1
|
Lambert-Niclot S, Grude M, Chaix ML, Charpentier C, Reigadas S, Le Guillou-Guillemette H, Rodallec A, Amiel C, Maillard A, Dufayard J, Mourez T, Mirand A, Guinard J, Montes B, Vallet S, Marcelin AG, Descamps D, Flandre P, Delaugerre C, Morand-Joubert L. Emerging resistance mutations in PI-naive patients failing an atazanavir-based regimen (ANRS multicentre observational study). J Antimicrob Chemother 2019; 73:2147-2151. [PMID: 29718247 DOI: 10.1093/jac/dky142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/21/2018] [Indexed: 11/12/2022] Open
Abstract
Background Atazanavir is a PI widely used as a third agent in combination ART. We aimed to determine the prevalence and the patterns of resistance in PI-naive patients failing on an atazanavir-based regimen. Methods We analysed patients failing on an atazanavir-containing regimen used as a first line of PI therapy. We compared the sequences of reverse transcriptase and protease before the introduction of atazanavir and at failure [two consecutive viral loads (VLs) >50 copies/mL]. Resistance was defined according to the 2014 Agence Nationale de Recherche sur le SIDA et les Hépatites Virales (ANRS) algorithm. Results Among the 113 patients, atazanavir was used in the first regimen in 71 (62.8%) patients and in the first line of a PI-based regimen in 42 (37.2%). Atazanavir was boosted with ritonavir in 95 (84.1%) patients and combined with tenofovir/emtricitabine or lamivudine (n = 81) and abacavir/lamivudine or emtricitabine (n = 22). At failure, median VL was 3.05 log10 copies/mL and the median CD4+ T cell count was 436 cells/mm3. The median time on atazanavir was 21.2 months. At failure, viruses were considered resistant to atazanavir in four patients (3.5%) with the selection of the following major atazanavir-associated mutations: I50L (n = 1), I84V (n = 2) and N88S (n = 1). Other emergent PI mutations were L10V, G16E, K20I/R, L33F, M36I/L, M46I/L, G48V, F53L, I54L, D60E, I62V, A71T/V, V82I/T, L90M and I93L/M. Emergent NRTI substitutions were detected in 21 patients: M41L (n = 2), D67N (n = 3), K70R (n = 1), L74I/V (n = 3), M184V/I (n = 16), L210W (n = 1), T215Y/F (n = 3) and K219Q/E (n = 2). Conclusions Resistance to atazanavir is rare in patients failing the first line of an atazanavir-based regimen according to the ANRS. Emergent NRTI resistance-associated mutations were reported in 18% of patients.
Collapse
Affiliation(s)
- S Lambert-Niclot
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Service de Virologie, APHP, Hôpital Saint-Antoine, INSERM UPMC UMR_S, Paris, France
| | - M Grude
- INSERM UPMC UMR_S, Paris, France
| | - M L Chaix
- Hôpital Saint-Louis, Université Paris Diderot, INSERM, Paris, France
| | - C Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - S Reigadas
- Hôpital Pellegrin, Centre de ressources biologiques plurithématique, CHU de Bordeaux, Bordeaux, France
| | | | | | - C Amiel
- Hôpital Tenon, UPMC, CR7, Paris, France
| | | | | | - T Mourez
- CHU Charles Nicolle, Rouen, France
| | - A Mirand
- CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - J Guinard
- Hôpital La Source-CHR Orléans, Orléans, France
| | - B Montes
- Hôpital Saint-Eloi, Montpellier, France
| | - S Vallet
- CHRU La Cavale Blanche, Brest, France
| | - A G Marcelin
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Service de Virologie, APHP Hôpital Pitié-Salpêtrière, Paris, France
| | - D Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | | | - C Delaugerre
- Hôpital Saint-Louis, Université Paris Diderot, INSERM, Paris, France
| | - L Morand-Joubert
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Service de Virologie, APHP, Hôpital Saint-Antoine, INSERM UPMC UMR_S, Paris, France
| | | |
Collapse
|
2
|
Nguyen T, Fofana DB, Lê MP, Charpentier C, Peytavin G, Wirden M, Lambert-Niclot S, Desire N, Grude M, Morand-Joubert L, Flandre P, Katlama C, Descamps D, Calvez V, Todesco E, Marcelin AG. Prevalence and clinical impact of minority resistant variants in patients failing an integrase inhibitor-based regimen by ultra-deep sequencing. J Antimicrob Chemother 2019; 73:2485-2492. [PMID: 29873733 DOI: 10.1093/jac/dky198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 04/27/2018] [Indexed: 12/20/2022] Open
Abstract
Background Integrase strand transfer inhibitors (INSTIs) are recommended by international guidelines as first-line therapy in antiretroviral-naive and -experienced HIV-1-infected patients. Objectives This study aimed at evaluating the prevalence at failure of INSTI-resistant variants and the impact of baseline minority resistant variants (MiRVs) on the virological response to an INSTI-based regimen. Methods Samples at failure of 134 patients failing a raltegravir-containing (n = 65), an elvitegravir-containing (n = 20) or a dolutegravir-containing (n = 49) regimen were sequenced by Sanger sequencing and ultra-deep sequencing (UDS). Baseline samples of patients with virological failure (VF) (n = 34) and of those with virological success (VS) (n = 31) under INSTI treatment were sequenced by UDS. Data were analysed using the SmartGene platform, and resistance was interpreted according to the ANRS algorithm version 27. Results At failure, the prevalence of at least one INSTI-resistant variant was 39.6% by Sanger sequencing and 57.5% by UDS, changing the interpretation of resistance in 17/134 (13%) patients. Among 53 patients harbouring at least one resistance mutation detected by both techniques, the most dominant INSTI resistance mutations were N155H (45%), Q148H/K/R (23%), T97A (19%) and Y143C (11%). There was no difference in prevalence of baseline MiRVs between patients with VF and those with VS. MiRVs found at baseline in patients with VF were not detected at failure either in majority or minority mutations. Conclusions UDS is more sensitive than Sanger sequencing at detecting INSTI MiRVs at treatment failure. The presence of MiRVs at failure could be important to the decision to switch to other INSTIs. However, there was no association between the presence of baseline MiRVs and the response to INSTI-based therapies in our study.
Collapse
Affiliation(s)
- T Nguyen
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - D B Fofana
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Saint-Antoine, Laboratoire de virologie, F-75012 Paris, France
| | - M P Lê
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Département de Pharmaco-Toxicologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - C Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - G Peytavin
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Département de Pharmaco-Toxicologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - M Wirden
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - S Lambert-Niclot
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Saint-Antoine, Laboratoire de virologie, F-75012 Paris, France
| | - N Desire
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - M Grude
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), F-75013 Paris, France
| | - L Morand-Joubert
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Saint-Antoine, Laboratoire de virologie, F-75012 Paris, France
| | - P Flandre
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), F-75013 Paris, France
| | - C Katlama
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Service de maladies infectieuses, F-75013 Paris, France
| | - D Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat-Claude Bernard, Paris, France
| | - V Calvez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - E Todesco
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| | - A G Marcelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (iPLESP), AP-HP, Hôpital Pitié-Salpêtrière, Laboratoire de virologie, F-75013 Paris, France
| |
Collapse
|
3
|
Todesco E, Charpentier C, Bertine M, Wirden M, Storto A, Desire N, Grude M, Nguyen T, Sayon S, Yazdanpanah Y, Katlama C, Descamps D, Calvez V, Marcelin AG. Disparities in HIV-1 transmitted drug resistance detected by ultradeep sequencing between men who have sex with men and heterosexual populations. HIV Med 2017; 18:696-700. [PMID: 28444829 DOI: 10.1111/hiv.12508] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Transmitted drug resistance (TDR) can impair the response to first-line antiretroviral therapy. In treatment-naïve patients chronically infected with HIV type 1 (HIV-1), it was previously shown through Sanger sequencing that TDR was more common in men who have sex with men (MSM) than in other transmission risk groups. We aimed to compare two HIV-1 transmission groups in terms of the presence of TDR mutations. METHODS We investigated, through Sanger sequencing and ultradeep sequencing (UDS), the presence of resistance mutations, both in majority (> 20%) and in minority (1-20%) proportions, in 70 treatment-naïve MSM and 70 treatment-naïve heterosexual patients who recently screened positive for HIV-1. RESULTS The global prevalence of TDR was not significantly different between the two groups, either by Sanger or by UDS. Nevertheless, a higher frequency of nucleoside reverse transcriptase inhibitor TDR was observed among heterosexual patients (P = 0.04). There was also a trend for a higher frequency of TDR among MSM infected with HIV-1 subtype B compared with MSM infected with HIV-1 non-B subtypes (P = 0.06). CONCLUSIONS Ultradeep sequencing UDS allowed sensitive monitoring of TDR, and highlighted some disparities between transmission groups.
