1
|
Lund N, Wieboldt H, Fischer L, Muschol N, Braun F, Huber T, Sorriento D, Iaccarino G, Müllerleile K, Tahir E, Adam G, Kirchhof P, Fabritz L, Patten M. Overexpression of VEGFα as a biomarker of endothelial dysfunction in aortic tissue of α-GAL-Tg/KO mice and its upregulation in the serum of patients with Fabry's disease. Front Cardiovasc Med 2024; 11:1355033. [PMID: 38374995 PMCID: PMC10875336 DOI: 10.3389/fcvm.2024.1355033] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction Fabry's disease is an X-linked lysosomal storage disorder caused by reduced activity of α-galactosidase A (GAL), leading to premature death on account of renal, cardiac, and vascular organ failure. Accumulation of the GAL substrate globotriaosylceramide (Gb3) in endothelial and smooth muscle cells is associated with early vascular cell damage, suggesting endothelial dysfunction as a driver of cardiorenal organ failure. Here, we studied the vascular expression of the key angiogenic factors, VEGFα and its antagonist angiostatin, in Fabry α-GAL-Tg/KO mice and determined circulating VEGFα and angiostatin serum levels in patients with Fabry's disease and healthy controls. Methods Cryopreserved aortic vessels from six α-GAL-Tg/KO and six wild-type (WT) mice were obtained and VEGFα and angiostatin levels were determined by performing Western blot analysis. VEGFα expression was visualized by an immunohistochemical staining of paraffin aortic rings. In addition, VEGFα and angiostatin serum levels were measured by using an enzyme-linked immunosorbent assay in 48 patients with genetically verified Fabry's disease (50% male) and 22 healthy controls and correlated with disease severity markers such as lyso-Gb3, albuminuria, NTproBNP, high-sensitive troponin T (hsTNT), and myocardial wall thickness. Results It was found that there was a significant increase in VEGFα protein expression (1.66 ± 0.35 vs. 0.62 ± 0.16, p = 0.0009) and a decrease in angiostatin expression (0.024 ± 0.007 vs. 0.053 ± 0.02, p = 0.038) in aortic lysates from α-GAL-Tg/KO compared with that from WT mice. Immunohistochemical staining revealed an adventitial VEGFα signal in α-GAL-Tg/KO mice, whereas no VEGFα signal could be detected in WT mice aortas. No differences in aortic angiostatin expression between α-GAL-Tg/KO- and WT mice could be visualized. The serum levels of VEGFα were significantly upregulated in patients with Fabry's disease compared with that in healthy controls (708.5 ± 426.3 vs. 458.5 ± 181.5 pg/ml, p = 0.048) and positively associated with albuminuria (r = 0.82, p < 0.0001) and elevated NTproBNP (r = 0.87, p < 0.0001) and hsTNT values (r = 0.41, p = 0.048) in male patients with Fabry's disease. For angiostatin, no significant difference was found between patients with Fabry's disease and healthy controls (747.6 ± 390.3 vs. 858.8 ± 599.3 pg/ml). Discussion In conclusion, an overexpression of VEGFα and downregulation of its counter player angiostatin in aortic tissue of α-GAL-Tg/KO mice support the hypothesis of an underlying vasculopathy in Fabry's disease. Elevated VEGFα serum levels were also observed in patients with Fabry's disease and were positively associated with elevated markers of organ manifestation in males. These findings suggest that angiogenetic markers, such as VEGFα, may be potentially useful biomarkers for the detection of endothelial dysfunction in classical Fabry's disease.
Collapse
Affiliation(s)
- N. Lund
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Intensive Care Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - H. Wieboldt
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L. Fischer
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - N. Muschol
- Department of Pediatrics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - F. Braun
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T. Huber
- III. Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Hamburg Center for Kidney Health, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - D. Sorriento
- Department of Advanced Biomedical Sciences, Interdepartmental Center of Research on Hypertension and Related Conditions of the Federico II University, Naples, Italy
| | - G. Iaccarino
- Department of Clinical Medicine and Surgery, Interdepartmental Center of Research on Hypertension and Related Conditions of the Federico II University, Naples, Italy
| | - K. Müllerleile
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - E. Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G. Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P. Kirchhof
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - L. Fabritz
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - M. Patten
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Fluschnik N, Tahir E, Erley J, Müllerleile K, Metzner A, Wenzel JP, Guerreiro H, Adam G, Blankenberg S, Kirchhof P, Tönnis T, Nikorowitsch J. 3 Tesla magnetic resonance imaging in patients with cardiac implantable electronic devices: a single centre experience. Europace 2022; 25:571-577. [PMID: 36413601 PMCID: PMC9935018 DOI: 10.1093/europace/euac213] [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] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/01/2022] [Indexed: 11/23/2022] Open
Abstract
AIMS Three Tesla (T) magnetic resonance imaging (MRI) provides critical imaging information for many conditions. Owing to potential interactions of the magnetic field, it is largely withheld from patients with cardiac implantable electronic devices (CIEDs). Therefore, we assessed the safety of 3T MRI in patients with '3T MRI-conditional' and 'non-3T MRI-conditional' CIEDs. METHODS AND RESULTS We performed a retrospective single-centre analysis of clinically indicated 3T MRI examinations in patients with conventional pacemakers, cardiac resynchronization devices, and implanted defibrillators from April 2020 to May 2022. All CIEDs were interrogated and programmed before and after scanning. Adverse events included all-cause death, arrhythmias, loss of capture, inappropriate anti-tachycardia therapies, electrical reset, and lead or generator failure during or shortly after MRI. Changes in signal amplitude and lead impedance were systematically assessed. Statistics included median and interquartile range. A total of 132 MRI examinations were performed on a 3T scanner in 97 patients. Thirty-five examinations were performed in patients with 'non-3T MRI-conditional' CIEDs. Twenty-six scans were performed in pacemaker-dependent patients. No adverse events occurred during or shortly after MRI. P-wave or R-wave reductions ≥ 50 and ≥ 25%, respectively, were noted after three (2.3%) scans, all in patients with '3T MRI-conditional' CIEDs. Pacing and shock impedance changed by ± 30% in one case (0.7%). Battery voltage and stimulation thresholds did not relevantly change after MRI. CONCLUSION Pending verification in independent series, our data suggest that clinically indicated MRI scans at 3T field strength should not be withheld from patients with cardiac pacemakers or defibrillators.
Collapse
Affiliation(s)
- Nina Fluschnik
- Corresponding author. Phone: +49 (0) 40 7410 18576, Fax: +49 (0) 40 7410 58206, E-mail address:
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Kai Müllerleile
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Jan-Per Wenzel
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
| | - Helena Guerreiro
- Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistr 52, 20251 Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany,Institute of Cardiovascular Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Tobias Tönnis
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart & Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20251 Hamburg, Germany,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Martinistr 52, 20251 Hamburg, Germany
| |
Collapse
|
3
|
Wenzel JP, Nikorowitsch J, Bei der Kellen R, Dohm L, Girdauskas E, Lund G, Bannas P, Blankenberg S, Kölbel T, Cavus E, Müllerleile K, Kaul MG, Adam G, Weinrich JM. Comparison of cine cardiac magnetic resonance and echocardiography derived diameters of the aortic root in a large population-based cohort. Sci Rep 2022; 12:15307. [PMID: 36096919 PMCID: PMC9468025 DOI: 10.1038/s41598-022-19461-5] [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: 04/29/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Transthoracic echocardiography (TTE) and cine cardiac magnetic resonance imaging (CMR) are established imaging methods of the aortic root. We aimed to evaluate the comparability of measurements in TTE and standard cine CMR sequences of the aortic root. Our study included 741 subjects (mean age 63.5 ± 8 years, 43.7% female) from the Hamburg City Health Study (HCHS). Subjects underwent CMR and TTE. Aortic root measurements were performed at the level of the aortic annulus (AoAn), sinus of Valsalva (SoV), and sinotubular junction (STJ) by standard cine CMR in left ventricular long axis and left ventricular outflow tract view. Measurements were performed applying the leading-edge to leading-edge (LL) convention and inner-edge to inner-edge (II) convention in TTE and the II convention in CMR. Inter correlation coefficients (ICCs) demonstrated high inter- and intraobserver reproducibility for CMR and TTE measurements of SoV and STJ (ICCs 0.9–0.98) and moderate reproducibility for AoAn (ICCs 0.68–0.91). CMR measurements of SoV and STJ showed strong agreement with TTE: while correlations were comparable (r = 0.75–0.85) bias was lower with TTE II (bias − 0.1 to − 0.74) versus TTE LL measurements (mean bias − 1.49 to − 2.58 mm). The agreement for AoAn was fair (r = 0.51–0.57) with variable bias (mean bias 0.39–3.9). Standard cine CMR and TTE derived aortic root measurements are reproducible and comparable with higher agreement for TTE II instead of LL measurements. These results support an interchangeable application of TTE and standard CMR for screening of aortic root diseases thereby possibly reducing redundant multimodality imaging.
