1
|
McElhinney DB, Aboulhosn JA, Dvir D, Whisenant B, Zhang Y, Eicken A, Ribichini F, Tzifa A, Hainstock MR, Martin MH, Kornowski R, Schubert S, Latib A, Thomson JD, Torres AJ, Meadows J, Delaney JW, Guerrero ME, Salizzoni S, El-Said H, Finkelstein A, George I, Gewillig M, Alvarez-Fuente M, Lamers L, Cheema AN, Kreutzer JN, Rudolph T, Hildick-Smith D, Cabalka AK, Boudjemline Y, Milani G, Bocks ML, Asnes JD, Mahadevan V, Himbert D, Goldstein BH, Fagan TE, Cheatham JP, Momenah TS, Kim DW, Colombo A, Ancona M, Butera G, Forbes TJ, Horlick E, Pedra C, Alfonsi J, Jones TK, Foerster S, Shahanavaz S, Crittendon I, Schranz D, Qureshi A, Thomas M, Kenny DP, Hoyer M, Bleiziffer S, Kefer J, Testa L, Gillespie M, Khan D, Pass RH, Abdel-Wahab M, Wijeysundera H, Casselman F, Moe T, Hayes N, Alli O, Nayak KR, Patel P, Piazza N, Seaman C, Windecker S, Kuo J, Ing FF, Makkar RR, Greif M, Cerillio AG, Champagnac D, Nietlispach F, Maisano F, Treede H, Seiffert M, Teles RC, Feuchtner G, Bonaros N, Bruschi G, Pesarini G. Mid-Term Valve-Related Outcomes After Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement. J Am Coll Cardiol 2019; 73:148-157. [DOI: 10.1016/j.jacc.2018.10.051] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Revised: 09/30/2018] [Accepted: 10/08/2018] [Indexed: 12/19/2022]
|
2
|
Hoppmann P, Dirschinger R, Greif M, Bleiziffer S, Laugwitz KL, Kupatt C. Right ventricular fistula post-TAVR: amenable to interventional closure treatment. Clin Res Cardiol 2017; 106:846-848. [PMID: 28656477 DOI: 10.1007/s00392-017-1130-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Accepted: 06/12/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Petra Hoppmann
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany
| | - Ralf Dirschinger
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany
| | - Martin Greif
- Heart and lung center Ebersberg, Altstadtpassage 6, 85560, Ebersberg, Germany
| | | | - Karl-Ludwig Laugwitz
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany
| | - Christian Kupatt
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
- Munich Heart Alliance, DZHK Site Munich, Munich, Germany.
| |
Collapse
|
3
|
Bongiovanni D, Kühl C, Bleiziffer S, Stecher L, Poch F, Greif M, Mehilli J, Massberg S, Frey N, Lange R, Laugwitz KL, Schymik G, Frank D, Kupatt C. Emergency treatment of decompensated aortic stenosis. Heart 2017; 104:23-29. [PMID: 28566471 DOI: 10.1136/heartjnl-2016-311037] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [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: 01/14/2017] [Revised: 04/24/2017] [Accepted: 04/25/2017] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE The optimal treatment of patients with acute and severe decompensation of aortic stenosis is unclear due to recent advances in transcatheter interventions and supportive therapies. Our aim was to assess the early outcome of emergency transcatheter aortic valve implantation (eTAVI) versus emergency balloon aortic valvuloplasty (eBAV) followed by TAVI under elective circumstances. METHODS Emergency conditions were defined as: cardiogenic shock with requirement of catecholamine therapy, severe acute dyspnoea (NYHA IV), cardiac resuscitation or mechanic respiratory support. The data were collected according to the Valve Academic Research Consortium 2 (VARC-2) criteria. RESULTS In five German centres, 23 patients (logistic Euroscore 37.7%±18.1) underwent eTAVI and 118 patients underwent eBAV (logistic Euroscore 35.3%±20.8). In the eTAVI group, immediate procedural mortality was 8.7%, compared with 20.3% for the eBAV group (p=0.19). After 30 days, cardiovascular mortality for the eTAVI group was 23.8% and for the eBAV group 33.0% (p=0.40). Analyses adjusting for potential confounders did not provide evidence of a difference between groups. Of note, the elective TAVI performed after eBAV (n=32, logistic Euroscore 25.9%±13.9) displayed an immediate procedural mortality of 9.4% and a cardiovascular mortality after 30 days of 15.6%. Major vascular complications were significantly more likely to occur after eTAVI (p=0.01) as well as stroke (p=0.01). CONCLUSION In this multicentre cohort, immediate procedural and 30-day mortality of eTAVI and eBAV were high, and mortality of secondary TAVI subsequent to eBAV was higher than expected. Randomised study data are required to define the role of emergency TAVI in tertiary care centres with current device generations.
Collapse
Affiliation(s)
- Dario Bongiovanni
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Constantin Kühl
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Sabine Bleiziffer
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Lynne Stecher
- Institut für Medizinische Statistik und Epidemiologie, Technical University of Munich, Munich, Germany
| | - Felix Poch
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Greif
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, LMU University, Munich, Germany
| | - Julinda Mehilli
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, LMU University, Munich, Germany
| | - Steffen Massberg
- Medizinische Klinik und Poliklinik I, Klinikum Großhadern, LMU University, Munich, Germany
| | - Norbert Frey
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Rüdiger Lange
- Clinic for Cardiovascular Surgery, German Heart Center Munich, Munich, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Gerhard Schymik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Derk Frank
- Klinik für Innere Medizin III, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Christian Kupatt
- I. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| |
Collapse
|
4
|
Schuler A, Greif M, Seitsonen AP, Mette G, Castiglioni L, Osterwalder J, Hengsberger M. Sensitivity of photoelectron diffraction to conformational changes of adsorbed molecules: Tetra-tert-butyl-azobenzene/Au(111). Struct Dyn 2017; 4:015101. [PMID: 28217715 PMCID: PMC5291794 DOI: 10.1063/1.4975594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 01/23/2017] [Indexed: 06/06/2023]
Abstract
Electron diffraction is a standard tool to investigate the atomic structure of surfaces, interfaces, and adsorbate systems. In particular, photoelectron diffraction is a promising candidate for real-time studies of structural dynamics combining the ultimate time resolution of optical pulses and the high scattering cross-sections for electrons. In view of future time-resolved experiments from molecular layers, we studied the sensitivity of photoelectron diffraction to conformational changes of only a small fraction of molecules in a monolayer adsorbed on a metallic substrate. 3,3',5,5'-tetra-tert-butyl-azobenzene served as test case. This molecule can be switched between two isomers, trans and cis, by absorption of ultraviolet light. X-ray photoelectron diffraction patterns were recorded from tetra-tert-butyl-azobenzene/Au(111) in thermal equilibrium at room temperature and compared to patterns taken in the photostationary state obtained by exposing the surface to radiation from a high-intensity helium discharge lamp. Difference patterns were simulated by means of multiple-scattering calculations, which allowed us to determine the fraction of molecules that underwent isomerization.
