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Rolfs N, Huber C, Schwarzkopf E, Mentzer D, Keller-Stanislawski B, Opgen-Rhein B, Frede W, Rentzsch A, Hecht T, Boehne M, Grafmann M, Kiski D, Graumann I, Foth R, Voges I, Schweigmann U, Ruf B, Fischer M, Wiegand G, Klingel K, Pickardt T, Friede T, Messroghli D, Schubert S, Seidel F. Clinical course and follow-up of pediatric patients with COVID-19 vaccine-associated myocarditis compared to non-vaccine-associated myocarditis within the prospective multicenter registry-"MYKKE". Am Heart J 2024; 267:101-115. [PMID: 37956921 DOI: 10.1016/j.ahj.2023.11.006] [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: 07/18/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Since the onset of widespread COVID-19 vaccination, increased incidence of COVID-19 vaccine-associated myocarditis (VA-myocarditis) has been noted, particularly in male adolescents. METHODS Patients <18 years with suspected myocarditis following COVID-19 vaccination within 21 days were enrolled in the PedMYCVAC cohort, a substudy within the prospective multicenter registry for pediatric myocarditis "MYKKE." Clinical data at initial admission, 3- and 9-months follow-up were monitored and compared to pediatric patients with confirmed non-vaccine-associated myocarditis (NVA-myocarditis) adjusting for various baseline characteristics. RESULTS From July 2021 to December 2022, 56 patients with VA-myocarditis across 15 centers were enrolled (median age 16.3 years, 91% male). Initially, 11 patients (20%) had mildly reduced left ventricular ejection fraction (LVEF; 45%-54%). No incidents of severe heart failure, transplantation or death were observed. Of 49 patients at 3-months follow-up (median (IQR) 94 (63-118) days), residual symptoms were registered in 14 patients (29%), most commonly atypical intermittent chest pain and fatigue. Diagnostic abnormalities remained in 23 patients (47%). Of 21 patients at 9-months follow-up (259 (218-319) days), all were free of symptoms and diagnostic abnormalities remained in 9 patients (43%). These residuals were mostly residual late gadolinium enhancement in magnetic resonance imaging. Patients with NVA-myocarditis (n=108) more often had symptoms of heart failure (P = .003), arrhythmias (P = .031), left ventricular dilatation (P = .045), lower LVEF (P < .001) and major cardiac adverse events (P = .102). CONCLUSIONS Course of COVID-19 vaccine-associated myocarditis in pediatric patients seems to be mild and differs from non-vaccine-associated myocarditis. Due to a considerable number of residual symptoms and diagnostic abnormalities at follow-up, further studies are needed to define its long-term implications.
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Affiliation(s)
- Nele Rolfs
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Cynthia Huber
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Eicke Schwarzkopf
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dirk Mentzer
- Paul-Ehrlich-Institut - Federal Institute for Vaccines and Biomedicines, Langen, Germany
| | | | - Bernd Opgen-Rhein
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Wiebke Frede
- Pediatric Cardiology and Congenital Heart Defects, Center for Pediatrics, University Hospital Heidelberg, Heidelberg, Germany
| | - Axel Rentzsch
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg (Saar), Germany
| | - Tobias Hecht
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany
| | - Martin Boehne
- Department of Pediatric Cardiology and Intensive Care Medicine, Hannover Medical School, Hannover, Germany
| | - Maria Grafmann
- Department of Pediatric Cardiology, Children's Heart Clinic, University Heart & Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Kiski
- Department of Pediatric Cardiology, University Hospital Muenster, Muenster, Germany
| | - Iva Graumann
- Department of Pediatrics, Martin-Luther-Universität Halle-Wittenberg, Halle, Germany
| | - Rudi Foth
- Department of Pediatric Cardiology, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Luebeck/Kiel, Kiel, Germany
| | | | - Bettina Ruf
- Department of Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Marcus Fischer
- Department of Pediatric Cardiology and Pediatric Intensive Care, Ludwig Maximilians University of Munich, Munich, Germany
| | - Gesa Wiegand
- Department of Pediatric Cardiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology, University Hospital Tuebingen, Tuebingen, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Tim Friede
- Medical Statistics, Universitätsmedizin Goettingen, Goettingen, Germany
| | - Daniel Messroghli
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Stephan Schubert
- Center of Congenital Heart Disease and Pediatric Cardiology, Heart- and Diabetes Center NRW and University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Franziska Seidel
- Department of Congenital Heart Disease - Pediatric Cardiology, Deutsches Herzzentrum der Charité, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Berlin, Germany
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Schöffl I, Holler S, Dittrich S, Pickardt T, Opgen-Rhein B, Boehne M, Wannenmacher B, Reineke K, Wiegand G, Hecht T, Kaestner M, Messroghli D, Schubert S, Seidel F, Weigelt A. Myocarditis and sports in the young: data from a nationwide registry on myocarditis-"MYKKE-Sport". Front Sports Act Living 2023; 5:1197640. [PMID: 37435596 PMCID: PMC10331598 DOI: 10.3389/fspor.2023.1197640] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Background Myocarditis represents one of the most common causes of Sudden Cardiac Death in children. Myocardial involvement during a viral infection is believed to be higher as a consequence of intensive exertion. Recommendations for return to sports are based on cohort and case studies only. This study aims to investigate the relationship between physical activity and myocarditis in the young. Patient Every patient in the MYKKE registry fulfilling criteria for suspicion of myocarditis was sent a questionnaire regarding the physical activity before, during and after the onset of myocarditis. Method This study is a subproject within the MYKKE registry, a multicenter registry for children and adolescents with suspected myocarditis. The observation period for this analysis was 93 months (September 2013-June 2021). Anamnestic, cardiac magnetic resonance images, echocardiography, biopsy and laboratory records from every patient were retrieved from the MYKKE registry database. Results 58 patients (mean age 14.6 years) were enrolled from 10 centers. Most patients participated in curricular physical activity and 36% in competitive sports before the onset of myocarditis. There was no significant difference of heart function at admission between the physically active and inactive subjects (ejection fraction of 51.8 ± 8.6% for the active group vs. 54.4 ± 7.7% for the inactive group). The recommendations regarding the return to sports varied widely and followed current guidelines in 45%. Most patients did not receive an exercise test before returning to sports. Conclusion Sports before the onset of myocarditis was not associated with a more severe outcome. There is still a discrepancy between current literature and actual recommendations given by health care providers. The fact that most participants did not receive an exercise test before being cleared for sports represents a serious omission.
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Affiliation(s)
- Isabelle Schöffl
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
- School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, Great Britain
| | - Sophia Holler
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Sven Dittrich
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Bernd Opgen-Rhein
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, 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
| | - Katja Reineke
- Department for Paediatric Cardiology, University Heart Center Freiburg, Freiburg, Germany
| | - Gesa Wiegand
- Department for Paediatric Cardiology, University Hospital Tübingen, Tübingen, Germany
| | - Tobias Hecht
- Heart- and Diabetes Center North Rhine-Westphalia, Center of Pediatric Cardiology and Congenital Heart Disease, Ruhr University Bochum, Bad Oeynhausen, Germany
| | | | - Daniel Messroghli
- Department of Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Cardiology, Charité-Universitätsmedizin, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
| | - Stephan Schubert
- Heart- and Diabetes Center North Rhine-Westphalia, Center of Pediatric Cardiology and Congenital Heart Disease, Ruhr University Bochum, Bad Oeynhausen, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Franziska Seidel
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Centre for Cardiovascular Research, Berlin, Germany
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine,Charité-Universitätsmedizin Berlin, 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, Berlin, Germany
| | - Annika Weigelt
- Department of Pediatric Cardiology, Friedrich-Alexander-Universität, Erlangen-Nürnberg, Germany
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3
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Paul T, Klingel K, Tschöpe C, Bertram H, Seidel F. Leitlinie Myokarditis der Deutschen Gesellschaft für
Pädiatrische Kardiologie. Klin Padiatr 2023; 235:e1-e15. [PMID: 37094605 DOI: 10.1055/a-2039-2604] [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] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
This consensus statement presents updated recommendations on diagnosis and treatment of myocarditis in childhood.
