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von Haehling S, Assmus B, Bekfani T, Dworatzek E, Edelmann F, Hashemi D, Hellenkamp K, Kempf T, Raake P, Schütt KA, Wachter R, Schulze PC, Hasenfuss G, Böhm M, Bauersachs J. Heart failure with preserved ejection fraction: diagnosis, risk assessment, and treatment. Clin Res Cardiol 2024:10.1007/s00392-024-02396-4. [PMID: 38602566 DOI: 10.1007/s00392-024-02396-4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/02/2024] [Indexed: 04/12/2024]
Abstract
The aetiology of heart failure with preserved ejection fraction (HFpEF) is heterogenous and overlaps with that of several comorbidities like atrial fibrillation, diabetes mellitus, chronic kidney disease, valvular heart disease, iron deficiency, or sarcopenia. The diagnosis of HFpEF involves evaluating cardiac dysfunction through imaging techniques and assessing increased left ventricular filling pressure, which can be measured directly or estimated through various proxies including natriuretic peptides. To better narrow down the differential diagnosis of HFpEF, European and American heart failure guidelines advocate the use of different algorithms including comorbidities that require diagnosis and rigorous treatment during the evaluation process. Therapeutic recommendations differ between guidelines. Whilst sodium glucose transporter 2 inhibitors have a solid evidence base, the recommendations differ with regard to the use of inhibitors of the renin-angiotensin-aldosterone axis. Unless indicated for specific comorbidities, the use of beta-blockers should be discouraged in HFpEF. The aim of this article is to provide an overview of the current state of the art in HFpEF diagnosis, clinical evaluation, and treatment.
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Affiliation(s)
- Stephan von Haehling
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Birgit Assmus
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Giessen, Germany
| | - Tarek Bekfani
- Department of Cardiology and Angiology, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Elke Dworatzek
- Institute of Gender in Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frank Edelmann
- 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 - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Djawid Hashemi
- 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 - Medical Heart Center of Charité and German Heart Institute Berlin, Campus Virchow-Klinikum, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Berlin, Germany
| | - Kristian Hellenkamp
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
| | - Tibor Kempf
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Philipp Raake
- I. Medical Department, Cardiology, Pneumology, Endocrinology and Intensive Care Medicine, University Hospital Augsburg, University of Augsburg, Augsburg, Germany
| | - Katharina A Schütt
- Department of Internal Medicine I, University Hospital RWTH Aachen, Aachen, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Paul Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, University Hospital Jena, FSU, Jena, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Strasse 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Michael Böhm
- Kardiologie, Angiologie und Internistische Intensivmedizin, Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Saarland University, Homburg, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
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Hou X, Hashemi D, Erley J, Neye M, Bucius P, Tanacli R, Kühne T, Kelm M, Motzkus L, Blum M, Edelmann F, Kuebler WM, Pieske B, Düngen HD, Schuster A, Stoiber L, Kelle S. Noninvasive evaluation of pulmonary artery stiffness in heart failure patients via cardiovascular magnetic resonance. Sci Rep 2023; 13:22656. [PMID: 38114509 PMCID: PMC10730605 DOI: 10.1038/s41598-023-49325-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023] Open
Abstract
Heart failure (HF) presents manifestations in both cardiac and vascular abnormalities. Pulmonary hypertension (PH) is prevalent in up 50% of HF patients. While pulmonary arterial hypertension (PAH) is closely associated with pulmonary artery (PA) stiffness, the association of HF caused, post-capillary PH and PA stiffness is unknown. We aimed to assess and compare PA stiffness and blood flow hemodynamics noninvasively across HF entities and control subjects without HF using CMR. We analyzed data of a prospectively conducted study with 74 adults, including 55 patients with HF across the spectrum (20 HF with preserved ejection fraction [HFpEF], 18 HF with mildly-reduced ejection fraction [HFmrEF] and 17 HF with reduced ejection fraction [HFrEF]) as well as 19 control subjects without HF. PA stiffness was defined as reduced vascular compliance, indicated primarily by the relative area change (RAC), altered flow hemodynamics were detected by increased flow velocities, mainly by pulse wave velocity (PWV). Correlations between the variables were explored using correlation and linear regression analysis. PA stiffness was significantly increased in HF patients compared to controls (RAC 30.92 ± 8.47 vs. 50.08 ± 9.08%, p < 0.001). PA blood flow parameters were significantly altered in HF patients (PWV 3.03 ± 0.53 vs. 2.11 ± 0.48, p < 0.001). These results were consistent in all three HF groups (HFrEF, HFmrEF and HFpEF) compared to the control group. Furthermore, PA stiffness was associated with higher NT-proBNP levels and a reduced functional status. PA stiffness can be assessed non-invasively by CMR. PA stiffness is increased in HFrEF, HFmrEF and HFpEF patients when compared to control subjects.Trial registration The study was registered at the German Clinical Trials Register (DRKS, registration number: DRKS00015615).
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Affiliation(s)
- Xuewen Hou
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Djawid Hashemi
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, BIH Charité Digital Clinician Scientist Program, Charitéplatz 1, 10117, Berlin, Germany
| | - Jennifer Erley
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marthe Neye
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Paulius Bucius
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Radu Tanacli
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Titus Kühne
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Congenital Heart Disease-Pediatric Cardiology, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Marcus Kelm
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Deutsches Herzzentrum der Charité, Institute of Computer-Assisted Cardiovascular Medicine, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Congenital Heart Disease-Pediatric Cardiology, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Laura Motzkus
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Moritz Blum
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Frank Edelmann
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Wolfgang M Kuebler
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- DZHK (German Center for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Lukas Stoiber
- Royal Brompton Hospital, Guy's and St Thomas' National Health Service Foundation Trust, London, UK
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353, Berlin, Germany.
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
- DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
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Doeblin P, Steinbeis F, Witzenrath M, Hashemi D, Chen W, Weiss KJ, Stawowy P, Kelle S. Half-Dose versus Single-Dose Gadobutrol for Extracellular Volume Measurements in Cardiac Magnetic Resonance. J Cardiovasc Dev Dis 2023; 10:316. [PMID: 37623329 PMCID: PMC10455162 DOI: 10.3390/jcdd10080316] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) imaging with gadolinium-based contrast agents offers unique non-invasive insights into cardiac tissue composition. Myocardial extracellular volume (ECV) has evolved as an objective and robust parameter with broad diagnostic and prognostic implications. For the gadolinium compound gadobutrol, the recommended dose for cardiac imaging, including ECV measurements, is 0.1 mmol/kg (single dose). This dose was optimized for late enhancement imaging, a measure of focal fibrosis. Whether a lower dose is sufficient for ECV measurements is unknown. We aim to evaluate the accuracy of ECV measurements using a half dose of 0.05 mmol/kg gadobutrol compared to the standard single dose of 0.1 mmol/kg. METHODS AND RESULTS From a contemporary trial (NCT04747366, registered 10 February 2021), a total of 25 examinations with available T1 mapping before and after 0.05 and 0.1 mmol/kg gadobutrol were analyzed. ECV values were calculated automatically from pre- and post-contrast T1 relaxation times. T1 and ECV Measurements were performed in the midventricular septum. ECV values after 0.05 and 0.1 mmol/kg gadobutrol were correlated (R2 = 0.920, p < 0.001). ECV values after 0.05 mmol/kg had a bias of +0.9% (95%-CI [0.4; 1.4], p = 0.002) compared to 0.1 mmol/kg gadobutrol, with limits of agreement from -1.5 to 3.3%. CONCLUSIONS CMR with a half dose of 0.05 mmol/kg gadobutrol overestimated ECV by 0.9% compared with a full dose of 0.1 mmol/kg, necessitating adjustment of normal values when using half-dose ECV imaging.