Collapse
Affiliation(s)
- A Schuler
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - M Greif
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - A P Seitsonen
- Département de Chimie, Ecole Normale Surpérieure , 24, Rue Lhomond, 75005 Paris, France
| | | | - L Castiglioni
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - J Osterwalder
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| | - M Hengsberger
- Physik-Institut, Universität Zürich , Winterthurerstrasse 190, 8057 Zürich, Switzerland
| |
Collapse
|
5
|
Mehilli J, Jochheim D, Abdel-Wahab M, Rizas K, Theiss H, Spenkuch N, Zadrozny M, Baquet M, El-Mawardy M, Sato T, Lange P, Kuppatt C, Greif M, Hausleiter J, Bauer A, Schwarz F, Pichlmaier M, Hagl C, Richardt G, Massberg S. One-year outcomes with two suture-mediated closure devices to achieve access-site haemostasis following transfemoral transcatheter aortic valve implantation. EUROINTERVENTION 2016; 12:1298-1304. [DOI: 10.4244/eijv12i10a213] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
6
|
Steffen J, Köhler A, Schwarz F, Sadoni S, Hagl C, Massberg S, Greif M. A Left-to-Right Shunt After Transfemoral TAVR Using Edwards SAPIEN 3. J Heart Valve Dis 2016; 25:491-493. [PMID: 28009955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is used for the treatment of aortic stenosis (AS). Besides major bleeding, conduction blocks, stroke or atrial fibrillation, complications include cardiac perforation with possible left-to-right-shunts. Herein is reported the sixth case of a left-to-right shunt in an 87-year-old man who underwent TAVR using a 29 mm Edwards SAPIEN S3 prosthesis to treat AS. Soon after the procedure, a small channel evolving from the right coronary cusp could be detected on echocardiography. The patient was managed medically.
Collapse
Affiliation(s)
- Julius Steffen
- Department of Cardiology, Ludwig Maximilians University (LMU), Munich, Germany. Electrronic correspondence:
| | - Anton Köhler
- Department of Cardiology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Florian Schwarz
- Department of Radiology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Sebastian Sadoni
- Department of Cardiac Surgery, Ludwig Maximilians University (LMU), Munich, Germany
| | - Christian Hagl
- Department of Cardiac Surgery, Ludwig Maximilians University (LMU), Munich, Germany
| | - Steffen Massberg
- Department of Cardiology, Ludwig Maximilians University (LMU), Munich, Germany
| | - Martin Greif
- Department of Cardiology, Ludwig Maximilians University (LMU), Munich, Germany
| |
Collapse
|
7
|
Lucchini M, Castiglioni L, Kasmi L, Kliuiev P, Ludwig A, Greif M, Osterwalder J, Hengsberger M, Gallmann L, Keller U. Light-Matter Interaction at Surfaces in the Spatiotemporal Limit of Macroscopic Models. Phys Rev Lett 2015; 115:137401. [PMID: 26451581 DOI: 10.1103/physrevlett.115.137401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Indexed: 06/05/2023]
Abstract
What is the spatiotemporal limit of a macroscopic model that describes the optoelectronic interaction at the interface between different media? This fundamental question has become relevant for time-dependent photoemission from solid surfaces using probes that resolve attosecond electron dynamics on an atomic length scale. We address this fundamental question by investigating how ultrafast electron screening affects the infrared field distribution for a noble metal such as Cu(111) at the solid-vacuum interface. Attosecond photoemission delay measurements performed at different angles of incidence of the light allow us to study the detailed spatiotemporal dependence of the electromagnetic field distribution. Surprisingly, comparison with Monte Carlo semiclassical calculations reveals that the macroscopic Fresnel equations still properly describe the observed phase of the IR field on the Cu(111) surface on an atomic length and an attosecond time scale.
Collapse
Affiliation(s)
- M Lucchini
- Department of Physics, ETH Zurich, 8093 Zürich, Switzerland
| | - L Castiglioni
- Department of Physics, University of Zurich, 8057 Zürich, Switzerland
| | - L Kasmi
- Department of Physics, ETH Zurich, 8093 Zürich, Switzerland
| | - P Kliuiev
- Department of Physics, University of Zurich, 8057 Zürich, Switzerland
| | - A Ludwig
- Department of Physics, ETH Zurich, 8093 Zürich, Switzerland
| | - M Greif
- Department of Physics, University of Zurich, 8057 Zürich, Switzerland
| | - J Osterwalder
- Department of Physics, University of Zurich, 8057 Zürich, Switzerland
| | - M Hengsberger
- Department of Physics, University of Zurich, 8057 Zürich, Switzerland
| | - L Gallmann
- Department of Physics, ETH Zurich, 8093 Zürich, Switzerland
- Institute of Applied Physics, University of Bern, 3012 Bern, Switzerland
| | - U Keller
- Department of Physics, ETH Zurich, 8093 Zürich, Switzerland
| |
Collapse
|
8
|
Jochheim D, Zadrozny M, Theiss H, Baquet M, Maimer-Rodrigues F, Bauer A, Lange P, Greif M, Kupatt C, Hausleiter J, Hagl C, Massberg S, Mehilli J. Aortic regurgitation with second versus third-generation balloon-expandable prostheses in patients undergoing transcatheter aortic valve implantation. EUROINTERVENTION 2015; 11:214-20. [DOI: 10.4244/eijv11i2a40] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
9
|
Jochheim D, Egger A, Theiss H, Baquet M, Greif M, Hausleiter J, Mehilli J. TCT-707 Impact of Area Cover Index on the Incidence of Conduction Abnormalities after Implantation of Balloon-Expandable Aortic Prosthesis. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
10
|
Jochheim D, Zadrozny M, Theiss H, Baquet M, Greif M, Kupatt C, Hausleiter J, Massberg S, Mehilli J. TCT-712 Better Outcomes with Sapien 3 vsSapien XT balloon-expandable prosthesis in patients undergoing transfemoral aortic valve replacement. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
11
|
Muehling OM, Wakili R, Greif M, von Ziegler F, Morhard D, Brueckmann H, Becker A. Immediate and 12 months follow up of function and lead integrity after cranial MRI in 356 patients with conventional cardiac pacemakers. J Cardiovasc Magn Reson 2014; 16:39. [PMID: 24903354 PMCID: PMC4053551 DOI: 10.1186/1532-429x-16-39] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [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: 12/15/2013] [Accepted: 05/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Conventional cardiac pacemakers are still often regarded as a contraindication to magnetic resonance imaging (MRI). We conducted this study to support the hypothesis that it is safe to scan patients with cardiac pacemakers in a 1.5 Tesla MRI, if close supervision and monitoring as well as adequate pre- and postscan programming is provided. METHODS We followed up 356 patients (age 61.3 ± 9.1 yrs., 229 men) with single (n = 132) or dual chamber (n = 224) cardiac pacemakers and urgent indication for a cranial MRI for 12 months. The scans were performed at 1.5T. During the scan patients were monitored with a 3-lead ECG and pulse oximetry. Prior to the scan pacemakers were programmed according to our own protocol. RESULTS All 356 scans were completed without complications. No arrhythmias were induced, programmed parameters remained unchanged. No pacemaker dysfunction was identified. Follow-up examinations were performed immediately, 2 weeks, 2, 6, and 12 months after the scan. There was no significant change of pacing capture threshold (ventricular 0.9 ± 0.4 V@0.4 ms, atrial 0.9 ± 0.3 V@0.4 ms) immediately (ventricular 1.0 ± 0.3 V@0.4 ms, atrial 0.9 ± 0.4 V@0.4 ms) or at 12 months follow-up examinations (ventricular 0.9 ± 0.2 V@0.4 ms, atrial 0.9 ± 0.3 V@0.4 ms). There was no significant change in sensing threshold (8.0 ± 4.0 mV vs. 8.1 ± 4.2 mV ventricular lead, 2.0 ± 0.9 mV vs. 2.1 ± 1.0 mV atrial lead) or lead impedance (ventricular 584 ± 179 Ω vs. 578 ± 188 Ω, atrial 534 ± 176 Ω vs. 532 ± 169 Ω) after 12 months. CONCLUSIONS This supports the evidence that patients with conventional pacemakers can safely undergo cranial MRI in a 1.5T system with suitable preparation, supervision and precautions. Long term follow-up did not reveal significant changes in pacing capture nor sensing threshold.
