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Göbel S, Braun AS, Hahad O, von Henning U, Brandt M, Keller K, Gaida MM, Gori T, Schultheiss HP, Escher F, Münzel T, Wenzel P. Etiologies and predictors of mortality in an all-comer population of patients with non-ischemic heart failure. Clin Res Cardiol 2024; 113:737-749. [PMID: 38224373 PMCID: PMC11026225 DOI: 10.1007/s00392-023-02354-6] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 11/29/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Despite progress in diagnosis and therapy of heart failure (HF), etiology and risk stratification remain elusive in many patients. METHODS The My Biopsy HF Study (German clinical trials register number: DRKS22178) is a retrospective monocentric study investigating an all-comer population of patients with unexplained HF based on a thorough workup including endomyocardial biopsy (EMB). RESULTS 655 patients (70.9% men, median age 55 [45/66] years) with non-ischemic, non-valvular HF were included in the analyses. 489 patients were diagnosed with HF with reduced ejection fraction (HFrEF), 52 patients with HF with mildly reduced ejection fraction (HFmrEF) and 114 patients with HF with preserved ejection fraction (HFpEF). After a median follow-up of 4.6 (2.5/6.6) years, 94 deaths were enumerated (HFrEF: 68; HFmrEF: 8; HFpEF: 18), equating to mortality rates of 3.3% and 11.6% for patients with HFrEF, 7.7% and 15.4% for patients with HFmrEF and 5.3% and 11.4% for patients with HFpEF after 1 and 5 years, respectively. In EMB, we detected a variety of putative etiologies of HF, including incidental cardiac amyloidosis (CA, 5.8%). In multivariate logistic regression analysis adjusting for age, sex and comorbidities only CA, age and NYHA functional class III + IV remained independently associated with all-cause mortality (CA: HRperui 3.13, 95% CI 1.5-6.51; p = 0.002). CONCLUSIONS In an all-comer population of patients presenting with HF of unknown etiology, incidental finding of CA stands out to be independently associated with all-cause mortality. Our findings suggest that prospective trials would be helpful to test the added value of a systematic and holistic work-up of HF of unknown etiology.
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Affiliation(s)
- S Göbel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - A S Braun
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - O Hahad
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - U von Henning
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - M Brandt
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - K Keller
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - M M Gaida
- Institute of Pathology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
- TRON, Translational Oncology at the University Medical Center Mainz, Mainz, Germany
| | - T Gori
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - F Escher
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Campus Virchow Klinikum, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - T Münzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - P Wenzel
- Cardiology I - Department of Cardiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany.
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Stoffers B, Bacmeister L, Braeuninger H, Warnke S, Brehm M, Kim S, Yan I, Becher M, Escher F, Klingel K, Zeller T, Kirchhof P, Blankenberg S, Westermann D, Lindner D. GPR15-mediated T cell recruitment during acute viral myocarditis is associated with improved virus elimination and outcome. Cardiovasc Res 2022. [DOI: 10.1093/cvr/cvac066.127] [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: Public grant(s) – National budget only. Main funding source(s): DZHK
Ernst und Berta Grimmke Stiftung
Background
Myocarditis is an inflammatory disease of the myocardium indicated by mononuclear cell infiltration. It is predominantly caused by infectious agents such as coxsackievirus B3 (CVB3). Especially in young adults, myocarditis is a major source of sudden cardiac arrest. However, its clinical course has a broad spectrum of outcomes, ranging from mild symptoms and complete recovery to cardiac dysfunction and dilated cardiomyopathy. G protein-coupled receptor 15 (GPR15) was identified as a T cell homing receptor in the context of inflammatory intestine and skin diseases. We found Gpr15 to be highly upregulated in the left ventricle (LV) 7 days after CVB3 infection in wild type (WT) mice.
Purpose
GPR15 has not been described in a cardiac context, yet. Our aim was to investigate the role of GPR15 in recruiting immune cell subsets and later in virus elimination during viral myocarditis.
Methods
Gpr15 deficient (Gpr15gfp/gfp) and WT mice were infected intraperitoneal with CVB3 to investigate the acute (6 & 7 days post infection(p.i.)) and the subacute phase (16 days p.i.) of myocarditis. To study differentially expressed genes, LV tissue was used for TaqMan analysis and RNA-sequencing. Inflammation and fibrosis were evaluated on histological level. For functional characterization, healthy and diseased mice were hemodynamically characterized 16 days p.i.. Furthermore, in vitro migration assays were used to study the interaction between GPR15 and its ligands in vitro.
Results
Infected Gpr15gfp/gfp mice exhibited higher upregulation of immune response related genes on mRNA level in the acute phase of myocarditis 7 days p.i.. For instance, Cd8a, a cytotoxic T cell marker, and Foxp3, a regulatory T cell marker, were significantly higher in infected Gpr15gfp/gfp compared to infected WT mice. Bulk RNA-sequencing confirmed that the response to virus did not decline from day 6 to 7 in infected GPR15-deficient mice as observed in infected WT mice. Subsequent gene ontology (GO) term analyses reveled enhanced chemotaxis and cytotoxic T cell-related GO terms in GPR15-deficient mice on day 7.
Among investigated T cell subsets, GPR15 was highest expressed on CD8+ T cell. Its deficiency abolished chemotaxis of T cells, especially of cytotoxic T cells, towards GPR15 ligand in vitro.
In the subacute phase of myocarditis 16 days p.i., viral persistence was observed in more than 85 % of Gpr15gfp/gfp mice. In contrast, more than 70 % of WT mice with verified viremia cleared the virus successfully. Furthermore, Gpr15gfp/gfp mice demonstrated a decreased cardiac function accompanied by increased fibrosis in comparison to WT mice.
Conclusion
Our findings indicate that despite the prolonged inflammatory response, scant virus elimination was presumably caused by decelerated recruitment of cytotoxic T cells leading to impaired outcome in the GPR15-deficient mice.
