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Kern M, Hauck SR, Dachs TM, Haider L, Stelzmüller ME, Ehrlich M, Loewe C, Funovics MA. Endovascular repair in type A aortic dissection: Anatomic candidacy for currently manufactured stentgrafts and conceptual valve-carrying devices for an Endo-Bentall procedure. Eur J Cardiothorac Surg 2023; 63:7077137. [PMID: 36916747 PMCID: PMC10206284 DOI: 10.1093/ejcts/ezad085] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 03/16/2023] Open
Abstract
OBJECTIVES Endovascular treatment has been suggested as alternative for open surgery as treatment for type A aortic dissection, but current devices have severe anatomic limitations. This study assesses computed-tomography-based anatomic suitability of currently manufactured stent grafts as well as two embodiments of valve-carrying devices. METHODS In a retrospective single-center cohort of 200 consecutive ascending/arch operations between 2009 and 2018, 112 type A aortic dissection patients were identified and evaluated for endovascular candidacy based on locations of entries, landing zone diameters/lengths and supra-aortic vessel origins according to the anatomical instructions for use criteria of 6 commercially available, (tubular, branched or fenestrated) stentgrafts. Two suggested valve-carrying devices with inner branches or fenestrations for the coronary arteries and branches for the supra-aortic vessels were also evaluated. RESULTS The anatomic feasibility for commercial stentgrafts ranged from 4% to 21%. The main limitations was proximal landing zone diameter (considering oversizing <15%) and length due to dilatation and an entry too close to the sinotubular junction. For the valve-carrying conduits, anatomical feasibility was between 31% and 80%. with the main limiting factors the diameter of the aortic annulus and its distance to the coronary arteries. CONCLUSIONS Anatomic applicability of currently manufactured stentgrafts for the treatment of type A aortic dissection is mainly limited by the absence of a suitable proximal landing zone in the ascending aorta and might substantially be improved by anchoring in the aortic annulus using a valve-carrying device which employs either fenestrations or branches for the coronary arteries.
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Affiliation(s)
- Maximilian Kern
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sven R Hauck
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
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2
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Rettl R, Wollenweber T, Duca F, Binder C, Cherouny B, Dachs TM, Luciana CL, Schrutka L, Dalos D, Beitzke D, Loewe C, Eslam RB, Kastner J, Hacker M, Bonderman D. Monitoring tafamidis treatment with quantitative SPECT/CT in transthyretin amyloid cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023:7070981. [PMID: 36881774 PMCID: PMC10364619 DOI: 10.1093/ehjci/jead030] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 03/09/2023] Open
Abstract
AIMS Tafamidis treatment positively affects left ventricular (LV) structure and function and improves outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). We aimed to investigate the relationship between treatment response and cardiac amyloid burden identified by serial quantitative 99mTc-DPD SPECT/CT. We furthermore aimed to identify nuclear imaging biomarkers that could be used to quantify and monitor response to tafamidis therapy. METHODS AND RESULTS Forty wild-type ATTR-CM patients who underwent 99mTc-DPD scintigraphy and SPECT/CT imaging at baseline and after treatment with tafamidis 61 mg once daily [median, 9.0 months (interquartile range 7.0-10.0)] were divided into two cohorts based on the median (-32.3%) of the longitudinal percent change in standardized uptake value (SUV) retention index. ATTR-CM patients with a reduction greater than or equal to the median (n = 20) had a significant decrease in SUV retention index (P < 0.001) at follow-up, which translated into significant benefits in serum N-terminal prohormone of brain natriuretic peptide levels (P = 0.006), left atrial volume index (P = 0.038), as well as LV [LV global longitudinal strain: P = 0.028, LV ejection fraction (EF): P = 0.027, LV cardiac index (CI): P = 0.034] and right ventricular (RV) [RVEF: P = 0.025, RVCI: P = 0.048] functions compared with patients with a decrease less than the median (n = 20). CONCLUSION Treatment with tafamidis in ATTR-CM patients results in a significant reduction in SUV retention index, associated with significant benefits for LV and RV function and cardiac biomarkers. Serial quantitative 99mTc-DPD SPECT/CT imaging with SUV may be a valid tool to quantify and monitor response to tafamidis treatment in affected patients. TRANSLATIONAL PERSPECTIVE 99mTc-DPD SPECT/CT imaging with determination of SUV retention index as part of a routine annual examination can provide evidence of treatment response in ATTR-CM patients receiving disease-modifying therapy. Further long-term studies with 99mTc-DPD SPECT/CT imaging may help to evaluate the relationship between tafamidis-induced reduction in SUV retention index and outcome in patients with ATTR-CM and will demonstrate whether highly disease-specific 99mTc-DPD SPECT/CT imaging is more sensitive than routine diagnostic monitoring.
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Affiliation(s)
- René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Tim Wollenweber
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Bernhard Cherouny
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Camuz Ligios Luciana
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Lore Schrutka
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Daniel Dalos
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Dietrich Beitzke
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria
| | - Marcus Hacker
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria.,Division of Cardiology, Department of Internal Medicine V, Favoriten Clinic, Kundratstraße 3, 1100 Vienna, Austria
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3
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Rettl R, Duca F, Binder C, Dachs TM, Cherouny B, Camuz Ligios L, Mann C, Schrutka L, Dalos D, Charwat-Resl S, Badr Eslam R, Kastner J, Bonderman D. Impact of tafamidis on myocardial strain in transthyretin amyloid cardiomyopathy. Amyloid 2023; 30:127-137. [PMID: 36251806 DOI: 10.1080/13506129.2022.2131385] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIMS The impact of tafamidis on myocardial strain in patients with transthyretin amyloid cardiomyopathy (ATTR-CM) have been barely investigated. We aimed to determine tafamidis-induced changes using serial speckle tracking echocardiography and to identify imaging parameters for specific therapy monitoring. METHODS AND RESULTS ATTR-CM patients underwent serial TTE with two-dimensional (2 D) speckle tracking imaging. Patients receiving tafamidis free acid 61 mg (n = 62) or tafamidis meglumine 20 mg (n = 21) once daily (QD) showed stable measurements at follow-up (61 mg: 8.5 months, 20 mg: 7.0 months) in LV global longitudinal strain (GLS) (61 mg: -11.75% vs. -11.58%, p = 0.534; 20 mg: -10.61% vs. -10.12%, p = 0.309), right ventricular (RV) GLS (61 mg: -14.18% vs. -13.72%, p = 0.377; 20 mg: -14.53% vs. -13.99%, p = 0.452) and left atrial (LA) reservoir strain (LASr; 61 mg: 8.80% vs. 9.42%, p = 0.283; 20 mg: 8.23% vs. 8.67%, p = 0.589), whereas treatment-naïve ATTR-CM patients (n = 54) had clear signs of disease progression at the end of the observation period (10.5 months; LV-GLS: -11.71% vs. -10.59%, p = 0.001; RV-GLS: -14.36% vs. -12.99%, p = 0.038; LASr: 10.67% vs. 8.41%, p = 0.005). Between-group comparison at follow-up revealed beneficial effects of tafamidis free acid 61 mg on LASr (p = 0.003) and the LV (LV-GLS: p = 0.030, interventricular septum (IVS): p = 0.006), resulting in clinical benefits (six-minute walk distance (6-MWD): p = 0.006, NT-proBNP: p= <0.001), while patients treated with tafamidis meglumine 20 mg QD showed positive effects on LASr (p = 0.039), but no differences with respect to the LV (LV-GLS: p = 0.274, IVS: p = 0.068) and clinical status (6-MWD: p = 0.124, NT-proBNP: p = 0.053) compared to the natural course. CONCLUSIONS Treatment with tafamidis free acid 61 mg in ATTR-CM patients delays the deterioration of LA and LV longitudinal function, resulting in significant clinical benefits compared with natural history. Serial TTE with 2 D speckle tracking imaging may be appropriate for disease-specific therapy monitoring.
