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Sagmeister F, Herrmann S, Gassenmaier T, Bernhardt P, Rasche V, Liebold A, Weidemann F, Brunner H, Beer M. Non-invasive determination of pressure recovery by cardiac MRI and echocardiography in patients with severe aortic stenosis: short and long-term outcome prediction. J Int Med Res 2020; 48:300060520954708. [PMID: 33076730 PMCID: PMC7592334 DOI: 10.1177/0300060520954708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the influence of pressure recovery (PR)-corrected haemodynamic parameters on outcome in patients with aortic stenosis. METHODS Aortic stenosis severity parameters were corrected for PR (increase in static pressure due to decreasing dynamic pressure), assessed using transthoracic echocardiography (TTE) or cardiac magnetic resonance imaging (CMR), in patients with aortic stenosis. PR, indexed PR (iPR) and energy loss index (ELI) were determined. Factors that predicted all-cause mortality, and 9-month or 10-year New York Heart Association classification ≥2 were assessed using Cox proportional hazards regression. RESULTS A total of 25 patients, aged 68 ± 10 years, were included. PR was 17 ± 6 mmHg using CMR, and CMR correlated with TTE measurements. PR correction using CMR data reduced the AS-severity classification in 12-20% of patients, and correction using TTE data reduced the AS-severity classification in 16% of patients. Age (Wald 4.774) was a statistically significant predictor of all-cause mortality; effective orifice area (Wald 3.753) and ELI (Wald 3.772) almost reached significance. CONCLUSIONS PR determination may result in significant reclassification of aortic stenosis severity and may hold value in predicting all-cause mortality.
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Affiliation(s)
- Florian Sagmeister
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Sebastian Herrmann
- Department of Medicine I, Division of Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Tobias Gassenmaier
- Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
| | | | - Volker Rasche
- Department of Medicine II, Cardiology, University Hospital Ulm, Ulm, Germany
| | - Andreas Liebold
- Department of Cardiac, Thoracic and Vascular Surgery, University Hospital Ulm, Ulm, Germany
| | - Frank Weidemann
- Department of Medicine I, Division of Cardiology, University Hospital Wuerzburg, Wuerzburg, Germany.,Department of Medicine I, Hospital Centre Vest, Recklinghausen, Germany
| | - Horst Brunner
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Wuerzburg, Wuerzburg, Germany
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Affiliation(s)
- Christopher Kloth
- *Klinik für Diagnostische und interventionelle Radiologie, Uniklinikum Ulm,
| | - Florian Sagmeister
- *Klinik für Diagnostische und interventionelle Radiologie, Uniklinikum Ulm,
| | - Horst Brunner
- *Klinik für Diagnostische und interventionelle Radiologie, Uniklinikum Ulm,
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Klenk C, Brunner H, Nickel T, Sagmeister F, Yilmaz A, Infanger D, Billich C, Scharhag J, Vogeser M, Beer M, Schütz U, Schmidt-Trucksäss A. Cardiac structure and function in response to a multi-stage marathon over 4486 km. Eur J Prev Cardiol 2019; 28:1102-1109. [DOI: 10.1177/2047487319885035] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 10/07/2019] [Indexed: 01/31/2023]
Abstract
Abstract
Aims
To investigate whether participation in the Trans Europe Foot Race 2009 (TEFR), an ultramarathon race held over 64 consecutive days and 4486 km, led to changes in cardiac structure and function.
Methods
Cardiac magnetic resonance imaging was performed in 20 of 67 participating runners (two women; mean ± SD age 47.8 ± 10.4 years) at three time points (baseline scan at 294 ± 135 km (B), scan two at 1735 ± 86 km (T1) and scan three at 3370 ± 90 km (T2)) during the TEFR. Imaging included an assessment of left ventricular structure (mass) and function (strain). In parallel, cardiac troponin I, NT-pro-BNP, myostatin and GDF11 were determined in venous blood samples. A subsample of ten runners returned for a follow-up scan eight months after the race.
