-related medical duties. Future analysis is necessary as the pandemic evolves and the long-term clinical and economic implications become clear.
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Affiliation(s)
- James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Karin Swartz
- Department of Neurological Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Catherine Mazzola
- New Jersey Pediatric Neuroscience Institute, Morristown, New Jersey, USA
| | - Vin Shen Ban
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ravi Singh
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Cody Eldridge
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Clemens Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
| | - Joseph Cheng
- Department of Neurological Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Andrew M Bauer
- Department of Neurological Surgery, University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Michael Steinmetz
- Center for Spine Health, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Owoicho Adogwa
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
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21
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Caruso JP, Adogwa O, Mazzola C, Steinmetz M, Simon SD, Schirmer CM. An Assessment of Neurosurgery Resident Clinical and Socioeconomic Training: The 2013 Council of State Neurosurgical Societies Postresidency Survey Results. World Neurosurg 2021; 151:e28-e36. [PMID: 33722718 DOI: 10.1016/j.wneu.2021.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 12/05/2020] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Council of State Neurosurgical Societies surveyed neurosurgeons applying for oral board certification in 2008 to assess their preparedness to practice. This survey was repeated in 2013 for a subsequent group of board applicants to evaluate the quality of neurosurgery training and identify opportunities for improvement. METHODS Applicants for the American Board of Neurological Surgeons oral examination from 2008 to 2013 were provided an anonymous survey focused on clinical and socioeconomic skills. Survey responses were compared with the published results of a similar survey using an inferential statistical analysis. RESULTS In total, 110 of 655 neurosurgeons responded (response rate 16.8%). Significantly more respondents from the 2013 survey felt prepared to perform the following techniques: angiography, endoscopic surgery, anterior lumbar interbody fusion, posterior lumbar interbody fusion, transforaminal lumbar interbody fusion, kyphoplasty, and deep brain stimulation. Significantly more respondents in 2013 attested to receiving appropriate education on Health Insurance Portability and Accountability Act and pay-for-performance practice models of health care. However, significantly fewer respondents in 2013 felt prepared in open vascular neurosurgery techniques. In both surveys, fewer than 35% of respondents felt adequately prepared in endovascular neurosurgery techniques, medical coding, negotiating an employment contract, and issues regarding practice management and the economics of neurosurgery. CONCLUSIONS The 2013 survey suggests that candidates for board certification in neurosurgery perceive themselves to be adequately prepared to independently perform nearly all neurosurgical procedures. However, additional work is required to optimize neurosurgery training in endovascular procedures and the socioeconomic aspects of neurosurgery practice.
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Affiliation(s)
- James P Caruso
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Owoicho Adogwa
- Department of Neurological Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Catherine Mazzola
- Department of Neurosurgery, New Jersey Pediatric Neuroscience Institute, Morristown, New Jersey, USA
| | - Michael Steinmetz
- Center for Spine Health, Department of Neurosurgery, Neurological Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Scott D Simon
- Department of Neurosurgery, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania, USA
| | - Clemens M Schirmer
- Department of Neurosurgery and Neuroscience Institute, Geisinger Health System and Geisinger Commonwealth School of Medicine, Wilkes-Barre, Pennsylvania, USA; Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria.
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22
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Steinmetz M, Schuster A. Left Ventricular Pathology in Ebstein's Anomaly-Myocardium in Motion: CMR Insights Into Left Ventricular Fibrosis, Deformation, and Exercise Capacity. Circ Cardiovasc Imaging 2021; 14:e012285. [PMID: 33722058 DOI: 10.1161/circimaging.121.012285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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)
- Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine (M.S.), University Medical Center, Georg-August-University, Goettingen, Germany.,Department of Cardiology and Pneumology (A.S.), University Medical Center, Georg-August-University, Goettingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology (A.S.), University Medical Center, Georg-August-University, Goettingen, Germany.,DZHK, German Center for Cardiovascular Research (DZHK), partner site Goettingen (M.S., A.S.)
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23
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Schuster A, Lange T, Backhaus SJ, Strohmeyer C, Boom P, Matz J, Kowallick JT, Steinmetz M, Kutty S, Bigalke B, Desch S, Hasenfuss G, Thiele H, Stiermaier T, Eitel I. Fully automated cardiac assessment for diagnostic and prognostic stratification following myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.260] [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
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiovascular magnetic resonance (CMR) imaging is considered the reference methodology for cardiac morphology and function but requires manual post-processing. Whether novel artificial intelligence (AI) -based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of AI-based analyses.
Methods
CMR data (n = 1017 patients) from two myocardial infarction multi-center trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and AI-based software. Obtained parameters entered regression analyses for prediction of major adverse clinical events (MACE) defined as death, reinfarction or congestive heart failure within one-year after the acute event.
Results
Both manual and uncorrected automated volumetric assessments showed similar impact on outcome on univariate (LVEF HR 0.93, [95% CI 0.91-0.95]; p < 0.001 for manual and HR 0.94 [0.92-0.96]; p < 0.001 for automated) and multivariable analyses (LVEF HR 0.95, [0.92-0.98]; p = 0.001 for manual and HR 0.95 [CI 0.92-0.98]; p = 0.001 for automated). Manual correction of the automated contours did not lead to improved risk prediction (LVEF AUC 0.67 automated vs. 0.68 automated corrected, p = 0.49). There was acceptable agreement (bias: 2.6%, 95% limits of agreement [LOA] -9.1-14.2%, intraclass correlation coefficient [ICC] 0.88 [0.77-0.93] for LVEF) of manual and automated volumetric assessments.
Conclusions
User independent volumetric analyses performed by fully automated software are feasible and results are equally predictive of MACE compared with conventional analyses in patients following myocardial infarction.
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Affiliation(s)
- A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - SJ Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - C Strohmeyer
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - P Boom
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - J Matz
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - JT Kowallick
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - M Steinmetz
- University Medical Center of Gottingen (UMG), Department of Pediatric Cardiology, Goettingen, Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Helen B. Taussig Heart Center, Baltimore, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - T Stiermaier
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - I Eitel
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
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24
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Backhaus SJ, Lange T, George EF, Hellenkamp K, Gertz RJ, Billing M, Wachter R, Steinmetz M, Kutty S, Raaz U, Lotz J, Friede T, Uecker M, Hasenfuß G, Seidler T, Schuster A. Exercise Stress Real-Time Cardiac Magnetic Resonance Imaging for Noninvasive Characterization of Heart Failure With Preserved Ejection Fraction: The HFpEF-Stress Trial. Circulation 2021; 143:1484-1498. [PMID: 33472397 DOI: 10.1161/circulationaha.120.051542] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Right heart catheterization using exercise stress is the reference standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF) but carries the risk of the invasive procedure. We hypothesized that real-time cardiac magnetic resonance (RT-CMR) exercise imaging with pathophysiologic data at excellent temporal and spatial resolution may represent a contemporary noninvasive alternative for diagnosing HFpEF. METHODS The HFpEF-Stress trial (CMR Exercise Stress Testing in HFpEF; URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621. URL: https://dzhk.de/; Unique identifier: DZHK-17) prospectively recruited 75 patients with echocardiographic signs of diastolic dysfunction and dyspnea on exertion (E/e'>8, New York Heart Association class ≥II) to undergo echocardiography, right heart catheterization, and RT-CMR at rest and during exercise stress. HFpEF was defined according to pulmonary capillary wedge pressure (≥15 mm Hg at rest or ≥25 mm Hg during exercise stress). RT-CMR functional assessments included time-volume curves for total and early (1/3) diastolic left ventricular filling, left atrial (LA) emptying, and left ventricular/LA long axis strain. RESULTS Patients with HFpEF (n=34; median pulmonary capillary wedge pressure at rest, 13 mm Hg; at stress, 27 mm Hg) had higher E/e' (12.5 versus 9.15), NT-proBNP (N-terminal pro-B-type natriuretic peptide; 255 versus 75 ng/L), and LA volume index (43.8 versus 36.2 mL/m2) compared with patients with noncardiac dyspnea (n=34; rest, 8 mm Hg; stress, 18 mm Hg; P≤0.001 for all). Seven patients were excluded because of the presence of non-HFpEF cardiac disease causing dyspnea on imaging. There were no differences in RT-CMR left ventricular total and early diastolic filling at rest and during exercise stress (P≥0.164) between patients with HFpEF and noncardiac dyspnea. RT-CMR revealed significantly impaired LA total and early (P<0.001) diastolic emptying in patients with HFpEF during exercise stress. RT-CMR exercise stress LA long axis strain was independently associated with HFpEF (adjusted odds ratio, 0.657 [95% CI, 0.516-0.838]; P=0.001) after adjustment for clinical and imaging measures and emerged as the best predictor for HFpEF (area under the curve at rest 0.82 versus exercise stress 0.93; P=0.029). CONCLUSIONS RT-CMR allows highly accurate identification of HFpEF during physiologic exercise and qualifies as a suitable noninvasive diagnostic alternative. These results will need to be confirmed in multicenter prospective research studies to establish widespread routine clinical use. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03260621. URL: https://dzhk.de/; Unique identifier: DZHK-17.