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Affiliation(s)
- B Stoffers
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - L Bacmeister
- University Hospital Heidelberg , Heidelberg , Germany
| | - H Braeuninger
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - S Warnke
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - M Brehm
- University of Siegen , Siegen , Germany
| | - S Kim
- Thomas Jefferson University , Philadelphia , United States of America
| | - I Yan
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - M Becher
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - F Escher
- Charite Universitatsmedizin Berlin , Berlin , Germany
| | - K Klingel
- University Hospital of Tuebingen, Cardiopathology, Institute of Pathology and Neuropathology , Tuebingen , Germany
| | - T Zeller
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - D Westermann
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
| | - D Lindner
- University Heart & Vascular Center Hamburg, Department of Cardiology , Hamburg , Germany
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Baumeier C, Escher F, Pietsch H, Aleshcheva G, Schultheiss HP. Plasminogen activator inhibitor-1 (PAI-1) is anti-fibrogenic in human inflammatory cardiomyopathy. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1729] [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/Introduction
Preclinical data indicate that plasminogen activator inhibitor-1 (PAI-1) is cardioprotective by repressing cardiac fibrosis through TGF-β and plasminogen mediated pathways. In addition it is linked to the recruitment and polarization of non-classical M2 macrophages in cancer.
Purpose
The role of cardiac PAI-1 in fibrogenesis and macrophage polarization is investigated in patients with dilated cardiomyopathy (DCM) and inflammatory dilated cardiomyopathy (DCMi).
Methods
We retrospectively analyzed endomyocardial biopsies (EMBs) of patients with DCM (n=27) and DCMi (n=149) for PAI-1 expression, number of activated myofibroblasts and M1/M2 macrophage polarization.
Results
Patients with high-grade DCMi (DCMi-high, CD3+ lymphocytes >30 cells/mm2) had significantly increased PAI-1 levels compared to DCM and low grade DCMi patients (DCMi-low, CD3+ lymphocytes = 14 - 30 cells/mm2) (15.5±0.4% vs. 1.0±0.1% and 4.0±0.1%, p≤0.001). Elevated PAI-1 expression in DCMi-high subjects was accompanied by a reduced number of alpha smooth muscle actin (α-SMA) positive myofibroblasts and an increased number of CD16+ CD68+ M2 macrophages, indicating anti-fibrogenic and M2 macrophage-favoring properties of PAI-1 in DCMi.
Conclusion
Our findings give evidence that elevated expression of PAI-1 suppresses cardiac fibrosis and promotes M2 macrophage polarization. Thus, PAI-1 could serve as a potential prognostic biomarker of cardiac fibrosis and inflammation, as well as possible therapeutic target in inflammatory cardiomyopathies.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ERA-Net on Cardiovascular Diseases (ERA-CVD) of the German Research Foundation (DFG)Transregional Collaborative Research Center “Inflammatory Cardiomyopathy-Molecular Pathogenesis and Therapy”
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Affiliation(s)
- C Baumeier
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - H Pietsch
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - G Aleshcheva
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Goebel S, Schwuchow-Thonke S, Hahad O, Brandt M, Von Henning U, Escher F, Karbach S, Braun A, Gori T, Schultheiss H, Muenzel T, Wenzel P. Prevalence and outcome of cardiac amyloidosis in an all-comer population of patients with non-ischaemic heart failure. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0846] [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
Cardiac amyloidosis (CA) is increasingly recognized as an underlying cause of heart failure with preserved ejection fraction (HFpEF), associated with high morbidity and mortality. However, most studies, solely investigated the prevalence of CA in special subgroups including HFpEF and severe aortic valve disease.
Purpose
With the present study we sought to investigate prevalence of different phenotypes of CA in an all comer-population of patients with non-ischaemic heart failure (HF) and to analyze the impact of CA on all-cause mortality.
Methods
The My Biopsy HF-Study (German clinical trials register number: 22178) is a retrospective monocentric study investigating the underlying etiology of HF in an all-comer population of patients with HF of unknown etiology. Patients presenting with symptoms of HF at the University Medical Centre between 14/10/2012 and 01/03/2021, who underwent endomyocardial biopsy (EMB) were enrolled in the present study. Ischaemic HF and valvular HF were ruled out prior to EMB. Specimens were sent for further examination to a specialized laboratory approved by the Food and Drug Administration
Results
Between October 2012 and March 2021, 767 patients (71.6% men) with HF of unknown etiology were included. Mean age at the time of presentation was 55.4 years (±14.4). Altogether, 72.5% of the patients presented with HF with reduced ejection fraction (HFrEF), 7.1% were diagnosed with HF with mid-range ejection fraction (HFmrEF) and 20.4% with HFpEF. Based on histological examination and genotyping, CA was diagnosed in 44 (5.7%) patients (immunglobulin light chain [AL] CA: 15 patients; variant transthyretin [ATTRv] CA: 6 patients; wild type transthyretin [ATTRwt] CA: 21 patients; de novo CA: 2 patients). Patients with CA were older compared with patients without CA (69.4±11.4 vs. 54.1±14.5; p<0.0001), had a higher prevalence of arterial hypertension (68.2% vs. 50.9%; p=0.045) and showed a better left ventricular ejection fraction based on echocardiographic examination (47.5% vs. 32.6%; p<0.0001). With respect to biomarker expression, levels of both brain natriuretic peptide and high-sensitive troponin I were significantly higher in patients without CA (BNP: 914.1 vs 612; p=0.01; troponin I: 812.8 vs. 171.7; p=0.006). In univariate logistic regression analysis CA was associated with a significant all-cause mortality (hazard ratio [HR] per unit increase [ui], 5.17, 95% CI, 2.93–9.08; p<0.0001), even after adjustment for classical cardiovascular risk factors (HRperui 3.12, 95% CI, 1.11–8.76; p=0.03) and comorbidities like chronic obstructive pulmonary disease, chronic kidney disease and stroke (HRperui 2.93, 95% CI, 1.2–7.15; p=0.018).
