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Backhaus SJ, Schulz A, Lange T, Schmidt-Schweda LS, Hellenkamp K, Evertz R, Kowallick JT, Kutty S, Hasenfuß G, Schuster A. Prognostic and diagnostic implications of impaired rest and exercise-stress left atrial compliance in heart failure with preserved ejection fraction: Insights from the HFpEF stress trial. Int J Cardiol 2024; 404:131949. [PMID: 38471649 DOI: 10.1016/j.ijcard.2024.131949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/24/2024] [Accepted: 03/05/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND With emerging therapies, early diagnosis of heart failure with preserved ejection fraction (HFpEF) comes to the fore. Whilst the reference standard of exercise-stress right heart catheterisation is well established, the clinical routine struggles between feasibility of exercise-stress and diagnostic accuracy of available tests. METHODS The HFpEF Stress Trial (DZHK-17) prospectively enrolled 75 patients with exertional dyspnoea and echocardiographic signs of diastolic dysfunction (E/e' > 8) who underwent simultaneous rest and exercise-stress echocardiography and right heart catheterisation (RHC). HFpEF was defined according to pulmonary capillary wedge pressure (HFpEF: PCWP rest: ≥15 mmHg stress: ≥25 mmHg). Patients were classified as non-cardiac dyspnoea (NCD) in the absence of HFpEF and cardiovascular disease. LA compliance was defined as reservoir strain (Es)/(E/e'). Follow-up was conducted after 4 years to evaluate cardiovascular hospitalisation (CVH). RESULTS The final study population included 68 patients (HFpEF n = 34 and NCD n = 34) of which 23 reached the clinical endpoint, 1 patient was lost to follow-up. Patients with HFpEF according to the HFA-PEFF score (≥5 points) had significantly lower LA compliance at rest (p < 0.001) compared to patients with a score ≤ 4. LA compliance at rest outperformed E/e' (AUC 0.78 vs 0.87, p = 0.024) and showed a statistical trend to outperform Es (AUC 0.79 vs 0.87, p = 0.090) for the diagnosis of HFpEF. LA compliance at rest predicted CVH (HR 2.83, 95% CI 1.70-4.74, p < 0.001) irrespective of concomitant atrial fibrillation. CONCLUSIONS LA compliance at rest can be obtained from clinical routine imaging and bears strong diagnostic and prognostic accuracy. Addition of LA compliance can improve the role of echocardiography as the primary test and gatekeeper.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - Alexander Schulz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Lennart S Schmidt-Schweda
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
| | - Kristian Hellenkamp
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany; University Medical Center Göttingen (UMG), Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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Schulz A, Mittelmeier H, Wagenhofer L, Backhaus SJ, Lange T, Evertz R, Kutty S, Kowallick JT, Hasenfuß G, Schuster A. Assessment of the cardiac output at rest and during exercise stress using real-time cardiovascular magnetic resonance imaging in HFpEF-patients. Int J Cardiovasc Imaging 2024; 40:853-862. [PMID: 38236362 PMCID: PMC11052864 DOI: 10.1007/s10554-024-03054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
This methodological study aimed to validate the cardiac output (CO) measured by exercise-stress real-time phase-contrast cardiovascular magnetic resonance imaging (CMR) in patients with heart failure and preserved ejection fraction (HFpEF). 68 patients with dyspnea on exertion (NYHA ≥ II) and echocardiographic signs of diastolic dysfunction underwent rest and exercise stress right heart catheterization (RHC) and CMR within 24 h. Patients were diagnosed as overt HFpEF (pulmonary capillary wedge pressure (PCWP) ≥ 15mmHg at rest), masked HFpEF (PCWP ≥ 25mmHg during exercise stress but < 15mmHg at rest) and non-cardiac dyspnea. CO was calculated using RHC as the reference standard, and in CMR by the volumetric stroke volume, conventional phase-contrast and rest and stress real-time phase-contrast imaging. At rest, the CMR based CO showed good agreement with RHC with an ICC of 0.772 for conventional phase-contrast, and 0.872 for real-time phase-contrast measurements. During exercise stress, the agreement of real-time CMR and RHC was good with an ICC of 0.805. Real-time measurements underestimated the CO at rest (Bias:0.71 L/min) and during exercise stress (Bias:1.4 L/min). Patients with overt HFpEF had a significantly lower cardiac index compared to patients with masked HFpEF and with non-cardiac dyspnea during exercise stress, but not at rest. Real-time phase-contrast CO can be assessed with good agreement with the invasive reference standard at rest and during exercise stress. While moderate underestimation of the CO needs to be considered with non-invasive testing, the CO using real-time CMR provides useful clinical information and could help to avoid unnecessary invasive procedures in HFpEF patients.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Hannah Mittelmeier
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Lukas Wagenhofer
- Institute of Biomedical Imaging, University of Technology Graz, Graz, Austria
| | - Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, MD, 21287, USA
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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Backhaus SJ, Schulz A, Lange T, Evertz R, Kowallick JT, Hasenfuß G, Schuster A. Rest and exercise-stress estimated pulmonary capillary wedge pressure using real-time free-breathing cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 2024; 26:101032. [PMID: 38431079 PMCID: PMC10950869 DOI: 10.1016/j.jocmr.2024.101032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND Identification of increased pulmonary capillary wedge pressure (PCWP) by right heart catheterization (RHC) is the reference standard for the diagnosis of heart failure with preserved ejection fraction (HFpEF). Recently, cardiovascular magnetic resonance (CMR) imaging estimation of PCWP at rest was introduced as a non-invasive alternative. Since many patients are only identified during physiological exercise-stress, we hypothesized that novel exercise-stress CMR-derived PCWP emerges superior compared to its assessment at rest. METHODS The HFpEF-Stress Trial prospectively recruited 75 patients with exertional dyspnea and diastolic dysfunction who then underwent rest and exercise-stress RHC and CMR. HFpEF was defined according to PCWP (overt HFpEF ≥15 mmHg at rest, masked HFpEF ≥25 mmHg during exercise-stress). CMR-derived PCWP was calculated based on previously published formula using left ventricular mass and either biplane left atrial volume (LAV) or monoplane left atrial area (LAA). RESULTS LAV (rest/stress: r = 0.50/r = 0.55, p < 0.001) and LAA PCWP (rest/stress: r = 0.50/r = 0.48, p < 0.001) correlated significantly with RHC-derived PCWP while numerically overestimating PCWP at rest and underestimating PCWP during exercise-stress. LAV and LAA PCWP showed good diagnostic accuracy to detect HFpEF (area under the receiver operating characteristic curve (AUC) LAV rest 0.73, stress 0.81; LAA rest 0.72, stress 0.77) with incremental diagnostic value for the detection of masked HFpEF using exercise-stress (AUC LAV rest 0.54 vs stress 0.67, p = 0.019, LAA rest 0.52 vs stress 0.66, p = 0.012). LAV but not LAA PCWP during exercise-stress was a predictor for 24 months hospitalization independent of a medical history for atrial fibrillation (hazard ratio (HR) 1.26, 95% confidence interval 1.02-1.55, p = 0.032). CONCLUSION Non-invasive PCWP correlates well with the invasive reference at rest and during exercise stress. There is overall good diagnostic accuracy for HFpEF assessment using CMR-derived estimated PCWP despite deviations in absolute agreement. Non-invasive exercise derived PCWP may particularly facilitate detection of masked HFpEF in the future.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology, Campus Kerckhoff of the Justus-Liebig-University Giessen, Kerckhoff-Clinic, Bad Nauheim, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Bad Nauheim, Germany.
| | - Alexander Schulz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Ruben Evertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany; University Medical Center Göttingen (UMG), Institute for Diagnostic and Interventional Radiology, Göttingen, Germany.
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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Schulz A, Beuthner BE, Böttiger ZM, Gersch SS, Lange T, Gronwald J, Evertz R, Backhaus SJ, Kowallick JT, Hasenfuß G, Schuster A. Epicardial adipose tissue as an independent predictor of long-term outcome in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement. Clin Res Cardiol 2024:10.1007/s00392-024-02387-5. [PMID: 38324040 DOI: 10.1007/s00392-024-02387-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Accurate risk stratification is important to improve patient selection and outcome of patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). As epicardial adipose tissue (EAT) is discussed to be involved in cardiovascular disease, it could be useful as a marker of poor prognosis in patients with severe AS undergoing TAVR. METHODS A total of 416 patients diagnosed with severe AS by transthoracic echocardiography were assigned for TAVR and enrolled for systematic assessment. Patients underwent clinical surveys and 5-year long-term follow-up, with all-cause mortality as the primary endpoint. EAT volume was quantified on pre-TAVR planning CTs. Patients were retrospectively dichotomized at the median of 74 cm3 of EAT into groups with low EAT and high EAT volumes. Mortality rates were compared using Kaplan-Meyer plots and uni- and multivariable cox regression analyses. RESULTS A total number of 341 of 416 patients (median age 80.9 years, 45% female) were included in the final analysis. Patients with high EAT volumes had similar short-term outcome (p = 0.794) but significantly worse long-term prognosis (p = 0.023) compared to patients with low EAT volumes. Increased EAT volumes were associated with worse long-term outcome (HR1.59; p = 0.031) independently from concomitant cardiovascular risk factors, general type of AS, and functional echocardiography parameters of AS severity (HR1.69; p = 0.013). CONCLUSION Increased EAT volume is an independent predictor of all-cause mortality in patients with severe AS undergoing TAVR. It can be easily obtained from pre-TAVR planning CTs and may thus qualify as a novel marker to improve prognostication and management of patient with severe AS. TRIAL REGISTRATION DRKS, DRKS00024479.
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Affiliation(s)
- Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Bo E Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Zoé M Böttiger
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Svante S Gersch
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Judith Gronwald
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
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Schmidt-Rimpler J, Backhaus SJ, Hartmann FP, Schaten P, Lange T, Evertz R, Schulz A, Kowallick JT, Lapinskas T, Hasenfuß G, Kelle S, Schuster A. Impact of temporal and spatial resolution on atrial feature tracking cardiovascular magnetic resonance imaging. Int J Cardiol 2024; 396:131563. [PMID: 37926379 DOI: 10.1016/j.ijcard.2023.131563] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/27/2023] [Accepted: 10/27/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Myocardial deformation assessment by cardiovascular magnetic resonance-feature tracking (CMR-FT) has incremental prognostic value over volumetric analyses. Recently, atrial functional analyses have come to the fore. However, to date recommendations for optimal resolution parameters for accurate atrial functional analyses are still lacking. METHODS CMR-FT was performed in 12 healthy volunteers and 9 ischemic heart failure (HF) patients. Cine sequences were acquired using different temporal (20, 30, 40 and 50 frames/cardiac cycle) and spatial resolution parameters (high 1.5 × 1.5 mm in plane and 5 mm slice thickness, standard 1.8 × 1.8 × 8 mm and low 3.0 × 3.0 × 10 mm). Inter- and intra-observer reproducibility were calculated. RESULTS Increasing temporal resolution is associated with higher absolute strain and strain rate (SR) values. Significant changes in strain assessment for left atrial (LA) total strain occurred between 20 and 30 frames/cycle amounting to 2,5-4,4% in absolute changes depending on spatial resolution settings. From 30 frames/cycle onward, absolute strain values remained unchanged. Significant changes of LA strain rate assessment were observed up to the highest temporal resolution of 50 frames/cycle. Effects of spatial resolution on strain assessment were smaller. For LA total strain a general trend emerged for a mild decrease in strain values obtained comparing the lowest to the highest spatial resolution at temporal resolutions of 20, 40 and 50 frames/cycle (p = 0.006-0.046) but not at 30 frames/cycle (p = 0.140). CONCLUSION Temporal and to a smaller extent spatial resolution affect atrial functional assessment. Consistent strain assessment requires a standard spatial resolution and a temporal resolution of 30 frames/cycle, whilst SR assessment requires even higher settings of at least 50 frames/cycle.