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Affiliation(s)
- Sören J Backhaus
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Torben Lange
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Elisabeth F George
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Kristian Hellenkamp
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Roman J Gertz
- Department of Diagnostic and Interventional Radiology, University Hospital Cologne, Germany (R.J.G.)
| | - Marcus Billing
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
| | - Rolf Wachter
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Germany (R.W.)
| | - Michael Steinmetz
- Departments of Pediatric Cardiology and Intensive Care Medicine (M.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD (S.K.)
| | - Uwe Raaz
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Joachim Lotz
- Diagnostic and Interventional Radiology (J.L., M.U.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Tim Friede
- Medical Statistics (T.F.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Martin Uecker
- Diagnostic and Interventional Radiology (J.L., M.U.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany (M.U., G.H.)
| | - Gerd Hasenfuß
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
- Cluster of Excellence "Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Germany (M.U., G.H.)
| | - Tim Seidler
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
| | - Andreas Schuster
- From the Department of Cardiology and Pneumology, Georg-August University (S.J.B., T.L., E.F.G., K.H., M.B., R.W., U.R., G.H., T.S., A.S.), University Medical Center Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany (S.J.B., T.L., E.F.G., K.H., M.S., U.R., J.L., T.F., M.U., G.H., T.S., A.S.)
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Jella TK, Desai A, Jella T, Steinmetz M, Kimmell K, Wright J, Wright CH. Geospatial Distribution of Neurosurgeons Age 60 and Older Relative to the Spread of COVID-19. World Neurosurg 2021; 145:e259-e266. [PMID: 33065354 PMCID: PMC7553865 DOI: 10.1016/j.wneu.2020.10.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 08/24/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To perform an ecological study to analyze the geospatial distribution of neurosurgeons ≥60 years old and compare these data with the spread of 2019 novel coronavirus disease (COVID-19) across the United States. METHODS Data regarding distribution of COVID-19 cases were collected from the Environmental Systems Research Institute, and demographic statistics were collected from the American Association of Medical Colleges 2019 State Workforce Reports. These figures were analyzed using geospatial mapping software. RESULTS As of July 5, 2020, the 10 states with the highest number of COVID-19 cases showed older neurosurgical workforce proportions (the proportion of active surgeons ≥60 years old) of 20.6%-38.9%. Among states with the highest number of COVID-19 deaths, the older workforce proportions were 25.0%-43.4%. Connecticut demonstrated the highest with 43.4% of neurosurgeons ≥60 years old. CONCLUSIONS Regional COVID-19 hotspots may coincide with areas where a substantial proportion of the neurosurgical workforce is ≥60 years old. Continuous evaluation and adjustment of local and national clinical practice guidelines are warranted throughout the pandemic era.
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Affiliation(s)
- Tarun K Jella
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Ansh Desai
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Taral Jella
- College of Arts and Sciences, Emory University, Atlanta, Georgia, USA
| | - Michael Steinmetz
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Kristopher Kimmell
- Department of Neurosurgery, Rochester Regional Health and University of Rochester Medical Center, Rochester, New York, USA
| | - James Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Christina Huang Wright
- Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Department of Neurosurgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.
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26
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Messiha D, Halfmann L, Azizy O, Steinmetz M, Rassaf T, Rammos C. Endovascular treatment of peripheral artery disease is associated with improved central hemodynamics and ventricular function. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2381] [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
Background
Peripheral artery disease (PAD) is a major manifestation of atherosclerosis and a risk factor for morbidity and mortality. PAD itself is associated with increased arterial stiffness with impact on cardiac functions. Previous studies have demonstrated that augmentation index (AIx) and central blood pressure (CBP) correlate with increased cardiovascular mortality. This mechanism has been described as arterio-ventricular (AV) coupling with altered ventricular afterload and a depressed ventricular function, measured by global longitudinal strain (GLS). The impact of PAD-related endovascular treatment on arterial stiffness, central hemodynamics and potential impact on AV coupling has not been elucidated until now.
Purpose
Aim of the study was to investigate, if endovascular treatment of PAD improves cardiac function via enhanced central hemodynamics and AV coupling.
Methods
To this aim 77 patients with known symptomatic PAD who underwent interventions in the iliac and femoropopliteal arteries were included in a cross-sectional study. AIx, CBP and GLS were determined using dedicated waveform analysis and echocardiography before and after endovascular treatment.
Results
Mean age was 65.1±10.4 years with 66.2% male patients. Symptoms were classified by Fontaine classification (stage IIb 80.7%, stage III 5.8% and stage IV 13.5%). Iliac vessel intervention was performed in 16 and femoropopliteal intervention in 61 cases. A stentless approach was feasible in 55 patients with DCB treatment and atherectomy.
After endovascular treatment, peripheral perfusion was enhanced (ABI 0.45±0.6 vs 0.81±0.5, p<0.0001). Moreover, central hemodynamics were improved (AIX 33.7±3% vs 27.9±2%, p=0.0008; AP 17.8±2 mmHg vs 14.0±2 mmHg, p=0.0004; central PP 52.4±6 mmHg vs 46.4±6 mmHg, p=0.0001). Impressively, left ventricular function was also significantly improved (GLS −15.7±2.3% vs −17.1±2.8%, p=0.005) with an improvement in AV coupling (PWV/GLS ratio −0.58m/sec% vs −0.56m/sec%, p<0.01).
Conclusion
Our results demonstrate that endovascular treatment of the peripheral vessels is associated with an improvement of central hemodynamics and left ventricular function via enhanced AV coupling. These prognostic relevant markers of cardiovascular disease could point to an overall potential mortality benefit through PAD treatment. Further investigation of the underlying mechanisms of AV coupling in the setting of endovascular treatment of PAD with impact on cardiovascular mortality is needed in this high-risk population.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Messiha
- University hospital Essen, Essen, Germany
| | - L Halfmann
- University hospital Essen, Essen, Germany
| | - O Azizy
- University hospital Essen, Essen, Germany
| | | | - T Rassaf
- University hospital Essen, Essen, Germany
| | - C Rammos
- University hospital Essen, Essen, Germany
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27
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Rammos C, Petrikhovich O, Mahabadi A, Steinmetz M, Lortz J, Hering R, Schulz M, Rassaf T. Prevalence, specialized ambulatory care and guideline-recommended therapy of peripheral vascular diseases in Germany. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2361] [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
Cardiovascular diseases are the leading causes of death in the industrialized world. In addition to coronary heart disease, PAD defines morbidity and is associated with increased mortality. Guideline-recommended therapy and specialized ambulatory care is essential for optimal treatment. Knowledge of the treatment structures, contact with dedicated specialists and pharmacotherapy in the outpatient area are essential for improving treatment, reducing symptoms and finally improve mortality in this high-risk population.
Methods
The study is based on the ambulatory claims data of the panel doctors services according to § 295 SGB V and drug prescription data according to § 300 SGB V. The prevalence of PAD in Germany (medical diagnoses of PAD ICD I70.2–9) was analyzed by age and gender-specific characteristics with a timeframe of 10 years (2009–2018). In addition, the current ambulatory care structure was examined subdivided by vascular specialist (vascular surgeons or angiologists) and primary care physicians (internal medicine or general practitioners). Additionally, the prescription of guideline-recommended pharmacotherapy like statins and antiplatelet inhibitors was analyzed for the years 2009–2016.
