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Kanter F, Lellmann J, Thiele H, Kalloger S, Schaeffer DF, Wellmann A, Klein O. Classification of Pancreatic Ductal Adenocarcinoma Using MALDI Mass Spectrometry Imaging Combined with Neural Networks. Cancers (Basel) 2023; 15:cancers15030686. [PMID: 36765644 PMCID: PMC9913229 DOI: 10.3390/cancers15030686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
Despite numerous diagnostic and therapeutic advances, pancreatic ductal adenocarcinoma (PDAC) has a high mortality rate, and is the fourth leading cause of cancer death in developing countries. Besides its increasing prevalence, pancreatic malignancies are characterized by poor prognosis. Omics technologies have potential relevance for PDAC assessment but are time-intensive and relatively cost-intensive and limited by tissue heterogeneity. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) can obtain spatially distinct peptide-signatures and enables tumor classification within a feasible time with relatively low cost. While MALDI-MSI data sets are inherently large, machine learning methods have the potential to greatly decrease processing time. We present a pilot study investigating the potential of MALDI-MSI in combination with neural networks, for classification of pancreatic ductal adenocarcinoma. Neural-network models were trained to distinguish between pancreatic ductal adenocarcinoma and other pancreatic cancer types. The proposed methods are able to correctly classify the PDAC types with an accuracy of up to 86% and a sensitivity of 82%. This study demonstrates that machine learning tools are able to identify different pancreatic carcinoma from complex MALDI data, enabling fast prediction of large data sets. Our results encourage a more frequent use of MALDI-MSI and machine learning in histopathological studies in the future.
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Affiliation(s)
- Frederic Kanter
- Institute of Mathematics and Image Computing, Universität zu Lübeck, 23562 Luebeck, Germany
| | - Jan Lellmann
- Institute of Mathematics and Image Computing, Universität zu Lübeck, 23562 Luebeck, Germany
- Correspondence: (J.L.); (O.K.)
| | - Herbert Thiele
- Fraunhofer Institute for Digital Medicine MEVIS, 23562 Luebeck, Germany
| | - Steve Kalloger
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - David F. Schaeffer
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Pancreas Centre BC, Vancouver, BC V5Z 1G1, Canada
- Division of Anatomic Pathology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Axel Wellmann
- Institute of Pathology, Wittinger Strasse 14, 29223 Celle, Germany
| | - Oliver Klein
- BIH Center for Regenerative Therapies, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence: (J.L.); (O.K.)
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Marin-Cuartas M, De Waha S, Naumann S, Deo V, Noack T, Hoyer A, Holzhey D, Leontyev S, Saeed D, Misfeld M, Ender J, Abdel-Wahab M, Desch S, Thiele H, Borger M, Kiefer P. Incidence and Outcomes of Emergent Intraprocedural Surgical Conversion during Transcatheter Aortic Valve Implantation: Insights from a Multicentric Germany-Wide Analysis. Thorac Cardiovasc Surg 2023. [DOI: 10.1055/s-0043-1761793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023]
Affiliation(s)
- M. Marin-Cuartas
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - S. De Waha
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - S. Naumann
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - V.S. Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, United States
| | - T. Noack
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - A. Hoyer
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | | | - S. Leontyev
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - D. Saeed
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - M. Misfeld
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - J. Ender
- Department of Anesthesiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - M. Abdel-Wahab
- Department of Cardiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - S. Desch
- Department of Cardiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - H. Thiele
- Department of Cardiology, Heart Centre Leipzig at University of Leipzig, Leipzig, Deutschland
| | - M. Borger
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
| | - P. Kiefer
- Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Deutschland
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Kokot K, Kneuer J, John D, Rebs S, Mueller M, Haas J, Thiele H, Mueller OJ, Hille S, Leuschner F, Dimmeler S, Streckfuss-Boemeke K, Meder B, Laufs U, Boeckel JN. Decrease of RNA editing in the failing heart leads to induction of circRNAs. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2962] [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: 11/15/2022] Open
Abstract
Abstract
Background and purpose
Adenosine-to-Inosine (A-to-I) RNA editing is a post-transcriptional modification process that affects the secondary structure of RNAs. Changes in RNA editing have been associated with human diseases. We therefore aimed to analyze editing in the healthy and failing human heart.
Methods and results
Transcriptome sequencing of human heart samples of heart failure (HF) patients (n=20) and controls (n=10) revealed A-to-I editing as the major type of editing (>80%). In HF patients, RNA editing was reduced, which was primarily attributable to Alu elements in introns of protein-coding genes. We identified 166 upregulated circRNAs in HF, with the majority showing reduced RNA editing in their parental host gene (88.3%). CircRNA expression did not correlate with their corresponding host gene (R=0.07, P<0.05), suggesting that an alternative splicing mechanism gives rise to the elevated circRNA levels in HF. The RNA editing enzyme ADAR2, which binds to RNA regions that are edited from adenosine to inosine, was decreased in failing human hearts (−68.2%). In vitro, reduction of ADAR2 increased circRNA levels suggesting a causal effect of reduced ADAR2 levels on increased circRNAs in the failing human heart. To gain mechanistic insight, we examined the formation of circRNAs on one exemplary candidate. AKAP13 was among the top edited mRNAs in the human heart and gave rise to a circular transcript, which was elevated in HF. ADAR2 reduced the formation of double-stranded structures in AKAP13 pre-mRNA, thereby reducing the stability of Alu elements and the circularization of the resulting circRNA. Overexpression of circAKAP13 impaired the sarcomere regularity of human induced pluripotent stem cell-derived cardiomyocytes (−31.0%).
Conclusion
Our study shows that ADAR2 mediates A-to-I RNA editing in the human heart. We describe an alternative splicing mechanism of circRNAs in the human heart. In the healthy human heart, A-to-I RNA editing represses the formation of dsRNA structures of Alu elements thereby favoring linear mRNA splicing. Our results contribute to a better mechanistic understanding into the human-specific regulation of circRNA formation and are relevant to diseases with reduced RNA editing and increased circRNA levels.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Kokot
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J Kneuer
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - D John
- Institute of Cardiovascular Regeneration , Frankfurt , Germany
| | - S Rebs
- Institute of Pharmacology and Toxicology , Würzburg , Germany
| | - M Mueller
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum , Bad Oeynhausen , Germany
| | - J Haas
- University of Heidelberg, Department of Internal Medicine III , Heidelberg , Germany
| | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - O J Mueller
- University of Kiel, Department of Internal Medicine III , Kiel , Germany
| | - S Hille
- University of Kiel, Department of Internal Medicine III , Kiel , Germany
| | - F Leuschner
- University of Heidelberg, Department of Internal Medicine III , Heidelberg , Germany
| | - S Dimmeler
- Institute of Cardiovascular Regeneration , Frankfurt , Germany
| | | | - B Meder
- University of Heidelberg, Department of Internal Medicine III , Heidelberg , Germany
| | - U Laufs
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J N Boeckel
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
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Schrage B, Sundermeyer J, Blankenberg S, Eitel I, Kirchhof P, Mangner N, Moebius-Winkler S, Orban M, Thiele H, Morrow DA, Schulze PC, Westermann D. Timing of active left ventricular unloading in patients with cardiogenic shock on veno-arterial extracorporeal membrane oxygenation therapy. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Aim
To evaluate the impact of timing of active left ventricular (LV) unloading in relation to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation on outcomes of patients with cardiogenic shock (CS).
Methods and results
Data from 421 patients with CS treated with active LV unloading on top of VA-ECMO at 18 tertiary-care centers in 4 countries were collected. Only patients in whom both devices were implanted within 24 hours of each other were considered and patients were stratified by timing of device implantation in early vs. delayed active LV unloading (e.g. active LV unloading before vs. after VA-ECMO). Cox and logistic regression models (adjusted for age, sex, lactate, cardiopulmonary resuscitation (CPR), VA-ECMO assisted CPR and enrollment center) were fitted to evaluate the association between early active LV unloading and 30-day mortality as well as several safety outcomes.
Overall, 310 (73.6%) patients were treated with early active LV unloading. Early active LV unloading was associated with a lower 30-day mortality risk (hazard ratio 0.63, 95% confidence interval 0.46–0.87) and a higher likelihood of weaning from mechanical ventilation (odds ratio 1.25, 95% confidence interval 1.03–1.52), but not with more complications. Importantly, postponing active LV unloading in these patients was associated with higher mortality risk (Figure 1), and lower likelihood of successful weaning from mechanical ventilation.
Conclusion
This exploratory study lends support to the use of early active LV unloading in CS patients on VA-ECMO as a primary treatment strategy, as opposed to a bail-out approach.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Unrestricted research grant from Abiomed
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Affiliation(s)
- B Schrage
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - J Sundermeyer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - I Eitel
- University Heart Center , Luebeck , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - N Mangner
- Heart Centre Dresden - Dresden Technical University Hospital , Dresden , Germany
| | | | - M Orban
- University Hospital of Munich , Munich , Germany
| | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - D A Morrow
- Brigham and Women's Hospital , Boston , United States of America
| | | | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
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5
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Winkler M, Kneuer JM, Meinecke T, Moebius-Winkler MN, Weiss R, Haas J, Garfias-Veitl T, Von Haehling S, Keller T, Thiele H, Lurz P, Speer T, Laufs U, Boeckel JN. The long non-coding RNA Heat4 is dynamically regulated during cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and purpose
Cardiogenic shock (CS) remains the leading cause of death in acute myocardial infarction (AMI), with high mortality rates of 40–50%. The long non-coding RNA (lncRNA) Heat4 is associated with the inflammatory response of non-classical monocytes. Previous experimental work shows that this mechanism may be important in heart failure (HF) and during regeneration after vascular injury. Here, we investigate the association of Heat4 with survival in patients with chronic HF and assessed its regulation in AMI and CS.
Methods and results
Heat4 was elevated in the blood of HF patients compared to age-matched non-failing controls (+5.2-fold; HF: N=63; Controls: N=38; p<0.05). Heat4 showed a positive correlation with systemic inflammation (hsCRP; r=0.41; p<0.05) and was negatively associated with LVEF (r=−0.45; p<0.001). Heat4 blood levels showed good discriminatory power for prevalence of HF (AUC = 0.734; p<0.05) and mortality prediction after 4-year follow-up (AUC = 0.789; HF: Death N=32; Controls: Death N=0; p<0.05). Furthermore, Heat4 was elevated in the blood of patients with AMI compared to controls (+1.85-fold; AMI: N=42; Controls: N=23; p<0.05). Heat4 showed a very strong induction in patients suffering from CS (+284.5-fold; CS: N=4; Controls: N=5; p<0.05). In agreement with an anti-inflammatory signaling, Heat4 showed a dynamic regulation in patients with CS with a 284.5-fold increase during acute shock and a decrease 24 hours after revascularization (−82.3% compared to day of revascularization). This regulation was validated in an independent second cohort.
Conclusion
The lncRNA Heat4 is upregulated in the blood of patients with chronic heart failure, acute myocardial infarction and cardiogenic shock. In CS, Heat4 is dynamically regulated. These data set the stage to further assess Heat4 blood levels as a strategy for risk stratification and potential treatment target in HF.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Projektfoerderung im Bereich der Herzmedizin, Leipzig
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Affiliation(s)
- M Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J M Kneuer
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - T Meinecke
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - M N Moebius-Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - R Weiss
- University of Leipzig, Institute of Clinical Immunology , Leipzig , Germany
| | - J Haas
- University of Heidelberg, Department of Internal Medicine III , Heidelberg , Germany
| | - T Garfias-Veitl
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - S Von Haehling
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - H Thiele
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - P Lurz
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - T Speer
- Saarland University Medical Center, Department of Internal Medicine, Nephrology and Hypertension , Homburg/Saar , Germany
| | - U Laufs
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J N Boeckel
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
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6
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Schrage B, Sundermeyer J, Blankenberg S, Graf T, Kirchhof P, Luedike P, Nordbeck P, Proudfoot A, Orban M, Skurk C, Tavazzi G, Thiele H, Winzer EB, Westenfeld R, Westermann D. Use of mechanical circulatory support in patients with non-ischemic cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The aim of this study was to evaluate mechanical circulatory support (MCS) for the treatment of non-ischemic cardiogenic shock (CS).
Methods
Data from 1,030 consecutive patients with non-ischemic CS treated with or without MCS at 16 tertiary-care centers were retrospectively collected. The association between MCS and 30-day mortality was assessed in a 1:1 propensity score matched cohort.
Results
MCS was used in 406 (39%) patients. MCS treated patients presented with more severe CS (lactate 5.4 vs. 4.1 mmol/l, systolic blood pressure 80 vs. 83 mmHg, higher SCAI class) and with more disease modifiers (prior cardiac arrest 42.4 vs. 36.1%, mechanical ventilation 78.4 vs. 56.5%). After matching, 272 patients treated with were compared vs. 272 patients treated without MCS. MCS was associated with a lower 30-day mortality (hazard ratio 0.77, 95% confidence interval 0.60–0.98, Figure 1). This finding was consistent through all tested sub-groups except when ejection fraction was considered, indicating an association especially in patients with an ejection fraction ≤20%. Complications occurred more frequently in patients with MCS; e.g. severe bleedings (21.8 vs. 9.2%) and access-site related ischemia (6.6 vs. 0%).