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Affiliation(s)
- Jonas Schmidt-Rimpler
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Finn P Hartmann
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
| | - Philip Schaten
- Graz University of Technology, Institute of Biomedical Imaging, Graz, Austria
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Alexander Schulz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany; Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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Lange T, Backhaus SJ, Schulz A, Evertz R, Schneider P, Kowallick JT, Hasenfuß G, Kelle S, Schuster A. Inter-study reproducibility of cardiovascular magnetic resonance-derived hemodynamic force assessments. Sci Rep 2024; 14:634. [PMID: 38182625 PMCID: PMC10770352 DOI: 10.1038/s41598-023-50405-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Cardiovascular magnetic resonance (CMR)-derived hemodynamic force (HDF) analyses have been introduced recently enabling more in-depth cardiac function evaluation. Inter-study reproducibility is important for a widespread clinical use but has not been quantified for this novel CMR post-processing tool yet. Serial CMR imaging was performed in 11 healthy participants in a median interval of 63 days (range 49-87). HDF assessment included left ventricular (LV) longitudinal, systolic peak and impulse, systolic/diastolic transition, diastolic deceleration as well as atrial thrust acceleration forces. Inter-study reproducibility and study sample sizes required to demonstrate 10%, 15% or 20% relative changes of HDF measurements were calculated. In addition, intra- and inter-observer analyses were performed. Intra- and inter-observer reproducibility was excellent for all HDF parameters according to intraclass correlation coefficient (ICC) values (> 0.80 for all). Inter-study reproducibility of all HDF parameters was excellent (ICC ≥ 0.80 for all) with systolic parameters showing lower coeffients of variation (CoV) than diastolic measurements (CoV 15.2% for systolic impulse vs. CoV 30.9% for atrial thrust). Calculated sample sizes to detect relative changes ranged from n = 12 for the detection of a 20% relative change in systolic impulse to n = 200 for the detection of 10% relative change in atrial thrust. Overall inter-study reproducibility of CMR-derived HDF assessments was sufficient with systolic HDF measurements showing lower inter-study variation than diastolic HDF analyses.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Patrick Schneider
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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Lange T, Gertz RJ, Schulz A, Backhaus SJ, Evertz R, Kowallick JT, Hasenfuß G, Desch S, Thiele H, Stiermaier T, Eitel I, Schuster A. Impact of myocardial deformation on risk prediction in patients following acute myocardial infarction. Front Cardiovasc Med 2023; 10:1199936. [PMID: 37636296 PMCID: PMC10449121 DOI: 10.3389/fcvm.2023.1199936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Strain analyses derived from cardiovascular magnetic resonance-feature tracking (CMR-FT) provide incremental prognostic benefit in patients sufferring from acute myocardial infarction (AMI). This study aims to evaluate and revalidate previously reported prognostic implications of comprehensive strain analyses in a large independent cohort of patients with ST-elevation myocardial infarction (STEMI). Methods Overall, 566 STEMI patients enrolled in the CONDITIONING-LIPSIA trial including pre- and/or postconditioning treatment in addition to conventional percutaneous coronary intervention underwent CMR imaging in median 3 days after primary percutaneous coronary intervention. CMR-based left atrial (LA) reservoir (Es), conduit (Ee), and boosterpump (Ea) strain analyses, as well as left ventricular (LV) global longitudinal strain (GLS), circumferential strain (GCS), and radial strain (GRS) analyses were carried out. Previously identified cutoff values were revalidated for risk stratification. Major adverse cardiac events (MACE) comprising death, reinfarction, and new congestive heart failure were assessed within 12 months after the occurrence of the index event. Results Both atrial and ventricular strain values were significantly reduced in patients with MACE (p < 0.01 for all). Predetermined LA and LV strain cutoffs enabled accurate risk assessment. All LA and LV strain values were associated with MACE on univariable regression modeling (p < 0.001 for all), with LA Es emerging as an independent predictor of MACE on multivariable regression modeling (HR 0.92, p = 0.033). Furthermore, LA Es provided an incremental prognostic value above LVEF (a c-index increase from 0.7 to 0.74, p = 0.03). Conclusion External validation of CMR-FT-derived LA and LV strain evaluations confirmed the prognostic value of cardiac deformation assessment in STEMI patients. In the present study, LA strain parameters especially enabled further risk stratification and prognostic assessment over and above clinically established risk parameters. Clinical Trial Registration ClinicalTrials.gov, identifier NCT02158468.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Roman J. Gertz
- Institute for Diagnostic and Interventional Radiology,Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Science, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Göttingen, Germany
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Evertz R, Hub S, Beuthner BE, Backhaus SJ, Lange T, Schulz A, Toischer K, Seidler T, von Haehling S, Puls M, Kowallick JT, Zeisberg EM, Hasenfuß G, Schuster A. Aortic valve calcification and myocardial fibrosis determine outcome following transcatheter aortic valve replacement. ESC Heart Fail 2023. [PMID: 37060191 PMCID: PMC10375183 DOI: 10.1002/ehf2.14307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 12/03/2022] [Accepted: 01/04/2023] [Indexed: 04/16/2023] Open
Abstract
AIMS There is evidence to suggest that the subtype of aortic stenosis (AS), the degree of myocardial fibrosis (MF), and level of aortic valve calcification (AVC) are associated with adverse cardiac outcome in AS. Because little is known about their respective contribution, we sought to investigate their relative importance and interplay as well as their association with adverse cardiac events following transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS One hundred consecutive patients with severe AS and indication for TAVR were prospectively enrolled between January 2017 and October 2018. Patients underwent transthoracic echocardiography, multidetector computed tomography, and left ventricular endomyocardial biopsies at the time of TAVR. The final study cohort consisted of 92 patients with a completed study protocol, 39 (42.4%) of whom showed a normal ejection fraction (EF) high-gradient (NEFHG) AS, 13 (14.1%) a low EF high-gradient (LEFHG) AS, 25 (27.2%) a low EF low-gradient (LEFLG) AS, and 15 (16.3%) a paradoxical low-flow, low-gradient (PLFLG) AS. The high-gradient phenotypes (NEFHG and LEFHG) showed the largest amount of AVC (807 ± 421 and 813 ± 281 mm3 , respectively) as compared with the low-gradient phenotypes (LEFLG and PLFLG; 503 ± 326 and 555 ± 594 mm3 , respectively, P < 0.05). Conversely, MF was most prevalent in low-output phenotypes (LEFLG > LEFHG > PLFLG > NEFHG, P < 0.05). This was paralleled by a greater cardiovascular (CV) mortality within 600 days after TAVR (LEFLG 28% > PLFLG 26.7% > LEFHG 15.4% > NEFHG 2.5%; P = 0.023). In patients with a high MF burden, a higher AVC was associated with a lower mortality following TAVR (P = 0.045, hazard ratio 0.261, 95% confidence interval 0.07-0.97). CONCLUSIONS MF is associated with adverse CV outcome following TAVR, which is most prevalent in low EF situations. In the presence of large MF burden, patients with large AVC have better outcome following TAVR. Conversely, worse outcome in large MF and relatively little AVC may be explained by a relative prominence of an underlying cardiomyopathy. The better survival rates in large AVC patients following TAVR indicate TAVR induced relief of severe AS-associated pressure overload with subsequently improved outcome.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Sebastian Hub
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Karl Toischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Johannes T Kowallick
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
| | - Elisabeth M Zeisberg
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Georg August University of Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Germany
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Lange T, Backhaus SJ, Schulz A, Evertz R, Kowallick JT, Bigalke B, Hasenfuß G, Thiele H, Stiermaier T, Eitel I, Schuster A. Cardiovascular magnetic resonance-derived left atrioventricular coupling index and major adverse cardiac events in patients following acute myocardial infarction. J Cardiovasc Magn Reson 2023; 25:24. [PMID: 37046343 PMCID: PMC10099819 DOI: 10.1186/s12968-023-00929-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/23/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Recently, a novel left atrioventricular coupling index (LACI) has been introduced providing prognostic value to predict cardiovascular events beyond common risk factors in patients without cardiovascular disease. Since data on cardiovascular magnetic resonance (CMR)-derived LACI in patients following acute myocardial infarction (AMI) are scarce, we aimed to assess the diagnostic and prognostic implications of LACI in a large AMI patient cohort. METHODS In total, 1046 patients following AMI were included. After primary percutaneous coronary intervention CMR imaging and subsequent functional analyses were performed. LACI was defined by the ratio of the left atrial end-diastolic volume divided by the left ventricular (LV) end-diastolic volume. Major adverse cardiac events (MACE) including death, reinfarction or heart failure within 12 months after the index event were defined as primary clinical endpoint. RESULTS LACI was significantly higher in patients with MACE compared to those without MACE (p < 0.001). Youden Index identified an optimal LACI cut-off at 34.7% to classify patients at high-risk (p < 0.001 on log-rank testing). Greater LACI was associated with MACE on univariate regression modeling (HR 8.1, 95% CI 3.4-14.9, p < 0.001) and after adjusting for baseline confounders and LV ejection fraction (LVEF) on multivariate regression analyses (HR 3.1 95% CI 1.0-9, p = 0.049). Furthermore, LACI assessment enabled further risk stratification in high-risk patients with impaired LV systolic function (LVEF ≤ 35%; p < 0.001 on log-rank testing). CONCLUSION Atrial-ventricular interaction using CMR-derived LACI is a superior measure of outcome beyond LVEF especially in high-risk patients following AMI. Trial registration ClinicalTrials.gov, NCT00712101 and NCT01612312.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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10
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Schuster A, Schulz A, Lange T, Evertz R, Hartmann F, Kowallick JT, Hellenkamp K, Uecker M, Seidler T, Hasenfuß G, Backhaus SJ. Concomitant latent pulmonary vascular disease leads to impaired global cardiac performance in heart failure with preserved ejection fraction. Eur J Heart Fail 2023; 25:322-331. [PMID: 36691723 DOI: 10.1002/ejhf.2781] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/05/2023] [Accepted: 01/15/2023] [Indexed: 01/25/2023] Open
Abstract
AIMS The REDUCE-LAP II trial demonstrated adverse outcomes after interatrial shunt device (IASD) placement in heart failure with preserved ejection fraction (HFpEF) attributed to latent pulmonary vascular disease (PVD). We hypothesized that exercise stress cardiovascular magnetic resonance (CMR) imaging could provide non-invasive characterization of cardiac and pulmonary physiology for improved patient selection. METHODS AND RESULTS The HFpEF-Stress trial prospectively enrolled 75 patients with exertional dyspnoea and diastolic dysfunction. Patients underwent rest and exercise stress right heart catheterization, echocardiography and CMR imaging. Pulmonary artery and capillary wedge pressures, cardiac index (CI) and pulmonary vascular resistance (PVR) were calculated. Latent PVD was defined as increased PVR ≥ 1.74 Wood units during exercise stress. CMR assessed long-axis strains (LAS) and filling volumes of all cardiac chambers. Right ventricular (RV) function was further quantified by stroke and peak flow volumes. Patients with latent PVD (n = 24) showed lower RV function (rest tricuspid annular plane systolic excursion, p = 0.010; stress RV LAS, p < 0.001) compared to patients without (n = 43). During exercise stress, RV stroke and peak flow volumes (p < 0.001) were reduced and led to impaired left atrial filling (p = 0.040) with a strong statistical trend to impaired ventricular (LV) filling (p = 0.098). This subsequently resulted in reduced LV-CI (p < 0.001) despite preserved LV systolic function (LV LAS p ≥ 0.255). The degree of RV dysfunction during exercise stress best predicted latent PVD (RV peak flow, area under the curve at rest 0.73 vs. stress 0.89, p = 0.004). CONCLUSIONS Latent PVD is a feature of HFpEF and is associated with impaired RV functional reserve, global diastolic filling and LV-CI. This can be quantified by CMR and used to identify patients likely to benefit from IASD implantation.
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Affiliation(s)
- Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Finn Hartmann
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,University Medical Center Göttingen (UMG), Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - Kristian Hellenkamp
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Martin Uecker
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,University Medical Center Göttingen (UMG), Institute for Diagnostic and Interventional Radiology, Göttingen, Germany.,Institute of Biomedical Imaging, Graz University of Technology, Graz, Austria
| | - Tim Seidler
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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Kowallick JT, Scholz M, Schuster A, Lotz J. [MINOCA-myocardial infarction with nonobstructive coronary arteries]. Radiologie (Heidelb) 2022; 62:912-919. [PMID: 36227368 DOI: 10.1007/s00117-022-01079-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) accounts for 5-10% of all presentations of acute myocardial infarction. OBJECTIVES To outline the role of cardiovascular magnetic resonance (CMR) in patients with suspected MINOCA. MATERIALS AND METHODS Current guidelines for the use of CMR in suspected MINOCA are summarized. Clinical cases with typical CMR findings are presented. RESULTS In 2019, the American Heart Association published a revised definition of the term MINOCA, which was recently adopted in the European Society of Cardiology 2020 guidelines on acute coronary syndromes without persistent ST-segment elevation (NSTE-ACS). The guidelines indicate that a CMR is recommended (class 1B) in all MINOCA cases with no obvious cause. CONCLUSION The major strength of CMR imaging is to differentiate nonischemic from ischemic etiologies of myocardial injury. This makes CMR the most important noninvasive diagnostic tool for the differential diagnosis of patients with suspected MINOCA.
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Affiliation(s)
- Johannes T Kowallick
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Göttingen, Deutschland.
| | - Matthias Scholz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Göttingen, Deutschland
| | - Andreas Schuster
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Göttingen, Deutschland
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Joachim Lotz
- Institut für Diagnostische und Interventionelle Radiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Standort Göttingen, Göttingen, Deutschland
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Evertz R, Schulz A, Lange T, Backhaus SJ, Vollmann D, Kowallick JT, von Haehling S, Hasenfuß G, Schuster A. Cardiovascular magnetic resonance imaging patterns of acute COVID-19 mRNA vaccine-associated myocarditis in young male patients: A first single-center experience. Front Cardiovasc Med 2022; 9:965512. [PMID: 36082124 PMCID: PMC9445185 DOI: 10.3389/fcvm.2022.965512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 07/25/2022] [Indexed: 01/14/2023] Open
Abstract
Background The risk of myocarditis after mRNA vaccination against COVID-19 has emerged recently. Current evidence suggests that young male patients are predominantly affected. In the majority of the cases, only mild symptoms were observed. However, little is known about cardiac magnetic resonance (CMR) imaging patterns in mRNA-related myocarditis and their differences when compared to classical viral myocarditis in the acute phase of inflammation. Methods and results In total, 10 mRNA vaccination-associated patients with myocarditis were retrospectively enrolled in this study and compared to 10 patients suffering from viral myocarditis, who were matched for age, sex, comorbidities, and laboratory markers. All patients (n = 20) were hospitalized and underwent a standardized clinical examination, as well as an echocardiography and a CMR. Both, clinical and imaging findings and, in particular, functional and volumetric CMR assessments, as well as detailed tissue characterization using late gadolinium enhancement and T1 + T2-weighted sequences, were compared between both groups. The median age of the overall cohort was 26 years (group 1: 25.5; group 2: 27.5; p = 0.57). All patients described chest pain as the leading reason for their initial presentation. CMR volumetric and functional parameters did not differ significantly between both groups. In all cases, the lateral left ventricular wall showed late gadolinium enhancement without significant differences in terms of the localization or in-depth tissue characterization (late gadolinium enhancement [LGE] enlargement: group 1: 5.4%; group 2: 6.5%; p = 0.14; T2 global/maximum value: group 1: 38.9/52 ms; group 2: 37.8/54.5 ms; p = 0.79 and p = 0.80). Conclusion This study yielded the first evidence that COVID-19 mRNA vaccine-associated myocarditis does not show specific CMR patterns during the very acute stage in the most affected patient group of young male patients. The observed imaging markers were closely related to regular viral myocarditis in our cohort. Additionally, we could not find any markers implying adverse outcomes in this relatively little number of patients; however, this has to be confirmed by future studies that will include larger sample sizes.