Results
An increase of PAD diagnosis was observed with a maximum in 2018 with 2.280.000 patients in Germany. The rise of PAD patients strongly correlates with increased age (age group 50–59: 243.000, age group 60–69: 533.000, age group 70–79: 735.000, age group 75–79: 438.000, age group 80–89: 710.000) and more commonly affects males (55%) than females (45%). Access to vascular specialist was low for all age groups with only 11% of patients receiving care from vascular surgeons and only 9% from angiologists. However, 99% received care by a primary care physician.
The prescription of lipid-lowering drugs and platelet aggregation inhibitors in the current analysis period from 2009–2016 is insufficient, with only 46% receiving statins and 29% receiving antiplatelets and 15% oral anticoagulation,
Conclusion
There are relevant differences in age and gender-specific prevalence of PAD in Germany. In addition to the regular care provided by primary care physicians, PAD patients are in need for specialized vascular care. Guideline recommended prescriptions are alarmingly low in PAD patients. There is a clear need to improve the treatment algorithms in the high-risk PAD population.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- C Rammos
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - O Petrikhovich
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - A Mahabadi
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - M Steinmetz
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - J Lortz
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - R Hering
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - M Schulz
- Central Research Institute for Ambulatory Healthcare in Germany (Zi), Department of Data Science and Healthcare Analyses, Berlin, Germany
| | - T Rassaf
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
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Schuster A, Lange T, Backhaus SJ, Strohmeyer C, Boom PC, Matz J, Kowallick JT, Lotz J, Steinmetz M, Kutty S, Bigalke B, Gutberlet M, de Waha-Thiele S, Desch S, Hasenfuß G, Thiele H, Stiermaier T, Eitel I. Fully Automated Cardiac Assessment for Diagnostic and Prognostic Stratification Following Myocardial Infarction. J Am Heart Assoc 2020; 9:e016612. [PMID: 32873121 PMCID: PMC7726968 DOI: 10.1161/jaha.120.016612] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 12/15/2022]
Abstract
Background Cardiovascular magnetic resonance imaging is considered the reference methodology for cardiac morphology and function but requires manual postprocessing. Whether novel artificial intelligence–based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of artificial intelligence–based, commercially available software analyses. Methods and Results Cardiovascular magnetic resonance data (n=1017 patients) from 2 myocardial infarction multicenter trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and artificial intelligence–based software. Obtained parameters entered regression analyses for prediction of major adverse cardiac events, defined as death, reinfarction, or congestive heart failure, within 1 year after the acute event. Both manual and uncorrected automated volumetric assessments showed similar impact on outcome in univariate analyses (left ventricular EF, manual: hazard ratio [HR], 0.93 [95% CI 0.91–0.95]; P<0.001; automated: HR, 0.94 [95% CI, 0.92–0.96]; P<0.001) and multivariable analyses (left ventricular EF, manual: HR, 0.95 [95% CI, 0.92–0.98]; P=0.001; automated: HR, 0.95 [95% CI, 0.92–0.98]; P=0.001). Manual correction of the automated contours did not lead to improved risk prediction (left ventricular EF, area under the curve: 0.67 automated versus 0.68 automated corrected; P=0.49). There was acceptable agreement (left ventricular EF: bias, 2.6%; 95% limits of agreement, −9.1% to 14.2%; intraclass correlation coefficient, 0.88 [95% CI, 0.77–0.93]) of manual and automated volumetric assessments. Conclusions User‐independent volumetric analyses performed by fully automated software are feasible, and results are equally predictive of major adverse cardiac events compared with conventional analyses in patients following myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00712101 and NCT01612312.
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Affiliation(s)
- Andreas Schuster
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Torben Lange
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Carolin Strohmeyer
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Patricia C Boom
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Jonas Matz
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Institute for Diagnostic and Interventional Radiology University Medical Center GöttingenGeorg-August University Göttingen Germany
| | - Joachim Lotz
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Institute for Diagnostic and Interventional Radiology University Medical Center GöttingenGeorg-August University Göttingen Germany
| | - Michael Steinmetz
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Department of Pediatric Cardiology University Medical Center GöttingenGeorg-August University Göttingen Germany
| | - Shelby Kutty
- Helen B. Taussig Heart Center The Johns Hopkins Hospital and School of Medicine Baltimore MD
| | - Boris Bigalke
- Department of Cardiology Charité Campus Benjamin FranklinUniversity Medical Center Berlin Berlin Germany
| | - Matthias Gutberlet
- Institute of Diagnostic and Interventional Radiology Heart Center Leipzig at University of Leipzig Germany
| | - Suzanne de Waha-Thiele
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center LübeckUniversity Hospital Schleswig-Holstein Lübeck Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute Heart Center Leipzig at University of Leipzig Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute Heart Center Leipzig at University of Leipzig Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center LübeckUniversity Hospital Schleswig-Holstein Lübeck Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center LübeckUniversity Hospital Schleswig-Holstein Lübeck Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
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29
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Becher PM, Schrage B, Weimann J, Smits J, Magnussen C, Reichenspurner H, Goßling A, Rodrigus I, Dumfarth J, de Pauw M, François K, van Caenegem O, Ancion A, Van Cleemput J, Milicic D, Moza A, Schenker P, Röhrich L, Schönrath F, Thul J, Steinmetz M, Schmack B, Ruhparwar A, Warnecke G, Rojas SV, Sandhaus T, Haneya A, Eifert S, Welp H, Ablonczy L, Wagner F, Westermann D, Bernhardt AM, Knappe D, Blankenberg S, Kirchhof P, Zengin E, Sinning C. Clinical characteristics and outcomes of patients with adult congenital heart disease listed for heart and heart‒lung transplantation in the Eurotransplant region. J Heart Lung Transplant 2020; 39:1238-1249. [PMID: 32778365 DOI: 10.1016/j.healun.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/13/2020] [Revised: 07/06/2020] [Accepted: 07/17/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The therapeutic success in patients with congenital heart disease (CHD) leads to a growing number of adults with CHD (adult CHD [ACHD]) who develop end-stage heart failure. We aimed to determine patient characteristics and outcomes of ACHD listed for heart transplantation. METHODS Using data from all the patients with ACHD in 20 transplant centers in the Eurotransplant region from 1999 to 2015, we analyzed patient characteristics, waiting list, and post-transplantation outcomes. RESULTS A total of 204 patients with ACHD were listed during the study period. The median age was 38 years, and 62.3% of the patients were listed in high urgency (HU), and 37.7% of the patients were in transplantable (T)-listing status. A total of 23.5% of the patients died or were delisted owing to clinical worsening, and 75% of the patients underwent transplantation. Median waiting time for patients with HU-listing status was 4.18 months and with T-listing status 9.07 months. There was no difference in crude mortality or delisting between patients who were HU status listed and T status listed (p = 0.65). In multivariable regression analysis, markers for respiratory failure (mechanical ventilation, hazard ratio [HR]: 1.41, 95% CI: 1.11-1.81, p = 0.006) and arrhythmias (anti-arrhythmic medication, HR: 1.42, 95% CI: 1.01-2.01, p = 0.044) were associated with a higher risk of death or delisting. In the overall cohort, post-transplantation mortality was 26.8% after 1 year and 33.4% after 5 years. CONCLUSIONS Listed patients are at high risk of death without differences in the urgency of listing. Respiratory failure requiring invasive ventilation and possibly arrhythmias requiring anti-arrhythmic medication indicate worse outcomes on waiting list.
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Affiliation(s)
- Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany.