Conclusion
In patients with non-ischemic CS, MCS use was associated with lower 30-day mortality as compared to medical therapy only, particularly in patients with a lower ejection fraction. This provides rationale for randomized trials to validate these findings.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B Schrage
- University Heart Centre Hamburg , Hamburg , Germany
| | | | | | - T Graf
- Schleswig-Holstein University Clinic, Lubeck Campus , Luebeck , Germany
| | - P Kirchhof
- University Heart Centre Hamburg , Hamburg , Germany
| | - P Luedike
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - P Nordbeck
- University Hospital of Wurzburg , Würzburg , Germany
| | - A Proudfoot
- Barts Heart Centre , London , United Kingdom
| | - M Orban
- University Hospital of Munich , Munich , Germany
| | - C Skurk
- Charite - Campus Benjamin Franklin , Berlin , Germany
| | | | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - E B Winzer
- Dresden University Heart Center , Dresden , Germany
| | - R Westenfeld
- Heinrich Heine University , Duesseldorf , Germany
| | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
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7
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Kneuer JM, Winkler M, Meinecke T, Moebius-Winkler MN, Weiss R, Haas J, Garfias-Veitl T, Von Haehling S, Keller T, Thiele H, Lurz P, Speer T, Laufs U, Boeckel JN. The long non-coding RNA Heat4 is elevated in heart failure patients and mediates anti-inflammatory functions thereby promoting vascular regeneration. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Activation of the immune system correlates with the severity and the prognosis of patients with heart failure (HF). Here, we aim to identify and characterize long non-coding RNAs (lncRNAs) as a potential mechanistic link between the activation of the immune system and the pathophysiology of HF.
Methods and results
Using next-generation sequencing we found a yet uncharacterized lncRNA to be significantly upregulated in peripheral blood mononuclear cells of ischemic cardiomyopathy patients compared to controls, which we named Heat4 – Heart-disease associated transcript 4 (N=4; 2.05-fold increase; p<0.05). In the blood, monocytes show the highest expression of Heat4 and here in particular the non-classical monocytes compared to classical monocytes (N=4; 3.37-fold; p<0.05). Matching the known anti-inflammatory properties of this monocyte subpopulation we found that overexpression of Heat4 in monocytes resulted in decreased levels of inflammation (TNFα: −38.6%; p<0.05). Accordingly, a knockdown of Heat4 increased levels of inflammatory cytokine expression (TNFα: +4.14-fold; p<0.05). Non-classical monocytes are known to maintain vascular homeostasis by patrolling the endothelium in search of injury. Indeed, overexpression of Heat4 in human monocytes increased vascular regeneration after injury of the carotid artery in NOD-SCID mice (N=6; +1.85-fold compared to injection of control monocytes; p<0.05). We found Heat4 enriched in the cytoplasm of monocytes compared to the nuclear fraction. Using biotin-labelled RNA probes containing 2$'$O-Me-RNA oligonucleotides we performed RNA antisense affinity selection and subsequent mass spectrometry to identify proteins interacting with Heat4. We found two proteins, namely IP1 and IP2, enriched in the Heat4 fraction (+1.20 and +1.45-fold, respectively compared to the control probe). Knockdown of IP1 resulted in reduced induction of inflammatory gene expression (IL-6: −49.2%; p<0.05) after stimulation of monocytes with TNFα. Mechanistically, overexpression of Heat4 resulted in reduced extracellular levels of the IP1/IP2 heterodimer (IP1/IP2: −23.6%; p<0.05) as determined by ELISA.
Conclusion
The lncRNA Heat4 is elevated in the blood of patients with HF. Heat4 limits the extent of the inflammatory response of non-classical monocytes and leads to a faster regeneration after vascular injury. Heat4 is located in the cytoplasm of monocytes interacting with the pro-inflammatory proteins IP1/IP2 and repealing their extracellular release. Modulating Heat4 levels may represent a novel strategy for treatment of cardiovascular diseases with impaired vascular functions.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Projektfoerderung im Bereich der Herzmedizin, Leipzig
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Affiliation(s)
- J M Kneuer
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - M Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - T Meinecke
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - M N Moebius-Winkler
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - R Weiss
- University of Leipzig, Institute of Clinical Immunology , Leipzig , Germany
| | - J Haas
- University of Heidelberg, Department of Internal Medicine III , Heidelberg , Germany
| | - T Garfias-Veitl
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - S Von Haehling
- University Medical Center of Goettingen (UMG), Department of Cardiology and Pneumology , Goettingen , Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology , Bad Nauheim , Germany
| | - H Thiele
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - P Lurz
- Heart Center at University of Leipzig, Department of Cardiology , Leipzig , Germany
| | - T Speer
- Saarland University Medical Center, Department of Internal Medicine, Nephrology and Hypertension , Homburg/Saar , Germany
| | - U Laufs
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
| | - J N Boeckel
- University Hospital Leipzig, Klinik und Poliklinik für Kardiologie , Leipzig , Germany
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8
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Sundermeyer J, Beer BN, Blankenberg S, Kirchhof P, Luedike P, Mangner N, Nordbeck P, Orban M, Pazdernik M, Proudfoot A, Schulze PC, Tavazzi G, Thiele H, Westermann D, Schrage B. Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Evidence in non-ischaemic cardiogenic shock (CS), especially regarding prognostic markers and use of mechanical circulatory support (MCS), is scarce.
Aim
The aim of this study was to evaluate left ventricular ejection fraction (LVEF) as a prognostic marker as well as a factor to guide the use of MCS in non-ischaemic CS.
Methods
In this international observational study, patients with non-ischaemic CS (e.g. caused by severe de-novo or acute on chronic heart failure; but not by acute myocardial infarction) treated with or without MCS from 18 tertiary-care centers in five countries were enrolled. Cox regression models adjusted for age, sex, SCAI class, lactate, prior resuscitation, mechanical ventilation and pH were fitted to evaluate the association between LVEF and 30-day mortality as well as the interaction between MCS use, LVEF and 30-day mortality.
Results
A total of 807 patients were enrolled, of whom 387 (47,9%) were treated with and 418 (52.1%) without MCS; mean age was 63 [interquartile range (IQR) 51.5–72) years, 601 (74.5%) were male, 486 (60.2%) had acute on chronic heart failure, 221 (32.7%) had an ischaemic cardiomyopathy and 277 (34.5%) had prior cardiac arrest. The baseline LVEF was 20 (IQR 15–30) % and baseline lactate was 4.9 (IQR 2.6–8.5) mmol/l.
There was no significant association between LVEF and 30-day mortality risk [hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.74–1.22 if LVEF was considered as a continuous variable; HR 1.09, 95% CI 0.83–1.44 if LVEF was considered as a categorical variable with ≤20% vs. >20%]. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with a depressed LVEF (HR 0.74, 95% CI 0.52–1.05, interaction-p = 0.04).
Conclusion
In this retrospective, multicenter, international study of patients with non-ischaemic CS, LVEF was not a predictor of 30-day mortality risk. However, we observed a significant interaction between MCS use and LVEF, indicating a lower morality risk with MCS use only in patients with a depressed LVEF. This provides rationale to use LVEF as a parameter to guide MCS therapy in non-ischaemic CS, and calls for a randomized trial on this topic.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Sundermeyer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - B N Beer
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - S Blankenberg
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P Kirchhof
- University Heart & Vascular Center Hamburg , Hamburg , Germany
| | - P Luedike
- University of Duisburg-Essen - West-German Heart and Vascular Center , Essen , Germany
| | - N Mangner
- Heart Centre Dresden - Dresden Technical University Hospital , Dresden , Germany
| | - P Nordbeck
- University Hospital of Wurzburg, Department of Internal Medicine I, , Würzburg , Germany
| | - M Orban
- University Hospital of Munich , Munich , Germany
| | - M Pazdernik
- Institute for Clinical and Experimental Medicine , Prague , Czechia
| | - A Proudfoot
- St Bartholomew's Hospital , London , United Kingdom
| | | | - G Tavazzi
- Policlinic Foundation San Matteo IRCCS , Pavia , Italy
| | - H Thiele
- Heart Center of Leipzig , Leipzig , Germany
| | - D Westermann
- Heart Center, University of Freiburg , Freiburg , Germany
| | - B Schrage
- University Heart & Vascular Center Hamburg , Hamburg , Germany
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9
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Büttner P, Böttner J, Krohn K, Baber R, Platzbecker U, Cross M, Thiele H, Branzan D. Clonal hematopoiesis of indeterminate potential in peripheral artery disease. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.093] [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: 11/02/2022]
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10
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Böttner J, Büttner P, Werner S, Borger M, Thiele H, Schlotter F. Sex-specific features of human fibro-calcific aortic valve disease. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.306] [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: 11/16/2022]
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11
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Von Roeder M, Maeder M, Wahl V, Stachel G, Thiele H, Desch S, Lurz P, Abdel-Wahab M. Prognostic significance of left atrial reservoir strain in patients undergoing transcatheter aortic valve implantation. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Left atrial reservoir strain (LARS) provides prognostic information in various patient groups and might help to detect elevated filling pressures. Patients with diastolic dysfunction experience worse outcomes after transcatheter aortic valve implantation (TAVI), but Doppler-derived measurements might be hampered by atrial fibrillation, mitral valve disease or impaired image quality. Aim of the current study is to elucidate the prognostic value of LASR in patients undergoing TAVI.
Methods
All consecutive patients undergoing TAVI at a single tertiary care hospital between 01/2018 and 12/2018 were included if discharge echo and follow-up was available. LASR was derived from 2-D-speckle-tracking averaged apical 2- and 4-chamber view. Patients were grouped in 3 tertiles according to LASR. Primary outcome was a composite of all-cause death and readmission for worsening heart failure.
Results
Overall, 606 patients were available (Age 80 years (IQR 77-84)), including 53% woman.
LASR was significantly impaired over tertiles (T1 21.4 (IQR 18.3-24.5), T2 13.0 (IQR 11.3-14.6), T3 7.1 (IQR 5.4-8.4), p < 0.0001). The primary outcome occurred more often with impaired LASR (T1 7,4%, T2 13.4%, T3 25,7%).
On multivariable Cox-regression analysis LASR was a significant factor to predict outcome (HR 0.95, CI 0.91-0.99, p = 0.02).
Conclusion
Impaired LASR is associated with impaired outcomes in patients undergoing TAVI.
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Affiliation(s)
| | - M Maeder
- Heart Center of Leipzig, Leipzig, Germany
| | - V Wahl
- Heart Center of Leipzig, Leipzig, Germany
| | - G Stachel
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - P Lurz
- Heart Center of Leipzig, Leipzig, Germany
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12
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Grieshaber P, Heringlake M, Bauer A, Thiele H, Schmitz T, Miera O, Groesdonk H, Böning A, Trummer G. The Use of Intraaortic Balloon Counterpulsation in Cardiac Surgery in Germany. Thorac Cardiovasc Surg 2022. [DOI: 10.1055/s-0042-1742843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- P. Grieshaber
- Division of Congenital Cardiac Surgery, Department of Cardiac Surgery, University Hospital Heidelberg, Heidelberg, Deutschland
| | | | - A. Bauer
- Lerchenfeld 1, Coswig, Deutschland
| | - H. Thiele
- Leipzig Heart Center, Leipzig, Deutschland
| | | | - O. Miera
- Pediatric cardiology, German Heart Institute Berlin, Berlin, Deutschland
| | | | - A. Böning
- Rudolf-Buchheim-Str. 7, Gießen, Deutschland
| | - G. Trummer
- Hugstetter Straße 55, Freiburg, Deutschland
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13
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HERMANN J, Brehmer K, Lellig M, Thiele H, Jankowski J, Jankowski V. POS-369 NOVEL APPROACH FOR IN DEPTH ANALYSES OF KIDNEY SAMPLES - 3D IMAGE MODELING. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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14
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Scholz KH, Busch HJ, Frey N, Kelm M, Rott N, Thiele H, Böttiger BW. Qualitätskriterien und strukturelle Voraussetzungen für Cardiac Arrest Zentren – Update 2021. Kardiologe 2021. [PMCID: PMC8591966 DOI: 10.1007/s12181-021-00517-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- K. H. Scholz
- Medizinische Klinik I, Kardiologie u. Intensivmedizin, St. Bernward-Krankenhaus Hildesheim, Treibestraße 9, 31134 Hildesheim, Deutschland
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
| | - H. J. Busch
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N. Frey
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M. Kelm
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herz- und Gefäßzentrum, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - N. Rott
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| | - H. Thiele
- Deutsche Gesellschaft für Kardiologie – Herz und Kreislaufforschung e. V. (DGK), Düsseldorf, Deutschland
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - B. W. Böttiger
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
- Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
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15
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Iliadis C, Kalbacher D, Lurz P, Petrescu A, Orban M, Karam N, Lubos E, Thiele H, Von Bardeleben S, Hausleiter J, Pfister R. Association of left atrial volume index with outcomes after transcatheter mitral valve repair for secondary mitral regurgitation: results from the EuroSMR registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The benefit of transcatheter edge-to-edge mitral valve repair (TMVr) in heart failure patients with secondary mitral regurgitation (SMR) shows large heterogeneity. A potential explanation might be the burden and chronicity of left-ventricular backward failure which is reflected by left atrial (LA) size.