Collapse
Affiliation(s)
- Olaf M Muehling
- Cardiology Clinic Harlaching, University of Munich, Munich, Germany
| | - Reza Wakili
- Department of Medicine, University of Munich, Munich, Germany
| | - Martin Greif
- Department of Medicine, University of Munich, Munich, Germany
| | | | - Dominik Morhard
- Department of Neuroradiology, University of Munich, Munich, Germany
| | | | | |
Collapse
|
12
|
Theiss HD, Greif M, Steinbeck G, Kupatt C, Franz WM. Balloon valvuloplasty for treatment of cardiogenic shock in the era of surgical valve replacement and TAVI. Intern Emerg Med 2014; 9:345-7. [PMID: 23824445 DOI: 10.1007/s11739-013-0972-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 06/24/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Hans D Theiss
- Medical Department I, Klinikum Grosshadern, Ludwig-Maximilians-University, Marchioninistr. 15, 81377, Munich, Germany,
| | | | | | | | | |
Collapse
|
13
|
von Ziegler F, Greif M, Tittus J, Schenzle J, Becker C, Becker A. Distribution of coronary calcifications in patients with suspected coronary heart disease. Am Heart J 2014; 167:568-75. [PMID: 24655707 DOI: 10.1016/j.ahj.2013.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 12/27/2013] [Indexed: 01/07/2023]
Abstract
BACKGROUND Coronary calcifications are a marker of coronary atherosclerosis. The role of coronary calcium scoring (CS) as part of the initial evaluation of patients with suspected coronary heart disease (CHD) is controversially discussed. The primary goal of this study was to characterize the coronary calcium distribution in this particular patient population. In a second step, we aimed to establish a possible clinical implication using CS for the diagnosis of CHD. METHODS Calcium scoring procedure was performed by either using a multidetector or a dual-source computed tomographic scanner. All patients underwent invasive coronary angiography (ICA) as the current criterion standard for CHD detection. A total of 4,137 (2,780 men, mean age 60.5 ± 12.4 years) consecutive patients were included. RESULTS Mean CS was 288 ± 446 (range 0-5,252). Overall coronary artery calcifications significantly increased with patients' age. In 2,048 patients (mean CS 101 ± 239, range 0-5252), significant CHD (≥50% stenosis) was excluded by ICA (1,939 patients without calcifications). In remaining 2,089 patients (51%, mean CS 607 ± 821, range 0-5,252), significant CHD was documented leading to intervention in 732 patients. A threshold of zero calcifications (existence of calcified tissue) had the best overall sensitivity and negative predictive value with 99%. Overall specificity with 34% and overall positive predictive value with 24% were rather low. CONCLUSION Coronary calcium scoring is able to exclude significant CHD in patients with suspected CHD with a high negative predictive value and, therefore, possibly reduce the number of invasive diagnostic examinations. Because of the low specificity and positive predictive value, CS cannot be used to indicate ICA.
Collapse
|
14
|
Bamberg F, Marcus RP, Becker A, Hildebrandt K, Bauner K, Schwarz F, Greif M, von Ziegler F, Bischoff B, Becker HC, Johnson TR, Reiser MF, Nikolaou K, Theisen D. Dynamic Myocardial CT Perfusion Imaging for Evaluation of Myocardial Ischemia as Determined by MR Imaging. JACC Cardiovasc Imaging 2014; 7:267-77. [DOI: 10.1016/j.jcmg.2013.06.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 05/30/2013] [Accepted: 06/13/2013] [Indexed: 10/25/2022]
|
15
|
Lange P, Greif M, Vogel A, Thaumann A, Helbig S, Schwarz F, Schmitz C, Becker C, D’Anastasi M, Boekstegers P, Pohl T, Laubender RP, Steinbeck G, Kupatt C. Reduction of pacemaker implantation rates after CoreValve® implantation by moderate predilatation. EUROINTERVENTION 2014; 9:1151-7. [DOI: 10.4244/eijv9i10a195] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
16
|
Kucher N, Boekstegers P, Müller OJ, Kupatt C, Beyer-Westendorf J, Heitzer T, Tebbe U, Horstkotte J, Müller R, Blessing E, Greif M, Lange P, Hoffmann RT, Werth S, Barmeyer A, Härtel D, Grünwald H, Empen K, Baumgartner I. Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. Circulation 2014; 129:479-86. [PMID: 24226805 DOI: 10.1161/circulationaha.113.005544] [Citation(s) in RCA: 636] [Impact Index Per Article: 63.6] [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: 12/29/2022]
Abstract
Background—
In patients with acute pulmonary embolism, systemic thrombolysis improves right ventricular (RV) dilatation, is associated with major bleeding, and is withheld in many patients at risk. This multicenter randomized, controlled trial investigated whether ultrasound-assisted catheter-directed thrombolysis (USAT) is superior to anticoagulation alone in the reversal of RV dilatation in intermediate-risk patients.
Methods and Results—
Fifty-nine patients (63±14 years) with acute main or lower lobe pulmonary embolism and echocardiographic RV to left ventricular dimension (RV/LV) ratio ≥1.0 were randomized to receive unfractionated heparin and an USAT regimen of 10 to 20 mg recombinant tissue plasminogen activator over 15 hours (n=30; USAT group) or unfractionated heparin alone (n=29; heparin group). Primary outcome was the difference in the RV/LV ratio from baseline to 24 hours. Safety outcomes included death, major and minor bleeding, and recurrent venous thromboembolism at 90 days. In the USAT group, the mean RV/LV ratio was reduced from 1.28±0.19 at baseline to 0.99±0.17 at 24 hours (
P
<0.001); in the heparin group, mean RV/LV ratios were 1.20±0.14 and 1.17±0.20, respectively (
P
=0.31). The mean decrease in RV/LV ratio from baseline to 24 hours was 0.30±0.20 versus 0.03±0.16 (
P
<0.001), respectively. At 90 days, there was 1 death (in the heparin group), no major bleeding, 4 minor bleeding episodes (3 in the USAT group and 1 in the heparin group;
P
=0.61), and no recurrent venous thromboembolism.
Conclusions—
In patients with pulmonary embolism at intermediate risk, a standardized USAT regimen was superior to anticoagulation with heparin alone in reversing RV dilatation at 24 hours, without an increase in bleeding complications.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT01166997.