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany
| | - Jessica Weimann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | | | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany
| | - Hermann Reichenspurner
- Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany; Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Alina Goßling
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Inez Rodrigus
- Department of Cardiovascular Surgery, Universitair Ziekenhuis Antwerpen, Antwerpen, Belgium
| | - Julia Dumfarth
- Department of Cardiovascular Surgery, University of Innsbruck, Innsbruck, Austria
| | | | - Katrien François
- Cardiovascular Surgery, Universitair Ziekenhuis Gent, Gent, Belgium
| | - Olivier van Caenegem
- Department of Cardiac Research, Université Catholique de Louvain Clinique Saint-Luc, Brussels, Belgium
| | - Arnaut Ancion
- Department of Cardiology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | - Johan Van Cleemput
- Department of Cardiology, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Davor Milicic
- Department of Cardiology, Medical Faculty University of Zagreb, Zagreb, Croatia
| | - Ajay Moza
- Department of Cardiovascular Surgery, University Hospital Aachen, Aachen, Germany
| | - Peter Schenker
- Department of Surgery, University Hospital Bochum, Bochum, Germany
| | - Luise Röhrich
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Felix Schönrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Josef Thul
- Department of Pediatric Cardiology, University Hospital Giessen/Marburg, Giessen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology, University Hospital Göttingen, Göttingen, Germany; Partner Site Göttingen, German Centre of Cardiovascular Research (DZHK), Berlin, Germany
| | - Bastian Schmack
- Department of Cardiovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Arjang Ruhparwar
- Department of Cardiovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Gregor Warnecke
- Department of Cardiovascular Surgery, University Hospital Hannover, Hannover, Germany
| | - Sebastian V Rojas
- Department of Cardiovascular Surgery, University Hospital Hannover, Hannover, Germany
| | - Tim Sandhaus
- Department of Cardiovascular Surgery, University Hospital Jena, Jena, Germany
| | - Assad Haneya
- Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sandra Eifert
- Department of Cardiovascular Surgery, Heart Center Leipzig, Leipzig, Germany
| | - Henryk Welp
- Department of Cardiovascular Surgery, University Hospital Münster, Münster, Germany
| | - László Ablonczy
- Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Florian Wagner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dirk Westermann
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Dorit Knappe
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany; University Hospital Birmingham, Institute of Cardiovascular Sciences, Birmingham, United Kingdom; SWBH and UHB NHS Trusts, Birmingham, United Kingdom
| | - Elvin Zengin
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Christoph Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany; Partner Site Hamburg/Kiel/Lübeck, German Center of Cardiovascular Research (DZHK), Berlin, Germany
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Sheikh SR, Kattan MW, Steinmetz M, Singer ME, Udeh BL, Jehi L. Cost-effectiveness of surgery for drug-resistant temporal lobe epilepsy in the US. Neurology 2020; 95:e1404-e1416. [PMID: 32641528 DOI: 10.1212/wnl.0000000000010185] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/16/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Surgery is an effective but costly treatment for many patients with drug-resistant temporal lobe epilepsy (DR-TLE). We aim to evaluate whether, in the United States, surgery is cost-effective compared to medical management for patients deemed surgical candidates and whether surgical evaluation is cost-effective for patients with DR-TLE in general. METHODS We use a semi-Markov model to assess the cost-effectiveness of surgery and surgical evaluation over a lifetime horizon. We use second-order Monte Carlo simulations to conduct probabilistic sensitivity analyses to estimate variation in model output. We adopt both health care and societal perspectives, including direct health care costs (e.g., surgery, antiepileptic drugs) and indirect costs (e.g., lost earnings by patients and care providers.) We compare the incremental cost-effectiveness ratio to societal willingness to pay (∼$100,000 per quality-adjusted life-year [QALY]) to determine whether surgery is cost-effective. RESULTS Epilepsy surgery is cost-effective compared to medical management in surgically eligible patients by virtue of being cost-saving ($328,000 vs $423,000) and more effective (16.6 vs 13.6 QALY) than medical management in the long run. Surgical evaluation is cost-effective in patients with DR-TLE even if the probability of being deemed a surgical candidate is only 5%. From a societal perspective, surgery becomes cost-effective within 3 years, and 89% of simulations favor surgery over the lifetime horizon. CONCLUSION For surgically eligible patients with DR-TLE, surgery is cost-effective. For patients with DR-TLE in general, referral for surgical evaluation (and possible subsequent surgery) is cost-effective. Patients with DR-TLE should be referred for surgical evaluation without hesitation on cost-effectiveness grounds.
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Affiliation(s)
- Shehryar R Sheikh
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.R.S.); Department of Quantitative Health Sciences (M.W.K., B.L.U.), Department of Neurological Surgery (M.S.), and Epilepsy Center (L.J.), Cleveland Clinic; and Department of Population and Quantitative Health Sciences (M.E.S.), Case Western Reserve University, Cleveland, OH
| | - Michael W Kattan
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.R.S.); Department of Quantitative Health Sciences (M.W.K., B.L.U.), Department of Neurological Surgery (M.S.), and Epilepsy Center (L.J.), Cleveland Clinic; and Department of Population and Quantitative Health Sciences (M.E.S.), Case Western Reserve University, Cleveland, OH
| | - Michael Steinmetz
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.R.S.); Department of Quantitative Health Sciences (M.W.K., B.L.U.), Department of Neurological Surgery (M.S.), and Epilepsy Center (L.J.), Cleveland Clinic; and Department of Population and Quantitative Health Sciences (M.E.S.), Case Western Reserve University, Cleveland, OH
| | - Mendel E Singer
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.R.S.); Department of Quantitative Health Sciences (M.W.K., B.L.U.), Department of Neurological Surgery (M.S.), and Epilepsy Center (L.J.), Cleveland Clinic; and Department of Population and Quantitative Health Sciences (M.E.S.), Case Western Reserve University, Cleveland, OH
| | - Belinda L Udeh
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.R.S.); Department of Quantitative Health Sciences (M.W.K., B.L.U.), Department of Neurological Surgery (M.S.), and Epilepsy Center (L.J.), Cleveland Clinic; and Department of Population and Quantitative Health Sciences (M.E.S.), Case Western Reserve University, Cleveland, OH
| | - Lara Jehi
- From the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University (S.R.S.); Department of Quantitative Health Sciences (M.W.K., B.L.U.), Department of Neurological Surgery (M.S.), and Epilepsy Center (L.J.), Cleveland Clinic; and Department of Population and Quantitative Health Sciences (M.E.S.), Case Western Reserve University, Cleveland, OH.
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31
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Smith GA, Chirieleison S, Levin J, Atli K, Winkelman R, Tanenbaum JE, Mroz T, Steinmetz M. Impact of length of stay on HCAHPS scores following lumbar spine surgery. J Neurosurg Spine 2020; 31:366-371. [PMID: 31151093 DOI: 10.3171/2019.3.spine181180] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 10/24/2018] [Accepted: 03/08/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, completed by patients following an inpatient stay, are utilized to assess patient satisfaction and quality of the patient experience. HCAHPS results directly impact hospital and provider reimbursements. While recent work has demonstrated that pre- and postoperative factors can affect HCAHPS results following lumbar spine surgery, little is known about how these results are influenced by hospital length of stay (LOS). Here, the authors examined HCAHPS results in patients with LOSs greater or less than expected following lumbar spine surgery to determine whether LOS influences survey scores after these procedures. METHODS The authors conducted a retrospective review of HCAHPS surveys, patient demographics, and outcomes following lumbar spine surgery at a single institution. A total of 391 patients who had undergone lumbar spine surgery and had completed an HCAHPS survey in the period between 2013 and 2015 were included in this analysis. Patients were divided into those with a hospital LOS equal to or less than the expected (LTE-LOS) and those with a hospital LOS longer than expected (GTE-LOS). Expected LOS was based on the University HealthSystem Consortium benchmarks. Nineteen questions from the HCAHPS survey were examined in relation to patient LOS. The primary outcome measure was a comparison of "top-box" ("9-10" or "always or usually") versus "low-box" ("1-8" and "somewhat or never") scores on the HCAHPS questions. Secondary outcomes of interest were whether the comorbid conditions of cancer, chronic renal failure, diabetes, coronary artery disease, hypertension, stroke, or depression occurred differently with respect to LOS. Statistical analysis was performed using Fisher's exact test for the 2 × 2 contingency tables and the chi-square test for categorical variables. RESULTS Two hundred fifty-seven patients had an LTE-LOS, whereas 134 patients had a GTE-LOS. The only statistically significant difference in preoperative characteristics between the patient groups was hypertension, which correlated to a shorter LOS. A GTE-LOS was associated with a decreased likelihood of a top-box score for the HCAHPS survey items on doctor listening and pain control. CONCLUSIONS Here, the authors report a decreased likelihood of top-box responses for some HCAHPS questions following lumbar spine surgery if LOS is prolonged. This study highlights the need to further examine the factors impacting LOS, identify patients at risk for long hospital stays, and improve mechanisms to increase the quality and efficiency of care delivered to this patient population.
