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Steinbeis F, Thibeault C, Steinbrecher S, Ahlgrimm Y, Haack IA, August D, Balzuweit B, Bellinghausen C, Berger S, Chaplinskaya-Sobol I, Cornely O, Doeblin P, Endres M, Fink C, Finke C, Frank S, Hanß S, Hartung T, Hellmuth JC, Herold S, Heuschmann P, Heyckendorf J, Heyder R, Hippenstiel S, Hoffmann W, Kelle SU, Knape P, Koehler P, Kretzler L, Leistner DM, Lienau J, Lorbeer R, Lorenz-Depiereux B, Lüttke CD, Mai K, Merle U, Meyer-Arndt LA, Miljukov O, Muenchhoff M, Müller-Plathe M, Neuhann J, Neuhauser H, Nieters A, Otte C, Pape D, Pinto RM, Pley C, Pudszuhn A, Reuken P, Rieg S, Ritter P, Rohde G, Rönnefarth M, Ruzicka M, Schaller J, Schmidt A, Schmidt S, Schwachmeyer V, Schwanitz G, Seeger W, Stahl D, Stobäus N, Stubbe HC, Suttorp N, Temmesfeld B, Thun S, Triller P, Trinkmann F, Vadasz I, Valentin H, Vehreschild M, von Kalle C, von Lilienfeld-Toal M, Weber J, Welte T, Wildberg C, Wizimirski R, Zvork S, Sander LE, Vehreschild J, Zoller T, Kurth F, Witzenrath M. Analysis of acute COVID-19 including chronic morbidity: protocol for the deep phenotyping National Pandemic Cohort Network in Germany (NAPKON-HAP). Infection 2024; 52:93-104. [PMID: 37434025 PMCID: PMC10811153 DOI: 10.1007/s15010-023-02057-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 05/29/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) pandemic causes a high burden of acute and long-term morbidity and mortality worldwide despite global efforts in containment, prophylaxis, and therapy. With unprecedented speed, the global scientific community has generated pivotal insights into the pathogen and the host response evoked by the infection. However, deeper characterization of the pathophysiology and pathology remains a high priority to reduce morbidity and mortality of coronavirus disease 2019 (COVID-19). METHODS NAPKON-HAP is a multi-centered prospective observational study with a long-term follow-up phase of up to 36 months post-SARS-CoV-2 infection. It constitutes a central platform for harmonized data and biospecimen for interdisciplinary characterization of acute SARS-CoV-2 infection and long-term outcomes of diverging disease severities of hospitalized patients. RESULTS Primary outcome measures include clinical scores and quality of life assessment captured during hospitalization and at outpatient follow-up visits to assess acute and chronic morbidity. Secondary measures include results of biomolecular and immunological investigations and assessment of organ-specific involvement during and post-COVID-19 infection. NAPKON-HAP constitutes a national platform to provide accessibility and usability of the comprehensive data and biospecimen collection to global research. CONCLUSION NAPKON-HAP establishes a platform with standardized high-resolution data and biospecimen collection of hospitalized COVID-19 patients of different disease severities in Germany. With this study, we will add significant scientific insights and provide high-quality data to aid researchers to investigate COVID-19 pathophysiology, pathology, and chronic morbidity.
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Affiliation(s)
- Fridolin Steinbeis
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Charlotte Thibeault
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Steinbrecher
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Yvonne Ahlgrimm
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ira An Haack
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dietrich August
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany
| | - Beate Balzuweit
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Carla Bellinghausen
- Department of Respiratory Medicine/Allergology, Medical Clinic 1, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sarah Berger
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Oliver Cornely
- Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Patrick Doeblin
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Fink
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Finke
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sandra Frank
- Department of Anesthesiology, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Sabine Hanß
- Department of Medical Informatics, University Medical Center Göttingen, Göttingen, Germany
| | - Tim Hartung
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Johannes Christian Hellmuth
- Department of Medicine III, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
- COVID-19 Registry of the LMU Munich (CORKUM), University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Susanne Herold
- Department of Medicine V, Internal Medicine, Infectious Diseases and Infection Control, University Hospital Giessen and Marburg, Giessen, Germany
- German Center for Lung Research (DZL), Institute of Lung Health (ILH), Excellence Cluster Cardiopulmonary Institute (CPI), Justus Liebig-University, Giessen, Germany
| | - Peter Heuschmann
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
- Clinical Trial Center, Institute for Medical Data Science, University Hospital Würzburg, Würzburg, Germany
| | - Jan Heyckendorf
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ralf Heyder
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Berlin, Germany
| | - Stefan Hippenstiel
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Wolfgang Hoffmann
- Institute for Community Medicine Section Health Care Epidemiology and Community Health, University Medicine Greifswald, Greifswald, Germany
| | - Sebastian Ulrich Kelle
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Philipp Knape
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Philipp Koehler
- Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Lucie Kretzler
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - David Manuel Leistner
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Cardiology and Angiology, Goethe University Frankfurt, Frankfurt, Germany
| | - Jasmin Lienau
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Roberto Lorbeer
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
- Department of Radiology, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | | | - Knut Mai
- Department of Endocrinology and Metabolism, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- German Center for Diabetes Research, Munich-Neuherberg, Germany
| | - Uta Merle
- Department of Internal Medicine IVM, University Hospital Heidelberg, Heidelberg, Germany
| | - Lil Antonia Meyer-Arndt
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, University Würzburg, Würzburg, Germany
| | - Maximilian Muenchhoff
- Max Von Pettenkofer Institute and Gene Center, Virology, National Reference Center for Retroviruses, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - Moritz Müller-Plathe
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Julia Neuhann
- Faculty of Medicine, Institute of Translational Research, Cologne Excellence Cluster On Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
- Faculty of Medicine, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology (ECMM), University of Cologne, Cologne, Germany
| | - Hannelore Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany
| | - Alexandra Nieters
- Faculty of Medicine, FREEZE-Biobank, Medical Center-University of Freiburg, Freiburg, Germany
- Faculty of Medicine, Institute for Immunodeficiency, Medical Center-University of Freiburg, Freiburg, Germany
| | - Christian Otte
- Department of Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Pape
- Department of Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Rafaela Maria Pinto
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Christina Pley
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, NUM Coordination Office, Berlin, Germany
| | - Annett Pudszuhn
- Department of ENT, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Philipp Reuken
- Department of Internal Medicine IV, University Hospital Jena, Jena, Germany
| | - Siegberg Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Centre-University of Freiburg, Freiburg, Germany
| | - Petra Ritter
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Gernot Rohde
- Department of Respiratory Medicine/Allergology, Medical Clinic 1, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria Rönnefarth
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Ruzicka
- Department of Medicine III, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jens Schaller
- Institute of Computer-Assisted Cardiovascular Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany
| | - Anne Schmidt
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sein Schmidt
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Verena Schwachmeyer
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Georg Schwanitz
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Werner Seeger
- German Center for Lung Research (DZL), Institute of Lung Health (ILH), Excellence Cluster Cardiopulmonary Institute (CPI), Justus Liebig-University, Giessen, Germany
- Max-Planck-Institute for Heart and Lung Research, Bad Nauheim, Germany
| | - Dana Stahl
- Independent Trusted Third Party, University Medicine Greifswald, Greifswald, Germany
| | - Nicole Stobäus
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Hans Christian Stubbe
- German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
- Department of Medicine II, University Hospital of Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Norbert Suttorp
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Bettina Temmesfeld
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sylvia Thun
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Paul Triller
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Frederik Trinkmann
- Department of Pneumology and Critical Care Medicine, Thoraxklinik, Translational Lung Research Center Heidelberg (TLRC), University of Heidelberg, Heidelberg, Germany
- Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health Baden-Württemberg (CPD-BW), University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Istvan Vadasz
- German Center for Lung Research (DZL), Institute of Lung Health (ILH), Excellence Cluster Cardiopulmonary Institute (CPI), Justus Liebig-University, Giessen, Germany
| | - Heike Valentin
- Independent Trusted Third Party, University Medicine Greifswald, Greifswald, Germany
| | - Maria Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christof von Kalle
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Marie von Lilienfeld-Toal
- Department of Internal Medicine II, Jena University Hospital, Jena, Germany
- Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Jena, Germany
| | - Joachim Weber
- Department of Neurology with Experimental Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tobias Welte
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Wildberg
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Robert Wizimirski
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Saskia Zvork
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Leif Erik Sander
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Janne Vehreschild
- Medical Department 2, Hematology/Oncology and Infectious Diseases, University Hospital of Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
- Department I for Internal Medicine, Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Thomas Zoller
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Florian Kurth
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Doeblin P, Steinbeis F, Witzenrath M, Hashemi D, Chen W, Weiss KJ, Stawowy P, Kelle S. Half-Dose versus Single-Dose Gadobutrol for Extracellular Volume Measurements in Cardiac Magnetic Resonance. J Cardiovasc Dev Dis 2023; 10:316. [PMID: 37623329 PMCID: PMC10455162 DOI: 10.3390/jcdd10080316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Cardiac magnetic resonance (CMR) imaging with gadolinium-based contrast agents offers unique non-invasive insights into cardiac tissue composition. Myocardial extracellular volume (ECV) has evolved as an objective and robust parameter with broad diagnostic and prognostic implications. For the gadolinium compound gadobutrol, the recommended dose for cardiac imaging, including ECV measurements, is 0.1 mmol/kg (single dose). This dose was optimized for late enhancement imaging, a measure of focal fibrosis. Whether a lower dose is sufficient for ECV measurements is unknown. We aim to evaluate the accuracy of ECV measurements using a half dose of 0.05 mmol/kg gadobutrol compared to the standard single dose of 0.1 mmol/kg. METHODS AND RESULTS From a contemporary trial (NCT04747366, registered 10 February 2021), a total of 25 examinations with available T1 mapping before and after 0.05 and 0.1 mmol/kg gadobutrol were analyzed. ECV values were calculated automatically from pre- and post-contrast T1 relaxation times. T1 and ECV Measurements were performed in the midventricular septum. ECV values after 0.05 and 0.1 mmol/kg gadobutrol were correlated (R2 = 0.920, p < 0.001). ECV values after 0.05 mmol/kg had a bias of +0.9% (95%-CI [0.4; 1.4], p = 0.002) compared to 0.1 mmol/kg gadobutrol, with limits of agreement from -1.5 to 3.3%. CONCLUSIONS CMR with a half dose of 0.05 mmol/kg gadobutrol overestimated ECV by 0.9% compared with a full dose of 0.1 mmol/kg, necessitating adjustment of normal values when using half-dose ECV imaging.