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Affiliation(s)
- Patrick Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Lung Research (DZL), 10117 Berlin, Germany
| | - Djawid Hashemi
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Wensu Chen
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Karl Jakob Weiss
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp Stawowy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Lerchenmüller C, Zelarayan L, Streckfuss-Bömeke K, Gimenez MR, Schnabel R, Hashemi D, Baldus S, Rudolph TK, Morbach C. Moving toward gender equity in the cardiology and cardiovascular research workforce in Germany: a report from the German Cardiac Society. Eur Heart J Open 2023; 3:oead034. [PMID: 37090057 PMCID: PMC10114529 DOI: 10.1093/ehjopen/oead034] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2023] [Accepted: 03/27/2023] [Indexed: 04/25/2023]
Abstract
Aims Although the share of women in cardiology in Germany is growing steadily, this does not translate into leadership positions. Medical societies play a crucial role in shaping the national and international medical and scientific environment. The German Cardiac Society (DGK) aims to serve the public discourse on gender-equity by systematic analysis of data on gender representation within the society and in Germany. Methods and results We present gender disaggregated data collection of members, official organs, working groups, scientific meetings, as well as awards of the DGK based on anonymized exports from the DGK office as well as on data gathered from the DGK web page. From 2000 to 2020, the overall number of DGK members as well as the share of women increased (12.5% to 25.3%). In 2021, the share of women ranged from 40% to 50% in earlier career stages but was substantially lower at senior levels (23.9% of consulting/attending physicians, 7.1% of physicians-in-chief, 3.4% of directors). The share of women serving in DGK working groups had gained overall proportionality, but nuclei and speaker positions were largely held by men. Boards and project groups were predominantly represented by men as well. At the DGK-led scientific meetings, women contributed more often in junior relative to (invited) senior roles. Conclusion Increasing numbers of women in cardiology and in the DGK over the past 20 years did not translate into the respective increase in representation of women in leadership positions. There is an urgent need to identify and, more importantly, to overcome barriers towards gender equity. Transparent presentation of society-related data is the first step for future targeted actions in this regard.
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Affiliation(s)
- Carolin Lerchenmüller
- Department of Cardiology, Angiology, Pulmonology, University Hospital Heidelberg, INF 410, 69120 Heidelberg, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Heidelberg/Mannheim, INF 410, 69120 Heidelberg, Germany
| | - Laura Zelarayan
- Institute of Pharmacology and Toxicology, University Medical Center Goettingen, Georg-August University, Robert-Koch-Straße 40, 37075 Göttingen, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Goettingen, Robert-Koch-Straße 40 37075, Göttingen, Germany
| | - Katrin Streckfuss-Bömeke
- DZHK (German Center for Heart and Cardiovascular Research), partner site Goettingen, Robert-Koch-Straße 40 37075, Göttingen, Germany
- Clinic for Cardiology and Pneumonology, University Medical Center Göttingen, Robert-Koch-Straße 40, 37075 Göttingen, Germany
- Institute of Pharmacology and Toxicology, Würzburg University, Versbacher Str. 9, 97078 Würzburg, Germany
| | - Maria Rubini Gimenez
- Leipzig Heart Institute, Strümpellstraße 39, 04289 Leipzig, Germany
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at the University of Leipzig, Strümpellstraße 39, 04289 Leipzig, Germany
| | - Renate Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Martinistr. 52, 20246 Hamburg, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Martinistr. 52, 20246 Hamburg, Germany
| | - Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Augustenburger Platz 11, 3353 Berlin, Germany
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Augustenburger Platz 11, 3353 Berlin, Germany
- DZHK (German Center for Heart and Cardiovascular Research), partner site Berlin, Augustenburger Platz 11, 3353 Berlin, Germany
| | - Stephan Baldus
- Department of General and Interventional Cardiology, Electrophysiology, Angiology, Pulmonology and Intensive Care, Heart Center, University of Cologne, Kerpener Str. 62, 50937 Köln, Germany
| | - Tanja K Rudolph
- Department for General and Interventional Cardiology/Angiology, Heart and Diabetes Center North Rhine-Westphalia, University Hospital of the Ruhr-University Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Caroline Morbach
- Department Internal Medicine I, University Hospital Wuerzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
- Department for Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Wuerzburg, Am Schwarzenberg 15, 97078 Würzburg, Germany
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5
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Hashemi D, Doeblin P, Blum M, Weiss KJ, Schneider M, Beyer R, Pieske B, Duengen HD, Edelmann F, Kelle S. Reduced functional capacity is associated with the proportion of impaired myocardial deformation assessed in heart failure patients by CMR. Front Cardiovasc Med 2023; 10:1038337. [PMID: 36844739 PMCID: PMC9947709 DOI: 10.3389/fcvm.2023.1038337] [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: 09/06/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Aims Heart failure (HF) does not only reduce the life expectancy in patients, but their life is also often limited by HF symptoms leading to a reduced quality of life (QoL) and a diminished exercise capacity. Novel parameters in cardiac imaging, including both global and regional myocardial strain imaging, promise to contribute to better patient characterization and ultimately to better patient management. However, many of these methods are not part of clinical routine yet, their associations with clinical parameters have been poorly studied. An imaging parameters that also indicate the clinical symptom burden of HF patients would make cardiac imaging more robust toward incomplete clinical information and support the clinical decision process. Methods and results This prospective study conducted at two centers in Germany between 2017 and 2018 enrolled stable outpatient subjects with HF [n = 56, including HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] and a control cohort (n = 19). Parameters assessed included measures for external myocardial function, for example, cardiac index and myocardial deformation measurements by cardiovascular magnetic resonance imaging, left ventricular global longitudinal strain (GLS), the global circumferential strain (GCS), and the regional distribution of segment deformation within the LV myocardium, as well as basic phenotypical characteristics including the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 6-minute walk test (6MWT). If less than 80% of the LV segments are preserved in their deformation capacity the functional capacity by 6MWT (6 minutes walking distance: MyoHealth ≥ 80%: 579.8 ± 177.6 m; MyoHealth 60-<80%: 401.3 ± 121.7 m; MyoHealth 40-<60%: 456.4 ± 68.9 m; MyoHealth < 40%: 397.6 ± 125.9 m, overall p-value: 0.03) as well as the symptom burden are significantly impaired (NYHA class: MyoHealth ≥ 80%: 0.6 ± 1.1 m; MyoHealth 60-<80%: 1.7 ± 1.2 m; MyoHealth 40-<60%: 1.8 ± 0.7 m; MyoHealth < 40%: 2.4 ± 0.5 m; overall p-value < 0.01). Differences were also observed in the perceived exertion assessed by on the Borg scale (MyoHealth ≥ 80%: 8.2 ± 2.3 m; MyoHealth 60-<80%: 10.4 ± 3.2 m; MyoHealth 40-<60%: 9.8 ± 2.1 m; MyoHealth < 40%: 11.0 ± 2.9 m; overall p-value: 0.20) as well as quality of life measures (MLHFQ; MyoHealth ≥ 80%: 7.5 ± 12.4 m; MyoHealth 60-<80%: 23.4 ± 23.4 m; MyoHealth 40-<60%: 20.5 ± 21.2 m; MyoHealth < 40%: 27.4 ± 24.4 m; overall p-value: 0.15)-while these differences were not significant. Conclusion The share of LV segments with preserved myocardial contraction promises to discriminate between symptomatic and asymptomatic subjects based on the imaging findings, even when the LV ejection fraction is preserved. This finding is promising to make imaging studies more robust toward incomplete clinical information.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany,*Correspondence: Djawid Hashemi,
| | - Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Karl Jakob Weiss
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Rebecca Beyer
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Hans-Dirk Duengen
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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6
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Hashemi D, Doeblin P, Blum M, Weiss KJ, Schneider M, Korosoglou G, Beyer RE, Pieske B, Edelmann F, Kelle S. CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure. Front Cardiovasc Med 2023; 9:1091768. [PMID: 36684590 PMCID: PMC9849678 DOI: 10.3389/fcvm.2022.1091768] [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: 11/07/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Aims The main management strategy of heart failure with preserved ejection fraction (HFpEF) is prevention since HFpEF is associated with many cardiovascular (CV) risk factors, especially since HFpEF is linked to a high risk for both mortality and recurrent heart failure (HF) hospitalizations. Therefore, there is a need for new tools to identify patients with a high risk profile early. Regional strain assessment by CMR seems to be superior in describing deformation impairment in HF. The MyoHealth score is a promising tool to identify cardiac changes early. Methods and results Heart failure patients irrespective of LVEF and asymptomatic controls were recruited, and CMR based measures were obtained. For this analysis the asymptomatic control group (n = 19) was divided into asymptomatic subjects without CV co-morbidities or evidence of cardiac abnormalities and (n = 12) and asymptomatic subjects with CV co-morbidities or evidence of cardiac abnormalities (n = 7) as well as patients with HFpEF (n = 19). We performed CMR scans at rest and during a stress test using isometric handgrip exercise (HG). Assessing the MyoHealth score at rest revealed preserved regional strain in 85 ± 9% of LV segments in controls, 73 ± 11% in at Risk subjects and 73 ± 8% in HFpEF patients. During stress the MyoHealth score was 84 ± 7% in controls, 83 ± 7 in at risk subjects and 74 ± 11 in HFpEF patients. Conclusion In summary, we show for the first time that asymptomatic subjects with increased CV risk present with HFpEF like impaired myocardial deformation at rest, while they show results like controls under HG stress. The potential of preventive treatment in this group of patients merits further investigation in future. Clinical trial registration [https://drks.de/search/de/trial/DRKS00015615], identifier [DRKS00015615].