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Affiliation(s)
- René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Bernhard Cherouny
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christopher Mann
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Lore Schrutka
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Silvia Charwat-Resl
- Division of Cardiology, Department of Internal Medicine V, Favoriten Clinic, Vienna, Austria
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Division of Cardiology, Department of Internal Medicine V, Favoriten Clinic, Vienna, Austria
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Kupferthaler A, Hauck SR, Schwarz M, Kern M, Deinsberger J, Dachs TM, Neumayer C, Stelzmüller ME, Ehrlich M, Loewe C, Funovics MA. Endovascular Repair of Penetrating Thoracic Aortic Ulcers Using Tubular Stent Grafts Versus Stent Grafts With a Proximal Scallop. J Endovasc Ther 2023:15266028221149919. [PMID: 36680393 DOI: 10.1177/15266028221149919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE In penetrating aortic ulcers (PAUs), limited data support tubular thoracic endovascular aortic repair (TEVAR) as a viable treatment option. For treatment of more proximal PAUs, hybrid approaches and-more recently-scalloped TEVAR (scTEVAR) have been advocated. Outcomes of scTEVAR specifically for PAUs have not yet been reported. This study reports long-term outcomes for tubular and scTEVAR in PAUs and compares the safety profile in both cohorts regarding the significantly more proximal landing zone (LZ) for scTEVAR. MATERIALS AND METHODS This single-center retrospective cohort study includes all nonacute patients treated for complicated PAU with scTEVAR and tubular TEVAR. Patient and PAU characteristics as well as procedural success, complication and reintervention rates, and all-cause and aortic mortality were analyzed. RESULTS Of 212 TEVAR procedures reviewed, 21 patients with tubular TEVAR and 19 patients with scTEVAR were included. Patient and PAU characteristics were similar, and LZ was significantly more proximal in the scTEVAR cohort (p=0.0001), with similar number and types of supra-aortic revascularization procedures. Clinical success was reached in all 40 patients (100%), and reintervention rate was 2/21 (9.5%) and 1/19 (5.3%), respectively. Over the mean follow-up of 63 (TEVAR) and 53 (scTEVAR) months, clinical success was stable in all patients with one (abdominal) aortic-related mortality in the scTEVAR cohort. CONCLUSION Treatment of complicated PAUs with TEVAR as well as scTEVAR provides excellent and similar clinical success, stability of clinical success, and aortic survival with acceptable complication and reintervention rates. Scalloped TEVAR safely lengthens the proximal sealing zone to address more proximal pathologies. CLINICAL IMPACT Treatment of asymptomatic complicated penetrating aortic ulcers (PAUs) with thoracic endovascular aortic repair (TEVAR) provides excellent clinical success and acceptable complication and reintervention rates. More patients become amenable to endovascular treatment by including scalloped TEVAR (scTEVAR) as a means to safely lengthen the proximal sealing zone to address more proximal pathologies.
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Affiliation(s)
- Alexander Kupferthaler
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
- Medical Faculty, Johannes Kepler University Linz, Linz, Austria
| | - Sven R Hauck
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Michael Schwarz
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
- Institute of Medical Radiology, Diagnostic, Intervention, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - Maximilian Kern
- Department of Radiology, Klinik Floridsdorf, Vienna, Austria
| | - Julia Deinsberger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Division of Cardiovascular and Interventional Radiology, Department of Biomedical Imaging and Image-guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
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5
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Kronberger C, Mousavi RA, Öztürk B, Willixhofer R, Dachs TM, Rettl R, Camuz-Ligios L, Rassoulpour N, Krall C, Litschauer B, Badr Eslam R. Functional capacity testing in patients with pulmonary hypertension (PH) using the one-minute sit-to-stand test (1-min STST). PLoS One 2023; 18:e0282697. [PMID: 36893125 PMCID: PMC9997887 DOI: 10.1371/journal.pone.0282697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/19/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND The one-minute sit-to-stand-test (1-min STST) is a quick, space saving test to evaluate functional capacity. Exercise testing plays an important role in the long-term follow-up of pulmonary hypertension (PH) patients and is currently evaluated using the six-minute-walk-test (6MWT). The aim of the study was to assess the convergent validity of the 1-min STST in patients with PH and its association with markers of PH severity. METHODS We evaluated 106 PH patients with the 1-min-STST and 6MWT and measured cardiorespiratory parameters (heart rate, blood pressure, oxygen saturation) before and after test conduction. N-terminal pro brain-type natriuretic peptide (NT-proBNP), WHO functional class (WHO-FC) and mean pulmonary artery pressure (mPAP) were defined as markers of PH severity. RESULTS Strong correlation was found between performances of 1-min STST and 6MWT (r = .711, p < .001), indicating convergent validity. Both tests were inversely associated with NT-proBNP (STST: r = -.405, p < .001; 6MWT: r = -.358, p < .001), WHO-FC (STST: r = -.591, p < .001; 6MWT: r = -.643, p < .001) and mPAP (STST: r = -.280, p < .001; 6MWT: r = -.250, p < .001). Significant changes in cardiorespiratory parameters were observed in both tests (all p < 0.001). Further the post-exercise cardiorespiratory parameters correlated strongly between the 1-min STST and 6MWT (all r ≥ .651, all p < .001). CONCLUSION The 1-min STST demonstrated good convergent validity with the 6MWT and was associated with markers of PH severity. Furthermore, both exercise tests caused similar cardiorespiratory responses.