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Affiliation(s)
- Patrick Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, 10117 Berlin, Germany
- German Center for Lung Research (DZL), 10117 Berlin, Germany
| | - Djawid Hashemi
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Wensu Chen
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Karl Jakob Weiss
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Philipp Stawowy
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Augustenburger Platz 1, 13353 Berlin, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Berlin, 10785 Berlin, Germany
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117 Berlin, Germany
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Hashemi D, Doeblin P, Blum M, Weiss KJ, Schneider M, Beyer R, Pieske B, Duengen HD, Edelmann F, Kelle S. Reduced functional capacity is associated with the proportion of impaired myocardial deformation assessed in heart failure patients by CMR. Front Cardiovasc Med 2023; 10:1038337. [PMID: 36844739 PMCID: PMC9947709 DOI: 10.3389/fcvm.2023.1038337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/23/2023] [Indexed: 02/11/2023] Open
Abstract
Aims Heart failure (HF) does not only reduce the life expectancy in patients, but their life is also often limited by HF symptoms leading to a reduced quality of life (QoL) and a diminished exercise capacity. Novel parameters in cardiac imaging, including both global and regional myocardial strain imaging, promise to contribute to better patient characterization and ultimately to better patient management. However, many of these methods are not part of clinical routine yet, their associations with clinical parameters have been poorly studied. An imaging parameters that also indicate the clinical symptom burden of HF patients would make cardiac imaging more robust toward incomplete clinical information and support the clinical decision process. Methods and results This prospective study conducted at two centers in Germany between 2017 and 2018 enrolled stable outpatient subjects with HF [n = 56, including HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] and a control cohort (n = 19). Parameters assessed included measures for external myocardial function, for example, cardiac index and myocardial deformation measurements by cardiovascular magnetic resonance imaging, left ventricular global longitudinal strain (GLS), the global circumferential strain (GCS), and the regional distribution of segment deformation within the LV myocardium, as well as basic phenotypical characteristics including the Minnesota Living with Heart Failure Questionnaire (MLHFQ) and the 6-minute walk test (6MWT). If less than 80% of the LV segments are preserved in their deformation capacity the functional capacity by 6MWT (6 minutes walking distance: MyoHealth ≥ 80%: 579.8 ± 177.6 m; MyoHealth 60-<80%: 401.3 ± 121.7 m; MyoHealth 40-<60%: 456.4 ± 68.9 m; MyoHealth < 40%: 397.6 ± 125.9 m, overall p-value: 0.03) as well as the symptom burden are significantly impaired (NYHA class: MyoHealth ≥ 80%: 0.6 ± 1.1 m; MyoHealth 60-<80%: 1.7 ± 1.2 m; MyoHealth 40-<60%: 1.8 ± 0.7 m; MyoHealth < 40%: 2.4 ± 0.5 m; overall p-value < 0.01). Differences were also observed in the perceived exertion assessed by on the Borg scale (MyoHealth ≥ 80%: 8.2 ± 2.3 m; MyoHealth 60-<80%: 10.4 ± 3.2 m; MyoHealth 40-<60%: 9.8 ± 2.1 m; MyoHealth < 40%: 11.0 ± 2.9 m; overall p-value: 0.20) as well as quality of life measures (MLHFQ; MyoHealth ≥ 80%: 7.5 ± 12.4 m; MyoHealth 60-<80%: 23.4 ± 23.4 m; MyoHealth 40-<60%: 20.5 ± 21.2 m; MyoHealth < 40%: 27.4 ± 24.4 m; overall p-value: 0.15)-while these differences were not significant. Conclusion The share of LV segments with preserved myocardial contraction promises to discriminate between symptomatic and asymptomatic subjects based on the imaging findings, even when the LV ejection fraction is preserved. This finding is promising to make imaging studies more robust toward incomplete clinical information.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany,*Correspondence: Djawid Hashemi,
| | - Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Karl Jakob Weiss
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Rebecca Beyer
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
| | - Hans-Dirk Duengen
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin, Berlin, Germany,German Centre for Cardiovascular Research, Partner Site Berlin, Berlin, Germany
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Alogna A, Faragli A, Kolp C, Doeblin P, Tanacli R, Confortola G, Oetvoes J, Perna S, Stehning C, Nagel E, Pieske BM, Post H, Kelle S. Blood-Oxygen-Level Dependent (BOLD) T2-Mapping Reflects Invasively Measured Central Venous Oxygen Saturation in Cardiovascular Patients. JACC Cardiovasc Imaging 2023; 16:251-253. [PMID: 36648039 DOI: 10.1016/j.jcmg.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 08/24/2022] [Accepted: 08/30/2022] [Indexed: 11/17/2022]
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5
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Hashemi D, Doeblin P, Blum M, Weiss KJ, Schneider M, Korosoglou G, Beyer RE, Pieske B, Edelmann F, Kelle S. CMR detects decreased myocardial deformation in asymptomatic patients at risk for heart failure. Front Cardiovasc Med 2023; 9:1091768. [PMID: 36684590 PMCID: PMC9849678 DOI: 10.3389/fcvm.2022.1091768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/09/2022] [Indexed: 01/06/2023] Open
Abstract
Aims The main management strategy of heart failure with preserved ejection fraction (HFpEF) is prevention since HFpEF is associated with many cardiovascular (CV) risk factors, especially since HFpEF is linked to a high risk for both mortality and recurrent heart failure (HF) hospitalizations. Therefore, there is a need for new tools to identify patients with a high risk profile early. Regional strain assessment by CMR seems to be superior in describing deformation impairment in HF. The MyoHealth score is a promising tool to identify cardiac changes early. Methods and results Heart failure patients irrespective of LVEF and asymptomatic controls were recruited, and CMR based measures were obtained. For this analysis the asymptomatic control group (n = 19) was divided into asymptomatic subjects without CV co-morbidities or evidence of cardiac abnormalities and (n = 12) and asymptomatic subjects with CV co-morbidities or evidence of cardiac abnormalities (n = 7) as well as patients with HFpEF (n = 19). We performed CMR scans at rest and during a stress test using isometric handgrip exercise (HG). Assessing the MyoHealth score at rest revealed preserved regional strain in 85 ± 9% of LV segments in controls, 73 ± 11% in at Risk subjects and 73 ± 8% in HFpEF patients. During stress the MyoHealth score was 84 ± 7% in controls, 83 ± 7 in at risk subjects and 74 ± 11 in HFpEF patients. Conclusion In summary, we show for the first time that asymptomatic subjects with increased CV risk present with HFpEF like impaired myocardial deformation at rest, while they show results like controls under HG stress. The potential of preventive treatment in this group of patients merits further investigation in future. Clinical trial registration [https://drks.de/search/de/trial/DRKS00015615], identifier [DRKS00015615].