Collapse
Affiliation(s)
- Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany. .,Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Ramona Bei der Kellen
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Luisa Dohm
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Evaldas Girdauskas
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Gunnar Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Tilo Kölbel
- Department of Vascular Medicine, German Aortic Center Hamburg, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Ersin Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Kai Müllerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, UKE Hamburg, Hamburg, Germany
| | - Michael Gerhard Kaul
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julius Matthias Weinrich
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
4
|
Schneider JN, Jahnke C, Cavus E, Chevalier C, Bohnen S, Radunski UK, Riedl KA, Tahir E, Adam G, Kirchhof P, Blankenberg S, Lund GK, Müllerleile K. Feature tracking cardiovascular magnetic resonance reveals recovery of atrial function after acute myocarditis. Int J Cardiovasc Imaging 2022; 38:2003-2012. [PMID: 37726601 PMCID: PMC10509057 DOI: 10.1007/s10554-022-02576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 02/17/2022] [Indexed: 11/24/2022]
Abstract
Follow-up after acute myocarditis is important to detect persisting myocardial dysfunction. However, recovery of atrial function has not been evaluated after acute myocarditis so far. Thirty-five patients with strictly defined acute myocarditis underwent cardiovascular magnetic resonance (CMR, 1.5 T) in the acute stage at baseline (BL) and at 3 months follow-up (FU). The study population included 13 patients with biopsy-proven "cardiomyopathy-like" myocarditis (CLM) and 22 patients with "infarct-like" (ILM) clinical presentation. CMR feature tracking (FT) was performed on conventional cine SSFP sequences. Median LA-GLS increased from 33.2 (14.5; 39.2) at BL to 37.0% (25.2; 44.1, P = 0.0018) at FU in the entire study population. Median LA-GLS also increased from 36.7 (26.5; 42.3) at BL to 41.3% (34.5; 44.8, P = 0.0262) at FU in the ILM subgroup and from 11.3 (6.4; 21.1) at BL to 21.4% (14.2; 30.7, P = 0.0186) at FU in the CLM subgroup. Median RA-GLS significantly increased from BL with 30.8 (22.5; 37.0) to FU with 33.7% (26.8; 45.4, P = 0.0027) in the entire study population. Median RA-GLS also significantly increased from 32.7 (25.8; 41.0) at BL to 35.8% (27.7; 48.0, P = 0.0495) at FU in the ILM subgroup and from 22.8 (13.1; 33.9) at BL to 31.0% (26.0; 40.8, P = 0.0266) at FU in the CLM subgroup. Our findings demonstrate recovery of LA and RA function by CMR-FT strain analyses in patients after acute myocarditis independent from clinical presentation. Monitoring of atrial strain could be an important tool for an individual assessment of healing after acute myocarditis.
Collapse
Affiliation(s)
- J N Schneider
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany.
| | - C Jahnke
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - E Cavus
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - C Chevalier
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - S Bohnen
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - U K Radunski
- Department of Cardiology, Regio Clinics Pinneberg and Elmshorn, Hamburg, Germany
| | - K A Riedl
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
| | - E Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kirchhof
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - S Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - G K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Müllerleile
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistrasse 52, 20246, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| |
Collapse
|
5
|
Schoennagel BP, Müllerleile K, Tahir E, Starekova J, Grosse R, Yamamura J, Bannas P, Adam G, Fischer R. Insights into diastolic function analyses using cardiac magnetic resonance imaging: impact of trabeculae and papillary muscles. Insights Imaging 2021; 12:159. [PMID: 34731305 PMCID: PMC8566627 DOI: 10.1186/s13244-021-01104-4] [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] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 10/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background This cardiovascular magnetic resonance (CMR) study investigates the impact of trabeculae and papillary muscles (TPM) on diastolic function parameters by differentiation of the time-volume curve. Differentiation causes additional problems, which is overcome by standardization. Methods Cine steady-state free-precession imaging at 1.5 T was performed in 40 healthy volunteers stratified for age (age range 7–78y). LV time-volume curves were assessed by software-assisted delineation of endocardial contours from short axis slices applying two different methods: (1) inclusion of TPM into the myocardium and (2) inclusion of TPM into the LV cavity blood volume. Diastolic function was assessed from the differentiated time-volume curves defining the early and atrial peaks, their filling rates, filling volumes, and further dedicated diastolic measures, respectively. Results Only inclusion of TPM into the myocardium allowed precise assessment of early and atrial peak filling rates (EPFR, APFR) with clear distinction of EPFR and APFR expressed by the minimum between the early and atrial peak (EAmin) (100% vs. 36% for EAmin < 0.8). Prediction of peak filling rate ratios (PFRR) and filling volume ratios (FVR) by age was superior with inclusion of TPM into the myocardium compared to inclusion into the blood pool (r2 = 0.85 vs. r2 = 0.56 and r2 = 0.89 vs. r2 = 0.66). Standardization problems were overcome by the introduction of a third phase (mid-diastole, apart from diastole and systole) and fitting of the early and atrial peaks in the differentiated time-volume curve. Conclusions Only LV volumetry with inclusion of TPM into the myocardium allows precise determination of diastolic measures and prevents methodological artifacts.
Collapse
Affiliation(s)
- Bjoern P Schoennagel
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany.
| | - Kai Müllerleile
- Department of Cardiology, University Heart and Vascular Center, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Jitka Starekova
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Regine Grosse
- Department of Pediatric Hematology and Oncology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Jin Yamamura
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Peter Bannas
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany
| | - Roland Fischer
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 22609, Hamburg, Germany.,UCSF Benioff Children's Hospital, Oakland, USA
| |
Collapse
|
6
|
Relan J, Ehrhardt J, Müllerleile K, Bahrmeyer A, Groth M, Handels H, Säring D. Reproducible Extraction of Local and Global Parameters for Functional Analysis of the Left Ventricle in 4D MR Image Data. Methods Inf Med 2018; 48:216-24. [DOI: 10.3414/me9210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: Left ventricle (LV) segmentation is required to quantify LV volume and mass parameters. Therefore, spatiotemporal Cine MR sequences in the short and long axis of the heart are acquired. Generally, LV segmentation methods consider short-axis sequences only. The reduced resolution in long-axis direction is one of the main reasons for inaccurate parameter extraction in the apical and basal area. The segmentation approach presented combines short- and long-axis information as well as motion tracking to enable the functional LV analysis in 4D MR Image Data.