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Affiliation(s)
- Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Alexander Schulz
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Dirk Vollmann
- Herz- and Gefäßzentrum Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Stephan von Haehling
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen (UMG), Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
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Backhaus SJ, Rösel SF, Stiermaier T, Schmidt-Rimpler J, Evertz R, Schulz A, Lange T, Kowallick JT, Kutty S, Bigalke B, Gutberlet M, Hasenfuß G, Thiele H, Eitel I, Schuster A. Left Atrial Long Axis Shortening Allows Effective Quantification of Atrial Function and Optimized Risk Prediction Following Acute Myocardial Infarction. European Heart Journal Open 2022; 2:oeac053. [PMID: 36268539 PMCID: PMC9574426 DOI: 10.1093/ehjopen/oeac053] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/22/2022] [Accepted: 07/17/2022] [Indexed: 11/15/2022]
Abstract
Aims Deformation imaging enables optimized risk prediction following acute myocardial infarction (AMI). However, costly and time-consuming post processing has hindered widespread clinical implementation. Since manual left-ventricular long-axis strain (LV LAS) has been successfully proposed as a simple alternative for LV deformation imaging, we aimed at the validation of left-atrial (LA) LAS. Methods and results The AIDA STEMI and TATORT-NSTEMI trials recruited 795 patients with ST-elevation myocardial infarction and 440 with non-ST-elevation myocardial infarction. LA LAS was assessed as the systolic distance change between the middle of a line connecting the origins of the mitral leaflets and either a perpendicular line towards the posterior atrial wall (LAS90) or a line connecting to the LA posterior portion of the greatest distance irrespective of a predefined angle (LAS). Primary endpoint was major adverse cardiac event (MACE) occurrence within 12 months. There were no significant differences between LA LAS and LAS90, both with excellent reproducibility. LA LAS correlated significantly with LA reservoir function (Es, r = 0.60, P < 0.001). Impaired LA LAS resulted in higher MACE occurrence [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.82–0.88, P < 0.001]. LA LAS (HR 0.90, 95% CI 0.83–0.97, P = 0.005) and LV global longitudinal strain (GLS, P = 0.025) were the only independent predictors for MACE in multivariate analyses. C-statistics demonstrated incremental value of LA LAS in addition to GLS (P = 0.016) and non-inferiority compared with FT Es (area under the receiver operating characteristic curve 0.74 vs. 0.69, P = 0.256). Conclusion Left-atrial LAS provides fast and software-independent approximations of quantitative LA function with similar value for risk prediction compared with dedicated deformation imaging. Clinical trial registration ClinicalTrials.gov: NCT00712101 and NCT01612312
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen , Göttingen , Germany
| | - Simon F Rösel
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen , Göttingen , Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein , Lübeck
- Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck , Lübeck , Germany
| | - Jonas Schmidt-Rimpler
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
| | - Ruben Evertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen , Göttingen , Germany
| | - Alexander Schulz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen , Göttingen , Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen , Göttingen , Germany
| | - Johannes T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University , Göttingen Germany
- Taussig Heart Center, Johns Hopkins Hospital , Baltimore, MD 21287 , USA
| | - Shelby Kutty
- Charité Campus Benjamin Franklin, University Medical Center Berlin, Department of Cardiology , Berlin , Germany
| | - Boris Bigalke
- Heart Center Leipzig, University of Leipzig, Institute of Diagnostic and Interventional Radiology , Leipzig , Germany
| | - Matthias Gutberlet
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology , Leipzig , Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen , Göttingen , Germany
| | - Holger Thiele
- Heart Center Leipzig at University of Leipzig, Department of Internal Medicine/Cardiology , Leipzig , Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein , Lübeck
- Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck , Lübeck , Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University , Göttingen Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen , Göttingen , Germany
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14
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Lange T, Backhaus SJ, Beuthner BE, Topci R, Rigorth KR, Kowallick JT, Evertz R, Schnelle M, Ravassa S, Díez J, Toischer K, Seidler T, Puls M, Hasenfuß G, Schuster A. Functional and structural reverse myocardial remodeling following transcatheter aortic valve replacement: a prospective cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 2022; 24:45. [PMID: 35897100 PMCID: PMC9331125 DOI: 10.1186/s12968-022-00874-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since cardiovascular magnetic resonance (CMR) imaging allows comprehensive quantification of both myocardial function and structure we aimed to assess myocardial remodeling processes in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR). METHODS CMR imaging was performed in 40 patients with severe AS before and 1 year after TAVR. Image analyses comprised assessments of myocardial volumes, CMR-feature-tracking based atrial and ventricular strain, myocardial T1 mapping, extracellular volume fraction-based calculation of left ventricular (LV) cellular and matrix volumes, as well as ischemic and non-ischemic late gadolinium enhancement analyses. Moreover, biomarkers including NT-proBNP as well as functional and clinical status were documented. RESULTS Myocardial function improved 1 year after TAVR: LV ejection fraction (57.9 ± 16.9% to 65.4 ± 14.5%, p = 0.002); LV global longitudinal (- 21.4 ± 8.0% to -25.0 ± 6.4%, p < 0.001) and circumferential strain (- 36.9 ± 14.3% to - 42.6 ± 11.8%, p = 0.001); left atrial reservoir (13.3 ± 6.3% to 17.8 ± 6.7%, p = 0.001), conduit (5.5 ± 3.2% to 8.4 ± 4.6%, p = 0.001) and boosterpump strain (8.2 ± 4.6% to 9.9 ± 4.2%, p = 0.027). This was paralleled by regression of total myocardial volume (90.3 ± 21.0 ml/m2 to 73.5 ± 17.0 ml/m2, p < 0.001) including cellular (55.2 ± 13.2 ml/m2 to 45.3 ± 11.1 ml/m2, p < 0.001) and matrix volumes (20.7 ± 6.1 ml/m2 to 18.8 ± 5.3 ml/m2, p = 0.036). These changes were paralleled by recovery from heart failure (decrease of NYHA class: p < 0.001; declining NT-proBNP levels: 2456 ± 3002 ng/L to 988 ± 1222 ng/L, p = 0.001). CONCLUSION CMR imaging enables comprehensive detection of myocardial remodeling in patients undergoing TAVR. Regression of LV matrix volume as a surrogate for reversible diffuse myocardial fibrosis is accompanied by increase of myocardial function and recovery from heart failure. Further data are required to define the value of these parameters as therapeutic targets for optimized management of TAVR patients. Trial registration DRKS, DRKS00024479. Registered 10 December 2021-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00024479.
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Bo Eric Beuthner
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Rodi Topci
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Karl-Rudolf Rigorth
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Moritz Schnelle
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Clinical Chemistry, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Susana Ravassa
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Javier Díez
- Program of Cardiovascular Diseases, Centre for Applied Medical Research, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Karl Toischer
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tim Seidler
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Miriam Puls
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Cluster of Excellence "Multiscale Bioimaging: From Molecular Machines to Networks of Excitable Cells" (MBExC), University of Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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15
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Backhaus SJ, Aldehayat H, Kowallick JT, Evertz R, Lange T, Kutty S, Bigalke B, Gutberlet M, Hasenfuß G, Thiele H, Stiermaier T, Eitel I, Schuster A. Artificial intelligence fully automated myocardial strain quantification for risk stratification following acute myocardial infarction. Sci Rep 2022; 12:12220. [PMID: 35851282 PMCID: PMC9293901 DOI: 10.1038/s41598-022-16228-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/06/2022] [Indexed: 11/09/2022] Open
Abstract
Feasibility of automated volume-derived cardiac functional evaluation has successfully been demonstrated using cardiovascular magnetic resonance (CMR) imaging. Notwithstanding, strain assessment has proven incremental value for cardiovascular risk stratification. Since introduction of deformation imaging to clinical practice has been complicated by time-consuming post-processing, we sought to investigate automation respectively. CMR data (n = 1095 patients) from two prospectively recruited acute myocardial infarction (AMI) populations with ST-elevation (STEMI) (AIDA STEMI n = 759) and non-STEMI (TATORT-NSTEMI n = 336) were analysed fully automated and manually on conventional cine sequences. LV function assessment included global longitudinal, circumferential, and radial strains (GLS/GCS/GRS). Agreements were assessed between automated and manual strain assessments. The former were assessed for major adverse cardiac event (MACE) prediction within 12 months following AMI. Manually and automated derived GLS showed the best and excellent agreement with an intraclass correlation coefficient (ICC) of 0.81. Agreement was good for GCS and poor for GRS. Amongst automated analyses, GLS (HR 1.12, 95% CI 1.08-1.16, p < 0.001) and GCS (HR 1.07, 95% CI 1.05-1.10, p < 0.001) best predicted MACE with similar diagnostic accuracy compared to manual analyses; area under the curve (AUC) for GLS (auto 0.691 vs. manual 0.693, p = 0.801) and GCS (auto 0.668 vs. manual 0.686, p = 0.425). Amongst automated functional analyses, GLS was the only independent predictor of MACE in multivariate analyses (HR 1.10, 95% CI 1.04-1.15, p < 0.001). Considering high agreement of automated GLS and equally high accuracy for risk prediction compared to the reference standard of manual analyses, automation may improve efficiency and aid in clinical routine implementation.Trial registration: ClinicalTrials.gov, NCT00712101 and NCT01612312.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Haneen Aldehayat
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Boris Bigalke
- Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Matthias Gutberlet
- Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Centre, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
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16
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Jäckle K, Lippross S, Michel TE, Kowallick JT, Dullin C, Lüders KA, Lorenz HM, Tsaknakis K, Hell AK. A Preclinical Pilot Study on the Effects of Thermal Ablation on Lamb Growth Plates. Children 2022; 9:children9060878. [PMID: 35740815 PMCID: PMC9222192 DOI: 10.3390/children9060878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/29/2022] [Accepted: 06/10/2022] [Indexed: 11/21/2022]
Abstract
(1) Background: Thermal ablation has been demonstrated to affect the bone growth of osteoid osteoma in adolescents. Growth modulation due to thermal heat in children is conceivable, but has not yet been established. We used lamb extremities as a preclinical model to examine the effect of thermal ablation on growth plates in order to evaluate its potential for axial or longitudinal growth modulation in pediatric patients. (2) Methods: Thermal ablation was performed by electrocautery on eight different growth plates of the legs and distal radii of a stillborn lamb. After treatment, target hits and the physical extent of the growth plate lesions were monitored using micro-computed tomography (micro-CT) and histology. (3) Results: Lesions and their physical extent could be quantified in 75% of the treated extremities. The histological analysis revealed that the disruption of tissue was confined to a small area and the applied heat did not cause the entire growth plate to be disrupted or obviously damaged. (4) Conclusions: Thermal ablation by electrocautery is minimally invasive and can be used for targeted disruption of small areas in growth plates in the animal model. The results suggest that thermal ablation can be developed into a suitable method to influence epiphyseal growth in children.
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Affiliation(s)
- Katharina Jäckle
- Pediatric Orthopaedics, Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (K.J.); (T.E.M.); (K.A.L.); (H.M.L.); (K.T.)
- Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany
| | - Sebastian Lippross
- Departement of Orthopaedics and Trauma Surgery, University Medical Center Schleswig-Holstein, Arnold-Heller-Str. 3, 24105 Kiel, Germany;
| | - Theresa Elisabeth Michel
- Pediatric Orthopaedics, Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (K.J.); (T.E.M.); (K.A.L.); (H.M.L.); (K.T.)
| | - Johannes T. Kowallick
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (J.T.K.); (C.D.)
| | - Christian Dullin
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (J.T.K.); (C.D.)
- Institute for Diagnostic und Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany
| | - Katja A. Lüders
- Pediatric Orthopaedics, Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (K.J.); (T.E.M.); (K.A.L.); (H.M.L.); (K.T.)
| | - Heiko M. Lorenz
- Pediatric Orthopaedics, Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (K.J.); (T.E.M.); (K.A.L.); (H.M.L.); (K.T.)
| | - Konstantinos Tsaknakis
- Pediatric Orthopaedics, Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (K.J.); (T.E.M.); (K.A.L.); (H.M.L.); (K.T.)
| | - Anna K. Hell
- Pediatric Orthopaedics, Department for Trauma Surgery, Orthopaedics and Plastic Surgery, University Medical Center Göttingen, Robert-Koch Str. 40, 37075 Göttingen, Germany; (K.J.); (T.E.M.); (K.A.L.); (H.M.L.); (K.T.)
- Correspondence: ; Tel.: +49-551-39-8701
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17
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Plüß M, Mese K, Kowallick JT, Schuster A, Tampe D, Tampe B. Case Report: Cytomegalovirus Reactivation and Pericarditis Following ChAdOx1 nCoV-19 Vaccination Against SARS-CoV-2. Front Immunol 2022; 12:784145. [PMID: 35116025 PMCID: PMC8803643 DOI: 10.3389/fimmu.2021.784145] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/30/2021] [Indexed: 01/08/2023] Open
Abstract
As the coronavirus disease 2019 (COVID-19) pandemic is ongoing and new variants of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) are emerging, there is an urgent need for vaccines to protect individuals at high risk for complications and to potentially control disease outbreaks by herd immunity. Surveillance of rare safety issues related to these vaccines is progressing, since more granular data emerge about adverse events of SARS-CoV-2 vaccines during post-marketing surveillance. Varicella zoster virus (VZV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV) reactivation has already been reported in COVID-19 patients. In addition, adverse events after SARS-CoV-2 mRNA vaccination have also been in the context of varicella zoster virus (VZV) reactivation and directly associated with the mRNA vaccine. We present the first case of CMV reactivation and pericarditis in temporal association with SARS-CoV-2 vaccination, particularly adenovirus-based DNA vector vaccine ChAdOx1 nCoV-19 against SARS-CoV-2. After initiation of antiviral therapy with oral valganciclovir, CMV viremia disappeared and clinical symptoms rapidly improved. Since huge vaccination programs are ongoing worldwide, post-marketing surveillance systems must be in place to assess vaccine safety that is important for the detection of any events. In the context of the hundreds of millions of individuals to be vaccinated against SARS-CoV-2, a potential causal association with CMV reactivation may result in a considerable number of cases with potentially severe complications.
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Affiliation(s)
- Marlene Plüß
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Kemal Mese
- Institute of Medical Microbiology and Virology, University Medical Center Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- Institute of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany
| | - Désirée Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
| | - Björn Tampe
- Department of Nephrology and Rheumatology, University Medical Center Göttingen, Göttingen, Germany
- *Correspondence: Björn Tampe,
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18
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Backhaus SJ, Schuster A, Lange T, Stehning C, Billing M, Lotz J, Pieske B, Hasenfuß G, Kelle S, Kowallick JT. Impact of fully automated assessment on interstudy reproducibility of biventricular volumes and function in cardiac magnetic resonance imaging. Sci Rep 2021; 11:11648. [PMID: 34078942 PMCID: PMC8172876 DOI: 10.1038/s41598-021-90702-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular magnetic resonance (CMR) imaging provides reliable assessments of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards novel artificial intelligence-based fully automated analyses. Hence, we sought to investigate the impact of artificial intelligence-based fully automated assessments on the inter-study variability of biventricular volumes and function. Eighteen participants (11 with normal, 3 with heart failure and preserved and 4 with reduced ejection fraction (EF)) underwent serial CMR imaging at in median 63 days (range 49–87) interval. Short axis cine stacks were acquired for the evaluation of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic, end-systolic and stroke volumes as well as EF. Assessments were performed manually (QMass, Medis Medical Imaging Systems, Leiden, Netherlands) by an experienced (3 years) and inexperienced reader (no active reporting, 45 min of training with five cases from the SCMR consensus data) as well as fully automated (suiteHEART, Neosoft, Pewaukee, WI, USA) without any manual corrections. Inter-study reproducibility was overall excellent with respect to LV volumetric indices, best for the experienced observer (intraclass correlation coefficient (ICC) > 0.98, coefficient of variation (CoV, < 9.6%) closely followed by automated analyses (ICC > 0.93, CoV < 12.4%) and lowest for the inexperienced observer (ICC > 0.86, CoV < 18.8%). Inter-study reproducibility of RV volumes was excellent for the experienced observer (ICC > 0.88, CoV < 10.7%) but considerably lower for automated and inexperienced manual analyses (ICC > 0.69 and > 0.46, CoV < 22.8% and < 28.7% respectively). In this cohort, fully automated analyses allowed reliable serial investigations of LV volumes with comparable inter-study reproducibility to manual analyses performed by an experienced CMR observer. In contrast, RV automated quantification with current algorithms still relied on manual post-processing for reliability.