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Affiliation(s)
| | | | - Begüm Öztürk
- Department of Cardiology, Clinic Favoriten, Vienna, Austria
| | - Robin Willixhofer
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - René Rettl
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | | | - Nima Rassoulpour
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christoph Krall
- Center for Medical Data Science, Medical University of Vienna, Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Roza Badr Eslam
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
- * E-mail:
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Schrutka L, Seirer B, Rettl R, Dachs TM, Binder C, Duca F, Dalos D, Badr-Eslam R, Kastner J, Hengstenberg C, Frommlet F, Bonderman D. Heart failure with preserved ejection fraction: Calculating the risk of future heart failure events and death. Front Cardiovasc Med 2022; 9:921132. [PMID: 36337874 PMCID: PMC9634582 DOI: 10.3389/fcvm.2022.921132] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 04/15/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objective We sought to develop a clinical model to identify heart failure patients with preserved ejection fraction (HFpEF) at highest risk for acute HF events or death. Methods and results Between 2010 and 2019, 422 patients with HFpEF were followed. Acute HF events occurred in 190 patients (45%), including 110 (58%) with recurrent hospitalizations. Those with recurrent events had worse 6-min walk test (p < 0.001), higher brain N-terminal prohormone natriuretic peptide (NT-proBNP, p < 0.001), and higher New York Heart Association functional class (NYHA, p < 0.001). Overall survival rates in patients with 1 HF event vs > 1 HF events were: at 1-year 91.6 vs. 91.8%, at 3-years 84.7 vs. 68.3% and at 5-years 67.4 vs. 42.7%, respectively (p < 0.04). The Hfpef survivAL hOspitalization (HALO) score revealed best predictive capability for all-cause mortality combining the variables age (p = 0.08), BMI (p = 0.124), NYHA class (p = 0.004), need for diuretic therapy (p = 0.06), left atrial volume index (p = 0.048), systolic pulmonary artery pressure (p = 0.013), NT-proBNP (p = 0.076), and number of prior hospitalizations (p = 0.006). HALO score predicted future HF hospitalizations in an ordinal logistic regression model (OR 3.24, 95% CI: 2.45–4.37, p < 0.001). The score performance was externally validated in 75 HFpEF patients, confirming a strong survival prediction (HR 2.13, 95% CI: 1.30–3.47, p = 0.002). Conclusions We developed a model to identify HFpEF patients at increased risk of death and HF hospitalization. NYHA class and recurrent HF hospitalizations were the strongest drivers of outcome.
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Affiliation(s)
- Lore Schrutka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Benjamin Seirer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - René Rettl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Roza Badr-Eslam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Florian Frommlet
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Medical Statistics, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
- Department of Internal Medicine V, Division of Cardiology, Clinic Favoriten, Vienna, Austria
- *Correspondence: Diana Bonderman,
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7
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Schrutka L, Seirer B, Dusik F, Rettl R, Duca F, Dalos D, Dachs TM, Binder C, Badr-Eslam R, Kastner J, Hengstenberg C, Stix G, Bonderman D. Validation of an electrocardiographic algorithm for the detection of cardiac amyloidosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Despite new therapies, diagnosis of cardiac amyloidosis (CA) is often delayed. We recently developed a simple electrocardiographic (ECG) algorithm to suspect CA without the aid of advanced imaging modalities (Figure).
Methods
The aim of this study was to validate the algorithms' usefulness in clinical practice. ECG readings from patients with CA, heart failure with preserved ejection fraction (HFpEF), and hypertrophic cardiomyopathy (HCMP) were analyzed in a blinded fashion.
Results
884 patients were included. Patients with pacemakers were excluded, leaving 827 ECGs (237 CA, 407 HFpEF, 183 HCMP) for final analysis. A characteristic pattern defined by the algorithm was visually perceptible in 165 ECGs (69.6%) of the amyloidosis patients vs. 114 (28%) of HFpEF vs. 22 (12.0%) of HCMP patients (p<0.001). The area under the curve (AUC) for the detection CA was 0.75 with a sensitivity of 69.6% and a specificity of 76.9% (Figure). Binary logistic regression analysis revealed that the presence of a distinctive pattern increased the probability of CA with an odds ratio of 7.66 (CI: 5.47–10.72; p<0.001).
Conclusion
This easy-to-use ECG algorithm has proven helpful to suspect CA. Our tool may significantly improve the treatment of heart failure patients by identifying those with amyloidosis-related disease.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Schrutka
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - B Seirer
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - F Dusik
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - R Rettl
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - F Duca
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - D Dalos
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - T M Dachs
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Binder
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - R Badr-Eslam
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - J Kastner
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - G Stix
- Medical University of Vienna, Cardiology , Vienna , Austria
| | - D Bonderman
- Medical University of Vienna, Cardiology , Vienna , Austria
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8
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Kronberger C, Mousavi RA, Öztürk B, Dachs TM, Rettl R, Camuz-Ligios L, Litschauer B, Badr-Eslam R. Exercise capacity assessed with the one-minute sit-to-stand test (1-min STST) and echocardiographic findings in patients with heart failure with preserved ejection fraction (HFpEF). Heart Lung 2022; 55:134-139. [PMID: 35567840 DOI: 10.1016/j.hrtlng.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a major cause of morbidity and mortality. Precise risk stratification remains challenging. The one-minute sit-to-stand-test (1-min STST), a quick, objective test of functional capacity may be helpful for stratification of clinical profile in HFpEF patients. OBJECTIVE The aim of this initial investigation was to prospectively examine whether the 1-min STST can be used for the evaluation of exercise capacity in HFpEF patients and whether it is in line with echocardiographic as well as quality of life (QoL) findings. METHODS 39 HFpEF patients were prospectively studied. Functional performance was examined with the 1-min STST and QoL with the CAMPHOR questionnaire. Clinical parameters including echocardiographic measurements [estimated pulmonary artery systolic pressure (ePASP), tricuspid regurgitation velocity (TRV)] were obtained. Patients were divided into two groups based on their number of 1-min STST repetitions (Group I: ≤50% of predicted 1-min STST repetitions using the norm-reference values developed by Strassmann et al. for healthy people, N=24; Group II: >50% of predicted 1-min STST repetitions, N=15). RESULTS Patients in group I with limited 1-min STST performance showed worse echocardiographic parameters [higher ePASP (p=0.038), higher TRV (p=0.018) and more reduced tricuspid annular plane systolic excursion (TAPSE) (p=0.001)], worse six-minute walk test (6MWT) (p<0.001) and worse QoL (p<0.001) compared to patients in group II. CONCLUSION Our study shows potential usefulness of the 1-min STST as an evaluative tool for exercise capacity in HFpEF patients, because patients with worse 1-min STST performance have worse clinical parameters and QoL.