Methods: First, anatomical landmarks like the mitral valve and the apex are defined in long-axis views in diastolic and systolic phase in order to specify the upper and lower boundary of the LV. Second, motion field approximation using non-linear registration enables the automatic contour propagation to all time points. Third, intersection planes are defined parallel to the mitral valve plane covering the whole ventricle. Finally, the 4D LV surface model is generated appending all in-plane contours. The segmentation results in short-axis images are checked and adjusted interactively and quantitative parameters are extracted.
Results: For evaluation the contours of 19 different datasets were traced by two medical experts using a contour drawing tool and the new segmentation tool. The results were compared to evaluate automatic contour propagation, robustness of the segmentation as well as interaction time.
Conclusion: The automatic contour propagation enables the fast and reproducible generation of a 4D model for the functional analysis of the heart. The interaction time is decreased from approx. 60 minutes to 10 minutes per case. Inter- and intraobserver differences of the extracted parameters are decreased significantly.
Collapse
|
7
|
Relan J, Groth M, Müllerleile K, Handels H, Säring D. 3D Segmentation of the Left Ventricle Combining Long- and Short-axis MR Images. Methods Inf Med 2018; 48:340-3. [DOI: 10.3414/me9233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Summary
Objectives: Segmentation of the left ventricle (LV) is required to quantify LV remodeling after myocardial infarction. Therefore spatiotemporal cine MR sequences including long-axis and short-axis images are acquired. In this paper a new segmentation method for fast and robust segmentation of the left ventricle is presented.
Methods: The new approach considers the position of the mitral valve and the apex as well as the long-axis contours to generate a 3D LV surface model. The segmentation result can be checked and adjusted in the short-axis images. Finally quantitative parameters were extracted.
Results: For evaluation the LV was segmented in eight datasets of the same subject by two medical experts using a contour drawing tool and the new segmentation tool. The results of both methods were compared concerning interaction time and intra- and inter-observer variance. The presented segmentation method proved to be fast. The mean difference and standard deviation of all parameters are decreased. In case of intra-observer comparison e.g. the mean ESV difference is reduced from 8.8% to 0.5%.
Conclusion: A semi-automatic LV segmentation method has been developed that combines long- and short-axis views. Using the presented approach the intra- and inter-observer difference as well as the time for the segmentation process are decreased. So the semi-automatic segmentation using long-and short-axis information proved to be fast and robust for the quantification of LV mass and volume properties.
Collapse
|
8
|
Stáreková J, Tahir E, Avanesov M, Patten-Hamel M, Münch J, Weinrich J, Bohnen S, Radunski U, Müllerleile K, Stritzky A, Adam G, Lund G. Inzidenz, Lokalisation und Ausprägung von Myokardvernarbungen bei ambitionierten Triathleten im Kardio-MRT. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600253] [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: 10/19/2022]
Affiliation(s)
- J Stáreková
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - E Tahir
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - M Avanesov
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - M Patten-Hamel
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - J Münch
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - J Weinrich
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - S Bohnen
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - U Radunski
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - K Müllerleile
- UHZ, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - A Stritzky
- UHZ, Allgemeine und interventionelle Kardiologie, Hamburg
| | - G Adam
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| | - G Lund
- UKE, Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie und Nuklearmedizin, Hamburg
| |
Collapse
|
9
|
Tahir E, Sinn M, Avanesov M, Bohnen S, Müllerleile K, Radunksi U, Stehning C, Säring D, Starekova J, Schnackenburg B, Adam G, Lund G. Quantitatives T1- und T2-Mapping CMR zur Differenzierung von akutem und chronischem Myokardinfarkt. ROFO-FORTSCHR RONTG 2017. [DOI: 10.1055/s-0037-1600256] [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: 10/19/2022]
Affiliation(s)
- E Tahir
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - M Sinn
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - M Avanesov
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - S Bohnen
- Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - K Müllerleile
- Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Hamburg
| | - U Radunksi
- Universitäres Herzzentrum Hamburg, Allgemeine und Interventionelle Kardiologie, Hamburg
| | | | - D Säring
- FH Wedel, Medizinische und Industrielle Bildverarbeitung, Wedel
| | - J Starekova
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | | | - G Adam
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| | - G Lund
- Universitätsklinikum Eppendorf-Hamburg, Diagnostische und Interventionelle Radiologie, Hamburg
| |
Collapse
|
10
|
Avanesov M, Weinrich J, Münch J, Well L, Säring D, Müllerleile K, Tahir E, Patten M, Adam G, Lund G. Comparison of global extracellular volume (ECV) and late gadolinium enhancement (LGE) to predict the estimated 5 year risk of sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM). J Cardiovasc Magn Reson 2016. [PMCID: PMC5032276 DOI: 10.1186/1532-429x-18-s1-p127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
11
|
Pappalardo F, Schulte C, Pieri M, Schrage B, Contri R, Soeffker G, Greco T, Lembo R, Müllerleile K, Colombo A, Sydow K, De Bonis M, Wagner F, Reichenspurner H, Blankenberg S, Zangrillo A, Westermann D. Concomitant implantation of Impella®on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail 2016; 19:404-412. [DOI: 10.1002/ejhf.668] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 09/01/2016] [Accepted: 09/02/2016] [Indexed: 11/10/2022] Open
Affiliation(s)
- Federico Pappalardo
- Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Christian Schulte
- Department of General and Interventional Cardiology; University Heart Centre Hamburg Eppendorf; Hamburg Germany
| | - Marina Pieri
- Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Benedikt Schrage
- Department of General and Interventional Cardiology; University Heart Centre Hamburg Eppendorf; Hamburg Germany
| | - Rachele Contri
- Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Gerold Soeffker
- Department of Intensive Care, Centre for Anaesthesiology and Intensive Care Medicine; University Medical Centre Hamburg Eppendorf; Hamburg Germany
| | - Teresa Greco
- Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Rosalba Lembo
- Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Kai Müllerleile
- Department of General and Interventional Cardiology; University Heart Centre Hamburg Eppendorf; Hamburg Germany
| | - Antonio Colombo
- Department of Interventional Cardiology, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Karsten Sydow
- Department of General and Interventional Cardiology; University Heart Centre Hamburg Eppendorf; Hamburg Germany
| | - Michele De Bonis
- Department of Cardiac Surgery, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Florian Wagner
- Department of Cardiovascular Surgery; University Heart Centre Hamburg Eppendorf; Hamburg Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery; University Heart Centre Hamburg Eppendorf; Hamburg Germany
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology; University Heart Centre Hamburg Eppendorf; Hamburg Germany
- German Centre for Cardiovascular Research (DZHK); Partner site Hamburg/Lübeck/Kiel; Hamburg Gemany
| | - Alberto Zangrillo
- Department of Cardiothoracic Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute; Vita Salute University; Milan Italy
| | - Dirk Westermann
- Department of General and Interventional Cardiology; University Heart Centre Hamburg Eppendorf; Hamburg Germany
- German Centre for Cardiovascular Research (DZHK); Partner site Hamburg/Lübeck/Kiel; Hamburg Gemany
| |
Collapse
|
12
|
Schrage B, Seiffert M, Müllerleile K, Zengin E, Lubos E, Sinning C, Schäfer U, Sydow K, Blankenberg S, Westermann D. Radiation exposure during the implantation of bioabsorbable vascular scaffolds versus drug-eluting stents in non-complex coronary lesions: a matched-cohort study. Minerva Cardioangiol 2016; 65:1-7. [PMID: 27249788 DOI: 10.23736/s0026-4725.16.04072-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Bioabsorbable vascular scaffolds (BVS) are a novel option for the treatment of coronary lesions in patients with stable coronary artery disease or acute coronary syndromes. We aimed to identify the influence of BVS implantation on radiation exposure and procedural outcomes compared to drug-eluting stents (DES) in daily clinical practice. METHODS A retrospective single-center study was performed in patients undergoing percutaneous coronary intervention with BVS from 2013 to 2014. Only patients with exclusive BVS implantation (N.=78 procedures) were compared with a 2:1 matched cohort of exclusive DES-treated patients in the same period (N.=156 procedures). We used a four-step protocol to reduce radiation exposure in all procedures. Furthermore, a 12-month clinical follow-up was performed. RESULTS Patients had similar baseline characteristics due to matching. Radiation exposure (1826 vs. 2167 cGy*cm2, P=0.673), procedure time (73 vs. 65 minutes, P=0.574), target vessel revascularization (1.3 vs. 1.3%, p=1.000 for PCI; 1.3 vs. 0.6%, P=0.616 for CABG), cardiovascular death (0.0 vs. 2.6%, P=0.304) or all-cause death (0.0 vs. 3.2%, P=0.172) were similar after implantation of BVS vs. DES. However, exposure to contrast agent (166 vs. 139 mL, P=0.028) was significantly higher in the BVS group. CONCLUSIONS The implantation of BVS in combination with a simple four-step protocol is a feasible option for interventional treatment of non-complex coronary lesions without significant impact on radiation exposure or outcome measures in daily clinical routine.