Collapse
Affiliation(s)
- E Todesco
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Department of Virology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - C Charpentier
- INSERM, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Paris, France.,Department of Virology, AP-HP, Bichat-Claude Bernard Hospital, Paris, France
| | - M Bertine
- INSERM, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Paris, France.,Department of Virology, AP-HP, Bichat-Claude Bernard Hospital, Paris, France
| | - M Wirden
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Department of Virology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - A Storto
- Department of Virology, AP-HP, Bichat-Claude Bernard Hospital, Paris, France
| | - N Desire
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - M Grude
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - T Nguyen
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Department of Virology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - S Sayon
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Department of Virology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - Y Yazdanpanah
- INSERM, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Paris, France.,Department of Infectious Diseases, AP-HP, Bichat-Claude Bernard Hospital, Paris, France
| | - C Katlama
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Department of Infectious Diseases, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - D Descamps
- INSERM, IAME, UMR 1137, Sorbonne Paris Cité, Paris, France.,Univ Paris Diderot, IAME, UMR 1137, Paris, France.,Department of Virology, AP-HP, Bichat-Claude Bernard Hospital, Paris, France
| | - V Calvez
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Department of Virology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - A G Marcelin
- Sorbonne University, UPMC Univ Paris 06, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France.,Department of Virology, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| |
Collapse
|
4
|
Abstract
Purpose: To assess patency and lumen visibility of coronary artery stents by multislice-CT angiography (MSCTA) in comparison with conventional coronary angiography as the standard of reference. Material and Methods: 47 stents of 13 different types were evaluated in 29 patients. MSCTA was performed on a 4-slice scanner with a standard coronary protocol (detector collimation 4 × 1 mm; table feed 1.5 mm/rotation, 400 mAs, 120 kV). Image evaluation was performed by two readers who were blinded to the reports from the catheter angiography. MIP reconstructions were evaluated for image quality on a 4-point scale (1 = poor, 4 = excellent) and stent patency (contrast distal to the stent as an indirect patency sign). Axial images and multiplanar reformations through the stents were used for assessment of stent lumen visibility (measurement of the visible stent lumen diameter) and detection of relevant in-stent stenosis (≥50%). Results: Image quality was fair to good on average (score 2.64 ± 1.0) and depended on the heart rate (heart rate 45–60: average score 3.2, heart rate 61–70: average score 2.8, heart rate >71: average score 1.4). Thirty-seven stents were correctly classified as patent, 1 was correctly classified as occluded and 9 stents were not assessible due to insufficient image quality because of triggering artifacts. Parts of the stent lumen could be visualized in 30 cases. On average, 20–40% of the stent lumen diameter was visible. Twenty-five stents were correctly classified as having no stenosis, 1 was falsely classified as stenosed, 1 was correctly classified as occluded. In 20 stents lumen visibility was not sufficient for stenosis evaluation. Conclusion: Although the stent lumen may be partly visualized in most stents, a reliable evaluation of in-stent stenoses does not seem practical by 4-slice MSCT. Nevertheless, for stent patency evaluation, MS-CTA might provide valuable clinical information. With submillimeter MSCT (e.g., 16-slice scanners) and more sophisticated reconstruction algorithms, further improvements may be expected.
Collapse
Affiliation(s)
- D Maintz
- Department of Clinical Radiology, Department of Cardiology and Angiology, University of Münster, Münster; Germany.
| | | | | | | | | |
Collapse
|
5
|
Lambert-Niclot S, Allavena C, Grude M, Flandre P, Sayon S, Andre E, Wirden M, Rodallec A, Jovelin T, Katlama C, Calvez V, Raffi F, Marcelin AG. Usefulness of an HIV DNA resistance genotypic test in patients who are candidates for a switch to the rilpivirine/emtricitabine/tenofovir disoproxil fumarate combination. J Antimicrob Chemother 2016; 71:2248-51. [PMID: 27231280 DOI: 10.1093/jac/dkw146] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 04/01/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES In the context of a rilpivirine/emtricitabine/tenofovir disoproxil fumarate switch in HIV-1-infected patients with at least 1 year of virological success, we determined whether proviral DNA is an alternative to plasma HIV RNA for resistance genotyping. METHODS Resistance-associated mutations (RAMs) in DNA after at least 1 year of virological success [viral load (VL) <50 copies/mL] were compared with those identified in the last plasma RNA genotype available. Rilpivirine/emtricitabine/tenofovir disoproxil fumarate RAMs studied were K65R, L100I, K101E/P, E138A/G/K/R/Q, V179L, Y181C/I/V, M184V/I, Y188L, H221Y, F227C and M230I/L in the RT. We studied patients without virological failure (VF) and with at least 1 VF (two consecutive VLs >50 copies/mL). Kappa's coefficient was used to measure agreement between the DNA and RNA genotypes. RESULTS In patients without VF (n = 130) and with VF (n = 114), RNA and DNA showed resistance to at least one drug of the rilpivirine/emtricitabine/tenofovir disoproxil fumarate combination in 8% and 9% and in 60% and 45%, respectively. For rilpivirine RAMs, correlation between RNA and DNA was higher in patients without VF than in patients with VF (kappa = 0.60 versus 0.19, P = 0.026). Overall, the prevalence of RAMs was lower in DNA than in RNA. CONCLUSIONS Incomplete information provided by the DNA genotypic test is more notable in patients with VF, suggesting that all resistance mutations associated with prior VF have not been archived in the proviral DNA or decreased to a level below the threshold of detection. In the case where no historical plasma genotypic test is available, DNA testing might be useful to rule out switching to rilpivirine/emtricitabine/tenofovir disoproxil fumarate.
