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Kupczyk PA, Mesropyan N, Isaak A, Endler C, Faron A, Kuetting D, Sprinkart AM, Mädler B, Thomas D, Attenberger UI, Luetkens JA. Quantitative MRI of the liver: Evaluation of extracellular volume fraction and other quantitative parameters in comparison to MR elastography for the assessment of hepatopathy. Magn Reson Imaging 2020; 77:7-13. [PMID: 33309923 DOI: 10.1016/j.mri.2020.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 11/27/2020] [Accepted: 12/06/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Chronic liver diseases pose a major health problem worldwide, while common tests for diagnosis and monitoring of diffuse hepatopathy have considerable limitations. Preliminary data on the quantification of hepatic extracellular volume fraction (ECV) with magnetic resonance imaging (MRI) for non-invasive assessment of liver fibrosis are encouraging, with ECV having the potential to overcome several of these constraints. PURPOSE To clinically evaluate ECV provided by quantitative MRI for assessing the severity of liver disease. MATERIALS AND METHODS In this prospective study, multiparametric liver MRI, including T1 mapping and magnetic resonance elastography (MRE), was performed in subjects with and without hepatopathy between November 2018 and October 2019. T1, T2, T2*, proton density fat fraction and stiffness were extracted from parametric maps by regions of interest and ECV was calculated from T1 relaxometries. Serum markers of liver disease were obtained by clinical database research. For correlation analysis, Spearman rank correlation was used. ROC analysis of serum markers and quantitative MRI data for discrimination of liver cirrhosis was performed with MRE as reference standard. RESULTS 109 participants were enrolled (50.7 ± 16.1 years, 61 men). ECV, T1 and MRE correlated significantly with almost all serum markers of liver disease, with ECV showing the strongest associations (up to r = 0.67 with MELD, p < 0.01). ECV and T1 correlated with MRE (0.75 and 0.73, p < 0.01 each). ECV (AUC 0.89, cutoff 32.2%, sensitivity 85%, specificity 87%) and T1 mapping (AUC 0.85, cutoff 592.5 ms, sensitivity 83%, specificity 75%) featured good performances in detection of liver cirrhosis with only ECV performing significantly superior to model of end stage liver disease (MELD), AST/ALT ratio and international normalized ratio (p < 0.01, respectively). CONCLUSION Quantification of hepatic extracellular volume fraction with MRI is suitable for estimating the severity of liver disease when using MRE as the standard of reference. It represents a promising tool for non-invasive assessment of liver fibrosis and cirrhosis.
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Affiliation(s)
- P A Kupczyk
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany.
| | - N Mesropyan
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - A Isaak
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - C Endler
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - A Faron
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - D Kuetting
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - A M Sprinkart
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - B Mädler
- Philips Healthcare, Hamburg, Germany
| | - D Thomas
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - U I Attenberger
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
| | - J A Luetkens
- University Hospital Bonn, Department of Diagnostic and Interventional Radiology, Quantitative Imaging Lab Bonn (QILaB), Venusberg-Campus 1, 53127 Bonn, Germany
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2
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Duerr GD, Heine A, Hamiko M, Zimmer S, Luetkens JA, Nattermann J, Rieke G, Isaak A, Jehle J, Held SAE, Wasmuth JC, Wittmann M, Strassburg CP, Brossart P, Coburn M, Treede H, Nickenig G, Kurts C, Velten M. Parameters predicting COVID-19-induced myocardial injury and mortality. Life Sci 2020. [PMID: 32918975 DOI: 10.1016/j.lfs.2020.11840] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
UNLABELLED Clinical manifestations of COVID-19 affect many organs, including the heart. Cardiovascular disease is a dominant comorbidity and prognostic factors predicting risk for critical courses are highly needed. Moreover, immunomechanisms underlying COVID-induced myocardial damage are poorly understood. OBJECTIVE To elucidate prognostic markers to identify patients at risk. RESULTS Only patients with pericardial effusion (PE) developed a severe disease course, and those who died could be identified by a high CD8/Treg/monocyte ratio. Ten out of 19 COVID-19 patients presented with PE, 7 (78%) of these had elevated APACHE-II mortality risk-score, requiring mechanical ventilation. At admission, PE patients showed signs of systemic and cardiac inflammation in NMR and impaired cardiac function as detected by transthoracic echocardiography (TTE), whereas parameters of myocardial injury e.g. high sensitive troponin-t (hs-TnT) were not yet increased. During the course of disease, hs-TnT rose in 8 of the PE-patients above 16 ng/l, 7 had to undergo ventilatory therapy and 4 of them died. FACS at admission showed in PE patients elevated frequencies of CD3+CD8+ T cells among all CD3+ T-cells, and lower frequencies of Tregs and CD14+HLA-DR+-monocytes. A high CD8/Treg/monocyte ratio predicted a severe disease course in PE patients, and was associated with high serum levels of antiviral cytokines. By contrast, patients without PE and PE patients with a low CD8/Treg/monocyte ratio neither had to be intubated, nor died. CONCLUSIONS PE predicts cardiac injury in COVID-19 patients. Therefore, TTE should be performed at admission. Immunological parameters for dysfunctional antiviral immunity, such as the CD8/Treg/monocyte ratio used here, supports risk assessment by predicting poor prognosis.