Conclusions
Among patients presenting with HF of unknown etiology, including patients with HFpEF, HFmrEF and HFrEF, cardiac amyloidosis is the underlying cause of HF in 5.7% of patients and is independently associated with all-cause mortality.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Goebel
- University Medical Center, Department of Cardiology, Mainz, Germany
| | | | - O Hahad
- University Medical Center, Department of Cardiology, Mainz, Germany
| | - M Brandt
- University Medical Center, Department of Cardiology, Mainz, Germany
| | - U Von Henning
- University Medical Center, Department of Cardiology, Mainz, Germany
| | - F Escher
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - S Karbach
- University Medical Center, Department of Cardiology, Mainz, Germany
| | - A.S Braun
- University Medical Center, Department of Cardiology, Mainz, Germany
| | - T Gori
- University Medical Center, Department of Cardiology, Mainz, Germany
| | - H.P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - T Muenzel
- University Medical Center, Department of Cardiology, Mainz, Germany
| | - P Wenzel
- University Medical Center, Department of Cardiology, Mainz, Germany
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5
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Arendt C, De Leuw P, Haberl A, Kann G, Wolf T, Stephan C, Schuettfort G, Arcari L, Vasquez M, Albrecht M, Escher F, Vogl T, Zeiher A, Nagel E, Puntmann V. Outcomes of cardiovascular magnetic resonance imaging in people living with HIV. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.028] [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
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction
People living with human immunodeficiency virus (HIV, PLWH) are at increased risk of cardiovascular disease (CVD). HIV infection and accelerated traditional risk factors due to highly-active antiretroviral therapy (HAART) are proposed mechanisms for increased rate of heart failure (HF). The pathophysiological drivers of myocardial dysfunction and worse cardiovascular outcome in HIV remain poorly understood.
Purpose
To examine prognostic relationships of cardiac imaging measures with cardiovascular outcome in PLWH on HAART.
Methods
This is a prospective observational longitudinal study using cardiac magnetic resonance (CMR) imaging in consecutive PLHWH on long-term HAART who were screened for underlying CVD and followed up clinically for adjudicated adverse cardiovascular events (cardiovascular mortality, non-fatal acute coronary syndrome, an appropriate device discharge, or a documented HF hospitalization). Imaging protocol included routine assessment of cardiac volumes and function, scar by late gadolinium enhancement, myocardial perfusion and native T1 /T2 mapping. Time-to-event analysis was performed from the index CMR exam to the first single event per patient Systematic risk scores for CVD (Framingham risk score (FRS), Data Collection on Adverse effects of anti-HIV Drugs score, D:A:D and MAGGIC integer score) were calculated using original online calculators.
Results
156 participants (males 62%, 50 [42-57] years of age) were included. 24 events were observed (4 HF deaths, 1 sudden cardiac death, 2 non-fatal acute myocardial infarction, 1 appropriate device discharge and 16 HF hospitalizations) during a median follow-up of 13 [9-19] months. Patients with events had higher native T1 (ms, 1149 [1115-1163] ms vs. 1110 [1075-1138] ms), native T2 (ms, 40 [38-41] vs. 37 [36-39]), LV mass index (g/m², 65 [49-77] vs. 57 [49-64]) p < 0.05 for all). In multivariable analyses, native T1 was independently predictive of adverse events (ChiSq 15.9, p < 0.001, native T1 (10 ms) hazard ratio (95% confidence interval) 1.20 (1.08-1.33), p = 0.001), followed by a model that also included LV mass (ChiSq 17.1, p < 0.001). Traditional cardiovascular risk scores were not predictive of the adverse events.
Conclusions
Native myocardial T1 and LV mass by CMR, as opposed to traditional cardiovascular risk scores, predict cardiovascular outcome in PLWH, together reflecting the pathological myocardial remodeling of myocardial fibrosis and inflammation that potentially explain higher rates of HF in PLWH as compared to the non-infected population. These findings may inform personalized approaches to screening and early intervention to reduce the burden of HF.