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany,BIH Charité Digital Clinician Scientist Program, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Berlin, Germany,*Correspondence: Djawid Hashemi,
| | - Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Moritz Blum
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Karl Jakob Weiss
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany
| | - Grigorios Korosoglou
- Department of Cardiology, Vascular Medicine and Pneumology, Gesundheitszentrum Rhein-Neckar Hospital Weinheim, Weinheim, Germany,Cardiac Imaging Center Weinheim, Hector Foundation, Weinheim, Germany
| | - Rebecca Elisabeth Beyer
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité – Universitätsmedizin Berlin, Charité Campus Virchow Clinic, Berlin, Germany,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Berlin, Germany,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
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6
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Winkel DJ, Stoiber L, Xiong T, Stuber M, Hays AG, Plöckinger U, Doeblin P, Stehning C, Kelle S. Simultaneous assessment of vascular distensibility and vessel wall area at coronary, carotid, and aortic level in diabetic patients using CMR: detection of vascular remodeling. Am J Cardiovasc Dis 2023; 13:73-86. [PMID: 37213319 PMCID: PMC10193244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/31/2023] [Indexed: 05/23/2023]
Abstract
AIMS No data is available about the significance of cardiovascular magnetic resonance (CMR) derived vascular distensibility (VD) and vessel wall ratio (VWR) for risk stratification in patients with type 2 diabetes mellitus (T2DM). Therefore, this study aimed to investigate the effects of T2DM on VD and VWR using CMR in both central and peripheral territories. METHODS Thirty-one T2DM-patients and nine controls underwent CMR. Angulation of the aorta, the common carotid, and the coronary arteries was performed to obtain cross-sectional vessel areas. RESULTS In T2DM the Carotid-VWR and the Aortic-VWR correlated significantly. Mean values of Carotid-VWR and Aortic-VWR were significantly higher in T2DM than in controls. Coronary-VD was significantly lower in T2DM than in controls. No significant difference in Carotid-VD or Aortic-VD in T2DM vs. controls, respectively, could be observed. In a subgroup of thirteen T2DM patients with coronary artery disease (CAD), Coronary-VD was significantly lower and Aortic-VWR was significantly higher compared to T2DM patients without CAD. CONCLUSION CMR allows a simultaneous evaluation of the structure and function of three important vascular territories to detect vascular remodeling in T2DM.
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Affiliation(s)
- David Jean Winkel
- Department of Radiology, University Hospital of BaselBasel, Switzerland
| | - Lukas Stoiber
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der CharitéBerlin, Germany
| | - Tingting Xiong
- Third Department of Medicine, University Medical Center Hamburg-EppendorfHamburg, Germany
| | - Matthias Stuber
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL)Lausanne, Switzerland
- Center for Biomedical Imaging (CIBM)Lausanne, Switzerland
| | - Allison G Hays
- Division of Cardiology, Johns Hopkins University School of MedicineBaltimore, Maryland
| | - Ursula Plöckinger
- Interdisciplinary Center of Metabolism: Endocrinology, Diabetes and Metabolism, Charité University Medicine BerlinBerlin, Germany
| | - Patrick Doeblin
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der CharitéBerlin, Germany
| | | | - Sebastian Kelle
- Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der CharitéBerlin, Germany
- Department of Internal Medicine and Cardiology, Charité University Medicine BerlinBerlin, Germany
- DHZK (German Center for Cardiovascular Research), Partner Site BerlinBerlin, Germany
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7
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Vidula MK, Rajewska-Tabor J, Cao JJ, Kang Y, Craft J, Mei W, Chandrasekaran PS, Clark DE, Poenar AM, Gorecka M, Malahfji M, Cowan E, Kwan JM, Reinhardt SW, Al-Tabatabaee S, Doeblin P, Villa ADM, Karagodin I, Alvi N, Christia P, Spetko N, Cassar MP, Park C, Nambiar L, Turgut A, Azad MR, Lambers M, Wong TC, Salerno M, Kim J, Elliott M, Raman B, Neubauer S, Tsao CW, LaRocca G, Patel AR, Chiribiri A, Kelle S, Baldassarre LA, Shah DJ, Hughes SG, Tong MS, Pyda M, Simonetti OP, Plein S, Han Y. Myocardial Injury on CMR in Patients With COVID-19 and Suspected Cardiac Involvement. JACC Cardiovasc Imaging 2022; 16:609-624. [PMID: 36752429 PMCID: PMC9833283 DOI: 10.1016/j.jcmg.2022.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/05/2022] [Accepted: 10/13/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Myocardial injury in patients with COVID-19 and suspected cardiac involvement is not well understood. OBJECTIVES The purpose of this study was to characterize myocardial injury in a multicenter cohort of patients with COVID-19 and suspected cardiac involvement referred for cardiac magnetic resonance (CMR). METHODS This retrospective study consisted of 1,047 patients from 18 international sites with polymerase chain reaction-confirmed COVID-19 infection who underwent CMR. Myocardial injury was characterized as acute myocarditis, nonacute/nonischemic, acute ischemic, and nonacute/ischemic patterns on CMR. RESULTS In this cohort, 20.9% of patients had nonischemic injury patterns (acute myocarditis: 7.9%; nonacute/nonischemic: 13.0%), and 6.7% of patients had ischemic injury patterns (acute ischemic: 1.9%; nonacute/ischemic: 4.8%). In a univariate analysis, variables associated with acute myocarditis patterns included chest discomfort (OR: 2.00; 95% CI: 1.17-3.40, P = 0.01), abnormal electrocardiogram (ECG) (OR: 1.90; 95% CI: 1.12-3.23; P = 0.02), natriuretic peptide elevation (OR: 2.99; 95% CI: 1.60-5.58; P = 0.0006), and troponin elevation (OR: 4.21; 95% CI: 2.41-7.36; P < 0.0001). Variables associated with acute ischemic patterns included chest discomfort (OR: 3.14; 95% CI: 1.04-9.49; P = 0.04), abnormal ECG (OR: 4.06; 95% CI: 1.10-14.92; P = 0.04), known coronary disease (OR: 33.30; 95% CI: 4.04-274.53; P = 0.001), hospitalization (OR: 4.98; 95% CI: 1.55-16.05; P = 0.007), natriuretic peptide elevation (OR: 4.19; 95% CI: 1.30-13.51; P = 0.02), and troponin elevation (OR: 25.27; 95% CI: 5.55-115.03; P < 0.0001). In a multivariate analysis, troponin elevation was strongly associated with acute myocarditis patterns (OR: 4.98; 95% CI: 1.76-14.05; P = 0.003). CONCLUSIONS In this multicenter study of patients with COVID-19 with clinical suspicion for cardiac involvement referred for CMR, nonischemic and ischemic patterns were frequent when cardiac symptoms, ECG abnormalities, and cardiac biomarker elevations were present.
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Affiliation(s)
- Mahesh K Vidula
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justyna Rajewska-Tabor
- Department of Magnetic Resonance, I Clinic of Cardiology, University of Medical Sciences, Poznan, Poland
| | - J Jane Cao
- St. Francis Hospital, Roslyn, New York, USA
| | - Yu Kang
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | - Daniel E Clark
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ana-Maria Poenar
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Miroslawa Gorecka
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Maan Malahfji
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Eilidh Cowan
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Jennifer M Kwan
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Samuel W Reinhardt
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Adriana D M Villa
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Ilya Karagodin
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Nazia Alvi
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | | | - Nicholas Spetko
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Mark Philip Cassar
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Christine Park
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lakshmi Nambiar
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Alper Turgut
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mahan Roosta Azad
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Moritz Lambers
- Department of Cardiology and Angiology, Contilia Heart and Vascular Centre Elisabeth-Krankenhaus, Essen, Germany
| | - Timothy C Wong
- Division of Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael Salerno
- Cardiovascular Division, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jiwon Kim
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Michael Elliott
- Sanger Heart and Vascular Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Betty Raman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC), University of Oxford, Oxford, United Kingdom
| | - Connie W Tsao
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Gina LaRocca
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amit R Patel
- Department of Medicine, Section of Cardiology, University of Chicago Medicine, Chicago, Illinois, USA
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Lauren A Baldassarre
- Cardiovascular Section, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Dipan J Shah
- Houston Methodist Heart and Vascular Center, Houston, Texas, USA
| | - Sean G Hughes
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Matthew S Tong
- Division of Cardiology, The Ohio State University, Columbus, Ohio, USA
| | - Malgorzata Pyda
- Department of Magnetic Resonance, I Clinic of Cardiology, University of Medical Sciences, Poznan, Poland
| | | | - Sven Plein
- Biomedical Imaging Science Department, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Yuchi Han
- Division of Cardiovascular Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA; Division of Cardiology, The Ohio State University, Columbus, Ohio, USA.