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | | | - Marcus Billing
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - Burkert Pieske
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.,Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Heart Center Berlin, Berlin, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany. .,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
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Backhaus SJ, Metschies G, Billing M, Schmidt-Rimpler J, Kowallick JT, Gertz RJ, Lapinskas T, Pieske-Kraigher E, Pieske B, Lotz J, Bigalke B, Kutty S, Hasenfuß G, Kelle S, Schuster A. Defining the optimal temporal and spatial resolution for cardiovascular magnetic resonance imaging feature tracking. J Cardiovasc Magn Reson 2021; 23:60. [PMID: 34001175 PMCID: PMC8127257 DOI: 10.1186/s12968-021-00740-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Myocardial deformation analyses using cardiovascular magnetic resonance (CMR) feature tracking (CMR-FT) have incremental value in the assessment of cardiac function beyond volumetric analyses. Since guidelines do not recommend specific imaging parameters, we aimed to define optimal spatial and temporal resolutions for CMR cine images to enable reliable post-processing. METHODS Intra- and inter-observer reproducibility was assessed in 12 healthy subjects and 9 heart failure (HF) patients. Cine images were acquired with different temporal (20, 30, 40 and 50 frames/cardiac cycle) and spatial resolutions (high in-plane 1.5 × 1.5 mm through-plane 5 mm, standard 1.8 × 1.8 x 8mm and low 3.0 × 3.0 x 10mm). CMR-FT comprised left ventricular (LV) global and segmental longitudinal/circumferential strain (GLS/GCS) and associated systolic strain rates (SR), and right ventricular (RV) GLS. RESULTS Temporal but not spatial resolution did impact absolute strain and SR. Maximum absolute changes between lowest and highest temporal resolution were as follows: 1.8% and 0.3%/s for LV GLS and SR, 2.5% and 0.6%/s for GCS and SR as well as 1.4% for RV GLS. Changes of strain values occurred comparing 20 and 30 frames/cardiac cycle including LV and RV GLS and GCS (p < 0.001-0.046). In contrast, SR values (LV GLS/GCS SR) changed significantly comparing all successive temporal resolutions (p < 0.001-0.013). LV strain and SR reproducibility was not affected by either temporal or spatial resolution, whilst RV strain variability decreased with augmentation of temporal resolution. CONCLUSION Temporal but not spatial resolution significantly affects strain and SR in CMR-FT deformation analyses. Strain analyses require lower temporal resolution and 30 frames/cardiac cycle offer consistent strain assessments, whilst SR measurements gain from further increases in temporal resolution.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Georg Metschies
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Marcus Billing
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Jonas Schmidt-Rimpler
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Roman J. Gertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
- Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Elisabeth Pieske-Kraigher
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
| | - Burkert Pieske
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD 21287 USA
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Heart Center Berlin (DHZB), Department of Internal Medicine/Cardiology, University of Berlin, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
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20
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Backhaus SJ, Metschies G, Zieschang V, Erley J, Zamani SM, Kowallick JT, Lapinskas T, Pieske B, Lotz J, Kutty S, Hasenfus G, Kelle S, Schuster A. Cardiovascular magnetic resonance deformation imaging: method comparison and considerations regarding reproducibility. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.269] [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
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): German Centre for Cardiovascular Research
Purpose
Myocardial Feature-Tracking (FT) deformation imaging is superior for risk-stratification compared to volumetric approaches. Since there is no clear recommendation regarding FT post-processing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain encoded (SENC) magnetic resonance imaging.
Methods
FT software from 4 different vendors (TomTec/Medis/Circle(CVI)/Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential and longitudinal strains (GCS/GLS) in 12 healthy volunteers and 12 heart failure patients. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as pearson correlation coefficients.
Results
For FT-GCS, consistency was excellent comparing different FT-vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and compared to fSENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared to tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements between FT-vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared to both tagging and fSENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64) and lowest for TomTec (ICCa = 0.41 and 0.47).
For FT-GLS, consistency was excellent (ICCc≥0.86, r≥0.76). Absolute agreements between FT-vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared to tagging but excellent compared to fSENC (ICCa = 0.77-0.90).
Conclusion
Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high irrespective of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.
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Affiliation(s)
- SJ Backhaus
- Heart Centre Goettingen, Goettingen, Germany
| | - G Metschies
- Heart Centre Goettingen, Goettingen, Germany
| | - V Zieschang
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - J Erley
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - SM Zamani
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - JT Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - T Lapinskas
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - B Pieske
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S Kutty
- The Johns Hopkins Hospital, Taussig Heart Center, Baltimore, United States of America
| | - G Hasenfus
- Heart Centre Goettingen, Goettingen, Germany
| | - S Kelle
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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21
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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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22
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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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Schuster A, Backhaus SJ, Stiermaier T, Kowallick JT, Stulle A, Koschalka A, Lotz J, Kutty S, Bigalke B, Gutberlet M, Hasenfuß G, Thiele H, Eitel I. Fast manual long-axis strain assessment provides optimized cardiovascular event prediction following myocardial infarction. Eur Heart J Cardiovasc Imaging 2020; 20:1262-1270. [PMID: 31329854 DOI: 10.1093/ehjci/jez077] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 04/12/2019] [Indexed: 01/09/2023] Open
Abstract
AIMS Cardiovascular magnetic resonance feature tracking (CMR-FT) global longitudinal strain (GLS) provides incremental prognostic value following acute myocardial infarction (AMI) but requires substantial post-processing. Alternatively, manual global long-axis strain (LAS) can be easily assessed from standard steady state free precession images. We aimed to define the prognostic value of LAS in a large multicentre study in patients following AMI. METHODS AND RESULTS A total of 1235 patients with myocardial infarction [n = 795 with ST-elevation myocardial infarction (STEMI) and 440 with non-ST-elevation myocardial infarction (NSTEMI)] underwent cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention in eight centres across Germany. Assessment of LAS was performed in a blinded core-laboratory measuring the systolic shortening between the epicardial apical border and the middle of a line connecting the origins of the mitral leaflets. Primary clinical endpoint was the occurrence of major adverse clinical events (MACE) including death, reinfarction, and congestive heart failure within 1 year after AMI. During 1-year follow-up, 76 patients suffered from MACE. Impaired LAS was associated with higher MACE occurrence both in STEMI (P < 0.001) and NSTEMI (P = 0.001) patients. Association of LAS remained significant (P = 0.017) after correction for univariate significant parameters for MACE prediction. C-statistics revealed incremental value of additional LAS assessment for optimized event prediction compared with left ventricular ejection fraction (MACE P = 0.044; mortality P = 0.013) and a combination of established clinical and imaging parameters (MACE P = 0.084; mortality P = 0.027), but not CMR-FT GLS (MACE P = 0.075; mortality P = 0.380). CONCLUSION LAS provides software independent, widely available, easy and fast approximation of longitudinal left ventricular shortening early after reperfused AMI with incremental prognostic value beyond established risk stratification parameters. CLINICAL TRIALS.GOV NCT00712101 and NCT01612312.
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Affiliation(s)
- Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany.,Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, 5th Floor, Acute Services Building, Reserve Road, St Leonard's, Sydney, NSW, Australia
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Thomas Stiermaier
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Alina Stulle
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Alexander Koschalka
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany.,Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany
| | - Shelby Kutty
- The Helen B. Taussig Heart Center, Johns Hopkins Children's Center, M 2303, 1800 Orleans Street, Baltimore, Maryland, USA
| | - Boris Bigalke
- Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Hindenburgdamm 30, Berlin, Germany
| | - Matthias Gutberlet
- Institute for Diagnostic and Interventional Radiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Göttingen, Robert-Koch-Str. 42a, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, Lübeck, Germany
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25
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Lange T, Stiermaier T, Backhaus SJ, Boom PC, Kowallick JT, de Waha-Thiele S, Lotz J, Kutty S, Bigalke B, Gutberlet M, Feistritzer HJ, Desch S, Hasenfuß G, Thiele H, Eitel I, Schuster A. Functional and prognostic implications of cardiac magnetic resonance feature tracking-derived remote myocardial strain analyses in patients following acute myocardial infarction. Clin Res Cardiol 2020; 110:270-280. [PMID: 33083869 PMCID: PMC7862195 DOI: 10.1007/s00392-020-01747-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/14/2020] [Indexed: 01/15/2023]
Abstract
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 1034 patients following acute myocardial infarction were included. CMR imaging and strain analyses as well as infarct 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 cutoff 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 among patients considered at risk according to established CMR parameters for (1) patients with reduced left ventricular ejection fraction (LVEF) ≤ 35% (p = 0.038 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 = 0.002 on log-rank testing). Conclusion CMR-FT-derived RM CS is a useful parameter to characterize the response of the remote myocardium and allows improved stratification following AMI beyond commonly used parameters, especially of high-risk patients. Trial registration ClinicalTrials.gov, NCT00712101 and NCT01612312 Graphic abstract Defining remote segments (R) in the presence of infarct areas (I) for the analysis of remote circumferential strain (CS). Remote CS was significantly lower in patients who suffered major adverse cardiac events (MACE) and a cutoff value for remote CS of − 25.8% best identified high-risk patients. In addition, impaired remote CS ≥ − 25.8 % (Remote −) and preserved remote CS < − 25.8 % (Remote +) enabled further risk stratification when added to established parameters like left ventricular ejection fraction (LVEF), global circumferential strain (GCS) or microvascular obstruction (MVO).![]()
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Affiliation(s)
- Torben Lange
- Department of Cardiology and Pneumology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen, Germany
| | - Patricia C Boom
- Department of Cardiology and Pneumology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen, Germany
| | - Johannes T Kowallick
- Institute for Diagnostic and Interventional Radiology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Suzanne de Waha-Thiele
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Joachim Lotz
- Institute for Diagnostic and Interventional Radiology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Shelby Kutty
- Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD, USA
| | - Boris Bigalke
- Department of Cardiology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Berlin, Germany
| | - Matthias Gutberlet
- Institute of Diagnostic and Interventional Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Hans-Josef Feistritzer
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Göttingen Germany and German Centre for Cardiovascular Research (DZHK), Partner Site Göttingen, University Medical Center Göttingen, Georg-August University, Robert-Koch-Straße 40, Göttingen, Germany.
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26
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Schuster A, Lange T, Backhaus SJ, Strohmeyer C, Boom PC, Matz J, Kowallick JT, Lotz J, Steinmetz M, Kutty S, Bigalke B, Gutberlet M, de Waha-Thiele S, Desch S, Hasenfuß G, Thiele H, Stiermaier T, Eitel I. Fully Automated Cardiac Assessment for Diagnostic and Prognostic Stratification Following Myocardial Infarction. J Am Heart Assoc 2020; 9:e016612. [PMID: 32873121 PMCID: PMC7726968 DOI: 10.1161/jaha.120.016612] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Cardiovascular magnetic resonance imaging is considered the reference methodology for cardiac morphology and function but requires manual postprocessing. Whether novel artificial intelligence–based automated analyses deliver similar information for risk stratification is unknown. Therefore, this study aimed to investigate feasibility and prognostic implications of artificial intelligence–based, commercially available software analyses. Methods and Results Cardiovascular magnetic resonance data (n=1017 patients) from 2 myocardial infarction multicenter trials were included. Analyses of biventricular parameters including ejection fraction (EF) were manually and automatically assessed using conventional and artificial intelligence–based software. Obtained parameters entered regression analyses for prediction of major adverse cardiac events, defined as death, reinfarction, or congestive heart failure, within 1 year after the acute event. Both manual and uncorrected automated volumetric assessments showed similar impact on outcome in univariate analyses (left ventricular EF, manual: hazard ratio [HR], 0.93 [95% CI 0.91–0.95]; P<0.001; automated: HR, 0.94 [95% CI, 0.92–0.96]; P<0.001) and multivariable analyses (left ventricular EF, manual: HR, 0.95 [95% CI, 0.92–0.98]; P=0.001; automated: HR, 0.95 [95% CI, 0.92–0.98]; P=0.001). Manual correction of the automated contours did not lead to improved risk prediction (left ventricular EF, area under the curve: 0.67 automated versus 0.68 automated corrected; P=0.49). There was acceptable agreement (left ventricular EF: bias, 2.6%; 95% limits of agreement, −9.1% to 14.2%; intraclass correlation coefficient, 0.88 [95% CI, 0.77–0.93]) of manual and automated volumetric assessments. Conclusions User‐independent volumetric analyses performed by fully automated software are feasible, and results are equally predictive of major adverse cardiac events compared with conventional analyses in patients following myocardial infarction. Registration URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00712101 and NCT01612312.