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Affiliation(s)
- Thomas Paul
- Universitätsmedizin Göttingen Klinik für Pädiatrische Kardiologie und Intensivmedizin, Göttingen, Deutschland
| | - Karin Klingel
- Universitätshospital Tübingen, Institut für Pathologie und Neuropathologie, Tübingen, Deutschland
| | - Carsten Tschöpe
- Charité Universitätsmedizin Berlin, Kardiologie, Berlin, Deutschland
| | - Harald Bertram
- Medizinische Hochschule Hannover, Klinik für Pädiatrische Kardiologie und Pädiatrische Intensivmedizin, Hannover, Deutschland
| | - Franziska Seidel
- Charité Universitätsmedizn Berlin, Pädiatrische Kardiologie, Berlin, Deutschland
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4
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Rolfs N, Seidel F, Opgen-Rhein B, Böhne M, Wannenmacher B, Hecht T, Mannert J, Reineker K, Rentzsch A, Grafmann M, Wiegand G, Kiski D, Fischer M, Ruf B, Papakostas K, Hellwig R, Foth R, Kaestner M, Kramp J, Voges I, Blank A, Tarusinov G, Schweigmann U, Oezcan S, Graumann I, Knirsch W, Pickardt T, Schwarzkopf E, Klingel K, Messroghli D, Schubert S. Mechanical Circulatory Support, Heart Transplantation and Death in a Large-Scale Population of the Multicenter Registry for Suspected Pediatric Myocarditis - "MYKKE". J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.687] [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: 04/05/2023] Open
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5
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Schöffl I, Dittrich S, Pickardt T, Seidel F, Opgen-Rhein B, Böhne M, Hecht T, Rentzsch A, Kaestner M, Weigelt A. Myocarditis and Sports in the Young: Data from a Nationwide Registry on Myocarditis—MYKKE-Sport. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761866] [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: 03/22/2023]
Affiliation(s)
- I. Schöffl
- Universitätsklinikum Erlangen, Kinderkardiologische Abteilung, Erlangen, Deutschland
| | - S. Dittrich
- Universitätsklinikum Erlangen, Kinderkardiologische Abteilung, Erlangen, Deutschland
| | - T. Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Deutschland
| | - F. Seidel
- Augustenburger Platz 1, Berlin, Deutschland
| | - B. Opgen-Rhein
- Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - M. Böhne
- Pediatric Cardiology, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - T. Hecht
- HDZ NRW, Bad Oeynhausen, Deutschland
| | - A. Rentzsch
- Pediatric Cardiology, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | | | - A. Weigelt
- Universitätsklinikum Erlangen, Kinderkardiologische Abteilung, Erlangen, Deutschland
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6
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Rolfs N, Schwarzkopf E, Mentzer D, Opgen-Rhein B, Hellwig R, Frede W, Rentzsch A, Hecht T, Böhne M, Kiski D, Graumann I, Foth R, Fischer G, Voges I, Schweigmann U, Ruf B, Fischer M, Pattathu J, Wiegand G, Kramp J, Pickardt T, Messroghli D, Schubert S, Seidel F. Clinical Course and Short-Term Follow-up of SARS-CoV-2 Vaccine–Related Myocarditis in Children and Adolescents within the Prospective German Registry for Suspected Myocarditis “MYKKE”. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761868] [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: 03/22/2023]
Affiliation(s)
- N. Rolfs
- German Heart Institute Berlin, Berlin, Deutschland
| | | | - D. Mentzer
- Paul Ehrlich Institute, Langen (Hessen), Deutschland
| | - B. Opgen-Rhein
- Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - R. Hellwig
- University Hospital Heidelberg, Heidelberg, Deutschland
| | - W. Frede
- University Hospital Heidelberg, Heidelberg, Deutschland
| | - A. Rentzsch
- Pediatric Cardiology, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - T. Hecht
- HDZ NRW, Bad Oeynhausen, Deutschland
| | - M. Böhne
- Pediatric Cardiology, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - D. Kiski
- Pediatric Cardiology, Universitätsklinikum Münster, Münster, Deutschland
| | - I. Graumann
- University Hospital Halle (Saale), Halle (Saale), Deutschland
| | - R. Foth
- University Medicine Göttingen, Göttingen, Deutschland
| | - G. Fischer
- University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - I. Voges
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | | | - B. Ruf
- Pediatric Cardiology, Deutsches Herzzentrum München, Munich, Deutschland
| | - M. Fischer
- Ludwig Maximilian University of Munich, München, Deutschland
| | - J. Pattathu
- Ludwig Maximilian University of Munich, München, Deutschland
| | - G. Wiegand
- Department of Pediatric Cardiology, University of Tuebingen, Deutschland
| | - J. Kramp
- Uniklinik Köln, Köln, Deutschland
| | - T. Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Deutschland
| | - D. Messroghli
- Department for Cardiology, Deutsches Herzzentrum Berlin, Berlin, Deutschland
| | | | - F. Seidel
- Augustenburger Platz 1, Berlin, Deutschland
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7
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Thurner L, Kessel C, Fadle N, Regitz E, Seidel F, Kindermann I, Lohse S, Kos I, Tschöpe C, Kheiroddin P, Kiblboeck D, Hoffmann MC, Bette B, Carbon G, Cetin O, Preuss KD, Christofyllakis K, Bittenbring JT, Pickardt T, Fischer Y, Thiele H, Baldus S, Stangl K, Steiner S, Gietzen F, Kerber S, Deneke T, Jellinghaus S, Linke A, Ibrahim K, Grabmaier U, Massberg S, Thilo C, Greulich S, Gawaz M, Mayatepek E, Meyer-Dobkowitz L, Kindermann M, Birk E, Birk M, Lainscak M, Foell D, Lepper PM, Bals R, Krawczyk M, Mevorach D, Hasin T, Keren A, Kabesch M, Abdul-Khaliq H, Smola S, Bewarder M, Thurner B, Böhm M, Pfeifer J, Klingel K. IL-1RA Antibodies in Myocarditis after SARS-CoV-2 Vaccination. N Engl J Med 2022; 387:1524-1527. [PMID: 36130012 PMCID: PMC9513854 DOI: 10.1056/nejmc2205667] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | | | | | | | | | | | | | - Igor Kos
- Saarland University, Homburg, Germany
| | | | | | | | | | | | | | | | | | | | | | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin, Germany
| | - Yvan Fischer
- Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany
| | | | | | - Karl Stangl
- Charité University Medicine Berlin, Berlin, Germany
| | | | - Frank Gietzen
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | - Sebastian Kerber
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | - Thomas Deneke
- Cardiovascular Center Bad Neustadt-Saale, Bad Neustadt-Saale, Germany
| | | | - Axel Linke
- Technische Universität Dresden, Dresden, Germany
| | | | | | | | | | | | | | - Ertan Mayatepek
- University Children's Hospital Duesseldorf, Duesseldorf, Germany
| | | | | | - Einat Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Merav Birk
- Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | | | - Dirk Foell
- University Children's Hospital Muenster, Muenster, Germany
| | | | | | | | | | - Tal Hasin
- Shaare Zedek Medical Center, Jerusalem, Israel
| | - Andre Keren
- Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Michael Kabesch
- University Children's Hospital Regensburg, Regensburg, Germany
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8
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Doeblin P, Jahnke C, Schneider M, Al-Tabatabaee S, Goetze C, Weiss KJ, Tanacli R, Faragli A, Witt U, Stehning C, Seidel F, Elsanhoury A, Kühne T, Tschöpe C, Pieske B, Kelle S. CMR findings after COVID-19 and after COVID-19-vaccination-same but different? Int J Cardiovasc Imaging 2022; 38:2057-2071. [PMID: 37726611 PMCID: PMC9097142 DOI: 10.1007/s10554-022-02623-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023]
Abstract
Cardiac involvement has been described in varying proportions of patients recovered from COVID-19 and proposed as a potential cause of prolonged symptoms, often described as post-COVID or long COVID syndrome. Recently, cardiac complications have been reported from COVID-19 vaccines as well. We aimed to compare CMR-findings in patients with clinical cardiac symptoms after COVID-19 and after vaccination. From May 2020 to May 2021, we included 104 patients with suspected cardiac involvement after COVID-19 who received a clinically indicated cardiac magnetic resonance (CMR) examination at a high-volume center. The mean time from first positive PCR to CMR was 112 ± 76 days. During their COVID-19 disease, 21% of patients required hospitalization, 17% supplemental oxygen and 7% mechanical ventilation. In 34 (32.7%) of patients, CMR provided a clinically relevant diagnosis: Isolated pericarditis in 10 (9.6%), %), acute myocarditis (both LLC) in 7 (6.7%), possible myocarditis (one LLC) in 5 (4.8%), ischemia in 4 (3.8%), recent infarction in 2 (1.9%), old infarction in 4 (3.8%), dilated cardiomyopathy in 3 (2.9%), hypertrophic cardiomyopathy in 2 (1.9%), aortic stenosis, pleural tumor and mitral valve prolapse each in 1 (1.0%). Between May 2021 and August 2021, we examined an additional 27 patients with suspected cardiac disease after COVID-19 vaccination. Of these, CMR provided at least one diagnosis in 22 (81.5%): Isolated pericarditis in 4 (14.8%), acute myocarditis in 9 (33.3%), possible myocarditis (acute or subsided) in 6 (22.2%), ischemia in 3 (37.5% out of 8 patients with stress test), isolated pericardial effusion (> 10 mm) and non-compaction-cardiomyopathy each in 1 (3.7%). The number of myocarditis diagnoses after COVID-19 was highly dependent on the stringency of the myocarditis criteria applied. When including only cases of matching edema and LGE and excluding findings in the right ventricular insertion site, the number of cases dropped from 7 to 2 while the number of cases after COVID-19 vaccination remained unchanged at 9. While myocarditis is an overall rare side effect after COVID-19 vaccination, it is currently the leading cause of myocarditis in our institution due to the large number of vaccinations applied over the last months. Contrary to myocarditis after vaccination, LGE and edema in myocarditis after COVID-19 often did not match or were confined to the RV-insertion site. Whether these cases truly represent myocarditis or a different pathological entity is to be determined in further studies.