Collapse
Affiliation(s)
- Benedikt Schrage
- Department of General and Interventional Cardiology, University Heart Center Hamburg Eppendorf, Hamburg, Germany -
| | | | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Avanesov M, Weinrich J, Münch J, Well L, Säring D, Stehning C, Müllerleile K, Patten M, Tahir E, Adam G, Lund G. Abschätzung des kalkulierten 5-Jahres-Risikos für plötzlichen Heztod durch quantitative LGE- und ECV-Bestimmung bei Patienten mit hypertropher Kardiomyopathie(HCM). ROFO-FORTSCHR RONTG 2016. [DOI: 10.1055/s-0036-1581381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
14
|
Avanesov M, Säring D, Radunski U, Müllerleile K, Stehning C, Adam G, Lund G. Quantifizierung der Myokardfibrose bei Patienten mit hypertropher Kardiomyopathie mit LGE, prä-/post-KM T1- und ECV-Mapping bezogen auf normal erscheinendes Myokard und Normalwerte gesunder Probanden. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550953] [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: 10/23/2022]
|
15
|
Groth M, Clausen E, Müllerleile K. MRT des Herzens für Einsteiger mit MR-Erfahrung. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1551492] [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: 10/23/2022]
|
16
|
Sinn M, Tahir E, Radunski U, Säring D, Müllerleile K, Stehning C, Adam G, Lund G. Serielle Beurteilung der Infarktgröße durch LGE und ECV-Mapping innerhalb von 6 Monaten nach akutem Herzinfarkt. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550957] [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: 10/23/2022]
|
17
|
Tahir E, Sinn M, Radunski U, Säring D, Stehning C, Müllerleile K, Adam G, Lund G. Quantitatives Monitoring der Ödemresorption nach akutem Myokardinfarkt mittels seriellem nativem T1- und T2-Mapping. ROFO-FORTSCHR RONTG 2015. [DOI: 10.1055/s-0035-1550956] [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: 10/23/2022]
|
18
|
Knappe D, von Stumm M, Deuschl F, Voss S, Bernhardt A, Wagner F, Deuse T, Blankenberg S, Reichenspurner H, Müllerleile K. Prevalence of Vitamin D Deficiency Among LVAD Patients. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.902] [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: 11/25/2022] Open
|
19
|
Rostock T, Salukhe TV, Hoffmann BA, Steven D, Berner I, Müllerleile K, Theis C, Bock K, Servatius H, Sultan A, Willems S. Prognostic Role of Subsequent Atrial Tachycardias Occurring During Ablation of Persistent Atrial Fibrillation. Circ Arrhythm Electrophysiol 2013; 6:1059-65. [DOI: 10.1161/circep.113.001019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Thomas Rostock
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Tushar V. Salukhe
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Boris A. Hoffmann
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Daniel Steven
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Imke Berner
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Kai Müllerleile
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Cathrin Theis
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Karsten Bock
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Helge Servatius
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Arian Sultan
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| | - Stephan Willems
- From the II. Medical Clinic, Department of Electrophysiology, University Medical Center, Johannes Gutenberg-University, Mainz, Germany (T.R., C.T., K.B.); Department of Electrophysiology, University Hospital Eppendorf, University Heart Center, Hamburg, Germany (T.R., T.V.S., B.A.H., D.S., I.B., K.M., C.T., K.B., H.S., A.S., S.W.); and Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust and National Heart Lung Institute, Imperial College London, London, United Kingdom (T.V.S.)
| |
Collapse
|
20
|
Groth M, Clausen E, Müllerleile K. - MRT des Herzens für Einsteiger mit MR-Erfahrungen. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346584] [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: 10/26/2022]
|
21
|
Lund G, Avanesov M, Säring D, Bannas P, Müllerleile K, Cürlis J, Barz D, Adam G. Evaluation eines neuen Algorithmus zur quantativen Vermessung von Infarktgrößen bei Patienten mit akutem und chronischem Myokardinfarkt unter Verwendung der kardialen Magnetresonanztomografie. ROFO-FORTSCHR RONTG 2013. [DOI: 10.1055/s-0033-1346615] [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: 10/26/2022]
|
22
|
Wagner FM, Subbotina I, Deuse T, Marcsek P, Treede H, Kubik M, Müllerleile K, Reichenspurner H. Additional intraoperative blood cardioplegia to improve donor heart ischemic tolerance – a single center prospective cohort study. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332366] [Citation(s) in RCA: 2] [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: 10/27/2022]
|
23
|
Ohdah S, Meyer S, Schlüter M, Deuse T, Müllerleile K, Reichenspurner H. Influence of everolimus-based immunosuppression on infections in heart transplant recipients. Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332605] [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: 10/27/2022]
|
24
|
Groth M, Bannas P, Regier M, Buhk JH, Müllerleile K, Adam G, Henes FO. Precision of pulmonary vein diameter measurements assessed by CE-MRA and steady-state-free precession imaging. Eur Radiol 2012; 23:1546-52. [PMID: 23255176 DOI: 10.1007/s00330-012-2752-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 11/14/2012] [Accepted: 11/25/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Pulmonary vein (PV) diameter assessment is important for planning and follow-up of PV ablation in atrial fibrillation. Therefore, the aim of our study was to evaluate inter- and intraobserver reliability of PV diameter measurements by contrast-enhanced magnetic resonance angiography (CE-MRA) and ECG-gated 2D multislice unenhanced steady-state-free precession sequences (multislice SSFP). METHODS Sixty PV diameters in 17 consecutive patients were measured in transverse and coronal orientation with CE-MRA and multislice SSFP by two observers. Statistics to evaluate inter- and intraobserver reliability included Bland-Altman analysis and F-test. RESULTS Intraobserver limits of agreement (LAG) ranged between ±0.50 cm (transverse) and ±0.86 cm (coronal) for CE-MRA versus ±0.40 cm (transverse) and ±0.67 cm (coronal) for multislice SSFP. Interobserver agreement showed LAG ranging between ±0.59 cm (transverse) and ±0.83 cm (coronal) for CE-MRA versus ±0.34 cm (transverse) and ±0.75 cm (coronal) for multislice SSFP. Intra- and interobserver variances did not reveal significant differences between CE-MRA and multislice SSFP in any orientation (all p-values >0.05). CONCLUSION Multislice SSFP and CE-MRA enable comparable precision of PV diameter measurements. However, both methods reveal a wide range of intra- and interobserver agreement, which has to be thoroughly considered in clinical use. KEY POINTS • Unenhanced magnetic resonance imaging can now provide measurement of pulmonary vein diameters • Steady-state-free precession offers a new method of performing unenhanced MR imaging • Both unenhanced and enhanced MRI measurements show wide intra- and interobserver variation • PV diameter measurements assessed by MRI have to be interpreted with care • Nevertheless, unenhanced MRI might replace some CT examinations for pulmonary vein demonstration.