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Affiliation(s)
| | | | - Jay Levin
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Karam Atli
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Robert Winkelman
- 2Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Thomas Mroz
- 1Center for Spine Health, Cleveland Clinic Foundation; and
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Tirilomis T, Grossmann M, Steinmetz M, Schoendube FA. Biventricular mechanical support bridging to heart transplantation in children and infants: Results from a low-volume transplant center. Pediatr Transplant 2020; 24:e13661. [PMID: 31985118 DOI: 10.1111/petr.13661] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Theodor Tirilomis
- Department of Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
| | - Marius Grossmann
- Department of Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology, University of Göttingen, Göttingen, Germany
| | - Friedrich A Schoendube
- Department of Thoracic, Cardiac, and Vascular Surgery, University of Göttingen, Göttingen, Germany
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Schuster A, Lange T, Backhaus SJ, Strohmeyer C, Matz J, Kowallick J, Lotz J, Steinmetz M, Kutty S, Bigalke B, Gutberlet M, Hasenfuß G, Thiele H, Stiermaier T, Eitel I. ARTIFICIAL INTELLIGENCE BASED FULLY AUTOMATED MYOCARDIAL FUNCTION ASSESSMENT FOR DIAGNOSTIC AND PROGNOSTIC STRATIFICATION FOLLOWING MYOCARDIAL INFARCTION. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32192-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Degener F, Opgen-Rhein B, Wagner R, Boehne M, Boecker D, Reineker K, Wiegand G, Racolta A, Müller G, Kiski D, Rentzsch A, Fischer M, Papakostas K, Ruf B, Hannes T, Khalil M, Kaestner M, Steinmetz M, ÖZcan S, Fischer G, Freudenthal N, Schweigmann U, Pickardt T, Huber C, Messroghli D, Schubert S. Prognostic Parameters for a Severe Disease Course in Pediatric Patients with Suspected Myocarditis: Data from the Prospective Multicenter Registry “MYKKE”. Thorac Cardiovasc Surg 2020. [DOI: 10.1055/s-0040-1705542] [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] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | | | | | | | | | | | - G. Wiegand
- University of Tuebingen, Tuebingen, Germany
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35
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Bunck AC, Baeßler B, Ritter C, Kröger JR, Persigehl T, Pinto Santos D, Steinmetz M, Niehaus A, Bamberg F, Beer M, Ley S, Tiemann K, Beerbaum P, Maintz D, Lotz J. [Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Cardiomyopathies (Myocarditis, Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Siderosis)]. ROFO-FORTSCHR RONTG 2019; 192:e1. [PMID: 31694058 DOI: 10.1055/a-1034-2379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Alexander Christian Bunck
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.,Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Ritter
- Department of Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Robert Kröger
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Daniel Pinto Santos
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Adelheid Niehaus
- Department of Thoracic, Cardiac and Vascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Meinrad Beer
- Department of Radiology, University-Hospital Ulm, Germany
| | - Sebastian Ley
- Department of Radiology, Internistisches Klinikum München-Süd, München, Germany
| | - Klaus Tiemann
- Clinic of Internal Medicine I, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - David Maintz
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joachim Lotz
- Department of Radiology, University Medical Center Göttingen, Göttingen, Germany
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36
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Schubert S, Opgen-Rhein B, Boehne M, Weigelt A, Wagner R, Müller G, Rentzsch A, Zu Knyphausen E, Fischer M, Papakostas K, Wiegand G, Ruf B, Hannes T, Reineker K, Kiski D, Khalil M, Steinmetz M, Fischer G, Pickardt T, Klingel K, Messroghli DR, Degener F. Severe heart failure and the need for mechanical circulatory support and heart transplantation in pediatric patients with myocarditis: Results from the prospective multicenter registry "MYKKE". Pediatr Transplant 2019; 23:e13548. [PMID: 31297930 DOI: 10.1111/petr.13548] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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: 03/10/2019] [Revised: 06/16/2019] [Accepted: 06/22/2019] [Indexed: 01/01/2023]
Abstract
Myocarditis represents an important cause for acute heart failure. MYKKE, a prospective multicenter registry of pediatric patients with myocarditis, aims to gain knowledge on courses, diagnostics, and therapy of pediatric myocarditis. The role of mechanical circulatory support (MCS) in children with severe heart failure and myocarditis is unclear. The aim of this study was to determine characteristics and outcome of patients with severe heart failure requiring MCS and/or heart transplantation. The MYKKE cohort between September 2013 and 2016 was analyzed. A total of 195 patients were prospectively enrolled by 17 German hospitals. Twenty-eight patients (14%) received MCS (median 1.5 years), more frequently in the youngest age group (0-2 years) than in the older groups (P < 0.001; 2-12 and 13-18 years). In the MCS group, 50% received a VAD, 36% ECMO, and 14% both, with a survival rate of 79%. The weaning rate was 43% (12/28). Nine (32%) patients were transplanted, one had ongoing support, and six (21%) died. Histology was positive for myocarditis in 63% of the MCS group. Patients within the whole cohort with age <2 years and/or ejection fraction <30% had a significantly worse survival with high risk for MCS, transplantation, and death (P < 0.001). Myocarditis represents a life-threatening disease with an overall mortality of 4.6% in this cohort. The fulminant form more often affected the youngest, leading to significantly higher rate of MCS, transplantation, and mortality. MCS represents an important and life-saving therapeutic option in children with myocarditis with a weaning rate of 43%.
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Affiliation(s)
- Stephan Schubert
- Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Bernd Opgen-Rhein
- Department for Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Boehne
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Annika Weigelt
- Department for Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Robert Wagner
- Department for Pediatric Cardiology, Herzzentrum Leipzig, Leipzig, Germany
| | - Götz Müller
- Department for Pediatric Cardiology, Universitäres Herzzentrum Hamburg, Hamburg, Germany
| | - Axel Rentzsch
- Department for Pediatric Cardiology, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Edzard Zu Knyphausen
- Department for Pediatric Cardiology, Herz- und Diabetes-zentrum NRW, Bad Oeynhausen, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | | | - Gesa Wiegand
- Department for Pediatric Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Bettina Ruf
- Department for Pediatric Cardiology, Deutsches Herzzentrum München, München, Germany
| | - Tobias Hannes
- Department for Pediatric Cardiology, University Hospital Köln, Köln, Germany
| | - Katja Reineker
- Department for Pediatric Cardiology, Universitäts-Herzzentrum Freiburg Bad Krozingen, Freiburg, Germany
| | - Daniela Kiski
- Department for Pediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Markus Khalil
- Department for Pediatric Cardiology, University Hospital Gießen, Giessen, Germany
| | - Michael Steinmetz
- Department for Pediatric Cardiology, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Gunther Fischer
- Department for Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Daniel R Messroghli
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department for Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Department for Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Degener
- Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Institute for Cardiovascular Computer-assisted Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Bunck AC, Baeßler B, Ritter C, Kröger JR, Persigehl T, Pinto Santos D, Steinmetz M, Niehaus A, Bamberg F, Beer M, Ley S, Tiemann K, Beerbaum P, Maintz D, Lotz J. Structured Reporting in Cross-Sectional Imaging of the Heart: Reporting Templates for CMR Imaging of Cardiomyopathies (Myocarditis, Dilated Cardiomyopathy, Hypertrophic Cardiomyopathy, Arrhythmogenic Right Ventricular Cardiomyopathy and Siderosis). ROFO-FORTSCHR RONTG 2019; 192:27-37. [DOI: 10.1055/a-0998-4116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Backround Structured reports have numerous benefits through standardizing the way imaging findings are reported and communicated. Nevertheless, the adoption of structured reports in everyday radiological practice is still limited. In view of the irrefutable benefits, various national and international radiological societies have started initiatives which aim at promoting a broader use of structured reports. Up to now, no consented templates in German language existed for the reporting of cross-sectional imaging studies of the heart.
Method Upon invitation of the working group for Cardiovascular Imaging of the German Society of Radiology a panel of radiologists, cardiologists, pediatric cardiologists and cardiothoracic surgeons, experts on the field of cardiovascular imaging and structured reporting, met for two interdisciplinary consensus meetings at the University Hospital Cologne in 2018. The aim of these meetings was to develop and agree on templates for the reporting of MR and CT studies of various cardiovascular disease entities.