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Affiliation(s)
- Christina Kronberger
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Roya Anahita Mousavi
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Begüm Öztürk
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Theresa-Marie Dachs
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - René Rettl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Luciana Camuz-Ligios
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Brigitte Litschauer
- Department of Clinical Pharmacology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Roza Badr-Eslam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Hauck SR, Kern M, Dachs TM, Haider L, Stelzmüller ME, Ehrlich M, Loewe C, Funovics MA. Applicability of endovascular branched and fenestrated aortic arch repair devices to treat residual type A dissection after ascending replacement. J Vasc Surg 2022; 76:1440-1448. [PMID: 36028159 DOI: 10.1016/j.jvs.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 08/14/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Endovascular repair of post-type-A aortic dissection after open ascending replacement (PTAD) has recently been shown as safe and feasible, but with limited anatomic applicability since only one stent graft was evaluated. We assessed anatomic and clinical applicability of six commercially available branched/fenestrated stent grafts for endovascular repair of PTAD. METHODS On postoperative CT-scans of 101 patients, we measured aortic diameter at: sino-tubular junction, supra-aortic vessels (SAV), and descending aorta, as well as the distances between these landmarks along the outer curvature of the arch and the diameters of the SAV. Anatomical applicability was evaluated according to the instructions-for-use, clinical applicability with regard to supra-aortic and iliac arteries. Assessed devices were: Cook aortic double branch; Terumo double branch; Najuta fenestrated; Endospan Nexus; Medtronic Mona LSA; and Gore TAG thoracic branch. RESULTS Single devices were anatomically and clinically applicable between 19/101 (Mona LSA) and 83/101 (Najuta) cases. Reasons for rejection varied considerably across devices. With all devices available, anatomical applicability was 97/101 and clinical applicability 95/101. Combinations of a fenestrated and a branched device showed the most favorable clinical applicability for a pair of two devices, ranging from 86/101 to 94/101. CONCLUSIONS Anatomical and clinical applicability of endovascular devices for the repair of PTAD is high for fenestrated and branched devices, and very high for the combination of fenestrated and branched devices. Manufacturers should amend specific device requirements for PTAD. Surgeons should emphasize the need for a sufficiently long and straight graft as a potential landing zone.
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Affiliation(s)
- Sven R Hauck
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Maximilian Kern
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Lukas Haider
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Marek Ehrlich
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Division of Cardiovascular and Interventional Radiology, Department of Bio-medical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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Dachs TM, Duca F, Rettl R, Binder-Rodriguez C, Dalos D, Ligios LC, Kammerlander A, Grünig E, Pretsch I, Steringer-Mascherbauer R, Ablasser K, Wargenau M, Mascherbauer J, Lang IM, Hengstenberg C, Badr-Eslam R, Kastner J, Bonderman D. Riociguat in pulmonary hypertension and heart failure with preserved ejection fraction: the haemoDYNAMIC trial. Eur Heart J 2022; 43:3402-3413. [PMID: 35909264 PMCID: PMC9492239 DOI: 10.1093/eurheartj/ehac389] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [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] [Received: 10/09/2021] [Revised: 06/12/2022] [Accepted: 07/06/2022] [Indexed: 12/16/2022] Open
Abstract
AIMS The presence of pulmonary hypertension (PH) severely aggravates the clinical course of heart failure with preserved ejection fraction (HFpEF). To date, neither established heart failure therapies nor pulmonary vasodilators proved beneficial. This study investigated the efficacy of chronic treatment with the oral soluble guanylate cyclase stimulator riociguat in patients with PH-HFpEF. METHODS AND RESULTS The phase IIb, randomized, double-blind, placebo-controlled, parallel-group, multicentre DYNAMIC trial assessed riociguat in PH-HFpEF. Patients were recruited at five hospitals across Austria and Germany. Key eligibility criteria were mean pulmonary artery pressure ≥25 mmHg, pulmonary arterial wedge pressure >15 mmHg, and left ventricular ejection fraction ≥50%. Patients were randomized to oral treatment with riociguat or placebo (1:1). Patients started at 0.5 mg three times daily (TID) and were up-titrated to 1.5 mg TID. The primary efficacy endpoint was change from baseline to week 26 in cardiac output (CO) at rest, measured by right heart catheterization. Primary efficacy analyses were performed on the full analysis set. Fifty-eight patients received riociguat and 56 patients placebo. After 26 weeks, CO increased by 0.37 ± 1.263 L/min in the riociguat group and decreased by -0.11 ± 0.921 L/min in the placebo group (least-squares mean difference: 0.54 L/min, 95% confidence interval 0.112, 0.971; P = 0.0142). Five patients dropped out due to riociguat-related adverse events but no riociguat-related serious adverse event or death occurred. CONCLUSION The vasodilator riociguat improved haemodynamics in PH-HFpEF. Riociguat was safe in most patients but led to more dropouts as compared to placebo and did not change clinical symptoms within the study period.