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Weiss KJ, Doeblin P, Djawid H, Schneider M, Pieske B, Kelle S, Tanacli R. Magnetic resonance hemodynamic forces predict pathological LVEDP in preserved LV-EF. J Mol Cell Cardiol 2022. [DOI: 10.1016/j.yjmcc.2022.08.274] [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: 01/02/2023]
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9
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Doeblin P, Weiss KJ, Hashemi D, Schneider M, Pieske B, Kelle S. Single center experience of CMR findings after COVID-19 and after COVID-19-vaccination. J Mol Cell Cardiol 2022. [DOI: 10.1016/j.yjmcc.2022.08.277] [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: 01/01/2023]
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10
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Doeblin P, Jahnke C, Schneider M, Al-Tabatabaee S, Goetze C, Weiss KJ, Tanacli R, Faragli A, Witt U, Stehning C, Seidel F, Elsanhoury A, Kühne T, Tschöpe C, Pieske B, Kelle S. CMR findings after COVID-19 and after COVID-19-vaccination-same but different? Int J Cardiovasc Imaging 2022; 38:2057-2071. [PMID: 37726611 PMCID: PMC9097142 DOI: 10.1007/s10554-022-02623-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/15/2022] [Indexed: 01/05/2023]
Abstract
Cardiac involvement has been described in varying proportions of patients recovered from COVID-19 and proposed as a potential cause of prolonged symptoms, often described as post-COVID or long COVID syndrome. Recently, cardiac complications have been reported from COVID-19 vaccines as well. We aimed to compare CMR-findings in patients with clinical cardiac symptoms after COVID-19 and after vaccination. From May 2020 to May 2021, we included 104 patients with suspected cardiac involvement after COVID-19 who received a clinically indicated cardiac magnetic resonance (CMR) examination at a high-volume center. The mean time from first positive PCR to CMR was 112 ± 76 days. During their COVID-19 disease, 21% of patients required hospitalization, 17% supplemental oxygen and 7% mechanical ventilation. In 34 (32.7%) of patients, CMR provided a clinically relevant diagnosis: Isolated pericarditis in 10 (9.6%), %), acute myocarditis (both LLC) in 7 (6.7%), possible myocarditis (one LLC) in 5 (4.8%), ischemia in 4 (3.8%), recent infarction in 2 (1.9%), old infarction in 4 (3.8%), dilated cardiomyopathy in 3 (2.9%), hypertrophic cardiomyopathy in 2 (1.9%), aortic stenosis, pleural tumor and mitral valve prolapse each in 1 (1.0%). Between May 2021 and August 2021, we examined an additional 27 patients with suspected cardiac disease after COVID-19 vaccination. Of these, CMR provided at least one diagnosis in 22 (81.5%): Isolated pericarditis in 4 (14.8%), acute myocarditis in 9 (33.3%), possible myocarditis (acute or subsided) in 6 (22.2%), ischemia in 3 (37.5% out of 8 patients with stress test), isolated pericardial effusion (> 10 mm) and non-compaction-cardiomyopathy each in 1 (3.7%). The number of myocarditis diagnoses after COVID-19 was highly dependent on the stringency of the myocarditis criteria applied. When including only cases of matching edema and LGE and excluding findings in the right ventricular insertion site, the number of cases dropped from 7 to 2 while the number of cases after COVID-19 vaccination remained unchanged at 9. While myocarditis is an overall rare side effect after COVID-19 vaccination, it is currently the leading cause of myocarditis in our institution due to the large number of vaccinations applied over the last months. Contrary to myocarditis after vaccination, LGE and edema in myocarditis after COVID-19 often did not match or were confined to the RV-insertion site. Whether these cases truly represent myocarditis or a different pathological entity is to be determined in further studies.
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Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | - Constantin Jahnke
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Collin Goetze
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Karl J Weiss
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Alessandro Faragli
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Undine Witt
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Franziska Seidel
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Ahmed Elsanhoury
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kühne
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Carsten Tschöpe
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
- BIH Berlin Institute of Health at Charite (BIH), BIH Center for Regenerative Therapies (BCRT) Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Germany
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11
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Doeblin P, Steinbeis F, Scannell CM, Goetze C, Al-Tabatabaee S, Erley J, Faragli A, Pröpper F, Witzenrath M, Zoller T, Stehning C, Gerhardt H, Sánchez-González J, Alskaf E, Kühne T, Pieske B, Tschöpe C, Chiribiri A, Kelle S. Brief Research Report: Quantitative Analysis of Potential Coronary Microvascular Disease in Suspected Long-COVID Syndrome. Front Cardiovasc Med 2022; 9:877416. [PMID: 35711381 PMCID: PMC9197432 DOI: 10.3389/fcvm.2022.877416] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Background Case series have reported persistent cardiopulmonary symptoms, often termed long-COVID or post-COVID syndrome, in more than half of patients recovering from Coronavirus Disease 19 (COVID-19). Recently, alterations in microvascular perfusion have been proposed as a possible pathomechanism in long-COVID syndrome. We examined whether microvascular perfusion, measured by quantitative stress perfusion cardiac magnetic resonance (CMR), is impaired in patients with persistent cardiac symptoms post-COVID-19. Methods Our population consisted of 33 patients post-COVID-19 examined in Berlin and London, 11 (33%) of which complained of persistent chest pain and 13 (39%) of dyspnea. The scan protocol included standard cardiac imaging and dual-sequence quantitative stress perfusion. Standard parameters were compared to 17 healthy controls from our institution. Quantitative perfusion was compared to published values of healthy controls. Results The stress myocardial blood flow (MBF) was significantly lower [31.8 ± 5.1 vs. 37.8 ± 6.0 (μl/g/beat), P < 0.001] and the T2 relaxation time was significantly higher (46.2 ± 3.6 vs. 42.7 ± 2.8 ms, P = 0.002) post-COVID-19 compared to healthy controls. Stress MBF and T1 and T2 relaxation times were not correlated to the COVID-19 severity (Spearman r = −0.302, −0.070, and −0.297, respectively) or the presence of symptoms. The stress MBF showed a U-shaped relation to time from PCR to CMR, no correlation to T1 relaxation time, and a negative correlation to T2 relaxation time (Pearson r = −0.446, P = 0.029). Conclusion While we found a significantly reduced microvascular perfusion post-COVID-19 compared to healthy controls, this reduction was not related to symptoms or COVID-19 severity.
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Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- *Correspondence: Patrick Doeblin,
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Cian M. Scannell
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Collin Goetze
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Jennifer Erley
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Alessandro Faragli
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Felix Pröpper
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Zoller
- Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | | | - Holger Gerhardt
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Integrative Vascular Biology Laboratory, Max-Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | | | - Ebraham Alskaf
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Titus Kühne
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Congenital Heart Disease, German Heart Center Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Carsten Tschöpe
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charite (BIH), Universitätsmedizin Berlin, Berlin, Germany
| | - Amedeo Chiribiri
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiology, Campus Virchow Klinikum, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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12
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Jahnke C, Doeblin P, Tanacli R, Witt U, Schneider M, Stehning C, Pieske B, Kelle S. Case Series of Potential Cardiac Inflammation Associated With Various SARS-CoV-2 Vaccinations Assessed by Cardiac MRI. Front Cardiovasc Med 2022; 9:829392. [PMID: 35463791 PMCID: PMC9024347 DOI: 10.3389/fcvm.2022.829392] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 02/18/2022] [Indexed: 12/24/2022] Open
Abstract
Serious adverse events associated with new vaccines targeting SARS-CoV-2 are of high interest to the public and to public health as a worldwide mass immunization campaign has been initiated to contain the ongoing COVID-19 pandemic. We describe a series of 4 individuals with signs of a myocarditis/pericarditis according to cardiac MRI results in temporal association with currently in the European Union authorized SARS-CoV-2 vaccines. We found mild abnormal MRI results independent of the type of SARS-CoV-2 vaccine. There is a need of continuing monitoring outcomes of myocarditis cases after COVID-19 vaccination as recently published cases suggest an uncomplicated short-term course whereas the long-term implications are not yet known but taking the available evidence into account the benefits of using COVID-19 vaccines still clearly outweigh the risks.