Collapse
Affiliation(s)
- S Lambert-Niclot
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| | - C Allavena
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
| | - M Grude
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| | - P Flandre
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| | - S Sayon
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| | - E Andre
- Virology, University Hospital of Nantes, Nantes, France
| | - M Wirden
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| | - A Rodallec
- Virology, University Hospital of Nantes, Nantes, France
| | - T Jovelin
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
| | - C Katlama
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de maladies Infectieuses, Paris F-75013, France
| | - V Calvez
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| | - F Raffi
- Infectious Diseases Department, University Hospital of Nantes, Nantes, France
| | - A-G Marcelin
- Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Pitié-Salpêtrière, Service de Virologie, Paris F-75013, France
| |
Collapse
|
6
|
Hofstra LM, Sauvageot N, Albert J, Alexiev I, Garcia F, Struck D, Van de Vijver DAMC, Åsjö B, Beshkov D, Coughlan S, Descamps D, Griskevicius A, Hamouda O, Horban A, Van Kasteren M, Kolupajeva T, Kostrikis LG, Liitsola K, Linka M, Mor O, Nielsen C, Otelea D, Paraskevis D, Paredes R, Poljak M, Puchhammer-Stöckl E, Sönnerborg A, Staneková D, Stanojevic M, Van Laethem K, Zazzi M, Zidovec Lepej S, Boucher CAB, Schmit JC, Wensing AMJ, Puchhammer-Stockl E, Sarcletti M, Schmied B, Geit M, Balluch G, Vandamme AM, Vercauteren J, Derdelinckx I, Sasse A, Bogaert M, Ceunen H, De Roo A, De Wit S, Echahidi F, Fransen K, Goffard JC, Goubau P, Goudeseune E, Yombi JC, Lacor P, Liesnard C, Moutschen M, Pierard D, Rens R, Schrooten Y, Vaira D, Vandekerckhove LPR, Van den Heuvel A, Van Der Gucht B, Van Ranst M, Van Wijngaerden E, Vandercam B, Vekemans M, Verhofstede C, Clumeck N, Van Laethem K, Beshkov D, Alexiev I, Lepej SZ, Begovac J, Kostrikis L, Demetriades I, Kousiappa I, Demetriou V, Hezka J, Linka M, Maly M, Machala L, Nielsen C, Jørgensen LB, Gerstoft J, Mathiesen L, Pedersen C, Nielsen H, Laursen A, Kvinesdal B, Liitsola K, Ristola M, Suni J, Sutinen J, Descamps D, Assoumou L, Castor G, Grude M, Flandre P, Storto A, Hamouda O, Kücherer C, Berg T, Braun P, Poggensee G, Däumer M, Eberle J, Heiken H, Kaiser R, Knechten H, Korn K, Müller H, Neifer S, Schmidt B, Walter H, Gunsenheimer-Bartmeyer B, Harrer T, Paraskevis D, Hatzakis A, Zavitsanou A, Vassilakis A, Lazanas M, Chini M, Lioni A, Sakka V, Kourkounti S, Paparizos V, Antoniadou A, Papadopoulos A, Poulakou G, Katsarolis I, Protopapas K, Chryssos G, Drimis S, Gargalianos P, Xylomenos G, Lourida G, Psichogiou M, Daikos GL, Sipsas NV, Kontos A, Gamaletsou MN, Koratzanis G, Sambatakou H, Mariolis H, Skoutelis A, Papastamopoulos V, Georgiou O, Panagopoulos P, Maltezos E, Coughlan S, De Gascun C, Byrne C, Duffy M, Bergin C, Reidy D, Farrell G, Lambert J, O'Connor E, Rochford A, Low J, Coakely P, O'Dea S, Hall W, Mor O, Levi I, Chemtob D, Grossman Z, Zazzi M, de Luca A, Balotta C, Riva C, Mussini C, Caramma I, Capetti A, Colombo MC, Rossi C, Prati F, Tramuto F, Vitale F, Ciccozzi M, Angarano G, Rezza G, Kolupajeva T, Vasins O, Griskevicius A, Lipnickiene V, Schmit JC, Struck D, Sauvageot N, Hemmer R, Arendt V, Michaux C, Staub T, Sequin-Devaux C, Wensing AMJ, Boucher CAB, van de Vijver DAMC, van Kessel A, van Bentum PHM, Brinkman K, Connell BJ, van der Ende ME, Hoepelman IM, van Kasteren M, Kuipers M, Langebeek N, Richter C, Santegoets RMWJ, Schrijnders-Gudde L, Schuurman R, van de Ven BJM, Åsjö B, Kran AMB, Ormaasen V, Aavitsland P, Horban A, Stanczak JJ, Stanczak GP, Firlag-Burkacka E, Wiercinska-Drapalo A, Jablonowska E, Maolepsza E, Leszczyszyn-Pynka M, Szata W, Camacho R, Palma C, Borges F, Paixão T, Duque V, Araújo F, Otelea D, Paraschiv S, Tudor AM, Cernat R, Chiriac C, Dumitrescu F, Prisecariu LJ, Stanojevic M, Jevtovic D, Salemovic D, Stanekova D, Habekova M, Chabadová Z, Drobkova T, Bukovinova P, Shunnar A, Truska P, Poljak M, Lunar M, Babic D, Tomazic J, Vidmar L, Vovko T, Karner P, Garcia F, Paredes R, Monge S, Moreno S, Del Amo J, Asensi V, Sirvent JL, de Mendoza C, Delgado R, Gutiérrez F, Berenguer J, Garcia-Bujalance S, Stella N, de Los Santos I, Blanco JR, Dalmau D, Rivero M, Segura F, Elías MJP, Alvarez M, Chueca N, Rodríguez-Martín C, Vidal C, Palomares JC, Viciana I, Viciana P, Cordoba J, Aguilera A, Domingo P, Galindo MJ, Miralles C, Del Pozo MA, Ribera E, Iribarren JA, Ruiz L, de la Torre J, Vidal F, Clotet B, Albert J, Heidarian A, Aperia-Peipke K, Axelsson M, Mild M, Karlsson A, Sönnerborg A, Thalme A, Navér L, Bratt G, Karlsson A, Blaxhult A, Gisslén M, Svennerholm B, Bergbrant I, Björkman P, Säll C, Mellgren Å, Lindholm A, Kuylenstierna N, Montelius R, Azimi F, Johansson B, Carlsson M, Johansson E, Ljungberg B, Ekvall H, Strand A, Mäkitalo S, Öberg S, Holmblad P, Höfer M, Holmberg H, Josefson P, Ryding U. Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe. Clin Infect Dis 2015; 62:655-663. [PMID: 26620652 PMCID: PMC4741360 DOI: 10.1093/cid/civ963] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [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: 06/08/2015] [Accepted: 11/06/2015] [Indexed: 11/13/2022] Open
Abstract
Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors. Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.
Collapse
Affiliation(s)
- L Marije Hofstra
- Luxembourg Institute of Health, Luxembourg.,Department of Virology, University Medical Center Utrecht, The Netherlands
| | | | - Jan Albert
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
| | - Ivailo Alexiev
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Federico Garcia
- Complejo Hospitalario Universitario de Granada, Instituto de Investigación IBS Granada; on behalf of Cohorte de Adultos de la Red de Investigación en SIDA, Spain
| | | | | | | | - Danail Beshkov
- National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | | | - Diane Descamps
- AP-HP Groupe hospitalier Bichat-Claude Bernard, IAME INSERM UMR 1137, Université Paris Diderot Sorbonne Paris Cité, Paris, France
| | | | | | | | | | | | | | - Kirsi Liitsola
- Department of Infectious Diseases, National Institute for Health and Welfare, Helsinki, Finland
| | - Marek Linka
- National Reference Laboratory for HIV/AIDS, National Institute of Public Health, Prague, Czech Republic
| | - Orna Mor
- National HIV Reference Laboratory, Chaim Sheba Medical Center, Tel-Hashomer, Israel
| | | | - Dan Otelea
- National Institute for Infectious Diseases "Prof. dr. Matei Bals", Bucharest, Romania
| | | | | | - Mario Poljak
- Faculty of Medicine, Slovenian HIV/AIDS Reference Centre, University of Ljubljana, Slovenia
| | | | - Anders Sönnerborg
- Karolinska Institute, Solna.,Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Fischbach R, Juergens KU, Ozgun M, Maintz D, Grude M, Seifarth H, Heindel W, Wichter T. Assessment of regional left ventricular function with multidetector-row computed tomography versus magnetic resonance imaging. Eur Radiol 2006; 17:1009-17. [PMID: 17008985 DOI: 10.1007/s00330-006-0438-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Revised: 05/22/2006] [Accepted: 08/10/2006] [Indexed: 10/24/2022]
Abstract
This study compares quantitative and qualitative information on global and regional left ventricular (LV) function obtained with multidetector-row computed tomography (MDCT) with that obtained with magnetic resonance imaging (MRI) in patients with a high prevalence of LV wall motion abnormalities. Thirty patients (19 male, 63.7+/-15.1 years) with myocardial infarction (n=12), coronary artery disease (n=9), arrhythmogenic right ventricular cardiomyopathy (n=6), and dilation cardiomyopathy (n=3) were included. Segmental LV wall motion (LV-WM) was assessed using a 4-point scale. Wall thickness measurements were calculated in diastolic and systolic short axis images. Two hundred and fifty-two out of 266 (94.7%) normal and 189 out of 214 (88.3%) segments with decreased wall motion were correctly identified by MDCT, yielding a sensitivity of 88% and specificity of 95% for identification of wall motion abnormalities. LV-WM scores were identical in 86.7% of 480 segments (kappa=0.809). MDCT had a tendency to underestimate the degree of wall motion impairment. Interobserver agreement was lower in MDCT (66.5%) than in MRI (89.1%; p<0.01). Normokinetic segments are reliably identified with MDCT. Sensitivity for detection and accurate classification of LV wall motion abnormalities need to be improved. Better temporal resolution of the CT system seems to be the most important factor for enhancing MDCT performance.