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Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - Constantin Jahnke
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Collin Goetze
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Karl J Weiss
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alessandro Faragli
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Undine Witt
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Franziska Seidel
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Ahmed Elsanhoury
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kühne
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Carsten Tschöpe
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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Seidel F, Laser KT, Klingel K, Dartsch J, Theisen S, Pickardt T, Holtgrewe M, Gärtner A, Berger F, Beule D, Milting H, Schubert S, Klaassen S, Kühnisch J. Pathogenic Variants in Cardiomyopathy Disorder Genes Underlie Pediatric Myocarditis—Further Impact of Heterozygous Immune Disorder Gene Variants? J Cardiovasc Dev Dis 2022; 9:jcdd9070216. [PMID: 35877578 PMCID: PMC9321514 DOI: 10.3390/jcdd9070216] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/23/2022] [Accepted: 07/01/2022] [Indexed: 12/04/2022] Open
Abstract
Myocarditis is an inflammatory disease of the heart. Pediatric myocarditis with the dilated cardiomyopathy (DCM) phenotype may be caused by likely pathogenic or pathogenic genetic variants [(L)P] in cardiomyopathy (CMP) genes. Systematic analysis of immune disorder gene defects has not been performed so far. We analyzed 12 patients with biopsy-proven myocarditis and the DCM phenotype together with their parents using whole-exome sequencing (WES). The WES data were filtered for rare pathogenic variants in CMP (n = 89) and immune disorder genes (n = 631). Twelve children with a median age of 2.9 (1.0–6.8) years had a mean left ventricular ejection fraction of 28% (22–32%) and myocarditis was confirmed by endomyocardial biopsy. Patients with primary immunodeficiency were excluded from the study. Four patients underwent implantation of a ventricular assist device and subsequent heart transplantation. Genetic analysis of the 12 families revealed an (L)P variant in the CMP gene in 8/12 index patients explaining DCM. Screening of recessive immune disorder genes identified a heterozygous (L)P variant in 3/12 index patients. This study supports the genetic impact of CMP genes for pediatric myocarditis with the DCM phenotype. Piloting the idea that additional immune-related genetic defects promote myocarditis suggests that the presence of heterozygous variants in these genes needs further investigation. Altered cilium function might play an additional role in inducing inflammation in the context of CMP.
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Affiliation(s)
- Franziska Seidel
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, 13353 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, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Kai Thorsten Laser
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart-and Diabetescenter NRW, University Clinic of Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (K.T.L.); (S.S.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, 72016 Tübingen, Germany;
| | - Josephine Dartsch
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
| | - Simon Theisen
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Thomas Pickardt
- National Register for Congenital Heart Defects, 13353 Berlin, Germany;
| | - Manuel Holtgrewe
- Core Unit Bioinformatics, Berlin Institute of Health (BIH), 10117 Berlin, Germany;
- Core Facility Bioinformatik, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10117 Berlin, Germany
| | - Anna Gärtner
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart-and Diabetescenter NRW, University Hospital of the Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (A.G.); (H.M.)
| | - Felix Berger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, 13353 Berlin, Germany;
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Dieter Beule
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Core Unit Bioinformatics, Berlin Institute of Health (BIH), 10117 Berlin, Germany;
| | - Hendrik Milting
- Erich and Hanna Klessmann-Institute for Cardiovascular Research and Development & Clinic for Thoracic and Cardiovascular Surgery, Heart-and Diabetescenter NRW, University Hospital of the Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (A.G.); (H.M.)
| | - Stephan Schubert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, 13353 Berlin, Germany;
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Center for Congenital Heart Disease/Pediatric Cardiology, Heart-and Diabetescenter NRW, University Clinic of Ruhr University Bochum, 32545 Bad Oeynhausen, Germany; (K.T.L.); (S.S.)
| | - Sabine Klaassen
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Pediatric Cardiology, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence: (S.K.); (J.K.); Tel.: +49-30-9406-3319 (S.K. & J.K.); Fax: +49-30-9406-3358 (S.K. & J.K.)
| | - Jirko Kühnisch
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (F.S.); (J.D.); (S.T.); (D.B.)
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité-Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Correspondence: (S.K.); (J.K.); Tel.: +49-30-9406-3319 (S.K. & J.K.); Fax: +49-30-9406-3358 (S.K. & J.K.)
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Klaassen S, Kühnisch J, Schultze-Berndt A, Seidel F. Left Ventricular Noncompaction in Children: The Role of Genetics, Morphology, and Function for Outcome. J Cardiovasc Dev Dis 2022; 9:jcdd9070206. [PMID: 35877568 PMCID: PMC9320003 DOI: 10.3390/jcdd9070206] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/05/2023] Open
Abstract
Left ventricular noncompaction (LVNC) is a ventricular wall anomaly morphologically characterized by numerous, excessively prominent trabeculations and deep intertrabecular recesses. Accumulating data now suggest that LVNC is a distinct phenotype but must not constitute a pathological phenotype. Some individuals fulfill the morphologic criteria of LVNC and are without clinical manifestations. Most importantly, morphologic criteria for LVNC are insufficient to diagnose patients with an associated cardiomyopathy (CMP). Genetic testing has become relevant to establish a diagnosis associated with CMP, congenital heart disease, neuromuscular disease, inborn error of metabolism, or syndromic disorder. Genetic factors play a more decisive role in children than in adults and severe courses of LVNC tend to occur in childhood. We reviewed the current literature and highlight the difficulties in establishing the correct diagnosis for children with LVNC. Novel insights show that the interplay of genetics, morphology, and function determine the outcome in pediatric LVNC.
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Affiliation(s)
- Sabine Klaassen
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (J.K.); (A.S.-B.); (F.S.)
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-30-9406-3319; Fax: +49-30-9406-3358
| | - Jirko Kühnisch
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (J.K.); (A.S.-B.); (F.S.)
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
| | - Alina Schultze-Berndt
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (J.K.); (A.S.-B.); (F.S.)
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, 13125 Berlin, Germany
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
| | - Franziska Seidel
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), 13125 Berlin, Germany; (J.K.); (A.S.-B.); (F.S.)
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, 13125 Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, 10785 Berlin, Germany
- Department of Paediatric Cardiology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 13353 Berlin, Germany
- Department of Congenital Heart Disease-Paediatric Cardiology, German Heart Institute Berlin, 13353 Berlin, Germany
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11
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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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12
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Al-Wakeel-Marquard N, Seidel F, Kühnisch J, Kuehne T, Berger F, Messroghli DR, Klaassen S. Midwall Fibrosis and Cardiac Mechanics: Rigid Body Rotation Is a Novel Marker of Disease Severity in Pediatric Primary Dilated Cardiomyopathy. Front Cardiovasc Med 2022; 8:810005. [PMID: 35252369 PMCID: PMC8891497 DOI: 10.3389/fcvm.2021.810005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
Background Midwall fibrosis (MWF) detected by late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) predicts adverse outcome in adults with dilated cardiomyopathy (DCM). Its relevance in children and adolescents is relatively unknown. Left ventricular (LV) strain, rotation and twist are important parameters of cardiac function; yet, their role in pediatric heart failure is understudied. This study aimed to evaluate MWF and cardiac mechanics in pediatric DCM. Methods Patients ≤21 years with primary DCM were prospectively enrolled and underwent standardized CMR including LGE. All participants were categorized according to the presence or absence of MWF (MWF+ vs. MWF–). Cardiac mechanics were assessed using CMR feature tracking. Impaired LV twist with apex and base rotating in the same direction was termed rigid body rotation (RBR). Results In total, 17 patients (median age 11.2 years) were included. MWF was present in seven patients (41%). Median N-terminal pro brain natriuretic peptide (NT-proBNP) was higher (5,959 vs. 242 pg/ml, p = 0.887) and LV ejection fraction (LVEF) lower (28 vs. 39%, p = 0.536) in MWF+ vs. MWF– patients, yet differences were not statistically significant. MWF+ patients had reduced global longitudinal (GLS), circumferential (GCS) and radial strain (GRS), again without statistical significance (p = 0.713, 0.492 and 1.000, respectively). A relationship between MWF and adverse outcome was not seen (p = 0.637). RBR was more common in MWF+ (67 vs. 50%), and was associated with the occurrence of adverse events (p = 0.041). Patients with RBR more frequently were in higher New York Heart Association classes (p = 0.035), had elevated NT-proBNP levels (p = 0.002) and higher need for catecholamines (p = 0.001). RBR was related to reduced GLS (p = 0.008), GCS (p = 0.031), GRS (p = 0.012), LV twist (p = 0.008), peak apical rotation (p < 0.001), and LVEF (p = 0.001), elevated LV end-diastolic volume (p = 0.023) and LV end-systolic volume (p = 0.003), and lower right ventricular stroke volume (p = 0.023). Conclusions MWF was common, but failed to predict heart failure. RBR was associated with clinical and biventricular functional signs of heart failure as well as the occurrence of adverse events. Our findings suggest that RBR may predict outcomes and may serve as a novel marker of disease severity in pediatric DCM. Clinical Trial Registration:https://clinicaltrials.gov/, identifier: NCT03572569.