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany,BIH Charité Digital Clinician Scientist Program, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany,*Correspondence: Djawid Hashemi,
| | - Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Karl Jakob Weiss
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany,Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
| | - Rebecca Elisabeth Beyer
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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Doeblin P, Weiss KJ, Hashemi D, Schneider M, Pieske B, Kelle S. Single center experience of CMR findings after COVID-19 and after COVID-19-vaccination. J Mol Cell Cardiol 2022. [DOI: 10.1016/j.yjmcc.2022.08.277] [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: 01/01/2023]
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8
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Hashemi D, Mende M, Trippel TD, Petutschnigg J, Hasenfuss G, Nolte K, Herrmann‐Lingen C, Feuerstein A, Langhammer R, Tschöpe C, Pieske B, Wachter R, Edelmann F. Evaluation of the HFA-PEFF Score: results from the prospective DIAST-CHF cohort. ESC Heart Fail 2022; 9:4120-4128. [PMID: 36070881 PMCID: PMC9773646 DOI: 10.1002/ehf2.14131] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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: 02/18/2022] [Revised: 07/19/2022] [Accepted: 08/18/2022] [Indexed: 01/19/2023] Open
Abstract
AIMS Although the number of patients suffering from heart failure with preserved ejection fraction (HFpEF) increases, the routine diagnosis remains a challenge. In the absence of a pathognomonic sign for HFpEF or specific treatment strategies, a prognosis-based characterization of suspected patients remains promising for both the risk stratification of the patients and a disease definition. The Heart Failure Association (HFA) of the European Society of Cardiology has introduced an algorithm with different levels of likelihood regarding the diagnosis of HFpEF, the HFA-PEFF score. We aimed to evaluate the predictive value of this algorithm in a large cohort regarding mortality, symptom burden, and the functional status. METHODS AND RESULTS DIAST-CHF is a multicentre, population-based, prospective, observational study in subjects with at least one risk factor for HFpEF between the age of 50 and 85. We calculated the HFA-PEFF score (n = 1668) and analysed the risk groups for overall mortality, cardiovascular hospitalization, and submaximal functional capacity (6-min walk distance) at baseline and after a follow-up period of 10 years. Patients with high HFA-PEFF score values 5&6 showed a higher mortality than those with an intermediate score (score values 2-4) and low score values (high 21.3% vs. intermediate 10.1% vs. low 4.3%, P < 0.001). Also, the burden of MACE (death, cardiovascular hospitalization, new myocardial infarction, first diagnosis of HF) was increased in the high score values group (high 40.7% vs. intermediate 25.9% vs. low 13.9%, P < 0.001). Similarly, patients with higher scores had higher cumulative incidences of cardiovascular hospitalizations (P = 0.011). Subjects with higher scores also had lower 6-min walk distance both at baseline and during follow-up. CONCLUSIONS The HFA-PEFF score provides a reliable instrument to stratify suspected HFpEF patients by their risk for mortality, symptom burden, and functional status in cohort at risk with a follow-up period of 10 years. As high HFA-PEFF scores are associated with worse outcome, the HFA-PEFF algorithm describes a defining approach towards HFpEF.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,Department of Internal Medicine and CardiologyGerman Heart Institute Berlin (DHZB)BerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Meinhard Mende
- Clinical Trial Centre and Institute for Medical Informatics, Statistics and Epidemiology (IMISE)University of LeipzigLeipzigGermany
| | - Tobias D. Trippel
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Johannes Petutschnigg
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Gerd Hasenfuss
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Department of Cardiology and PneumologyGeorg‐August UniversityGöttingenGermany
| | - Kathleen Nolte
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Department of Cardiology and PneumologyGeorg‐August UniversityGöttingenGermany
| | - Christoph Herrmann‐Lingen
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Anna Feuerstein
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Romy Langhammer
- Clinic and Policlinic for CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Carsten Tschöpe
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany,Berlin Institute of Health (BIH) & Berlin‐Brandenburg Center for Regenerative Therapies (BCRT)Charité ‐ Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany
| | - Burkert Pieske
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,Department of Internal Medicine and CardiologyGerman Heart Institute Berlin (DHZB)BerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
| | - Rolf Wachter
- DZHK (German Centre for Cardiovascular Research), partner site GöttingenBerlinGermany,Clinic and Policlinic for CardiologyUniversity Hospital LeipzigLeipzigGermany
| | - Frank Edelmann
- Department of Internal Medicine and CardiologyCharité – Universitätsmedizin Berlin, Campus Virchow KlinikumBerlinGermany,DZHK (German Centre for Cardiovascular Research), partner site BerlinBerlinGermany
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Gupta S, Poret A, Hashemi D, Esenou A, Yu S, D'Gama J, Neel V, Lieberman T. LB973 Cutaneous surgical wounds have distinct microbiomes from intact skin. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hashemi D, Kelle S, Bourantas CV, Chandrasekharan KH. Editorial: Highlights in Cardiovascular Imaging: 2021. Front Cardiovasc Med 2022; 9:934668. [PMID: 35757354 PMCID: PMC9215203 DOI: 10.3389/fcvm.2022.934668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022] Open
Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Deutsches Zentrum Für Herz-Kreislaufforschung (German Centre for Cardiovascular Research), Berlin, Germany
- *Correspondence: Djawid Hashemi
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Deutsches Zentrum Für Herz-Kreislaufforschung (German Centre for Cardiovascular Research), Berlin, Germany
| | - Christos V. Bourantas
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University London, London, United Kingdom
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Karthik H. Chandrasekharan
- Department of Cardiology, Barts Heart Centre, Barts Health National Health Service (NHS) Trust, London, United Kingdom
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11
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Fitz J, Edelmann F, Hasenfuß G, Sandek A, Nolte K, Hashemi D, Trippel TD, Wachter R, Herrmann-Lingen C. Influence of baseline parameters on one-year physical, mental, and health-related quality of life in patients with heart failure and preserved ejection fraction. ESC Heart Fail 2021; 8:4635-4643. [PMID: 34480783 PMCID: PMC8712837 DOI: 10.1002/ehf2.13593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/22/2021] [Accepted: 08/19/2021] [Indexed: 12/28/2022] Open
Abstract
Aims To identify baseline parameters longitudinally influencing overall health‐related quality of life (HRQoL), physical function and mental health 1 year later in patients with chronic heart failure and preserved ejection fraction (HFpEF). Methods and results We performed post hoc analyses of the randomized aldosterone in diastolic heart failure (Aldo‐DHF) trial, including 422 patients with HFpEF and NYHA class II or III. Overall HRQoL, measured by the Minnesota Living with Heart Failure Questionnaire (MLHFQ), physical functioning and mental health, both measured by the Short Form 36 Health Survey (SF‐36), after 12 months were predicted in correlation analyses and multivariate regression analyses with continuous values and worst versus three better HRQoL quartiles as dependent variables. The mean age of the study population was 66.8 ± 7.6 years, 52.4% were female, and 86.0% had NYHA class II. All HRQoL variables at 1 year were predicted by their respective baseline values (all P < 0.001), which were also the best variables to predict lowest versus higher HRQoL quartiles (all P < 0.001). For overall HRQoL, six‐minute‐walking‐distance (P = 0.009), Borg‐score (P = 0.001), coronary heart disease (P = 0.036) and SF‐36 role‐emotional (P = 0.005) independently predicted one‐year‐outcome, while depression diagnosis (P = 0.044), self‐reported health status (P = 0.023) and PHQ depression (P = 0.001) were only significant predictors when excluding MLHFQ total score at baseline. In logistic regression analyses, only SF‐36 role‐emotional (P = 0.016) independently predicted overall HRQoL group status at follow up. For physical functioning, Borg‐score (P ≤ 0.001), 6 min walking distance (P = 0.005), coronary heart disease (P = 0.009), and SF‐36 vitality (P = 0.001) were significant independent predictors, also when excluding baseline physical functioning. Low SF‐36 vitality (P = 0.021) and presence of coronary heart disease (P = 0.027) independently predicted a patient's membership in the lowest quartile 1 year later. For mental health, SF‐36 physical functioning (P = 0.025) and HADS anxiety (P = 0.046) were independent predictors, while self‐rated fatigue and poor performance (P = 0.033) and SF‐36 vitality (P = 0.008) only served as significant predictors when excluding mental health at baseline. HADS anxiety (P = 0.009) also served as independent predictor of a patient's group status after 1 year. Conclusion Overall HRQoL, physical functioning, and mental health of HFpEF patients 1 year later are mainly influenced by their respective baseline values. Other self‐rated baseline parameters also showed independent effects while objective severity measures had limited predictive value.