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Affiliation(s)
- Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christina Binder-Rodriguez
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Daniel Dalos
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andreas Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Centre Heidelberg (TLRC), German Centre for Lung Research (DZL), 69126 Heidelberg, Germany
| | - Ingrid Pretsch
- Division of Cardiology and Intensive Care, Department of Internal Medicine II, Paracelsus Medical University of Salzburg, Muellner Hauptstraße 48, 5020 Salzburg, Austria
| | - Regina Steringer-Mascherbauer
- Division of Cardiology, Angiology and Intensive Care, Department of Internal Medicine II, Public Hospital Elisabethinen Linz, Fadingerstraße 1, 4020 Linz, Austria
| | - Klemens Ablasser
- Division of Cardiology, Medical University of Graz, Auenbruggerplatz 15, 8036 Graz, Austria
| | - Manfred Wargenau
- M.A.R.C.O. GmbH & Co. KG, Institute for Clinical Research and Statistics, Schirmerstraße 71, 40211 Duesseldorf, Germany
| | - Julia Mascherbauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Division of Cardiology, Department of Internal Medicine III, University Hospital of St. Poelten, Dunant-Platz 1, 3100 St. Poelten, Austria
| | - Irene M Lang
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Roza Badr-Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Division of Cardiology, Department of Internal Medicine V, Favoriten Clinic, Kundratstraße 3, 1100 Vienna, Austria
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11
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Dachs TM, Hauck SR, Kern M, Klausenitz C, Funovics MA. Fenestrierte und verzweigte endovaskuläre Aortenprothesen. Radiologie 2022; 62:586-591. [PMID: 35726073 PMCID: PMC9242898 DOI: 10.1007/s00117-022-01019-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/19/2022] [Indexed: 11/28/2022]
Abstract
Hintergrund Komplexe abdominelle aortale Pathologien, welche die Abgänge der Viszeralarterien miterfassen und bei denen kein adäquater proximaler Hals gegeben ist, können heute mittels fortgeschrittener FEVAR/BEVAR-Technik („fenestrated/branched endovascular aneurysm repair“) mit ähnlicher Sicherheit und vergleichbaren Erfolgsraten behandelt werden wie infrarenale Pathologien mit konventionellem EVAR. Methodische Innovationen und Probleme Zur Versorgung der Viszeralarterien können Fenestrierungen (bei Abgang der Viszeralarterie aus der nichtdilatierten Aorta) oder Verzweigungen (bei Abgang aus der dilatierten Aorta) verwendet werden. Beide Arten von Öffnungen werden mit Verbindungsstentgrafts (VSG) zu den Viszeralarterien abgedichtet. Mehrere Hersteller bieten fenestrierte oder verzweigte Endoprothesen an, wobei diese nur in Einzelfällen CE-zertifiziert und überwiegend in Europa als individuelle Sonderanfertigungen patientenbezogen erhältlich sind. Dies setzt eine entsprechende Lieferzeit voraus, was die Behandlung akuter Patienten mit solchen Prothesen unmöglich macht. Es liegen allerdings zwei Produkte von vierfach verzweigten Endoprothesen vor, die einen größeren Bereich der anatomischen Gegebenheiten bei thorakoabdominellen Aneurysmen auch im Akutfall abdecken und behandelbar machen. Sämtliche FEVAR- und BEVAR-Hauptkörper benötigen VSG, die durchgehend von Fremdherstellern stammen und von denen gegenwärtig noch kein einziges Produkt für diese Anwendung zertifiziert ist. Empfehlungen Da Probleme an Verbindungsstentgrafts eine wesentliche Ursache für Reinterventionen sind, sollte in der Nachsorge Knickbildungen und Brüchen an diesen Verbindungsstents besonderes Augenmerk geschenkt und von der Verwendung einschichtiger Designs beim BEVAR abgesehen werden.
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Affiliation(s)
- Theresa-Marie Dachs
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Sven Rudolf Hauck
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Maximilian Kern
- Institut für Radiologie, Klinik Floridsdorf, Wien, Österreich
| | - Catharina Klausenitz
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Martin A Funovics
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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12
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Badr Eslam R, Öztürk B, Rettl R, Capelle CDJ, Qin H, Binder C, Dachs TM, Camuz Ligios L, Duca F, Dalos D, Schrutka L, Alasti F, Kastner J, Vila G, Bonderman D. Impact of Tafamidis and Optimal Background Treatment on Physical Performance in Patients With Transthyretin Amyloid Cardiomyopathy. Circ Heart Fail 2022; 15:e008381. [PMID: 35766028 DOI: 10.1161/circheartfailure.121.008381] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In patients with transthyretin amyloid cardiomyopathy, tafamidis was shown to slow the decline in 6-minute walking distance as compared with placebo. We aimed to define the impact of tafamidis and optimal background treatment on functional capacity as determined by cardiopulmonary exercise testing (CPET). METHODS Seventy-eight consecutive patients were enrolled in the study. They underwent CPET at baseline, and outcome defined as death or heart failure hospitalization was obtained for a time period of up to 30 months. Fifty-four patients completed a follow-up CPET at 9±3 months (range, 4-16 months). Improvement in peak VO2 at follow-up was defined as ∆peak VO2≥1.0 mL/(kg·min), stable peak VO2 was defined as 0≤∆peak VO2<1.0 mL/(kg·min), and decline in peak VO2 was defined by ∆peak VO2<0 mL/(kg·min). RESULTS Baseline peak VO2>14 mL/(kg·min) as well as minute ventilation/carbon dioxide production slope≤34 were associated with a lower risk of death or heart failure hospitalization (P=0.002, P=0.007, respectively). In 54 patients, who received tafamidis and underwent repeat CPET testing, an improvement in physical performance (P=0.002) was observed at follow-up. When comparing pre and post-treatment parameters, 29 patients (54%) showed an increase in percent predicted peak VO2 (P<0.0001), an improvement of peak VO2 (P<0.0001), and better physical performance at follow-up (P<0.0001). Patients with stable or improved peak VO2 had less advanced heart disease at baseline (P=0.046). CONCLUSIONS Our findings demonstrate that baseline peak VO2 and baseline minute ventilation/carbon dioxide production slope predict outcomes and an improvement in physical performance as measured by CPET was observed in patients receiving tafamidis, who had less advanced disease at baseline, emphasizing the importance of early diagnosis.
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Affiliation(s)
- Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Begüm Öztürk
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - René Rettl
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Christophe Denis Josef Capelle
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Hong Qin
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Daniel Dalos
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Lore Schrutka
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Farideh Alasti
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria (F.A.)
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
| | - Greisa Vila
- Division of Endocrinology and Metabolism, Department of Internal Medicine III (G.V.), Medical University of Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II (R.B.E., B.O., R.R., C.D.J.C., H.Q., C.B., T.-M.D., L.C.L., F.D., D.D., L.S., J.K., D.B.), Medical University of Vienna, Austria
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Hauck SR, Schernthaner R, Dachs TM, Kern M, Funovics M. Endovaskuläre Aortenreparatur bei Endoleaks. Radiologie 2022; 62:592-600. [PMID: 35736998 PMCID: PMC9242926 DOI: 10.1007/s00117-022-01033-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/25/2022]
Abstract
Sämtliche Patienten nach endovaskulärer Versorgung eines Aortenaneurysmas bedürfen einer regelmäßigen Nachkontrolle, zumeist in jährlichem Abstand. Der kontrastmittelverstärkte Ultraschall und die Computertomographie-Angiographie (CTA) sind die wichtigsten diagnostischen Modalitäten für die Erkennung von Endoleaks. Die (CTA) erlaubt eine bessere Unterscheidung der verschiedenen Endoleak-Typen. Sogenannte Hochdruck-Endoleaks (Typ I und Typ III) stellen, wenn sich nicht kurzzeitig ein Spontanverschluss zeigt, eine absolute Indikation zur Nachbehandlung dar. Typ-II-Endoleaks weisen in der Mehrzahl einen benignen Verlauf auf. Wenn kein Wachstum des Aneurysmasacks erfolgt, kann eine Nachkontrolle im gewohnten Intervall durchgeführt werden. Typ-II-Endoleaks mit assoziiertem Wachstum des Aneurysmasacks können durch Embolisation der verantwortlichen Gefäße behandelt werden. Ob eine Behandlung immer durchgeführt werden muss, ist umstritten. Eine Behandlungsindikation von einem Typ-II-Endoleak mit wachsendem Aneurysmasack ist jedoch gegeben, wenn durch eine Verkürzung des Aneurysmahalses ein sekundäres Typ-I-Endoleak droht. Typ-I-Endoleaks stellen die Hauptlimitation der Stentgraft-Therapie dar. Die beste Prävention eines Typ-I-Endoleaks ist die Bereitstellung einer adäquaten proximalen Landezone. Dies kann durchaus bedeuten, dass fenestrierte Stentgrafts verwendet werden müssen. Die Verwendung von Schrauben oder anderen Fixationsinstrumenten zur sicheren Behandlung auch kurzer Hälse ist derzeit noch in der Studienphase.