Results
Left ventricular mass increased significantly (B, 158.5 ± 23.8 g; T1, 165.1 ± 23.2 g; T2, 167 ± 24.6 g; p < 0.001) over the course of the race, although no significant change was seen in the remaining structural and functional parameters. Serum concentrations of cardiac troponin I and NT-proBNP significantly increased 1.5 - and 3.5-fold, respectively, during the first measurement interval, with no further increase thereafter (cardiac troponin I, 6.8 ± 3.1 (B), 16.9 ± 10.4 (T1) and 17.1 ± 9.7 (T2); NT-proBNP, 30.3 ± 22.8 (B), 135.9 ± 177.5 (T1) and 111.2 ± 87.3 (T2)), whereas the growth markers myostatin and GDF11 did not change. No association was observed with functional parameters, including the ejection fraction and the volume of both ventricles. The follow-up scans showed a reduction to baseline values (left ventricular mass 157 ± 19.3 g).
Conclusions
High exercise-induced cardiac volume load for >2 months in ultra-endurance runners results in a physiological structural adaptation with no sign of adverse cardiovascular remodelling.
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Affiliation(s)
- Christopher Klenk
- Division of Sports and Exercise Medicine, Department of Sport, Exercise, and Health, Medical Faculty, University of Basel, Switzerland
| | - Horst Brunner
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Thomas Nickel
- Department of Internal Medicine/Cardiology, University Hospital Grosshadern, Germany
| | - Florian Sagmeister
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Atilgan Yilmaz
- The Azrieli Center for Stem Cells and Genetic Research, Department of Genetics, Silberman Institute of Life Sciences, The Hebrew University, Israel
| | - Denis Infanger
- Division of Sports and Exercise Medicine, Department of Sport, Exercise, and Health, Medical Faculty, University of Basel, Switzerland
| | - Christian Billich
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Jürgen Scharhag
- Sports- and Exercise Physiology, University of Vienna, Austria
| | - Michael Vogeser
- Institute of Laboratory Medicine, University Hospital, LMU Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Uwe Schütz
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Germany
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise, and Health, Medical Faculty, University of Basel, Switzerland
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Klenk C, Brunner H, Nickel T, Sagmeister F, Infanger D, Billich C, Beer M, Schuetz U, Schmidt-Trucksaess A. P649Harmonic cardiac adaptation of myocardial structure and mass in the course of a multistage marathon over 4.486 km. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C Klenk
- University of Basel, Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Basel, Switzerland
| | - H Brunner
- University Hospital Ulm, Department of Diagnostic and Interventional Radiology, Ulm, Germany
| | - T Nickel
- University Hospital Grosshadern, Ludwig-Maximilians-University, Department of Internal Medicine/Cardiology, Munich, Germany
| | - F Sagmeister
- University Hospital Ulm, Department of Diagnostic and Interventional Radiology, Ulm, Germany
| | - D Infanger
- University of Basel, Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Basel, Switzerland
| | - C Billich
- University Hospital Ulm, Department of Diagnostic and Interventional Radiology, Ulm, Germany
| | - M Beer
- University Hospital Ulm, Department of Diagnostic and Interventional Radiology, Ulm, Germany
| | - U Schuetz
- University Hospital Ulm, Department of Diagnostic and Interventional Radiology, Ulm, Germany
| | - A Schmidt-Trucksaess
- University of Basel, Department of Sport, Exercise and Health, Division of Sports and Exercise Medicine, Basel, Switzerland
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Allkemper T, Sagmeister F, Cicinnati V, Beckebaum S, Kooijman H, Kanthak C, Stehling C, Heindel W. Evaluation of fibrotic liver disease with whole-liver T1ρ MR imaging: a feasibility study at 1.5 T. Radiology 2013; 271:408-15. [PMID: 24475807 DOI: 10.1148/radiol.13130342] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To test at 1.5 T whether T1ρ magnetic resonance (MR) imaging of fibrotic liver disease is feasible, to investigate whether liver T1ρ imaging allows assessment of the severity of liver cirrhosis, and to assess the normal liver T1ρ range in healthy patients. MATERIALS AND METHODS This prospective study was approved by the institutional ethics committee. Written informed consent was obtained. Healthy volunteers (n = 25) and patients (n = 34) with cirrhosis underwent whole-liver T1ρ MR imaging at 1.5 T. Mean