Collapse
Affiliation(s)
- Nils Kucher
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Peter Boekstegers
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Oliver J. Müller
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Christian Kupatt
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Jan Beyer-Westendorf
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Thomas Heitzer
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Ulrich Tebbe
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Jan Horstkotte
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Ralf Müller
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Erwin Blessing
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Martin Greif
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Philipp Lange
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Ralf-Thorsten Hoffmann
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Sebastian Werth
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Achim Barmeyer
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Dirk Härtel
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Henriette Grünwald
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Klaus Empen
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| | - Iris Baumgartner
- From the Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital Bern, Bern, Switzerland (N.K., I.B.); Helios Hospital Siegburg, Siegburg, Germany (P.B., J.H., R.M.); Internal Medicine III, University Hospital Heidelberg, Heidelberg, Germany (O.J.M., E.B.); Großhadern Hospital, Ludwig-Maximilians University Munich, Munich, Germany (C.K., M.G., P.L.); University Hospital Carl Gustav Carus of Technical University Dresden, Dresden, Germany (J.B.-W., R.H., S.W.); Dortmund
| |
Collapse
|
17
|
Greif M, Lange P, Näbauer M, Schwarz F, Becker C, Schmitz C, Pohl T, D'Anastasi M, Boekstegers P, Massberg S, Kupatt C. Transcutaneous aortic valve replacement with the Edwards SAPIEN XT and Medtronic CoreValve prosthesis under fluoroscopic guidance and local anaesthesia only. Heart 2014; 100:691-5. [DOI: 10.1136/heartjnl-2013-304918] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
18
|
Bouras I, Fochler O, Greif M, Reining F, Senzel F, Uphoff J, Wesp C, Xu Z, Greiner C. From microscopic interactions to the dynamics of the fireball. EPJ Web of Conferences 2014. [DOI: 10.1051/epjconf/20146604010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
19
|
Locher R, Lucchini M, Herrmann J, Sabbar M, Weger M, Ludwig A, Castiglioni L, Greif M, Hengsberger M, Gallmann L, Keller U. Versatile attosecond beamline in a two-foci configuration for simultaneous time-resolved measurements. Rev Sci Instrum 2014; 85:013113. [PMID: 24517751 DOI: 10.1063/1.4862656] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We present our attoline which is a versatile attosecond beamline at the Ultrafast Laser Physics Group at ETH Zurich for attosecond spectroscopy in a variety of targets. High-harmonic generation (HHG) in noble gases with an infrared (IR) driving field is employed to generate pulses in the extreme ultraviolet (XUV) spectral regime for XUV-IR cross-correlation measurements. The IR pulse driving the HHG and the pulse involved in the measurements are used in a non-collinear set-up that gives independent access to the different beams. Single attosecond pulses are generated with the polarization gating technique and temporally characterized with attosecond streaking. This attoline contains two target chambers that can be operated simultaneously. A toroidal mirror relay-images the focus from the first chamber into the second one. In the first interaction region a dedicated double-target allows for a simple change between photoelectron/photoion measurements with a time-of-flight spectrometer and transient absorption experiments. Any end station can occupy the second interaction chamber. A surface analysis chamber containing a hemispherical electron analyzer was employed to demonstrate successful operation. Simultaneous RABBITT measurements in two argon jets were recorded for this purpose.
Collapse
Affiliation(s)
- R Locher
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| | - M Lucchini
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| | - J Herrmann
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| | - M Sabbar
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| | - M Weger
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| | - A Ludwig
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| | - L Castiglioni
- Institute of Physics, University of Zurich, CH-8057 Zürich, Switzerland
| | - M Greif
- Institute of Physics, University of Zurich, CH-8057 Zürich, Switzerland
| | - M Hengsberger
- Institute of Physics, University of Zurich, CH-8057 Zürich, Switzerland
| | - L Gallmann
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| | - U Keller
- Department of Physics, ETH Zurich, CH-8093 Zürich, Switzerland
| |
Collapse
|
20
|
Diemert P, Lange P, Greif M, Seiffert M, Conradi L, Massberg S, Blankenberg S, Reichenspurner H, Hagl C, Schmitz C, Schröfel H, Treede H, Schymik G, Kupatt C. Edwards Sapien XT valve placement as treatment option for aortic regurgitation after transfemoral CoreValve implantation: a multicenter experience. Clin Res Cardiol 2013; 103:183-90. [DOI: 10.1007/s00392-013-0632-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 11/05/2013] [Indexed: 11/27/2022]
|
21
|
Piotrowski K, Becker M, Zugwurst J, Biller-Friedmann I, Spoettl G, Greif M, Leber AW, Becker A, Laubender RP, Lebherz C, Goeke B, Marx N, Parhofer KG, Lehrke M. Circulating concentrations of GLP-1 are associated with coronary atherosclerosis in humans. Cardiovasc Diabetol 2013; 12:117. [PMID: 23953602 PMCID: PMC3765863 DOI: 10.1186/1475-2840-12-117] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 07/30/2013] [Indexed: 12/25/2022] Open
Abstract
Background GLP-1 is an incretine hormone which gets secreted from intestinal L-cells in response to nutritional stimuli leading to pancreatic insulin secretion and suppression of glucagon release. GLP-1 further inhibits gastric motility and reduces appetite which in conjunction improves postprandial glucose metabolism. Additional vasoprotective effects have been described for GLP-1 in experimental models. Despite these vasoprotective actions, associations between endogenous levels of GLP-1 and cardiovascular disease have yet not been investigated in humans which was the aim of the present study. Methods GLP-1 serum levels were assessed in a cohort of 303 patients receiving coronary CT-angiography due to typical or atypical chest pain. Results GLP-1 was found to be positively associated with total coronary plaque burden in a fully adjusted model containing age, sex, BMI, hypertension, diabetes mellitus, smoking, triglycerides, LDL-C (low density lipoprotein cholesterol), hsCRP (high-sensitive C-reactive protein), and eGFR (estimated glomerular filtration rate) (OR: 2.53 (95% CI: 1.12 – 6.08; p = 0.03). Conclusion Circulating GLP-1 was found to be positivity associated with coronary atherosclerosis in humans. The clinical relevance of this observation needs further investigations.
Collapse
Affiliation(s)
- Katja Piotrowski
- Department of Internal Medicine I, University Hospital Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Greif M, von Ziegler F, Bamberg F, Tittus J, Schwarz F, D'Anastasi M, Marcus RP, Schenzle J, Becker C, Nikolaou K, Becker A. CT stress perfusion imaging for detection of haemodynamically relevant coronary stenosis as defined by FFR. Heart 2013; 99:1004-11. [DOI: 10.1136/heartjnl-2013-303794] [Citation(s) in RCA: 91] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
|
23
|
Greif M, von Ziegler F, Wakili R, Tittus J, Becker C, Helbig S, Laubender RP, Schwarz W, D'Anastasi M, Schenzle J, Leber AW, Becker A. Increased pericardial adipose tissue is correlated with atrial fibrillation and left atrial dilatation. Clin Res Cardiol 2013; 102:555-62. [PMID: 23584714 DOI: 10.1007/s00392-013-0566-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/03/2013] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Pericardial adipose tissue (PAT), a visceral fat depot surrounding the heart, serves as an endocrine active organ and is associated with inflammation. There is growing evidence that atrial fibrillation (AF) is linked with inflammation, which in turn can be a promoter of left atrial remodeling. The aim of this study was to evaluate a potential correlation of PAT to AF and left atrial structural remodeling represented by LA size. METHODS PAT was measured in 1,288 patients who underwent coronary artery calcium-scanning for coronary risk stratification. LA size was determined by two independent readers. Patients were subdivided into patients without AF, patients with paroxysmal and persistent AF. RESULTS PAT was independently correlated with AF, persistent AF, and LA size (all p values <0.001). No association could be observed between paroxysmal AF and PAT. These associations persisted after multivariate adjustment for AF risk factors such as age, hypertension, valvular disease, heart failure, and body mass index (AF: OR 1.52, 95 % CI 1.15-2.00, p = 0.003; persistent AF: OR 2.58, 95 % CI 1.69-3.99, p = 0.001; LA size: regression coefficient 0.15 with 95 % CI 0.10-0.20, p < 0.001). CONCLUSION PAT is associated with AF, in particular with persistent AF and LA size. These findings suggest that PAT could be an independent risk factor for the development of AF and for LA remodeling.