Purpose
To investigate the role of LA volume index (LAVi) in real-world SMR patients undergoing TMVr.
Methods
SMR patients in a European multicenter registry were evaluated. Outcomes were evaluated according to LAVi at baseline. Main analysis was performed for all-cause mortality; residual mitral regurgitation, improvement of NYHA class and heart failure hospitalization were analyzed for patients available.
Results
823 included patients were divided according to LAVi into quintiles (≤42, 43–52, 53–62, 63–78, ≥79). A higher hazard for mortality occurred in the four upper quintiles compared to the lower quintile (HR [95% CI] 1.61 [1.08–2.4], 1.65 [1.11–2.46], 1.52 [1.02–2.26] and 1.35 [0.89–2.05]). The incidence of all-cause mortality per 100 patient-years was 14.6, 23, 23.9, 21.7 and 19.5, respectively. Consequently, a cut-off of 42ml/m2 was adopted, which was associated with a significantly higher hazard for mortality after a mean of 589 days (HR 1.54 [95%-CI 1.1–2.1], p=0.01). Technical success rate (postprocedural MR ≤2+) was higher in large LAVi group (95% vs. 91%, p=0.045). The endpoints of heart failure hospitalization, improvement of NYHA class were not different among groups. Multivariable Cox regression analysis including age, EF<30%, diabetes mellitus and NTproBNP showed LAVi >42ml/m2 to be an independent predictor of mortality.
Conclusion
LA dilatation defined by LAVi>42 ml/m2 was associated with higher mortality hazard in SMR patients undergoing TMVr after multivariable adjustment. Our findings warrant further study on whether timely TMVr intervention in patients with SMR and small LAVi can modify outcome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C Iliadis
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
| | - D Kalbacher
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - P Lurz
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - A Petrescu
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - M Orban
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - N Karam
- Georges Pompidou APHP Site of Paris Ouest University Hospital, Department of Cardiology and Paris Cardiovascular Research Center, Paris, France
| | - E Lubos
- University Heart Center Hamburg, University Heart Center Eppendorf, Hamburg, Department of Cardiology, Hamburg, Germany
| | - H Thiele
- University of Leipzig, Department of Cardiology, Heart Center Leipzig, Leipzig, Germany
| | - S Von Bardeleben
- Johannes Gutenberg University Mainz (JGU), Cardiology Center, Mainz, Germany
| | - J Hausleiter
- Ludwig-Maximilians University, Medical Clinic and Policlinic I, University Clinic Munich, Munich, Germany
| | - R Pfister
- Cologne University Hospital - Heart Center, Department III of Internal Medicine, Heart Center, University of Cologne, Cologne Germany, Cologne, Germany
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16
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Kneuer J, Meinecke T, Weiss R, Gaul S, Haas J, Meder B, Garfias-Veitel T, Von Haehling S, Kogel A, Keller T, Speer T, Thiele H, Lurz P, Laufs U, Boeckel JN. The long non-coding RNA Heat4 is upregulated in heart failure and decreases the immune response of non-classical monocytes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and purpose
Activation of the immune system correlates with the severity and the prognosis of patients with heart failure (HF). This study aims to identify and characterize long non-coding RNAs (lncRNAs) as a potential mechanistic link between the pathophysiology of HF and the activation of the immune system.
Methods and results
Next-generation sequencing (NGS) studies identified a 2.05-fold increase of the lncRNA Heat4 in the blood of patients with HF compared to controls, which was validated in a larger cohort (HF: N=63; Controls: N=38; p<0.05). Interestingly, the lncRNA Heat4 is encoded in the well-known immune receptor locus CD300, together with 8 CD300-receptors which are associated with activation of the immune system. To determine the cellular origin of Heat4 in blood, we performed MACS and identified Heat4 to be enriched in non-classical monocytes compared to classical monocytes (3.37-fold, p<0.05). The expression of Heat4 in non-classical monocytes was further validated by single-cell RNA sequencing. Overexpression of Heat4 in monocytes decreased levels of pro-inflammatory cytokines such as TNFα (38.6% reduction, p<0.05). Conversely, the knockdown of Heat4 resulted in elevated levels of pro-inflammatory cytokines, including IL6 (10.83-fold, p<0.05) and TNFα (4.14-fold, p<0.05). In a larger cohort including patients with HF, Heat4 was able to determine the prevalence of heart failure by AUC=0.734 (p<0.05). Moreover, in a 4-year follow-up of the same cohort, Heat4 predicted mortality by AUC=0.789 (HF: N=63, Dead=32; Controls: N=38, Dead=0; p<0.05).
Conclusion
The long non-coding RNA Heat4 is elevated in the blood of HF patients. Mechanistically, Heat4 limits the extent of the inflammatory response of non-classical monocytes. Therefore, Heat4 may provide a regulatory link between inflammation and HF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Kneuer
- University Hospital Leipzig, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - T Meinecke
- University Hospital Leipzig, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - R Weiss
- University of Leipzig, Institute of Clinical Immunology, Leipzig, Germany
| | - S Gaul
- University Hospital Leipzig, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - J Haas
- University of Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
| | - B Meder
- University of Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
| | - T Garfias-Veitel
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology, Goettingen, Germany
| | - S Von Haehling
- University Medical Center of Gottingen (UMG), Department of Cardiology and Pneumology, Goettingen, Germany
| | - A Kogel
- University Hospital Leipzig, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - T Keller
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - T Speer
- Saarland University Medical Center, Department of Internal Medicine, Nephrology and Hypertension, Homburg/Saar, Germany
| | - H Thiele
- Heart Center at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - P Lurz
- Heart Center at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - U Laufs
- University Hospital Leipzig, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - J.-N Boeckel
- University Hospital Leipzig, Clinic and Polyclinic for Cardiology, Leipzig, Germany
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17
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Kokot K, Kneuer J, John D, Moebius-Winkler M, Mueller M, Andritschke M, Gaul S, Sheikh B, Haas J, Thiele H, Leuschner F, Dimmeler S, Meder B, Laufs U, Boeckel JN. Reduced RNA editing in the failing human heart mediates alternative circular RNA splicing. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and purpose
Post-transcriptional RNA editing is an important mechanism in the development of human diseases. RNA editing can affect RNA stability and alternative splicing. The aim of our study was to characterize RNA editing and its impact on alternative RNA splicing in the healthy and failing human heart.
Methods and results
Human heart samples of heart failure (HF) patients (n=20) and controls (n=10) were analyzed using RNA sequencing with subsequent analysis of RNA editing. We identified adenosine-to-inosine (A-to-I) editing as the major form of RNA editing in human hearts, being reduced in HF patients. Consistently, we found the editing enzyme ADAR2 reduced in HF patients. A-to-I RNA editing predominantly occurred in intronic regions of protein-coding genes, specifically in repetitive, primate-specific Alu elements which can affect RNA splicing. Indeed, we found 173 circular RNAs (circRNAs) regulated by alternative mRNA splicing in the failing heart.
Loss of ADAR2 led to reduced RNA editing concomitant with an increase of circRNA, while overexpression reduced circRNA expression and enhanced RNA editing.
Conclusion
A-to-I editing is the major type of RNA editing in the human heart, being reduced in HF. We demonstrate a primate-specific alternative RNA splicing mechanism mediated by RNA editing in human hearts. The findings may be relevant to diseases with reduced RNA editing such as cancer, neurological and cardiac diseases.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K Kokot
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - J Kneuer
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - D John
- Goethe University Hospital, Institute for Cardiovascular Regeneration, Frankfurt, Germany
| | - M Moebius-Winkler
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - M Mueller
- Herz- und Diabeteszentrum NRW, Ruhr-Universitaet Bochum, Bad Oeynhausen, Germany
| | - M Andritschke
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - S Gaul
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - B Sheikh
- Helmholtz Institute for Metabolic, Obesity and Vascular Research (HI-MAG), Leipzig, Germany
| | - J Haas
- University of Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
| | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
| | - F Leuschner
- University of Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
| | - S Dimmeler
- Goethe University Hospital, Institute for Cardiovascular Regeneration, Frankfurt, Germany
| | - B Meder
- University of Heidelberg, Department of Internal Medicine III, Heidelberg, Germany
| | - U Laufs
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
| | - J N Boeckel
- Leipzig University Hospital, Clinic and Polyclinic for Cardiology, Leipzig, Germany
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18
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Kleeberger JA, Ouarrak T, Freund A, Fuernau G, Geissler T, Huber K, Noc M, Montalescot G, Clemmensen P, Zeymer U, Desch S, Schneider S, Hausleiter J, Thiele H, Orban M. ADP-receptor antagonists in patients with acute myocardial infarction complicated by cardiogenic shock: a pooled IABP-SHOCK II and CULPRIT-SHOCK trial sub-analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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
Purpose
The purpose of this pooled analysis is to compare the clinical outcome of patients with acute myocardial infarction complicated by cardiogenic shock treated with either clopidogrel or the newer, more potent ADP-receptor antagonists prasugrel or ticagrelor. Patients from the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) and Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) trial were included.
Methods and results
For the current analysis, the primary endpoint was 1-year mortality and the secondary safety endpoint was moderate or severe bleedings until hospital discharge with respect to three different ADP-receptor antagonists. Eight hundred fifty-six patients were eligible for analysis. Of these, five hundred seven patients (59.2%) received clopidogrel, one hundred seventy-eight patients (20.8%) prasugrel and one hundred seventy-one patients (20.0%) ticagrelor as acute antiplatelet therapy. The adjusted rate of mortality after 1-year did not differ between prasugrel and clopidogrel (hazard ratio [HR]: 0.81, 95% confidence interval [CI] 0.60–1.09, padj=0.17) or between ticagrelor and clopidogrel treated patients (HR: 0.86, 95% CI 0.65–1.15, padj=0.31). In-hospital bleeding events were significantly less frequent in patients treated with ticagrelor vs. clopidogrel (HR: 0.37, 95% CI 0.20–0.69, padj=0.002) and not different in patients treated with prasugrel vs. clopidogrel (HR: 0.73, 95% CI 0.43–1.24, padj=0.24), see Table 1.
Conclusion
This pooled sub-analysis is the largest analysis on safety and efficacy of three oral ADP-receptor antagonists and shows that an acute therapy with either clopidogrel, prasugrel or ticagrelor is no predictor of 1-year mortality. Treatment with ticagrelor seems to be associated with less in-hospital moderate and severe bleeding events in comparison to clopidogrel.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): German Heart FoundationEuropean Union 7th Framework Program
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Affiliation(s)
| | - T Ouarrak
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - A Freund
- Heart Center at University of Leipzig, Leipzig, Germany
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - T Geissler
- University Hospital of Tuebingen, Tuebingen, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Noc
- University Medical Centre of Ljubljana, Ljubljana, Slovenia
| | - G Montalescot
- Pitié-Salpêtrière APHP University Hospital, Paris, France
| | - P Clemmensen
- University Heart & Vascular Center Hamburg, Hamburg, Germany
| | - U Zeymer
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - S Desch
- Heart Center at University of Leipzig, Leipzig, Germany
| | - S Schneider
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
| | - M Orban
- University Hospital of Munich, Munich, Germany
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19
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Foldyna B, Uhlig J, Mayrhofer T, Natale L, Vliegenthart R, Lotz J, Salgado R, Francone M, Nikolaou K, Bamberg F, Maintz D, Maurovich-Horvat P, Thiele H, Hoffmann U, Gutberlet M. Rising utilization of coronary CT angiography across Europe over the last decade: insights from a large prospective European registry. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
The recently updated 2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes endorse the use of coronary computed tomography angiography (CCTA) for exclusion of obstructive coronary artery disease in patients with a low clinical likelihood (Class I, LOE B). Higher demand for CCTA requires broad availability, inevitably involving smaller healthcare providers, such as non-academic hospitals and private practices. Nevertheless, most published data on CCTA image quality and safety rely on exams performed in high-volume academic centers, and little is known about CCTA in non-academic settings.
Purpose
To investigate the utilization of CCTA across Europe over the last decade, focusing on differences between academic and non-academic centers.
Methods
We included patients with stable chest pain and suspected coronary artery disease (CAD) who received CCTA and were included in the European Society of Cardiovascular Radiology MR/CT registry 01/2010–01/2020. We compared CT equipment, image quality, radiation dose, the incidence of periprocedural adverse events, patient characteristics, and CCTA findings between academic (high volume university hospitals) and non-academic centers (non-academic hospitals and private practices).