Collapse
Affiliation(s)
- Michael Groth
- Department of Diagnostic and Interventional Radiology, Center for Radiology and Endoscopy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
25
|
Lund G, Müllerleile K, Bannas P, Barz D, Cürlis J, Radunski U, Sydow K, Stehning C, Schnackenburg B, Adam G. Serielles T2-mapping zur quantitativen Beurteilung der myokardialen Ödemresorption nach akutem Myokardinfarkt. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311440] [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: 10/28/2022]
|
26
|
Groth M, Müllerleile K, Clausen E. MRT des Herzens für Einsteiger. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311401] [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: 10/28/2022]
|
27
|
Lund GK, Groth M, Müllerleile K, Klinik T, Halaj S, Folwarski G, Säring D, Adam G. Improved reproducibility of LV volumetry and infarct size measurement using a standardized evaluation protocol for cardiac magnetic resonance imaging. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106537 DOI: 10.1186/1532-429x-13-s1-p160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
28
|
Rostock T, Salukhe TV, Steven D, Drewitz I, Hoffmann BA, Bock K, Servatius H, Müllerleile K, Sultan A, Gosau N, Meinertz T, Wegscheider K, Willems S. Long-term single- and multiple-procedure outcome and predictors of success after catheter ablation for persistent atrial fibrillation. Heart Rhythm 2011; 8:1391-7. [PMID: 21699825 DOI: 10.1016/j.hrthm.2011.04.012] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 04/04/2011] [Indexed: 11/29/2022]
Affiliation(s)
- Thomas Rostock
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Sultan A, Steven D, Rostock T, Hoffmann B, Müllerleile K, Servatius H, Drewitz I, Lüker J, Meyer P, Salukhe T, Willems S. Intravenous administration of magnesium and potassium solution lowers energy levels and increases success rates electrically cardioverting atrial fibrillation. J Cardiovasc Electrophysiol 2011; 23:54-9. [PMID: 21815963 DOI: 10.1111/j.1540-8167.2011.02146.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND External biphasic electrical cardioversion (CV) is a standard treatment option for patients suffering from acute symptoms of atrial fibrillation (AF). Nevertheless, CV is not always successful, and thus strategies to increase the success rate are desirable. OBJECTIVE The purpose of this study was to evaluate the effect of intravenously administered K/Mg solution on the biphasic CV energy threshold and success rate to restore sinus rhythm (SR) in patients with AF. METHODS The study consisted of 170 patients with persistent AF. The patients were randomly assigned to undergo biphasic CV either with (n = 84) or without (n = 86) pretreatment with K/Mg solution. An energy step-up protocol of 75, 100, and 150 W (J) was used. RESULTS Biphasic CV of AF was effective in 81 (96.4%) patients in the pretreatment and 74 (86.0%) patients in the control group (P = 0.005). The effective energy level required to achieve SR was significantly lower in the pretreated group (140.8 ± 26.9 J vs 182.5 ± 52.2 J, P = 0.02). No K/Mg-solution-associated side effects such as hypotension or bradycardia were observed. CONCLUSION Administration of K/Mg solution positively influences the success rate of CV in patients with persistent AF. Furthermore, significantly less energy is required to successfully restore SR and therefore K/Mg pretreatment may facilitate SR restoration in patients undergoing CV for AF.
Collapse
Affiliation(s)
- Arian Sultan
- Cardiac Electrophysiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Groth M, Müllerleile K, Clausen E, Koller A, Schröder S. MRT des Herzens. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1279532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
31
|
Willems S, Steven D, Servatius H, Hoffmann BA, Drewitz I, Müllerleile K, Aydin MA, Wegscheider K, Salukhe TV, Meinertz T, Rostock T. Persistence of pulmonary vein isolation after robotic remote-navigated ablation for atrial fibrillation and its relation to clinical outcome. J Cardiovasc Electrophysiol 2011; 21:1079-84. [PMID: 20455974 DOI: 10.1111/j.1540-8167.2010.01773.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS A robotic navigation system (RNS, Hansen™) has been developed as an alternative method of performing ablation for atrial fibrillation (AF). Despite the growing application of RNS-guided pulmonary vein isolation (PVI), its consequences and mechanisms of subsequent AF recurrences are unknown. We investigated the acute procedural success and persistence of PVI over time after robotic PVI and its relation to clinical outcome. METHODS AND RESULTS Sixty-four patients (60.7 ± 9.8 years, 53 male) with paroxysmal AF underwent robotic circumferential PVI with 3-dimensional left atrial reconstruction (NavX™). A voluntary repeat invasive electrophysiological study was performed 3 months after ablation irrespective of clinical course. Robotic PVI was successful in all patients without complication (fluoroscopy time: 23.5 [12-34], procedure time: 180 [150-225] minutes). Fluoroscopy time demonstrated a gradual decline but was significantly reduced after the 30th patient following the introduction of additional navigation software (34 [29-45] vs 12 [9-17] minutes; P < 0.001). A repeat study at 3 months was performed in 63% of patients and revealed electrical conduction recovery in 43% of all PVs. Restudied patients without AF recurrence (n = 28) showed a significantly lower number of recovered PVs (1 (0-2) vs 2 (2-3); P = 0.006) and a longer LA-PV conduction delay than patients with AF recurrences (n = 12). Persistent block of all PVs was associated with freedom from AF in all patients. At 3 months, 67% of patients were free of AF, while reablation of recovered PVs led to an overall freedom from AF in 81% of patients after 1 year. CONCLUSION Robotic PVI for PAF is safe, effective, and requires limited fluoroscopy while yielding comparable success rates to conventional ablation approaches with PV reconduction as a common phenomenon associated with AF recurrences.
Collapse
Affiliation(s)
- Stephan Willems
- Department of Electrophysiology, University Heart Center, University Hospital Eppendorf, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Steven D, Rostock T, Salukhe T, Müllerleile K, Willems S. "Electrically silent" pulmonary veins connecting to the right atrium: does the atrium make the difference? Pacing Clin Electrophysiol 2010; 35:e69-72. [PMID: 21091733 DOI: 10.1111/j.1540-8159.2010.02962.x] [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: 11/27/2022]
Abstract
Pulmonary veins (PVs) usually drain into the left atrium (LA) and are frequently targeted for electrical isolation, since it became evident that PVs may trigger and maintain paroxysmal atrial fibrillation (AF). We present a patient with right-sided PVs anomalously connecting to the right atrium with lack of electrical PV-atrial connection. Therefore, isolation of the left veins was performed resulting in freedom from AF as shown during a midterm follow-up. These findings indicate that PV connection to the LA may be a prerequisite for the arrhythmogenic properties of the PVs causing AF.