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Affiliation(s)
- Judith Fitz
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Anja Sandek
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Kathleen Nolte
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany
| | - Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | - Tobias D Trippel
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital, Leipzig, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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12
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Trippel TD, Mende M, Düngen HD, Hashemi D, Petutschnigg J, Nolte K, Herrmann-Lingen C, Binder L, Hasenfuss G, Pieske B, Wachter R, Edelmann F. The diagnostic and prognostic value of galectin-3 in patients at risk for heart failure with preserved ejection fraction: results from the DIAST-CHF study. ESC Heart Fail 2021; 8:829-841. [PMID: 33566456 PMCID: PMC8006663 DOI: 10.1002/ehf2.13174] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/30/2023] Open
Abstract
Aims Galectin‐3 (Gal‐3) predicts long‐term outcome among patients with heart failure (HF) with preserved ejection fraction (HFpEF). The ability of Gal‐3 to diagnose and predict incident HFpEF in a cohort at risk for HFpEF is of particular interest. We aimed to determine the association between Gal‐3 and clinical manifestations of HFpEF, the relationship between Gal‐3 and all‐cause mortality, or the composite of cardiovascular hospitalization and death. Methods and results The observational Diast‐CHF study included patients aged 50 to 85 years with ≥1 risk factor for HF (e.g. hypertension, diabetes mellitus, and atherosclerotic disease) or previously suspected HF. Patients were followed for 10 years. The association between Gal‐3, evidence of diastolic dysfunction, and Framingham criteria for HF was examined. All deaths and hospitalizations were adjudicated as cardiovascular or non‐cardiovascular. The analysis population was composed of 1386 subjects (67 years old, 50.9% female). The area under the receiver operating characteristic curve to diagnose HFpEF was 0.71. At a cut‐off value of 13.57 ng/mL, sensitivity was 0.61 and specificity was 0.73 for Gal‐3, and the diagnostic power to detect HFpEF was superior to N‐terminal pro‐brain natriuretic peptide (area under the receiver operating characteristic curve 0.59, P > 0.001). Baseline Gal‐3 was associated with risk factors for HF (P < 0.001). Higher levels of Gal‐3 predicted incident HFpEF (P < 0.05), adjusted all‐cause mortality (P < 0.001), and the adjusted composite of cardiovascular hospitalization and death (P < 0.001), both independent from N‐terminal pro‐brain natriuretic peptide. Conclusions Gal‐3 differentiated patients with HFpEF from an overall cohort of well‐characterized patients with risk factors for HFpEF. Independent of other factors, baseline Gal‐3 levels were associated with a higher risk for incident HFpEF, mortality, or the composite of cardiovascular hospitalization and death over 10 year follow‐up. In conjunction with clinical parameters, Gal‐3 adds a statistically significant value for the diagnosis of HFpEF within this study, yet the clinical relevance remains debatable.
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Affiliation(s)
- Tobias Daniel Trippel
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Meinhard Mende
- Clinical Trial Centre (KKS) and Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Leipzig, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Johannes Petutschnigg
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Kathleen Nolte
- Department of Cardiology and Pneumology, Heart Center Göttingen, Göttingen, Germany.,DZHK (German Cardiovascular Research Center), partner site Göttingen, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- DZHK (German Cardiovascular Research Center), partner site Göttingen, Göttingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany
| | - Lutz Binder
- DZHK (German Cardiovascular Research Center), partner site Göttingen, Göttingen, Germany.,Department of Clinical Chemistry, University of Göttingen Medical Centre, Göttingen, Germany
| | - Gerd Hasenfuss
- Department of Cardiology and Pneumology, Heart Center Göttingen, Göttingen, Germany.,DZHK (German Cardiovascular Research Center), partner site Göttingen, Göttingen, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,Department of Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, Heart Center Göttingen, Göttingen, Germany.,DZHK (German Cardiovascular Research Center), partner site Göttingen, Göttingen, Germany.,Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
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Hashemi D, Motzkus L, Blum M, Kraft R, Tanacli R, Tahirovic E, Doeblin P, Zieschang V, Zamani SM, Kelm M, Kuehne T, Pieske B, Alogna A, Edelmann F, Duengen HD, Kelle S. Myocardial deformation assessed among heart failure entities by cardiovascular magnetic resonance imaging. ESC Heart Fail 2021; 8:890-897. [PMID: 33539681 PMCID: PMC8006725 DOI: 10.1002/ehf2.13193] [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: 05/11/2020] [Revised: 09/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Although heart failure (HF) is a leading cause for hospitalization and mortality, normalized and comparable non-invasive assessment of haemodynamics and myocardial action remains limited. Moreover, myocardial deformation has not been compared between the guideline-defined HF entities. The distribution of affected and impaired segments within the contracting left ventricular (LV) myocardium have also not been compared. Therefore, we assessed myocardial function impairment by strain in patients with HF and control subjects by magnetic resonance imaging after clinically phenotyping these patients. METHODS AND RESULTS This prospective study conducted at two centres in Germany between 2017 and 2018 enrolled stable outpatient subjects with HF [n = 56, including HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] and a control cohort (n = 12). Parameters assessed included measures for external myocardial function, for example, cardiac index and myocardial deformation measurements by cardiovascular magnetic resonance imaging, left ventricular global longitudinal strain (GLS), the global circumferential strain (GCS) and the regional distribution of segment deformation within the LV myocardium, as well as basic phenotypical characteristics. Comparison of the cardiac indices at rest showed no differences neither between the HF groups nor between the control group and HF patients (one-way ANOVA P = 0.70). The analysis of the strain data revealed differences between all groups in both LV GLS (One-way ANOVA: P < 0.01. Controls vs. HFpEF: -20.48 ± 1.62 vs. -19.27 ± 1.25. HFpEF vs. HFmrEF: -19.27 ± 1.25 vs. -15.72 ± 2.76. HFmrEF vs. HFrEF: -15.72 ± 2.76 vs. -11.51 ± 3.97.) and LV GCS (One-way ANOVA: P < 0.01. Controls vs. HFpEF: -19.74 ± 2.18 vs. -17.47 ± 2.10. HFpEF vs. HFmrEF: -17.47 ± 2.10 vs. -12.78 ± 3.47. HFrEF: -11.41 ± 3.27). Comparing the segment deformation distribution patterns highlighted the discriminating effect between the groups was much more prominent between the groups (one-way ANOVA P < 0.01) when compared by a score combining regional effects and a global view on the LV. Further analyses of the patterns among the segments affected showed that while the LVEF is preserved in HFpEF, the segments impaired in their contractility are located in the ventricular septum. The worse the LVEF is, the more segments are affected, but the septum remains an outstanding location with the most severe contractility impairment throughout the HF entities. CONCLUSIONS While cardiac index at rest did not differ significantly between controls and stable HF patients suffering from HFrEF, HFmrEF, or HFpEF, the groups did differ significantly in LV GLS and LV GCS values. Regional strain analysis revealed that the LV septum is the location affected most, with reduced values already visible in HFpEF and further reductions in HFmrEF and HFrEF.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Laura Motzkus
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Moritz Blum
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Robin Kraft
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Patrick Doeblin
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Victoria Zieschang
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - S Mahsa Zamani
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Marcus Kelm
- Charité-Universitätsmedizin Berlin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Titus Kuehne
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Hans-Dirk Duengen
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
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14
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Bahrami R, Hashemi D, Aziziraftar SK, Rahimi P. Coronaviruses as the emerging threats for human health: should we be prepared for the future outbreaks of new coronaviruses? BRATISL MED J 2020; 121:733-741. [PMID: 32955906 DOI: 10.4149/bll_2020_120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent emergence of SARS-CoV-2 in human communities as the first major zoonotic pandemics of the new millennium following the emergence of SARS-CoV and MERS-CoV has increased our awareness about the future threat of viral zoonosis. Although, several studies have been conducted for better understanding of these viruses` evolution, and designing the effective anti-viral drugs and vaccines, the impact of human beings on occurrence of zoonotic diseases has been less considered and discussed. Improvement in global health resulted in human population growth, increasing demand for animal proteins, more exposures to wildlife, zoonotic and degradation of environment, which have facilitated interspecies transmissions. Since world population is increasing proportionately, the protection of public health against zoonotic diseases is a challenging task. It seems that intensified revision of human lifestyle is the best strategy to prevent the potential devastating future zoonotic pandemics. Herein, the characteristics of SARS-CoV, MERS-CoV, SARS-CoV-2, their transmission routs, their pathogenicity, the therapeutic and prevention approaches including of attempts for designing of effective prophylactic vaccines, anti-viral drugs, and the animal models that have been used for these studies have been reviewed (Ref. 134). Keywords: SARS-CoV-2, COVID-19, pandemic, zoonosis, SARS, MERS.