Collapse
Affiliation(s)
- Roman Fischbach
- Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Strasse 33, 48149, Münster, Germany
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Paul M, Schäfers M, Grude M, Reinke F, Juergens KU, Fischbach R, Schober O, Breithardt G, Wichter T. Idiopathic left ventricular aneurysm and sudden cardiac death in young adults. ACTA ACUST UNITED AC 2006; 8:607-12. [PMID: 16864613 DOI: 10.1093/europace/eul074] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [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: 11/14/2022]
Abstract
AIMS We report three young patients presenting with life-threatening ventricular tachycardia (VT) or ventricular fibrillation (VF) and/or survived sudden cardiac arrest, who were admitted to our institution for further diagnostic evaluation. METHODS AND RESULTS In all patients, idiopathic left ventricular (LV) aneurysms were identified after a detailed non-invasive and invasive evaluation. Sustained VT/VF was inducible during programmed ventricular stimulation in two of the three patients. Left ventricular aneurysms were depicted and characterized by various imaging modalities (echocardiography, magnetic resonance imaging, LV angiography). To elucidate the pathogenesis further, both myocardial viability and regional sympathetic innervation were assessed by radionuclide imaging techniques. Defects of innervation and metabolism were documented in the area of the aneurysm but distal to the aneurysm there were no signs of downstream denervation. CONCLUSION Life-threatening arrhythmias may be the first manifestation of an idiopathic LV aneurysm, which can be reliably diagnosed with modern imaging techniques. Radionuclide imaging may yield additional information as to the involvement of the autonomic nervous system potentially associated with arrhythmogenesis. Management strategies in patients with an idiopathic LV aneurysm range from antiarrhythmic drug treatment, implantation of an automatic cardioverter-defibrillator to surgical aneurysmectomy.
Collapse
Affiliation(s)
- Matthias Paul
- Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Str. 33, D-48149 Münster, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Juergens KU, Seifarth H, Maintz D, Grude M, Ozgun M, Wichter T, Heindel W, Fischbach R. MDCT Determination of Volume and Function of the Left Ventricle: Are Short-Axis Image Reformations Necessary? AJR Am J Roentgenol 2006; 186:S371-8. [PMID: 16714611 DOI: 10.2214/ajr.04.1764] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [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: 11/18/2022]
Abstract
OBJECTIVE Determination of left ventricular (LV) volumes and global function parameters from MDCT data sets is usually based on short-axis reformations from primarily reconstructed axial images, which prolong postprocessing time. The aim of this study was to evaluate the feasibility of LV volumetry and global LV function assessment from axial images in comparison with short-axis image reformations. SUBJECTS AND METHODS This study consisted of 20 patients with either coronary artery disease or dilated cardiomyopathy. We evaluated MDCT results using cine MRI as the reference technique. RESULTS LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were significantly overestimated by the axial MDCT approach in comparison with volume measurements from short-axis CT image reformations. The mean LV ejection fraction (LVEF) was not significantly different (41.2% vs 42.7%). Short-axis and axial MDCT determination of LVEF revealed a systematic underestimation by a mean +/- SD of -2.1% +/- 3.6% versus -3.6% +/- 8.2%, respectively, when compared with LVEF values based on cine MRI. The interobserver variability for volume and function measurements from axial images (LVEDV = 8.5%, LVESV = 10.8%, LVEF = 9.6%) was slightly higher than those measurements from short-axis reformations (LVEDV = 7.2%, LVESV = 9.5%, LVEF = 8.7%). The mean total evaluation time was significantly shorter using axial images (14.1 +/- 3.9 min) compared with short-axis reformations (16.9 +/- 5.2 min) (p < 0.05). CONCLUSION Determination of LV volumes and assessment of global LV function from axial MDCT image reformations is feasible and time efficient. This approach might be a clinically useful alternative to established short-axis-based measurements in patients with normal or near-normal LV function. A progressive underestimation of LVEF with increasing LV volumes may limit the clinical applicability of the axial approach in patients with dilated cardiomyopathy.
Collapse
Affiliation(s)
- Kai U Juergens
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, D-48149 Muenster, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T. Left bundle branch block in chronic heart failure-impact on diastolic function, filling pressures, and B-type natriuretic peptide levels. J Am Soc Echocardiogr 2006; 19:95-101. [PMID: 16423676 DOI: 10.1016/j.echo.2005.07.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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: 04/07/2005] [Indexed: 11/20/2022]
Abstract
BACKGROUND For patients with chronic heart failure (CHF), left bundle branch block (LBBB) is associated with impaired systolic function and increased morbidity and mortality, but data on diastolic function are scarce. In this patient population, we attempted to define the impact of LBBB on diastolic function, filling pressures, and brain natriuretic peptide and its circulating N-terminal precursor (NT-proBNP) levels. METHODS A total of 94 patients with stable CHF (48 with complete LBBB, 46 without intraventricular conduction delay and normal QRS duration) underwent conventional 2-dimensional/Doppler echocardiography and Doppler tissue analysis of mitral annular velocities. As a measure of left ventricular filling pressures, the ratio of peak early mitral flow velocity to peak early diastolic mitral annular velocity was derived. NT-proBNP measurements were carried out on a bench-top analyzer (Elecsys-2010, Roche Diagnostics, Mannheim, Germany). RESULTS Patients with or without LBBB did not differ with respect to the cause of CHF or ejection fraction, but in LBBB deceleration time was shorter (163 +/- 66 vs 205 +/- 95 milliseconds, P = .021) and a restrictive mitral filling pattern was more frequent (35% vs 11%, P = .005). In such patients, the ratio of peak early mitral flow velocity to peak early diastolic mitral annular velocity was higher (14.5 +/- 6.2 vs 10.6 +/- 5.2, P < .001) and NT-proBNP was elevated (3553 +/- 3725 vs 850 +/- 896 pg/mL, P < .01) as compared with patients without LBBB. CONCLUSION For patients with CHF and comparable systolic performance, LBBB is associated with more severe diastolic dysfunction, elevated filling pressures, and higher NT-proBNP levels. These findings may contribute to increased morbidity and mortality of such patients.