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Affiliation(s)
- G D Duerr
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Heine
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Hamiko
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J A Luetkens
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Nattermann
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Rieke
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Isaak
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Jehle
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S A E Held
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J C Wasmuth
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - P Brossart
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - H Treede
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C Kurts
- Institute for Experimental Immunology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
| | - M Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
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3
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Duerr GD, Heine A, Hamiko M, Zimmer S, Luetkens JA, Nattermann J, Rieke G, Isaak A, Jehle J, Held SAE, Wasmuth JC, Wittmann M, Strassburg CP, Brossart P, Coburn M, Treede H, Nickenig G, Kurts C, Velten M. Parameters predicting COVID-19-induced myocardial injury and mortality. Life Sci 2020; 260:118400. [PMID: 32918975 PMCID: PMC7480277 DOI: 10.1016/j.lfs.2020.118400] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/01/2020] [Accepted: 09/03/2020] [Indexed: 11/02/2022]
Abstract
Clinical manifestations of COVID-19 affect many organs, including the heart. Cardiovascular disease is a dominant comorbidity and prognostic factors predicting risk for critical courses are highly needed. Moreover, immunomechanisms underlying COVID-induced myocardial damage are poorly understood. OBJECTIVE To elucidate prognostic markers to identify patients at risk. RESULTS Only patients with pericardial effusion (PE) developed a severe disease course, and those who died could be identified by a high CD8/Treg/monocyte ratio. Ten out of 19 COVID-19 patients presented with PE, 7 (78%) of these had elevated APACHE-II mortality risk-score, requiring mechanical ventilation. At admission, PE patients showed signs of systemic and cardiac inflammation in NMR and impaired cardiac function as detected by transthoracic echocardiography (TTE), whereas parameters of myocardial injury e.g. high sensitive troponin-t (hs-TnT) were not yet increased. During the course of disease, hs-TnT rose in 8 of the PE-patients above 16 ng/l, 7 had to undergo ventilatory therapy and 4 of them died. FACS at admission showed in PE patients elevated frequencies of CD3+CD8+ T cells among all CD3+ T-cells, and lower frequencies of Tregs and CD14+HLA-DR+-monocytes. A high CD8/Treg/monocyte ratio predicted a severe disease course in PE patients, and was associated with high serum levels of antiviral cytokines. By contrast, patients without PE and PE patients with a low CD8/Treg/monocyte ratio neither had to be intubated, nor died. CONCLUSIONS PE predicts cardiac injury in COVID-19 patients. Therefore, TTE should be performed at admission. Immunological parameters for dysfunctional antiviral immunity, such as the CD8/Treg/monocyte ratio used here, supports risk assessment by predicting poor prognosis.
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Affiliation(s)
- G D Duerr
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Heine
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Hamiko
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S Zimmer
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J A Luetkens
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Nattermann
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Rieke
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - A Isaak
- Department of Radiology, Quantitative Imaging Lab Bonn (QILaB), University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J Jehle
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - S A E Held
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - J C Wasmuth
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Wittmann
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C P Strassburg
- Department of Internal Medicine I, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - P Brossart
- Department of Internal Medicine III for Hematology, Oncology, Rheumatology and Immune-Oncology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - M Coburn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - H Treede
- Department of Cardiovascular Surgery, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - G Nickenig
- Department of Internal Medicine II - Cardiology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany
| | - C Kurts
- Institute for Experimental Immunology, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
| | - M Velten
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany.