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15
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Blum M, Hashemi D, Motzkus LA, Neye M, Dordevic A, Zieschang V, Zamani SM, Lapinskas T, Runte K, Kelm M, Kühne T, Tahirovic E, Edelmann F, Pieske B, Düngen HD, Kelle S. Variability of Myocardial Strain During Isometric Exercise in Subjects With and Without Heart Failure. Front Cardiovasc Med 2020; 7:111. [PMID: 32714945 PMCID: PMC7344153 DOI: 10.3389/fcvm.2020.00111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 04/15/2020] [Accepted: 05/28/2020] [Indexed: 12/28/2022] Open
Abstract
Background: Fast strain-encoded cardiac magnetic resonance imaging (cMRI, fast-SENC) is a novel technology potentially improving characterization of heart failure (HF) patients by quantifying cardiac strain. We sought to describe the impact of isometric handgrip exercise (HG) on cardiac strain assessed by fast-SENC in HF patients and controls. Methods: Patients with stable HF and controls were examined using cMRI at rest and during HG. Left ventricular (LV) global longitudinal strain (GLS) and global circumferential (GCS) were derived from image analysis software using fast-SENC. Strain change < -0.5 and > +0.5 was classified as increase and decrease, respectively. Results: The study population comprised 72 subjects, including HF with reduced, mid-range and preserved ejection fraction and controls (HFrEF n = 18 HFmrEF n = 18, HFpEF n = 17, controls: n = 19). In controls, LV GLS remained stable in 36.8%, increased in 36.8% and decreased in 26.3% of subjects during HG. In HF subgroups, similar patterns of LV GLS response were observed (HFpEF: stable 41.2%, increase 35.3%, decrease: 23.5%; HFmrEF: stable 50.0%, increase 16.7%, decrease: 33.3%; HFrEF: stable 33.3%, increase 22.2%, decrease: 44.4%, p = 0.668). Mean change between LV GLS at rest and during HG ranged close to zero with broad standard deviation in all subgroups and was not significantly different between subgroups (+1.2 ± 5.4%, -0.6 ± 8.3%, -1.7 ± 10.7%, and -3.1 ± 19.4%, p = 0.746 in controls, HFpEF, HFmrEF and HFrEF, respectively). However, the absolute value of LV GLS change-irrespective of increase or decrease-was significantly different between subgroups with 4.4 ± 3.2% in controls, 5.9 ± 5.7% in HFpEF, 6.8 ± 8.3% in HFmrEF and 14.1 ± 13.3% in HFrEF (p = 0.005). The absolute value of LV GLS change significantly correlated with resting LVEF, NTproBNP and Minnesota Living with Heart Failure questionnaire scores. Conclusion: The response to isometric exercise in LV GLS is heterogeneous in all HF subgroups and in controls. The absolute value of LV GLS change during HG exercise is elevated in HF patients and associated with measures of HF severity. The diagnostic utility of fast-SENC strain assessment in conjunction with HG appears to be limited. Trial Registration: URL: https://www.drks.de; Unique Identifier: DRKS00015615.
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Affiliation(s)
- Moritz Blum
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Djawid Hashemi
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Laura Astrid Motzkus
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marthe Neye
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Aleksandar Dordevic
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Victoria Zieschang
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Seyedeh Mahsa Zamani
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Tomas Lapinskas
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Kilian Runte
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marcus Kelm
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kühne
- DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Berlin, Germany.,Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
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16
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Tanacli R, Hashemi D, Neye M, Motzkus LA, Blum M, Tahirovic E, Dordevic A, Kraft R, Zamani SM, Pieske B, Düngen HD, Kelle S. Multilayer myocardial strain improves the diagnosis of heart failure with preserved ejection fraction. ESC Heart Fail 2020; 7:3240-3245. [PMID: 32567247 PMCID: PMC7524074 DOI: 10.1002/ehf2.12826] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/08/2020] [Accepted: 05/21/2020] [Indexed: 01/09/2023] Open
Abstract
Aims The diagnostic and treatment of patients with heart failure with preserved ejection fraction (HFpEF) are both hampered by an incomplete understanding of the pathophysiology of the disease. Novel imaging tools to adequately identify these patients from individuals with a normal cardiac function and respectively patients with HF with reduced EF are warranted. Computing multilayer myocardial strain with feature tracking is a fast and accurate method to assess cardiac deformation. Our purpose was to assess the HFpEF diagnostic ability of multilayer strain parameters and compare their sensitivity and specificity with other established parameters. Methods and results We included 20 patients with a diagnosis of HFpEF and, respectively, 20 matched controls. We assessed using feature‐tracking cardiac magnetic resonance longitudinal and circumferential myocardial strain at three distinct layers of the myocardium: subendocardial (Endo‐), mid‐myocardial (Myo‐), and subepicardial (Epi‐). Comparatively, we additionally assessed various others clinical, imaging, and biochemical parameters with a putative role in HFpEF diagnostic: left ventricular end‐diastolic volume (LVEDV), left ventricular mass (LVM), interventricular septum (IVS) wall thickness and free wall thickness, left atrial volume and strain, septal and lateral mitral annular early diastolic velocity (e`), E/e´ ratio, and plasma levels of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP). Global longitudinal strain (GLS) is significantly impaired at Endo (−20.8 ± 4.0 vs. −23.2 ± 3.4, P = 0.046), Myo‐ (−18.0 ± 3.0 vs. −21.0 ± 2.5, P = 0.002), and Epi‐ (−12.2 ± 2.0 vs. −16.2 ± 2.5, P < 0.001) levels. Compared with any other imaging parameter, an Epi‐GLS lower than 13% shows the highest ability to detect patients with HFpEF [area under the curve (AUC) = 0.90 (0.81–1), P < 0.001] and in tandem with NT‐proBNP can diagnose with maximal sensibility (93%) and specificity (100%), patients with HFpEF from normal, composed variable [AUC = 0.98 (0.95–1), P < 0.001]. In a logistic regression model, a composite predictive variable taking into account both GLS Epi and NT‐proBNP values in each individual subject reached a sensitivity of 89% and a specificity of 100% with an AUC of 0.98 (0.95–1), P < 0.001, to detect HFpEF. Conclusions Epi‐GLS is a promising new imaging parameter to be considered in the clinical assessment of HFpEF patients. Given its excellent specificity, in tandem with a highly sensitive parameter such as NT‐proBNP, Epi‐GLS holds the potential to greatly improve the current diagnostic algorithms.