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Affiliation(s)
- Constantin Jahnke
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
- *Correspondence: Constantin Jahnke
| | - Patrick Doeblin
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Radu Tanacli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
| | - Undine Witt
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Matthias Schneider
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
| | | | - Burkert Pieske
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
- Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
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13
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Chen W, Doeblin P, Al-Tabatabaee S, Klingel K, Tanacli R, Jakob Weiß K, Stehning C, Patel AR, Pieske B, Zou J, Kelle S. Synthetic Extracellular Volume in Cardiac Magnetic Resonance Without Blood Sampling: a Reliable Tool to Replace Conventional Extracellular Volume. Circ Cardiovasc Imaging 2022; 15:e013745. [PMID: 35360924 PMCID: PMC9015035 DOI: 10.1161/circimaging.121.013745] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: The calculation of extracellular volume (ECV) in cardiac magnetic resonance requires hematocrit, limiting its applicability in clinical practice. Based on the linear relationship between hematocrit and blood T1 relaxivity, a synthetic ECV could be estimated without a blood sample. We aim to develop and test regression models for synthetic ECV without blood sampling in 1.5-T and 3.0-T scanners. Methods: A total of 1101 subjects who underwent cardiac magnetic resonance scanning with native and postcontrast T1 mapping and venous hematocrit within 24 hours were retrospectively enrolled. Subjects were randomly split into derivation (n=550) and validation (n=551) subgroups for each scanner. Different regression models were derived controlling for sex, field strength, and left ventricle/right ventricle blood pool and validated in the validation group. We performed additional validation analyses in subgroups of patients with histological validation (n=17), amyloidosis (n=29), anemia (n=185), and reduced ejection fraction (n=322). Results: In the derivation group, 8 specific models and 2 common estimate models were derived. In the validation group, using specific models, synthetic ECV had high agreement with conventional ECV (R2, 0.87; P<0.0001 and R2, 0.88, P<0.0001; −0.16% and −0.10%, left ventricle and right ventricle model, respectively). Common models also performed well (R2, 0.88; P<0.0001 and R2, 0.89, P<0.0001; −0.21% and −0.18%, left ventricle and right ventricle model, respectively). Histological validation demonstrated equal performance of synthetic and measured ECV. Synthetic ECV as calculated by the common model showed a bias in the anemia cohort significantly reduced by the specific model (−2.45 to −1.28, right ventricle common and specific model, respectively). Conclusions: Synthetic ECV provided a promising way to calculate ECV without blood sampling. Specific models could provide the most accurate value, while common models could be more suitable in routine clinical practice because of their simplicity while maintaining adequate accuracy.
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Affiliation(s)
- Wensu Chen
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, China (W.C.)
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | - Sarah Al-Tabatabaee
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.)
| | - Karin Klingel
- Department of Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tuebingen, Germany (K.K.)
| | - Radu Tanacli
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | - Karl Jakob Weiß
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | | | - Amit R Patel
- Department of Medicine and Radiology, University of Chicago, IL (A.R.P.)
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
| | - Jiangang Zou
- Department of Cardiology, First Affiliated Hospital, Nanjing Medical University, China (J.Z.)
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Germany (W.C., P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,Department of Internal Medicine/Cardiology, Charité University Medicine, Campus Virchow Clinic, Berlin, Germany (P.D., S.A.-T., R.T., K.J.W., B.P., S.K.).,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Germany (P.D., R.T., K.J.W., B.P., S.K.)
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14
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Tanacli R, Doeblin P, Götze C, Zieschang V, Faragli A, Stehning C, Korosoglou G, Erley J, Weiss J, Berger A, Pröpper F, Steinbeis F, Kühne T, Seidel F, Geisel D, Cannon Walter-Rittel T, Stawowy P, Witzenrath M, Klingel K, Van Linthout S, Pieske B, Tschöpe C, Kelle S. COVID-19 vs. Classical Myocarditis Associated Myocardial Injury Evaluated by Cardiac Magnetic Resonance and Endomyocardial Biopsy. Front Cardiovasc Med 2022; 8:737257. [PMID: 35004872 PMCID: PMC8739473 DOI: 10.3389/fcvm.2021.737257] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/15/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Despite the ongoing global pandemic, the impact of COVID-19 on cardiac structure and function is still not completely understood. Myocarditis is a rare but potentially serious complication of other viral infections with variable recovery, and is, in some cases, associated with long-term cardiac remodeling and functional impairment. Aim: To assess myocardial injury in patients who recently recovered from an acute SARS-CoV-2 infection with advanced cardiac magnetic resonance imaging (CMR) and endomyocardial biopsy (EMB). Methods: In total, 32 patients with persistent cardiac symptoms after a COVID-19 infection, 22 patients with acute classic myocarditis not related to COVID-19, and 16 healthy volunteers were included in this study and underwent a comprehensive baseline CMR scan. Of these, 10 patients post COVID-19 and 13 with non-COVID-19 myocarditis underwent a follow-up scan. In 10 of the post-COVID-19 and 15 of the non-COVID-19 patients with myocarditis endomyocardial biopsy (EMB) with histological, immunohistological, and molecular analysis was performed. Results: In total, 10 (31%) patients with COVID-19 showed evidence of myocardial injury, eight (25%) presented with myocardial oedema, eight (25%) exhibited global or regional systolic left ventricular (LV) dysfunction, and nine (28%) exhibited impaired right ventricular (RV) function. However, only three (9%) of COVID-19 patients fulfilled updated CMR–Lake Louise criteria (LLC) for acute myocarditis. Regarding EMB, none of the COVID-19 patients but 87% of the non-COVID-19 patients with myocarditis presented histological findings in keeping with acute or chronic inflammation. COVID-19 patients with severe disease on the WHO scale presented with reduced biventricular longitudinal function, increased RV mass, and longer native T1 times compared with those with only mild or moderate disease. Conclusions: In our cohort, CMR and EMB findings revealed that SARS-CoV-2 infection was associated with relatively mild but variable cardiac involvement. More symptomatic COVID-19 patients and those with higher clinical care demands were more likely to exhibit chronic inflammation and impaired cardiac function compared to patients with milder forms of the disease.
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Affiliation(s)
- Radu Tanacli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Collin Götze
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | | | - Alessandro Faragli
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Jennifer Erley
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Jakob Weiss
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Alexander Berger
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Felix Pröpper
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany
| | - Fridolin Steinbeis
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Titus Kühne
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Franziska Seidel
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Institute for Imaging Science and Computational Modelling in Cardiovascular Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Philipp Stawowy
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Karin Klingel
- Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany
| | - Sophie Van Linthout
- German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Cardiology, German Heart Centre Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Berlin, Germany
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15
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Weiss KJ, Nasser SB, Bigvava T, Doltra A, Schnackenburg B, Berger A, Anker MS, Stehning C, Doeblin P, Abdelmeguid M, Talat M, Gebker R, E-Naggar W, Pieske B, Kelle S. Long-term prognostic value of vasodilator stress cardiac magnetic resonance in patients with atrial fibrillation. ESC Heart Fail 2021; 9:110-121. [PMID: 34866358 PMCID: PMC8787987 DOI: 10.1002/ehf2.13736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 10/04/2021] [Accepted: 11/11/2021] [Indexed: 11/09/2022] Open
Abstract
AIMS Although the prevalence of coronary artery disease (CAD) is high among patients with atrial fibrillation (AF), studies on stress perfusion cardiac magnetic resonance (CMR) imaging frequently exclude patients with AF, and its prognostic and diagnostic value in high-risk patients with suspected or known CAD remains unclear. METHODS AND RESULTS In this longitudinal cohort study, we included 164 consecutive patients with AF during vasodilator perfusion CMR. Diagnostic value was evaluated regarding invasive coronary angiography in a subset of patients. We targeted a follow-up of >5 years and used CMR results as stratification, and the primary outcome was major adverse cardiac events [MACE, cardiovascular (CV) death and myocardial infarction (MI)]. Secondary outcomes included late coronary revascularization or stroke and the components of the primary outcome. Of the whole cohort (73.8% male, mean age 72.2 years ± 7.8 SD), 99.4% were successfully scanned (163/164 patients). Median CHA2DS2-VASc score was 4 [interquartile range (IQR) 3-5], and median 10-year risk for CV events based on SMART risk score was high (24%, IQR 16-32%). Thirty-two patients (19.6%) presented with ischaemia and 52 patients (31.9%) with late gadolinium enhancement (LGE). A combination of LGE and inducible ischaemia was present in 20 patients (12.3%). Diagnostic accuracy was 86.2% [confidence interval (CI) 68.3-96.1%]. The median follow-up was 6.6 years (IQR 3.6-7.8). Ischaemia in vasodilator perfusion CMR was significantly associated with the occurrence of MACE [P < 0.01; hazard ratio (HR) 2.65, CI 1.39-5.08], as well as LGE (P = 0.03; 1.74, CI 1.07-3.64) and the combination of both (P < 0.01; HR 2.67, CI 1.59-5.62). After adjustment by age, left ventricular ejection fraction, and the presence of diabetes, ischaemia in vasodilator perfusion CMR remained significantly associated with the occurrence of MACE (2.10, CI 1.08-4.10; P = 0.03). In secondary endpoint analysis, there was a significant association of ischaemia in CMR with CV death (P < 0.05; HR 1.93, CI 0.95-3.9) and MI (P < 0.01; HR 13, CI 1.35-125.4), while no significant association was found regarding the occurrence of revascularization (P = 0.45; HR 1.43, CI 0.57-3.58) or stroke (P = 0.99; HR 0.99, CI 0.21-2.59). CONCLUSIONS Vasodilator stress perfusion CMR demonstrated an excellent diagnostic and significant prognostic value at long-term follow-up in high-risk patients with persistent AF and suspected or known CAD.