Collapse
Affiliation(s)
- Daniel Steven
- Department of Electrophysiology, Heart Center, University Hospital Hamburg, Hamburg, Germany.
| | | | | | | | | |
Collapse
|
33
|
Groth M, Henes FO, Müllerleile K, Adam G, Begemann PGC, Regier M. Correlation of right ventricular dysfunction parameters and pulmonary vascular obstruction score in acute pulmonary embolism in a porcine model. Emerg Radiol 2010; 17:367-74. [PMID: 20428913 DOI: 10.1007/s10140-010-0872-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [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: 03/11/2010] [Accepted: 04/15/2010] [Indexed: 11/26/2022]
Abstract
This paper aims to non-invasively determine right ventricular dysfunction parameters (RVDP) in acute pulmonary embolism (APE) and to correlate these parameters with a computed tomography (CT)-based pulmonary artery obstruction score (OS). In seven domestic pigs, magnetic resonance imaging (MRI) was performed before (n = 7) and after (n = 5) APE was induced. Analysis of relative changes in right ventricular stroke volume (RVSV%), output (RVO%), end-systolic (RVESV%), end-diastolic volume (RVEDV%), and heart rate (HR%) was performed. Additionally, for the determination of the OS, all animals underwent contrast-enhanced CT-pulmonary angiography. The CT-based OS correlated strongly with RVSV% (r = 0.9576; p = 0.0104) and RVO% (r = 0.9703; p = 0.0061). Contrarily, almost no correlation could be demonstrated for the OS and the increase of RVESV % (r = 0.3850; p = 0.5222), RVEDV% (r = 0.1830; p = 0.7683), and HR% (r = 0.5494; p = 0.3375). The results of this experimental study underline that the CT-based OS correlates with RVDP as determined by cardiac MRI and might be a helpful tool for the severity assessment in APE.
Collapse
Affiliation(s)
- Michael Groth
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | | | | | | | | | | |
Collapse
|
34
|
Groth M, Henes FO, Müllerleile K, Adam G, Regier M. Intraindividueller Vergleich von nativen und Kontrastmittel-angehobenen MRT-Sequenzen zur Bestimmung der Diameter stenotischer und nicht-stenotischer Pulmonalarterien. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252824] [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: 10/19/2022]
|
35
|
Groth M, Henes FO, Müllerleile K, Adam G, Begemann P, Regier M. Der pulmonalarterielle Obstruktionsgrad bei akuter Lungenarterienembolie korreliert mit der Abnahme des rechtsventrikulären Schlag- und Minutenvolumen – Tierexperiementelle Untersuchungen. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1248007] [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: 10/20/2022]
|
36
|
Hoffmann BA, Koops A, Rostock T, Müllerleile K, Steven D, Karst R, Steinke MU, Drewitz I, Lund G, Koops S, Adam G, Willems S. Interactive real-time mapping and catheter ablation of the cavotricuspid isthmus guided by magnetic resonance imaging in a porcine model. Eur Heart J 2009; 31:450-6. [PMID: 19897495 PMCID: PMC2821629 DOI: 10.1093/eurheartj/ehp460] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims We investigated the feasibility of real-time magnetic resonance imaging (RTMRI) guided ablation of the cavotricuspid isthmus (CTI) by using a MRI-compatible ablation catheter. Methods and results Cavotricuspid isthmus ablation was performed in an interventional RTMRI suite by using a novel 7 French, steerable, non-ferromagnetic ablation catheter in a porcine in vivo model (n = 20). The catheter was introduced and navigated by RTMRI visualization only. Catheter position and movement during manipulation were continuously visualized during the entire intervention. Two porcine prematurely died due to VT/VF. Anatomical completion of the CTI ablation line could be achieved after a mean of 6.3±3 RF pulses (RF energy: 1807±1016.4 Ws/RF pulse, temperature: 55.9±5.9°C) in n = 18 animals. In 15 of 18 procedures (83.3%) a complete CTI block was proven by conventional mapping in the electrophysiological (EP) lab. Conclusion Completely non-fluoroscopic ablation guided by RTMRI using a steerable and non-ferromagnetic catheter is a promising novel technology in interventional electrophysiology.
Collapse
Affiliation(s)
- Boris A Hoffmann
- Department of Cardiology/Electrophysiology, University Hospital Eppendorf, University Heart Center, Martinistr 52, D-20246 Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Rostock T, Steven D, Hoffmann BA, Drewitz I, Servatius H, Müllerleile K, Ventura R, Meinertz T, Willems S. [Surface ECG presentation and intracardiac electrogram characteristics of uncommon supraventricular tachycardia entities]. Herzschrittmacherther Elektrophysiol 2009; 20:14-22. [PMID: 19421836 DOI: 10.1007/s00399-009-0028-7] [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] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Accepted: 01/14/2009] [Indexed: 05/27/2023]
Abstract
The vast majority of patients with supraventricular tachycardias present with specific 12-lead surface ECG characteristics allowing the diagnosis of the underlying mechanisms prior to the invasive electrophysiological study. However, an accurate diagnosis remains challenging in a subset of patients, even when using well-established stimulation maneuvers and sophisticated conventional mapping methods. Thus, the aim of the present manuscript is to describe some cases with uncommon entities of supraventricular tachycardias where the combined interpretation of 12-lead ECG presentation and invasive electrophysiological characteristics revealed the correct diagnoses.
Collapse
Affiliation(s)
- T Rostock
- Klinik für Kardiologie mit Schwerpunkt Elektrophysiologie, Universitätsklinikum Hamburg-Eppendorf, Universitäres Herzzentrum Hamburg, Martinistr. 52, 20246, Hamburg, Deustchland.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Willems S, Hoffmann B, Steven D, Drewitz I, Servatius H, Müllerleile K, Meinertz T, Rostock T. Katheterablation bei Vorhofflimmern: wann bereits klinisch etabliert, wann noch experimentell? Herz 2009; 33:402-11. [DOI: 10.1007/s00059-008-3150-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
39
|
Barmeyer A, Müllerleile K, Mortensen K, Meinertz T. Diastolic dysfunction in exercise and its role for exercise capacity. Heart Fail Rev 2008; 14:125-34. [PMID: 18758943 DOI: 10.1007/s10741-008-9105-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [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: 05/14/2008] [Accepted: 07/23/2008] [Indexed: 01/08/2023]
Abstract
Diastolic dysfunction is frequent in elderly subjects and in patients with left ventricular hypertrophy, vascular disease and diabetes mellitus. Patients with diastolic dysfunction demonstrate a reduced exercise capacity and might suffer from congestive heart failure (CHF). Presence of symptoms of CHF in the setting of a normal systolic function is referred to as heart failure with normal ejection fraction (HFNEF) or, if evidence of an impaired diastolic function is observed, as diastolic heart failure (DHF). Reduced exercise capacity in diastolic dysfunction results from a number of pathophysiological alterations such as slowed myocardial relaxation, reduced myocardial distensibility, elevated filling pressures, and reduced ventricular suction forces. These alterations limit the increase of ventricular diastolic filling and cardiac output during exercise and lead to pulmonary congestion. In healthy subjects, exercise training can enhance diastolic function and exercise capacity and prevent deterioration of diastolic function in the course of aging. In patients with diastolic dysfunction, exercise capacity can be enhanced by exercise training and pharmacological treatment, whereas improvement of diastolic function can only be observed in few patients.