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Affiliation(s)
- C Arendt
- Goethe University Hospital, Frankfurt, Germany
| | - P De Leuw
- Infektiologikum, Frankfurt am Main, Germany
| | - A Haberl
- Goethe University Hospital, Frankfurt, Germany
| | - G Kann
- Infektiologikum, Frankfurt am Main, Germany
| | - T Wolf
- Goethe University Hospital, Frankfurt, Germany
| | - C Stephan
- Goethe University Hospital, Frankfurt, Germany
| | | | - L Arcari
- Sapienza University of Rome, Rome, Italy
| | - M Vasquez
- Enrique Baltodano Briceño Hospital, Liberia, Costa Rica
| | - M Albrecht
- Goethe University Hospital, Frankfurt, Germany
| | - F Escher
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - T Vogl
- Goethe University Hospital, Frankfurt, Germany
| | - A Zeiher
- Goethe University Hospital, Frankfurt, Germany
| | - E Nagel
- Goethe University Hospital, Frankfurt, Germany
| | - V Puntmann
- Goethe University Hospital, Frankfurt, Germany
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Schwuchow-Thonke S, Göbel S, Emrich T, Schmitt VH, Fueting F, Klank C, Escher F, Schultheiss HP, Münzel T, Keller K, Wenzel P. Increased C reactive protein, cardiac troponin I and GLS are associated with myocardial inflammation in patients with non-ischemic heart failure. Sci Rep 2021; 11:3008. [PMID: 33542341 PMCID: PMC7862434 DOI: 10.1038/s41598-021-82592-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 05/28/2020] [Accepted: 01/18/2021] [Indexed: 11/09/2022] Open
Abstract
Inflammatory cardiomyopathy diagnosed by endomyocardial biopsy (EMB) is common in non-ischemic heart failure (HF) and might be associated with adverse outcome. We aimed to identify markers predicting myocardial inflammation in HF. We screened 517 patients with symptomatic non-ischemic HF who underwent EMB; 397 patients (median age 54 [IQR 43/64], 28.7% females) were included in this study. 230 patients were diagnosed with myocardial inflammation, defined as ≥ 7.0 CD3+ lymphocytes/mm2 and/or ≥ 35.0 Mac1 macrophages/mm2 and were compared to 167 inflammation negative patients. Patients with myocardial inflammation were more often smokers (52.4% vs. 39.8%, p = 0.013) and had higher C-reactive protein (CRP) levels (5.4 mg/dl vs. 3.7 mg/dl, p = 0.003). In logistic regression models CRP ≥ 8.15 mg/dl (OR 1.985 [95%CI 1.160–3.397]; p = 0.012) and Troponin I (TnI) ≥ 136.5 pg/ml (OR 3.011 [1.215–7.464]; p = 0.017) were independently associated with myocardial inflammation, whereas no association was found for elevated brain natriuretic peptide (OR 1.811 [0.873–3.757]; p = 0.111). In prognostic performance calculation the highest positive predictive value (90%) was detected for the combination of Global longitudinal strain (GLS) ≥ -13.95% and TnI ≥ 136.5 pg/ml (0.90 (0.74–0.96)). Elevated CRP, TnI and GLS in combination with TnI can be useful to detect myocardial inflammation. Smoking seems to predispose for myocardial inflammation.
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Affiliation(s)
- S Schwuchow-Thonke
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - S Göbel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - T Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center Mainz (Johannes Gutenberg University Mainz), Mainz, Germany
| | - V H Schmitt
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Fueting
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - C Klank
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany
| | - F Escher
- Departement of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany
| | - H P Schultheiss
- Institut Kardiale Diagnostik Und Therapie (IKDT), Moltkestrasse 31, 12203, Berlin, Germany
| | - T Münzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
| | - K Keller
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - P Wenzel
- Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Langenbeckstr. 1, 55131, Mainz, Germany. .,Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany.
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7
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Abstract
BACKGROUND Point-of-care ultrasound (POCUS) of the lung in patients with COVID-19 plays a key role in the emergency room and intensive care unit. Lung ultrasound is able to depict typical pulmonary findings of COVID-19 and is therefore suitable for diagnosis and follow-up of these patients. CLINICAL/METHODOLOGICAL ISSUE Lung ultrasound in COVID-19 patients in the emergency room and intensive care unit. STANDARD RADIOLOGICAL METHODS Computed tomography (low-dose CT) and X‑ray of the lung. METHODOLOGICAL INNOVATIONS Lung ultrasound in COVID-19 patients. RECOMMENDATIONS Lung ultrasound in patients with COVID-19 offers similar performance as CT and is superior when compared to X‑ray in evaluating pneumonia and acute respiratory distress syndrome (ARDS). Lung ultrasound plays an important role in the emergency room and intensive care unit. POCUS reduces exposure to radiation, therapy delays, and minimizes transport of high-risk patients. Differential diagnoses can also be clarified.
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Affiliation(s)
- M Schmid
- Klinik für Gastroenterologie, Pneumologie, Internistische Akut- und Intensivmedizin, München Klinik Harlaching, Sanatoriumsplatz 2, München, 81545, Deutschland
| | - F Escher
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschallzentrum, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - D-A Clevert
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschallzentrum, Klinikum der Ludwig-Maximilians-Universität München, Campus Großhadern, Marchioninistraße 15, 81377, München, Deutschland.
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8
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Poller W, Klaassen S, Haas J, Kaya Z, Mochmann HC, Gast M, Escher F, Kayvanpour E, Berger F, Monserrat L, Klingel K, Meder B, Landmesser U. P3688Familial recurrent autoimmune myocarditis associated with a truncating nonsense mutation of the desmoplakin gene. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0542] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Arrhythmogenic cardiomyopathy (AC) is an important cause of ventricular arrhythmias in children and young adults. AC is associated with mutation of desmosomal proteins, however, cardiac disease penetrance is incomplete and the clinical course varies widely without recognizable exogenous or epi/genetic co-factors. Importantly, DSP mutation carriers may also display entirely non-cardiac e.g. dermatological phenotypes.
Methods and results
In two brothers with recurrent fulminant myocarditis, mutation screening of 218 cardiomyopathy-related genes identified a truncating mutation Arg1458* of desmoplakin (DSP). DSP immunhistology unexpectedly revealed complete loss (“knockout”) of DSP protein in endomyocardial biopsies (EMBs), but none of the histological anomalies of AC. Criteria for histological diagnosis of myocarditis were not either fulfilled, and cardiac MRI revealed no features associated with AC. Screening for infections was negative, there was no substance abuse, medication or vaccination. Possible disease triggers were competitive sport events. Myosin and troponin I autoantibodies were detected at titers up to 1:320.
We used allele-specific RT-PCR to distinguish if the patients' allele classified as “normal” was actually defective due to promotor mutation or epigenetic silencing. RT-PCRs were done on EMBs and peripheral blood mononuclear cells (PBMCs). In a cohort of dilated cardiomyopathy (DCM) patients we were able to detect DSP transcripts in both, PBMC and left-ventricular heart tissue. RNA sequencing of human PBMC subpopulations suggested that DSP transcription may be restricted to certain immune cell subtypes. RT-PCRs revealed that both Arg1458* carriers have a functional second DSP allele, indicating that their “DSP knockout” occurs at the protein level and may be due to protein instability and degradation within desmosomes.