Results
Overall, 64,317 patients (41.2% women; age 60±13 years) from 212 sites across 19 European countries were included. Academic centers submitted most cases in 2010—2014 (51.6%), whereas non-academic centers accounted for 71.3% of records in 2015–2020. While non-academic centers used less advanced technology, radiation dose remained low (4.54 [interquartile range (IQR) 2.28–6.76] mSv) with a 30% decline of high-dose scans (>7 mSv) over time. Diagnostic image quality was reported in 97.7% of cases, and the rate of acute scan-related events was low (0.4%) (Figure 1). From 2010–2014 to 2015–2020, CCTA nearly doubled in patients with low to intermediate pretest-probability, women >50, and 40–60 years old men (Figure 2). CAD presence and extent decreased slightly over time (prevalence: 2010–2014: 41.5% vs. 2015–2020: 40.6%), (multi-vessel disease in those with CAD: 2010–2014: 61.9% vs. 2015–2020: 55.9%; all p<0.01).
Conclusion
CCTA expands rapidly to non-academic centers across Europe, increasing availability while maintaining relatively low radiation dose, high diagnostic image quality, and safety. Broad availability of high-quality CCTA is essential for a successfully implementation of the recently updated guidelines for the diagnosis and management of chronic coronary syndromes.
Funding Acknowledgement
Type of funding sources: None. Changes in CCTA utilizationChanges in patient characteristics
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Affiliation(s)
- B Foldyna
- Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, United States of America
| | - J Uhlig
- University Medical Center Goettingen, Department of Diagnostic and Interventional Radiology, Goettingen, Germany
| | - T Mayrhofer
- Stralsund University of Applied Sciences, School of Business Studies, Stralsund, Germany
| | - L Natale
- Catholic University of the Sacred Heart, Radiology, Rome, Italy
| | - R Vliegenthart
- University Medical Center Groningen, Department of Radiology, Groningen, Netherlands (The)
| | - J Lotz
- University Medical Center Goettingen, Department of Diagnostic and Interventional Radiology, Goettingen, Germany
| | - R Salgado
- Antwerp University Hospital, Department of Radiology, Antwerp, Belgium
| | - M Francone
- Humanitas University, Department of Biomedical Sciences, Milan, Italy
| | - K Nikolaou
- University Hospital Tuebingen, Department of Diagnostic and Interventional Radiology, Tuebingen, Germany
| | - F Bamberg
- University of Freiburg, Department of Diagnostic and Interventional Radiology, Freiburg, Germany
| | - D Maintz
- University of Cologne, Department of Diagnostic and Interventional Radiology, Cologne, Germany
| | - P Maurovich-Horvat
- Semmelweis University, MTA-SE Cardiovascular Imaging Research Group, Department of Radiology, Budapest, Hungary
| | - H Thiele
- Heart Center at University of Leipzig, Department of Cardiology, Leipzig, Germany
| | - U Hoffmann
- Massachusetts General Hospital - Harvard Medical School, Department of Radiology, Boston, United States of America
| | - M Gutberlet
- Heart Center at University of Leipzig, Department of Diagnostic and Interventional Radiology, Leipzig, Germany
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20
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Clemmensen P, Schrage BN, Zeymer U, Montalecot G, Windecker S, Serpytis P, Stepinska J, Savonitto S, Desch S, Fuernau G, Huber K, Noc M, Ouarrak T, Blankenberg S, Thiele H. Impact of center-volume on outcomes in myocardial infarction complicated by cardiogenic shock – a CULPRIT-SHOCK sub-study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Little is known about the impact of center-volume on outcomes in acute myocardial infarction complicated by cardiogenic shock (AMI-CS). The aim of this study was to investigate the association between center-volume, treatment strategies and subsequent outcome in patients with AMI-CS.
Methods
In this subanalysis of the randomized CULPRIT-SHOCK trial, study sites were categorized based on the annual volume of AMI-CS into low/intermediate/high volume centers (<50; 50–100;>100 cases/year). Subjects from the study/compulsory registry with available volume data were included. Baseline/procedural characteristics, overall treatment and 1-year all-cause mortality were compared across categories.
Results
N=1032 patients were included in this study (537 treated at low-volume, 240 at intermediate-volume and 255 at high volume centers). Baseline risk profile of patients across the volume categories was similar, although high volume centers included more older patients. Low/intermediate-volume centers had more resuscitated patients (57.5%/58.8% vs. 42.2%; p<0.01), and more patients on mechanical ventilation in comparison to high volume centers. Mechanical circulatory support differed with more use in low/intermediate-volume centers and overall lower use in high-volume centers (30.7%/36.7% vs. 19.2%; p<0.001). There were no differences in reperfusion success despite considerable differences in adjunctive pharmacological/device therapies (figure 1). There was no difference in 1-year all-cause mortality across volume categories (51.1% vs. 56.5% vs. 54.4%; p=0.34).
Conclusion
In this study of patients with AMI-CS, considerable differences in adjunctive medical and mechanical support therapies was observed. However, we could not detect an impact of center volume on reperfusion success or mortality.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): The CULPRIT-SHOCK trial was funded by European Union, Seventh Framework Programme (FP7/2007-2013) Grant agreement n°602202, German Heart Research Foundation Treatment according to center volumeLong-term survival
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Affiliation(s)
- P Clemmensen
- University Heart Center Hamburg, Hamburg, Germany
| | - B N Schrage
- University Heart Center Hamburg, Hamburg, Germany
| | - U Zeymer
- IHF Gmbh - Institut Fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - G Montalecot
- Pitié-Salpêtrière APHP University Hospital, Paris, France
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - J Stepinska
- National Institute of Cardiology, Warsaw, Poland
| | | | - S Desch
- Heart Center at University of Leipzig, Leipzig, Germany
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Noc
- University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - T Ouarrak
- IHF Gmbh - Institut Fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
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21
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Freund A, Poess J, De Waha-Thiele S, Meyer-Saraei R, Fuernau G, Zeymer U, Feistritzer HJ, Rubini M, Oldroyd K, Windecker S, Montalescot G, Schneider S, Baran D, Desch S, Thiele H. Comparison of risk prediction models in infarct-related cardiogenic shock. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several prediction models have been developed to allow accurate risk assessment and provide better treatment guidance in patients with infarct-related cardiogenic shock (CS). However, comparative data between these models are still scarce.
Objectives
To externally validate different risk prediction models in infarct-related CS and compare their predictive value in the early clinical course.
Methods
The Simplified Acute Physiology Score (SAPS)-II Score, the CardShock score, the IABP-SHOCK II score and the Society for Cardiovascular Angiography and Intervention (SCAI) classification were each externally validated in a total of 1055 patients with infarct-related CS enrolled into the randomized CULPRIT-SHOCK trial or the corresponding registry. Discriminative power was assessed by comparing area under the curves (AUC) in case of continuous scores.
Results
In direct comparison of the continuous scores in a total of 161 patients, the IABP-SHOCK II score revealed best discrimination (AUC=0.74), followed by the CardShock score (AUC=0.69) and the SAPS-II score, giving only moderate discrimination (AUC=0.63). All of the three scores revealed acceptable calibration by Hosmer-Lemeshow test. The SCAI classification as a categorical predictive model displayed good prognostic assessment for the highest risk group (stage E), but showed poor discrimination between stages C and D with respect to short-term-mortality.
Conclusion
Based on the present findings, the IABP-SHOCK II score appears to be the most suitable of the examined models for immediate risk prediction in infarct-related CS. Prospective evaluation of the models, further modification or even development of new scores might be necessary to reach higher levels of discrimination.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union, German Centre for Cardiovascular Research Survival probabilities continuous scoresSurvival probabilities SCAI
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Affiliation(s)
- A Freund
- Heart Center at University of Leipzig, Leipzig, Germany
| | - J Poess
- Heart Center at University of Leipzig, Leipzig, Germany
| | | | | | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | | | - M Rubini
- Heart Center at University of Leipzig, Leipzig, Germany
| | - K Oldroyd
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - S Schneider
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - D Baran
- Sentara Cardiovascular Research Institute, Norfolk, United States of America
| | - S Desch
- Heart Center at University of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center at University of Leipzig, Leipzig, Germany
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22
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Rott N, Scholz KH, Busch HJ, Frey N, Kelm M, Thiele H, Böttiger BW. Criteria for the certification of Cardiac Arrest Centers in Germany. Resuscitation 2021; 169:1-3. [PMID: 34627867 DOI: 10.1016/j.resuscitation.2021.09.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- N Rott
- German Resuscitation Council (GRC), Ulm, Germany; Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - K H Scholz
- German Resuscitation Council (GRC), Ulm, Germany; Department of Cardiology and Intensive Care Medicine, St. Bernward Hospital, Treibestr. 9, 31134 Hildesheim, Germany
| | - H J Busch
- German Resuscitation Council (GRC), Ulm, Germany; Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany
| | - N Frey
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), University of Kiel/UKSH, Campus Kiel, Arnold Heller-Str. 6, 24105 Kiel, Germany
| | - M Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmology, Vascular Diseases, Heinrich Heine University Hospital, Moorenstr 5, 40225 Düsseldorf, Germany
| | - H Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Struempellstr. 39, 04289 Leipzig, Germany
| | - B W Böttiger
- German Resuscitation Council (GRC), Ulm, Germany; Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
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23
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Scholz KH, Busch HJ, Frey N, Kelm M, Rott N, Thiele H, Böttiger BW. [Quality indicators and structural requirements for Cardiac Arrest Centers-Update 2021]. Notf Rett Med 2021; 24:826-830. [PMID: 34276249 PMCID: PMC8275904 DOI: 10.1007/s10049-021-00920-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Accepted: 06/18/2021] [Indexed: 11/28/2022]
Abstract
Es handelt sich hierbei um ein Update der im Frühjahr 2017 erstmals beschriebenen Qualitätskriterien und strukturellen Voraussetzungen für Cardiac Arrest Zentren auf Basis der ersten Zertifizierungen und Erfahrungen. Die Kriterien wurden angepasst und konkretisiert und zum Teil zur Umsetzbarkeit im klinischen Alltag neu definiert.
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Affiliation(s)
- K H Scholz
- Medizinische Klinik I, Kardiologie u. Intensivmedizin, St. Bernward-Krankenhaus Hildesheim, Treibestraße 9, 31134 Hildesheim, Deutschland.,Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland
| | - H J Busch
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Zentrum für Notfall- und Rettungsmedizin, Universitäts-Notfallzentrum Freiburg, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - N Frey
- Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik III, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Kelm
- Herz- und Gefäßzentrum, Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - N Rott
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
| | - H Thiele
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - B W Böttiger
- Deutscher Rat für Wiederbelebung (GRC), Ulm, Deutschland.,Klinik für Anästhesiologie und Operative Intensivmedizin, Uniklinik Köln, Köln, Deutschland
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24
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Laqua FC, Polacin M, Luecke C, Klingel K, Alkadhi H, Manka R, Thiele H, Gutberlet M, Lurz P, Baessler B. Value of cardiac magnetic resonance imaging derived spectral myocardial strain pattern for non-invasive diagnosis of myocarditis. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Society of Radiology European Institute for Biomedical Imaging Research
Background
Traditionally, cardiac function is quantified by measures of peak excursion, for example ejection fraction. However, myocardial strain estimation from cine- cardiac MRI allows quantification of cardiac motion over the whole heart cycle. We propose a spectral decomposition of the strain curves applying Discrete Fourier transformation (DFT).
Purpose
To evaluate a potential additive diagnostic value of spectral temporal strain curve quantification for non-invasive diagnosis of myocarditis using cardiac MRI.
Methods
In the single-center prospective study patients with suspected myocarditis underwent comprehensive cardiac MRI followed by biventricular endomyocardial biopsy (EMB) between 2012 and 2014. DFT was applied to myocardial strain curves extracted from cine-Images. As reference model, a L1- and L2-penalized logistic regression model using global native T1 time, T2 time and presence of late-gadolinium enhancement was trained to predict EMB results and compared to two models which additionally include three orders of DFT coefficients and ejection fraction, respectively. Predictive performance was evaluated in a tournament-leave-pair-out cross-validation approach with a bootstrap correction for testing of multiple hyperparameter configurations.
Results
Out of 100 patients (28 % female, median age 40 [IQR 32 to 56) years) with acute symptom-onset (<30 days) 65 had pathologically proven myocarditis in EMB. The DFT model showed best discrimination (Area under the receiver-operating-curve [AUC] 0.72 [95% CI 52 to 87]). Addition of ejection fraction (AUC 0.60 [95% CI: 0.43 to 0.74]) did not increase AUC compared to the reference (AUC 0.60 [95% CI: 0.43 to 0.74]). Posterior distribution of the bootstrap-corrected AUC difference between DFT and reference model was gaussian (mean 12%, standard deviation 12%) with a posterior probability of 86%, that DFT has a greater AUC.
Conclusions
Discrimination of myocarditis from similar clinical presentations remains challenging. The results support incremental discriminatory value of DFT-decomposed myocardial strain for non-invasive diagnosis of myocarditis. Future research should address the value of the spectral decomposition of cardiac motion trajectories in larger samples and different disease entities.