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Affiliation(s)
- Karl J Weiss
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sarah B Nasser
- Department of Cardiovascular Medicine, Dar Al Fouad Hospital, Cairo, Egypt.,Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Tamar Bigvava
- Department of Cardiovascular Medicine, Tbilisi Heart and Vascular Clinic, Tbilisi, Georgia
| | - Adelina Doltra
- Cardiac Imaging Section, Cardiovascular Institute, Hospital Clinic De Barcelona, University of Barcelona, Barcelona, Spain
| | | | - Alexander Berger
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany
| | - Markus S Anker
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Cardiology (CBF), Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany
| | | | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Mohamed Abdelmeguid
- Department of Cardiovascular Medicine, Dar Al Fouad Hospital, Cairo, Egypt.,Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Talat
- Department of Radiology, Cairo University, Cairo, Egypt
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany
| | - Wael E-Naggar
- Department of Cardiovascular Medicine, Dar Al Fouad Hospital, Cairo, Egypt.,Department of Cardiovascular Medicine, Cairo University, Cairo, Egypt
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Augustenburgerplatz 1, Berlin, 13533, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
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16
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Seidel F, Kuehne T, Kelle S, Doeblin P, Zieschang V, Tschoepe C, Al-Wakeel-Marquard N, Nordmeyer S. Cardiovascular magnetic resonance findings in non-hospitalized paediatric patients after recovery from COVID-19. ESC Heart Fail 2021; 8:5583-5588. [PMID: 34704672 PMCID: PMC8652950 DOI: 10.1002/ehf2.13678] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 10/01/2021] [Accepted: 10/05/2021] [Indexed: 01/04/2023] Open
Abstract
Aims Our study aimed to investigate the cardiac involvement with sensitive tissue characterization in non‐hospitalized children with coronavirus disease 2019 (COVID‐19) infection using cardiovascular magnetic resonance (CMR) imaging. Methods and results We prospectively enrolled children who recovered from mildly symptomatic COVID‐19 infection between November 2020 and January 2021. Patients underwent CMR at 1.5 T (Achieva, Philips Healthcare, Best, the Netherlands) including cine images, native T1 and T2 mapping. Healthy children and paediatric patients with biopsy‐proven myocarditis served as control groups. We performed CMR in 18 children with a median (25th–75th percentile) age of 12 (10–15) years, 38 (24–47) days after positive PCR test, and compared them with 7 healthy controls [15 (10–19) years] and 9 patients with myocarditis [10 (4–16) years]. The COVID‐19 patients reported no cardiac symptoms. None of the COVID‐19 patients showed CMR findings consistent with a myocarditis. Three patients (17%) from the COVID‐19 cohort presented with minimal pericardial effusion. CMR parameters of COVID‐19 patients, including volumetric and strain values as well as T1 and T2 times, were not significantly different from healthy controls, but from myocarditis patients. These had significantly reduced left ventricular (LV) ejection fraction (P = 0.035), LV global longitudinal strain, and left atrial strain values as well as elevated native T1 values compared with COVID‐19 patients (P < 0.001, respectively). Conclusions There was no evidence of myocardial inflammation, fibrosis, or functional cardiac impairment in the studied cohort of children recently. CMR findings were comparable with those of healthy controls. Pericardial effusion suggests a mild pericarditis in a small subgroup. This is pointing to a minor clinical relevance of myocardial involvement in children after mildly symptomatic COVID‐19 infections.
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Affiliation(s)
- Franziska Seidel
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Titus Kuehne
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Kelle
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Patrick Doeblin
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Victoria Zieschang
- Department of Internal Medicine and Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Carsten Tschoepe
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Medical Department, Division of Cardiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nadya Al-Wakeel-Marquard
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sarah Nordmeyer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany.,Institute of Computer-assisted Cardiovascular Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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17
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Doeblin P, Goetze C, Al-Tabatabaee S, Berger A, Steinbeis F, Witzenrath M, Faragli A, Stehning C, Chiribiri A, Scannell CM, Alskaf E, Pieske B, Kelle S. Stress myocardial blood flow reduced after severe COVID-19, not related to symptoms. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Persistent cardiopulmonary symptoms after COVID-19 are reported in a large number of patients and the underlying pathology is still poorly understood. (1) Histopathologic studies revealed myocardial macrophage infiltrates in deceased patients, likely an unspecific finding of severe illness, and increased prevalence of micro- and macrovascular thrombi. (2) We examined whether microvascular perfusion, measured by quantitative cardiac magnetic resonance under vasodilator stress, was altered post COVID-19.
Methods
Our population consisted of 12 patients from the Pa-COVID-19-Study of the Charité Berlin, which received a cardiac MRI as part of a systematic follow up post discharge, 10 patients that presented at the German Heart Center Berlin with persistent cardiac symptoms post COVID-19 and 12 patients from the Kings College London referred for stress MRI and previous COVID-19.
The scan protocol included standard functional, edema and scar imaging and quantitative stress and rest perfusion to assess both macro- and microvascular coronary artery disease. The pharmacological stress agent was regadenosone in 20 and adenosine in 13 of the patients. To control for the higher heart rate increase under regadenosone compared to adenosine, we calculated the myocardial blood flow per heartbeat (MBF_HRi) under stress.
Results
The median time between first positive PCR for COVID-19 and the CMR exam was 2 months (Range 0 to 12). None of the 33 patients exhibited signs of myocardial edema. One patient with a previous history of myocarditis had focal fibrosis. Three patients with known coronary artery disease showed ischemic Late Enhancement. Five patients had a small pericardial effusion; one of these four patients showed slight focal pericardial edema and LGE, consistent with mild focal pericarditis. Five Patients had a stress-induced focal perfusion deficit.
Mean Stress MBF_HRi was 32.5±6.5 μl/beat/g. Stress MBF_HRi was negatively correlated with COVID-19 severity (rho=−0.361, P=0.039) and age (r=−0.452, P=0.009). The correlation with COVID-19 severity remained significant after controlling for age (rho=−0.390, P=0.027). There was no apparent difference in stress MBF_HRi between patients with and without persistent chest pain (34.5 vs. 31.5 μl/beat/g, P=0.229)
Conclusion
While vasodilator-stress myocardial blood flow after COVID-19 was negatively correlated to COVID-19 severity, it was not correlated to the presence of chest pain. The etiology of persistent cardiac symptoms after COVID-19 remains unclear.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Philips Figure 1. A) Quantitative regadenosone stress myocardial blood flow (MBF) map, medial short axis slice, in a patient with persistent cardiac symptoms after COVID-19. B) Boxplot of stress MBF per heart beat by COVID-19 severity, showing decreasing MBF with increasing COVID-19 severity.