Collapse
Affiliation(s)
- A Barmeyer
- Department of Cardiology/Angiology, Center for Cardiology and Cardiovascular Surgery, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | | | | | | |
Collapse
|
40
|
Steven D, Rostock T, Servatius H, Hoffmann B, Drewitz I, Müllerleile K, Meinertz T, Willems S. Robotic versus conventional ablation for common-type atrial flutter: a prospective randomized trial to evaluate the effectiveness of remote catheter navigation. Heart Rhythm 2008; 5:1556-60. [PMID: 18984532 DOI: 10.1016/j.hrthm.2008.08.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 08/23/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Conventional catheter ablation for common-type atrial flutter (AFL) is a widely established therapy but has not been compared with the use of a robotic navigation system (RNS) thus far. OBJECTIVES The purpose of this study was to investigate the feasibility of a new, nonmagnetic RNS with regard to safety, efficacy, and X-ray exposure to investigator and patient compared with the conventional ablation approach in patients with AFL. METHODS Fifty patients (65.7 +/- 9.3 years, 40 male) undergoing de novo catheter ablation for AFL were randomly assigned to conventional or RNS-guided cavotricuspid isthmus (CTI) ablation. RESULTS Complete bidirectional isthmus block was achieved for all patients without occurrence of procedure-related complications. The fluoroscopy time and the investigator X-ray exposure (8.2 +/- 4.6 vs. 5.8 +/- 3.6, P = .038; and 8.2 +/- 4.6 vs. 1.9 +/- 1.1 minutes, P<.001) as well as the mean radiofrequency (RF) duration and the energy delivered were significantly higher in the conventional than in the RNS group (321.7 +/- 214.6 vs. 496.4 +/- 213.9 seconds, P = .006; 8279 +/- 5767 vs. 16,308 +/- 6870 J, P<.001, respectively). The overall procedure time in the RNS group was significantly longer than in the conventional group (79.2 +/- 30.6 vs. 58.4 +/- 17.7 minutes; P = .04) but significantly decreased comparing the first 10 with the last 10 patients in the RNS group (105.3 +/- 34.8 vs. 60.6 +/- 6.3 minutes; P = .003). Starting ablation during AFL, bidirectional block instantly after termination was observed in 90% of the RNS and 50% of the conventionally treated patients (P = .03). CONCLUSION The present study demonstrates the safety and feasibility of RNS for performing CTI ablation in patients with common-type AFL for use in the clinical routine. As a result of the remote navigation, X-ray exposure and RF duration to achieve bidirectional block were significantly decreased and occurred more often immediately after AFL termination. These findings are consistent with increased catheter stability and RF application efficacy using RNS compared with conventional catheter manipulation.
Collapse
Affiliation(s)
- Daniel Steven
- University Hospital Hamburg-Eppendorf, Department of Cardiology, Hamburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Rostock T, Steven D, Lutomsky B, Servatius H, Drewitz I, Klemm H, Müllerleile K, Ventura R, Meinertz T, Willems S. Atrial fibrillation begets atrial fibrillation in the pulmonary veins on the impact of atrial fibrillation on the electrophysiological properties of the pulmonary veins in humans. J Am Coll Cardiol 2008; 51:2153-60. [PMID: 18510963 DOI: 10.1016/j.jacc.2008.02.059] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 02/04/2008] [Accepted: 02/11/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Our purpose was to investigate the impact of short-lasting atrial fibrillation (AF) on the electrophysiological properties of the atria and pulmonary veins (PVs) in patients devoid of AF. BACKGROUND The presence of AF is associated with electrical remodeling processes that promote a substrate for arrhythmia maintenance in the atria, which has been termed "AF begets AF." However, it is unclear whether those electrical alterations also occur in the PVs. METHODS Thirty-five patients with a left-sided accessory pathway and without a prior history of AF were included. After successful ablation, the effective refractory periods (ERPs) and conduction times of the right atrium (RA), left atrium (LA), and the PVs were determined. Afterwards, AF was induced and maintained for a period of 15 min. Thereafter, the stimulation protocol was repeated. RESULTS At baseline, the PVs had significantly longer ERPs than the atria. After exposure to AF, the ERPs of both the atria and the PVs decreased significantly. The ERPs of the PVs, however, decreased by a significantly greater extent than the ERPs of the atria (PVs: 248 +/- 27 ms vs. 211 +/- 40 ms, p < 0.001; LA: 233 +/- 23 ms vs. 214 +/- 20 ms, p = 0.004; RA: 226 +/- 29 ms vs. 188 +/- 20 ms; p = 0.003). After AF exposure, the PVs demonstrated a significant conduction slowing whereas the atria did not (PVs: 125 +/- 33 ms vs. 159 +/- 37 ms, p < 0.001; LA: 129 +/- 26 ms vs. 130 +/- 24 ms, p = NS; RA: 192 +/- 36 ms vs. 196 +/- 32 ms, p = NS). Finally, AF was more frequently induced after the presence of AF, particularly by pacing in the PVs (14% vs. 49%, p = 0.001). CONCLUSIONS New-onset, short-lasting AF creates electrical characteristics similar to those of patients with AF. However, these alterations are pronounced in the PVs compared with the atria, indicating that "AF begets AF in the PVs" (Electrophysiological Properties of the Pulmonary Veins; NCT00530608).
Collapse
Affiliation(s)
- Thomas Rostock
- University Hospital Eppendorf, Department of Cardiology, Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Rostock T, Sydow K, Steven D, Lutomsky B, Servatius H, Drewitz I, Falke V, Müllerleile K, Ventura R, Meinertz T, Willems S. A new algorithm for concealed accessory pathway localization using T-wave-subtracted retrograde P-wave polarity during orthodromic atrioventricular reentrant tachycardia. J Interv Card Electrophysiol 2008; 22:55-63. [PMID: 18415672 DOI: 10.1007/s10840-008-9253-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2008] [Accepted: 03/04/2008] [Indexed: 11/21/2022]
Abstract
INTRODUCTION AP localization can be predicted by analyzing the polarity of the delta wave, QRS polarity, and R/S ratio in patients with Wolff-Parkinson-White syndrome. However, the estimation of AP location is limited in patients with concealed pathways during atrioventricular reentrant tachycardias (AVRT). Thus, we analyzed retrograde P-wave polarity during orthodromic AVRT and developed an algorithm to predict the localization of concealed accessory pathways (AP). METHODS AND RESULTS A total number of 131 patients with a single AP and inducible orthodromic AVRT were included. The initial 61 patients were analyzed retrospectively for algorithm development, whereas 70 patients were evaluated prospectively. The retrograde P-wave polarity was analyzed by subtracting the superimposing T-wave during orthodromic AVRT using custom-designed software. Four leads of the surface electrocardiogram (ECG) were identified to accurately distinguish AP locations assigned to four different regions around each AV annulus: I, aVR, aVL, and V(1). Lead V(1) was used to differentiate right (negative or isoelectric) from left (solely positive) APs. Retrograde P-wave in lead I was negative in left posterior APs exclusively and became more positive with an AP location shifting towards right anterior. P-wave polarity in lead aVR demonstrated a shift from a positive polarity from left APs to isoelectric in right APs. The opposite direction (shift from positive to isoelectric) was observed for lead aVL. The subsequently developed algorithm for concealed AP localization using these surface ECG leads demonstrated a high sensitivity, specificity, and positive predictive value particularly for common AP localizations (left posterior and inferior, and right septal) when applied in a prospective fashion. CONCLUSION Concealed AP localization can be accurately predicted by the analysis of retrograde P-wave polarity during orthodromic AVRT using the algorithm derived from the presented study.