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Affiliation(s)
- FC Laqua
- University Hospital Zurich, Institute of Diagnostical and Interventional Radiology, Zurich, Switzerland
| | - M Polacin
- University Hospital Zurich, Institute of Diagnostical and Interventional Radiology, Zurich, Switzerland
| | - C Luecke
- Heart Center at University of Leipzig, Department of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - K Klingel
- University Hospital of Tuebingen, Department of Molecular Pathology, Tuebingen, Germany
| | - H Alkadhi
- University Hospital Zurich, Institute of Diagnostical and Interventional Radiology, Zurich, Switzerland
| | - R Manka
- University Hospital Zurich, Institute of Diagnostical and Interventional Radiology, Zurich, Switzerland
| | - H Thiele
- Heart Center at University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - M Gutberlet
- Heart Center at University of Leipzig, Department of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - P Lurz
- Heart Center at University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - B Baessler
- University Hospital Zurich, Institute of Diagnostical and Interventional Radiology, Zurich, Switzerland
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25
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Gohmann R, Pawelka K, Seitz P, Majunke N, Desch S, Lauten P, Holzhey D, Noak T, Kiefer P, Krieghoff C, Gottschling S, Lücke C, Wilde J, Ebel S, Borger M, Thiele H, Abdel-Wahab M, Gutberlet M. Combined Coronary CT-angiography And TAVI-planning For Ruling-out Significant Coronary Artery Disease: Added Value Of Machine-Learning Based CT-FFR. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.202] [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: 10/20/2022]
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26
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Hermann J, Brehmer K, Jankowski V, Lellig M, Hohl M, Mahfoud F, Speer T, Schunk SJ, Tschernig T, Thiele H, Jankowski J. Registration of Image Modalities for Analyses of Tissue Samples Using 3D Image Modelling. Proteomics Clin Appl 2021; 15:e2170024. [PMID: 34117729 DOI: 10.1002/prca.202170024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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27
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Lellig M, Brehmer K, Hohl M, Speer T, Schunk S, Thiele H, Jankowski J, Jankowski V, Hermann J. MO435MULTIMODAL IMAGING FOR MOLECULAR TISSUE ANALYSIS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab088.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
MALDI mass spectrometric imaging (MALDI MSI) is a powerful histologic tool for the analysis of biomolecules in tissue samples. MALDI MSI measurements result in a high sensitivity and accuracy of spatial distribution of biomolecules in tissue samples. For more detailed analysis of MALDI MSI data and correlation between the molecular and microscopic levels, a combination of MALDI MSI data and histological staining is essential. By combining MALDI MSI data and histological data, much more information are obtained than by analyzing both methods individually. Therefore, MALDI MSI datasets and histological staining were fused to a 3D model presenting a biomolecule distribution of the whole organ and provides more information than a single tissue section. We have developed, established and validated an algorithm for an automatic registration of MALDI data with different histological image data for cross-process evaluation of multimodal datasets to create 3D models. This multimodal imaging approach simplifies and improves molecular analyses of tissue samples in clinical research and diagnosis.
Method
The datasets for fusion and creation of a 3D model consist of mass spectrometric data, histological and immunohistochemical staining methods. Histological tissue sections of a whole mouse kidney were prepared. For MALDI MSI data, organ sections were analyzed by using a Rapiflex mass-spectrometer.
Results
A mathematical registration was used to achieve a perfect superposition of the individual histological sections of mass spectrometric data. It is feasible to combine mass spectrometric data, histological and immunohistochemical datasets in high numbers and reconstruct the measured mouse kidney. By using different imaging methods, a variety of information about tissue structure as well as tissue changes and protein distributions can be obtained. The fusion of the data also offers a virtual incision of the organ from arbitrary angle and level. The algorithms are adapted to take the data fusion automatically offering a high-throughput approach for clinical diagnostics and the possibility to involved artificial intelligence in its interpretation in research.
Conclusion
A successful fusion of MALDI MSI data and different histological and immunohistochemical staining datasets of a whole organ is performed.
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Affiliation(s)
- Michaela Lellig
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
| | - Kai Brehmer
- Institute of Mathematics and Image Computing, University of Lübeck, Lübeck, Germany
| | - Mathias Hohl
- Clinic for Internal Medicine-Cardiology, Angiology and Internal Intensive Care Medicine, Saarland University, Homburg, Germany
| | - Thimoteus Speer
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg, Germany
| | - Stefan Schunk
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Homburg, Germany
| | - Herbert Thiele
- Institute of Mathematics and Image Computing, University of Lübeck, Lübeck, Germany
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht, The Netherlands
- European Uremic Toxin Work Group (EUTox)
| | - Vera Jankowski
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
- European Uremic Toxin Work Group (EUTox)
| | - Juliane Hermann
- Institute for Molecular Cardiovascular Research (IMCAR), RWTH Aachen University, Aachen, Germany
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28
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Lange T, Stiermaier T, Backhaus SJ, Boom P, Kowallick JT, Lotz J, Kutty S, Bigalke B, Gutberlet M, De Waha-Thiele S, Desch S, Hasenfuss G, Thiele H, Eitel I, Schuster A. Fully automated artificial intelligence-based myocardial scar quantification for diagnostic and prognostic stratification in patients following acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background Myocardial infarct size (IS) remains one of the strongest predictors of adverse cardiac events following acute myocardial infarction (AMI). Late gadolinium enhancement (LGE) cardiac magnetic resonance (CMR) can precisely quantify the extent of injury but requires manual post-processing. Whether novel user-independent artificial intelligence (AI) based fully-automated analyses may facilitate clinical workflow and deliver similar information for risk stratification is unknown.
Methods 913 AMI patients from two multi-center trials (AIDA-STEMI n = 704 with ST-elevation myocardial infarction [STEMI] and TATORT-NSTEMI n = 245 with non-ST-elevation-infarction [NSTEMI]) were included in this sub-study. IS was quantified manually using conventional software (Medis, Leiden Netherlands) and fully automated AI-based software (NeoSoft). All automatically detected IS were evaluated visually and corrected if necessary. Analyzed data were tested for agreement and prediction of major adverse clinical events (MACE) within one year after AMI.
Results Automated and manual IS were similarly associated with outcome in cox regression analyses (HR 1.05 [95% CI 1-02-1.07] p < 0.001 for automated IS and HR 1.04 [95% CI 1.02-1.06]; p < 0.001 for manual IS). Comparison of C-statistics derived area under the curve (AUC) resulted in equivalent MACE prediction (AUC 0.65 for automated vs. AUC 0.66 for manual, p = 0.53). Manual correction of the automated scar detection did not lead to an improved risk prediction of MACE (AUC 0.65 to 0.66, p = 0.43). There was good agreement of automated and manually derived IS (intraclass correlation coefficient [ICC] 0.75 [0.07-0.89]) which was further improved after manual correction of the underlying contours (ICC 0.98 [0.97-0.98]).
Conclusion AI-based software enables automated scar quantification with similar prognostic value compared to conventional methods in patients following AMI.
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Affiliation(s)
- T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Stiermaier
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - SJ Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - P Boom
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - JT Kowallick
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - J Lotz
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Helen B. Taussig Heart Center, Baltimore, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology , Berlin, Germany
| | - M Gutberlet
- University of Leipzig, Institute of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - S De Waha-Thiele
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
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29
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Schuster A, Lange T, Backhaus SJ, Strohmeyer C, Boom P, Matz J, Kowallick JT, Steinmetz M, Kutty S, Bigalke B, Desch S, Hasenfuss G, Thiele H, Stiermaier T, Eitel I. Fully automated cardiac assessment for diagnostic and prognostic stratification following myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiovascular magnetic resonance (CMR) imaging is considered the reference methodology for cardiac morphology and function but requires manual post-processing. Whether novel artificial intelligence (AI) -based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of AI-based analyses.
Methods
CMR data (n = 1017 patients) from two myocardial infarction multi-center trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and AI-based software. Obtained parameters entered regression analyses for prediction of major adverse clinical events (MACE) defined as death, reinfarction or congestive heart failure within one-year after the acute event.
Results
Both manual and uncorrected automated volumetric assessments showed similar impact on outcome on univariate (LVEF HR 0.93, [95% CI 0.91-0.95]; p < 0.001 for manual and HR 0.94 [0.92-0.96]; p < 0.001 for automated) and multivariable analyses (LVEF HR 0.95, [0.92-0.98]; p = 0.001 for manual and HR 0.95 [CI 0.92-0.98]; p = 0.001 for automated). Manual correction of the automated contours did not lead to improved risk prediction (LVEF AUC 0.67 automated vs. 0.68 automated corrected, p = 0.49). There was acceptable agreement (bias: 2.6%, 95% limits of agreement [LOA] -9.1-14.2%, intraclass correlation coefficient [ICC] 0.88 [0.77-0.93] for LVEF) of manual and automated volumetric assessments.
Conclusions
User independent volumetric analyses performed by fully automated software are feasible and results are equally predictive of MACE compared with conventional analyses in patients following myocardial infarction.
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Affiliation(s)
- A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - SJ Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - C Strohmeyer
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - P Boom
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - J Matz
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - JT Kowallick
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - M Steinmetz
- University Medical Center of Gottingen (UMG), Department of Pediatric Cardiology, Goettingen, Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Helen B. Taussig Heart Center, Baltimore, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology, Berlin, Germany
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - T Stiermaier
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - I Eitel
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
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Lange T, Stiermaier T, Backhaus SJ, Boom P, Kowallick JT, De Waha-Thiele S, Lotz J, Kutty S, Bigalke B, Gutberlet M, Desch S, Hasenfuss G, Thiele H, Eitel I, Schuster A. CMR feature tracking remote myocardial strain analyses for optimized risk prediction following acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Cardiac magnetic resonance myocardial feature tracking (CMR-FT) derived global strain assessments provide incremental prognostic information in patients following acute myocardial infarction (AMI). Functional analyses of the remote myocardium (RM) are scarce and whether they provide an additional prognostic value in these patients is unknown.
Methods
1052 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as scar size quantification were performed after reperfusion by primary percutaneous coronary intervention. The occurrence of major adverse cardiac events (MACE) within 12 months after the index event was defined as primary clinical endpoint.
Results
Patients with MACE had significantly lower RM circumferential strain (CS) compared to those without MACE. A cut-off value for RM CS of -25.8% best identified high-risk patients (p < 0.001 on log-rank testing) and impaired RM CS was a strong predictor of MACE (HR 1.05, 95% CI 1.07-1.14, p = 0.003). RM CS provided further risk stratification amongst patients considered at risk according to established CMR parameters for 1.) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35 % (p = 0.002 on log-rank testing), 2.) patients with reduced global circumferential strain (GCS) > -18,3 % (p = 0.015 on log-rank testing), and 3.) patients with large microvascular obstruction ≥ 1.46 % (p = 0.038 on log-rank testing).
Conclusion
CMR-FT derived RM CS is a useful parameter to characterize the response of RM and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients.
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Affiliation(s)
- T Lange
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - T Stiermaier
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - SJ Backhaus
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - P Boom
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - JT Kowallick
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - S De Waha-Thiele
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - J Lotz
- University Medical Center Goettingen (UMG), Department of Diagnostic& Interventional Radiology, German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - S Kutty
- Johns Hopkins University School of Medicine, Helen B. Taussig Heart Center, Baltimore, United States of America
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology , Berlin, Germany
| | - M Gutberlet
- Heart Center of Leipzig, Institute of Diagnostic and Interventional Radiology, Leipzig, Germany
| | - S Desch
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology , Leipzig, Germany
| | - G Hasenfuss
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology , Leipzig, Germany
| | - I Eitel
- University Heart Center, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - A Schuster
- University Medical Center Goettingen (UMG), Department of Cardiology and Pneumology and German Center for Cardiovascular Research (DZHK), Goettingen, Germany
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Mohamed SA, Taube ET, Thiele H, Noack F, Nebrich G, Mohamady K, Hanke T, Klein O. Inside Front Cover: Evaluation of the Aortopathy in the Ascending Aorta: The Novelty of Using Matrix‐Assisted Laser Desorption/Ionization Imaging. Proteomics Clin Appl 2021. [DOI: 10.1002/prca.202170012] [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: 11/10/2022]
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32
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Hermann J, Brehmer K, Jankowski V, Lellig M, Hohl M, Mahfoud F, Speer T, Schunk SJ, Tschernig T, Thiele H, Jankowski J. Front Cover: Registration of Image Modalities for Analyses of Tissue Samples Using 3D Image Modelling. Proteomics Clin Appl 2021. [DOI: 10.1002/prca.202170011] [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: 11/11/2022]
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33
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Mohamed SA, Taube ET, Thiele H, Noack F, Nebrich G, Mohamady K, Hanke T, Klein O. Evaluation of the Aortopathy in the Ascending Aorta: The Novelty of Using Matrix-Assisted Laser Desorption/Ionization Imaging. Proteomics Clin Appl 2020; 15:e2000047. [PMID: 33270371 DOI: 10.1002/prca.202000047] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE Histopathological evaluation presents conflicting reports regarding aortic abnormalities. The authors aim to present proof-of-concept study to explore the feasibility of matrix-assisted laser desorption/ionization imaging mass spectrometry (MALDI-IMS) in combination with histopathology for characterizing alterations in the aneurysmal ascending formalin-fixed paraffin-embedded (FFPE) aorta tissue. EXPERIMENTAL DESIGN The authors assess FFPE specimens from patients with a dilated aorta and bicuspid aortic valve (BAV), those with a standard tricuspid aortic valve (TAV), and those with Marfan syndrome (MFS) via histopathology and grade the conditions for elastic fiber fragmentation (EFF) and MALDI-IMS. The proteins using liquid chromatographic-mass spectrometry are identified and the results are confirmed by immunohistochemistry. RESULTS There is significant difference in terms of EFF between MFS and BAV, and TAV and BAV. Characteristic peptide signatures and m/z values in the EFF facilitate the characterization among the aortic specimens of BAV, MFS, and TAV. The m/z values from the aortic alpha smooth muscle actin and myosin heavy chains significantly increase in BAV compared with MFS and TAV. These findings are confirmed by immunohistochemistry. CONCLUSION The results represent a strategy that uses MALDI-IMS in combination with histopathology as promising approaches to characterize spatial alteration in the structure of the aneurysmal ascending aorta.