We screened additional existing cohorts for such variants and identified stopgain variant Gln307Ter in a 37-yrs-old woman with ARVC. This patient's sister died from heart failure at the age of 39. In a 59-yrs-old female LVNC patient, stopgain variant Y1391X was identified. Here, family history was unclear, her brother probably died from coronary artery disease. In a 71-yrs-old female DCM patient with no family history, stopgain variant Tyr1512Ter was identified.
Conclusions
The described patients with DSP truncations strongly suggest the existence of additional genetic or exogenous modifiers driving pathogenesis either way. DSP defects may cause recurrent myocarditis, and mutation screening is advisable to enable early detection of high-risk patients with similar phenotypes. Our finding of complete myocardial DSP protein loss emphasizes that DNA sequencing may miss critical molecular disturbances. It is indispensable to also analyze transcriptome and protein level in the tissue actually affected in a patient in order to recognize his/her individual pathogenesis.
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Affiliation(s)
- W Poller
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - S Klaassen
- Charite University Hospital, Pediatric Cardiology, Berlin, Germany
| | - J Haas
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - Z Kaya
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | | | - M Gast
- Charite - Campus Benjamin Franklin, Berlin, Germany
| | - F Escher
- Charité - Universitätsmedizin Berlin, Cardiology, Berlin, Germany
| | - E Kayvanpour
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - F Berger
- Charite University Hospital, Pediatric Cardiology, Berlin, Germany
| | - L Monserrat
- Instituto Universitario de Ciencias de la Salud, Health in Code, A Coruna, Spain
| | - K Klingel
- University Hospital, Pathology, Tübingen, Germany
| | - B Meder
- University Hospital of Heidelberg, Cardiology, Heidelberg, Germany
| | - U Landmesser
- Charite - Campus Benjamin Franklin, Berlin, Germany
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Escher F, Agirbasli M, Lassner D, Aleshcheva G, Schultheiss HP. P6450Plasminogen activator inhibitor type-1 (PAI-1) expression relates to the presence of myocardial inflammation in patients with nonischemic cardiomyopathy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1043] [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
Plasminogen activator inhibitor type-1 (PAI-1) is an important inhibitor of the fibrinolytic pathway and an acute phase reactant in response to inflammatory cytokines, resulting in thrombosis, arteriosclerosis, and tissue fibrosis. It has been identified as a potential biomarker for coronary artery disease and metabolic syndrom. However, so far, nothing is known about its importance in nonischemic cardiomyopathy.
Aims
To analyzed PAI-1 expression in patients with different forms of cardiomyopathies and evaluate possible influence of PAI-1-dependent pathomechanisms in patients with intramyocardial inflammation.
Methods and results
In this study, endomyocardial biopsies (EMBs) from 309 patients (mean age 48.0±13.9 years) with different forms of cardiomyopathies were enrolled, including 123 patients with dilated cardiomyopathy (DCM) (mean LVEF 28.01±9.06%) and 186 patients with EMB-proven virus-negative inflammatory cardiomyopathy (DCMi) (mean LVEF 31.76±14.14%). 10 patients (mean LVEF 60.50±4.76%) without viral or inflammation in EMB served as controls. Hemodynamic parameters were measured by catheterization and echocardiography. EMBs were performed at first admission after exclusion of ischemic of valvular heart disease. In EMBs PAI-1 was assessed by immunohistology including digital imaging analysis. PAI-1 expression was significantly higher in patients with DCMi in contrast to DCM patients and controls (0.517±2.20 vs. 0.187±0.598 vs. 0.023±0.032% Area Fraction; p=0.0002). PAI-expression correlates significantly with lymphocytic infiltrates (for CD3 r=0.56, p<0.0001, and LFA-1 r=0.59, p<0.0001). This was found to be independent of hemodynamic parameters, and age.
Conclusion
Myocardial inflammation is associated with a significant increase in PAI-1 expression in DCMi independently of the hemodynamic conditions. This new pathophysiological axis could be a potiential therapeutic target in future treatment stategies in DCMi.
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Affiliation(s)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - M Agirbasli
- Medeniyet University, Cardiology, Istanbul, Turkey
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - G Aleshcheva
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Zainal Abidin HA, Klingel K, Rolf A, Keller T, Zhou H, Vasquez M, Escher F, Lassner D, Vasa-Nicotera M, Zeiher A, Schultheiss P, Nagel E, Puntmann V. 5035Comparative assessment of diagnostic algorithms of myocardial inflammation by endomyocardial biopsy and tissue mapping by CMR against high-sensitive troponin in viral myocarditis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0038] [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
Myocarditis is defined by inflammatory involvement of the myocardium, either histologically by evidence of myocardial necrosis and cellular infiltration on endomyocardial biopsy (EMB), or non-invasively by presence of myocardial oedema using tissue mapping with cardiovascular magnetic resonance (CMR). Objective: to undertake intra-individual comparisons of EMB vs. CMR diagnostic algorithms of myocardial inflammation, as well as against an independent gold-standard of myocardial injury, high-sensitive troponin (hs-TropT).
Methods
Prospective multicentre study of consecutive patients (n=109) with clinical diagnosis of myocarditis. EMBs were analysed by 2 reference centres using the ESC diagnostic and their local algorithms. The CMR criteria used sequence-specific cut-offs for native T1 and T2 (standard deviation, SD); myocardial inflammation T1 ≥2SD, T2 ≥2SD and no inflammation: T1 and T2<2SD, with subcategories for acute/high-grade: T1 ≥5SD, T2 ≥2SD; chronic/low-grade: T1 ≥2SD, T2 ≥2SD; healed: T1 <2SD, T2 <2SD but myocardial impairment and non-inflammatory cardiomyopathy: T1 ≥2SD, T2 <2SD.