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Affiliation(s)
- Radu Tanacli
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, 13353, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany
| | - Djawid Hashemi
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, 10115, Germany
| | - Marthe Neye
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, 13353, Germany
| | - Laura Astrid Motzkus
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany
| | - Moritz Blum
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany
| | - Aleksandar Dordevic
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany
| | - Robin Kraft
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany
| | - Seyedeh Mahsa Zamani
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, 13353, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, 13353, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, 10115, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, 10115, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, 13353, Germany.,Department of Internal Medicine/Cardiology, Charité Campus Virchow Klinikum, Berlin, 13353, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, 10115, Germany
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17
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Hashemi D, Blum M, Mende M, Störk S, Angermann CE, Pankuweit S, Tahirovic E, Wachter R, Pieske B, Edelmann F, Düngen HD. Syncopes and clinical outcome in heart failure: results from prospective clinical study data in Germany. ESC Heart Fail 2020; 7:942-952. [PMID: 32003157 PMCID: PMC7261586 DOI: 10.1002/ehf2.12605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 12/11/2022] Open
Abstract
AIMS Whereas syncopal episodes are a frequent complication of cardiovascular disorders, including heart failure (HF), little is known whether syncopes impact the prognosis of patients with HF. We aimed to assess the impact of a history of syncope (HoS) on overall and hospitalization-free survival of these patients. METHODS AND RESULTS We pooled the data of prospective, nationwide, multicentre studies conducted within the framework of the German Competence Network for Heart Failure including 11 335 subjects. Excluding studies with follow-up periods <10 years, we assessed 5318 subjects. We excluded a study focusing on cardiac changes in patients with an HIV infection because of possible confounding factors and 849 patients due to either missing key parameters or missing follow-up data, resulting in 3594 eligible subjects, including 2130 patients with HF [1564 patients with heart failure with reduced ejection fraction (HFrEF), 314 patients with heart failure with mid-range ejection fraction, and 252 patients with heart failure with preserved ejection fraction (HFpEF)] and 1464 subjects without HF considered as controls. HoS was more frequent in the overall cohort of patients with HF compared with controls (P < 0.001)-mainly driven by the HFpEF subgroup (HFpEF vs. controls: 25.0% vs. 12.8%, P < 0.001). Of all the subjects, 14.6% reported a HoS. Patients with HFrEF in our pooled cohort showed more often syncopes than subjects without HF (15.0% vs. 12.8%, P = 0.082). Subjects with HoS showed worse overall survival [42.4% vs. 37.9%, hazard ratio (HR) = 1.21, 99% confidence interval (0.99, 1.46), P = 0.04] and less days alive out of hospital [HR = 1.39, 99% confidence interval (1.18, 1.64), P < 0.001] compared with all subjects without HoS. Patients with HFrEF with HoS died earlier [30.3% vs. 41.6%, HR = 1.40, 99% confidence interval (1.12, 1.74), P < 0.001] and lived fewer days out of hospital than those without HoS. We could not find these changes in mortality and hospital-free survival in the heart failure with mid-range ejection fraction and HFpEF cohorts. HoS represented a clinically high-risk profile within the HFrEF group-combining different risk factors. Further analyses showed that among patients with HFrEF with HoS, known cardiovascular risk factors (e.g. age, male sex, diabetes mellitus, and anaemia) were more prevalent. These constellations of the risk factors explained the effect of HoS in a multivariable Cox regression models. CONCLUSIONS In a large cohort of patients with HF, HoS was found to be a clinically and easily accessible predictor of both overall and hospitalization-free survival in patients with HFrEF and should thus routinely be assessed.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Moritz Blum
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Meinhard Mende
- Clinical Trial Centre, University of Leipzig, Leipzig, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, Würzburg, Germany
| | | | - Sabine Pankuweit
- Department of Cardiology, University Hospital Giessen & Marburg, Marburg, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Rolf Wachter
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Department of Internal Medicine and Cardiology, University of Leipzig, Leipzig, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, 13353, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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18
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Hashemi D, Dettmann L, Trippel TD, Holzendorf V, Petutschnigg J, Wachter R, Hasenfuß G, Pieske B, Zapf A, Edelmann F. Economic impact of heart failure with preserved ejection fraction: insights from the ALDO-DHF trial. ESC Heart Fail 2020; 7:786-793. [PMID: 31984661 PMCID: PMC7261555 DOI: 10.1002/ehf2.12606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/02/2019] [Accepted: 12/09/2019] [Indexed: 12/28/2022] Open
Abstract
Aims Although heart failure (HF) with preserved ejection fraction (HFpEF) is a leading cause for hospitalization, its overall costs remain unclear. Therefore, we assessed the health care‐related costs of ambulatory HFpEF patients and the effect of spironolactone. Methods and results The aldosterone receptor blockade in diastolic HF trial is a multicentre, prospective, randomized, double‐blind, placebo‐controlled trial conducted between March 2007 and April 2011 at 10 sites in Germany and Austria that included 422 ambulatory patients [mean age: 67 years (standard deviation: 8); 52% women]. All subjects suffered from chronic New York Heart Association (NYHA) class II or III HF and preserved left ventricular ejection fraction of 50% or greater. They also showed evidence of diastolic dysfunction. Patients were randomly assigned to receive 25 mg of spironolactone once daily (n = 213) or matching placebo (n = 209) with 12 months of follow‐up. We used a single‐patient approach to explore the resulting general cost structure and included medication, number of general practitioner and cardiologist visits, and hospitalization in both acute and rehabilitative care facilities. The average annual costs per patient in this cohort came up to €1, 118 (±2,475), and the median costs were €332. We confirmed that the main cost factor was hospitalization and spironolactone did not affect the overall costs. We identified higher HF functional class (NYHA), male patients with low haemoglobin level, with high oxygen uptake (VO2max) and coronary artery disease, hyperlipidaemia, and atrial fibrillation as independent predictors for higher costs. Conclusions In this relatively young, oligosymptomatic, and with regard to the protocol without major comorbidities patient cohort, the overall costs are lower than expected compared with the HFrEF population. Further investigation is needed to investigate the impact of, for example, comorbidities and their effect over a longer period of time. Simultaneously, this analysis suggests that prevention of comorbidities are necessary to reduce costs in the health care system.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Ludwig Dettmann
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany
| | - Tobias D Trippel
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | | | - Johannes Petutschnigg
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Rolf Wachter
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
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19
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Petutschnigg J, Ferreira JP, Holzendorf V, Trippel TD, Hashemi D, Wachter R, Herrmann-Lingen C, Hasenfuß G, Zannad F, Pieske B, Edelmann F. Body fat phenotypes and treatment response to spironolactone in ambulatory patients with heart failure and preserved ejection fraction: a post-hoc analysis of the Aldo-DHF trial. Eur J Heart Fail 2020; 22:559-561. [PMID: 31912594 DOI: 10.1002/ejhf.1723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/18/2019] [Accepted: 11/27/2019] [Indexed: 11/07/2022] Open
Affiliation(s)
- Johannes Petutschnigg
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin
| | - João Pedro Ferreira
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
- Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | | | - Tobias D Trippel
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin
| | - Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin
| | - Rolf Wachter
- Department of Cardiology and Pneumology, Georg-August University Goettingen, Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Clinic and Policlinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August University Goettingen, Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Faiez Zannad
- INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin
- Department of Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
- Berlin Institute of Health (BIH), Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Berlin
- DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
- Berlin Institute of Health (BIH), Germany
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20
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Tanacli R, Hashemi D, Lapinskas T, Edelmann F, Gebker R, Pedrizzetti G, Schuster A, Nagel E, Pieske B, Düngen HD, Kelle S. Range Variability in CMR Feature Tracking Multilayer Strain across Different Stages of Heart Failure. Sci Rep 2019; 9:16478. [PMID: 31712641 PMCID: PMC6848170 DOI: 10.1038/s41598-019-52683-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [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: 06/28/2019] [Accepted: 10/22/2019] [Indexed: 12/12/2022] Open
Abstract
Heart failure (HF) is associated with progressive ventricular remodeling and impaired contraction that affects distinctly various regions of the myocardium. Our study applied cardiac magnetic resonance (CMR) feature tracking (FT) to assess comparatively myocardial strain at 3 distinct levels: subendocardial (Endo-), mid (Myo-) and subepicardial (Epi-) myocardium across an extended spectrum of patients with HF. 59 patients with HF, divided into 3 subgroups as follows: preserved ejection fraction (HFpEF, N = 18), HF with mid-range ejection fraction (HFmrEF, N = 21), HF with reduced ejection fraction (HFrEF, N = 20) and a group of age- gender- matched volunteers (N = 17) were included. Using CMR FT we assessed systolic longitudinal and circumferential strain and strain-rate at Endo-, Myo- and Epi- levels. Strain values were the highest in the Endo- layer and progressively lower in the Myo- and Epi- layers respectively, this gradient was present in all the patients groups analyzed but decreased progressively in HFmrEF and further on in HFrEF groups. GLS decreased with the severity of the disease in all 3 layers: Normal > HFpEF > HFmrEF > HFrEF (Endo-: −23.0 ± 3.5 > −20.0 ± 3.3 > −16.4 ± 2.2 > −11.0 ± 3.2, p < 0.001, Myo-: −20.7 ± 2.4 > −17.5.0 ± 2.6 > −14.5 ± 2.1 > −9.6 ± 2.7, p < 0.001; Epi-: −15.7 ± 1.9 > −12.2 ± 2.1 > −10.6 ± 2.3 > −7.7 ± 2.3, p < 0.001). In contrast, GCS was not different between the Normal and HFpEF (Endo-: −34.5 ± 6.2 vs −33.9 ± 5.7, p = 0.51; Myo-: −21.9 ± 3.8 vs −21.3 ± 2.2, p = 0.39, Epi-: −11.4 ± 2.0 vs −10.9 ± 2.3, p = 0.54) but was, as well, markedly lower in the systolic heart failure groups: Normal > HFmrEF > HFrEF (Endo-: −34.5 ± 6.2 > −20.0 ± 4.2 > 12.3 ± 4.2, p < 0.001; Myo-: −21.9 ± 3.8 > −13.0 ± 3.4 > −8.0 ± 2.7. p < 0.001; Epi-: −11.4 ± 2.0 > −7.9 ± 2.3 > −4.5 ± 1.9. p < 0.001). CMR feature tracking multilayer strain assessment identifies large range differences between distinct myocardial regions. Our data emphasizes the importance of sub-endocardial myocardium for cardiac contraction and thus, its predilect role in imaging detection of functional impairment. CMR feature tracking offers a convenient, readily available, platform to evaluate myocardial contraction with excellent spatial resolution, rendering further details about discrete areas of the myocardium. Using this technique across distinct groups of patients with heart failure (HF), we demonstrate that subendocardial regions of the myocardium exhibit much higher strain values than mid-myocardium or subepicardial and are more sensitive to detect contractile impairment. We also show comparatively higher values of circumferential strain compared with longitudinal and a higher sensitivity to detect contractile impairment. A newly characterized group of patients, HF with mid-range ejection fraction (EF), shows similar traits of decompensation but has relatively higher strain values as patients with HF with reduced EF.