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Affiliation(s)
- Salah A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, UKSH-Campus Luebeck, Luebeck, 23538, Germany
| | - Eliane T Taube
- Charité-Universitaetsmedizin, Institute for Pathology, Berlin, 10117, Germany
| | - Herbert Thiele
- Fraunhofer Institute for Digital Medicine MEVIS, Luebeck, 23538, Germany
| | - Frank Noack
- Institute of Pathology Martin-Luther Hospital, Berlin, 14193, Germany
| | - Grit Nebrich
- Berlin Institute of Health Center for Regenerative Therapies & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Charité - Universitätsmedizin Berlin, Berlin, 13353, Germany
| | | | | | - Oliver Klein
- Berlin Institute of Health Center for Regenerative Therapies & Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Charité - Universitätsmedizin Berlin, Berlin, 13353, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Berlin, Berlin, 13353, Germany
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: 10.1177/2048872619883997] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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35
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Claeys MJ, Roubille F, Casella G, Zukermann R, Nikolaou N, De Luca L, Gierlotka M, Iakobishvili Z, Thiele H, Koutouzis M, Sionis A, Monteiro S, Beauloye C, Held C, Tint D, Zakke I, Serpytis P, Babic Z, Belohlavev J, Magdy A, Sivagowry Rasalingam M, Daly K, Arroyo D, Vavlukis M, Radovanovic N, Trendafilova E, Marandi T, Hassenger C, Lettino M, Price S, Bonnefoy E. Organization of intensive cardiac care units in Europe: Results of a multinational survey. European Heart Journal. Acute Cardiovascular Care 2020; 9:993-1001. [DOI: mj claeys, f roubille, g casella, r zukermann, n nikolaou, l de luca, m gierlotka, z iakobishvili, h thiele, m koutouzis, a sionis, s monteiro, c beauloye, c held, d tint, i zakke, p serpytis, z babic, j belohlavev, a magdy, m sivagowry rasalingam, k daly, d arroyo, m vavlukis, n radovanovic, e trendafilova, t marandi, c hassenger, m lettino, s price, e bonnefoy, organization of intensive cardiac care units in europe: results of a multinational survey, european heart journal.acute cardiovascular care, volume 9, issue 8, 1 december 2020, pages 993–1001, https:/doi.org/10.1177/2048872619883997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background:
The present survey aims to describe the intensive cardiac care unit organization and admission policies in Europe.
Methods:
A total of 228 hospitals (61% academic) from 27 countries participated in this survey. In addition to the organizational aspects of the intensive cardiac care units, including classification of the intensive cardiac care unit levels, data on the admission diagnoses were gathered from consecutive patients who were admitted during a two-day period. Admission policies were evaluated by comparing illness severity with the intensive cardiac care unit level. Gross national income was used to differentiate high-income countries (n=13) from middle-income countries (n=14).
Results:
A total of 98% of the hospitals had an intensive cardiac care unit: 70% had a level 1 intensive cardiac care unit, 76% had a level 2 intensive cardiac care unit, 51% had a level 3 intensive cardiac care unit, and 60% of the hospitals had more than one intensive cardiac care unit level. High-income countries tended to have more level 3 intensive cardiac care units than middle-income countries (55% versus 41%, p=0.07). A total of 5159 admissions were scored on illness severity: 63% were low severity, 24% were intermediate severity, and 12% were high severity. Patients with low illness severity were predominantly admitted to level 1 intensive cardiac care units, whereas patients with high illness severity were predominantly admitted to level 2 and 3 intensive cardiac care units. A policy mismatch was observed in 12% of the patients; some patients with high illness severity were admitted to level 1 intensive cardiac care units, which occurred more often in middle-income countries, whereas some patients with low illness severity were admitted to level 3 intensive cardiac care units, which occurred more frequently in high-income countries.
Conclusion:
More than one-third of the admitted patients were considered intermediate or high risk. Although patients with higher illness severity were mostly admitted to high-level intensive cardiac care units, an admission policy mismatch was observed in 12% of the patients; this mismatch was partly related to insufficient logistic intensive cardiac care unit capacity.
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Affiliation(s)
- MJ Claeys
- Department of Cardiology, Antwerp University Hospital, Belgium
| | - F Roubille
- Department of Cardiology, University Hospital of Montpellier, France
| | - G Casella
- Department of Cardiology, Ospedale Maggiore, Italy
| | | | - N Nikolaou
- Department of Cardiology, Konstantopouleio General Hospital, Greece
| | - L De Luca
- Department of Cardiology, S. Giovanni Evangelista Hospital, Italy
| | - M Gierlotka
- Department of Cardiology, University of Opole, Poland
| | | | - H Thiele
- Heart Center Leipzig, University Hospital, Germany
| | | | - A Sionis
- Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain
| | | | - C Beauloye
- Cliniques Universitaires Saint Luc, UCLouvain, Belgium
| | - C Held
- Department of Medical Sciences, Uppsala Clinical Research Center, Sweden
| | - D Tint
- ICCO Clinics, Transilvania University, Romania
| | - I Zakke
- Pauls Stradins Clinical University Hospital, Latvia
| | - P Serpytis
- Faculty of Medicine, Vilnius University, Lithuania
| | - Z Babic
- University Hospital Centre, Sisters of Mercy, Croatia
| | - J Belohlavev
- 2nd Department of Medicine, Charles University, Czech Republic
| | - A Magdy
- National Heart Institution, Egypt
| | | | - K Daly
- University College Hospital, Ireland
| | - D Arroyo
- Hôpital Cantonal Fribourg, Switzerland
| | - M Vavlukis
- PHO University Clinic of Cardiology, Macedonia
| | | | | | - T Marandi
- North Estonia Medical Centre, Estonia
- Department of Cardiology, University of Tartu, Estonia
| | - C Hassenger
- Department of Cardiology, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Denmark
| | - M Lettino
- Division of Cardiology, San Gerardo Hospital, Italy
| | - S Price
- Adult Intensive Care Unit, Royal Brompton Hospital, London
| | - E Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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Hermann J, Brehmer K, Jankowski V, Lellig M, Hohl M, Mahfoud F, Speer T, Schunk SJ, Tschernig T, Thiele H, Jankowski J. Registration of Image Modalities for Analyses of Tissue Samples Using 3D Image Modelling. Proteomics Clin Appl 2020; 15:e1900143. [PMID: 33142355 DOI: 10.1002/prca.201900143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 10/21/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Biopsies are a diagnostic tool for the diagnosis of histopathological, molecular biological, proteomic, and imaging data, to narrow down disease patterns or identify diseases. Matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI) provides an emerging state-of-the-art technique for molecular imaging of biological tissue. The aim of this study is the registration of MALDI MSI data sets and data acquired from different histological stainings to create a 3D model of biopsies and whole organs. EXPERIMENTAL DESIGN The registration of the image modalities is achieved by using a variant of the authors' global, deformable Schatten-q-Norm registration approach. Utilizing a connected-component segmentation for background removal followed by a principal-axis based linear pre-registration, the images are adjusted into a homogeneous alignment. This registration approach is accompanied by the 3D reconstruction of histological and MALDI MSI data. RESULTS With this, a system of automatic registration for cross-process evaluation, as well as for creating 3D models, is developed and established. The registration of MALDI MSI data with different histological image data is evaluated by using the established global image registration system. CONCLUSIONS AND CLINICAL RELEVANCE In conclusion, this multimodal image approach offers the possibility of molecular analyses of tissue specimens in clinical research and diagnosis.
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Affiliation(s)
- Juliane Hermann
- Institute for Molecular Cardiovascular Research IMCAR, University hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Kai Brehmer
- Institute of Mathematics and Image Computing, University of Lübeck, Maria-Goeppert-Straße 3, 23562, Lübeck, Germany
| | - Vera Jankowski
- Institute for Molecular Cardiovascular Research IMCAR, University hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Michaela Lellig
- Institute for Molecular Cardiovascular Research IMCAR, University hospital, Pauwelsstraße 30, 52074, Aachen, Germany
| | - Mathias Hohl
- Clinic for Internal Medicine-Cardiology, Angiology and Internal Intensive Care Medicine, Saarland University, Kirrberger Straße 100, Gebäude 41.1 (IMED), Homburg, Saarland, 66421, Germany
| | - Felix Mahfoud
- Clinic for Internal Medicine-Cardiology, Angiology and Internal Intensive Care Medicine, Saarland University, Kirrberger Straße 100, Gebäude 41.1 (IMED), Homburg, Saarland, 66421, Germany
| | - Timotheus Speer
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Straße 100, Gebäude 40.2, Homburg, Saarland, 66421, Germany
| | - Stefan J Schunk
- Department of Internal Medicine IV, Nephrology and Hypertension, Saarland University Hospital, Kirrberger Straße 100, Gebäude 40.2, Homburg, Saarland, 66421, Germany
| | - Thomas Tschernig
- Cell Biology and Developmental Biology, Institute for Anatomy, Saarland University, Kirrberger Straße 100, Gebäude 61, Homburg, Saarland, 66421, Germany
| | - Herbert Thiele
- Fraunhofer Institute for Digital Medicine MEVIS, Maria-Goeppert-Straße 3, 23562, Lübeck, Germany
| | - Joachim Jankowski
- Institute for Molecular Cardiovascular Research IMCAR, University hospital, Pauwelsstraße 30, 52074, Aachen, Germany.,School for Cardiovascular Diseases, Maastricht University, Minderbroedersberg 4-6, 6211 LK, Maastricht, The Netherlands
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Rubini Gimenez M, Millet E, Alviar C, Van Diepen S, Granger C, Windecker S, Serpytis P, Oldroyd K, Fuernau G, Huber K, Sandri M, De Waha-Thiele S, Zeymer U, Desch S, Thiele H. Outcomes associated with respiratory failure for patients with cardiogenic shock and acute myocardial infarction: a substudy of the culprit-shock trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Respiratory insufficiency with the need for mechanical ventilation (MV) is one of the most common indications for admission to intensive care units. However, little is known about the clinical outcomes of patients with acute myocardial infraction (AMI) complicated by cardiogenic shock (CS) who require mechanical ventilation (MV). The aim of this study was to identify the characteristics, risk factors, and outcomes associated with the provision of MV in this specific high-risk population.
Methods
Patients with CS complicating AMI and multivessel coronary artery disease from the CULPRIT-SHOCK trial were included. We explored clinical outcome within 30 days in patients not requiring MV, those with MV on admission, and those in whom MV was initiated within the first day after admission.
Results
Among 683 randomized patients included in the analysis, 17.4% received no MV, 59.7% were ventilated at admission and 22.8% received MV within or after the first day after admission. Patients requiring MV were younger, more frequently non-smokers, had higher body mass indices, presented more often with clinical signs of impaired organ perfusion including worse renal function, higher burden of coronary artery disease, were more likely to have experienced resuscitation within 24h before admission, had worse left ventricular function, and presented more often with non-ST-segment elevation myocardial infarction. The primary endpoint of all-cause death or need for renal replacement therapy occurred in 21.8% of patients without MV, in 53.3% of patients with MV at admission (adjusted odds ratio [aOR] 6.03, 95% confidence interval (CI) 3.17–11.47, p=0.002, compared to patients without) and 65.4% of patients with MV initiated within the first day after admission (aOR 8.09 95% CI 4.32–15.16, p<0.001, compared to patients without). Factors independently associated with the provision of MV on admission included higher body weight, resuscitation within 24h before admission, elevated heart rate and evidence of triple vessel disease.