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Affiliation(s)
- Andreas Schuster
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Torben Lange
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Carolin Strohmeyer
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Patricia C Boom
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Jonas Matz
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Johannes T Kowallick
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Institute for Diagnostic and Interventional Radiology University Medical Center GöttingenGeorg-August University Göttingen Germany
| | - Joachim Lotz
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Institute for Diagnostic and Interventional Radiology University Medical Center GöttingenGeorg-August University Göttingen Germany
| | - Michael Steinmetz
- German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Department of Pediatric Cardiology University Medical Center GöttingenGeorg-August University Göttingen Germany
| | - Shelby Kutty
- Helen B. Taussig Heart Center The Johns Hopkins Hospital and School of Medicine Baltimore MD
| | - Boris Bigalke
- Department of Cardiology Charité Campus Benjamin FranklinUniversity Medical Center Berlin Berlin Germany
| | - Matthias Gutberlet
- Institute of Diagnostic and Interventional Radiology Heart Center Leipzig at University of Leipzig Germany
| | - Suzanne de Waha-Thiele
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center LübeckUniversity Hospital Schleswig-Holstein Lübeck Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute Heart Center Leipzig at University of Leipzig Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology University Medical Center GöttingenGeorg-August University Göttingen Germany.,German Centre for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute Heart Center Leipzig at University of Leipzig Germany
| | - Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center LübeckUniversity Hospital Schleswig-Holstein Lübeck Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center LübeckUniversity Hospital Schleswig-Holstein Lübeck Germany.,German Centre for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
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27
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Backhaus SJ, Metschies G, Zieschang V, Erley J, Mahsa Zamani S, Kowallick JT, Lapinskas T, Pieske B, Lotz J, Kutty S, Hasenfuß G, Kelle S, Schuster A. Head-to-head comparison of cardiovascular MR feature tracking cine versus acquisition-based deformation strain imaging using myocardial tagging and strain encoding. Magn Reson Med 2020; 85:357-368. [PMID: 32851707 DOI: 10.1002/mrm.28437] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [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: 04/06/2020] [Revised: 05/29/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022]
Abstract
PURPOSE Myocardial feature-tracking (FT) deformation imaging is superior for risk stratification compared with volumetric approaches. Because there is no clear recommendation regarding FT postprocessing, we compared different FT-strain analyses with reference standard techniques, including tagging and strain-encoded (SENC) MRI. METHODS Feature-tracking software from four different vendors (TomTec, Medis, Circle [CVI], and Neosoft), tagging (Segment), and fastSENC (MyoStrain) were used to determine left ventricular global circumferential strains (GCS) and longitudinal strains (GLS) in 12 healthy volunteers and 12 patients with heart failure. Variability and agreements were assessed using intraclass correlation coefficients for absolute agreement (ICCa) and consistency (ICCc) as well as Pearson correlation coefficients. RESULTS For FT-GCS, consistency was excellent comparing different FT vendors (ICCc = 0.84-0.97, r = 0.86-0.95) and in comparison to fast SENC (ICCc = 0.78-0.89, r = 0.73-0.81). FT-GCS consistency was excellent compared with tagging (ICCc = 0.79-0.85, r = 0.74-0.77) except for TomTec (ICCc = 0.68, r = 0.72). Absolute FT-GCS agreements among FT vendors were highest for CVI and Medis (ICCa = 0.96) and lowest for TomTec and Neosoft (ICCa = 0.32). Similarly, absolute FT-GCS agreements were excellent for CVI and Medis compared with both tagging and fast SENC (ICCa = 0.84-0.88), good to excellent for Neosoft (ICCa = 0.77 and 0.64), and lowest for TomTec (ICCa = 0.41 and 0.47). For FT-GLS, consistency was excellent (ICCc ≥ 0.86, r ≥ 0.76). Absolute agreements among FT vendors were excellent (ICCa = 0.91-0.93) or good to excellent for TomTec (ICCa = 0.69-0.85). Absolute agreements (ICCa) were good (CVI 0.70, Medis 0.60) and fair (TomTec 0.41, Neosoft 0.59) compared with tagging, but excellent compared with fast SENC (ICCa = 0.77-0.90). CONCLUSION Although absolute agreements differ depending on deformation assessment approaches, consistency and correlation are consistently high regardless of the method chosen, thus indicating reliable strain assessment. Further standardisation and introduction of uniform references is warranted for routine clinical implementation.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Georg Metschies
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Victoria Zieschang
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Jennifer Erley
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Seyedeh Mahsa Zamani
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany.,Department of Cardiology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Burkert Pieske
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research, Göttingen, Göttingen, Germany.,German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
| | - Sebastian Kelle
- German Heart Center Berlin, Department of Internal Medicine/Cardiology, Charité Campus Virchow Clinic, University of Berlin, Berlin, Germany.,German Centre for Cardiovascular Research, Berlin, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.,German Center for Cardiovascular Research, Göttingen, Göttingen, Germany
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28
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Wolfien M, Klatt D, Salybekov AA, Ii M, Komatsu-Horii M, Gaebel R, Philippou-Massier J, Schrinner E, Akimaru H, Akimaru E, David R, Garbade J, Gummert J, Haverich A, Hennig H, Iwasaki H, Kaminski A, Kawamoto A, Klopsch C, Kowallick JT, Krebs S, Nesteruk J, Reichenspurner H, Ritter C, Stamm C, Tani-Yokoyama A, Blum H, Wolkenhauer O, Schambach A, Asahara T, Steinhoff G. Hematopoietic stem-cell senescence and myocardial repair - Coronary artery disease genotype/phenotype analysis of post-MI myocardial regeneration response induced by CABG/CD133+ bone marrow hematopoietic stem cell treatment in RCT PERFECT Phase 3. EBioMedicine 2020; 57:102862. [PMID: 32629392 PMCID: PMC7339012 DOI: 10.1016/j.ebiom.2020.102862] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/11/2020] [Accepted: 06/11/2020] [Indexed: 01/08/2023] Open
Abstract
Background Bone marrow stem cell clonal dysfunction by somatic mutation is suspected to affect post-infarction myocardial regeneration after coronary bypass surgery (CABG). Methods Transcriptome and variant expression analysis was studied in the phase 3 PERFECT trial post myocardial infarction CABG and CD133+ bone marrow derived hematopoetic stem cells showing difference in left ventricular ejection fraction (∆LVEF) myocardial regeneration Responders (n=14; ∆LVEF +16% day 180/0) and Non-responders (n=9; ∆LVEF -1.1% day 180/0). Subsequently, the findings have been validated in an independent patient cohort (n=14) as well as in two preclinical mouse models investigating SH2B3/LNK antisense or knockout deficient conditions. Findings 1. Clinical: R differed from NR in a total of 161 genes in differential expression (n=23, q<0•05) and 872 genes in coexpression analysis (n=23, q<0•05). Machine Learning clustering analysis revealed distinct RvsNR preoperative gene-expression signatures in peripheral blood acorrelated to SH2B3 (p<0.05). Mutation analysis revealed increased specific variants in RvsNR. (R: 48 genes; NR: 224 genes). 2. Preclinical:SH2B3/LNK-silenced hematopoietic stem cell (HSC) clones displayed significant overgrowth of myeloid and immune cells in bone marrow, peripheral blood, and tissue at day 160 after competitive bone-marrow transplantation into mice. SH2B3/LNK−/− mice demonstrated enhanced cardiac repair through augmenting the kinetics of bone marrow-derived endothelial progenitor cells, increased capillary density in ischemic myocardium, and reduced left ventricular fibrosis with preserved cardiac function. 3. Validation: Evaluation analysis in 14 additional patients revealed 85% RvsNR (12/14 patients) prediction accuracy for the identified biomarker signature. Interpretation Myocardial repair is affected by HSC gene response and somatic mutation. Machine Learning can be utilized to identify and predict pathological HSC response. Funding German Ministry of Research and Education (BMBF): Reference and Translation Center for Cardiac Stem Cell Therapy - FKZ0312138A and FKZ031L0106C, German Ministry of Research and Education (BMBF): Collaborative research center - DFG:SFB738 and Center of Excellence - DFG:EC-REBIRTH), European Social Fonds: ESF/IV-WM-B34-0011/08, ESF/IV-WM-B34-0030/10, and Miltenyi Biotec GmbH, Bergisch-Gladbach, Germany. Japanese Ministry of Health : Health and Labour Sciences Research Grant (H14-trans-001, H17-trans-002) Trial registration ClinicalTrials.gov NCT00950274
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Affiliation(s)
- Markus Wolfien
- Department of Systems Biology and Bioinformatics, University Rostock, Institute of Computer Science, Ulmenstrasse 69, 18057 Rostock, Germany.
| | - Denise Klatt
- Hannover Medical School, Institute of Experimental Hematology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Amankeldi A Salybekov
- Department of Advanced Medicine Science, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa 259-1143, Japan
| | - Masaaki Ii
- Nanobridge, LLC. 1-3-5-202, Sawaragi-Nishi Ibaraki Osaka 567-0868, Japan.
| | - Miki Komatsu-Horii
- Institute of Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Ralf Gaebel
- Reference and Translation Center for Cardiac Stem Cell Therapy, Department Life, Light and Matter and Department of cardiac surgery, University Medicine Rostock, Schillingallee 35, 18055 Rostock, Germany.
| | - Julia Philippou-Massier
- Ludwig-Maximilians-Universität München, LAFUGA Genomics, Gene Center, Feodor-Lynen-Strasse 25, 81377 Muenchen, Germany.
| | - Eric Schrinner
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
| | - Hiroshi Akimaru
- Institute of Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Erika Akimaru
- Institute of Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Robert David
- Reference and Translation Center for Cardiac Stem Cell Therapy, Department Life, Light and Matter and Department of cardiac surgery, University Medicine Rostock, Schillingallee 35, 18055 Rostock, Germany.
| | - Jens Garbade
- Department of Cardiac Surgery, Heart Center University Medicine Leipzig, Strümpellstrasse 39, 04289 Leipzig, Germany.
| | - Jan Gummert
- Heart and diabetes center North Rhine Westfalia, University hospital of the Ruhr university Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany.
| | - Axel Haverich
- Medical school Hannover, Department of heart-, thoracic- and vascular surgery, Carl Neuberg Strasse 1, 30625 Hannover, Germany.
| | - Holger Hennig
- Department of Systems Biology and Bioinformatics, University Rostock, Institute of Computer Science, Ulmenstrasse 69, 18057 Rostock, Germany.
| | - Hiroto Iwasaki
- Department of cardiothoracic surgery, Osaka city university, 1-4-3, Asahimachi, Abeno. Osaka, 545-8585. Japan.
| | - Alexander Kaminski
- Reference and Translation Center for Cardiac Stem Cell Therapy, Department Life, Light and Matter and Department of cardiac surgery, University Medicine Rostock, Schillingallee 35, 18055 Rostock, Germany.
| | - Atsuhiko Kawamoto
- Institute of Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Christian Klopsch
- Reference and Translation Center for Cardiac Stem Cell Therapy, Department Life, Light and Matter and Department of cardiac surgery, University Medicine Rostock, Schillingallee 35, 18055 Rostock, Germany.
| | - Johannes T Kowallick
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
| | - Stefan Krebs
- Ludwig-Maximilians-Universität München, LAFUGA Genomics, Gene Center, Feodor-Lynen-Strasse 25, 81377 Muenchen, Germany.
| | - Julia Nesteruk
- Reference and Translation Center for Cardiac Stem Cell Therapy, Department Life, Light and Matter and Department of cardiac surgery, University Medicine Rostock, Schillingallee 35, 18055 Rostock, Germany.
| | - Hermann Reichenspurner
- Department of Cardiac and Vascular Surgery, University heart center Hamburg, Martinistraße. 52, 20246 Hamburg, Germany.
| | - Christian Ritter
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
| | - Christof Stamm
- German Heart Center Berlin, Department of Heart-, Thoracic- and Vascular Surgery, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Ayumi Tani-Yokoyama
- Institute of Biomedical Research and Innovation, 2-2 Minatojima-minamimachi, Chuo-ku, Kobe 650-0047, Japan.
| | - Helmut Blum
- Ludwig-Maximilians-Universität München, LAFUGA Genomics, Gene Center, Feodor-Lynen-Strasse 25, 81377 Muenchen, Germany.
| | - Olaf Wolkenhauer
- Department of Systems Biology and Bioinformatics, University Rostock, Institute of Computer Science, Ulmenstrasse 69, 18057 Rostock, Germany.
| | - Axel Schambach
- Hannover Medical School, Institute of Experimental Hematology, Carl-Neuberg-Strasse 1, 30625 Hannover, Germany.
| | - Takayuki Asahara
- Department of Advanced Medicine Science, Tokai University School of Medicine, Shimokasuya 143, Isehara, Kanagawa 259-1143, Japan.
| | - Gustav Steinhoff
- Reference and Translation Center for Cardiac Stem Cell Therapy, Department Life, Light and Matter and Department of cardiac surgery, University Medicine Rostock, Schillingallee 35, 18055 Rostock, Germany.
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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Navarra JL, Koschalka A, Evertz R, Lotz J, Kutty S, Hasenfuß G, Gutberlet M, Thiele H, Eitel I, Schuster A. Cardiac Magnetic Resonance Myocardial Feature Tracking for Optimized Risk Assessment After Acute Myocardial Infarction in Patients With Type 2 Diabetes. Diabetes 2020; 69:1540-1548. [PMID: 32335515 DOI: 10.2337/db20-0001] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 04/17/2020] [Indexed: 11/13/2022]
Abstract
Type 2 diabetes predicts outcome following acute myocardial infarction (AMI). Since underlying mechanics are incompletely understood, we investigated left ventricular (LV) and left atrial (LA) pathophysiological changes and their prognostic implications using cardiovascular magnetic resonance (CMR). Consecutive patients (N = 1,147; n = 265 with diabetes, n = 882 without diabetes) underwent CMR 3 days after AMI. Analyses included LV ejection fraction (LVEF); global longitudinal strain (GLS) and circumferential and radial strains; LA reservoir, conduit, and booster pump strains; and infarct size, edema, and microvascular obstruction. Predefined end points were major adverse cardiovascular events (MACE) within 12 months. Patients with diabetes had impaired LA reservoir (19.8% vs. 21.2%, P < 0.01) and conduit (7.6% vs. 9.0%, P < 0.01) strains but not ventricular function or myocardial damage. They were at higher risk of MACE than patients without diabetes (10.2% vs. 5.8%, P < 0.01), with most MACE occurring in patients with LVEF ≥35%. While LVEF (P = 0.045) and atrial reservoir strain (P = 0.024) were independent predictors of MACE in patients without diabetes, GLS was in patients with diabetes (P = 0.010). Considering patients with diabetes and LVEF ≥35% (n = 237), GLS and LA reservoir strain below median were significantly associated with MACE. In conclusion, in patients with diabetes, LA and LV longitudinal strain permit optimized risk assessment early after reperfused AMI with incremental prognostic value over and above that of LVEF.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Jenny-Lou Navarra
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Alexander Koschalka
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Ruben Evertz
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
| | - Matthias Gutberlet
- Department of Radiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology and Leipzig Heart Institute, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research, Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research, Partner Site Göttingen, Göttingen, Germany
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Backhaus SJ, Lange T, Beuthner BE, Topci R, Wang X, Kowallick JT, Lotz J, Seidler T, Toischer K, Zeisberg EM, Puls M, Jacobshagen C, Uecker M, Hasenfuß G, Schuster A. Real-time cardiovascular magnetic resonance T1 and extracellular volume fraction mapping for tissue characterisation in aortic stenosis. J Cardiovasc Magn Reson 2020; 22:46. [PMID: 32564773 PMCID: PMC7310147 DOI: 10.1186/s12968-020-00632-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 04/24/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Myocardial fibrosis is a major determinant of outcome in aortic stenosis (AS). Novel fast real-time (RT) cardiovascular magnetic resonance (CMR) mapping techniques allow comprehensive quantification of fibrosis but have not yet been compared against standard techniques and histology. METHODS Patients with severe AS underwent CMR before (n = 110) and left ventricular (LV) endomyocardial biopsy (n = 46) at transcatheter aortic valve replacement (TAVR). Midventricular short axis (SAX) native, post-contrast T1 and extracellular volume fraction (ECV) maps were generated using commercially available modified Look-Locker Inversion recovery (MOLLI) (native: 5(3)3, post-contrast: 4(1)3(1)2) and RT single-shot inversion recovery Fast Low-Angle Shot (FLASH) with radial undersampling. Focal late gadolinium enhancement was excluded from T1 and ECV regions of interest. ECV and LV mass were used to calculate LV matrix volumes. Variability and agreements were assessed between RT, MOLLI and histology using intraclass correlation coefficients, coefficients of variation and Bland Altman analyses. RESULTS RT and MOLLI derived ECV were similar for midventricular SAX slice coverage (26.2 vs. 26.5, p = 0.073) and septal region of interest (26.2 vs. 26.5, p = 0.216). MOLLI native T1 time was in median 20 ms longer compared to RT (p < 0.001). Agreement between RT and MOLLI was best for ECV (ICC > 0.91), excellent for post-contrast T1 times (ICC > 0.81) and good for native T1 times (ICC > 0.62). Diffuse collagen volume fraction by biopsies was in median 7.8%. ECV (RT r = 0.345, p = 0.039; MOLLI r = 0.40, p = 0.010) and LV matrix volumes (RT r = 0.45, p = 0.005; MOLLI r = 0.43, p = 0.007) were the only parameters associated with histology. CONCLUSIONS RT mapping offers fast and sufficient ECV and LV matrix volume calculation in AS patients. ECV and LV matrix volume represent robust and universally comparable parameters with associations to histologically assessed fibrosis and may emerge as potential targets for clinical decision making.