T1ρ values were calculated from liver regions of interest. Mean T1ρ values were correlated to clinical data and histopathologic analysis by analysis of variance. Receiver operating characteristic curves were calculated to determine the accuracy of mean T1ρ values for the assessment of Child-Pugh class. RESULTS Mean T1ρ values of volunteers (mean, 40.9 msec ± 2.9 [standard deviation]; range, 33.9-46.3 msec) were significantly lower than those of patients who were Child-Pugh class A (P < .004), B (P < .001), or C (P < .001), and significant differences were found between each Child-Pugh stage (A vs B, P < .002; B vs C, P < .009; A vs C, P < .001). Liver cirrhosis was confirmed via histologic analysis in all patients with liver biopsy. Mean T1ρ values did not correlate with necroinflammatory activity (r = 0.31; P = .23), degree of steatosis (r = -0.016; P = .68), or presence of iron load (r = 0.22; P = .43). Mean T1ρ values performed well by assessing the Child-Pugh stage, with receiver operating characteristic areas of 0.95-0.98. Intraclass correlation coefficient values ranged between 0.890 and 0.987, which indicated excellent imaging and reimaging reproducibility and interobserver and intraobserver variability. CONCLUSION Whole-liver T1ρ MR imaging at 1.5 T to detect and assess human liver cirrhosis is feasible. Further investigation and optimization of this technique are warranted to cover the entire spectrum of fibrotic liver disease.
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Affiliation(s)
- Thomas Allkemper
- From the Departments of Clinical Radiology (T.A., F.S., C.S., W.H.) and Transplant Medicine (V.C., S.B.), University of Muenster, Albert-Schweitzer-Campus 1, 48149 Muenster, Germany; Philips Medical Systems, Hamburg, Germany (H.K.); and Fraunhofer MEVIS, Institute for Medical Image Computing, Bremen, Germany (C.K.)
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Sagmeister F, Herrmann S, Ritter C, Machann W, Köstler H, Hahn D, Voelker W, Weidemann F, Beer M. [Functional cardiac MRI for assessment of aortic valve disease]. Radiologe 2010; 50:541-7. [PMID: 20521022 DOI: 10.1007/s00117-010-1988-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Aortic valve disease shows a rising incidence with the increasing mean age of Western populations. The detection of hemodynamic parameters, which transcends the mere assessment of valve morphology, has an important future potential concerning classification of the severity of disease. MRI allows a non-invasive and a spatially flexible view of the aortic valve and the adjacent anatomic region, left ventricular outflow tract (LVOT) and ascending aorta. Moreover, the technique allows the determination of functional hemodynamic parameters, such as flow velocities and effective orifice areas. The new approach of a serial systolic planimetry velocity-encoded MRI sequence (VENC-MRI) facilitates the sizing of blood-filled cardiac structures with the registration of changes in magnitude during systole. Additionally, the subvalvular VENC-MRI measurements improve the clinically important exact determination of the LVOT area with respect to its specific eccentric configuration and its systolic deformity.
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Affiliation(s)
- F Sagmeister
- Institut für Röntgendiagnostik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Deutschland.
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Sagmeister F, Weidemann F, Voelker W, Hahn D, Köstler H, Beer M. Magnetresonanztomografische Bestimmung der Fläche des linksventrikulären Ausflusstraktes mittels Phasenkontrastflussmessungen – Planimetrischer Nachweis der ekzentrischen Form des LVOT. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1247990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sagmeister F, Weidemann F, Voelker W, Hahn D, Köstler H, Beer M. Anwendung der Magnetresonanztomografie zur nichtinvasiven Bestimmung der Druckerholung bei Patienten mit Aortenklappenstenosen – Abschätzung der poststenotischen Druckerholung durch Bestimmung aortaler Durchmesser distal der Aortenklappe. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0029-1247980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Weininger M, Sagmeister F, Herrmann S, Weidemann F, Ritter C, Köstler H, Hahn D, Beer M. Beurteilung der Klappendynamik bei hochgradiger Aortenstenose: Kann die MRT einen neuen Vorhersagewert zur Beurteilung der Regression der links-ventrikulären Masse nach Klappenersatztherapie liefern? ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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