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4
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Holzer D, Epro G, McCrum C, Doerner J, Luetkens JA, Scheef L, Kukuk GM, Boecker H, Mierau A, Brüggemann GP, Maganaris CN, Karamanidis K. The role of muscle strength on tendon adaptability in old age. Eur J Appl Physiol 2018; 118:2269-2279. [PMID: 30088133 PMCID: PMC6182320 DOI: 10.1007/s00421-018-3947-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/20/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE The purpose of the study was to determine: (1) the relationship between ankle plantarflexor muscle strength and Achilles tendon (AT) biomechanical properties in older female adults, and (2) whether muscle strength asymmetries between the individually dominant and non-dominant legs in the above subject group were accompanied by inter-limb AT size differences. METHODS The maximal generated AT force, AT stiffness, AT Young's modulus, and AT cross-sectional area (CSA) along its length were determined for both legs in 30 women (65 ± 7 years) using dynamometry, ultrasonography, and magnetic resonance imaging. RESULTS No between-leg differences in triceps surae muscle strength were identified between dominant (2798 ± 566 N) and non-dominant limb (2667 ± 512 N). The AT CSA increased gradually in the proximo-distal direction, with no differences between the legs. There was a significant correlation (P < 0.05) of maximal AT force with AT stiffness (r = 0.500) and Young's modulus (r = 0.414), but only a tendency with the mean AT CSA. However, region-specific analysis revealed a significant relationship between maximal AT force and the proximal part of the AT, indicating that this region is more likely to display morphological adaptations following an increase in muscle strength in older adults. CONCLUSIONS These findings demonstrate that maximal force-generation capabilities play a more important role in the variation of AT stiffness and material properties than in tendon CSA, suggesting that exercise-induced increases in muscle strength in older adults may lead to changes in tendon stiffness foremost due to alterations in material rather than in its size.
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Affiliation(s)
- D Holzer
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - G Epro
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Rd, London, SE1 0AA, UK.
| | - C McCrum
- Department of Nutrition and Movement Sciences, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+, Maastricht, The Netherlands.,Institute of Movement and Sport Gerontology, German Sport University Cologne, Cologne, Germany
| | - J Doerner
- Department of Radiology, University of Bonn, Bonn, Germany
| | - J A Luetkens
- Department of Radiology, University of Bonn, Bonn, Germany
| | - L Scheef
- Department of Radiology, University of Bonn, Bonn, Germany
| | - G M Kukuk
- Department of Radiology, University of Bonn, Bonn, Germany
| | - H Boecker
- Department of Radiology, University of Bonn, Bonn, Germany
| | - A Mierau
- Department of Exercise and Sport Science, LUNEX International University of Health, Exercise and Sports, Differdange, Luxembourg.,Institute of Movement and Neuroscience, German Sport University Cologne, Cologne, Germany
| | - G-P Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany.,Cologne Center for Musculoskeletal Biomechanics, Medical Faculty, University of Cologne, Cologne, Germany
| | - C N Maganaris
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - K Karamanidis
- Sport and Exercise Science Research Centre, School of Applied Sciences, London South Bank University, 103 Borough Rd, London, SE1 0AA, UK
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5
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Eichhorn L, Doerner J, Luetkens JA, Lunkenheimer JM, Dolscheid-Pommerich RC, Erdfelder F, Fimmers R, Nadal J, Stoffel-Wagner B, Schild HH, Hoeft A, Zur B, Naehle CP. Cardiovascular magnetic resonance assessment of acute cardiovascular effects of voluntary apnoea in elite divers. J Cardiovasc Magn Reson 2018; 20:40. [PMID: 29909774 PMCID: PMC6004697 DOI: 10.1186/s12968-018-0455-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 05/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Prolonged breath holding results in hypoxemia and hypercapnia. Compensatory mechanisms help maintain adequate oxygen supply to hypoxia sensitive organs, but burden the cardiovascular system. The aim was to investigate human compensatory mechanisms and their effects on the cardiovascular system with regard to cardiac function and morphology, blood flow redistribution, serum biomarkers of the adrenergic system and myocardial injury markers following prolonged apnoea. METHODS Seventeen elite apnoea divers performed maximal breath-hold during cardiovascular magnetic resonance imaging (CMR). Two breath-hold sessions were performed to assess (1) cardiac function, myocardial tissue properties and (2) blood flow. In between CMR sessions, a head MRI was performed for the assessment of signs of silent brain ischemia. Urine and blood samples were analysed prior to and up to 4 h after the first breath-hold. RESULTS Mean breath-hold time was 297 ± 52 s. Left ventricular (LV) end-systolic, end-diastolic, and stroke volume increased significantly (p < 0.05). Peripheral oxygen saturation, LV ejection fraction, LV fractional shortening, and heart rate decreased significantly (p < 0.05). Blood distribution was diverted to cerebral regions with no significant changes in the descending aorta. Catecholamine levels, high-sensitivity cardiac troponin, and NT-pro-BNP levels increased significantly, but did not reach pathological levels. CONCLUSION Compensatory effects of prolonged apnoea substantially burden the cardiovascular system. CMR tissue characterisation did not reveal acute myocardial injury, indicating that the resulting cardiovascular stress does not exceed compensatory physiological limits in healthy subjects. However, these compensatory mechanisms could overly tax those limits in subjects with pre-existing cardiac disease. For divers interested in competetive apnoea diving, a comprehensive medical exam with a special focus on the cardiovascular system may be warranted. TRIAL REGISTRATION This prospective single-centre study was approved by the institutional ethics committee review board. It was retrospectively registered under ClinicalTrials.gov (Trial registration: NCT02280226 . Registered 29 October 2014).