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Affiliation(s)
- Nadya Al-Wakeel-Marquard
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- *Correspondence: Nadya Al-Wakeel-Marquard
| | - Franziska Seidel
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Jirko Kühnisch
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation Between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kuehne
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- Institute of Computer-Assisted Cardiovascular Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Berger
- Department of Congenital Heart Disease – Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel R. Messroghli
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Internal Medicine – Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Cardiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sabine Klaassen
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Experimental and Clinical Research Center, A Cooperation Between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Pediatrics, Division of Cardiology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Seidel F, Kuehnisch J, Klingel K, Dartsch J, Laser KT, Berger F, Thomas P, Milting H, Schubert S, Klaassen S. Pathogenic Variants in Cardiomyopathy and Not Immune Disorder Genes Cause Pediatric Myocarditis with Dilated Cardiomyopathy Phenotype. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742972] [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)
- F. Seidel
- Augustenburger Platz 1, Berlin, Deutschland
| | - J. Kuehnisch
- Experimental and Clinical Research Center Berlin, Berlin, Deutschland
| | | | - J. Dartsch
- Dzhk (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Experimental and Clinical Research Center Berlin, Berlin, Deutschland
| | | | - F. Berger
- Augustenburger Platz 1, Berlin, Deutschland
| | - P. Thomas
- Kompetenznetz Angeborene Herzfehler, Berlin, Deutschland
| | - H. Milting
- Herz- und Diabeteszentrum NRW, Georgstraße, Bad Oeynhausen, Germany, Bad Oeynhausen, Deutschland
| | | | - S. Klaassen
- Max-Delbrück-Centrum für Molekulare Medizin, Berlin, Deutschland
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14
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Schöffl I, Holler S, Dittrich S, Seidel F, Thomas P, Kaestner M, Opgen-Rhein B, Böhne M, Wannenmacher B, Reineker K, Wiegand G, Rentzsch A, Weigelt A. Myocarditis and Sports: Data from a Nationwide Registry on Myocarditis: “MYKKE-Sport”. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1743016] [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)
- I. Schöffl
- Universitätsklinikum Erlangen, Kinderkardiologische Abteilung, Erlangen, Deutschland
| | - S. Holler
- Kinderkardiologische abteilung, University of Erlangen-Nuremberg, Erlangen, Deutschland
| | - S. Dittrich
- Kinderkardiologische abteilung, Friedrich-Alexander-Universität Erlangen-Nürnberg, Schloßplatz, Erlangen, Germany, Erlangen, Deutschland
| | - F. Seidel
- Pediatric Cardiology, German Heart Institute Berlin, Berlin, Deutschland
| | - P. Thomas
- Kompetenznetz Angeborene Herzfehler, Berlin, Deutschland
| | | | - B. Opgen-Rhein
- Pediatric Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Deutschland
| | - M. Böhne
- Pediatric Cardiology, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - B. Wannenmacher
- Kinderkardiologie, Herzzentrum Leipzig, Leipzig, Deutschland
| | - K. Reineker
- Department of Congenital Heart Disease and Paediatric Cardiology, University Heart Centre Freiburg - Bad Krozingen, Medical Centre-University of Freiburg, Freiburg, Deutschland
| | - G. Wiegand
- Department of Pediatric Cardiology, University of Tuebingen, Tuebingen, Deutschland
| | - A. Rentzsch
- Pediatric Cardiology, Universitätsklinikum des Saarlandes, Homburg, Deutschland
| | - A. Weigelt
- Kinderkardiologie, Universitätsklinikum Erlangen, Erlangen, Deutschland
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15
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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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16
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Tanacli R, Doeblin P, Götze C, Zieschang V, Faragli A, Stehning C, Korosoglou G, Erley J, Weiss J, Berger A, Pröpper F, Steinbeis F, Kühne T, Seidel F, Geisel D, Cannon Walter-Rittel T, Stawowy P, Witzenrath M, Klingel K, Van Linthout S, Pieske B, Tschöpe C, Kelle S. COVID-19 vs. Classical Myocarditis Associated Myocardial Injury Evaluated by Cardiac Magnetic Resonance and Endomyocardial Biopsy. Front Cardiovasc Med 2022; 8:737257. [PMID: 35004872 PMCID: PMC8739473 DOI: 10.3389/fcvm.2021.737257] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Despite the ongoing global pandemic, the impact of COVID-19 on cardiac structure and function is still not completely understood. Myocarditis is a rare but potentially serious complication of other viral infections with variable recovery, and is, in some cases, associated with long-term cardiac remodeling and functional impairment. Aim: To assess myocardial injury in patients who recently recovered from an acute SARS-CoV-2 infection with advanced cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB). Methods: In total, 32 patients with persistent cardiac symptoms after a COVID-19 infection, 22 patients with acute classic myocarditis not related to COVID-19, and 16 healthy volunteers were included in this study and underwent a comprehensive baseline CMR scan. Of these, 10 patients post COVID-19 and 13 with non-COVID-19 myocarditis underwent a follow-up scan. In 10 of the post-COVID-19 and 15 of the non-COVID-19 patients with myocarditis endomyocardial biopsy (EMB) with histological, immunohistological, and molecular analysis was performed. Results: In total, 10 (31%) patients with COVID-19 showed evidence of myocardial injury, eight (25%) presented with myocardial oedema, eight (25%) exhibited global or regional systolic left ventricular (LV) dysfunction, and nine (28%) exhibited impaired right ventricular (RV) function. However, only three (9%) of COVID-19 patients fulfilled updated CMR–Lake Louise criteria (LLC) for acute myocarditis. Regarding EMB, none of the COVID-19 patients but 87% of the non-COVID-19 patients with myocarditis presented histological findings in keeping with acute or chronic inflammation. COVID-19 patients with severe disease on the WHO scale presented with reduced biventricular longitudinal function, increased RV mass, and longer native T1 times compared with those with only mild or moderate disease. Conclusions: In our cohort, CMR and EMB findings revealed that SARS-CoV-2 infection was associated with relatively mild but variable cardiac involvement. More symptomatic COVID-19 patients and those with higher clinical care demands were more likely to exhibit chronic inflammation and impaired cardiac function compared to patients with milder forms of the disease.
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Affiliation(s)
- Radu Tanacli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Collin Götze
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | | | - Alessandro Faragli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jennifer Erley
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Jakob Weiss
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Alexander Berger
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Felix Pröpper
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kühne
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Seidel
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Philipp Stawowy
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Sophie Van Linthout
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
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Seidel F, Scheibenbogen C, Heidecke H, Opgen-Rhein B, Pickardt T, Klingel K, Berger F, Messroghli D, Schubert S. Compensatory Upregulation of Anti-Beta-Adrenergic Receptor Antibody Levels Might Prevent Heart Failure Presentation in Pediatric Myocarditis. Front Pediatr 2022; 10:881208. [PMID: 35573966 PMCID: PMC9096696 DOI: 10.3389/fped.2022.881208] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Myocarditis can be associated with severe heart failure and is caused by different inflammatory and autoimmune responses. The aim of this study was to describe the immunological response in children with myocarditis by analyzing anti-beta-adrenergic receptor antibodies (anti-β-AR Abs). METHODS Sera of children who were hospitalized with biopsy-proven myocarditis were prospectively collected between April 2017 and March 2019. Anti-β1-AR Ab, anti-β2-AR Ab, and anti-β3-AR Ab were quantified by a CE-certified ELISA kit. According to normal values for immunoglobulin G (IgG), three age groups, <1, 1-5, and >5-17 years, were defined. Children without inflammatory cardiac pathology and no heart failure signs were served as a control group. RESULTS We compared 22 patients with biopsy-proven myocarditis and 28 controls. The median age (interquartile range) of the myocarditis group (MYC) was 12.1 (2.7-16.4) years, 13 men, left ventricular ejection fraction (LVEF) 51% and for control group, the median age was 5.0 (3.0-6.8) years, nine men, LVEF 64%. Myocarditis patients in the age group >5-17 years showed significantly higher anti-β3-AR Ab levels as compared to controls (p = 0.014). Lower anti-β2-AR Ab and anti-β3-AR Ab levels were significantly correlated with higher left ventricular diameters in myocarditis patients. The event-free survival using a combined endpoint (mechanical circulatory support [MCS], transplantation, and/or death) was significantly lower in myocarditis patients with antibody levels below the median as compared to myocarditis patients with antibody levels ≥ the median. CONCLUSION Anti-β-AR Ab levels are increased in children with myocarditis and >5 years of age. These antibodies might be upregulated compensatory to prevent further cardiac deterioration. A worse event-free survival in patients with lower anti-β-AR Ab levels might be a therapeutic target for immunoglobulin substitution.