Collapse
Affiliation(s)
- Christian Bruch
- Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany.
| | | | | | | | | | | |
Collapse
|
11
|
Maintz D, Juergens KU, Grude M, Ozgun M, Fischbach R, Wichter T. Magnetic Resonance Imaging and Computed Tomography Findings in Arrhythmogenic Right Ventricular Cardiomyopathy. Circulation 2006; 113:e673-5. [PMID: 16585398 DOI: 10.1161/circulationaha.105.174008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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] [Indexed: 11/16/2022]
Affiliation(s)
- D Maintz
- Department of Clinical Radiology, University of Muenster, Muenster, Germany.
| | | | | | | | | | | |
Collapse
|
12
|
Acil T, Wichter T, Stypmann J, Janssen F, Paul M, Grude M, Scheld HH, Breithardt G, Bruch C. Prognostic value of tissue Doppler imaging in patients with chronic congestive heart failure. Int J Cardiol 2005; 103:175-81. [PMID: 16080977 DOI: 10.1016/j.ijcard.2004.08.048] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [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: 03/15/2004] [Accepted: 08/10/2004] [Indexed: 01/23/2023]
Abstract
BACKGROUND The prognostic value of tissue Doppler imaging (TDI) in patients with chronic congestive heart failure (CHF) has not been compared against conventional measures of systolic, diastolic and overall left ventricular LV performance. The aim of this study was to assess the prognostic value of TDI-derived parameters in patients with CHF. METHODS One hundred thirty-two subjects with chronic CHF [due to ischemic (n=82) or dilated (n=50) cardiomyopathy, 101 males, mean age 57+/-11 years] underwent conventional two-dimensional/Doppler echocardiography and assessment of the Tei-index (isovolumic contraction time and isovolumic relaxation time divided by ejection time). Systolic, early and late diastolic mitral annular velocities (S', E' and A') were derived from pulsed TDI. A cardiac event (cardiac death, urgent cardiac transplantation or hospitalization due to decompensated CHF) was defined as the combined study endpoint. RESULTS The patients were followed for a mean of 224+/-123 days. Thirty-one patients suffered an event (cardiac death, n=5; urgent cardiac transplantation, n=2; hospitalization due to CHF, n=24). In patients with event, ejection fraction was lower (25+/-10 vs. 32+/-9%), mitral deceleration time was shorter (138+/-58 vs. 193+/-72 ms), and the peak mitral E/E'-ratio (16.1+/-6.6 vs. 10.6+/-5.0) was significantly elevated as compared to patients free of events (p<0.001 for all comparisons). In those patients, the Tei-index was elevated (1.09+/-0.39 vs. 0.86+/-0.26, p<0.01), and a restrictive mitral filling pattern was more frequent (51.6 vs. 17.5%, p<0.001). Stepwise multivariate analysis identified the mitral E/E'-ratio (p<0.001) and the Tei-index (p=0.019) as the only independent predictors of a combined event. E/E'-ratio was the best predictor of hospitalization due to CHF also. In patients with mitral E/E'-ratio>12.5 or Tei-index>0.90, outcome was poor. CONCLUSIONS In subjects with chronic CHF, the mitral E/E'-ratio is a stronger predictor of future cardiac events than conventional parameters of systolic, diastolic or overall LV performance. The E/E'-ratio may be a useful addition in the routine follow-up of such patients.
Collapse
Affiliation(s)
- Tayfun Acil
- Department of Cardiology and Angiology, University Hospital of Münster, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|
13
|
Paul M, Gerdes P, Wirdeier S, Wollmann C, Grude M, Breithardt G, Wichter T. Diagnostic impact of right ventricular endomyocardial biopsy in patients with arrhythmogenic right ventricular cardiomyopathy. Heart Rhythm 2005. [DOI: 10.1016/j.hrthm.2005.02.914] [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: 11/25/2022]
|
14
|
Juergens U, Ozgun M, Maintz D, Seifarth H, Grude M, Heindel W, Fischbach R. Analyse der globalen und regionalen linksventrikulären Funktion mittels 16-Zeilen-Spiral-Computertomographie des Herzens im Vergleich zur MR-Tomographie. ROFO-FORTSCHR RONTG 2005. [DOI: 10.1055/s-2005-867896] [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]
|
15
|
Wollmann C, Grude M, Tombach B, Kugel H, Heindel W, Breithardt G, Böcker D, Vahlhaus C. Safe Performance of Magnetic Resonance Imaging on a Patient with an ICD. Pacing and Clinical Electrophysiology 2005; 28:339-42. [PMID: 15826273 DOI: 10.1111/j.1540-8159.2005.09535.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is a report on a patient with an implanted cardioverter defibrillator (ICD) who intentionally underwent magnetic resonance imaging (MRI) of a malignant brain tumor. To avoid inadequate detection of ventricular tachycardia (VT) or ventricular fibrillation (VF), the ICD was inactivated by programming the VT-detection and VT/VF-therapy status off. The patient came through the protocol safely and without any difficulty or discomfort. There was no arrhythmic event. MRI affected neither programmed data nor the function of the ICD system.
Collapse
Affiliation(s)
- Christian Wollmann
- Department of Cardiology and Angiology, Hospital of the University of Münster, Albert-Schweitzer-Strasse 33, D-48149 Münster, Germany
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Bruch C, Grude M, Müller J, Breithardt G, Wichter T. Usefulness of tissue Doppler imaging for estimation of left ventricular filling pressures in patients with systolic and diastolic heart failure. Am J Cardiol 2005; 95:892-5. [PMID: 15781027 DOI: 10.1016/j.amjcard.2004.12.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.4] [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: 09/28/2004] [Revised: 12/01/2004] [Accepted: 12/01/2004] [Indexed: 11/19/2022]
Abstract
The diagnostic usefulness of the mitral E/E' ratio (derived from tissue Doppler imaging) as an estimate of left ventricular filling pressures was studied in 28 patients with diastolic heart failure (defined by heart failure signs and symptoms but with preserved ejection fraction) and in 46 patients with systolic heart failure (heart failure signs and symptoms and reduced ejection fraction). E/E' was reflective of filling pressures in subjects with diastolic and systolic heart failure and may be of special use in ruling out elevated filling pressures in subjects with suspected diastolic heart failure.
Collapse
Affiliation(s)
- Christian Bruch
- Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany.
| | | | | | | | | |
Collapse
|
17
|
Bruch C, Gotzmann M, Stypmann J, Wenzelburger F, Rothenburger M, Grude M, Scheld HH, Eckardt L, Breithardt G, Wichter T. Electrocardiography and Doppler echocardiography for risk stratification in patients with chronic heart failure. J Am Coll Cardiol 2005; 45:1072-5. [PMID: 15808766 DOI: 10.1016/j.jacc.2004.12.064] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [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: 10/30/2004] [Revised: 12/08/2004] [Accepted: 12/21/2004] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This prospective study tested whether Doppler echocardiographic variables add incremental value to QRS duration in determining the prognosis of patients with chronic heart failure (CHF) and systolic dysfunction. BACKGROUND Diastolic dysfunction frequently is observed in patients with CHF, but its prognostic impact relative to that of QRS duration is unknown. METHODS A total of 193 patients with CHF and an ejection fraction <45% were enrolled prospectively. Echo measurements included left ventricular dimensions/volumes, ejection fraction, mitral early/late diastolic velocity ratio, deceleration time, and tissue Doppler mitral annular velocities. The mitral filling pattern was classified as either restrictive (RFP) or nonrestrictive. A cardiac event (cardiac death or urgent cardiac transplantation) was defined as combined study end point. RESULTS During a follow-up of 385 +/- 270 days, 24 patients suffered an event (cardiac death, n = 21; urgent transplantation, n = 3). The RFP, QRS duration, left ventricular systolic diameter, and mitral annular early diastolic velocity were independent predictors of an event. In patients with QRS duration >144 ms, the outcome was markedly poorer in the presence of RFPs as compared with their absence. Similarly, despite a QRS duration <or =144 ms, the outcome was worse in the presence of a RFP. A risk-stratification model based on the three strongest independent predictors separated groups into those with good prognosis and those with high, intermediate, and low event-free survival rates. CONCLUSIONS In subjects with CHF and systolic dysfunction, transmitral flow patterns add incremental value to QRS duration in determining the prognosis.