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Affiliation(s)
- Sven Rudolf Hauck
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Rüdiger Schernthaner
- Zentrales Radiologie Institut - Diagnostische und Interventionelle Radiologie, Klinik Landstraße, Wien, Österreich
| | - Theresa-Marie Dachs
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - Maximilian Kern
- Institut für Radiologie, Klinik Floridsdorf, Wien, Österreich
| | - Martin Funovics
- Abteilung für Kardiovaskuläre und Interventionelle Radiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich.
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14
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Hauck SR, Eilenberg W, Kupferthaler A, Kern M, Dachs TM, Wressnegger A, Neumayer C, Loewe C, Funovics MA. Use of a Steerable Sheath for Completely Femoral Access in Branched Endovascular Aortic Repair Compared to Upper Extremity Access. Cardiovasc Intervent Radiol 2022; 45:744-751. [PMID: 35391546 PMCID: PMC9117381 DOI: 10.1007/s00270-022-03064-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 07/20/2021] [Accepted: 01/22/2022] [Indexed: 12/01/2022]
Abstract
PURPOSE To compare bridging stent graft (BSG) implantation in downward oriented branches in branched endovascular aortic repair (bEVAR), using a commercially available steerable sheath from an exclusively femoral access (TFA) with traditional upper extremity access (UEA). METHODS In a retrospective cohort study, 7 patients with 19 branches in the TFA cohort received BSG insertion using the Medtronic Heli FX steerable sheath from a femoral access, and 10 patients with 32 branches in the UEA cohort from a brachial approach. Technical success, total intervention time, fluoroscopy time, branch cannulation time, and complication rate were recorded. RESULTS Technical success was 19/19 branches in the TFA and 31/32 in the UEA cohort. The mean branch cannulation time was considerably shorter in the TFA group (17 vs. 29 min, p = 0.003), and total intervention time tended to be shorter (169 vs. 217 min, p = 0.176). CONCLUSION Using a commercially available steerable sheath allowed successful cannulation of all branches in this cohort and was associated with significantly shorter branch cannulation times. Potentially, this technique can lower the stroke and brachial puncture site complication risk as well as reduce total intervention time and radiation dose. LEVEL OF EVIDENCE 2b, retrospective cohort study.
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Affiliation(s)
- Sven R Hauck
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Wolf Eilenberg
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Alexander Kupferthaler
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
- Department of Diagnostic and Interventional Radiology, Ordensklinikum Linz, Linz, Austria
- Johannes Kepler University Linz, Medical Faculty, Linz, Austria
| | - Maximilian Kern
- Department of Radiology, Klinik Floridsdorf, Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Alexander Wressnegger
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Christoph Neumayer
- Division of Vascular Surgery, Department of General Surgery, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Martin A Funovics
- Cardiovascular and Interventional Radiology, Department of Bioimaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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15
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Rettl R, Mann C, Duca F, Dachs TM, Binder C, Ligios LC, Schrutka L, Dalos D, Koschutnik M, Donà C, Kammerlander A, Beitzke D, Loewe C, Charwat-Resl S, Hengstenberg C, Kastner J, Eslam RB, Bonderman D. Tafamidis treatment delays structural and functional changes of the left ventricle in patients with transthyretin amyloid cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 23:767-780. [PMID: 34788394 DOI: 10.1093/ehjci/jeab226] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Tafamidis improves outcomes in patients with transthyretin amyloid cardiomyopathy (ATTR-CM). However, it is not yet known whether tafamidis affects cardiac amyloid deposition and structural changes in the myocardium. We aimed to determine disease-modifying effects on myocardial amyloid progression and to identify imaging parameters that could be applied for specific therapy monitoring. METHODS AND RESULTS ATTR-CM patients underwent serial cardiac magnetic resonance (CMR) imaging using T1 mapping techniques to derive extracellular volume (ECV). Patients receiving tafamidis 61 mg (n = 35) or 20 mg (n = 15) once daily showed stable measurements at follow-up (FU) {61 mg: 9.0 [interquartile range (IQR) 7.0-11.0] months, 20 mg: 11.0 (IQR 8.0-18.0) months} in left ventricular (LV) ejection fraction (LVEF; 61 mg: 47.6% vs. 47.5%, P = 0.935; 20 mg: 52.4% vs. 52.1%, P = 0.930), LV mass index (LVMI; 61 mg: 110.2 vs. 106.2 g/m2, P = 0.304; 20 mg: 114.5 vs. 115.4 g/m2, P = 0.900), and ECV (61 mg: 47.5% vs. 47.7%, P = 0.861; 20 mg: 56.7% vs. 57.5%, P = 0.759), whereas treatment-naïve ATTR-CM patients (n = 19) had clear signs of disease progression at the end of the observation period [12.0 (IQR 10.0-21.0) months; LVEF: 53.3% vs. 45.7%, P = 0.031; LVMI: 98.9 vs. 106.9 g/m2, P = 0.027; ECV: 49.3% vs. 54.6%, P = 0.023]. Between-group comparison at FU revealed positive effects in tafamidis 61 mg-treated compared to treatment-naïve patients (LVEF: P = 0.035, LVMI: P = 0.036, ECV: P = 0.030), while those treated with 20 mg showed no difference in the above LV measurements when compared with treatment-naïve (P = 0.120, P = 0.287, P = 0.158). However, both treatment groups showed clinically beneficial effects compared to the natural course [61 mg, 6-min walk distance (6-MWD): P = 0.005, N-terminal prohormone of brain natriuretic peptide (NT-proBNP): P = 0.002; 20 mg, 6-MWD: P = 0.023, NT-proBNP: P = 0.003]. CONCLUSION Tafamidis delays myocardial amyloid progression in ATTR-CM patients, resulting in structural, functional, and clinical benefits compared to the natural course. Serial CMR including measurement of ECV may be appropriate for disease-specific therapy monitoring.