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Affiliation(s)
- L. Eichhorn
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - J. Doerner
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
| | - J. A. Luetkens
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | | | | | - F. Erdfelder
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - R. Fimmers
- Medical Biometry, Information Technology and Epidemiology, University of Bonn, Bonn, Germany
| | - J. Nadal
- Medical Biometry, Information Technology and Epidemiology, University of Bonn, Bonn, Germany
| | - B. Stoffel-Wagner
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Bonn, Germany
| | - H. H. Schild
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
| | - A. Hoeft
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - B. Zur
- Institute for Medical Biometry, Informatics and Epidemiology (IMBIE), Bonn, Germany
| | - C. P. Naehle
- Department of Radiology, University Hospital of Bonn, Bonn, Germany
- Department of Radiology, University Hospital of Cologne, Cologne, Germany
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6
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Doerner J, Eichhorn L, Luetkens JA, Lunkenheimer JN, Albers J, Nadal J, Schild HH, Naehle CP. Effects of repetitive prolonged breath-hold in elite divers on myocardial fibrosis and cerebral morphology. Eur J Radiol 2018; 103:13-18. [PMID: 29803378 DOI: 10.1016/j.ejrad.2018.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Prolonged apnea by breath-hold (BH) divers leads to hypoxemia and compensatory mechanisms of the cardiovascular system (i.e. increase of total peripheral resistance, increase of systolic blood-pressure, left-ventricular enlargement) to maintain oxygen supply to oxygen sensitive organs such as the brain. All these changes may result in structural myocardial or subclinical brain alterations. Therefore, the aim of this study was to investigate mid-term effects of repetitive prolonged apnea using cardiac magnetic resonance imaging (CMR) and magnetic resonance imaging of the brain. MATERIALS AND METHODS 17 elite BH divers (15 males) were investigated at baseline, from whom 9 (7 males) were investigated again at follow-up one year later. CMR included functional imaging and tissue characterization using T1- and T2-mapping as well as late gadolinium enhancement. Results were compared intra-individually and with 50 age matched controls. RESULTS Mean BH time were 297 ± 52 s (entire cohort) and 315 ± 56 s (sub-cohort) at initial, and 334 ± 104 s at follow-up examination. Apnea resulted in a progressive increase of the left ventricle and impaired function, whichfully resolved after cessation of apnea. At rest, no dilation of the left ventricle was notable (LV-EDV: 106.7 ± 28.8 ml; LV-EDV/BSA: 52.2 ± 12.7 ml/m2). Compared to controls, the apnea group showed significantly lower volumes (LV-EDV: 106.7 ± 28.8 ml vs. 140.9 ± 36.3 ml, p = .008; LV-EDV/BSA: 52.2 ± 12.7 ml/m2 vs. 73.7 ± 12.8 ml/m2). In contrast, LV-EF showed no significant differences between both groups (61.0 ± 7.0% vs. 60.9 ± 3.6%). T1- and T2-mapping revealed no significant differences, neither intra-individually nor in comparison with age matched controls. (T1 pre-contrast: 974.1 ± 12.9 ms vs. 969.4 ± 29.0 ms, p = .2; T1 post-contrast: 368.9 ± 38.5 ms vs. 966.7 ± 40.5 ms, p = .4; ECV: 29.2 ± 1.5% vs. 29.8 ± 1.6%, p = .3; T2. 52 ± 2 ms vs. 52 ± 3 ms; p = .4). Except for one old embolic lesion no structural changes were found in brain imaging. CONCLUSION Although, prolonged apnea leads to impressive adaptions of the cardiovascular system (i.e. dilation of the left ventricle) and hypertension due to peripheral vasoconstriction no mid-term morphological changes could be observed in both, the myocardium and the brain. BH divers are suitable as a model to investigate acute physiological changes of prolonged apnea and hypoxemia, but not as a model for chronic alterations.