Collapse
Affiliation(s)
- Christian Bruch
- Department of Cardiology and Angiology, University Hospital of Münster, Albert-Schweitzer-Strasse 33, D-48129 Münster, Germany.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Juergens KU, Maintz D, Grude M, Boese JM, Heimes B, Fallenberg EM, Heindel W, Fischbach R. Multi-detector row computed tomography of the heart: does a multi-segment reconstruction algorithm improve left ventricular volume measurements? Eur Radiol 2004; 15:111-7. [PMID: 15565319 DOI: 10.1007/s00330-004-2530-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2004] [Revised: 09/17/2004] [Accepted: 09/28/2004] [Indexed: 11/30/2022]
Abstract
A multi-segment cardiac image reconstruction algorithm in multi-detector row computed tomography (MDCT) was evaluated regarding temporal resolution and determination of left ventricular (LV) volumes and global LV function. MDCT and cine magnetic resonance (CMR) imaging were performed in 12 patients with known or suspected coronary artery disease. Patients gave informed written consent for the MDCT and the CMR exam. MDCT data were reconstructed using the standard adaptive cardiac volume (ACV) algorithm as well as a multi-segment algorithm utilizing data from three, five and seven rotations. LV end-diastolic (LV-EDV) and end-systolic volumes and ejection fraction (LV-EF) were determined from short-axis image reformations and compared to CMR data. Mean temporal resolution achieved was 192+/-24 ms using the ACV algorithm and improved significantly utilizing the three, five and seven data segments to 139+/-12, 113+/-13 and 96+/-11 ms (P<0.001 for each). Mean LV-EDV was without significant differences using the ACV algorithm, the multi-segment approach and CMR imaging. Despite improved temporal resolution with multi-segment image reconstruction, end-systolic volumes were less accurately measured (mean differences 3.9+/-11.8 ml to 8.1+/-13.9 ml), resulting in a consistent underestimation of LV-EF by 2.3-5.4% in comparison to CMR imaging (Bland-Altman analysis). Multi-segment image reconstruction improves temporal resolution compared to the standard ACV algorithm, but this does not result in a benefit for determination of LV volume and function.
Collapse
Affiliation(s)
- Kai Uwe Juergens
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, 48149 Muenster, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Bruch C, Stypmann J, Grude M, Gradaus R, Breithardt G, Wichter T. Tissue Doppler imaging in patients with moderate to severe aortic valve stenosis: clinical usefulness and diagnostic accuracy. Am Heart J 2004; 148:696-702. [PMID: 15459603 DOI: 10.1016/j.ahj.2004.03.049] [Citation(s) in RCA: 100] [Impact Index Per Article: 5.0] [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: 11/26/2022]
Abstract
BACKGROUND Mitral annular velocities derived from tissue Doppler imaging (TDI) provide information about left ventricular (LV) long-axis function and allow for the assessment of LV filling pressures in selected subsets of patients. It was the aim of this study to assess the usefulness of TDI in patients with moderate to severe aortic valve stenosis (AS). METHODS Twenty-three patients with moderate to severe AS (mean aortic valve area 0.8 +/- 0.4 cm2), in whom coronary artery disease had been ruled out, and 36 asymptomatic age-matched control subjects underwent assessment of ejection fraction, fractional shortening, and mitral inflow (E, A, E/A ratio). TDI velocities (S', E', A') were derived from the septal mitral annulus. In patients with AS, LV pressure before atrial contraction (LV pre-A pressure), LV end-diastolic pressure, and cardiac index were measured during cardiac catheterization. RESULTS In patients with AS, systolic (S') and early diastolic mitral annular velocities (E') were significantly reduced in comparison to control subjects (systolic, 5.5 +/- 1.2 vs 8.3 +/- 1.3 cm/s; early diastolic, 5.6 +/- 1.6 vs 10.2 +/- 3.0 cm/s, P <.001 for both comparisons), but ejection fraction, fractional shortening, and cardiac index were normal. In patients with AS, LV pre-A pressures (14 +/- 4 mm Hg) and end-diastolic pressures were high (19 +/- 7 mm Hg). In such patients, the mitral E/E' ratio was significantly related to LV pre-A pressure (r = 0.75, P <.001) and to LV end-diastolic pressure (r = 0.78, P <.001). In patients with AS, an E/E' ratio > or =13 identified an LV end-diastolic pressure >15 mm Hg, with a sensitivity of 93% and a specificity of 88%. CONCLUSIONS In patients with moderate to severe AS, TDI allows for a reliable, noninvasive estimation of filling pressures. In such patients, systolic long-axis function is impaired even in the presence of normal ejection fraction and cardiac index. Thus, TDI integrates information about systolic and diastolic performance and may be a useful addition in the echocardiographic workup and care of patients with AS.
Collapse
Affiliation(s)
- Christian Bruch
- Department of Cardiology and Angiology, Hospital of the University of Münster, Münster, Germany.
| | | | | | | | | | | |
Collapse
|
20
|
Grude M, Juergens KU, Wichter T, Paul M, Fallenberg EM, Muller JG, Heindel W, Breithardt G, Fischbach R. Evaluation of global left ventricular myocardial function with electrocardiogram-gated multidetector computed tomography: comparison with magnetic resonance imaging. Invest Radiol 2004; 38:653-61. [PMID: 14501493 DOI: 10.1097/01.rli.0000077070.40713.76] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [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: 12/13/2022]
Abstract
RATIONALE AND OBJECTIVES Electrocardiogram-gated 3D volume data from multidetector computed tomography coronary angiography (MDCT-CA) enable image reconstruction in any phase of the cardiac cycle. The objective was to determine left ventricular (LV) function parameters by MDCT in comparison to cine magnetic resonance imaging (MRI). METHOD Thirty patients with known or suspected coronary artery disease (CAD) underwent MDCT-CA. From multiplanar reformations in short axis orientation end-diastolic and end-systolic LV volumes (LVEDV, LVESV) were determined to calculate LV stroke volume and ejection fraction (LVSV, LVEF) and compared with MRI measurements. RESULTS LVEDV (147 +/- 27 mL) and LVESV (65 +/- 22 mL) determined by MDCT correlated well to the respective MRI measurements (LVEDV 133 +/- 27 mL, r = 0.80, P < 0.001; LVESV 48 +/- 19 mL, r = 0.89, P < 0.001). LVSV (MDCT 82 +/- 15 mL; MRI 85 +/- 17 mL; r = 0.77, P < 0.001) and LVEF (MDCT 56 +/- 9%; MRI 65 +/- 8%; r = 0.85, P < 0.001) showed a good correlation as well. LVEF was significantly underestimated by MDCT (-8.5 +/- 4.7%, P < 0.001). CONCLUSIONS Initial experience in patients evaluated for CAD shows that spiral MDCT studies may provide LV functional data in good correlation to Cine MRI.