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Affiliation(s)
- P Doeblin
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - C Goetze
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - A Berger
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - F Steinbeis
- Charite - Campus Mitte (CCM), Department of Infectious Diseases and Respiratory Medicine, Berlin, Germany
| | - M Witzenrath
- Charite - Campus Mitte (CCM), Department of Infectious Diseases and Respiratory Medicine, Berlin, Germany
| | - A Faragli
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - A Chiribiri
- King's College London, Division of Imaging Sciences, London, United Kingdom
| | - C M Scannell
- King's College London, Division of Imaging Sciences, London, United Kingdom
| | - E Alskaf
- King's College London, Division of Imaging Sciences, London, United Kingdom
| | - B Pieske
- Deutsches Herzzentrum Berlin, Berlin, Germany
| | - S Kelle
- Deutsches Herzzentrum Berlin, Berlin, Germany
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18
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Tanacli R, Hassel JH, Gebker R, Berger A, Gräfe M, Schneeweis C, Doeblin P, Fleck E, Stehning C, Tacke F, Pieske B, Spranger J, Plöckinger U, Ziagaki A, Kelle S. Cardiac Magnetic Resonance Reveals Incipient Cardiomyopathy Traits in Adult Patients With Phenylketonuria. J Am Heart Assoc 2021; 10:e020351. [PMID: 34423658 PMCID: PMC8649272 DOI: 10.1161/jaha.120.020351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Phenylketonuria is the most common inborn error of amino acid metabolism, where oxidative stress and collateral metabolic abnormalities are likely to cause cardiac structural and functional modifications. We aim herein to characterize the cardiac phenotype of adult subjects with phenylketonuria using advanced cardiac imaging. Methods and Results Thirty-nine adult patients with phenylketonuria (age, 30.5±8.7 years; 10-year mean phenylalanine concentration, 924±330 µmol/L) and 39 age- and sex-matched healthy controls were investigated. Participants underwent a comprehensive cardiac magnetic resonance and echocardiography examination. Ten-year mean plasma levels of phenylalanine and tyrosine were used to quantify disease activity and adherence to treatment. Patients with phenylketonuria had thinner left ventricular walls (septal end-diastolic thickness, 7.0±17 versus 8.8±1.7 mm [P<0.001]; lateral thickness, 6.1±1.4 versus 6.8±1.2 mm [P=0.004]), more dilated left ventricular cavity (end-diastolic volume, 87±14 versus 80±14 mL/m2 [P=0.0178]; end-systolic volume, 36±9 versus 29±8 mL/m2 [P<0.001]), lower ejection fraction (59±6% versus 64±6% [P<0.001]), reduced systolic deformation (global circumferential strain, -29.9±4.2 % versus -32.2±5.0 % [P=0.027]), and lower left ventricular mass (38.2±7.9 versus 47.8±11.0 g/m2 [P<0.001]). T1 native values were decreased (936±53 versus 996±26 ms [P<0.001]), with particular low values in patients with phenylalanine >1200 µmol/L (909±48 ms). Both mean phenylalanine (P=0.013) and tyrosine (P=0.035) levels were independently correlated with T1; and in a multiple regression model, higher phenylalanine levels and higher left ventricular mass associate with lower T1. Conclusions Cardiac phenotype of adult patients with phenylketonuria reveals some traits of an early-stage cardiomyopathy. Regular cardiology follow-up, tighter therapeutic control, and prophylaxis of cardiovascular risk factors, in particular dyslipidemia, are recommended.
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Affiliation(s)
- Radu Tanacli
- Department of Cardiology German Heart Centre Berlin Berlin Germany.,Department of Cardiology Charité University Medicine Berlin Berlin Germany
| | | | - Rolf Gebker
- Department of Cardiology German Heart Centre Berlin Berlin Germany
| | - Alexander Berger
- Department of Cardiology German Heart Centre Berlin Berlin Germany
| | - Michael Gräfe
- Department of Cardiology German Heart Centre Berlin Berlin Germany
| | | | - Patrick Doeblin
- Department of Cardiology German Heart Centre Berlin Berlin Germany
| | - Eckart Fleck
- Department of Cardiology German Heart Centre Berlin Berlin Germany
| | | | - Frank Tacke
- Department of Hepatology and Gastroenterology Charité University Medicine Berlin Berlin Germany.,Interdisziplinäres Stoffwechsel-Centrum Charité-Universitätsmedizin BerlinCampus Virchow Klinikum Berlin Germany
| | - Burkert Pieske
- Department of Cardiology German Heart Centre Berlin Berlin Germany.,Department of Cardiology Charité University Medicine Berlin Berlin Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin Berlin Germany
| | - Joachim Spranger
- Department of Endocrinology, Diabetes, and Nutrition Charité University Medicine Berlin Berlin Germany.,Interdisziplinäres Stoffwechsel-Centrum Charité-Universitätsmedizin BerlinCampus Virchow Klinikum Berlin Germany
| | - Ursula Plöckinger
- Interdisziplinäres Stoffwechsel-Centrum Charité-Universitätsmedizin BerlinCampus Virchow Klinikum Berlin Germany
| | - Athanasia Ziagaki
- Interdisziplinäres Stoffwechsel-Centrum Charité-Universitätsmedizin BerlinCampus Virchow Klinikum Berlin Germany
| | - Sebastian Kelle
- Department of Cardiology German Heart Centre Berlin Berlin Germany.,Department of Cardiology Charité University Medicine Berlin Berlin Germany.,German Centre for Cardiovascular Research DZHK, Partner Site Berlin Berlin Germany
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19
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Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine - Cardiology, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Potsdamer Str. 58, 10785 Berlin, Germany.,Division of Cardiology, Medical Department, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
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20
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Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine-Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine-Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Medical Department, Division of Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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21
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Doeblin P, Gebker R, Pieske B, Kelle S. Late onset apical hypertrophic cardiomyopathy: a case report. Eur Heart J Case Rep 2021; 5:ytaa493. [PMID: 33554024 PMCID: PMC7850629 DOI: 10.1093/ehjcr/ytaa493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/15/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022]
Abstract
Background Apical hypertrophic cardiomyopathy provides diagnostic challenges through varying presentation, impaired visualization on echocardiography and dissent on diagnostic criteria. While hypertrophic cardiomyopathy in general requires an absolute wall thickness ≥15 mm, a threshold for relative apical hypertrophy (ratio 1.5) has been proposed. Case summary We report the case of a 57-year-old man with newly arisen chest pain and slight T-wave inversions. Serial cardiac magnetic resonance imaging over 9 years documented the gradual evolvement of late-onset apical hypertrophy with apical fibrosis and strain abnormalities. Symptoms, electrocardiographic changes, and relative apical hypertrophy preceded the traditional imaging criteria of hypertrophic cardiomyopathy. Discussion Relative apical hypertrophy can be an early manifestation of apical hypertrophic cardiomyopathy. Persistent cardiac signs and symptoms warrant a follow-up, as apical hypertrophic cardiomyopathy can evolve over time. Cardiac magnetic resonance imaging readily visualizes apical hypertrophic cardiomyopathy and associated changes in tissue composition and function.