Collapse
Affiliation(s)
- Martin Greif
- Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Schramm R, Schuba B, Mair H, Sodian R, Hagl C, Greif M, Lange P, Kupatt C, Schmitz C. Can EuroSCORE predict operative mortality of Transcatheter Aortic Valve Implantation (TAVI)? Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
25
|
Mair H, Schramm R, Sodian R, Hagl C, Greif M, Lange P, Kupatt C, Schmitz C. Previous cardic surgery does not increase mortality of Transcatheter Aortic Valve Implantation (TAVI). Thorac Cardiovasc Surg 2013. [DOI: 10.1055/s-0032-1332520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
26
|
Abstract
Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy with a prevalence of 1 out of 2,500 in adults. Due to mild clinical symptoms in the early phase of the disease, the true prevalence is probably even much higher. Patients present with variable clinical symptoms ranging from mild systolic impairment of left ventricular function to congestive heart failure. Even sudden cardiac death may be the first clinical symptom of DCM. The severity of the disease is defined by the degree of impairment of global left ventricular function. Arrhythmias, such as ventricular or supraventricular tachycardia, atrioventricular (AV) block, ventricular extrasystole and atrial fibrillation are common cardiac manifestations of DCM. Magnetic resonance imaging (MRI) plays an important role in the exact quantification of functional impairment of both ventricles and in the evaluation of regional wall motion abnormalities. With its excellent ability for the assessment of myocardial structure, it is becoming increasingly more important for risk stratification and therapy guidance.
Collapse
Affiliation(s)
- M D'Anastasi
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Deutschland.
| | | | | | | |
Collapse
|
27
|
Greif M, Arnoldt T, von Ziegler F, Ruemmler J, Becker C, Wakili R, D'Anastasi M, Schenzle J, Leber AW, Becker A. Lipoprotein (a) is independently correlated with coronary artery calcification. Eur J Intern Med 2013; 24:75-9. [PMID: 23021791 DOI: 10.1016/j.ejim.2012.08.014] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [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: 04/25/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Lipoprotein a (Lp(a)) has been recognized as a risk factor for both coronary heart diseases and for cardiovascular events. Coronary artery calcification (CAC) is a well proven marker for coronary artery disease and risk factor for cardiovascular events. Still there are conflicting data regarding the relationship of Lp(a) and CAC. We therefore wanted to evaluate the influence of Lp(a) on CAC. METHODS 1560 European patients (1123 men, age 59.3 ± 20.8 years) with typical or atypical chest pain underwent CAC scoring by a multi-slice CT-scanner, using a standard protocol. Blood samples were evaluated the same day using an automated particle enhanced immunoturbidimetric assay to determine Lp(a) serum levels. RESULTS There was a positive correlation between CAC score, age, and common cardiovascular risk factors. Lp(a) serum levels were not associated with age but a positive correlation between Lp(a) serum levels and CAC was found. In the multivariate analysis age, diabetes, statin therapy, and Lp(a) could be identified as independent risk factors for CAC. (p<0.001). BMI, smoking, hypertension and LDL-C were not independently associated with CAC. CONCLUSION Lp (a) could be identified as an independent predictor of CAC, a marker of coronary atherosclerosis. Further a positive correlation between increasing Lp (a) levels and CAC scores was found.
Collapse
Affiliation(s)
- Martin Greif
- Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
von Ziegler F, Brendel M, Uebleis C, Helbig S, Greif M, Ruemmler J, Becker C, Hacker M, Steinbeck G, Becker A. SPECT myocardial perfusion imaging as an adjunct to coronary calcium score for the detection of hemodynamically significant coronary artery stenosis. BMC Cardiovasc Disord 2012. [PMID: 23206557 PMCID: PMC3527199 DOI: 10.1186/1471-2261-12-116] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background Coronary artery calcifications (CAC) are markers of coronary atherosclerosis, but do not correlate well with stenosis severity. This study intended to evaluate clinical situations where a combined approach of coronary calcium scoring (CS) and nuclear stress test (SPECT-MPI) is useful for the detection of relevant CAD. Methods Patients with clinical indication for invasive coronary angiography (ICA) were included into our study during 08/2005-09/2008. At first all patients underwent CS procedure as part of the study protocol performed by either using a multidetector computed tomography (CT) scanner or a dual-source CT imager. CAC were automatically defined by dedicated software and the Agatston score was semi-automatically calculated. A stress-rest SPECT-MPI study was performed afterwards and scintigraphic images were evaluated quantitatively. Then all patients underwent ICA. Thereby significant CAD was defined as luminal stenosis ≥75% in quantitative coronary analysis (QCA) in ≥1 epicardial vessel. To compare data lacking Gaussian distribution an unpaired Wilcoxon-Test (Mann–Whitney) was used. Otherwise a Students t-test for unpaired samples was applied. Calculations were considered to be significant at a p-value of <0.05. Results We consecutively included 351 symptomatic patients (mean age: 61.2±12.3 years; range: 18–94 years; male: n=240) with a mean Agatston score of 258.5±512.2 (range: 0–4214). ICA verified exclusion of significant CAD in 66/67 (98.5%) patients without CAC. CAC was detected in remaining 284 patients. In 132/284 patients (46.5%) with CS>0 significant CAD was confirmed by ICA, and excluded in 152/284 (53.5%) patients. Sensitivity for CAD detection by CS alone was calculated as 99.2%, specificity was 30.3%, and negative predictive value was 98.5%. An additional SPECT in patients with CS>0 increased specificity to 80.9% while reducing sensitivity to 87.9%. Diagnostic accuracy was 84.2%. Conclusions In patients without CS=0 significant CAD can be excluded with a high negative predictive value by CS alone. An additional SPECT-MPI in those patients with CS>0 leads to a high diagnostic accuracy for the detection of CAD while reducing the number of patients needing invasive diagnostic procedure.
Collapse
Affiliation(s)
- Franz von Ziegler
- Department of Cardiology, University of Munich, Campus Grosshadern, Munich, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
von Ziegler F, Rümmler J, Kaczmarek I, Greif M, Schenzle J, Helbig S, Becker C, Meiser B, Becker A. Detection of significant coronary artery stenosis with cardiac dual-source computed tomography angiography in heart transplant recipients. Transpl Int 2012; 25:1065-71. [DOI: 10.1111/j.1432-2277.2012.01536.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
30
|
Greif M, Lange P, Mair H, Becker C, Schmitz C, Steinbeck G, Kupatt C. Transcatheter Edwards Sapien XT valve in valve implantation in degenerated aortic bioprostheses via transfemoral access. Clin Res Cardiol 2012; 101:993-1001. [PMID: 22729757 DOI: 10.1007/s00392-012-0488-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 06/08/2012] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Surgical treatment of degenerated aortic bioprostheses is associated with an increased risk of morbidity and mortality, especially in elderly patients with significant co-morbidities. Therefore, transcatheter aortic valve implantation (TAVI) performed as valve in valve technique appears as an attractive alternative treatment option. We report of a case series of seven patients with dysfunctional bioprosthetic aortic heart valves who have been treated with TAVI via transfemoral access. METHODS AND RESULTS Valve in valve implantation using the Edwards Sapien XT bioprostheses (Edwards Lifesciences LLC, Irvine, CA, USA) was performed in eight patients (3 men, 5 women, mean age 85.3 ± 6.1 years) with a high operative risk (logistic euroSCORE 27.2 ± 7.3). Six patients underwent TAVI because of high grade stenosis of the aortic bioprostheses, whereas two patients presented with high grade regurgitation. All patients suffered at least from NYHA class III dyspnea during admission. TAVI was successfully performed via transfemoral access under local anesthesia with mild analgesic medication in all cases. Mild aortic regurgitation occurred in three patients while no permanent pacemaker implantation was required. Major cardiac events or cerebrovascular events did not occur. One aneurysm spurium, with the need of one blood transfusion, occurred. All patients improved at least one NYHA class within 30 days. CONCLUSION TAVI for degenerated aortic bioprostheses, using the Edwards Sapien XT valve via transfemoral access is a feasible option for patients at high surgical risk.