Collapse
Affiliation(s)
- Matthias Grude
- Department of Cardiology and Angiology, University of Muenster, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Bruch C, Grude M, Gradaus R, Stypmann J, Breithardt G. 863-3 Tissue doppler imaging for estimation of filling pressures: Validation in patients with primary or secondary mitral regurgitation. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91570-7] [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: 10/26/2022]
|
22
|
Acil T, Wichter T, Stypmann J, Janssen F, Paul M, Grude M, Scheld HH, Breithardt G, Bruch C. 823-2 The ratio of early diastolic mitral flow velocity to early diastolic mitral annular velocity predicts prognosis in patients with chronic congestive heart failure. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91465-9] [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: 11/24/2022]
|
23
|
Bruch C, Grude M, Gradaus R, Stypmann J, Breithardt G. 863-6 Tissue doppler imaging in patients with moderate to severe aortic valve stenosis: Clinical usefulness and diagnostic accuracy. J Am Coll Cardiol 2004. [DOI: 10.1016/s0735-1097(04)91573-2] [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: 11/17/2022]
|
24
|
Maintz D, Juergens KU, Grude M, Ozgun M, Wichter T, Fischbach R, Heindel W. Verzögerte Kontrastmittelanreicherung (Late Enhancement) in der MRT bei Arrhythmogener Rechtsventrikulärer Kardiomyopathie (ARVC). ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827821] [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]
|
25
|
Juergens KKU, Maintz D, Grude M, Oezgun M, Tiemann A, Wichter T, Fischbach R, Heindel W. Linksventrikuläre Funktionsdiagnostik mittels 16 Zeilen-Spiral Computertomographie des Herzens: Evaluierung einer Analysesoftware mit automatischer Konturdetektion im Vergleich zur MR-Tomographie. ROFO-FORTSCHR RONTG 2004. [DOI: 10.1055/s-2004-827786] [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]
|
26
|
Juergens KU, Grude M, Maintz D, Fallenberg EM, Wichter T, Heindel W, Fischbach R. Multi-detector row CT of left ventricular function with dedicated analysis software versus MR imaging: initial experience. Radiology 2003; 230:403-10. [PMID: 14668428 DOI: 10.1148/radiol.2302030042] [Citation(s) in RCA: 201] [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: 01/28/2023]
Abstract
PURPOSE To determine left ventricular (LV) volumetric and functional parameters from retrospectively electrocardiographically gated multi-detector row computed tomography (CT) by using semiautomated analysis software and to correlate results with those of magnetic resonance (MR) imaging. MATERIALS AND METHODS In 30 patients (mean age, 59.2 years +/- 7.1 [SD]) known to have or suspected of having coronary artery disease, four-channel multi-detector row CT was performed with standard technique, and diastolic and systolic image reconstructions were generated. With commercially available analysis software capable of semiautomated contour detection, end diastolic and end systolic LV volumes were determined from short-axis secondary CT reformations. Steady-state free-precession cine MR images were acquired in short-axis orientation within 48 hours and analyzed by using dedicated software. Bland-Altman analysis was performed to calculate limits of agreement and systematic errors between CT and MR imaging. RESULTS Mean end diastolic (138.8 mL +/- 31.9) and end systolic (53.9 mL +/- 21.2) LV volumes as determined with CT correlated well with MR imaging measurements (142.0 mL +/- 32.5 [r = 0.93] and 54.9 mL +/- 22.8 [r = 0.94], respectively [P <.001]). LV ejection fraction (61.6% +/- 10.6 for CT vs 62.3% +/- 10.1 for MR imaging; r = 0.89) and stroke volume (84.6 mL +/- 20.9 for CT vs 86.9 mL +/- 21.5 for MR imaging; r = 0.88) also showed good correlation (P <.001). Bland-Altman analysis showed acceptable limits of agreement (+/-9.8% for ejection fraction) without systematic errors. CONCLUSION In selected patients, semiautomated analysis software enables LV volumetric and functional analysis based on multi-detector row CT data sets, the results of which correlate well with MR imaging findings.
Collapse
Affiliation(s)
- Kai Uwe Juergens
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Strasse 33, D-48149 Muenster, Germany.
| | | | | | | | | | | | | |
Collapse
|
27
|
Juergens KU, Fischbach R, Grude M, Maintz D, Fallenberg EM, Wichter T, Heindel W. Semiautomatisierte linksventrikuläre Funktionsdiagnostik mittels 16-Zeilen-Computertomographie des Herzens im Vergleich zur Steady-State-Free-Precession(SSFP)-Magnetresonanztomographie: Erste Ergebnisse. ROFO-FORTSCHR RONTG 2003. [DOI: 10.1055/s-2003-819924] [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]
|
28
|
Abstract
PURPOSE To assess patency and lumen visibility of coronary artery stents by multislice-CT angiography (MSCTA) in comparison with conventional coronary angiography as the standard of reference. MATERIAL AND METHODS 47 stents of 13 different types were evaluated in 29 patients. MSCTA was performed on a 4-slice scanner with a standard coronary protocol (detector collimation 4 x 1 mm; table feed 1.5 mm/rotation, 400 mAs, 120 kV). Image evaluation was performed by two readers who were blinded to the reports from the catheter angiography. MIP reconstructions were evaluated for image quality on a 4-point scale (1 = poor, 4 = excellent) and stent patency (contrast distal to the stent as an indirect patency sign). Axial images and multiplanar reformations through the stents were used for assessment of stent lumen visibility (measurement of the visible stent lumen diameter) and detection of relevant in-stent stenosis (> or =50%). RESULTS Image quality was fair to good on average (score 2.64 +/- 1.0) and depended on the heart rate (heart rate 45-60: average score 3.2, heart rate 61-70: average score 2.8, heart rate >71: average score 1.4). Thirty-seven stents were correctly classified as patent, 1 was correctly classified as occluded and 9 stents were not assessible due to insufficient image quality because of triggering artifacts. Parts of the stent lumen could be visualized in 30 cases. On average, 20-40% of the stent lumen diameter was visible. Twenty-five stents were correctly classified as having no stenosis, 1 was falsely classified as stenosed, 1 was correctly classified as occluded. In 20 stents lumen visibility was not sufficient for stenosis evaluation. CONCLUSION Although the stent lumen may be partly visualized in most stents, a reliable evaluation of in-stent stenoses does not seem practical by 4-slice MSCT. Nevertheless, for stent patency evaluation, MS-CTA might provide valuable clinical information. With submillimeter MSCT (e.g., 16-slice scanners) and more sophisticated reconstruction algorithms, further improvements may be expected.
Collapse
Affiliation(s)
- D Maintz
- Department of Clinical Radiology, Department of Cardiology and Angiology, University of Münster, Münster; Germany.
| | | | | | | | | |
Collapse
|
29
|
Paul M, Grude M, Bachmann R, Bruch C, Kotthoff S, Fischbach R, Hammel D, Breithardt G, Wichter T. [Aneurysm of the subclavian artery after operatively corrected coarctation of the aorta: 20 years of follow-up and review of the current literature]. Z Kardiol 2003; 92:339-46. [PMID: 12707794 DOI: 10.1007/s00392-003-0914-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report of long-term follow-up of a combined fusiform aneurysm of the right subclavian artery extending to the thyreocervical trunk (3.2 x 2.8 x 2.2 cm (width x height x depth)) in a 33-year old patient. As a newborn, the clinical diagnosis of an aortic isthmus stenosis was made without need for intervention at this stage. Further development of the child remained unremarkable until the age of eleven years when he experienced dizziness after sporting activities. Due to clinically proven progress, cardiac catheterization was performed and confirmed the initial diagnosis of a juxtaductale stenosis of the aortic isthmus, which was operated thereafter with an end-to-end anastomosis. Furthermore, an aneurysm of the right subclavian artery was revealed. Since then, non-invasive routine follow-up showed no significant worsening of this aneurysm, which extends to the thyreocervical trunk. The patient has been event free and completely asymptomatic. This case report illustrates the more than twenty years of follow-up of an asymptomatic combined fusiform aneurysm of the subclavian artery and thyreocervical trunk and provides a review of the literature on this topic.
Collapse
Affiliation(s)
- M Paul
- Medizinische Klinik und Poliklinik C, Kardiologie und Angiologie, Universitätsklinikum München, Albert-Schweitzer-Str. 33, 48149 Münster, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Maintz D, Juergens KU, Wichter T, Grude M, Heindel W, Fischbach R. Imaging of coronary artery stents using multislice computed tomography: in vitro evaluation. Eur Radiol 2003; 13:830-5. [PMID: 12664124 DOI: 10.1007/s00330-002-1651-4] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2002] [Revised: 07/01/2002] [Accepted: 07/15/2002] [Indexed: 10/25/2022]
Abstract
The aim of this study was to evaluate imaging features of different coronary artery stents during multislice CT Angiography (MSCTA). Nineteen stents made of varying material (steel, nitinol, tantalum) and of varying stent design were implanted in plastic tubes with an inner diameter of 3 mm to simulate a coronary artery. The tubes were filled with iodinated contrast material diluted to 200 Hounsfield units (HU), closed at both ends and positioned in a plastic container filled with oil (-70 HU). The MSCT scans were obtained perpendicular to the stent axes (detector collimation 4x1 mm, table feed 2 mm/rotation, 300 mAs, 120 kV). Axial images and multiplanar reformations were evaluated regarding artifact size, lumen visibility, and intraluminal attenuation values. Artifacts characterized by artifactual thickening of the stent struts leading to apparent reduction in the lumen diameter and increased intraluminal attenuation values were observed in all cases. The stent lumen was totally obscured in the Wiktor stent, the Wallgraft stent, and the Nir Royal stent. Partial residual of the stent lumen could be visualized in all other utilized stent products (artificial lumen reductions ranged from 62% in the V-Flex stent to 94% in the Bx Velocity stent). Parts of the stent lumen can be visualized in most coronary artery stents; however, detectability of in-stent stenoses remains to be evaluated for each stent type.