Collapse
Affiliation(s)
- Thomas Rostock
- Department of Cardiology, University Hospital Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Müllerleile K, Stork A, Lund GK, Baholli L, Koester R, Costard-Jäckle A, Adam G, Meinertz T, Reichenspurner H. Detection of mechanical ventricular asynchrony in patients with left bundle branch block by cine – MRI. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037734] [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]
|
44
|
Baholli L, Sill B, Knappe D, Meyer S, Müllerleile K, Reichenspurner H, Costard-Jäckle A. Hydropic decompensation with hyponatraemia in patients awaiting cardiac transplantation – effect of the calcium sensitizer levosimendan. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037984] [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]
|
45
|
Baholli L, Sill B, Müllerleile K, Knappe D, Meyer S, Reichenspurner H, Costard-Jäckle A. The prognostic relevance of the right heart hemodynamics in advanced chronic heart failure and transplant candidates. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037985] [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]
|
46
|
Müllerleile K, Saering D, Stork A, Lund GK, Handels H, Adam G, Meinertz T, Reichenspurner H. HeAT: Integrated analysis of delayed enhancement and cine MRI to study regional and global remodeling after revascularization. Thorac Cardiovasc Surg 2008. [DOI: 10.1055/s-2008-1037894] [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]
|
47
|
Säring D, Relan J, Groth M, Müllerleile K, Handels H. Combination of short- and longaxis MR image sequences for the 3D segmentation of the left ventricle. Stud Health Technol Inform 2008; 136:333-338. [PMID: 18487753] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Segmentation of the left ventricle (LV) is required to quantify LV remodeling after myocardial infarction. Therefore spatiotemporal Cine MR sequences including longaxis and shortaxis images are acquired. In this paper a new segmentation method for fast and robust segmentation of the left ventricle in 4D MR images is presented. The new approach considers the position of the mitral valve and the apex as well as the longaxis contours to generate a 3D LV surface model. The segmentation result can be checked and adjusted in the shortaxis images. Finally quantitative parameters were extracted. For evaluation the LV was segmented in eight datasets of the same subject by two medical experts using a contour drawing tool and the new segmentation tool. The results of both methods were compared concerning robustness and interaction time and intra- and interobserver differences. The presented segmentation method proved to be fast and robust and the intra- and interobserver differences are decreased significantly.
Collapse
Affiliation(s)
- Dennis Säring
- Department of Medical Informatics, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | | | | | | | | |
Collapse
|
48
|
Stork A, Franzen O, Ruschewski H, Detter C, Müllerleile K, Bansmann PM, Adam G, Lund GK. Assessment of functional anatomy of the mitral valve in patients with mitral regurgitation with cine magnetic resonance imaging: comparison with transesophageal echocardiography and surgical results. Eur Radiol 2007; 17:3189-98. [PMID: 17549489 DOI: 10.1007/s00330-007-0671-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [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: 10/01/2006] [Revised: 03/28/2007] [Accepted: 04/19/2007] [Indexed: 10/23/2022]
Abstract
The ability of magnetic resonance imaging (MRI) to accurately define the functional anatomy of mitral regurgitation was assessed. Transesophageal echocardiography (TEE) and cine MRI were performed on 43 patients with mitral regurgitation and were compared for the jet number, location, direction and presence of a prolapse (atrial displacement, malapposition or a flail). In 36 patients, diagnostic accuracy in reference to surgery was assessed. Comparing TEE and MRI the jet number and location were judged in concordance in 86% of patients. Jet location did not show a significant difference (Wilcoxon: P = 0.66) and both modalities correlated strongly (Spearman: r = 0.68, P<0.0001). Jet direction was judged with high concordance (kappa=0.63). Additionally, prolapse evaluation showed high concordance (kappa: valve, 0.63; anterior mitral leaflet, 0.70; posterior mitral leaflet, 0.73). Compared with surgery, the sensitivity for the detection of malapposition of any leaflet or one of both leaflets ranged between 75% and 93% for TEE and 71% and 89% for MRI. Specificities ranged between 88 and 96% for TEE and 88 and 100% for MRI. TEE detected torn chordae in all ten patients, six of which were missed by MRI. MRI is comparable with TEE in prolapse and jet evaluation. MRI is inferior to TEE in depicting anatomical details such as torn chordae.
Collapse
Affiliation(s)
- A Stork
- Department of Diagnostic and Interventional Radiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Ventura R, Steven D, Klemm HU, Lutomsky B, Müllerleile K, Rostock T, Servatius H, Risius T, Meinertz T, Kuck KH, Willems S. Decennial follow-up in patients with recurrent tachycardia originating from the right ventricular outflow tract: electrophysiologic characteristics and response to treatment. Eur Heart J 2007; 28:2338-45. [PMID: 17656346 DOI: 10.1093/eurheartj/ehm293] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [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: 11/13/2022] Open
Abstract
AIMS In the setting of right ventricular outflow tract-tachycardia (RVOT-T), data about long-term follow-up (FU) with respect to the therapeutic strategies are missing. All patients (pts) referred to our institution during the last 20 years for the treatment of RVOT-T were studied in a retrospective analysis to assess mortality and efficacy of treatment. METHODS AND RESULTS One hundred and thirty-three patients (77 female; 39+/-13 years) with sustained RVOT-T were included in this study. At the time of first presentation, diagnosis of RVOT-T was made by complete invasive and non-invasive diagnostic assessment, including electrophysiology study and two-dimensional echocardiography. After 135+/-68 months (median 136, range 29-248), patients were invited to undergo clinical assessment. Of the 133 pts, 127 (95%) survived and six (5%) died from non-cardiac disease. Anti-arrhythmic (AA) drugs were given to 62 of the 133 pts (47%); of them 32 (52%) had recurrences during follow-up. The mean time to recurrence was 10.02 years (95% CI 7.46-12.59). The other 71 study patients (53%) underwent catheter ablation. The procedure was successful in 58 pts (82%). During follow-up, 30 (52%) of the 58 successfully treated patients had recurrences of RVOT-T. The mean time to recurrence was 6.28 years (95% CI 4.96-7.6). RVOT-T recurrences were similar in morphology to those treated previously in 33% and different in 67% of cases. CONCLUSIONS Long-term follow-up in patients with RVOT-T is favourable. Catheter ablation is effective in this setting. However, late recurrences with similar or different morphology may arise in half of the patients after initially successful treatment. AA drug therapy is a valid initial therapeutic option, since it is effective in about half of the patients.
Collapse
Affiliation(s)
- Rodolfo Ventura
- Department of Cardiology, University Heart Center, Martinistrasse 52, 20246 Hamburg, and Asklepios Hospital, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Stork A, Müllerleile K, Bansmann PM, Koops A, Meinertz T, Adam G, Lund GK. Muster der späten Kontrastmittelanreicherung in der MRT bei ischämischen und nicht-ischämischen Kardiomyopathien. ROFO-FORTSCHR RONTG 2007; 179:21-30. [PMID: 17203440 DOI: 10.1055/s-2006-927204] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Contrast-enhanced MRI using the delayed-enhancement technique (DE-MRI) is widely applied in the clinical work-up of myocardial diseases. Myocardial diseases of varying etiology result in myocardial changes, such as necrosis, fibrosis, edema and metabolite deposition, which can be visualized by DE-MRI. Acute and chronic ischemic diseases based on a coronary artery disease as well as non-ischemic cardiomyopathies display DE. Cardiomyopathies often show a characteristic enhancement pattern. While ischemic lesions are localized in the subendocardium, non-ischemic cardiomyopathies often display an intramyocardial or subepicardial pattern. The typical pattern for dilated cardiomyopathies is band-like and intramyocardial with septal involvement. Arrhythmogenic right-ventricular dysplasias/cardiomyopathies are frequently associated with right-ventricular DE. In the case of amyloid cardiomyopathies which are often restrictive cardiomyopathies, subendocardial and circular DE is typically observed. Hypertrophic cardiomyopathies display patchy intramyocardial DE usually in the anteroseptal region. Acute myocarditis is typically accompanied by intramyocardial or subepicardial DE affecting the lateral wall. In the case of chronic myocarditis, intramyocardial or subepicardial DE is observed most frequently. Cardiac sarcoidosis typically entails patchy subepicardial DE with right- and left-ventricular involvement. Since there is an overlap between the enhancement patterns of cardiomyopathies, the diagnostic accuracy of DE-MRI is limited and the diagnosis must be based on additional clinical and MRI findings. The amount of DE often corresponds with cardiac functional parameters as well as with the frequency of cardiac events so that DE-MRI may be useful for risk stratification. Furthermore, DE-MRI can be helpful in the planning and evaluation of myocardial biopsies and electrophysiological examinations.
Collapse
Affiliation(s)
- A Stork
- Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Hamburg-Eppendorf.
| | | | | | | | | | | | | |
Collapse
|