Collapse
Affiliation(s)
- Martin Greif
- Medizinische Klinik und Poliklinik I, Klinikum Grosshadern, University Hospital of Munich, Munich, Germany.
| | | | | | | | | | | | | |
Collapse
|
31
|
Bamberg F, Theisen D, Bauner K, Hildebrandt K, Marcus R, Greif M, Schwarz F, Johnson TR, Reiser MF, Becker A, Nikolaou K. Stress-induzierte Myokardiale Perfusionsuntersuchung mittels Dynamischer CT: Diagnostische Genauigkeit im Vergleich zur Kardialen MRT. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
32
|
Greif M, Leber AW, Saam T, Uebleis C, von Ziegler F, Rümmler J, D'Anastasi M, Arias-Herrera V, Becker C, Steinbeck G, Hacker M, Becker A. Determination of pericardial adipose tissue increases the prognostic accuracy of coronary artery calcification for future cardiovascular events. Cardiology 2012; 121:220-7. [PMID: 22516924 DOI: 10.1159/000337083] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Accepted: 01/29/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pericardial adipose tissue (PAT) is associated with coronary artery plaque accumulation and the incidence of coronary heart disease. We evaluated the possible incremental prognostic value of PAT for future cardiovascular events. METHODS 145 patients (94 males, age 60 ± 10 years) with stable coronary artery disease underwent coronary artery calcification (CAC) scanning in a multislice CT scanner, and the volume of pericardial fat was measured. Mean observation time was 5.4 years. RESULTS 34 patients experienced a severe cardiac event. They had a significantly higher CAC score (1,708 ± 2,269 vs. 538 ± 1,150, p < 0.01), and the CAC score was highly correlated with the relative risk of a future cardiac event: 2.4 (1.8-3.7; p = 0.01) for scores >400, 3.5 (1.9-5.4; p = 0.007) for scores >800 and 5.9 (3.7-7.8; p = 0.005) for scores >1,600. When additionally a PAT volume >200 cm(3) was determined, there was a significant increase in the event rate and relative risk. We calculated a relative risk of 2.9 (1.9-4.2; p = 0.01) for scores >400, 4.0 (2.1-5.0; p = 0.006) for scores >800 and 7.1 (4.1-10.2; p = 0.005) for scores >1,600. CONCLUSIONS The additional determination of PAT increases the predictive power of CAC for future cardiovascular events. PAT might therefore be used as a further parameter for risk stratification.
Collapse
Affiliation(s)
- Martin Greif
- Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Becker A, von Ziegler F, Greif M, Becker C. PROGRESSION OF CORONARY CALCIFICATIONS: A PROSPECTIVE STUDY IN 1207 PATIENTS OVER 5 YEARS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Becker A, Bamberg F, Greif M, von Ziegler F, Becker C. INCREMENTAL DIAGNOSTIC VALUE OF DYNAMIC CT-BASED MYOCARDIAL PERFUSION IMAGING FOR THE DETECTION OF HEMODYNAMIC RELEVANT CORONARY ARTERY STENOSIS AS DETERMINED BY FRACTIONAL FLOW RESERVE. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
35
|
Bamberg F, Becker A, Schwarz F, Marcus RP, Greif M, von Ziegler F, Blankstein R, Hoffmann U, Sommer WH, Hoffmann VS, Johnson TRC, Becker HCR, Wintersperger BJ, Reiser MF, Nikolaou K. Detection of Hemodynamically Significant Coronary Artery Stenosis: Incremental Diagnostic Value of Dynamic CT-based Myocardial Perfusion Imaging. Radiology 2011; 260:689-98. [PMID: 21846761 DOI: 10.1148/radiol.11110638] [Citation(s) in RCA: 225] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Fabian Bamberg
- Department of Clinical Radiology, Ludwig-Maximilians University, Klinikum Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Becker A, von Ziegler F, Tittus J, Greif M, Nikolaou K, Becker C. RULING OUT OF SIGNIFICANT CORONARY HEART DISEASE BY EXCLUSION OF CORONARY CALCIFICATIONS WITH CARDIAC MULTIDETECTOR ROW COMPUTED TOMOGRAPHY. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60887-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
37
|
Saam T, Rominger A, Wolpers S, Rist C, Greif M, Cumming PK, Becker A, Foerster S, Reiser M, Bartenstein P, Hacker M, Nikolaou K. Assoziation entzündlicher Veränderungen der linken Koronararterie mit kardiovaskulären Risikofaktoren, atherosklerotischer Plaquelast und dem Volumen des perikardialen Fettgewebes: Eine PET/CT-Studie. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1252542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
38
|
Lehrke M, Becker A, Greif M, Stark R, Laubender RP, von Ziegler F, Lebherz C, Tittus J, Reiser M, Becker C, Göke B, Leber AW, Parhofer KG, Broedl UC. Chemerin is associated with markers of inflammation and components of the metabolic syndrome but does not predict coronary atherosclerosis. Eur J Endocrinol 2009; 161:339-44. [PMID: 19497986 DOI: 10.1530/eje-09-0380] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [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] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Chemerin is a recently discovered adipokine that regulates adipocyte differentiation and modulates chemotaxis and activation of dendritic cells and macrophages. Given the convergence of adipocyte and macrophage function, chemerin may provide an interesting link between obesity, inflammation and atherosclerosis in humans. We sought to examine the relationship of i) chemerin and markers of inflammation, ii) chemerin and components of the metabolic syndrome, and iii) chemerin and coronary atherosclerotic plaque burden and morphology. DESIGN Serum chemerin levels were determined in 303 patients with stable typical or atypical chest pain who underwent dual-source multi-slice CT-angiography to exclude coronary artery stenosis. Atherosclerotic plaques were classified as calcified, mixed, or non-calcified. RESULTS Chemerin levels were highly correlated with high sensitivity C-reactive protein (r=0.44, P<0.0001), interleukin-6 (r=0.18, P=0.002), tumor necrosis factor-alpha (r=0.24, P<0.0001), resistin (r=0.28, P<0.0001), and leptin (r=0.36, P<0.0001) concentrations. Furthermore, chemerin was associated with components of the metabolic syndrome including body mass index (r=0.23, P=0.0002), triglycerides (r=0.29, P<0.0001), HDL-cholesterol (r=-0.18, P=0.003), and hypertension (P<0.0001). In bivariate analysis, chemerin levels were weakly correlated with coronary plaque burden (r=0.16, P=0.006) and the number of non-calcified plaques (r=0.14, P=0.02). These associations, however, were lost after adjusting for established cardiovascular risk factors (odds ratio, OR 1.17, 95% confidence interval (CI) 0.97-1.41, P=0.11 for coronary plaque burden; OR 1.06, 95% CI 0.96-1.17, P=0.22 for non-calcified plaques). CONCLUSIONS Chemerin is strongly associated with markers of inflammation and components of the metabolic syndrome. However, chemerin does not predict coronary atherosclerosis.