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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, 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, Berlin, Germany
| | - Carmen Scheibenbogen
- Charité - Universitätsmedizin Berlin, Outpatient Clinic for Immunodeficiencies, Institute for Medical Immunology, Berlin, Germany
| | | | - Bernd Opgen-Rhein
- Charité - Universitätsmedizin Berlin, Department of Pediatric Cardiology, Berlin, Germany
| | - Thomas Pickardt
- Competence Network for Congenital Heart Diseases, Berlin, Germany
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Felix Berger
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Pediatric Cardiology, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Daniel Messroghli
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,German Heart Center Berlin, Department of Internal Medicine - Cardiology, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology, 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, Berlin, Germany.,Center for Congenital Heart Disease/Pediatric Cardiology, Heart and Diabetes Center NRW, University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany
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18
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Seidel F, Kuehne T, Kelle S, Doeblin P, Zieschang V, Tschoepe C, Al-Wakeel-Marquard N, Nordmeyer S. Cardiovascular magnetic resonance findings in non-hospitalized paediatric patients after recovery from COVID-19. ESC Heart Fail 2021; 8:5583-5588. [PMID: 34704672 PMCID: PMC8652950 DOI: 10.1002/ehf2.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 06/18/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/04/2023] Open
Abstract
Aims Our study aimed to investigate the cardiac involvement with sensitive tissue characterization in non‐hospitalized children with coronavirus disease 2019 (COVID‐19) infection using cardiovascular magnetic resonance (CMR) imaging. Methods and results We prospectively enrolled children who recovered from mildly symptomatic COVID‐19 infection between November 2020 and January 2021. Patients underwent CMR at 1.5 T (Achieva, Philips Healthcare, Best, the Netherlands) including cine images, native T1 and T2 mapping. Healthy children and paediatric patients with biopsy‐proven myocarditis served as control groups. We performed CMR in 18 children with a median (25th–75th percentile) age of 12 (10–15) years, 38 (24–47) days after positive PCR test, and compared them with 7 healthy controls [15 (10–19) years] and 9 patients with myocarditis [10 (4–16) years]. The COVID‐19 patients reported no cardiac symptoms. None of the COVID‐19 patients showed CMR findings consistent with a myocarditis. Three patients (17%) from the COVID‐19 cohort presented with minimal pericardial effusion. CMR parameters of COVID‐19 patients, including volumetric and strain values as well as T1 and T2 times, were not significantly different from healthy controls, but from myocarditis patients. These had significantly reduced left ventricular (LV) ejection fraction (P = 0.035), LV global longitudinal strain, and left atrial strain values as well as elevated native T1 values compared with COVID‐19 patients (P < 0.001, respectively). Conclusions There was no evidence of myocardial inflammation, fibrosis, or functional cardiac impairment in the studied cohort of children recently. CMR findings were comparable with those of healthy controls. Pericardial effusion suggests a mild pericarditis in a small subgroup. This is pointing to a minor clinical relevance of myocardial involvement in children after mildly symptomatic COVID‐19 infections.
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Affiliation(s)
- Franziska Seidel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Titus Kuehne
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Kelle
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Victoria Zieschang
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Carsten Tschoepe
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Medical Department, Division of Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nadya Al-Wakeel-Marquard
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Nordmeyer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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19
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Seidel F, Holtgrewe M, Al-Wakeel-Marquard N, Opgen-Rhein B, Dartsch J, Herbst C, Beule D, Pickardt T, Klingel K, Messroghli D, Berger F, Schubert S, Kühnisch J, Klaassen S. Pathogenic Variants Associated With Dilated Cardiomyopathy Predict Outcome in Pediatric Myocarditis. Circ Genom Precis Med 2021; 14:e003250. [PMID: 34213952 PMCID: PMC8373449 DOI: 10.1161/circgen.120.003250] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Myocarditis is one of the most common causes leading to heart failure in children and a possible genetic background has been postulated. We sought to characterize the clinical and genetic characteristics in patients with myocarditis ≤18 years of age to predict outcome. METHODS A cohort of 42 patients (Genetics in Pediatric Myocarditis) with biopsy-proven myocarditis underwent genetic testing with targeted panel sequencing of cardiomyopathy-associated genes. Genetics in Pediatric Myocarditis patients were divided into subgroups according to the phenotype of dilated cardiomyopathy (DCM) at presentation, resulting in 22 patients without DCM (myocarditis without phenotype of DCM) and 20 patients with DCM (myocarditis with phenotype of DCM). RESULTS Myocarditis with phenotype of DCM patients (median age 1.4 years) were younger than myocarditis without phenotype of DCM patients (median age 16.1 years; P<0.001) and were corresponding to heart failure-like and coronary syndrome-like phenotypes, respectively. At least one likely pathogenic/pathogenic variant was identified in 9 out of 42 patients (22%), 8 of them were heterozygous, and 7 out of 9 were in myocarditis with phenotype of DCM. Likely pathogenic/pathogenic variants were found in genes validated for primary DCM (BAG3, DSP, LMNA, MYH7, TNNI3, TNNT2, and TTN). Rare variant enrichment analysis revealed significant accumulation of high-impact disease variants in myocarditis with phenotype of DCM versus healthy individuals (P=0.0003). Event-free survival was lower (P=0.008) in myocarditis with phenotype of DCM patients compared with myocarditis without phenotype of DCM and primary DCM. CONCLUSIONS We report heterozygous likely pathogenic/pathogenic variants in biopsy-proven pediatric myocarditis. Myocarditis patients with DCM phenotype were characterized by early-onset heart failure, significant enrichment of likely pathogenic/pathogenic variants, and poor outcome. These phenotype-specific and age group-specific findings will be useful for personalized management of these patients. Genetic evaluation in children newly diagnosed with myocarditis and DCM phenotype is warranted.
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Affiliation(s)
- Franziska Seidel
- German Heart Center Berlin, Department of Congenital Heart Disease - Pediatric Cardiology (F.S., N.A.-W.-M., F.B., S.S.).,Department of Pediatric Cardiology (F.S., B.O.-R., F.B., S.K.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health.,Institute for Imaging Science & Computational Modelling in Cardiovascular Medicine (F.S., N.A.-W.-M.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health.,Experimental & Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association & Charité - Universitätsmedizin Berlin (F.S., J.D., C.H., J.K., S.K.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (F.S., N.A.-W.-M., F.B., S.S., J.K., S.K.)
| | - Manuel Holtgrewe
- Core Facility Bioinformatik (M.H.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health.,Berlin Institute of Health (BIH), Core Unit Bioinformatics (M.H., D.B.)
| | - Nadya Al-Wakeel-Marquard
- German Heart Center Berlin, Department of Congenital Heart Disease - Pediatric Cardiology (F.S., N.A.-W.-M., F.B., S.S.).,Institute for Imaging Science & Computational Modelling in Cardiovascular Medicine (F.S., N.A.-W.-M.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health.,DZHK (German Centre for Cardiovascular Research), partner site Berlin (F.S., N.A.-W.-M., F.B., S.S., J.K., S.K.)
| | - Bernd Opgen-Rhein
- Department of Pediatric Cardiology (F.S., B.O.-R., F.B., S.K.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health
| | - Josephine Dartsch
- Experimental & Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association & Charité - Universitätsmedizin Berlin (F.S., J.D., C.H., J.K., S.K.)
| | - Christopher Herbst
- Experimental & Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association & Charité - Universitätsmedizin Berlin (F.S., J.D., C.H., J.K., S.K.)
| | - Dieter Beule
- Berlin Institute of Health (BIH), Core Unit Bioinformatics (M.H., D.B.).,Max-Delbrück-Center for Molecular Medicine, Berlin, Germany (D.B.)
| | - Thomas Pickardt
- Competence Network for Congenital Heart Defects, Berlin (T.P.)
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen (K.K.)
| | - Daniel Messroghli
- Department of Internal Medicine & Cardiology (D.M.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health.,German Heart Center Berlin, Department of Internal Medicine - Cardiology (D.M.)
| | - Felix Berger
- German Heart Center Berlin, Department of Congenital Heart Disease - Pediatric Cardiology (F.S., N.A.-W.-M., F.B., S.S.).,Department of Pediatric Cardiology (F.S., B.O.-R., F.B., S.K.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health.,DZHK (German Centre for Cardiovascular Research), partner site Berlin (F.S., N.A.-W.-M., F.B., S.S., J.K., S.K.)
| | - Stephan Schubert
- German Heart Center Berlin, Department of Congenital Heart Disease - Pediatric Cardiology (F.S., N.A.-W.-M., F.B., S.S.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (F.S., N.A.-W.-M., F.B., S.S., J.K., S.K.).,Center for Congenital Heart Disease/Pediatric Cardiology, Heart- and Diabetescenter NRW & University Clinic of Ruhr-University Bochum, Bad Oeynhausen, Germany (S.S.)
| | - Jirko Kühnisch
- Experimental & Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association & Charité - Universitätsmedizin Berlin (F.S., J.D., C.H., J.K., S.K.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (F.S., N.A.-W.-M., F.B., S.S., J.K., S.K.)
| | - Sabine Klaassen
- Department of Pediatric Cardiology (F.S., B.O.-R., F.B., S.K.), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin & Berlin Institute of Health.,Experimental & Clinical Research Center, a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association & Charité - Universitätsmedizin Berlin (F.S., J.D., C.H., J.K., S.K.).,DZHK (German Centre for Cardiovascular Research), partner site Berlin (F.S., N.A.-W.-M., F.B., S.S., J.K., S.K.)