Results During the meetings the panel of experts developed and reached consensus on 11 different templates for the structured reporting of the following: myocarditis, dilated cardiomyopathy, hypertrophic (obstructive) cardiomyopathy, arrythmogenic right ventricular cardiomyopathy, siderosis, ischemia and vitality imaging, tetralogy of Fallot, aortic coarctation, coronary CT and CT for Transcatheter Aortic Valve Implantation (TAVI) planning. The first five templates are presented in this publication and are currently being transferred to a HTML 5/IHR MRRT compatible format. Subsequently, the templates will be made available for free use on the website www.befundung.drg.de.
Conclusion For the first time, consented templates in German language for the structured reporting of cross-sectional imaging studies of the heart are presented. These templates are aimed at providing a constant level of high reporting quality and increasing the efficiency of the generation and communication of imaging reports.
Key points:
Citation Format
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Affiliation(s)
- Alexander Christian Bunck
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Bettina Baeßler
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Ritter
- Department of Radiology, University Medical Center Göttingen, Göttingen, Germany
| | - Jan Robert Kröger
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Daniel Pinto Santos
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Adelheid Niehaus
- Department of Thoracic, Cardiac and Vascular Surgery, University Medical Center Göttingen, Göttingen, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Meinrad Beer
- Department of Radiology, University-Hospital Ulm, Germany
| | - Sebastian Ley
- Department of Radiology, Internistisches Klinikum München-Süd, München, Germany
| | - Klaus Tiemann
- Clinic of Internal Medicine I, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Philipp Beerbaum
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - David Maintz
- Department of Diagnostic and Interventional Radiology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Joachim Lotz
- Department of Radiology, University Medical Center Göttingen, Göttingen, Germany
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Sheikh SR, Thompson NR, Benzel E, Steinmetz M, Mroz T, Tomic D, Machado A, Jehi L. Can We Justify It? Trends in the Utilization of Spinal Fusions and Associated Reimbursement. Neurosurgery 2019; 86:E193-E202. [DOI: 10.1093/neuros/nyz400] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/17/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
BACKGROUND
Previous reports have suggested an increasing rate of utilization of spinal fusions, but contemporary data have not been analyzed, and there has been little investigation of putative drivers of increased utilization.
OBJECTIVE
To investigate whether there is an ongoing trend of increased utilization of spinal fusions in recent data, and if there may be associations with an increasing proportion of elderly in the population, changing patterns of payer-types, and changing reimbursement rates.
METHODS
We analyze 7.1 million cases from the National Inpatient Sample between 1998 and 2014. We measure annual utilization per 100 000 persons and conduct trend analyses with subgroup analysis of the senior (65 + ) population. Spine surgery utilization is compared with nonspine surgical procedures (coronary artery bypass grafting, hernia repair, hip, and knee replacement). We assess trends in charges, payer type, Medicare reimbursement rates, and hospital type.
RESULTS
There was an 88% increase in the utilization rate of spinal fusion procedures from 1998 to 2014 (from 74 to 139 cases per 100 000 persons) with a significant upward trend (P < .001) that persisted in the 65 + subgroup (P < .001). An increasing proportion of spinal fusions is paid for by public payers, but per-procedure reimbursement for spinal fusions by Medicare has decreased recently (5% reduction from 2014 to 2016).
CONCLUSION
Utilization of spinal fusions continues to increase and is not explained by increased proportion of elderly in the population, increased utilization of surgeries across specialties, or increased Medicare reimbursement. In fact, increased utilization of spinal fusions temporally correlated with decreasing per-procedure Medicare reimbursement.
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Affiliation(s)
- Shehryar Rahim Sheikh
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | - Edward Benzel
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | | | - Thomas Mroz
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Dennis Tomic
- Neurological Institute, Cleveland Clinic, Cleveland, Ohio
| | - Andre Machado
- Department of Neurosurgery, Cleveland Clinic, Cleveland, Ohio
| | - Lara Jehi
- Epilepsy Center, Cleveland Clinic, Cleveland, Ohio
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Rammos C, Halfmann L, Lortz J, Steinmetz M, Janosi A, Rassaf T. P948Rapid and automated risk stratification by determination of aortic stiffness in healthy and cardiovascular diseased. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0542] [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 and aims
Aortic stiffness is an independent predictor of cardiovascular morbidity and mortality and thus simple, rapid and preferably automated techniques are indispensableto persue a global approach in risk statification. A novel oscillometric based carotido-femoral pulse-wave velocity (cfPWV) was investigated, regarding diagnostic accuracy, sensitivity and specificity and with emphasis on costs, training curves and procedural time effort.
Methods
In a single-center crossover study, we evaluated subjects free of known cardiovascular disease (CVD) and CVD subjects and a subgroup with peripheral artery disease (PAD) undergoing ankle-brachial index (ABI) and PWV measurements using oscillometry (BoSo, Bosch + Sohn, Germany) compared to tonometry (SphymoCor, Atcor Australia). Pearson's correlation analysis was used to assess the relationship of PWV measurements for both methods. Moreover, examination times and costs were compared.
Results
A total of 174 study subjects underwent assessment of oscillometric and tonometric PWV measurements. CVD-free subjects (n=57) were younger (60.4±15.6 vs. 67±12.9 years, p=0.003) compared to CVD subjects (n=117). PWV measurements showed significant correlations in CVD-free subjects (r=0.797, p<0.001), in CVD subjects (r=0.817, p<0.001) and the subgroup of PAD subjects (r=0.807, p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value of the oscillometric measurement for detecting arterial stiffness reached 93%, 84%, 86%, and 92%. The examination time of the oscillometric method was shorter compared to tonometry (4.4±0.5 vs. 9.2±0.8 min, p<0.001) in line with reduced costs.
Conclusion
Using a simple and rapid automated oscillometric method, we provide good diagnostic accuracy for the determination of aortic stiffness through PWV, both in CVD-free and in CVD subjects. This might help in terms of cost-effectiveness and simplification in daily practice to screen for cardiovascular morbidity and for vascular damage in atherosclerosis.
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Affiliation(s)
- C Rammos
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - L Halfmann
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - J Lortz
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - M Steinmetz
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - A Janosi
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
| | - T Rassaf
- University of Duisburg-Essen, West German Heart Center, Essen, Germany
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuss G, Kowallick JT, Schuster A. P5284Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0255] [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
Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a “real-world” clinical setting.
Methods
Three-hundred CMR examinations were randomly selected from the local data base. Fully automatic quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software. Parameters were compared to manual assessments. Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF).
Results
Biventricular automatic segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias −2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73–0.91; RV parameters ICC 0.41–0.94) and/or reduced image quality (LV parameters ICC 0.86–0.95; RV parameters ICC 0.56–0.91), which was more common on 3.0T than on 1.5T.
Conclusions
Fully automated assessment of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring is still required.
Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
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Affiliation(s)
| | - W Staab
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - M Steinmetz
- University Medical Center Göttingen, Department of Pediatric Cardiology and Intensive Care Medicine, Goettingen, Germany
| | - C O Ritter
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - G Hasenfuss
- Heart Centre Goettingen, Goettingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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Unterberg-Buchwald C, Fasshauer M, Staab W, Steinmetz M, Kowallick J, Ritter CO. P408Unusual case of pericardial effusion. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.047] [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: 11/14/2022] Open
Affiliation(s)
- C Unterberg-Buchwald
- Universitaetsmedizin Goettingen, Dept. of Cardiology and Pneumology, Insitute of Diag. and Interv. Radiology, Goettingen, Germany
| | - M Fasshauer
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - W Staab
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - M Steinmetz
- Universitatesmedizin Goettingen, Dep.t of Pediatric Cardiology and Intensive Care medicine, Goettingen, Germany
| | - J Kowallick
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - C O Ritter
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
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Unterberg-Buchwald C, Kowallick J, Fasshauer M, Steinmetz M, Backhaus S, Lotz J, Ritter CO. P392Fulminant autoimmune myocarditis in Hashimoto thyreoidtis. Eur Heart J Cardiovasc Imaging 2019. [DOI: 10.1093/ehjci/jez109.033] [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)
- C Unterberg-Buchwald
- Universitaetsmedizin Goettingen, Dept. of Cardiology and Pneumology, Insitute of Diag. and Interv. Radiology, Goettingen, Germany
| | - J Kowallick
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - M Fasshauer
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - M Steinmetz
- Universitatesmedizin Goettingen, Dep.t of Pediatric Cardiology and Intensive Care medicine, Goettingen, Germany
| | - S Backhaus
- Universitatesmedizin, Dept. of Cardiology and Pneumology, Goettingen, Germany
| | - J Lotz
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
| | - C O Ritter
- Institute of Diagn. and Interv. Radiology, Goettingen, Germany
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Abstract
By 2060, population projections estimate the number of individuals older than 65 will double. Prevalence of degenerative spondylolisthesis is reported as 4.1%-11.1% within the general population. Given the growing older population, the need for evidence-based guidance is essential. Regarding benefit derived from decompression alone versus decompression plus fusion for degenerative spondylolisthesis, the consensus is that all patients do not require a fusion; however, clarity around clearly identifying this cohort is lacking. Nevertheless, instrumented fusion is an effective strategy in the elderly. Numerous options exist, and individual patient characteristics as well as surgeon experience should be evaluated when planning surgery.