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Affiliation(s)
- J Doerner
- Department of Radiology, University Hospital Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Cologne, Germany.
| | - L Eichhorn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - J A Luetkens
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - J N Lunkenheimer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - J Albers
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Bonn, Bonn, Germany
| | - J Nadal
- Medical Biometry, Information Technology and Epidemiology, University of Bonn, Bonn, Germany
| | - H H Schild
- Department of Radiology, University Hospital Bonn, Bonn, Germany
| | - C P Naehle
- Department of Radiology, University Hospital Bonn, Bonn, Germany; Department of Radiology, University Hospital Cologne, Cologne, Germany
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7
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Schmeel FC, Luetkens JA, Kukuk GM. [Not Available]. ROFO-FORTSCHR RONTG 2015; 188:302-3. [PMID: 26713417 DOI: 10.1055/s-0041-108201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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8
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Luetkens JA, Wilhelm K, Düsing R, Woitas RP, Thomas D, Hundt F, Doerner J, Schild HH, Nähle CP. Renal denervation: results of a single-center cohort study. ROFO-FORTSCHR RONTG 2014; 187:36-41. [PMID: 25188311 DOI: 10.1055/s-0034-1385125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the effect of renal denervation on office-based and 24-h ambulatory blood pressure measurements (ABPM) in a highly selective patient population with drug-resistant hypertension. MATERIALS AND METHODS Patients with drug resistant hypertension eligible for renal denervation were included in the study population. Office blood pressure and ABPM were assessed prior to and after renal denervation. To detect procedure related renal or renal artery damage, magnetic resonance imaging (MRI) and angiography (MRA) were performed pre-interventional, one day post-interventional, and one month after renal denervation. RESULTS Mean follow-up time between renal denervation and blood pressure re-assessment was 9.5 ± 3.9 months. Between August 2011 and March 2013, 17 patients prospectively underwent renal denervation. Pre-interventional mean office blood pressure and ABPM were 177.3 ± 20.3/103.8 ± 20.4 mmHg and 155.2 ± 20.5/93.7 ± 14.5 mmHg, respectively. Post-interventional, office blood pressure was significantly reduced to 144.7 ± 14.9/89.5 ± 12.1 (p < 0.05). ABPM values remained unchanged (147.9 ± 20.3/90.3 ± 15.6, p > 0.05). The number of prescribed antihypertensive drugs was unchanged after renal denervation (4.7 ± 2.0 vs. 4.2 ± 1.2, p = 0.18). No renovascular complications were detected in follow-up MRI. CONCLUSION After renal denervation, no significant decrease in ABPM was observed. These results may indicate a limited impact of renal denervation for drug resistant hypertension. KEY POINTS • Renal denervation showed no significant effects on 24-h ambulatory blood pressure measurements. • A significant decrease in office blood pressure measurements may be explained by a potential detection bias. • Renal artery alterations were not observed on follow-up MRI scans.
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Affiliation(s)
- J A Luetkens
- Department of Radiology, University of Bonn, Bonn
| | - K Wilhelm
- Department of Radiology, Johanniter Hospital, Bonn
| | | | - R P Woitas
- Department of Internal Medicine I, University of Bonn, Bonn
| | - D Thomas
- Department of Radiology, University of Bonn, Bonn
| | - F Hundt
- Department of Internal Medicine I, University of Bonn, Bonn
| | - J Doerner
- Department of Radiology, University of Bonn, Bonn
| | - H H Schild
- Department of Radiology, University of Bonn, Bonn
| | - C P Nähle
- Department of Radiology, University of Bonn, Bonn
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Luetkens JA, Dörner J, Thomas D, Dabir D, Gieseke J, Sprinkart AM, Fimmers R, Stehning C, Homsi R, Schwab JO, Schild HH, Nähle CP. Diagnostische Wertigkeit der multiparametrischen kardialen Magnetresonanztomografie inklusive T1 Mapping für die Diagnosestellung einer akuten Myokarditis bei 3 Tesla. ROFO-FORTSCHR RONTG 2014. [DOI: 10.1055/s-0034-1373474] [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: 10/25/2022]
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