Results
The agreement between ESC criteria and CMR criteria (AUC: 0.56, p=0.381) was poor. There was a significant agreement between myocardial injury (hs-TropT ≥13.9 ng/L) and CMR criteria (AUC: 0.84, p<0.001), but not ESC algorithm. hs-TropT levels had significant associations with native T1 and T2 (r=0.37 and 0.35, p<0.001), but not with immunohistochemical inflammatory markers. Viral presence was similarly proportioned between inflammatory/non-inflammatory subjects, irrespective of the algorithm.
AUC of CMR and EMB versus hs-TroponinT
Conclusions
Poor agreement between CMR and EMB-based diagnostic algorithms suggests non-overlapping definitions of myocardial inflammatory involvement. Excellent agreement between CMR algorithm and hs-TropT reiterates its high sensitivity for inflammatory myocardial injury.
Acknowledgement/Funding
1. National Institute for Health Research (NIHR) Biomedical Research Centre 2. German Centre for Cardiovascular Research (DZHK)
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Affiliation(s)
- H A Zainal Abidin
- Department of Cardiology, Universiti Teknologi MARA (UiTM), Sungai Buloh, Malaysia
| | - K Klingel
- Institute for Pathology and Neuropathology, University Hospital Tubingen, Tubingen, Germany
| | - A Rolf
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - T Keller
- Department of Cardiology, Kerckhoff Hospital, University Giessen, Bad Nauheim, Germany
| | - H Zhou
- Department of Radiology, Xiang Ya Hospital, Central South University, Changsha, China
| | - M Vasquez
- Department of Cardiology, Enrique Baltodano Briceno Hospital, Liberia, Costa Rica
| | - F Escher
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - M Vasa-Nicotera
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - A Zeiher
- Department of Cardiology, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - E Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - V Puntmann
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Frankfurt, Frankfurt am Main, Germany
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Escher F, Pietsch HP, Gross UG, Lassner DL, Schultheiss HP. 2425Evaluation of myocardial gene expression profiling for superior diagnosis of idiopathic giant cell myocarditis in a large cohort of patients with acute cardiac decompensation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0173] [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
Idiopathic giant cell myocarditis (IGCM) diagnostics is based on differential patterns of inflammatory cell infiltration, and multinucleated giant cells (GCs) in histological sections of endomyocardial biopsies (EMBs). However, the sampling error is high for the detection of focally GCs by histopathology. We report on a clinical evaluation of a recently published method for improved differential diagnosis of this frequently fatal disease by myocardial gene expression profiling.
Objective
This is to improve the diagnostics of IGCM by gene expression profiling, and to demonstrate the feasibility of this method in clinical practice in a large cohort of patients.
Methods
In this multicenter study, EMBs of n=427 patients with clinically acute cardiac decompensation and suspected acute myocarditis were screened (mean age 47.03±15.69 years). In each patient, EMBs were analyzed by histology, immunohistology, molecular virology, and gene expression profiling.
Results
Out of the total of n=427 patient samples examined, GCs could be detected in 26 cases (6.0%) by histology. An established myocardial gene profile – consisting of 27 genes – was revealed resulting in a specified profile of 5 genes (chemokine receptor 5 (CCR5), chemokine receptor 6 (CCR6); carnitine palmitoyltransferase I (CPT1), toll-like receptor 8 (TLR8), and chemokine (C-C motif) ligand 20 (CCL20)) which identified histologically proven IGCM with high specificity in 25 of the 26 patients (96.2%). Applying this newly established profiling on the remaining patient samples, additional n=31 (7.3%) patients were identified for IGCM without any histological proof of myocardial GCs.
Conclusions
Myocardial gene expression profiling is a reliable method in clinical practice to predict IGCM even without direct histological proof of GCs in EMB section. The gene profiling is of high clinical relevance to overcome the sampling error of purely histological examination, and to control the effectiveness of the therapy. The data clearly show the importance to take EMB in unexplained acute decompensation to get a diagnosis and improve the prognosis.
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Affiliation(s)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - H P Pietsch
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - U G Gross
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - D L Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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12
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Escher F, Kuehl U, Lassner D, Pieske B, Poller W, Schultheiss HP. P4532High cytotoxic cells infiltration and male gender predict adverse long-term mortality in patients with inflammatory cardiomyopathy (CMi). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4532] [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)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - U Kuehl
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - W Poller
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Escher F, Siegismuns CS, Lassner D, Gross U, Linke R, Schultheiss HP. P683Intramyocardial inflammation correlates with poor prognosis in patients with cardiac AL amyloidosis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p683] [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)
- F Escher
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - C S Siegismuns
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - D Lassner
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - U Gross
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
| | - R Linke
- amYmed, Reference Center of Amyloid Diseases, Martinsried, Germany