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Affiliation(s)
- Vikram Chakravarthy
- Department of Neurosurgery, Cleveland Clinic Learner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44106, USA
| | - Arpan Patel
- University of Arizona School of Medicine, 1501 N Campbell Avenue, Tucson, AZ 85724, USA
| | - William Kemp
- Department of Neurosurgery, Cleveland Clinic Learner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44106, USA
| | - Michael Steinmetz
- Department of Neurosurgery, Cleveland Clinic Learner College of Medicine of Case Western Reserve University, 9500 Euclid Avenue, Cleveland, OH 44106, USA.
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuß G, Schuster A, Kowallick JT. Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. J Cardiovasc Magn Reson 2019; 21:24. [PMID: 31023305 PMCID: PMC8059518 DOI: 10.1186/s12968-019-0532-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a "real-world" clinical setting. METHODS Three-hundred CMR examinations were randomly selected from the local data base. Fully automated quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and end-systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software (suiteHEART®, Neosoft, Pewaukee, Wisconsin, USA). Parameters were compared to manual assessments (QMass®, Medis Medical Imaging Systems, Leiden, Netherlands). Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF). RESULTS Biventricular automated segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias - 2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73-0.91; RV parameters ICC 0.41-0.94) and/or reduced image quality (LV parameters ICC 0.86-0.95; RV parameters ICC 0.56-0.91), which was more common on 3.0 T than on 1.5 T. CONCLUSIONS Fully automated assessments of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring are still required.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wieland Staab
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Michael Steinmetz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Christian O. Ritter
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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Morhenn K, Quentin T, Wichmann H, Steinmetz M, Prondzynski M, Söhren KD, Christ T, Geertz B, Schröder S, Schöndube FA, Hasenfuss G, Schlossarek S, Zimmermann WH, Carrier L, Eschenhagen T, Cardinaux JR, Lutz S, Oetjen E. Mechanistic role of the CREB-regulated transcription coactivator 1 in cardiac hypertrophy. J Mol Cell Cardiol 2018; 127:31-43. [PMID: 30521840 DOI: 10.1016/j.yjmcc.2018.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 07/30/2018] [Revised: 11/27/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
The sympathetic nervous system is the main stimulator of cardiac function. While acute activation of the β-adrenoceptors exerts positive inotropic and lusitropic effects by increasing cAMP and Ca2+, chronically enhanced sympathetic tone with changed β-adrenergic signaling leads to alterations of gene expression and remodeling. The CREB-regulated transcription coactivator 1 (CRTC1) is activated by cAMP and Ca2+. In the present study, the regulation of CRTC1 in cardiomyocytes and its effect on cardiac function and growth was investigated. In cardiomyocytes, isoprenaline induced dephosphorylation, and thus activation of CRTC1, which was prevented by propranolol. Crtc1-deficient mice exhibited left ventricular dysfunction, hypertrophy and enlarged cardiomyocytes. However, isoprenaline-induced contractility of isolated trabeculae or phosphorylation of cardiac troponin I, cardiac myosin-binding protein C, phospholamban, and ryanodine receptor were not altered, suggesting that cardiac dysfunction was due to the global lack of Crtc1. The mRNA and protein levels of the Gαq GTPase activating protein regulator of G-protein signaling 2 (RGS2) were lower in hearts of Crtc1-deficient mice. Chromatin immunoprecipitation and reporter gene assays showed stimulation of the Rgs2 promoter by CRTC1. In Crtc1-deficient cardiomyocytes, phosphorylation of the Gαq-downstream kinase ERK was enhanced. CRTC1 content was higher in cardiac tissue from patients with aortic stenosis or hypertrophic cardiomyopathy and from two murine models mimicking these diseases. These data suggest that increased CRTC1 in maladaptive hypertrophy presents a compensatory mechanism to delay disease progression in part by enhancing Rgs2 gene transcription. Furthermore, the present study demonstrates an important role of CRTC1 in the regulation of cardiac function and growth.
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Affiliation(s)
- Karoline Morhenn
- Department of Clinical Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Kiel, Lübeck, Germany
| | - Thomas Quentin
- Department of Clinical Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Helen Wichmann
- Department of Pediatric Cardiology and Intensive Medicine, University Medical Center Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Medicine, University Medical Center Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany; DZHK (German Center for Cardiovascular Research), Partner Site, Göttingen, Germany
| | - Maksymilian Prondzynski
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Kiel, Lübeck, Germany; Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Klaus-Dieter Söhren
- Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Torsten Christ
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Kiel, Lübeck, Germany; Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Birgit Geertz
- Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Sabine Schröder
- Department of Clinical Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Friedrich A Schöndube
- Department of Thoracic-Cardiac and Vascular Surgery, University Medical Center Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuss
- DZHK (German Center for Cardiovascular Research), Partner Site, Göttingen, Germany; Department of Cardiology and Pneumology, University Medical Center Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - Saskia Schlossarek
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Kiel, Lübeck, Germany; Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Wolfram H Zimmermann
- DZHK (German Center for Cardiovascular Research), Partner Site, Göttingen, Germany; Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - Lucie Carrier
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Kiel, Lübeck, Germany; Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Thomas Eschenhagen
- DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Kiel, Lübeck, Germany; Department of Experimental Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Jean-René Cardinaux
- Center for Psychiatric Neuroscience and Service of Child and Adolescent Psychiatry, Department of Psychiatry, University Medical Center, University of Lausanne, 1008 Prilly-Lausanne, Switzerland
| | - Susanne Lutz
- DZHK (German Center for Cardiovascular Research), Partner Site, Göttingen, Germany; Institute of Pharmacology and Toxicology, University Medical Center Göttingen, Robert Koch Str. 40, 37075 Göttingen, Germany
| | - Elke Oetjen
- Department of Clinical Pharmacology and Toxicology, Cardiovascular Research Center, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg, Kiel, Lübeck, Germany; Institute of Pharmacy, University of Hamburg, Bundesstr. 45, 20146 Hamburg, Germany.
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Wisotzki L, Bacon R, Brinchmann J, Cantalupo S, Richter P, Schaye J, Schmidt KB, Urrutia T, Weilbacher PM, Akhlaghi M, Bouché N, Contini T, Guiderdoni B, Herenz EC, Inami H, Kerutt J, Leclercq F, Marino RA, Maseda M, Monreal-Ibero A, Nanayakkara T, Richard J, Saust R, Steinmetz M, Wendt M. Author Correction: Nearly all the sky is covered by Lyman-α emission around high-redshift galaxies. Nature 2018; 563:E31. [PMID: 30377312 DOI: 10.1038/s41586-018-0664-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Change history: In this Letter, author M. Akhlaghi should be associated with affiliation (2) rather than (3). This error has been corrected online.