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20
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Al-Wakeel-Marquard N, Seidel F, Herbst C, Kühnisch J, Kuehne T, Berger F, Klaassen S, Messroghli DR. Diffuse myocardial fibrosis by T1 mapping is associated with heart failure in pediatric primary dilated cardiomyopathy. Int J Cardiol 2021; 333:219-225. [PMID: 33737165 DOI: 10.1016/j.ijcard.2021.03.023] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 12/10/2020] [Accepted: 03/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND In adult cardiomyopathy (CM), diffuse myocardial fibrosis is associated with adverse clinical outcome. However, its relevance in pediatric patients remains relatively unknown. The study aimed to evaluate myocardial extracellular volume (ECV) reflecting diffuse myocardial fibrosis with cardiovascular magnetic resonance (CMR) T1 mapping, and to analyze correlations with clinical and functional data in children and adolescents with different CM phenotypes. METHODS Patients with primary dilated (DCM), hypertrophic (HCM) or left ventricular non-compaction CM (LVNC) were prospectively enrolled and compared with healthy controls. Study participants underwent standardized CMR with modified Look-Locker Inversion recovery (MOLLI) T1 mapping. RESULTS In total, 33 patients (median age 12.0 years; DCM: n = 10, HCM: n = 13; LVNC: n = 10) and 7 controls (14.5 years) were included. DCM: ECV was higher than in controls (38.1 ± 7.5% vs. 27.2 ± 3.6%; p = 0.014). Patients with elevated ECV were younger than those with normal values (p = 0.044). ECV correlated with N-terminal pro brain natriuretic peptide (r = 0.66, p = 0.038), left ventricular ejection fraction (r = -0.63, p = 0.053), and stroke volume of left (r = -0.75, p = 0.013) and right ventricle (r = -0.67, p = 0.033). During a median follow-up of 25.3 months, 3 patients underwent heart transplantation (HTx), and 2 were listed for HTx. All 5 patients had elevated ECV. HCM/LVNC ECV was within normal range in HCM (25.5 ± 4.5%) and LVNC (29.6 ± 4.2), and was not related with clinical and/or functional parameters. CONCLUSIONS Our results indicate an increased burden of diffuse myocardial fibrosis in relation with younger age in pediatric DCM. ECV was associated with clinical and biventricular functional markers of heart failure in DCM.
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Affiliation(s)
- Nadya Al-Wakeel-Marquard
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Augustenburger Platz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin.
| | - Franziska Seidel
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatrics, Division Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Christopher Herbst
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin; Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Jirko Kühnisch
- DZHK (German Centre for Cardiovascular Research), partner site Berlin; Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine, Lindenberger Weg 80, 13125 Berlin, Germany
| | - Titus Kuehne
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Augustenburger Platz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin
| | - Felix Berger
- German Heart Center Berlin, Department of Congenital Heart Disease and Pediatric Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), partner site Berlin; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatrics, Division Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Sabine Klaassen
- DZHK (German Centre for Cardiovascular Research), partner site Berlin; Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max-Delbrück-Center for Molecular Medicine, Lindenberger Weg 80, 13125 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Pediatrics, Division Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Daniel R Messroghli
- DZHK (German Centre for Cardiovascular Research), partner site Berlin; German Heart Center Berlin, Department of Internal Medicine and Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiology, Augustenburger Platz 1, 13353 Berlin, Germany
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Schultze-Berndt A, Kühnisch J, Herbst C, Seidel F, Al-Wakeel-Marquard N, Dartsch J, Theisen S, Knirsch W, Jenni R, Greutmann M, Oechslin E, Berger F, Klaassen S. Reduced Systolic Function and Not Genetic Variants Determine Outcome in Pediatric and Adult Left Ventricular Noncompaction Cardiomyopathy. Front Pediatr 2021; 9:722926. [PMID: 34540771 PMCID: PMC8447880 DOI: 10.3389/fped.2021.722926] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Left ventricular noncompaction cardiomyopathy (LVNC CMP) is a genetic cardiomyopathy. Genotype-phenotype correlation and clinical outcome of genetic variants in pediatric and adult LVNC CMP patients are still unclear. Methods: The retrospective multicenter study was conducted in unrelated index patients with LVNC CMP, diagnosed between the years 1987 and 2017, and all available family members. All index patients underwent next-generation sequencing for genetic variants in 174 target genes using the Illumina TruSight Cardio Sequencing Panel. Major adverse cardiac events (MACE) included mechanical circulatory support, heart transplantation, survivor of cardiac death, and/or all-cause death as combined endpoint. Results: Study population included 149 LVNC CMP patients with a median age of 27.8 (9.2-44.8) years at diagnosis; 58% of them were symptomatic, 18% suffered from non-sustained and sustained arrhythmias, and 17% had an implantable cardioverter defibrillator (ICD) implanted. 55/137 patients (40%) were ≤ 18 years at diagnosis. A total of 134 variants were identified in 87/113 (77%) index patients. 93 variants were classified as variant of unknown significance (VUS), 24 as likely pathogenic and 15 as pathogenic. The genetic yield of (likely) pathogenic variants was 35/113 (31%) index patients. Variants occurred most frequently in MYH7 (n=19), TTN (n = 10) and MYBPC3 (n = 8). Altogether, sarcomere gene variants constituted 42.5% (n = 57) of all variants. The presence or absence of (likely) pathogenic variants or variants in specific genes did not allow risk stratification for MACE. Reduced left ventricular (LV) systolic function and increased left ventricular end-diastolic diameter (LVEDD) were risk factors for event-free survival in the Kaplan-Meier analysis. Through multivariate analysis we identified reduced LV systolic function as the main risk factor for MACE. Patients with reduced LV systolic function were at a 4.6-fold higher risk for MACE. Conclusions: Genetic variants did not predict the risk of developing a MACE, neither in the pediatric nor in the adult cohort. Multivariate analysis emphasized reduced LV systolic function as the main independent factor that is elevating the risk for MACE. Genetic screening is useful for cascade screening to identify family members at risk for developing LVNC CMP.
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Affiliation(s)
- Alina Schultze-Berndt
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 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, Berlin, Germany
| | - Jirko Kühnisch
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Christopher Herbst
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Franziska Seidel
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 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, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Nadya Al-Wakeel-Marquard
- DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Josephine Dartsch
- Experimental and Clinical Research Center, A Cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Theisen
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 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, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
| | - Walter Knirsch
- Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, and Children's Research Center, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Rolf Jenni
- University of Zurich, Zurich, Switzerland
| | - Matthias Greutmann
- Department of Cardiology, University Heart Center, University of Zurich, Zurich, Switzerland
| | - Erwin Oechslin
- Toronto Adult Congenital Heart Disease Program, University Health Network/Toronto General Hospital, Peter Munk Cardiac Centre, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada
| | - Felix Berger
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany.,Department of Congenital Heart Disease - Pediatric Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Sabine Klaassen
- Department of Pediatric Cardiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, 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, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Berlin, Germany
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22
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Baltzer AWA, Stosch D, Seidel F, Ostapczuk MS. [Low level laser therapy : A narrative literature review on the efficacy in the treatment of rheumatic orthopaedic conditions]. Z Rheumatol 2018; 76:806-812. [PMID: 28466181 DOI: 10.1007/s00393-017-0309-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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] [Indexed: 01/02/2023]
Abstract
BACKGROUND In low level laser therapy (LLLT) low wattage lasers are used to irradiate the affected skin areas, joints, nerves, muscles and tendons without any sensation or thermal damage. Although the exact mechanism of its effect is still unknown, it seems beyond dispute that LLLT induces a variety of stimulating processes at the cellular level affecting cell repair mechanisms, the vascular system and lymphatic system. LLLT has been popular among orthopaedic practitioners for many years, whereas university medicine has remained rather sceptical about it. OBJECTIVES Overview of studies on the efficacy of LLLT in the treatment of rheumatic orthopaedic conditions, i. e. muscle, tendon lesions and arthropathies. MATERIALS AND METHODS Narrative literature review (PubMed, Web of Science). RESULTS While earlier studies often failed to demonstrate the efficacy of LLLT, several recent studies of increasing quality proved the efficacy of LLLT in the treatment of multiple musculoskeletal pain syndromes like neck or lower back pain, tendinopathies (especially of the Achilles tendon) and epicondylolpathies, chronic inflammatory joint disorders like rheumatoid arthritis or chronic degenerative osteoarthritis of the large and small joints. In addition, there is recent evidence that LLLT can have a preventive capacity and can enhance muscle strength and accelerate muscle regeneration. CONCLUSION LLLT shows potential as an effective, noninvasive, safe and cost-efficient means to treat and prevent a variety of acute and chronic musculoskeletal conditions. Further randomized controlled studies, however, are required to confirm this positive assessment.