Collapse
Affiliation(s)
- Michael Lehrke
- Department of Internal Medicine II, University of Munich, Campus Grosshadern, Marchioninistrasse 15, 81377 Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Greif M, Zwermann L, Reithmann C, Weis M. Levosimendan as rescue therapy in severe cardiogenic shock after ST-elevation myocardial infarction. ACTA ACUST UNITED AC 2009; 10:185-90. [DOI: 10.1080/17482940801935774] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
40
|
Lehrke M, Greif M, Broedl UC, Lebherz C, Laubender R, Becker A, Ziegler FV, Reiser M, Becker C, Göke B, Leber AW, Parhofer KG. MMP-1 serum levels predict non-calcified atherosclerotic plaques. DIABETOL STOFFWECHS 2009. [DOI: 10.1055/s-0029-1221816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
41
|
Broedl UC, Lebherz C, Lehrke M, Stark R, Greif M, Becker A, von Ziegler F, Tittus J, Reiser M, Becker C, Göke B, Parhofer KG, Leber AW. Low adiponectin levels are an independent predictor of mixed and non-calcified coronary atherosclerotic plaques. PLoS One 2009; 4:e4733. [PMID: 19266101 PMCID: PMC2649379 DOI: 10.1371/journal.pone.0004733] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [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: 07/26/2008] [Accepted: 02/01/2009] [Indexed: 01/24/2023] Open
Abstract
Background Atherosclerosis is the primary cause of coronary artery disease (CAD). There is increasing recognition that lesion composition rather than size determines the acute complications of atherosclerotic disease. Low serum adiponectin levels were reported to be associated with coronary artery disease and future incidence of acute coronary syndrome (ACS). The impact of adiponectin on lesion composition still remains to be determined. Methodology/Principal Findings We measured serum adiponectin levels in 303 patients with stable typical or atypical chest pain, who underwent dual-source multi-slice CT-angiography to exclude coronary artery stenosis. Atherosclerotic plaques were classified as calcified, mixed or non-calcified. In bivariate analysis adiponectin levels were inversely correlated with total coronary plaque burden (r = −0.21, p = 0.0004), mixed (r = −0.20, p = 0.0007) and non-calcified plaques (r = −0.18, p = 0.003). No correlation was seen with calcified plaques (r = −0.05, p = 0.39). In a fully adjusted multivariate model adiponectin levels remained predictive of total plaque burden (estimate: −0.036, 95%CI: −0.052 to −0.020, p<0.0001), mixed (estimate: −0.087, 95%CI: −0.132 to −0.042, p = 0.0001) and non-calcified plaques (estimate: −0.076, 95%CI: −0.115 to −0.038, p = 0.0001). Adiponectin levels were not associated with calcified plaques (estimate: −0.021, 95% CI: −0.043 to −0.001, p = 0.06). Since the majority of coronary plaques was calcified, adiponectin levels account for only 3% of the variability in total plaque number. In contrast, adiponectin accounts for approximately 20% of the variability in mixed and non-calcified plaque burden. Conclusions/Significance Adiponectin levels predict mixed and non-calcified coronary atherosclerotic plaque burden. Low adiponectin levels may contribute to coronary plaque vulnerability and may thus play a role in the pathophysiology of ACS.
Collapse
Affiliation(s)
- Uli C Broedl
- Department of Internal Medicine II, University of Munich, Munich, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Greif M, Becker A, von Ziegler F, Lebherz C, Lehrke M, Broedl UC, Tittus J, Parhofer K, Becker C, Reiser M, Knez A, Leber AW. Pericardial adipose tissue determined by dual source CT is a risk factor for coronary atherosclerosis. Arterioscler Thromb Vasc Biol 2009; 29:781-6. [PMID: 19229071 DOI: 10.1161/atvbaha.108.180653] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Pericardial fat as a visceral fat depot may be involved in the pathogenesis of coronary atherosclerosis. To gain evidence for that concept we sought to investigate the relation of pericardial fat volumes to risk factors, serum adiponectin levels, inflammatory biomarkers, and the quantity and morphology of coronary atherosclerosis. METHODS AND RESULTS Using Dual source CT angiography pericardial fat volume and coronary atherosclerosis were assessed simultaneously. Plaques were classified as calcified, mixed, and noncalcified, and the number of affected segments served as quantitative score. Patients with atherosclerotic lesions had significant larger PAT volumes (226 cm3+/-92 cm3) than patients without atherosclerosis (134 cm3+/-56 cm3; P>0.001). No association was found between BMI and coronary atherosclerosis. PAT volumes >300 cm3 were the strongest independent risk factor for coronary atherosclerosis (odds ratio 4.1; CI 3.63 to 4.33) also significantly stronger compared to the Framingham score. We furthermore demonstrated that elevated PAT volumes are significantly associated with low adiponectin levels, low HDL levels, elevated TNF-alpha levels, and hsCRP. CONCLUSION In the present study we demonstrated that elevated PAT volumes are associated with coronary atherosclerosis, hypoadiponectinemia, and inflammation and represent the strongest risk factor for the presence of atherosclerosis and may be important for risk stratification and monitoring.
Collapse
Affiliation(s)
- Martin Greif
- Department of Cardiology, Klinikum Grosshadern, University Hospital of Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Nowak J, Jastrzebski D, Streb W, Rozentryt P, Wojarski J, Greif M, Kozielski J, Polonski L, Zembala M, Kukulski T. Right ventricular function in patients with severe interstitial lung disease: a Tissue Doppler imaging study. J Physiol Pharmacol 2008; 59 Suppl 6:531-538. [PMID: 19218678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/06/2008] [Accepted: 08/28/2008] [Indexed: 05/27/2023]
Abstract
Tissue Doppler imaging (TDI) can be useful in the evaluation of right ventricular (RV) regional dysfunction due to pulmonary diseases. The aim of the study was to assess RV dysfunction in patients with severe interstitial lung diseases (ILD), using both TDI and conventional transthoracic echocardiography (TTE). The study group consisted of 40 consecutive patients with end-stage ILD referred for lung transplantation (LT). Eighteen of them, mean age 47 +/-12 yr, who fulfilled the ATS/ERS criteria for LT (mean forced vital capacity (FVC) 1.4 +/-0.8 l, mean diffusing capacity for carbon dioxide (DLCO) <50% of predicted) constituted the active group, and 22 age-matched patients (mean age 49 +/-12 yr), who did not fulfill these criteria, were placed in the waiting group for LT. We found that among the TDI parameters, the longitudinal peak systolic strain rate (SR) measured at the RV outflow tract, was significantly more negative (-1.1 +/-0.3 vs. -3.2 +/-1.2 s(-1), P=0.03) and the time to peak velocity (TpVEL) in the medial and apical septal segments were shorter (129.9 +/-47.9 vs. 159.2 +/-38.1 ms, P=0.018 and 126.8 +/-44.3 vs. 154.6 +/-40.9 ms, P=0.019) in the patients from the active than those from the waiting group. TTE showed that patients from the active group had significantly lower values of tricuspid annulus plane systolic excursion (TAPSE) (14.3 +/-3.3 vs. 20.6 +/-6.2 mm, P=0.0003) and pulmonary artery acceleration time (PVAT) (70.3 +/-23.3 vs. 96.9 +/-12.4 ms, P=0.0001)compared with those from the waiting group. No other differences were found for other parameters of RV function between the examined groups. In conclusion, severity of lung disease in patients with ILD influences RV systolic dysfunction, which is reflected in both TDI and conventional echocardiographic parameters.