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Affiliation(s)
- Sören J. Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Bo Eric Beuthner
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Rodi Topci
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Xiaoqing Wang
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Tim Seidler
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Karl Toischer
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Elisabeth M. Zeisberg
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Miriam Puls
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Claudius Jacobshagen
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
| | - Martin Uecker
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Department of Diagnostic and Interventional Radiology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
- Cluster of Excellence “Multiscale Bioimaging: from Molecular Machines to Networks of Excitable Cells” (MBExC), University of Göttingen, Göttingen, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Robert-Koch-Str. 40, 37099 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Göttingen, Germany
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31
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Brunnert F, Erpenbeck L, Vlahova L, Kowallick JT, Thoms K, Schön MP, Mitteldorf C. Schmerzhafte Induration am Oberschenkel. J Dtsch Dermatol Ges 2020; 18:505-508. [DOI: 10.1111/ddg.14082_g] [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: 11/27/2022]
Affiliation(s)
- Fiona Brunnert
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Luise Erpenbeck
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Lyubomira Vlahova
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Johannes T. Kowallick
- Institut für Diagnostische und Interventionelle Radiologie Universitätsmedizin Göttingen
| | - Kai‐Martin Thoms
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Michael P. Schön
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
| | - Christina Mitteldorf
- Klinik für Dermatologie Venerologie und Allergologie Universitätsmedizin Göttingen
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Brunnert F, Erpenbeck L, Vlahova L, Kowallick JT, Thoms KM, Schön MP, Mitteldorf C. Painful induration of the thigh. J Dtsch Dermatol Ges 2020; 18:505-508. [PMID: 32346920 DOI: 10.1111/ddg.14082] [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: 11/30/2022]
Affiliation(s)
- Fiona Brunnert
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Luise Erpenbeck
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Lyubomira Vlahova
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Johannes T Kowallick
- Institute for Diagnostic and Interventional Radiology, University Medical Center, Göttingen, Germany
| | - Kai-Martin Thoms
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
| | - Christina Mitteldorf
- Department of Dermatology, Venereology and Allergology, University Medical Center, Göttingen, Germany
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Schuster A, Backhaus SJ, Stiermaier T, Navarra JL, Uhlig J, Rommel KP, Koschalka A, Kowallick JT, Bigalke B, Kutty S, Gutberlet M, Hasenfuß G, Thiele H, Eitel I. Impact of Right Atrial Physiology on Heart Failure and Adverse Events after Myocardial Infarction. J Clin Med 2020; 9:jcm9010210. [PMID: 31940959 PMCID: PMC7019524 DOI: 10.3390/jcm9010210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/03/2020] [Accepted: 01/06/2020] [Indexed: 12/13/2022] Open
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 need further evaluation. Methods: In this cardiovascular magnetic resonance (CMR)-substudy of AIDA STEMI and TATORT NSTEMI, 1235 AMI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation myocardial infarction and 440 with non-ST-elevation MI). Right atrial (RA) performance was evaluated using CMR 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 endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post AMI. Results: RA reservoir (εsp = 0.061, SRs p = 0.049) and conduit functions (εep = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εap = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with the clinical onset of heart failure and MACE independently of RV systolic function and atrial fibrillation (AF) (multivariable analysis hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.009), while RV systolic function and AF were not independent prognosticators. Furthermore, RA conduit strain identified low- and high-risk groups within patients with reduced RV systolic function (p = 0.019 on log rank testing). Conclusions: RA 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)
- Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany; (S.J.B.); (J.-L.N.); (A.K.); (G.H.)
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney 2065, Australia
- Correspondence: ; Tel.: +49-551-39-20870; Fax: +49-551-39-22026
| | - Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany; (S.J.B.); (J.-L.N.); (A.K.); (G.H.)
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, German Center for Cardiovascular Research (DZHK), 23538 Lübeck, Germany; (T.S.); (I.E.)
| | - Jenny-Lou Navarra
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany; (S.J.B.); (J.-L.N.); (A.K.); (G.H.)
| | - Johannes Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany; (J.U.); (J.T.K.)
| | - Karl-Philipp Rommel
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig Heart Institute, 04289 Leipzig, Germany; (K.-P.R.); (H.T.)
| | - Alexander Koschalka
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany; (S.J.B.); (J.-L.N.); (A.K.); (G.H.)
| | - Johannes T. Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany; (J.U.); (J.T.K.)
| | - Boris Bigalke
- Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, 12203 Berlin, Germany;
| | - Shelby Kutty
- Taussig Heart Center, Johns Hopkins Hospital, Baltimore, MD 21287, USA;
| | - Matthias Gutberlet
- Department of Radiology, Heart Center Leipzig, University of Leipzig, 04289 Leipzig, Germany;
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, German Center for Cardiovascular Research (DZHK), 37075 Göttingen, Germany; (S.J.B.); (J.-L.N.); (A.K.); (G.H.)
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig at University of Leipzig, Leipzig Heart Institute, 04289 Leipzig, Germany; (K.-P.R.); (H.T.)
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, German Center for Cardiovascular Research (DZHK), 23538 Lübeck, Germany; (T.S.); (I.E.)
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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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35
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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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Backhaus SJ, Metschies G, Billing M, Kowallick JT, Gertz RJ, Lapinskas T, Pieske-Kraigher E, Pieske B, Bigalke B, Kutty S, Hasenfus G, Kelle S, Schuster A. P1838 Defining the Optimal Temporal and Spatial Resolution for Cardiovascular Magnetic Resonance Imaging Feature Tracking. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1180] [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
Myocardial deformation analyses using cardiovascular magnetic resonance feature tracking (CMR-FT) have incremental value in the assessment of cardiac function beyond volumetric analyses. Since guidelines do not recommend specific imaging parameters, we aimed to define optimal spatial and temporal resolutions for CMR cine images to enable reliable post-processing.
Methods
Intra- and inter-observer reproducibility was assessed in 12 healthy volunteers. Cine images were acquired with differing temporal (20, 30, 40 and 50 frames/cardiac cycle) and spatial resolutions (high in-plane 1.5x1.5mm through-plane 5mm, standard 1.8x1.8x8mm and low 3.0x3.0x10mm). CMR-FT analyses comprised left ventricular (LV) global longitudinal strain (GLS) and systolic strain rate (SRs) as well as LV circumferential and radial strains (GCS and GRS) and right ventricular (RV) GLS. Intra- and inter-observer reproducibility was assessed in all subjects.
Results
Temporal but not spatial resolution did impact absolute strain and SR. Maximum absolute changes between lowest and highest temporal resolution were as follows: 2.3% LV GLS, 2.2%
GCS, 7.2% GRS, 1.7% RV GLS and 0.32s-1 SRs. Changes of time-integrated (strain) values occurred predominantly comparing 20 and 30 frames/cardiac cycle including LV GLS, GCS and GRS (p = 0.034, p = 0.008 and p = 0.034) in highest spatial resolution settings. In contrast, time-derivatives values (SRs) changed significantly from lower temporal resolutions to 40 frames/cardiac cycle and beyond (20 to 30 p = 0.002; 30 to 40 p = 0.018; 40 to 50 frames/cardiac cycle p = 0.075) in highest spatial resolution settings. Strain reproducibility was not affected by either temporal or spatial resolution. SRs variability as assessed by coefficient of variation decreased with higher temporal resolutions.
Conclusion
Temporal but not spatial resolutions significantly affect strain and SR in CMR-FT deformation analyses. Clinical CMR-FT strain and SR analyses require minimum temporal resolutions of 30 and 40frames/cardiac cycle, respectively to ensure precise quantification of myocardial function.
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Affiliation(s)
- S J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - G Metschies
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - M Billing
- 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
| | - R J Gertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - T Lapinskas
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine/Cardiology , Berlin, Germany
| | - E Pieske-Kraigher
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine/Cardiology , Berlin, Germany
| | - B Pieske
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine/Cardiology , Berlin, 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
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - S Kelle
- Charite - Campus Virchow-Klinikum (CVK), Department of Internal Medicine/Cardiology , Berlin, 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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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Koschalka A, Navarra JL, Lotz J, Kutty S, Bigalke B, Gutberlet M, Feistritzer HJ, Hasenfus G, Thiele H, Eitel I, Schuster A. 567 Interplay of infarct territory related myocardial mechanics and prognostic implications following acute myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.297] [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
Prognosis in acute myocardial infarction (AMI) depends on the amount of infarct related artery (IRA) subtended myocardium and associated damage but has not been described in great detail. Consequently, we sought to describe IRA associated pathophysiological consequences using cardiac magnetic resonance (CMR).
Methods
1235 AMI patients (n = 795 ST-elevation (STEMI) and 440 non-STEMI) underwent CMR following percutaneous coronary intervention. Blinded core-laboratory data were compared according to left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) regarding major adverse clinical events (MACE) within 12 months. Left ventricular (LV) global longitudinal/circumferential/radial (GLS/GCS/GRS) as well as left atrial (LA) total (εs), passive (εe) and active (εa) strains were determined using CMR-feature tracking. Tissue characterisation included infarct size (IS) and microvascular obstruction.
Results
LAD and LCx were associated with higher mortality compared to RCA lesions (4.6% and 4.4% vs 1.6%). LAD lesions showed largest IS (16.8%), largest ventricular (LV ejection fraction (EF) 47.4%, GLS -13.2%, GCS -20.8%) and atrial (εs 20.2%) impairment. There was less impairment in LCx (IS 11.8%, LVEF 50.8%, GLS -17.4%, GCS -25.0%, εs 20.7%) followed by RCA lesions (IS 11.3%, LVEF 50.8%, GLS -19.1%, GCS -26.6%, εs 21.7%). In AUC analyses εs (LAD, RCA) and GLS (LCx) best predicted MACE (AUC > 0.69). Multivariate analyses identified εs (p = 0.017) in LAD and GLS (p = 0.034) in LCx infarcts as independent predictors of MACE.
Conclusions
CMR allows IRA specific phenotyping and characterisation of morphologic and functional changes. These alterations carry infarct specific prognostic implications and may represent novel diagnostic and therapeutic targets following AMI.
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Affiliation(s)
- S J Backhaus
- 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
| | - T Stiermaier
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, Luebeck, Germany
| | - T Lange
- 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
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S Kutty
- Children"s Hospital and Medical Center, Omaha, 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
| | - H J Feistritzer
- Heart Center of Leipzig, Department of Internal Medicine/Cardiology , 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, 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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Stiermaier T, Backhaus SJ, Lange T, Koschalka A, Navarra JL, Boom P, Lamata P, Kowallick JT, Lotz J, Hasenfus G, Gutberlet M, Thiele H, Eitel I, Schuster A. 566 Myocardial left ventricular mechanical uniformity and adverse cardiac events following myocardial infarction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.296] [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
Despite limitations as a standalone parameter, left ventricular ejection fraction (LVEF) is the preferred measure of myocardial function and marker for post-infarction risk stratification. LV myocardial uniformity may provide superior prognostic information after acute myocardial infarction (AMI), which was subject of this study.
Methods and Results:
Consecutive patients with AMI (n = 1082; median age 63 years; 75% male) undergoing cardiac magnetic resonance (CMR) in median 3 days after infarction were included in this multicenter, observational study. Circumferential and radial uniformity ratio estimates (CURE and RURE) were derived from CMR feature-tracking as markers of mechanical uniformity (values between 0 and 1 with 1 reflecting perfect uniformity). The clinical endpoint was the 12-month rate of major adverse cardiac events (MACE), consisting of all-cause death, re-infarction, and new congestive heart failure.
Patients with MACE (n = 73) had significantly impaired CURE [0.76 (IQR 0.67-0.86) versus 0.84 (IQR 0.76-0.89); p < 0.001] and RURE [0.69 (IQR 0.60-0.79) versus 0.76 (IQR 0.67-0.83); p < 0.001] compared to patients without events. While uniformity estimates did not provide independent prognostic information in the overall cohort, CURE below the median of 0.84 emerged as an independent predictor of outcome in post-infarction patients with LVEF >35% (n = 959) even after adjustment for established prognostic markers (hazard ratio 1.99; 95% confidence interval 1.06-3.74; p = 0.033 in stepwise multivariable Cox regression analysis). In contrast, LVEF was not associated with adverse events in this subgroup of AMI patients.
Conclusions
CMR-derived estimates of mechanical uniformity are novel markers for risk assessment after AMI and CURE provides independent prognostic information in patients with preserved or only moderately reduced LVEF.