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Affiliation(s)
- A W A Baltzer
- Gemeinschaftspraxis Königsallee/Zentrum für Molekulare Orthopädie, Königsallee 53-55, 40212, Düsseldorf, Deutschland.
| | - D Stosch
- Gemeinschaftspraxis Königsallee/Zentrum für Molekulare Orthopädie, Königsallee 53-55, 40212, Düsseldorf, Deutschland
| | - F Seidel
- Gemeinschaftspraxis Königsallee/Zentrum für Molekulare Orthopädie, Königsallee 53-55, 40212, Düsseldorf, Deutschland
| | - M S Ostapczuk
- Abteilung für Orthopädie und Unfallchirurgie, St. Josef Krankenhaus Moers, Asberger Str. 4, 47441, Moers, Deutschland
- Heinrich-Heine-Universität Düsseldorf, Institut für Experimentelle Psychologie, Universitätsstr. 1, 40225, Düsseldorf, Deutschland
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23
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Bender H, Seidel F, Favia P, Richard O, Vandervorst W. X-ray absorption in pillar shaped transmission electron microscopy specimens. Ultramicroscopy 2017; 177:58-68. [PMID: 28292687 DOI: 10.1016/j.ultramic.2017.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 10/12/2016] [Revised: 01/11/2017] [Accepted: 03/05/2017] [Indexed: 11/25/2022]
Abstract
The dependence of the X-ray absorption on the position in a pillar shaped transmission electron microscopy specimen is modeled for X-ray analysis with single and multiple detector configurations and for different pillar orientations relative to the detectors. Universal curves, applicable to any pillar diameter, are derived for the relative intensities between weak and medium or strongly absorbed X-ray emission. For the configuration as used in 360° X-ray tomography, the absorption correction for weak and medium absorbed X-rays is shown to be nearly constant along the pillar diameter. Absorption effects in pillars are about a factor 3 less important than in planar specimens with thickness equal to the pillar diameter. A practical approach for the absorption correction in pillar shaped samples is proposed and its limitations discussed. The modeled absorption dependences are verified experimentally for pillars with HfO2 and SiGe stacks.
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Affiliation(s)
- H Bender
- Imec, Kapeldreef 75, 3001 Leuven, Belgium.
| | - F Seidel
- Imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - P Favia
- Imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - O Richard
- Imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - W Vandervorst
- Imec, Kapeldreef 75, 3001 Leuven, Belgium; Instituut voor Kern- en Stralingsfysica, KU Leuven, 3001 Leuven, Belgium
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Abstract
Necrotising fasciitis is a rare infection with a high mortality rate. Clinical manifestation may be influenced by an underlying disease state. We report a case of a 70-year-old man with an anaplastic large-cell lymphoma who presented with inconclusive signs of necrotising fasciitis following a neutropenic phase after chemotherapy. Surgical exploration did not reveal the typical macroscopic features of necrotising fasciitis. Microbiological investigations revealed Escherichia coli. The lack of massive tissue inflammation, probably due to the neutropenia in our patient, has not been described by other authors. Diagnostic uncertainties owing to masked or uncharacteristic signs in immune compromised patients may lead to a delayed surgical debridement, of which clinicians should be aware.
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Affiliation(s)
- K Kunz
- Medical Intensive Care Unit, University Hospital Leipzig , Germany
| | - F Seidel
- Medical Intensive Care Unit, University Hospital Leipzig , Germany
| | - L Weidhase
- Medical Intensive Care Unit, University Hospital Leipzig , Germany
| | - P Hepp
- Department of Orthopaedics, Trauma and Plastic Surgery, University Hospital Leipzig , Germany
| | - S Strocka
- Department of Radiology, University Hospital Leipzig , Germany
| | - T Gradistanac
- Institute of Pathology, University Hospital Leipzig , Germany
| | - S Petros
- Medical Intensive Care Unit, University Hospital Leipzig , Germany
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25
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Scholz H, Gumpinger R, Mayer R, Seidel F. Reaktion des Reizleitungssystems des Herzens auf die Piezoelektrische Stoßwellenlithotripsie (EPL). Aktuelle Urol 2008. [DOI: 10.1055/s-2008-1060656] [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: 10/21/2022]
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26
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Razlog O, Longbottom S, Marcoci L, Seidel F, Razlog I. Alexithymia in patients with substance addiction being treated by cognitive-behavioural psychotherapy within Minnesota model treatment. Eur Psychiatry 2007. [DOI: 10.1016/j.eurpsy.2007.01.652] [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: 11/17/2022] Open
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Burkhardt U, Zahn R, Höffler U, Siegler KE, Frilling B, Weber M, Gottwik M, Wehr M, Seidel F, Rosocha S, Tebbe U, Senges J. Antibody levels against Chlamydia pneumoniae and outcome of roxithromycin therapy in patients with acute myocardial infarction. Results from a sub-study of the randomised Antibiotic Therapy in Acute Myocardial Infarction (ANTIBIO) trial. ACTA ACUST UNITED AC 2004; 93:671-8. [PMID: 15365734 DOI: 10.1007/s00392-004-0113-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2004] [Accepted: 03/24/2004] [Indexed: 11/27/2022]
Abstract
BACKGROUND Results of studies concerning prevention of cardiovascular disease by treatment with macrolide antibiotics targeting C. pneumoniae infection are still controversial. This study describes the results of different tests for infection with C. pneumoniae as well as the effect of treatment with roxithromycin in patients with acute myocardial infarction (AMI) in relation to their serostatus against C. pneumoniae. METHODS We analysed blood of 160 patients who came from the ANTIBIOtic therapy after an AMI ( ANTIBIO-) study, a prospective, randomised, placebo-controlled, double-blind study to investigate the effect of roxithromycin 300 mg/OD for 6 weeks in patients with an AMI. Anti- Chlamydia IgG-, IgA-, and IgM-antibodies of these patients were analysed by means of different test systems. RESULTS There was a good correlation between the two IgG and IgA methods (r = 0.900, p < 0.001 and r = 0.878, p < 0.001, respectively), but marked differences in the prevalence of positive tests. This resulted in only moderate concordance values, as expressed by the Kappa coefficients, for IgG kappa = 0.611 (95% CI = 0.498-0.724, p < 0.001) and for IgA kappa = 0.431 (95% CI: 0.322-0.540, p < 0.001). No significant association between positive C. pneumonia titers and the combined clinical endpoint during the 12 month follow-up could be found. In all test systems used, patients with positive anti- C. pneumoniae titers did not benefit from roxithromycin therapy (p = ns). CONCLUSION Depending on the test system used, there are large differences in the prevalence of anti- C. pneumoniae seropositive patients. Clinical events during the 12 month follow-up after AMI did not depend on serostatus against C. pneumoniae and treatment with roxithromycin did not influence these events, independently of the serostatus against C. pneumoniae. However, the power of this subgroup analysis was low to detect small but significant differences.
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Affiliation(s)
- U Burkhardt
- Institut für Mikrobiologie und Hygiene, Städt. Klinikum, Bremserstr. 79, 67063 Ludwigshafen, Germany
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Seidel F, Schulze M, Baltz H. Über die Autoxydation des 1,3,5- Triisopropyl-benzols, eine neue Synthese des Phloroglucins. ACTA ACUST UNITED AC 2004. [DOI: 10.1002/prac.19560030504] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Abstract
BACKGROUND Soluble acetylcholinesterase (AChE, E.C. 3.1.1.7.) is released by neurons, glial and meningeal cells into the CSF. AChE activity in cerebrospinal fluid (CSF) is altered in various disorders of the nervous system. The objects of this study are to define a reference range for CSF AChE activity in human lumbar CSF, to prove that the enzyme activity does not depend on the blood/CSF barrier function, and to provide information about AChE in ventricular CSF. In addition, drugs used in neurosurgical care have been examined for their in vitro effects on CSF AChE activity to exclude interference with the test system. METHODS We tested the AChE activity in 64 lumbar CSF samples collected from a clinically healthy population and in 169 ventricular CSF samples obtained from 90 neurosurgical patients. AChE activity was assayed with our inhibitor-free test procedure. RESULTS The reference range determined for lumbar CSF AChE activity is 9.2-24.4 nmol/min per ml. Lumbar CSF AChE activity does not correlate with parameters characterising the status of the blood/CSF barrier. Ventricular puncture is only justified for underlying pathology making it impossible to provide reference data for ventricular CSF. Most measurements reveal ventricular enzyme activity below 4 nmol/min per ml. CONCLUSION The results of this study suggest the utility of lumbar CSF AChE activity as a measure of specific secretory function in enzyme releasing cells of the nervous system.
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Affiliation(s)
- W H Kluge
- Clinic of Orthopaedics, 'Rudolf Elle' Hospital Eisenberg, Friedrich Schiller University Jena, Jena, Germany.