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Affiliation(s)
- René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christopher Mann
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Lore Schrutka
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Daniel Dalos
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Matthias Koschutnik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Carolina Donà
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Andreas Kammerlander
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Silvia Charwat-Resl
- Department of Cardiology, Clinic Favoriten, Kundratstraße 3, 1100 Vienna, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Diana Bonderman
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.,Department of Cardiology, Clinic Favoriten, Kundratstraße 3, 1100 Vienna, Austria
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16
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Schrutka L, Anner P, Agibetov A, Seirer B, Dusik F, Rettl R, Duca F, Dalos D, Dachs TM, Binder C, Badr-Eslam R, Kastner J, Beitzke D, Loewe C, Hengstenberg C, Laufer G, Stix G, Dorffner G, Bonderman D. Machine learning-derived electrocardiographic algorithm for the detection of cardiac amyloidosis. Heart 2021; 108:1137-1147. [PMID: 34716183 PMCID: PMC9240336 DOI: 10.1136/heartjnl-2021-319846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/07/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Diagnosis of cardiac amyloidosis (CA) requires advanced imaging techniques. Typical surface ECG patterns have been described, but their diagnostic abilities are limited. OBJECTIVE The aim was to perform a thorough electrophysiological characterisation of patients with CA and derive an easy-to-use tool for diagnosis. METHODS We applied electrocardiographic imaging (ECGI) to acquire electroanatomical maps in patients with CA and controls. A machine learning approach was then used to decipher the complex data sets obtained and generate a surface ECG-based diagnostic tool. FINDINGS Areas of low voltage were localised in the basal inferior regions of both ventricles and the remaining right ventricular segments in CA. The earliest epicardial breakthrough of myocardial activation was visualised on the right ventricle. Potential maps revealed an accelerated and diffuse propagation pattern. We correlated the results from ECGI with 12-lead ECG recordings. Ventricular activation correlated best with R-peak timing in leads V1-V3. Epicardial voltage showed a strong positive correlation with R-peak amplitude in the inferior leads II, III and aVF. Respective surface ECG leads showed two characteristic patterns. Ten blinded cardiologists were asked to identify patients with CA by analysing 12-lead ECGs before and after training on the defined ECG patterns. Training led to significant improvements in the detection rate of CA, with an area under the curve of 0.69 before and 0.97 after training. INTERPRETATION Using a machine learning approach, an ECG-based tool was developed from detailed electroanatomical mapping of patients with CA. The ECG algorithm is simple and has proven helpful to suspect CA without the aid of advanced imaging modalities.
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Affiliation(s)
- Lore Schrutka
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Philip Anner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.,Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Artificial Intelligence and Decision Support, Medical University of Vienna, Vienna, Austria
| | - Asan Agibetov
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Artificial Intelligence and Decision Support, Medical University of Vienna, Vienna, Austria
| | - Benjamin Seirer
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Fabian Dusik
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - René Rettl
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Franz Duca
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Daniel Dalos
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Theresa-Marie Dachs
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Roza Badr-Eslam
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Johannes Kastner
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Dietrich Beitzke
- Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Loewe
- Department of Biomedical Imaging and Image-guided Therapy, Division of Cardiovascular and Interventional Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Hengstenberg
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Günther Laufer
- Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria
| | - Guenter Stix
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Georg Dorffner
- Center for Medical Statistics, Informatics and Intelligent Systems, Institute of Artificial Intelligence and Decision Support, Medical University of Vienna, Vienna, Austria
| | - Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria .,Department of Internal Medicine V, Division of Cardiology, Clinic Favoriten, Vienna, Austria
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17
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Schrutka L, Anner P, Seirer B, Rettl R, Duca F, Dalos D, Dachs TM, Binder C, Badr-Eslam R, Kastner J, Loewe C, Hengstenberg C, Stix G, Dorffner G, Bonderman D. A machine learning-derived electrocardiographic algorithm for the detection of cardiac amyloidosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The diagnosis of cardiac amyloidosis (CA) requires advanced imaging techniques. Typical surface ECG patterns have been described, but their diagnostic value is limited.
Purpose
The aim of this study was to perform a comprehensive electrophysiological characterization in CA patients and to develop a robust, easy-to-use diagnostic tool.
Methods
First, we applied electrocardiographic imaging (ECGI) to generate detailed electroanatomical maps in CA patients and controls. Then, a machine learning approach was used to generate a surface ECG-based diagnostic algorithm from the complex dataset.
Results
Areas of low voltage were localized in the basal inferior regions of both ventricles and the remaining right ventricular segments in CA. The earliest epicardial breakthrough of myocardial activation was visualized in the right ventricle. Potential maps showed an accelerated and diffuse propagation pattern. We correlated the results from ECGI with 12-lead ECG recordings. Ventricular activation correlated best with R-peak timing in leads V1 to V3. Epicardial voltage showed a strong positive correlation with R-peak amplitude in inferior leads II, III, aVF. Ten blinded cardiologists were then asked to identify CA patients by analyzing 12-lead ECGs before and after training for the defined ECG patterns. Training resulted in significant improvements in the detection rate of CA with an AUC of 0.69 before and 0.97 after training (Figure).