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Affiliation(s)
- Radu Tanacli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.
| | - Djawid Hashemi
- Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Tomas Lapinskas
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Rolf Gebker
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Gianni Pedrizzetti
- Department of Engineering and Architecture, University of Trieste, Trieste, Italy
| | - Andreas Schuster
- Department of Cardiology and Pulmonology and German Centre for Cardiovascular Research (DZHK) Partner Site, Göttingen, Germany
| | - Eike Nagel
- Institute of Experimental and Translational Cardiac Imaging, DZHK Centre for Cardiovascular Imaging, Goethe University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Burkert Pieske
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
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21
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Tanacli R, Hashemi D, Lapinskas T, Duengen HD, Edelmann F, Gebker R, Pieske B, Kelle S. P5265Magnetic resonance multilayer assessment of strain in patients with heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Muscular architecture of the heart is three dimensionally complex and contractility parameters vary widely. Cardiac magnetic resonance (CMR) feature tracking is a largely available and facile method to assess myocardial strain at different layers of the myocardium.
Purpose
Assessing and compare the myocardial longitudinal (GLS) and circumferential strain (GCS) at three distinct layers of the myocardium in patients with heart failure (HF).
Methods
59 patients with a clinical diagnosis of HF who were post-hoc subdivided according to the measured EF and echo assessment of diastolic impairment into 3 groups, following ESC guidelines, were included: (1) patients with HF with preserved ejection fraction (HFpEF) where EF >50% and diastolic dysfunction (E/e' ratio) is present and plasma levels of natriuretic peptides are elevated, (2) patients with HF with mid-range ejection fraction (HFmrEF), where EF = 40–49% and similar additional criterias are present, (3) patients with HF with reduced ejection fraction (HFrEF) where EF <40%. Exclusion criteria: valvulopathy, arrhythmias, insufficient acquisition and artefacts.
Results
Strain values are the highest in the Endo− and progressively lower in the Myo− and Epi− layers with a gradient present in all groups but decreasing in HFmEF and further in HFrEF. GLS decrease with the severity of the disease in all 3 layers Normal > HFpEF > HFmrEF > HFrEF (Endo−: −23.0±3.5 vs −20.0±3.3 vs −16.4±2.2 vs −11.0±3.2, p<0.001, Myo−: −20.7±2.4 vs −17.5.0±2.6 vs −14.5±2.1 vs −9.6±2.7, p<0.001, Epi−: −15.7±1.9 vs −12.2±2.1 vs −10.6±2.3 vs −7.7±2.3, p<0.001) (Figure A), GCS is not different between the Normal and HFpEF (Endo−: −34.5±6.2 vs −33.9±5.7, p=0.51; Myo−: −21.9±3.8 vs −21.3±2.2, p=0.39; Epi−: −11.4±2.0 vs −10.9±2.3, p=0.54) but markedly lower in systolic HF groups Normal > HFmrEF > HFrEF (Endo−: −34.5±6.2 vs −20.0±4.2 vs −12.3±4.2, p<0.001; Myo−: −21.9±3.8 vs −13.0±3.4 vs −8.0±2.7, p<0.001; Epi−: −11.4±2.0 vs −7.9±2.3 vs −4.5±1.9) (Figure B). ROC analysis renders Endo− GCS (AUC=0.89) and respectively Endo− GLS (AUC=0.74) as optimal to detect contractile impairment in HF with Youden's thresholds of −20.2 for Endo− GLS and, respectively, −28.1 for Endo− GCS. Endo− GCS is not different between control and HFpEF and GLS impairment is present only inconstantly in HFpEF.
Conclusions
Feature tracking CMR successfully assess layer-specific myocardial strain and emerges as a powerful tool in functional stratification of patients with HF. Strain amplitude varies consistently throughout the myocardium and its quantification warrants careful standardization. Sub-endocardial strain values of strain are comparatively the highest and show most predictive power to detect contractile impairment. Underlying systolic impairment is present only in a subgroup of patients with HFpEF and only GLS and not the GCS is for this purpose a useful diagnostic tool.
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Affiliation(s)
- R Tanacli
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - D Hashemi
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - T Lapinskas
- Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - H.-D Duengen
- Charite - Campus Virchow-Klinikum (CVK), Berlin, Germany
| | - F Edelmann
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - R Gebker
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - B Pieske
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S Kelle
- Deutsches Herzzentrum Berlin, Berlin, Germany
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22
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Petutschnigg J, De Ronde MWJ, Trippel TD, Schleussner L, Baehr F, Hashemi D, Holzendorf V, Leenders JJ, Pinto YM, Wachter R, Hasenfuss G, Hermann-Lingen C, Pieske B, Edelmann F. 4379Circulating miRNAs as a prognostic tool for heart failure related morbidity and mortality in patients suffering from stable HFpEF: a subgroup analysis of the ALDO-DHF trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Petutschnigg
- Charite - Campus Virchow-Klinikum (CVK), Department of Medicine and Cardiology, Berlin, Germany
| | - M W J De Ronde
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - T D Trippel
- Charite - Campus Virchow-Klinikum (CVK), Department of Medicine and Cardiology, Berlin, Germany
| | - L Schleussner
- Charite - Campus Virchow-Klinikum (CVK), Department of Medicine and Cardiology, Berlin, Germany
| | - F Baehr
- Charite - Campus Virchow-Klinikum (CVK), Department of Medicine and Cardiology, Berlin, Germany
| | - D Hashemi
- Charite - Campus Virchow-Klinikum (CVK), Department of Medicine and Cardiology, Berlin, Germany
| | - V Holzendorf
- University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - J J Leenders
- Academic Medical Center of Amsterdam, ACS Biomarker BV, Amsterdam, Netherlands
| | - Y M Pinto
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - R Wachter
- University of Leipzig, Faculty of Medicine, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Göttingen, Department of Cardiology and Pulmonology, Göttingen, Germany
| | - C Hermann-Lingen
- University Medical Center Göttingen, Department of Psychosomatic medicine - Psycho-cardiology, Göttingen, Germany
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Department of Medicine and Cardiology, Berlin, Germany
| | - F Edelmann
- Charite - Campus Virchow-Klinikum (CVK), Department of Medicine and Cardiology, Berlin, Germany
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23
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Düngen HD, Tscholl V, Obradovic D, Radenovic S, Matic D, Musial Bright L, Tahirovic E, Marx A, Inkrot S, Hashemi D, Veskovic J, Apostolovic S, von Haehling S, Doehner W, Cvetinovic N, Lainscak M, Pieske B, Edelmann F, Trippel T, Loncar G. Prognostic performance of serial in-hospital measurements of copeptin and multiple novel biomarkers among patients with worsening heart failure: results from the MOLITOR study. ESC Heart Fail 2018; 5:288-296. [PMID: 29476612 PMCID: PMC5880673 DOI: 10.1002/ehf2.12231] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/10/2017] [Accepted: 09/27/2017] [Indexed: 01/08/2023] Open
Abstract
Aims In heart failure, various biomarkers are established for diagnosis and risk stratification; however, little is known about the relevance of serial measurements during an episode worsening heart failure (WHF). This study sought to investigate the trajectory of natriuretic peptides and multiple novel biomarkers during hospitalization for WHF and to determine the best time point to predict outcome. Methods and results MOLITOR (Impact of Therapy Optimisation on the Level of Biomarkers in Patients with Acute and Decompensated Chronic Heart Failure) was an eight‐centre prospective study of 164 patients hospitalized with a primary diagnosis of WHF. C‐terminal fragment of pre‐pro‐vasopressin (copeptin), N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP), mid‐regional pro‐atrial natriuretic peptide (MR‐proANP), mid‐regional pro‐adrenomedullin (MR‐proADM), and C‐terminal pro‐endothelin‐1 (CT‐proET1) were measured on admission, after 24, 48, and 72 h, and every 72 h thereafter, at discharge and follow‐up visits. Their performance to predict all‐cause mortality and rehospitalization at 90 days was compared. All biomarkers decreased during recompensation (P < 0.05) except MR‐proADM. Copeptin at admission was the best predictor of 90 day mortality or rehospitalization (χ2 = 16.63, C‐index = 0.724, P < 0.001), followed by NT‐proBNP (χ2 = 10.53, C‐index = 0.646, P = 0.001), MR‐proADM (χ2 = 9.29, C‐index = 0.686, P = 0.002), MR‐proANP (χ2 = 8.75, C‐index = 0.631, P = 0.003), and CT‐proET1 (χ2 = 6.60, C‐index = 0.64, P = 0.010). Re‐measurement of copeptin at 72 h and of NT‐proBNP at 48 h increased prognostic value (χ2 = 23.48, C‐index = 0.718, P = 0.00001; χ2 = 14.23, C‐index = 0.650, P = 0.00081, respectively). Conclusions This largest sample of serial measurements of multiple biomarkers in WHF found copeptin at admission with re‐measurement at 72 h to be the best predictor of 90 day mortality and rehospitalization.