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Berg H, Schaefer T, Seidel F. Regulatory and safety aspects concerning the implementation of modern instrumentation and control systems in German nuclear power plants / Genehmigungs- und Sicherheitsaspekte im Zusammenhang mit der Einführung moderner Leittechnik-Systeme in deutschen Kernkraftwerken. KERNTECHNIK 1997. [DOI: 10.1515/kern-1996-620112] [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: 11/15/2022]
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Carlsson J, Tebbe U, Rox J, Harmjanz D, Haerten K, Neuhaus KL, Seidel F, Niederer W, Miketić S. Cardioversion of atrial fibrillation in the elderly. ALKK-Study Group. Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausaerzte. Am J Cardiol 1996; 78:1380-4. [PMID: 8970410 DOI: 10.1016/s0002-9149(96)00647-9] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [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] [Indexed: 02/03/2023]
Abstract
The purpose of this investigation was to define cardioversion success rates, frequency of complications of cardioversion, and current treatment practices in elderly patients (aged > or = 65 years) with atrial fibrillation (AF). The results were compared with those in younger patients (aged < 65 years). The investigation was a prospective multicenter observational study with 61 participating cardiology clinics. Consecutive patients in whom cardioversion of AF was planned had to be prospectively registered. Of 1,152 patients registered, 570 (49.5%) were < 65 years old (group 1) and 582 (50.5%) were > or = 65 years (group 2). The overall success rate of cardioversion on an intention-to-treat basis was 76.1% in group 1 and 72.7% in group 2 (p = 0.18). In multivariate analysis, left atrial size and New York Heart Association functional class before cardioversion were identified as predictors of success (p < 0.001, respectively; p = 0.025). These clinical factors were not equally distributed between the age groups: Left atrial size was larger in the elderly than in younger patients (44.0 +/- 6.4 mm vs 42.8 +/- 6.4 mm; p = 0.006) and a New York Heart Association functional class > or = II was more prevalent in group 2 than in group 1 (48.6% vs 29.6%; p < 0.001). The overall complication rates were not significantly different between the 2 groups (4.2% in group 1 vs 5.3% in group 2; p = 0.37). The frequency of patients who were adequately anticoagulated for cardioversion was 56.9% in age group 1 and 39.6% in age group 2 (p < 0.001). In chronic AF the same trend for age-dependent underuse of anticoagulation was observed. Age itself was not a predictor of cardioversion success and did not predispose to higher complication rates. Therefore, cardioversion should be considered in older patients with the same criteria and emphasis as in younger patients. Anticoagulation and antithrombotic medication is underused for cardioversion and in treating chronic AF, especially in elderly patients.
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Affiliation(s)
- J Carlsson
- Medizinische Klinik II, Klinikum Lippe-Detmold, Germany
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36
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Michel D, Seidel F. [Progress in cardiologic therapy. Thrombolysis expanded--prevention possibilities employed early--ACE inhibitors as therapeutic hit]. Fortschr Med 1985; 103:5-7. [PMID: 2982710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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37
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Seidel F. [Infusion therapy in the prehospital phase]. Z Arztl Fortbild (Jena) 1984; 78:637-638. [PMID: 6208698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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38
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Seidel F, Alber G, Uberreiter A, Nebelsieck H, Pawelke R, Bender M. [Transluminal coronary dilatation]. Fortschr Med 1983; 101:2065-2069. [PMID: 6228505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Percutaneous transluminal coronary angioplasty (PTCA) represents in patients with single-vessel disease the treatment of choice. Under adequate precautions the method can be performed with reasonable risk outside of a hospital with cardiac surgical operating rooms.
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Unsicker K, Seidel F, Hofmann HD, Müller TH, Schmidt R, Wilson A. Catecholaminergic innervation of the chicken ovary. With special reference to the follicular wall. Cell Tissue Res 1983; 230:431-50. [PMID: 6342801 DOI: 10.1007/bf00213816] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The innervation of the chicken ovary was investigated with special emphasis on adrenergic nerves in the follicular wall. Quantitative determinations of catecholamines (CA) by high-performance liquid chromatography and electrochemical detection (hplc-ed) revealed 15.4 +/- 3.3 ng/mg protein of norepinephrine (NE) and 3.14 ng/mg protein of epinephrine (E), with even larger amounts in the cranial part of the ovary close to the adrenal gland. Serial sections that had been processed for the visualisation of aminergic nerves (Falck-Hillarp- or glyoxylic acid techniques) showed CA localized in nerve-fibre bundles; cell bodies of chromaffin and sympathetic neurons were only found at the ovarian-adrenal junction suggesting that ovarian nerves stored considerable quantities of E. An antiserum against bovine phenylethanolamine N-methyltransferase (PNMT, the E-synthesizing enzyme) produced no immunostaining in chicken ovary or adrenal gland, due to a lack of cross-reactivity between the antiserum and chicken PNMT. Serial sections processed alternately for the visualisation of aminergic nerves and myosin (from chicken gizzard) immunoreactivity revealed a scarce nerve supply of contractile cells in the theca externa compared to an extraordinarily dense innervation of the endocrine interstitial tissue of the theca interna. This distribution pattern of nerve fibres in the follicular wall was confirmed by electron microscopy in ovarian tissue that had been pretreated with 5- or 6-hydroxydopamine (HDA). More than 90% of the terminal axons were specifically labeled by these false adrenergic transmitters. Many of these terminals were seen in close contact (20 nm) with steroidogenic cells suggesting a neuromodulatory function of CA in hormone synthesis and/or release. It is yet unclear whether E and NE are stored in separate or identical axon moieties and within the same organelles. Choline acetyltransferase activity, which was taken as a measure for a cholinergic nerve component in the ovary, amounted to only 7% of its adrenal activity. It is suggested that the chicken ovary may serve as an excellent model to investigate the modulatory role of nerves in the endocrine function of the ovary.
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Spangenberg G, Alber G, Kreul HG, Seidel F. [Ductus arteriosus Botalli persistens in adults with pressure compensation. Clinical symptoms and findings]. Fortschr Med 1981; 99:1447-2. [PMID: 7297982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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41
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Zimmermann W, Frank N, Weiss-Simon C, Bartl G, Burkhard B, Seidel F. [Diagnosis of space-occupying renal processes: sonography and aimed fine-needle biopsy]. Fortschr Med 1981; 99:1275-80. [PMID: 7297974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
It is reported on 3 cases in which by sonographic examination a tumorous process could be established. In all cases the additional investigation by fine needle biopsy and cytological examination proved the presence of malignant cells. This local renal process proved by sonography could be verified neither by i.v. pyelographic nor arteriographic methods. For two patients the diagnosis based on sonography, fine needle puncture and cytological test could be verified by operation. The third patient was not operated in spite of malignant cells in the cytogram because of negative computer tomography provided by an external hospital.
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Alber G, Seidel F, Spangenberg G, Uberreiter A, Bender M, Kreul HG. [Systolic heart sounds. The differential diagnostic classification with "non-invasive" examination methods]. Fortschr Med 1981; 99:1168-71. [PMID: 7196870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Zimmermann W, Frank N, Weiss-Simon C, Burkhard B, Seidel F. [The normal pancreas. Demonstration in the sonogram in relation to age]. Fortschr Med 1981; 99:1178-82. [PMID: 7274931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
For 191 patients without any clinically or anamnestically traceable disease of pancreas sonographic inspection was performed, a real time-equipment type Aloka, SSD 240 was used. The age of the patients, divided into 5 groups ranged from 15 to 90 years. The measurements of the pancreas sonographic inspection was performed, a real time-equipment type Aloka, SSD 240 was used. The age of the patients, divided into 5 groups ranged from 15 to 90 years. The measurements of the pancreas were established for head, neck, corpus and tail respectively. The following mean values for the thickness were found: Head: 2,41 +/- 0,41 cm; neck: 1,53 +/- 0,34 cm; corpus: 1,90 +/- 0,37 cm; tail: 1,67 +/- 0,37 cm. The width of the organ was in the area of the head: 1,3 to 3,5 cm, neck 1,0 to 2,7 cm, corpus 1,1 to 3,0 cm, tail 0,8 to 2,6 cm. A comparison between normal weight- and overweight-patients showed no significant differences at all. The echostructure of the pancreas showed a clear increase of intensity with progress in age. The reason for this more detailed echostructure is seen in an infiltration of fat as well as collagenous and fibrous elements. No change in organ size was found in this connection.
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Kating H, Seidel F. [Cultivation experiments with Arnica species. II. Vegetative propagation of Arnica montana L]. Planta Med 1967; 15:420-429. [PMID: 5603484 DOI: 10.1055/s-0028-1100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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45
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Güntzel U, Seidel F, Kating H. [Studies on the contents of Arnica-species. I. Content on essential oil in the flowers of different Arnica-species]. Planta Med 1967; 15:205-214. [PMID: 5608995 DOI: 10.1055/s-0028-1099974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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46
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Schiemann E, Scharrer K, Seidel F, Hase A. Besprechungen. Naturwissenschaften 1936. [DOI: 10.1007/bf01473645] [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: 11/24/2022]
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47
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Seidel F. Besprechungen. Naturwissenschaften 1935. [DOI: 10.1007/bf01498076] [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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48
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49
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Seidel F, Neumann R, Stern C, Michelsen. Besprechungen. Naturwissenschaften 1931. [DOI: 10.1007/bf01516781] [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: 11/28/2022]
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50
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