Conclusions
Requiring MV in patients with CS complicating AMI is common and independently associated with mortality after adjusting for covariates. Patients with delayed MV initiation appear to be at higher risk of adverse outcomes. Further research is necessary to identify the optimal timing of MV in this high-risk population.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Swiss National Foundation
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Affiliation(s)
| | - E Millet
- Yale University, New Haven, United States of America
| | - C Alviar
- New York Medical College, New York, United States of America
| | | | - C Granger
- Duke University, Durham, United States of America
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - P Serpytis
- University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - K Oldroyd
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - G Fuernau
- University Heart Center, Luebeck, Germany
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - M Sandri
- Heart Center of Leipzig, Leipzig, Germany
| | | | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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Feistritzer H, Desch S, Freund A, Poess J, Zeymer U, Ouarrak T, Schneider S, De Waha-Thiele S, Fuernau G, Eitel I, Noc M, Stepinska J, Huber K, Thiele H. Prognostic impact of active mechanical circulatory support in cardiogenic shock complicating acute myocardial infarction: results from the CULPRIT-SHOCK trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Active mechanical circulatory support (MCS) devices are increasingly used in patients with cardiogenic shock (CS) complicating acute myocardial infarction (AMI). However, data derived from randomized controlled trials on the efficacy and safety of these devices are still limited.
Purpose
To analyze the prognostic impact of active MCS devices in a large prospective contemporary cohort of patients with CS complicating AMI.
Methods
This is a predefined subanalysis of the Culprit Lesion Only PCI versus Multivessel PCI in Cardiogenic Shock (CULPRIT-SHOCK) randomized trial and prospective registry. Patients with CS, AMI and multivessel coronary artery disease were categorized in two groups; (1) use of at least one active MCS device, vs. (2) no active MCS or use of intra-aortic balloon pump (IABP) only. The primary endpoint was a composite of all-cause death or need of renal replacement therapy at 30 days.
Results
Two hundred of 1055 (19%) patients received at least one active MCS device (n=112 Impella®; n=95 extracorporeal membrane oxygenation [ECMO]; n=6 other devices). The primary endpoint occurred significantly more often in patients treated with active MCS devices compared to those without active MCS devices (142 of 197, 72% vs. 374 of 827, 45%; p<0.001). All-cause mortality at 30 days and 1 year as well as bleeding rates were significantly higher in the active MCS group (all p<0.001). After multivariable adjustment the use of active MCS was significantly associated with the primary endpoint (odds ratio [OR] 4.0, 95% confidence interval [CI] 2.7–5.9; p<0.001).
Conclusion
In the CULPRIT-SHOCK randomized trial and prospective registry approximately one fifth of patients was treated with active MCS devices. Compared to patients without active MCS, patients treated with active MCS devices showed worse outcome at 30 days and 1 year.
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Supported by a grant (FP7/2007-2013) from the European Union 7th Framework Program and by the German Heart Research Foundation and the German Cardiac Society.
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Affiliation(s)
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - A Freund
- Heart Center of Leipzig, Leipzig, Germany
| | - J Poess
- Heart Center of Leipzig, Leipzig, Germany
| | - U Zeymer
- Stiftung Institut, Ludwigshafen, Germany
| | - T Ouarrak
- Stiftung Institut, Ludwigshafen, Germany
| | | | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - G Fuernau
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - M Noc
- University Medical Centre Ljubljana, Cardiology, Ljubljana, Slovenia
| | - J Stepinska
- Institute of Cardiology in Warsaw, Warsaw, Poland
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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Stiermaier T, Schaefer P, Saad M, Meyer-Saraei R, De Waha-Thiele S, Fuernau G, Langer H, Barkhausen J, Desch S, Thiele H, Eitel I. Impact of morphine treatment with and without metoclopramide co-administration on myocardial and microvascular injury in acute myocardial infarction: insights from a randomized trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Intravenous morphine administration in patients with acute myocardial infarction (AMI) can adversely affect platelet inhibition induced by P2Y12 receptor antagonists, potentially resulting in an increased risk of adverse clinical events. In contrast, some evidence suggests that opioid agonists may have cardioprotective effects on the myocardium. Currently available data in this regard are, however, sparse, inconsistent, and methodologically limited.
Purpose
The aim of this study was to investigate the impact of morphine with or without metoclopramide (MCP) co-administration on myocardial and microvascular injury after AMI assessed by cardiac magnetic resonance (CMR).
Methods
This prospective, randomized, single-center study assigned 138 patients with AMI in a 1:1:1 ratio to (a) ticagrelor 180 mg plus intravenous morphine 5 mg (morphine group); (b) ticagrelor 180 mg plus intravenous morphine 5 mg and MCP 10 mg (morphine + MCP group); or (c) ticagrelor 180 mg plus intravenous placebo (control group). Study drugs were administered before primary percutaneous coronary intervention. CMR was performed in 101 patients on day 1–4 after the index event to assess infarct size, microvascular obstruction, and left ventricular ejection fraction.
Results
Infarct size was significantly smaller in the morphine only group as compared to controls (15.5%LV [IQR 5.0 to 21.4%LV] vs. 17.9%LV [IQR 12.3 to 32.9%LV]; p=0.047). Furthermore, the number of patients with microvascular obstruction was significantly lower after morphine administration (10/36 [28%] versus 21/39 [54%]; p=0.022) and the extent of microvascular obstruction was smaller (0%LV [0 to 1.40%LV] versus 0.74%LV [0 to 3.10%LV]; p=0.037). In multivariable regression analysis, morphine administration was independently associated with a reduced risk for the occurrence of microvascular obstruction (odds ratio 0.37; 95% confidence interval 0.14 to 0.93; p=0.035). Left ventricular ejection fraction did not differ significantly between the morphine and the control group (p=0.970) and there was no significant difference in left ventricular ejection fraction (p=0.790), infarct size (p=0.491), and extent (p=0.753) or presence (p=0.914) of microvascular obstruction when comparing the morphine + MCP group to the control group.
Conclusions
In this randomized study, intravenous administration of morphine prior to primary percutaneous coronary intervention resulted in a significant reduction of myocardial and microvascular damage following AMI. This potential cardioprotective effect of morphine requires further evaluation in well-designed future trials with clinical endpoints.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Stiermaier
- University Heart Center Luebeck, Luebeck, Germany
| | - P Schaefer
- University Heart Center Luebeck, Luebeck, Germany
| | - M Saad
- University Heart Center Luebeck, Luebeck, Germany
| | | | | | - G Fuernau
- University Heart Center Luebeck, Luebeck, Germany
| | - H Langer
- University Heart Center Luebeck, Luebeck, Germany
| | - J Barkhausen
- University hospital Schleswig-Holstein Campus Lübeck, Luebeck, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- University Heart Center Luebeck, Luebeck, Germany
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Fuernau G, Lehrke M, Jung C, Kahles F, Lebherz C, Eitel I, Thelemann N, Desch S, Werdan K, Zeymer U, Adams V, Marx N, Thiele H. GLP-1 is an independent predictor of long-term mortality in patients with myocardial infarction complicated by cardiogenic shock – a substudy of the IABP-SHOCK II trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The incretin hormone Glucagon-like-peptide 1 (GLP-1) is a major stimulus for glucose dependent insulin secretion and holds cardioprotective efficacy. This has made the GLP-1 system a preferred target for diabetes therapy. Secretion of GLP-1 happens in response to nutritional but also inflammatory stimuli. Consequently, marked elevation of circulating GLP-1 levels were found in critically ill patients featuring marked association to markers of inflammation.
Purpose
Our study sought to investigate GLP-1 levels in patients with cardiogenic shock (CS) complicating myocardial infarction and a possible prognostic correlation to short- and long-term outcome.
Methods
We serially assessed circulating GLP-1 levels in a prospectively planned biomarker substudy in the IABP-SHOCK II trial. Blood samples were drawn during index PCI and at day 2. The blood was centrifuged immediately, and serum was frozen at −87°C. GLP-1 was measured with a standard ELISA-kit. All-cause mortality at short- (30 days), intermediate- (1 year) and long-term (6 years) follow-up was used for outcome assessment.
Results
In this study we found circulating GLP-1 to be markedly elevated in patients with myocardial infarction complicated by CS (n=172) at time of index PCI. Patients with fatal short-term outcome (n=70) exhibited higher GLP-1 levels (86 [45–130] pM) at ICU admission in comparison to patients with 30-day survival (48 [33–78] pM; p<0.001) (n=102). In repeated measures ANOVA the course of GLP-1 levels between baseline and day 2 showed a significant interaction between survivors and non-survivors (p=0.04). By univariate Cox-regression analysis GLP-1 levels >median were predictive of short- (hazard ratio [HR] 2.43; 95% confidence interval [CI] 1.50–3.94; p<0.001), intermediate- (HR 2.46; 95% CI 1.62–3.76; p<0.001) and long-term (HR 2.12; 95% CI 1.44–3.11; p<0.001) outcome. This association remained after multivariable correction (HR 2.01; 95% CI 1.37–3.07; p<0.001). In a landmark analysis we found a significant higher mortality in patients with GLP-1 levels >median from day 30 to 1 year (HR 2.56; 95% CI 1.08–6.09; p=0.03). In contrast, beyond 1 year up to 6 years no difference has been observed anymore (HR 1.02; 95% CI 0.41–2.58; p=0.96).
Conclusions
Elevated plasma levels of GLP-1 are an independent predictor for impaired prognosis in patients with myocardial infarction complicated by CS at short-, intermediate and long-term follow-up. In a landmark analysis this prognostic effect is sustained up to 1 year. The functional relevance of GLP-1 in this context is currently unknown and needs further investigations.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation (DFG), German Heart Research Foundation
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Affiliation(s)
- G Fuernau
- University Heart Center, Luebeck, Germany
| | - M Lehrke
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Jung
- University Hospital Duesseldorf, Duesseldorf, Germany
| | - F Kahles
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - C Lebherz
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - I Eitel
- University Heart Center, Luebeck, Germany
| | | | - S Desch
- University of Leipzig, Heart Center, Leipzig, Germany
| | - K Werdan
- University Clinic Halle (Saale), Halle, Germany
| | - U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - V Adams
- Heart Center - University Hospital Dresden, Dresden, Germany
| | - N Marx
- RWTH University Hospital Aachen, Department of Internal Medicine I, Aachen, Germany
| | - H Thiele
- University of Leipzig, Heart Center, Leipzig, Germany
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Stiermaier T, Backhaus S, Matz J, Koschalka A, Kowallick J, De Waha-Thiele S, Desch S, Hasenfuss G, Thiele H, Eitel I, Schuster A. Frequency and prognostic impact of right ventricular involvement in acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) involvement complicating myocardial infarction (MI) is thought to impact prognosis, but potent RV markers for risk stratification are lacking.
Purpose
To assess the frequency and prognostic implications of concomitant structural and functional RV injury in MI.
Methods
Cardiac magnetic resonance (CMR) was performed in 1235 patients with MI (STEMI: n=795; NSTEMI: n=440) 3 days after reperfusion by primary percutaneous coronary intervention. Central core laboratory-masked analyses included structural (edema representing reversible ischemia, irreversible infarction, microvascular obstruction [MVO]) and functional (ejection fraction, global longitudinal strain [GLS]) RV alterations. The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE).
Results
RV ischemia and infarction were observed in 19.6% and 12.1% of patients, respectively, suggesting complete myocardial salvage in one-third of patients. RV ischemia was associated with a significantly increased risk of MACE (10.1% versus 6.2%; p=0.035), while patients with RV infarction showed only numerically increased event rates (p=0.075). RV MVO was observed in 2.4% and not linked to outcome (p=0.894). Stratification according to median RV GLS (10.2% versus 3.8%; p<0.001) but not RV ejection fraction (p=0.175) resulted in elevated MACE rates. Multivariable analysis including clinical and left ventricular MI characteristics identified RV GLS as an independent predictor of outcome (hazard ratio 1.05, 95% confidence interval 1.00–1.09; p=0.034) in addition to age (p=0.001), Killip class (p=0.020), and left ventricular GLS (p=0.001), while RV ischemia was not independently associated with outcome.
Conclusions
RV GLS is a predictor of post-infarction adverse events over and above established risk factors, while structural RV involvement was not independently associated with outcome.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- T Stiermaier
- University Heart Center Luebeck, Luebeck, Germany
| | - S.J Backhaus
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - J Matz
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - A Koschalka
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - J.T Kowallick
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | | | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - G Hasenfuss
- University Medical Center of Gottingen (UMG), Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- University Heart Center Luebeck, Luebeck, Germany
| | - A Schuster
- University Heart Center Luebeck, Luebeck, Germany
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Feistritzer H, Jobs A, De Waha-Thiele S, Eitel I, Freund A, Abdel-Wahab M, Desch S, Thiele H. Multivessel versus culprit-only PCI in STEMI patients with multivessel disease: meta-analysis of randomized controlled trials. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous randomized controlled trials (RCTs) indicated a benefit of multivessel percutaneous coronary intervention (PCI) compared to culprit vessel-only PCI in ST-elevation myocardial infarction (STEMI) without cardiogenic shock.
Purpose
To perform a pairwise meta-analysis of RCTs, already including the recently published COMPLETE (The Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI) trial, comparing multivessel PCI and culprit vessel-only PCI in STEMI patients without cardiogenic shock.