Collapse
Affiliation(s)
- David Maintz
- Department of Clinical Radiology, University of Münster, Albert-Schweitzer-Strasse 33, 48129 Münster, Germany.
| | | | | | | | | | | |
Collapse
|
31
|
Bruch C, Grude M, Gradaus R, Wichter T, Breithardt G. Impact of stroke volume on mitral annular velocities derived from tissue doppler imaging. J Am Coll Cardiol 2003. [DOI: 10.1016/s0735-1097(03)81361-x] [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: 11/15/2022]
|
32
|
Juergens KU, Grude M, Fallenberg EM, Opitz C, Wichter T, Heindel W, Fischbach R. Using ECG-gated multidetector CT to evaluate global left ventricular myocardial function in patients with coronary artery disease. AJR Am J Roentgenol 2002; 179:1545-50. [PMID: 12438052 DOI: 10.2214/ajr.179.6.1791545] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [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: 12/12/2022]
Abstract
OBJECTIVE Retrospectively ECG-gated three-dimensional volume data from multidetector CT (MDCT) coronary angiography enable image reconstruction of the cardiac cycle in the diastolic and systolic phases. The objective of our study was to investigate the feasibility of determining left ventricular function from MDCT coronary angiography data sets in 22 patients with coronary artery disease and to study the correlation of MDCT results with those of functional data from biplane cineventriculography. CONCLUSION Multiplanar reformations from three-dimensional MDCT data allowed good delineation of endocardial and epicardial left ventricular contours. In patients evaluated for coronary artery disease, MDCT coronary angiography with retrospective ECG gating provides functional data in an acceptable correlation (r = 0.8; p < 0.05) to biplane cineventriculography.
Collapse
Affiliation(s)
- Kai Uwe Juergens
- Department of Clinical Radiology, University of Muenster, Albert-Schweitzer-Str. 33, D-48149 Muenster, Germany
| | | | | | | | | | | | | |
Collapse
|
33
|
Droste DW, Jekentaite R, Stypmann J, Grude M, Hansberg T, Ritter M, Nabavi D, Nam EM, Dittrich R, Wichter T, Ringelstein EB. Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: comparison of Echovist-200 and Echovist-300, timing of the Valsalva maneuver, and general recommendations for the performance of the test. Cerebrovasc Dis 2002; 13:235-41. [PMID: 12011547 DOI: 10.1159/000057849] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [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: 11/19/2022] Open
Abstract
BACKGROUND AND PURPOSE Cardiac right-to-left shunts (RLS) can be identified by transesophageal echocardiography (TEE) as well as by transcranial Doppler ultrasound (TCD) using contrast agents, such as Echovist-200 or Echovist-300 in conjunction with a Valsalva maneuver (VM) as provocation procedure. Both Echovist preparations are in use. Currently, the appropriate timing of the VM is still under debate. METHODS Sixty-four patients were investigated by both TEE and bilateral TCD of the middle cerebral arteries. The following protocol was applied in a randomized way: (1) no VM, (2) VM for 5 s starting with the beginning of Echovist-300 injection, (3) VM for 5 s starting 5 s after the beginning of Echovist-300 injection, (4) VM for 5 s starting 10 s after the beginning of Echovist-300 injection, and (5) VM for 5 s starting 5 s after the beginning of Echovist-200 injection. RESULTS In 27 patients, an RLS was demonstrated by both TEE and contrast TCD (shunt-positive). Twenty-two patients were negative in both investigations, no patient was positive on TEE but negative on TCD, 15 patients were only positive on at least one TCD investigation but negative on TEE. Tests 3 and 5 were the most appropriate ones; test 3 was slightly superior to test 5. CONCLUSIONS TCD using Echovist-300 or Echovist-200 is a sensitive method to identify TEE-proven cardiac RLS. To achieve the best diagnostic accuracy, the VM should be performed for a duration of 5 s starting at 5 s following the beginning of contrast injection.
Collapse
Affiliation(s)
- Dirk W Droste
- Department of Neurology, University of Münster, Münster, Germany.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Droste DW, Silling K, Stypmann J, Grude M, Kemény V, Wichter T, Kühne K, Ringelstein EB. Contrast transcranial doppler ultrasound in the detection of right-to-left shunts : time window and threshold in microbubble numbers. Stroke 2000; 31:1640-5. [PMID: 10884466 DOI: 10.1161/01.str.31.7.1640] [Citation(s) in RCA: 74] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Valsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient. METHODS Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of 10 mL of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity and specificity of combined results of the tests with VM. RESULTS In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least 1 TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the results of 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt. CONCLUSIONS TCD performed twice with 2 provocation maneuvers with Echovist is a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.
Collapse
Affiliation(s)
- D W Droste
- Department of Neurology, Institute for Arteriosclerosis Research, University of Münster, Münster, Germany
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Krieter DH, Grude M, Lemke HD, Fink E, Bönner G, Schölkens BA, Schulz E, Müller GA. Anaphylactoid reactions during hemodialysis in sheep are ACE inhibitor dose-dependent and mediated by bradykinin. Kidney Int 1998; 53:1026-35. [PMID: 9551414 DOI: 10.1111/j.1523-1755.1998.00837.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [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: 11/26/2022]
Abstract
Anaphylactoid reactions (AR) have been attributed to the generation of bradykinin (BK) when AN69 membranes are used together with angiotensin converting enzyme (ACE) inhibitors during hemodialysis. However, conclusive evidence for the involvement of the BK as the mediator of these AR is still lacking. This study examined the degree of contact activation in an animal model caused by three PAN membranes--AN69, PAN DX, and SPAN- and the effects of different doses of the ACE inhibitor enalapril (ENA) and the BK B2-receptor antagonist icatibant on AR during hemodialysis. Six sheep were dialyzed for one hour with or without ENA pre-treatment using the different membranes in random order. Severe AR were observed only during hemodialysis with AN69 dialyzers together with ENA pre-treatment; the severity of AR increased with the ENA dose. Mild hypotension was noted during hemodialysis with AN69 without ACE inhibition and with PAN DX and 20 mg ENA. Compared to pre-dialysis values, maximum generation of BK after blood passage through the dialyzer was found at five minutes: 73-fold (AN69 without ENA), 161-fold (AN69 with 10 mg ENA), 97-fold (AN69 with 20 mg ENA), 108-fold (AN69 with 30 mg ENA), 154-fold (AN69 with 30 mg ENA and 0.1 mg/kg icatibant), 18-fold (PAN DX without ENA), and 42-fold (PAN DX with 20 mg ENA). Elevated BK levels in arterial blood were detected during hemodialysis with AN69 membranes even without ACE inhibition (2.5-fold); pre-treatment with 20 mg ENA further increased arterial BK concentrations (4-fold). Furthermore, a marked decline of prekallikrein and high molecular weight kininogen concentrations was noted for both AN69 and PAN DX membranes. Anaphylactoid reactions during hemodialysis were completely prevented by icatibant even after pre-treatment with ENA and in the presence of high BK concentrations. Concentrations of prekallikrein, high molecular weight kininogen, and BK remained unchanged and no AR were observed during hemodialysis with SPAN and pre-treatment with 20 mg ENA. Our findings confirm that AR during hemodialysis with the negatively charged AN69 membrane are mediated by BK, since they can be prevented by the BK B2-receptor antagonist icatibant.
Collapse
Affiliation(s)
- D H Krieter
- Department of Nephrology and Rheumatology, Georg-August-University of Göttingen, Germany. dkriete.gwdg.de
| | | | | | | | | | | | | | | |
Collapse
|