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Affiliation(s)
- Patrick Doeblin
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Charité Campus Virchow Klinikum, Department of Internal Medicine/Cardiology, Berlin, Germany
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22
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Hashemi D, Motzkus L, Blum M, Kraft R, Tanacli R, Tahirovic E, Doeblin P, Zieschang V, Zamani SM, Kelm M, Kuehne T, Pieske B, Alogna A, Edelmann F, Duengen HD, Kelle S. Myocardial deformation assessed among heart failure entities by cardiovascular magnetic resonance imaging. ESC Heart Fail 2021; 8:890-897. [PMID: 33539681 PMCID: PMC8006725 DOI: 10.1002/ehf2.13193] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/30/2020] [Accepted: 12/21/2020] [Indexed: 12/15/2022] Open
Abstract
AIMS Although heart failure (HF) is a leading cause for hospitalization and mortality, normalized and comparable non-invasive assessment of haemodynamics and myocardial action remains limited. Moreover, myocardial deformation has not been compared between the guideline-defined HF entities. The distribution of affected and impaired segments within the contracting left ventricular (LV) myocardium have also not been compared. Therefore, we assessed myocardial function impairment by strain in patients with HF and control subjects by magnetic resonance imaging after clinically phenotyping these patients. METHODS AND RESULTS This prospective study conducted at two centres in Germany between 2017 and 2018 enrolled stable outpatient subjects with HF [n = 56, including HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF)] and a control cohort (n = 12). Parameters assessed included measures for external myocardial function, for example, cardiac index and myocardial deformation measurements by cardiovascular magnetic resonance imaging, left ventricular global longitudinal strain (GLS), the global circumferential strain (GCS) and the regional distribution of segment deformation within the LV myocardium, as well as basic phenotypical characteristics. Comparison of the cardiac indices at rest showed no differences neither between the HF groups nor between the control group and HF patients (one-way ANOVA P = 0.70). The analysis of the strain data revealed differences between all groups in both LV GLS (One-way ANOVA: P < 0.01. Controls vs. HFpEF: -20.48 ± 1.62 vs. -19.27 ± 1.25. HFpEF vs. HFmrEF: -19.27 ± 1.25 vs. -15.72 ± 2.76. HFmrEF vs. HFrEF: -15.72 ± 2.76 vs. -11.51 ± 3.97.) and LV GCS (One-way ANOVA: P < 0.01. Controls vs. HFpEF: -19.74 ± 2.18 vs. -17.47 ± 2.10. HFpEF vs. HFmrEF: -17.47 ± 2.10 vs. -12.78 ± 3.47. HFrEF: -11.41 ± 3.27). Comparing the segment deformation distribution patterns highlighted the discriminating effect between the groups was much more prominent between the groups (one-way ANOVA P < 0.01) when compared by a score combining regional effects and a global view on the LV. Further analyses of the patterns among the segments affected showed that while the LVEF is preserved in HFpEF, the segments impaired in their contractility are located in the ventricular septum. The worse the LVEF is, the more segments are affected, but the septum remains an outstanding location with the most severe contractility impairment throughout the HF entities. CONCLUSIONS While cardiac index at rest did not differ significantly between controls and stable HF patients suffering from HFrEF, HFmrEF, or HFpEF, the groups did differ significantly in LV GLS and LV GCS values. Regional strain analysis revealed that the LV septum is the location affected most, with reduced values already visible in HFpEF and further reductions in HFmrEF and HFrEF.
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Affiliation(s)
- Djawid Hashemi
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Laura Motzkus
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Moritz Blum
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Robin Kraft
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany
| | - Radu Tanacli
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Elvis Tahirovic
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Patrick Doeblin
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Victoria Zieschang
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - S Mahsa Zamani
- Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Marcus Kelm
- Charité-Universitätsmedizin Berlin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Titus Kuehne
- DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, Institute for Computational and Imaging Science in Cardiovascular Medicine, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
| | - Alessio Alogna
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Hans-Dirk Duengen
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany.,Department of Internal Medicine and Cardiology, German Heart Institute Berlin (DHZB), Augustenburger Platz 1, Berlin, 13353, Germany
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23
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Nasser SB, Doeblin P, Doltra A, Schnackenburg B, Wassilew K, Berger A, Gebker R, Bigvava T, Hennig F, Pieske B, Kelle S. Cardiac Myxomas Show Elevated Native T1, T2 Relaxation Time and ECV on Parametric CMR. Front Cardiovasc Med 2020; 7:602137. [PMID: 33330663 PMCID: PMC7710854 DOI: 10.3389/fcvm.2020.602137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: While cardiac tumors are rare, their identification and differentiation has wide clinical implications. Recent cardiac magnetic resonance (CMR) parametric mapping techniques allow for quantitative tissue characterization. Our aim was to examine the range of values encountered in cardiac myxomas in correlation to histological measurements. Methods and Results: Nine patients with histologically proven cardiac myxomas were included. CMR (1.5 Tesla, Philips) including parametric mapping was performed in all patients pre-operatively. All data are reported as mean ± standard deviation. Compared to myocardium, cardiac myxomas demonstrated higher native T1 relaxation times (1,554 ± 192 ms vs. 1,017 ± 58 ms, p < 0.001), ECV (46.9 ± 13.0% vs. 27.1 ± 2.6%, p = 0.001), and T2 relaxation times (209 ± 120 ms vs. 52 ± 3 ms, p = 0.008). Areas with LGE showed higher ECV than areas without (54.3 ± 17.8% vs. 32.7 ± 18.6%, p = 0.042), with differences in native T1 relaxation times (1,644 ± 217 ms vs. 1,482 ± 351 ms, p = 0.291) and T2 relaxation times (356 ± 236 ms vs. 129 ± 68 ms, p = 0.155) not reaching statistical significance. Conclusions: Parametric CMR showed elevated native T1 and T2 relaxation times and ECV values in cardiac myxomas compared to normal myocardium, reflecting an increased interstitial space and fluid content. This might help in the differentiation of cardiac myxomas from other tumor entities.
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Affiliation(s)
- Sarah B Nasser
- Department of Cardiology, Dar Al Fouad Hospital, Cairo, Egypt
| | - Patrick Doeblin
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Adelina Doltra
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Cardiovascular Institute, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | | | - Katharina Wassilew
- Department of Pathology, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Alexander Berger
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Rolf Gebker
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | | | - Felix Hennig
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
| | - Sebastian Kelle
- Department of Internal Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Charité University Medicine Berlin, Berlin, Germany
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24
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Doeblin P, Schilling R, Wagner M, Luhur R, Huppertz A, Hamm B, Taupitz M, Durmus T. Intraindividual comparison of T1 relaxation times after gadobutrol and Gd-DTPA administration for cardiac late enhancement imaging. Eur J Radiol 2013; 83:660-4. [PMID: 24433640 DOI: 10.1016/j.ejrad.2013.12.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Revised: 11/11/2013] [Accepted: 12/15/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate T1-relaxation times of chronic myocardial infarction (CMI) using gadobutrol and gadopentetate dimeglumine (Gd-DTPA) over time and to determine the optimal imaging window for late enhancement imaging with both contrast agents. MATERIAL AND METHODS Twelve patients with CMI were prospectively included and examined on a 1.5 T magnetic resonance (MR) system using relaxivity-adjusted doses of gadobutrol (0.15 mmol/kg) and Gd-DTPA (0.2 mmol/kg) in random order. T1-relaxation times of remote myocardium (RM), infarcted myocardium (IM), and left ventricular cavity (LVC) were assessed from short-axis TI scout imaging using the Look-Locker approach and compared intraindividually using a Wilcoxon paired signed-rank test (α<0.05). RESULTS Within 3 min of contrast agent administration (CA), IM showed significantly lower T1-relaxation times than RM with both contrast agents, indicating beginning cardiac late enhancement. Differences between gadobutrol and Gd-DTPA in T1-relaxation times of IM and RM were statistically not significant through all time points. However, gadobutrol led to significantly higher T1-relaxation times of LVC than Gd-DTPA from 6 to 9 min (220 ± 15 ms vs. 195 ± 30 ms p<0.01) onwards, resulting in a significantly greater ΔT1 of IM to LVC at 9-12 min (-20 ± 35 ms vs. 0 ± 35 ms, p<0.05) and 12-15 min (-25 ± 45 ms vs. -10 ± 60 ms, p<0.05). Using Gd-DTPA, comparable ΔT1 values were reached only after 25-35 min. CONCLUSION This study indicates good delineation of IM to RM with both contrast agents as early as 3 min after administration. However, we found significant differences in T1 relaxation times with greater ΔT1 IM-LVC using 0.15 mmol/kg gadobutrol compared to 0.20 mmol/kg Gd-DTPA after 9-15 min post-CA suggesting earlier differentiability of IM and LVC using gadobutrol.
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Affiliation(s)
- Patrick Doeblin
- Department of Cardiology, Charité - Universitätsmedizin Berlin, Charité Campus Benjamin Franklin, Berlin, Germany.
| | - Rene Schilling
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
| | - Moritz Wagner
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
| | - Reny Luhur
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
| | - Alexander Huppertz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany; Imaging Science Institute, Charité, Berlin, Germany.
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
| | - Matthias Taupitz
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
| | - Tahir Durmus
- Department of Radiology, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Berlin, Germany.
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25
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Wagner M, Schilling R, Doeblin P, Huppertz A, Luhur R, Schwenke C, Maurer M, Hamm B, Taupitz M, Durmus T. Macrocyclic contrast agents for magnetic resonance imaging of chronic myocardial infarction: intraindividual comparison of gadobutrol and gadoterate meglumine. Eur Radiol 2012; 23:108-14. [DOI: 10.1007/s00330-012-2563-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 05/18/2012] [Accepted: 05/24/2012] [Indexed: 01/25/2023]
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