Conclusion
Using a machine learning approach, a robust ECG-based tool was developed to detect CA from detailed electroanatomical mapping of CA patients. The developed tool proved to be a simple and reliable diagnostic tool to suspect CA without the aid of advanced imaging modalities.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Schrutka
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - P Anner
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| | - B Seirer
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Rettl
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - F Duca
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - D Dalos
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - T M Dachs
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - C Binder
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - R Badr-Eslam
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - J Kastner
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - C Loewe
- Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna, Austria
| | - C Hengstenberg
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - G Stix
- Medical University of Vienna, Cardiology, Vienna, Austria
| | - G Dorffner
- Medical University of Vienna, Institute of Artificial Intelligence and Decision Support, Vienna, Austria
| | - D Bonderman
- Medical University of Vienna, Cardiology, Vienna, Austria
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18
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Rettl R, Dachs TM, Duca F, Binder C, Dusik F, Seirer B, Schönauer J, Kronberger C, Camuz Ligios L, Hengstenberg C, Derkits N, Kastner J, Badr Eslam R, Bonderman D. What Type of Patients Did PARAGON-HF Select? Insights from a Real-World Prospective Cohort of Patients with Heart Failure and Preserved Ejection Fraction. J Clin Med 2020; 9:jcm9113669. [PMID: 33203151 PMCID: PMC7697501 DOI: 10.3390/jcm9113669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
The PARAGON-HF clinical trial suggested that sacubitril/valsartan may become a treatment option for particular subgroups of patients with heart failure and preserved ejection fraction (HFpEF). However, the proportion of real-world HFpEF patients who are theoretically superimposable with the PARAGON-HF population is yet unknown. The present study was performed to define the proportion of real-world PARAGON-HF-like patients and to describe their clinical characteristics and long-term prognosis in comparison with those who would not meet PARAGON-HF criteria. We systematically applied PARAGON-HF inclusion and exclusion criteria to a total of 427 HFpEF patients who have been participating in a prospective national registry between December 2010 and December 2019. In total, only 170 (39.8%) registry patients were theoretically eligible for PARAGON-HF. Patients not meeting inclusion criteria (41.0%) were less impaired with respect to exercise capacity (median 6-min walk distance: 385 m (IQR: 300-450) versus 323 m (IQR: 240-383); p < 0.001) had lower pulmonary pressures (mean pulmonary artery pressure (mPAP): 31.2 mmHg, standard deviation (SD): ±10.2 versus 32.8 mmHg, SD: ±9.7; p < 0.001) and better outcomes (log-rank: p < 0.001) as compared to the PARAGON-like cohort. However, patients theoretically excluded from the trial (19.2%) were those with most advanced heart failure symptoms (median 6-min walk test: 252 m (IQR: 165-387); p < 0.001), highest pulmonary pressures (mPAP: 38.2 mmHg, SD: ±12.4; p < 0.001) and worst outcome (log-rank: p = 0.037). We demonstrate here that < 40% of real-world HFpEF patients meet eligibility criteria for PARAGON-HF. We conclude that despite reasons for optimism after PARAGON-HF, a large proportion of HFpEF patients will remain without meaningful treatment options.
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Affiliation(s)
- René Rettl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Theresa-Marie Dachs
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Franz Duca
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Christina Binder
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Fabian Dusik
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Benjamin Seirer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Johannes Schönauer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Christina Kronberger
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Luciana Camuz Ligios
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Nina Derkits
- Novartis Pharma GmbH, Stella-Klein-Loew-Weg 17, 1020 Vienna, Austria;
| | - Johannes Kastner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
| | - Roza Badr Eslam
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; (R.R.); (T.-M.D.); (F.D.); (C.B.); (F.D.); (B.S.); (J.S.); (C.K.); (L.C.L.); (C.H.); (J.K.)
- Correspondence: (R.B.E.); (D.B.); Tel.: +43-1-40-400-46140 (R.B.E.); +43-1-601-91-2508 (D.B.)
| | - Diana Bonderman
- Division of Cardiology, Klinik Favoriten, Kundratstraße 3, 1100 Vienna, Austria
- Correspondence: (R.B.E.); (D.B.); Tel.: +43-1-40-400-46140 (R.B.E.); +43-1-601-91-2508 (D.B.)
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19
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Duca F, Snidat A, Binder C, Rettl R, Dachs TM, Seirer B, Camuz-Ligios L, Dusik F, Capelle CDJ, Hong Q, Agis H, Kain R, Mascherbauer J, Hengstenberg C, Badr Eslam R, Bonderman D. Hemodynamic Profiles and Their Prognostic Relevance in Cardiac Amyloidosis. J Clin Med 2020; 9:jcm9041093. [PMID: 32290508 PMCID: PMC7230541 DOI: 10.3390/jcm9041093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 03/11/2020] [Revised: 04/03/2020] [Accepted: 04/07/2020] [Indexed: 12/27/2022] Open
Abstract
This study sought to characterize cardiac amyloidosis (CA) patients with respect to hemodynamic parameters and asses their prognostic impact in different CA cohorts. Intracardiac and pulmonary arterial pressures (PAPs) are among the strongest predictors of outcomes in patients with heart failure (HF). Despite that, the hemodynamic profiles of patients with CA and their relation to prognosis have rarely been investigated. Invasive hemodynamic, clinical, and laboratory assessment, as well as cardiac magnetic resonance imaging were performed in our CA cohort. A total of 61 patients, 35 (57.4%) with wild-type transthyretin amyloidosis (ATTRwt) and 26 (42.6%) with light-chain amyloidosis (AL) were enrolled. ATTRwt patients had lower N-terminal prohormone of brain natriuretic peptide values and were less frequently in New York Heart Association class ≥ III. Intracardiac and PAPs were elevated, but hemodynamic parameters did not differ between CA groups. Whereas in ATTRwt, the median mean PAP (hazard ratio (HR): 1.130, p = 0.040) and pulmonary vascular resistance (HR: 1.010, p = 0.046) were independent predictors of outcome, no hemodynamic parameter was associated with outcome in the AL group. Cardiac ATTRwt and AL patients feature elevated intracardiac and PAPs and show similar hemodynamic profiles. However, hemodynamic parameters are of greater prognostic relevance in ATTRwt, potentially providing a new therapeutic target.
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Affiliation(s)
- Franz Duca
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Amir Snidat
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Christina Binder
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - René Rettl
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Theresa-Marie Dachs
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Benjamin Seirer
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Luciana Camuz-Ligios
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Fabian Dusik
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Christophe Denis Josef Capelle
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Qin Hong
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Hermine Agis
- Department of Internal Medicine I, Department of Oncology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Renate Kain
- Clinical Institute of Pathology, Medical University of Vienna, 1090 Vienna, Austria;
| | - Julia Mascherbauer
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Christian Hengstenberg
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
| | - Roza Badr Eslam
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
- Correspondence: (R.B.E.); (D.B.); Tel.: +43-140-4004-6140 (D.B.); Fax: +43-140-4004-2160 (D.B.)
| | - Diana Bonderman
- Department of Internal Medicine II, Department of Cardiology, Medical University of Vienna, 1090 Vienna, Austria; (F.D.); (A.S.); (C.B.); (R.R.); (T.-M.D.); (B.S.); (L.C.-L.); (F.D.); (C.D.J.C.); (Q.H.); (J.M.); (C.H.)
- Correspondence: (R.B.E.); (D.B.); Tel.: +43-140-4004-6140 (D.B.); Fax: +43-140-4004-2160 (D.B.)
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