Methods
We searched MEDLINE, Cochrane Central Register of Controlled Trials, and Embase for randomized controlled trials (RCTs) comparing multivessel PCI with culprit vessel-only PCI in STEMI patients without cardiogenic shock and multivessel coronary artery disease. Only RCTs reporting mortality or myocardial reinfarction after at least 6 months following randomization were included. Hazard ratios (HRs) were pooled using random-effect models.
Results
Nine RCTs were included in the final analysis. In total, 523 (8.3%) of 6,314 patients suffered the combined primary endpoint of death or non-fatal reinfarction. This primary endpoint was significantly reduced with multivessel PCI compared to culprit vessel-only PCI (HR 0.63, 95% confidence interval [CI] 0.43–0.93; p=0.03). This finding was driven by a reduction of non-fatal reinfarction (HR 0.64, 95% CI 0.52–0.79; p=0.001), whereas no significant reduction of all-cause death (HR 0.77, 95% CI 0.44–1.35; p=0.28) or cardiovascular death (HR 0.64, 95% CI 0.37–1.11; p=0.09) was observed.
Conclusion
In STEMI patients without cardiogenic shock multivessel PCI reduced the risk of death or non-fatal reinfarction compared to culprit vessel-only PCI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | - A Jobs
- Heart Center of Leipzig, Leipzig, Germany
| | - S De Waha-Thiele
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - I Eitel
- Medical University, Department of Cardiology, Angiology and Intensive Care Medicine, University Heart Centre Lübeck, Lübeck, Germany
| | - A Freund
- Heart Center of Leipzig, Leipzig, Germany
| | | | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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Zeymer U, Alushi B, Lauten A, Akin I, Desch S, De Waha-Thiele S, Leistner D, Ouarrak T, Schneider S, Thiele H. Impact of pre-hospital resuscitation on short-and long-term mortality in patients with cardiogenic shock and multivessel disease. Results of the CULPRIT trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There are only a few prospective data on the outcome of patients with cardio-pulmonary resuscitation (CPR) admitted with acute myocardial infarction (AMI) complicated by cardiogenic shock and an invasive strategy including primary percutaneous coronary intervention (PCI). Therefore, we evaluated the impact of pre-hospital CPR on outcomes in a large group of patients with AMI complicated by cardiogenic shock.
Methods
We used the data of the prospective CULPRIT-Shock trial and registry and including patients with acute myocardial infarction complicated by cardiogenic shock. The primary endpoint was 30-day mortality or renal replacement therapy.
Results
Between 2013 and 2017, a total of 1055 patients were included in the randomized trial (n=686) and in the registry (n=369), 550 (54%) had CPR, 40 had no information regarding CPR. Baseline characteristics, procedural features and outcomes in the two groups with and without CPR are given in the table.
Conclusion
Patients with pre-hospital CPR represent more than half of the population with AMI complicated by cardiogenic shock. They are younger, have less risk factors and more often LAD as infarct vessel. Despite the younger age and a high success rate of PCI patients with CPR have a high 30-day mortality.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Deutsches Zentrum fuer Herz-Kreislauf-Forschung - DZHK
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Affiliation(s)
- U Zeymer
- Klinikum Ludwigshafen, Heart Center, Ludwigshafen, Germany
| | - B Alushi
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - A Lauten
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - I Akin
- University Medical Centre of Mannheim, Cardiology, Mannheim, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | | | - D Leistner
- Charite - Campus Benjamin Franklin, Cardiology, Berlin, Germany
| | - T Ouarrak
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - S Schneider
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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Wetscherek M, Rutschke W, Frank C, Stehning C, Lurz P, Grothoff M, Thiele H, Gutberlet M, Lücke C. High inter- and intra-observer agreement in mapping sequences compared to classical Lake Louise Criteria assessment of myocarditis by inexperienced observers. Clin Radiol 2020; 75:796.e17-796.e26. [DOI: 10.1016/j.crad.2020.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 05/08/2020] [Indexed: 11/24/2022]
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Affiliation(s)
- H Thiele
- Herzzentrum Leipzig, Universität Leipzig, Leipzig, Deutschland
| | - R Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen am Rhein gGmbH, Bremserstraße 79, 67063, Ludwigshafen, Deutschland.
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Rott N, Scholz KH, Busch HJ, Frey N, Kelm M, Thiele H, Böttiger BW. Cardiac Arrest Center Certification for out-of-hospital cardiac arrest patients successfully established in Germany. Resuscitation 2020; 156:1-3. [PMID: 32860855 PMCID: PMC7448872 DOI: 10.1016/j.resuscitation.2020.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 08/11/2020] [Indexed: 11/25/2022]
Affiliation(s)
- N Rott
- German Resuscitation Council (GRC), Ulm, Germany; Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany
| | - K H Scholz
- German Resuscitation Council (GRC), Ulm, Germany; Department of Cardiology and Intensive Care Medicine, St. Bernward Hospital, Treibestr. 9, 31134 Hildesheim, Germany
| | - H J Busch
- German Resuscitation Council (GRC), Ulm, Germany; Department of Emergency Medicine, Faculty of Medicine, University Hospital of Freiburg, University of Freiburg, Freiburg, Germany
| | - N Frey
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care Medicine), University of Kiel/UKSH, Campus Kiel, Arnold Heller-Str. 6, 24105 Kiel, Germany
| | - M Kelm
- Department of Internal Medicine, Division of Cardiology, Pulmology, Vascular Diseases, Heinrich Heine University Hospital, Moorenstr 5, 40225 Düsseldorf, Germany
| | - H Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology, Strümpellstr. 39, 04289 Leipzig, Germany
| | - B W Böttiger
- German Resuscitation Council (GRC), Ulm, Germany; Department of Anaesthesiology and Intensive Care Medicine, Medical Faculty and University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
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Rott N, Scholz KH, Busch HJ, Frey N, Kelm M, Thiele H, Böttiger BW. 50. Cardiac Arrest Center Audit – Zertifizierung erfolgreich etabliert. Notf Rett Med 2020. [DOI: 10.1007/s10049-020-00761-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hermann J, Brehmer K, Thiele H, Jankowski V, Jankowski J. P0659MULTIMODAL IMAGING OF MALDI MSI DATA. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aims
MALDI mass spectrometric imaging (MALDI MSI) is a powerful histologic tool for the analysis of biomolecules in tissue samples. MALDI MSI measurements results in a high sensitivity and accuracy of spatial distribution of biomolecules in tissue samples The resolution information of MALDI MSI is in the range of 5-10 µm in the spatial distribution and has the ability to identify proteins, peptides, lipids and small biomolecules directly in tissue samples in one analytical step..For a more detailed analysis of MALDI MSI data and a correlation between the molecular and microscopic level, a combination of MALDI MSI data and histological staining is essential. By combining MALDI MSI data and histological data, much more information are obtained than from a single analysis of both methods. Therefore, MALDI MSI data sets and histological staining were fused to a 3D model presenting a biomolecule distribution of the whole organ and provide more information than a single tissue section. We developed, established and validate an algorithm for an automatic registration of MALDI data with different histological image data for the cross-process evaluation of multimodal data sets for creating 3D models. This multimodal image approach simplifies and improves molecular analyses of tissue samples clinical research and diagnosis.
Method
The data sets for the fusion and creating of a 3D model consist of mass spectrometric data as well as histological and Immunohistochemical staining methods. Histological tissue sections of a whole mice kidney were prepared. For MALDI MSI data the organ sections were coated and incubated with a trypsin solution were performed by using a sprayer for MALDI imaging. As matrix, α-cyano-4-hydroxycinnamic acid was used. MALDI MSI was performed using the Rapiflex. For histological staining the hematoxylin-eosin and Gomori staining were chosen. For Immunohistochemical double staining and immunofluorescence, were used for the detection of Collagen type I, smooth muscle actin and the cell nuclei.
Results
By using a mathematical registration, a perfect superposition of the individual histological sections mass spectrometric data was achieved. It is possible to combine mass spectrometric data, histological and Immunohistochemical data sets in a high number and to reconstruct the measured mice kidney. By using different imaging methods, a variety of information about tissue structure as well as tissue changes and protein distribution can be obtained. The fusion of the data also offers a virtual incision of the organ from any angle and level. The algorithms are adapted to take the data fusion automatically offering a high-throughput approach for clinical diagnostics and the possibility to involved artificial intelligence in its interpretation in research.
Conclusion
There is a successful fusion of MALDI MSI data and different histological and Immunohistochemical staining data sets of a whole organ
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Affiliation(s)
- Juliane Hermann
- Institute for molecular cardiovascular research (IMCAR), Germany
| | - Kai Brehmer
- Institute for Mathematics and Computing Imaging, Germany
| | - Herbert Thiele
- Institute for Mathematics and Computing Imaging, Germany
| | - Vera Jankowski
- Institute for molecular cardiovascular research (IMCAR), Germany
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Kowallick JT, Backhaus SJ, Stiermaier T, Lange T, Navarra JL, Koschalka A, Rommel KP, Lotz J, Gutberlet M, Kutty S, Hasenfus G, Thiele H, Eitel I, Schuster A. 564 Cardiac magnetic resonance myocardial feature tracking for optimized risk assessment after acute myocardial infarction in patients with type 2 diabetes. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.294] [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
Objective
Type 2 diabetes mellitus (T2DM) associates with worse cardiovascular outcome following acute myocardial infarction (AMI) as compared to non-diabetic patients. Since the mechanisms behind these observations are not fully understood we aimed to quantify the underlying pathophysiology on ventricular and atrial levels and study their prognostic implications using cardiovascular magnetic resonance (CMR) quantitative feature-tracking (FT) and tissue characterization.
Research Design and Methods:
A total of 1147 consecutive patients with AMI (n = 265 with diabetes; n = 882 without diabetes) undergoing cardiac magnetic resonance (CMR) imaging in median 3 days after AMI were included in this multicenter study. Left ventricular (LV) function and volumetry included LV ejection fraction (LV-EF), global longitudinal (GLS), radial (GRS) and circumferential strain (GCS) as well as left atrial (LA) strain and strain rate parameters of LA reservoir, conduit and booster pump function. LV damage assessment included infarct size (IS), edema and microvascular obstruction (MO). The clinical study endpoint was the rate of major adverse cardiovascular events (MACE) at 12 months.
Results
T2DM patients had impaired LA reservoir (19.8 vs. 21.2%, p < 0.01) and conduit strains 7.6 vs. 9.0%, p < 0.01) but no differences in ventricular function or myocardial damage. They were at higher risk of MACE than non-diabetic patients (10.2% vs. 5.8%, p < 0.01) with the majority of MACE occurring in patients with LVEF ≥ 35%. Whilst LVEF was an independent predictor of adverse events in non-diabetic patients (p = 0.04 on multivariable analysis), LV GLS as well as LA strain emerged as independent predictors of poor prognosis in patients with diabetes (p < 0.02 on multivariable analysis). Considering patients with diabetes and LVEF ≥35% (n = 237), GLS and LA reservoir strain below median were significantly associated with higher 12-month event rates.
Conclusions
In patients with diabetes, LA and LV longitudinal strain permit optimized risk assessment early after reperfused AMI with incremental prognostic value over and above LVEF.
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Affiliation(s)
- J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - T Stiermaier
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - T Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - A Koschalka
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - K P Rommel
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - M Gutberlet
- Heart Center of Leipzig, Department of Radiology, Leipzig, Germany
| | - S Kutty
- Children"s Hospital and Medical Center, Omaha, United States of America
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - A Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
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Schuster A, Backhaus SJ, Navarra JL, Stiermaier T, Rommel KP, Koschalka A, Kowallick JT, Lotz J, Bigalke B, Kutty S, Gutberlet M, Hasenfus G, Thiele H, Eitel I. 565 Impact of right atrial physiology on heart failure and adverse events after myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion needs further evaluation.
Methods
1235 MI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation MI and 440 with non ST-elevation MI). Right atrial (RA) performance was evaluated using cardiac magnetic resonance myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa) and associated strain rates (SR) in a blinded core-laboratory. The primary clinical endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post MI.
Results
RA reservoir (εs p = 0.061, SRs p = 0.049) and conduit functions (εe p = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εa p = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with clinical onset of heart failure and MACE independently of RV systolic function (multi-variable analysis HR 0.95, 95% CI 0.91-0.99, p = 0.006) while RV systolic function was no independent prognosticator (HR 0.98, 95% CI 0.96-1.00, p = 0.055). Furthermore, RA conduit strain identified low- and high-risk groups within patients with relatively preserved and reduced RV and LV systolic functions (p < 0.019 on log rank testing).
Conclusions
Right atrial impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT derived quantification of RA strain.
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Affiliation(s)
- A Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - S J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - T Stiermaier
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
| | - K P Rommel
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - A Koschalka
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - B Bigalke
- Charite - Campus Benjamin Franklin, Department of Cardiology and Pneumology, Berlin, Germany
| | - S Kutty
- Children"s Hospital and Medical Center, Omaha, United States of America
| | - M Gutberlet
- Heart Center of Leipzig, Department of Radiology, Leipzig, Germany
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Luebeck, Germany
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