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Affiliation(s)
- L Wisotzki
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany.
| | - R Bacon
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - J Brinchmann
- Leiden Observatory, Leiden University, Leiden, The Netherlands.,Instituto de Astrofísica e Ciências do Espaço, Universidade do Porto, CAUP, Porto, Portugal
| | - S Cantalupo
- Department of Physics, ETH Zürich, Zürich, Switzerland
| | - P Richter
- Institut für Physik und Astronomie, Universität Potsdam, Potsdam, Germany
| | - J Schaye
- Leiden Observatory, Leiden University, Leiden, The Netherlands
| | - K B Schmidt
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - T Urrutia
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - P M Weilbacher
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - M Akhlaghi
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - N Bouché
- Institut de Recherche en Astrophysique et Planétologie (IRAP), Université de Toulouse, CNRS, Toulouse, France
| | - T Contini
- Institut de Recherche en Astrophysique et Planétologie (IRAP), Université de Toulouse, CNRS, Toulouse, France
| | - B Guiderdoni
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - E C Herenz
- Department of Astronomy, Stockholm University, AlbaNova University Centre, Stockholm, Sweden
| | - H Inami
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - J Kerutt
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - F Leclercq
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - R A Marino
- Department of Physics, ETH Zürich, Zürich, Switzerland
| | - M Maseda
- Leiden Observatory, Leiden University, Leiden, The Netherlands
| | - A Monreal-Ibero
- Instituto de Astrofísica de Canarias (IAC), La Laguna, Tenerife, Spain.,Universidad de La Laguna, Departamento Astrofísica, La Laguna, Tenerife, Spain
| | - T Nanayakkara
- Leiden Observatory, Leiden University, Leiden, The Netherlands
| | - J Richard
- Université Lyon, Université Lyon 1, ENS de Lyon, CNRS, Centre de Recherche Astrophysique de Lyon, Saint-Genis-Laval, France
| | - R Saust
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - M Steinmetz
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany
| | - M Wendt
- Leibniz-Institut für Astrophysik Potsdam (AIP), Potsdam, Germany.,Institut für Physik und Astronomie, Universität Potsdam, Potsdam, Germany
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Pfeifer P, Steinmetz M, Ackerschott A, Dregger H, Jehle J, Nickenig G, Latz E, Zimmer S. P5128Role of CLEC4E expression in development of aortic valve stenosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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 Pfeifer
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | | | - A Ackerschott
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - H Dregger
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - J Jehle
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - G Nickenig
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
| | - E Latz
- University Hospital Bonn, Institute of Innate Immunity Biomedical Center, Bonn, Germany
| | - S Zimmer
- University Hospital Bonn, Department of Internal Medicine II Cardiology, Pneumology, and Angiology, Bonn, Germany
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Steinmetz M, Krause U, Lauerer P, Konietschke F, Aguayo R, Ritter CO, Schuster A, Lotz J, Paul T, Staab W. Diagnosing ARVC in Pediatric Patients Applying the Revised Task Force Criteria: Importance of Imaging, 12-Lead ECG, and Genetics. Pediatr Cardiol 2018; 39:1156-1164. [PMID: 29754204 DOI: 10.1007/s00246-018-1875-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 04/03/2018] [Indexed: 02/07/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a potentially lethal disease that is well described in adults. In pediatric patients, however, identification of patients at risk of adverse events of ARVC remains a challenge. We aimed to determine which criteria of the revised Task Force Criteria (rTFC), alone or combined, have an impact on diagnosis of ARVC when compared to disease-specific genetic mutations in pediatric patients ≤ 18 years. Between September 2010 and December 2013, 48 consecutive young patients ≤ 18 years of age (mean 14, range of 12.9-15.1 years) underwent contrast-enhanced magnetic resonance imaging (CMR), genetic testing, and comprehensive clinical work-up for ARVC criteria to test for clinically suspected ARVC. As specified by the rTFC, patients were grouped into four categories: "definite," "borderline," "possible," and "none" ARVC. Of the 48 patients, 12 were found to have gene mutations of either the desmoplakin (9/12) or plakophilin (3/12) locus. According to rTFC 12/48 patients were considered as "definite" ARVC (25%), while 10/12 (83.3%) had an ARVC-specific gene mutation. Of the remaining 36 patients, 6 (12.5%) were grouped as "borderline" ARVC, 7 (14.6%) as "possible" ARVC (including the remaining two genetic mutations), and 22 (45.8%) as "none" ARVC, respectively. Statistical analysis of ARVC criteria in patients diagnosed with "definite" ARVC revealed high prevalence of positive findings by imaging (CMR and echocardiography) and positive genetics. The positive predictive value to detect "definite" ARVC by genotyping was 83.3%, while the negative predictive value was 94%. Logistic regression analyses for different criteria combinations revealed that imaging modalities (echo and CMR combined) and abnormalities of 12-lead ECG were significant markers (p < 0.01). Positive results of endomyocardial biopsies or arrhythmia on ECG or Holter as defined by the rTFC were not significant in this analysis. The rTFC for ARVC should be used with caution in children and adolescents suspected for ARVC. 12-Lead ECG and imaging modalities (CMR and echo) were of major value, positive results should prompt genetic testing.
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Affiliation(s)
- Michael Steinmetz
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany.
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany.
- Department of Pediatric Cardiology and Intensive Care Medicine, Goettingen Heart Center and DZHK Goettingen, University Medical Center of Georg-August-University, Robert-Koch-Str. 40, 37075, Goettingen, Germany.
| | - Ulrich Krause
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Peter Lauerer
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Frank Konietschke
- Department of Mathematical Sciences, The University of Texas at Dallas, Richardson, TX, USA
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Randolph Aguayo
- College of Medicine, American University of Antigua, Coolidge, Antigua and Barbuda
| | - Christian Oliver Ritter
- Department of Cardiology and Pneumology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Joachim Lotz
- Department of Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
| | - Wieland Staab
- Department of Diagnostic and Interventional Radiology, University Medical Center, Georg-August-University, Goettingen, Germany
- German Center for Cardiovascular Research (DZHK) Partnersite Goettingen, Goettingen, Germany
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Steffen E, Mayer Von Wittgenstein WBE, Nickenig G, Zimmer S, Steinmetz M. P4229Mouse sca1/flk-1 positive cells are no endothelial progenitors but B cells. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4229] [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: 11/12/2022] Open
Affiliation(s)
- E Steffen
- University Hospital Bonn, Cardiology, Bonn, Germany
| | | | - G Nickenig
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - S Zimmer
- University Hospital Bonn, Cardiology, Bonn, Germany
| | - M Steinmetz
- University Hospital of Essen (Ruhr), Cardiology, Essen, Germany
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Rammos C, Burghardt A, Lortz J, Azizy O, Jánosi RA, Steinmetz M, Rassaf T. Impact of anticoagulation and vasoactive medication on regained radial artery patency after catheterization: a case-control study. Eur J Med Res 2018; 23:25. [PMID: 29788990 PMCID: PMC5964909 DOI: 10.1186/s40001-018-0324-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 05/14/2018] [Indexed: 01/10/2023] Open
Abstract
Background Radial artery access is the primary approach for coronary interventions due to higher safety profile in comparison to femoral access. Radial artery occlusion (RAO) is the main complication of transradial catheterization that can lead to severe symptoms and a permanent artery occlusion. The incidence of RAO after transradial access ranges from 5 to 38% and data regarding treatment is scarce. Whether anticoagulation and vasoactive medication provides an additional benefit in recovery of radial artery patency (RAP) after catheterization has not been investigated in detail. Aim The objective was to investigate the impact of anticoagulation and vasoactive medication on regained patency after documented RAO following transradial catheterization. Patients and methods Overall 2635 patients were screened. 2215 (84%) catheterizations were performed by femoral and 420 (16%) by radial access. In 30 patients RAO was observed. In case of RAO patients were classified in three groups: Anticoagulation, anticoagulation added with alprostadil and controls. Follow-up was conducted after 3 months with ultrasound and clinical examination. Results Eight patients received anticoagulation and 11 patients anticoagulation together with alprostadil. Eleven patients served as controls. Recovery of RAP after catheterization was higher following either treatment (79.5%) compared to controls (0%, p = 0.006). Subgroup analysis yielded a higher RAP recovery in patients treated with anticoagulation (62.5%) as compared to controls (0%, p = 0.002). No effect on regained RAP was found with additional alprostadil therapy (33.3%) compared to anticoagulation therapy (62.5%, p = 0.229). Conclusion RAO should be treated with anticoagulation to regain patency. Addition of vasoactive medication does not lead to further beneficial effects. Further research is needed regarding preventive and therapeutic strategies following RAO.
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Affiliation(s)
- C Rammos
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany.
| | - A Burghardt
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - J Lortz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - O Azizy
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - R A Jánosi
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - M Steinmetz
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - T Rassaf
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Medical Faculty, University Hospital Essen, Hufelandstr. 55, 45147, Essen, Germany
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