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Affiliation(s)
- T Stiermaier
- 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
| | - T Lange
- 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
| | - J L Navarra
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - P Boom
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - P Lamata
- King"s College London, Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, London, United Kingdom of Great Britain & Northern Ireland
| | - 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
| | - G Hasenfus
- University Medical Center Göttingen, Department of Cardiology and Pneumology and German Centre for Cardiovascular Research (DZHK), Göttingen, Germany
| | - M Gutberlet
- University of Leipzig, Heart Center Leipzig, Department of Radiology, Leipzig, Germany
| | - H Thiele
- University of Leipzig, Heart Center Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - I Eitel
- University Medical Center of Schleswig-Holstein, University Heart Center Lübeck, Medical Clinic II, 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, Stiermaier T, Navarra JL, Uhlig J, Rommel KP, Koschalka A, Kowallick JT, Lotz J, Gutberlet M, Bigalke B, Kutty S, Hasenfuss G, Thiele H, Eitel I. Left Atrial Function with MRI Enables Prediction of Cardiovascular Events after Myocardial Infarction: Insights from the AIDA STEMI and TATORT NSTEMI Trials. Radiology 2019; 293:292-302. [PMID: 31526253 DOI: 10.1148/radiol.2019190559] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The role of left atrial (LA) performance in acute myocardial infarction (AMI) remains controversial. Cardiac MRI myocardial feature tracking (hereafter, MRI-FT) is a method used to quantify myocardial function that enables reliable assessment of atrial function. Purpose To assess the relationship between LA function assessed with MRI-FT and major adverse cardiovascular events (MACE) after AMI. Materials and Methods This secondary analysis of two prospective multicenter cardiac MRI studies (AIDA STEMI [NCT00712101] and TATORT NSTEMI [NCT01612312]) included 1235 study participants with ST-elevation myocardial infarction (n = 795) or non-ST-elevation myocardial infarction (n = 440) between July 2008 and June 2013. All study participants underwent primary percutaneous coronary intervention. MRI-FT analyses were performed in a core laboratory by researchers blinded to clinical status to determine LA performance using LA reservoir function peak systolic strain (εs), LA conduit strain (εe), and LA booster pump function active strain (εa). The relationship of LA performance to a MACE within 12 months after AMI was evaluated by using Cox proportional hazards models and area under the receiver operating characteristic curve (AUC). Results Study participants with MACE had worse LA performance parameters compared with study participants without MACE (εs = 21.2% vs 16.2%, εe = 8.8% vs 6.9%, εa = 11.8% vs 10%; P < .001 for all). All atrial parameters were strongly associated with MACE (hazard ratio [HR], εs = 0.9, εe = 0.88, εa = 0.89; P < .001 for all). For εs, a cutoff of 18.8% was identified as the only independent atrial parameter with which to predict MACE after accounting for confounders and established prognostic markers in adjusted analysis (HR, 0.95; P = .02). The εs yielded incremental prognostic value above left ventricular ejection fraction, global longitudinal strain, microvascular obstruction, and infarct size (AUC comparisons, P < .04 for all). Conclusion Feature tracking of cardiac MRI to derive left atrial peak reservoir strain provided incremental prognostic value for major adverse cardiovascular events prediction versus established cardiac risk factors after acute myocardial infarction. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Almeida in this issue.
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Affiliation(s)
- Andreas Schuster
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Sören J Backhaus
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Thomas Stiermaier
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Jenny-Lou Navarra
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Johannes Uhlig
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Karl-Philipp Rommel
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Alexander Koschalka
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Johannes T Kowallick
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Joachim Lotz
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Matthias Gutberlet
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Boris Bigalke
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Shelby Kutty
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Gerd Hasenfuss
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Holger Thiele
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
| | - Ingo Eitel
- From the Department of Cardiology, 5th Floor, Acute Services Building, Royal North Shore Hospital, Reserve Road, St Leonard's, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, NSW, 2065, Australia (A.S.); Department of Cardiology and Pneumology (A.S., S.J.B., J.L.N., A.K., G.H.) and Institute for Diagnostic and Interventional Radiology (J.U., J.T.K., J.L.), University Medical Center Göttingen, Georg-August University, Göttingen, Germany; German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany (A.S., S.J.B., J.L.N., A.K., G.H., J.U., J.T.K., J.L.) ; University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany (T.S., I.E.); German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany (T.S., I.E.); Departments of Internal Medicine/Cardiology (K.P.R., H.T.) and Radiology (M.G.), Heart Center Leipzig, University of Leipzig, Leipzig, Germany; Charité Campus Benjamin Franklin, Department of Cardiology, University Medical Center Berlin, Berlin, Germany (B.B.); and Helen B. Taussig Heart Center, The Johns Hopkins Hospital and School of Medicine, Baltimore, MD (S.K.)
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuss G, Kowallick JT, Schuster A. P5284Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0255] [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
Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a “real-world” clinical setting.
Methods
Three-hundred CMR examinations were randomly selected from the local data base. Fully automatic quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software. Parameters were compared to manual assessments. Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF).
Results
Biventricular automatic segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias −2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73–0.91; RV parameters ICC 0.41–0.94) and/or reduced image quality (LV parameters ICC 0.86–0.95; RV parameters ICC 0.56–0.91), which was more common on 3.0T than on 1.5T.
Conclusions
Fully automated assessment of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring is still required.
Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
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Affiliation(s)
| | - W Staab
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - M Steinmetz
- University Medical Center Göttingen, Department of Pediatric Cardiology and Intensive Care Medicine, Goettingen, Germany
| | - C O Ritter
- 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
| | - G Hasenfuss
- Heart Centre Goettingen, Goettingen, Germany
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Koschalka A, Navarra JL, Lotz J, Kutty S, Bigalke B, Gutberlet M, Feistritzer HJ, Hasenfuss G, Thiele H, Eitel I, Schuster A. P5255Culprit vessel related myocardial mechanics and prognostic implications following acute myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0226] [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
Prognosis in acute myocardial infarction (AMI) depends on the amount of infarct related artery (IRA) subtended myocardium and associated damage but has not been described in great detail. Consequently, we sought to describe IRA associated pathophysiological consequences using cardiac magnetic resonance (CMR).
Methods
1235 AMI patients (n=795 ST-elevation (STEMI) and 440 non-STEMI) underwent CMR following percutaneous coronary intervention. Blinded core-laboratory data were compared according to left anterior descending (LAD), left circumflex (LCx) and right coronary artery (RCA) regarding major adverse clinical events (MACE) within 12 months. Left ventricular (LV) global longitudinal/circumferential/radial (GLS/GCS/GRS) as well as left atrial (LA) total (εs), passive (εe) and active (εa) strains were determined using CMR-feature tracking. Tissue characterisation included infarct size (IS) and microvascular obstruction.
Results
LAD and LCx were associated with higher mortality compared to RCA lesions (4.6% and 4.4% vs 1.6%). LAD lesions showed largest IS (16.8%), largest ventricular (LV ejection fraction (EF) 47.4%, GLS −13.2%, GCS −20.8%) and atrial (εs 20.2%) impairment. There was less impairment in LCx (IS 11.8%, LVEF 50.8%, GLS −17.4%, GCS −25.0%, εs 20.7%) followed by RCA lesions (IS 11.3%, LVEF 50.8%, GLS −19.1%, GCS −26.6%, εs 21.7%). In AUC analyses εs (LAD, RCA) and GLS (LCx) best predicted MACE (AUC>0.69). Multivariate analyses identified εs (p=0.017) in LAD and GLS (p=0.034) in LCx infarcts as independent predictors of MACE.
Conclusions
CMR allows IRA specific phenotyping and characterisation of morphologic and functional changes. These alterations carry infarct specific prognostic implications and may represent novel diagnostic and therapeutic targets following AMI.
Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
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Affiliation(s)
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - T Stiermaier
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - T Lange
- Heart Centre Goettingen, Goettingen, Germany
| | - A Koschalka
- Heart Centre Goettingen, Goettingen, Germany
| | - J L Navarra
- Heart Centre Goettingen, Goettingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S Kutty
- Children's Hospital and Medical Center, Omaha, 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
| | | | - G Hasenfuss
- Heart Centre Goettingen, Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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Backhaus SJ, Kowallick JT, Stiermaier T, Lange T, Koschalka A, Navarra JL, Lotz J, Kutty S, Bigalke B, Gutberlet M, Hasenfuss G, Thiele H, Eitel I, Schuster A. P3097Atrioventricular mechanical coupling and major adverse cardiac events in female patients following acute ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0173] [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
Data on sex-specific outcomes following myocardial infarction (MI) are inconclusive with some evidence suggesting association of female sex and increased major adverse clinical events (MACE). Since underlying mechanisms remain elusive, we aimed to quantify the underlying phenotype using cardiovascular magnetic resonance (CMR) quantitative deformation imaging and tissue characterisation.
Methods
Amongst 8 centres across Germany, 795 ST-elevation MI (STEMI) patients underwent post-interventional CMR imaging. CMR feature-tracking (FT) was performed in a blinded core-laboratory. Left ventricular function was quantified using ejection fraction (LVEF) and global longitudinal/circumferential/radial strains (GLS/GCS/GRS). Left atrial function was assessed by reservoir (εs), conduit (εe) and booster pump function (εa). Tissue characterisation included infarct size (IS), microvascular obstruction (MO), area at risk and myocardial salvage index (MSI). Primary endpoint was the occurrence of major adverse clinical events (MACE) within 1 year.
Results
Female sex was associated with increased MACE (HR 1.96, 95% CI 1.13–3.42, p=0.017) but not independently of baseline confounders (p=0.526) with women being older, more often diabetic and hypertensive (p<0.001) and of higher Killip-class (p=0.010). Tissue characterisation was similar between sexes. Women showed impaired atrial (εs p=0.011, εe p<0.001) but increased systolic ventricular mechanics (GLS p=0.001, LVEF p=0.048). Ventricular strain was associated with MACE irrespective of all univariate significant baseline characteristics (GLS HR 1.08, 95% CI 1.01–1.16, p=0.036 and GCS HR 1.07, 95% CI 1.00–1.14, p=0.040).
Conclusion
Atrial function is reduced in women following STEMI, while ventricular systolic function is increased. This may reflect ventricular diastolic failure with systolic compensation, which is independently associated with MACE and may add to sex-specific prognosis evaluation.
Acknowledgement/Funding
DZHK - German Centre for Cardiovascular Research
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Affiliation(s)
| | - J T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - T Stiermaier
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - T Lange
- Heart Centre Goettingen, Goettingen, Germany
| | - A Koschalka
- Heart Centre Goettingen, Goettingen, Germany
| | - J L Navarra
- Heart Centre Goettingen, Goettingen, Germany
| | - J Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - S Kutty
- Children's Hospital and Medical Center, Omaha, 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
| | - G Hasenfuss
- Heart Centre Goettingen, Goettingen, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
| | - I Eitel
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - A Schuster
- Heart Centre Goettingen, Goettingen, Germany
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Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Uhlig J, Freund A, Kowallick JT, Gertz RJ, Bigalke B, Villa A, Lotz J, Hasenfuß G, Thiele H, Eitel I, Schuster A. Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study. Eur Heart J Cardiovasc Imaging 2019; 20:1059-1069. [DOI: 10.1093/ehjci/jey219] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
AbstractAimsThe exact pathophysiology of Takotsubo syndrome (TTS) remains not fully understood with most studies focussing on ventricular pathology. Since atrial involvement may have a significant role, we assessed the diagnostic and prognostic potential of atrial cardiovascular magnetic resonance feature tracking (CMR-FT) in TTS.Methods and resultsThis multicentre study recruited 152 TTS patients who underwent CMR on average within 3 days after hospitalization. Reservoir [total strain εs and peak positive strain rate (SR) SRs], conduit (passive strain εe and peak early negative SRe), and booster pump function (active strain εa and peak late negative SRa) were assessed in a core laboratory. Results were compared with 21 control patients with normal biventricular function. A total of 20 patients underwent follow-up CMR (median 3.5 months, interquartile range 3–5). All patients were approached for general follow-up. Left atrial (LA) but not right atrial (RA) reservoir and conduit function were impaired during the acute phase (εs: P = 0.043, εe: P < 0.001, SRe: P = 0.047 vs. controls) and recovered until follow-up (εs: P < 0.001, SRs: P = 0.04, εe: P = 0.001, SRe: P = 0.04). LA and RA booster pump function were increased in the acute setting (LA-εa: P = 0.045, SRa: P = 0.002 and RA-εa: P = 0.004, SRa: P = 0.002 vs. controls). LA-εs predicted mortality [hazard ratio 1.10, 95% confidence interval (CI) 1.01–1.20; P = 0.037] irrespectively of established cardiovascular risk factors (P = 0.019, multivariate analysis) including left ventricular ejection fraction (LVEF) (area under the curve 0.71, 95% CI 0.55–0.86, P = 0.048).ConclusionTTS pathophysiology comprises transient impairments in LA reservoir and conduit functions and enhanced bi-atrial active booster pump functions. Atrial CMR-FT may evolve as a superior marker of adverse events over and above established parameters such as LVEF and atrial volume.
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Affiliation(s)
- Sören J Backhaus
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Thomas Stiermaier
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Torben Lange
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, SW1 7EH London, UK
| | - Johannes Uhlig
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Anne Freund
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Roman J Gertz
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Boris Bigalke
- Department of Cardiology and Pneumology, Charité Campus Benjamin Franklin, University Medical Center Berlin, Hindenburgdamm 30, 12203 Berlin, Germany
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, Department of Cardiovascular Imaging, King’s College London, St Thomas’ Hospital, Westminster Bridge Road, SW1 7EH London, UK
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, Heart Center Leipzig, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany
| | - Ingo Eitel
- Department of Cardiology/Angiology/Intensive Care Medicine, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, Georg-August University, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Str. 42a, 37075 Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, 5th Floor, Acute Services Building, Reserve Road, St Leonard’s, Sydney, NSW 2065, Australia
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Stiermaier T, Backhaus SJ, Lange T, Koschalka A, Navarra JL, Boom P, Lamata P, Kowallick JT, Lotz J, Gutberlet M, de Waha-Thiele S, Desch S, Hasenfuß G, Thiele H, Eitel I, Schuster A. Cardiac Magnetic Resonance Left Ventricular Mechanical Uniformity Alterations for Risk Assessment After Acute Myocardial Infarction. J Am Heart Assoc 2019; 8:e011576. [PMID: 31387432 PMCID: PMC6759895 DOI: 10.1161/jaha.118.011576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Despite limitations as a stand-alone parameter, left ventricular (LV) ejection fraction is the preferred measure of myocardial function and marker for postinfarction risk stratification. LV myocardial uniformity alterations may provide superior prognostic information after acute myocardial infarction, which was the subject of this study. Methods and Results Consecutive patients with acute myocardial infarction (n=1082; median age: 63 years; 75% male) undergoing cardiac magnetic resonance at a median of 3 days after infarction were included in this multicenter observational study. Circumferential and radial uniformity ratio estimates were derived from cardiac magnetic resonance feature tracking as markers of mechanical uniformity alterations (values between 0 and 1 with 1 reflecting perfect uniformity). The clinical end point was the 12-month rate of major adverse cardiac events, consisting of all-cause death, reinfarction, and new congestive heart failure. Patients with major adverse cardiac events (n=73) had significantly impaired circumferential uniformity ratio estimates (0.76 [interquartile range: 0.67-0.86] versus 0.84 [interquartile range: 0.76-0.89]; P<0.001) and radial uniformity ratio estimates (0.69 [interquartile range: 0.60-0.79] versus 0.76 [interquartile range: 0.67-0.83]; P<0.001) compared with patients without events. Although uniformity estimates did not provide independent prognostic information in the overall cohort, a circumferential uniformity ratio estimate below the median of 0.84 emerged as an independent predictor of outcome in postinfarction patients with LV ejection fraction >35% (n=959), even after adjustment for established risk factors (hazard ratio: 1.99; 95% CI, 1.06-3.74; P=0.033 in multivariable Cox regression analysis). In contrast, LV ejection fraction was not associated with adverse events in this subgroup of patients with acute myocardial infarction. Conclusions Cardiac magnetic resonance-derived estimates of mechanical uniformity alterations are novel markers for risk assessment after acute myocardial infarction, and the circumferential uniformity ratio estimate provides independent prognostic information for patients with preserved or only moderately reduced LV ejection fraction.