| | - H P Schultheiss
- Institute of Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany
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Escher F, Kuehl U, Lassner D, Gross U, Schultheiss HP. P5141Biopsy-based diagnosis in a large cohort of 2822 consecutive patients with unexplained heart failure. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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15
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Escher F, Kuehl U, Lassner D, Poller W, Pieske B, Tschoepe C, Schultheiss HP. P2574A 10 years observation study in patients with virus-negative inflammatory cardiomyopathy after immunosuppressive treatment. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Escher F, Kühl U, Gross U, Westermann D, Poller W, Tschöpe C, Lassner D, Schultheiss HP. Aggravation of left ventricular dysfunction in patients with biopsy-proven cardiac human herpesvirus A and B infection. J Clin Virol 2015; 63:1-5. [DOI: 10.1016/j.jcv.2014.11.026] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 11/16/2014] [Accepted: 11/22/2014] [Indexed: 11/27/2022]
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Escher F, Lassner D, Kühl U, Gross U, Westermann D, Poller W, Skurk C, Weitmann K, Hoffmann W, Tschöpe C, Schultheiss HP. Analysis of endomyocardial biopsies in suspected myocarditis—Diagnostic value of left versus right ventricular biopsy. Int J Cardiol 2014; 177:76-8. [DOI: 10.1016/j.ijcard.2014.09.071] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/17/2014] [Indexed: 12/18/2022]
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Lassner D, Kuhl U, Siegismund CS, Rohde M, Elezkurtaj S, Escher F, Tschope C, Gross UM, Poller W, Schultheiss HP. Improved diagnosis of idiopathic giant cell myocarditis and cardiac sarcoidosis by myocardial gene expression profiling. Eur Heart J 2014; 35:2186-95. [DOI: 10.1093/eurheartj/ehu101] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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20
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Kuhl U, Lassner D, Dorner A, Rohde M, Escher F, Seeberg B, Hertel E, Tschope C, Skurk C, Gross UM, Schultheiss HP, Poller W. Erratum to: A distinct subgroup of cardiomyopathy patients characterized by transcriptionally active cardiotropic erythrovirus and altered cardiac gene expression. Basic Res Cardiol 2013. [DOI: 10.1007/s00395-013-0394-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kasner M, Sinning DL, Escher F, Lassner D, Kuehl U, Schultheiss HP, Tschoepe C. Global longitudinal 2D strain for evaluation of myocarditis as proven by endomyocardial biopsy. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p2912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lassner D, Rohde M, Gross UM, Escher F, Schultheiss HP, Linke RP, Kühl U. Classification of four chemically different amyloid types in routine endomyocardial biopsies by advanced immunohistochemistry. Amyloid 2011; 18 Suppl 1:76-8. [PMID: 21838439 DOI: 10.3109/13506129.2011.574354027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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]
Affiliation(s)
- D Lassner
- Institute of Cardiac Diagnostics and Therapy IKDT, Berlin, Germany
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Escher F, Westermann D, Gaub R, Pronk J, Bock T, Al-Saadi N, Kuhl U, Schultheiss HP, Tschope C. Development of diastolic heart failure in a 6-year follow-up study in patients after acute myocarditis. Heart 2010; 97:709-14. [PMID: 21134904 DOI: 10.1136/hrt.2010.199489] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Westermann D, Lindner D, Kasner M, Zietsch C, Savvatis K, Escher F, von Schlippenbach J, Skurk C, Steendijk P, Riad A, Poller W, Schultheiss HP, Tschöpe C. Cardiac inflammation contributes to changes in the extracellular matrix in patients with heart failure and normal ejection fraction. Circ Heart Fail 2010; 4:44-52. [PMID: 21075869 DOI: 10.1161/circheartfailure.109.931451] [Citation(s) in RCA: 432] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND The pathophysiology of heart failure with normal ejection fraction (HFNEF) is still under discussion. Here we report the influence of cardiac inflammation on extracellular matrix (ECM) remodeling in patients with HFNEF. METHODS AND RESULTS We investigated left ventricular systolic and diastolic function in 20 patients with HFNEF and 8 control patients by conductance catheter methods and echocardiography. Endomyocardial biopsy samples were also obtained, and ECM proteins as well as cardiac inflammatory cells were investigated. Primary human cardiac fibroblasts were outgrown from the endomyocardial biopsy samples to investigate the gene expression of ECM proteins after stimulation with transforming growth factor-β. Diastolic dysfunction was present in the HFNEF patients compared with the control patients. In endomyocardial biopsy samples from HFNEF patients, we found an accumulation of cardiac collagen, which was accompanied by a decrease in the major collagenase system (matrix metalloproteinase-1) in the heart. Moreover, a subset of inflammatory cells, which expressed the profibrotic growth factor transforming growth factor-β, could be documented in the HFNEF patients. Stimulation of primary human cardiac fibroblasts from HFNEF patients with transforming growth factor-β resulted in transdifferentiation of fibroblasts to myofibroblasts, which produced more collagen and decreased the amount of matrix metalloproteinase-1, the major collagenase in the human heart. A positive correlation between cardiac collagen, as well as the amount of inflammatory cells, and diastolic dysfunction was evident and suggests a direct influence of inflammation on fibrosis triggering diastolic dysfunction. CONCLUSIONS Cardiac inflammation contributes to diastolic dysfunction in HFNEF by triggering the accumulation of ECM.
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Affiliation(s)
- Dirk Westermann
- Department of Cardiology and Pneumology, Charité, Universititäts-Medizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, Germany.