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Affiliation(s)
- Hans-Dirk Düngen
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Verena Tscholl
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Danilo Obradovic
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Sara Radenovic
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Dragan Matic
- Emergency Department, Clinic for Cardiology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Lindy Musial Bright
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany
| | - Elvis Tahirovic
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | | | - Simone Inkrot
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Djawid Hashemi
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Jovan Veskovic
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | | | - Stephan von Haehling
- Applied Cachexia Research, Department of Cardiology, Charité Medical School, Berlin, Germany.,Division of Innovative Trials, University Medical Center Göttingen, Göttingen, Germany
| | - Wolfram Doehner
- Center for Stroke Research, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Natasa Cvetinovic
- Department of Cardiology, Clinical Hospital Zvezdara, Belgrade, Serbia
| | - Mitja Lainscak
- Department of Cardiology, General Hospital Celje, Celje, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Burkert Pieske
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Tobias Trippel
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Medizinische Klinik m. S. Kardiologie, Augustenburger Platz 1, D-13353, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Goran Loncar
- Department of Cardiology, Clinical Hospital Zvezdara, Belgrade, Serbia.,School of Medicine, University of Belgrade, Belgrade, Serbia
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24
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Hashemi D, Blum M, Kraft R, Mende M, Stoerk S, Angermann C, Pankuweit S, Wachter R, Edelmann F, Pieske B, Duengen H. P1082The history of syncope in heart failure. Mortality increases - but not in all. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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25
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Beckmann S, Weisrock F, Fritschka M, Wagner J, Hashemi D, Tahirovic E, Radenovic S, Busjahn A, Pieske B, Krahn T, Dinh W, Duengen H. P5271Non-invasive monitoring of peripheral and cardiac influence on exercise limitation in patients with heart failure with preserved ejection fraction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5271] [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: 11/12/2022] Open
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26
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Hashemi D, Blum M, Mende M, Stoerk S, Angermann CE, Pankuweit S, Pieske B, Wachter R, Duengen HD. P1486Syncopes in heart failure - Robust predictor in all patients? Europace 2017. [DOI: 10.1093/ehjci/eux158.113] [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: 11/13/2022] Open
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27
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Weisrock F, Fritschka M, Beckmann S, Litmeier S, Wagner J, Tahirovic E, Radenovic S, Zelenak C, Hashemi D, Busjahn A, Krahn T, Pieske B, Dinh W, Düngen HD. Reliability of peripheral arterial tonometry in patients with heart failure, diabetic nephropathy and arterial hypertension. Vasc Med 2017; 22:292-300. [PMID: 28555533 DOI: 10.1177/1358863x17706752] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Endothelial dysfunction plays a major role in cardiovascular diseases and pulse amplitude tonometry (PAT) offers a non-invasive way to assess endothelial dysfunction. However, data about the reliability of PAT in cardiovascular patient populations are scarce. Thus, we evaluated the test-retest reliability of PAT using the natural logarithmic transformed reactive hyperaemia index (LnRHI). Our cohort consisted of 91 patients (mean age: 65±9.7 years, 32% female), who were divided into four groups: those with heart failure with preserved ejection fraction (HFpEF) ( n=25), heart failure with reduced ejection fraction (HFrEF) ( n=22), diabetic nephropathy ( n=21), and arterial hypertension ( n=23). All subjects underwent two separate PAT measurements at a median interval of 7 days (range 4-14 days). LnRHI derived by PAT showed good reliability in subjects with diabetic nephropathy (intra-class correlation (ICC) = 0.863) and satisfactory reliability in patients with both HFpEF (ICC = 0.557) and HFrEF (ICC = 0.576). However, in subjects with arterial hypertension, reliability was poor (ICC = 0.125). We demonstrated that PAT is a reliable technique to assess endothelial dysfunction in adults with diabetic nephropathy, HFpEF or HFrEF. However, in subjects with arterial hypertension, we did not find sufficient reliability, which can possibly be attributed to variations in heart rate and the respective time of the assessments. Clinical Trial Registration Identifier: NCT02299960.
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Affiliation(s)
- Fabian Weisrock
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
| | - Max Fritschka
- 2 Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Germany
| | - Sebastian Beckmann
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
| | - Simon Litmeier
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
| | - Josephine Wagner
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
| | - Elvis Tahirovic
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
| | - Sara Radenovic
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
| | - Christine Zelenak
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
| | - Djawid Hashemi
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany.,3 DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | | | - Thomas Krahn
- 5 Department Head Global Biomarker Research, BAYER Pharma AG, Wuppertal, Germany
| | - Burkert Pieske
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany.,2 Department of Internal Medicine - Cardiology, Deutsches Herzzentrum Berlin, Germany.,3 DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Wilfried Dinh
- 6 Bayer AG, Drug Discovery, Clinical Sciences- Experimental Medicine, Wuppertal, Germany.,7 Department of Cardiology, HELIOS Clinic Wuppertal, University Hospital Witten/Herdecke, Germany
| | - Hans-Dirk Düngen
- 1 Department of Cardiology, Charité Universitätsmedizin, Campus Virchow-Klinikum, Berlin, Germany
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28
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Zelenak C, Radenovic S, Musial-Bright L, Tahirovic E, Sacirovic M, Lee CB, Jahandar-Lashki D, Inkrot S, Trippel TD, Busjahn A, Hashemi D, Wachter R, Pankuweit S, Störk S, Pieske B, Edelmann F, Düngen HD. Heart failure awareness survey in Germany: general knowledge on heart failure remains poor. ESC Heart Fail 2017; 4:224-231. [PMID: 28772053 PMCID: PMC5542724 DOI: 10.1002/ehf2.12144] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [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: 12/06/2016] [Revised: 01/19/2017] [Accepted: 02/10/2017] [Indexed: 11/18/2022] Open
Abstract
Aims Previous studies demonstrated poor public awareness of heart failure (HF) compared with myocardial infarction and stroke. With respect to several activities to improve HF awareness in recent years, we present data on the development of HF awareness and information sources in Germany over 8 years. Methods and results In 2007, 2012, and 2015, respectively, 2531, 359, and 171 respondents answered questions about causes, presentation, prognosis, and treatment of HF from a survey developed by the German Competence Network HF. Relationships between respondents' sociodemographic data and their HF knowledge were explored and changes in knowledge and use of information sources analysed. Sixty‐eight per cent of respondents knew HF as ‘weakness of the heart’. Seventy‐nine per cent knew shortness of breath, 74% reduced exercise tolerance, and 52% knew leg edema as symptoms. Only 40% knew all three symptoms. Although up to 34% of the respondents were directly or indirectly affected by HF, they demonstrated poor knowledge about severity and prognosis. Between 2007 and 2015, overall HF awareness has not changed; awareness about treatment has dropped significantly. Younger respondents used all media, especially internet, for information about health; older respondents preferred printed/verbal media and their physician. Conclusions We found rather insufficient public knowledge on HF etiology and symptoms but especially about management, severity, and prognosis, which is essential for good self‐care and adherence of patients. Heart failure awareness has not improved even though awareness campaigns were held over the years. It seems that especially older patients should be much more approached by their family physicians.
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Affiliation(s)
- Christine Zelenak
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Sara Radenovic
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Lindy Musial-Bright
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Mesud Sacirovic
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Chong-Bin Lee
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Diana Jahandar-Lashki
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Simone Inkrot
- Department of Cardiology, Waikato Hospital, Hamilton, New Zealand
| | - Tobias Daniel Trippel
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | - Djawid Hashemi
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology, University of Göttingen, and DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Berlin, Germany
| | - Sabine Pankuweit
- Department of Cardiology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg and Department of Medicine I, Würzburg, Germany
| | - Burkert Pieske
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Hans-Dirk Düngen
- Department of Internal Medicine-Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin-Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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