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Affiliation(s)
- Thomas Stiermaier
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center Lübeck University Hospital Schleswig-Holstein Lübeck Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Sören J Backhaus
- Department of Cardiology and Pneumology University Medical Center Göttingen Georg-August University Göttingen Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Torben Lange
- Department of Cardiology and Pneumology University Medical Center Göttingen Georg-August University Göttingen Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Alexander Koschalka
- Department of Cardiology and Pneumology University Medical Center Göttingen Georg-August University Göttingen Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Jenny-Lou Navarra
- Department of Cardiology and Pneumology University Medical Center Göttingen Georg-August University Göttingen Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Patricia Boom
- Department of Cardiology and Pneumology University Medical Center Göttingen Georg-August University Göttingen Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Pablo Lamata
- Department of Biomedical Engineering School of Biomedical Engineering and Imaging Sciences King's College of London London United Kingdom
| | - Johannes T Kowallick
- German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Institute for Diagnostic and Interventional Radiology University Medical Center Göttingen Georg-August University Göttingen Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Institute for Diagnostic and Interventional Radiology University Medical Center Göttingen Georg-August University Göttingen Germany
| | - Matthias Gutberlet
- Department of Radiology Heart Center Leipzig at University of Leipzig Germany
| | - Suzanne de Waha-Thiele
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center Lübeck University Hospital Schleswig-Holstein Lübeck Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Steffen Desch
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology University Medical Center Göttingen Georg-August University Göttingen Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig Germany
| | - Ingo Eitel
- Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) University Heart Center Lübeck University Hospital Schleswig-Holstein Lübeck Germany.,German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology University Medical Center Göttingen Georg-August University Göttingen Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen Göttingen Germany.,Department of Biomedical Engineering School of Biomedical Engineering and Imaging Sciences King's College of London London United Kingdom.,Department of Cardiology Royal North Shore Hospital The Kolling Institute Northern Clinical School University of Sydney Australia
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Backhaus SJ, Staab W, Steinmetz M, Ritter CO, Lotz J, Hasenfuß G, Schuster A, Kowallick JT. Fully automated quantification of biventricular volumes and function in cardiovascular magnetic resonance: applicability to clinical routine settings. J Cardiovasc Magn Reson 2019; 21:24. [PMID: 31023305 PMCID: PMC8059518 DOI: 10.1186/s12968-019-0532-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 03/12/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance (CMR) represents the clinical gold standard for the assessment of biventricular morphology and function. Since manual post-processing is time-consuming and prone to observer variability, efforts have been directed towards automated volumetric quantification. In this study, we sought to validate the accuracy of a novel approach providing fully automated quantification of biventricular volumes and function in a "real-world" clinical setting. METHODS Three-hundred CMR examinations were randomly selected from the local data base. Fully automated quantification of left ventricular (LV) mass, LV and right ventricular (RV) end-diastolic and end-systolic volumes (EDV/ESV), stroke volume (SV) and ejection fraction (EF) were performed overnight using commercially available software (suiteHEART®, Neosoft, Pewaukee, Wisconsin, USA). Parameters were compared to manual assessments (QMass®, Medis Medical Imaging Systems, Leiden, Netherlands). Sub-group analyses were further performed according to image quality, scanner field strength, the presence of implanted aortic valves and repaired Tetralogy of Fallot (ToF). RESULTS Biventricular automated segmentation was feasible in all 300 cases. Overall agreement between fully automated and manually derived LV parameters was good (LV-EF: intra-class correlation coefficient [ICC] 0.95; bias - 2.5% [SD 5.9%]), whilst RV agreement was lower (RV-EF: ICC 0.72; bias 5.8% [SD 9.6%]). Lowest agreement was observed in case of severely altered anatomy, e.g. marked RV dilation but normal LV dimensions in repaired ToF (LV parameters ICC 0.73-0.91; RV parameters ICC 0.41-0.94) and/or reduced image quality (LV parameters ICC 0.86-0.95; RV parameters ICC 0.56-0.91), which was more common on 3.0 T than on 1.5 T. CONCLUSIONS Fully automated assessments of biventricular morphology and function is robust and accurate in a clinical routine setting with good image quality and can be performed without any user interaction. However, in case of demanding anatomy (e.g. repaired ToF, severe LV hypertrophy) or reduced image quality, quality check and manual re-contouring are still required.
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Affiliation(s)
- Sören J. Backhaus
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Wieland Staab
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Michael Steinmetz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Christian O. Ritter
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
| | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
| | - Andreas Schuster
- Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany
- Institute for Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Georg-August University, Robert-Koch-Str. 40, 37075 Göttingen, Germany
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46
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Backhaus SJ, Metschies G, Billing M, Kowallick JT, Gertz RJ, Lapinskas T, Pieske B, Lotz J, Bigalke B, Kutty S, Hasenfuß G, Beerbaum P, Kelle S, Schuster A. Cardiovascular magnetic resonance imaging feature tracking: Impact of training on observer performance and reproducibility. PLoS One 2019; 14:e0210127. [PMID: 30682045 PMCID: PMC6347155 DOI: 10.1371/journal.pone.0210127] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 12/16/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Cardiovascular magnetic resonance feature tracking (CMR-FT) is increasingly used for myocardial deformation assessment including ventricular strain, showing prognostic value beyond established risk markers if used in experienced centres. Little is known about the impact of appropriate training on CMR-FT performance. Consequently, this study aimed to evaluate the impact of training on observer variance using different commercially available CMR-FT software. METHODS Intra- and inter-observer reproducibility was assessed prior to and after dedicated one-hour observer training. Employed FT software included 3 different commercially available platforms (TomTec, Medis, Circle). Left (LV) and right (RV) ventricular global longitudinal as well as LV circumferential and radial strains (GLS, GCS and GRS) were studied in 12 heart failure patients and 12 healthy volunteers. RESULTS Training improved intra- and inter-observer reproducibility. GCS and LV GLS showed the highest reproducibility before (ICC >0.86 and >0.81) and after training (ICC >0.91 and >0.92). RV GLS and GRS were more susceptible to tracking inaccuracies and reproducibility was lower. Inter-observer reproducibility was lower than intra-observer reproducibility prior to training with more pronounced improvements after training. Before training, LV strain reproducibility was lower in healthy volunteers as compared to patients with no differences after training. Whilst LV strain reproducibility was sufficient within individual software solutions inter-software comparisons revealed considerable software related variance. CONCLUSION Observer experience is an important source of variance in CMR-FT derived strain assessment. Dedicated observer training significantly improves reproducibility with most profound benefits in states of high myocardial contractility and potential to facilitate widespread clinical implementation due to optimized robustness and diagnostic performance.
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Affiliation(s)
- Sören J. Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Georg Metschies
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Marcus Billing
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Roman J. Gertz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Tomas Lapinskas
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Burkert Pieske
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Boris Bigalke
- Charité Campus Benjamin Franklin, University Medical Center Berlin, Department of Cardiology and Pneumology, Berlin, Germany
| | - Shelby Kutty
- Children's Hospital and Medical Center, University of Nebraska College of Medicine, Omaha, United States of America
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Philipp Beerbaum
- Hanover Medical School, Department of Pediatric Cardiology and Intensive Care, Hanover, Germany
| | - Sebastian Kelle
- German Heart Center Berlin (DHZB), University of Berlin, Department of Internal Medicine / Cardiology, Charité Campus Virchow Clinic, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Nothern Clinical School, University of Sydney, Sydney, Australia
- * E-mail:
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47
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Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Lamata P, Uhlig J, Kowallick JT, Raaz U, Villa A, Lotz J, Hasenfuß G, Thiele H, Eitel I, Schuster A. Temporal changes within mechanical dyssynchrony and rotational mechanics in Takotsubo syndrome: A cardiovascular magnetic resonance imaging study. Int J Cardiol 2018; 273:256-262. [PMID: 30195843 PMCID: PMC6236127 DOI: 10.1016/j.ijcard.2018.04.088] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 04/13/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND The pathophysiological significance of dyssynchrony and rotation in Takotsubo syndrome (TTS) is unknown. We aimed to define the influence of cardiovascular magnetic resonance feature tracking (CMR-FT) dyssynchrony and rotational mechanics in acute and during clinical course of TTS. METHODS This multicenter study included 152 TTS patients undergoing CMR (mean 3 days after symptom onset). Apical, midventricular and basal short axis views were analysed in a core-laboratory. Systolic torsion, diastolic recoil and dyssynchrony expressed as circumferential and radial uniformity ratio estimates (CURE and RURE: 0 to 1; 1 = perfect synchrony) were compared to a matched control group (n = 21). Follow-up CMR (n = 20 patients; mean 62 days, SD 7.2) and general follow-up (n = 136; mean 3.3 years, SD 2.4) were performed. RESULTS CURE was initially reduced compared to controls (p = 0.001) and recovered at follow-up (p < 0.001) as opposed to RURE (p = 0.116 and p = 0.179). CURE and RURE discriminated between ballooning patterns (p = 0.001 and p = 0.045). Recoil was generally impaired during the acute phase (p = 0.015), torsion only in highly dyssynchronous patients (p = 0.024). Diabetes (p = 0.007), physical triggers (p = 0.013) and malignancies (p = 0.001) predicted mortality. The latter showed a distinct association with impaired torsion (p = 0.042) and dyssynchrony (p = 0.047). Physical triggers and malignancies were related to biventricular impairment (p = 0.004 and p = 0.026), showing higher dyssynchrony (p < 0.01), greater reduction of left ventricular function (p < 0.001) and a strong trend towards increased mortality (p = 0.074). CONCLUSION Transient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with different severities according to the pattern of ballooning. Patients with malignancies and precipitating physical triggers frequently show biventricular affection, greater dyssynchrony and high mortality risk.
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Affiliation(s)
- Sören J Backhaus
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Pablo Lamata
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Johannes Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Johannes T Kowallick
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Uwe Raaz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Joachim Lotz
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Heart Center Leipzig, University of Leipzig, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany.
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen Germany and German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany; Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia.
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Eitel I, Stiermaier T, Lange T, Rommel KP, Koschalka A, Kowallick JT, Lotz J, Kutty S, Gutberlet M, Hasenfuß G, Thiele H, Schuster A. Cardiac Magnetic Resonance Myocardial Feature Tracking for Optimized Prediction of Cardiovascular Events Following Myocardial Infarction. JACC Cardiovasc Imaging 2018; 11:1433-1444. [DOI: 10.1016/j.jcmg.2017.11.034] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 11/15/2017] [Accepted: 11/27/2017] [Indexed: 12/17/2022]
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Stiermaier T, Lange T, Chiribiri A, Möller C, Graf T, Raaz U, Villa A, Kowallick JT, Lotz J, Hasenfuß G, Thiele H, Schuster A, Eitel I. Right ventricular strain assessment by cardiovascular magnetic resonance myocardial feature tracking allows optimized risk stratification in Takotsubo syndrome. PLoS One 2018; 13:e0202146. [PMID: 30157266 PMCID: PMC6114723 DOI: 10.1371/journal.pone.0202146] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/27/2018] [Indexed: 12/18/2022] Open
Abstract
Background A substantial number of patients with Takotsubo syndrome (TTS) exhibit right ventricular (RV) dysfunction which has been associated with adverse outcome. The aim of this study was to assess the clinical and prognostic value of RV myocardial strain in TTS using cardiovascular magnetic resonance myocardial feature tracking (CMR-FT). Methods CMR-FT was performed in a core laboratory to determine RV longitudinal strain in 134 TTS patients undergoing CMR in median 2 days after admission to 2 experienced centers. For comparison, RV involvement was evaluated by sole visual assessment concerning RV contraction abnormalities. Both approaches were analyzed regarding their long-term prognostic value. Results The peak global RV longitudinal strain was in median -19%. Segmental analyses located contraction abnormalities primarily in the apical parts of the right ventricle. Sole visual assessment identified 38 patients (28%) with RV involvement. These patients showed a numerically higher long-term mortality without reaching statistical significance (17.1% versus 10.5%; hazard ratio 1.38 [95% confidence interval 0.49–3.88]; p = 0.31). The optimal RV strain cutoff value for risk prediction was -17.24%. Stratification according to this threshold categorized 41% of TTS patients (n = 55) in the high-risk group which demonstrated a significantly increased long-term mortality compared to patients with preserved global RV strain (20.0% versus 7.0%; hazard ratio 2.98 [95% confidence interval 1.02–8.73]; p = 0.03). Conclusions The assessment of RV myocardial strain using CMR-FT enables an accurate evaluation of RV involvement in TTS and represents a promising approach for optimized risk stratification.
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Affiliation(s)
- Thomas Stiermaier
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Torben Lange
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Amedeo Chiribiri
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Christian Möller
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Tobias Graf
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Uwe Raaz
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Adriana Villa
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Johannes T. Kowallick
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Joachim Lotz
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany
| | - Gerd Hasenfuß
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Holger Thiele
- Heart Center Leipzig – University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany
| | - Andreas Schuster
- University Medical Center Göttingen, Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
- University of Sydney, The Kolling Institute, Northern Clinical School, Royal North Shore Hospital, Department of Cardiology, Sydney, Australia
| | - Ingo Eitel
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
- German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, Lübeck, Germany
- * E-mail:
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50
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Schuster A, Backhaus SJ, Stiermaier T, Navarra JL, Uhlig J, Rommel KP, Koschalka A, Kowallick JT, Lotz J, Bigalke B, Kutty S, Hasenfus G, Eitel I. P3695Quantitative left atrial function allows optimized prediction of cardiovascular events following myocardial infarction: a cardiovascular magnetic resonance imaging study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Schuster
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - S J Backhaus
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - T Stiermaier
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
| | - J L Navarra
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - J Uhlig
- University Medical Center Göttingen, Institute for Diagnostic and Interventional Radiology, Göttingen, Germany
| | - K P Rommel
- Heart Center of Leipzig, Leipzig, Germany
| | - A Koschalka
- Georg-August University, Department of Cardiology and Pneumology, 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, Berlin, Germany
| | - S Kutty
- Children's Hospital and Medical Center, Omaha, United States of America
| | - G Hasenfus
- Georg-August University, Department of Cardiology and Pneumology, Göttingen, Germany
| | - I Eitel
- Medical University, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), Lübeck, Germany
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