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27
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Escher F, Roth F. L'hypophysectomie transéthmoïdale dans les cas de cancer mammaire métastasant. Stereotact Funct Neurosurg 2010. [DOI: 10.1159/000105186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Escher F. Démonstrations cliniques: Deux cas rares de thrombophlébite postotitique avec complications endocraniennes. Stereotact Funct Neurosurg 2009. [DOI: 10.1159/000105647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Kratzer A, Handschin S, Lehmann V, Gross D, Escher F, Conde-Petit B. Hydration Dynamics of Durum Wheat Endosperm as Studied by Magnetic Resonance Imaging and Soaking Experiments. Cereal Chem 2008. [DOI: 10.1094/cchem-85-5-0660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A. Kratzer
- Institute of Food Science and Nutrition, ETH Zurich, CH-8092 Zurich, Switzerland
| | - S. Handschin
- Institute of Food Science and Nutrition, ETH Zurich, CH-8092 Zurich, Switzerland
| | - V. Lehmann
- Bruker-Biospin GmbH, D-76287 Rheinstetten/Germany
| | - D. Gross
- Bruker-Biospin GmbH, D-76287 Rheinstetten/Germany
| | - F. Escher
- Institute of Food Science and Nutrition, ETH Zurich, CH-8092 Zurich, Switzerland
| | - B. Conde-Petit
- Institute of Food Science and Nutrition, ETH Zurich, CH-8092 Zurich, Switzerland
- Corresponding author. Phone: +41 44 632 37 31. Fax: +41 44 632 11 23. E-mail:
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Conde-Petit B, Brunnschweiler J, Konan G, Tschannen A, Escher F. Prozesstechnische Möglichkeiten zur Verarbeitung von Yam zu Grundstoffen und Lebensmitteln in Westafrika. CHEM-ING-TECH 2005. [DOI: 10.1002/cite.200590087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Affiliation(s)
- S. Hug-Iten
- Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
| | - F. Escher
- Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
| | - B. Conde-Petit
- Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
- Corresponding author. Phone: +41 1 632 37 31. Fax: +41 1 632 11 23. E-mail:
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Affiliation(s)
- C. Zweifel
- Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH) Zurich, CH-8092 Zurich, Switzerland
| | - S. Handschin
- Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH) Zurich, CH-8092 Zurich, Switzerland
| | - F. Escher
- Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH) Zurich, CH-8092 Zurich, Switzerland
| | - B. Conde-Petit
- Institute of Food Science and Nutrition, Swiss Federal Institute of Technology (ETH) Zurich, CH-8092 Zurich, Switzerland
- Corresponding author. Phone: +41 1 632 37 31. Fax: +41 1 632 11 23. E-mail:
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39
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Escher F. Book Reviews. Lebensm Wiss Technol 2002. [DOI: 10.1006/fstl.2002.0905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Melzig MF, Escher F. Induction of neutral endopeptidase and angiotensin-converting enzyme activity of SK-N-SH cells in vitro by quercetin and resveratrol. Pharmazie 2002; 57:556-8. [PMID: 12227197] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
Quercetin and resveratrol are weak inhibitors of neutral endopeptidase (NEP) and angiotensin-converting enzyme (ACE) activity of the neuroblastoma cell line SK-N-SH. The long term incubation of the cells for 4 days with quercetin, resveratrol and a combination of both substances in concentrations lower than necessary for inhibition of NEP and ACE activity induced the cellular enzyme activity of NEP and ACE associated with an inhibition of cellular proliferation. The long term treatment of neuroblastoma cells with quercetin and resveratrol enhanced the differentiation state of the cells. Taking into account the significance of NEP and ACE for the degradation of amyloid beta peptides, the effect of quercetin and resveratrol as constituents of red wine for a neuroprotective activity is discussed.
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Affiliation(s)
- M F Melzig
- Institut für Pharmazie, Humboldt-Universität zu Berlin, Germany.
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Affiliation(s)
- S. Hug-Iten
- Institute of Food Science, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
| | - F. Escher
- Institute of Food Science, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
| | - B. Conde-Petit
- Institute of Food Science, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
- Corresponding author. E-mail: Phone: +41 1 632 3731. Fax: +41 1 632 1123
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Scheeder M, Casutt MM, Roulin M, Escher F, Dufey PA, Kreuzer M. Fatty acid composition, cooking loss and texture of beef patties from meat of bulls fed different fats. Meat Sci 2001; 58:321-8. [DOI: 10.1016/s0309-1740(01)00037-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/1999] [Revised: 07/12/2000] [Accepted: 01/03/2001] [Indexed: 11/30/2022]
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Abstract
Starch, in particular the linear amylose, is able to form inclusion complexes with a wide spectrum of ligand molecules, among them flavor compounds. The complexing ability of a homologous series of gamma- and delta-lactones with potato starch was followed by amperometric iodine titration, differential scanning calorimetry, and wide-angle X-ray diffraction measurements. Lactones with a linear chain of a size > or = C(5) form inclusion complexes with starch, whereas lactones with a short linear chain, such as gamma-heptalactone, show poor complexing ability. The thermal stability of starch-lactone complexes increases with increasing chain length of the lactone. In general, lactones induce the formation of V(h) helices. Only delta-decalactone complexes with starch were not definitely identified as V(h) amylose helices. Complexation of starch dispersions with lactones induce turbidity and gelation or phase separation, both phenomena being the result of microphase separation.
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Affiliation(s)
- C Heinemann
- Swiss Federal Institute of Technology (ETH) Zurich, Institute of Food Science, CH-8092 Zurich, Switzerland
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Schaller E, Zenhäusern S, Zesiger T, Bosset JO, Escher F. Use of preconcentration techniques
applied to a MS-based “Electronic Nose”. ACTA ACUST UNITED AC 2000. [DOI: 10.1051/analusis:2000145] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Affiliation(s)
- C. Zweifel
- Institute of Food Science, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
| | - B. Conde-Petit
- Institute of Food Science, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
- Corresponding author. Phone: +41 1 632 37 31. Fax: +41 1 632 11 23. E-mail:
| | - F. Escher
- Institute of Food Science, Swiss Federal Institute of Technology (ETH), CH-8092 Zurich, Switzerland
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Affiliation(s)
- D. Benczédi
- Institute of Polymers, Institute of Food Science, Swiss Federal Institute of Technology ETH, 8092 Zurich, Switzerland
| | - I. Tomka
- Institute of Polymers, Institute of Food Science, Swiss Federal Institute of Technology ETH, 8092 Zurich, Switzerland
| | - F. Escher
- Institute of Polymers, Institute of Food Science, Swiss Federal Institute of Technology ETH, 8092 Zurich, Switzerland
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Affiliation(s)
- D. Benczédi
- Institute of Polymers, Institute of Food Science, Swiss Federal Institute of Technology ETH, 8092 Zurich, Switzerland
| | - I. Tomka
- Institute of Polymers, Institute of Food Science, Swiss Federal Institute of Technology ETH, 8092 Zurich, Switzerland
| | - F. Escher
- Institute of Polymers, Institute of Food Science, Swiss Federal Institute of Technology ETH, 8092 Zurich, Switzerland
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Escher F. Handbook of industrial seasonings. Lebensm Wiss Technol 1995. [DOI: 10.1016/0023-6438(95)90038-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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