Collapse
Affiliation(s)
- J Nowak
- Third Department of Cardiology, Silesian Center for Heart Diseases, Medical University of Silesia, Zabrze, Poland
| | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Broedl UC, Lehrke M, Greif M, Becker A, Becker C, Stark R, Leber A, Parhofer KG. Adiponektinplasmaspiegel sind ein unabhängiger Prädiktor für die koronare Gesamtplaquelast. DIABETOL STOFFWECHS 2008. [DOI: 10.1055/s-2008-1076290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
45
|
Abstract
Epidemiological data provide evidence that disease activity of T cell-mediated, organ-specific autoimmune diseases is reduced during pregnancy. Although there are several experimental animal studies on the effect of pregnancy on the immune system, the situation in humans is less clear. We therefore performed a prospective analysis of cytokine mRNA expression in whole blood by a new on-line reverse transcriptase-polymerase chain reaction technique and of serum hormone levels during pregnancy in healthy women. The control group included age-matched non-pregnant healthy women. Quantitativecytokine mRNA expression revealed significantly reduced IL-18, interferon-gamma (IFN-gamma), and IL-2 mRNA levels in the first and second trimester in pregnancy compared with non-pregnant women. No difference between groups was detected for tumour necrosis factor-alpha (TNF-alpha) mRNA. IL-4 and IL-10 mRNA were detected at low levels in only 20% of pregnant women and were reduced to a statistically significant extent in the second and third trimester compared with the control group. Changes in IL-18 mRNA expression correlated inversely with serum values for human choriogonadotropin (HCG) and IL-10 serum levels correlated with increases in serum 17beta-oestradiol levels. These data indicate immunomodulatory effects of pregnancy at the cytokine level which may be related to the variations in the clinical course of organ-specific, T cell-mediated autoimmune diseases during pregnancy.
Collapse
Affiliation(s)
- N Kruse
- Department of Neurology, Julius-Maximilians University of Würzburg, Germany
| | | | | | | | | | | |
Collapse
|
46
|
Abstract
Interleukin 10 (IL-10) expression has been found to be correlated with the extent of malignancy in gliomas. In vitro, IL-10 increases proliferation and migratory capacity in human glioma cell lines. In this study, we localized the site of IL-10 synthesis in gliomas to cells of microglial origin. Biopsy specimens from 11 patients with malignant glioma were processed on native tissues and at early cell culture passages (0-4). IL-10 mRNA was analyzed by RT-PCR and in situ hybridization. Protein was quantitatively assessed by ELISA in cell culture supernatants, and cells expressing IL-10 were determined by a combination of immunohistochemistry for CD68 (specific for microglia/macrophage lineage) and IL-10 in situ hybridization. IL-10 mRNA decreased from passage 0 to 4 in all samples and was undetectable beyond passage 5. Such downregulation of mRNA leads to a steep decrease of IL-10 protein in culture supernatants (below detection level, 0.05 ng/ml, beyond passage 1). The combination of in situ hybridization for IL-10 and CD68 immunostaining revealed that only cells of the microglia/macrophage lineage produced IL-10 mRNA. Our results identify microglia/macrophage cells as the major source of IL-10 expression in gliomas which decreases markedly during early passages of primary cultures of human gliomas due to a progressive reduction of microglia/macrophages present.
Collapse
Affiliation(s)
- S Wagner
- Department of Neurosurgery, University of Würzburg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Rieckmann P, Kruse N, Marx L, Greif M, Dietl J, Toyka K. Complex immunoregulatory events during pregnancy may explain reduced relapse rate in multiple sclerosis. J Neuroimmunol 1998. [DOI: 10.1016/s0165-5728(98)91439-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
48
|
Hebart H, Greif M, Krause H, Kanz L, Jahn G, Müller CA, Einsele H. Interstrain variation of immediate early DNA sequences and glycoprotein B genotypes in cytomegalovirus clinical isolates. Med Microbiol Immunol 1997; 186:135-8. [PMID: 9403841 DOI: 10.1007/s004300050055] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 02/05/2023]
Abstract
Cytomegalovirus (CMV) disease is associated with a high mortality in recipients of an allogeneic stem cell transplant. Apparent differences in biological behaviour have been noted among clinical CMV isolates. By amplifying specific functionally relevant regions of the CMV genome [immediate early (IE) exon 3, glycoprotein B (gB)], a possible association of strain variation and clinical symptoms of infection was analysed in 24 patients. A high number of genome mutations of the IE exon 3 region could be documented translating into amino acid changes of viral isolated of 8 out of 15 patients with symptomatic and 2 out of 9 patients with asymptomatic CMV infection. Identical IE mutations and gB types were observed in isolates from two different sites in 6 patients. gB strain 2 was found to be associated with symptomatic CMV infection (P = 0.03). Thus, apart from host factors viral factors might influence the virus-host interaction in severely immunosuppressed patients.
Collapse
Affiliation(s)
- H Hebart
- Medizinische Klinik und Poliklinik, Abt. II, Tübingen, Germany
| | | | | | | | | | | | | |
Collapse
|
49
|
Greif M. [Salutogenesis--therapy for the healthy]. Krankenpfl J 1997; 35:305-6. [PMID: 9295602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
50
|
Hauser R, Yogev L, Greif M, Hirshenbein A, Botchan A, Gamzu R, Paz G, Yavetz H. Sperm binding and ultrasound changes after operative repair of varicocele: correlation with fecundity. Andrologia 1997; 29:145-7. [PMID: 9197919 DOI: 10.1111/j.1439-0272.1997.tb00309.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [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: 02/04/2023] Open
Abstract
The study was conducted to evaluate the changes in sperm binding capacity and ultrasound measurements of the internal spermatic vein, after operative repair of a varicocele. In order to clarify the effect of a varicocele on fertility, these changes were correlated to pregnancy achievement. Twelve infertile males with subnormal semen parameters and varicocele, underwent operative repair. Pre- and post-operatively, all had semen analysis, hemizona assay and ultrasound of the internal spermatic veins. The patients were divided into three subgroups according to pregnancy outcome, and the changes in the different evaluation tests after the operation were compared. Sperm concentration and motility improved post-operatively in all three subgroups, whereas the hemizona index and ultrasonographic measurements improved significantly only in the subgroup that achieved early pregnancies (the mean post-operative percentage of normal morphology was significantly higher), compared to the subgroup without pregnancies. Unlike sperm parameters which improve after operative repair of the varicocele, but have no correlation to conception, sperm binding and ultrasound measurements of the internal spermatic veins improve significantly in cases that achieve early pregnancies. The use of these tests, as well as measuring the percentage of normal morphology, are recommended in all cases of infertility-related varicocele.
Collapse
Affiliation(s)
- R Hauser
- Institute for the Study of Fertility, Serlin Maternity Hospital, Tel Aviv, Israel
| | | | | | | | | | | | | | | |
Collapse
|