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Eichenlaub M, Mueller-Edenborn B, Minners J, Hein M, Ruile P, Lehrmann H, Schoechlin S, Allgeier J, Bohnen M, Trenk D, Neumann FJ, Arentz T, Jadidi A. Comparison of various late gadolinium enhancement magnetic resonance imaging methods to high-definition voltage and activation mapping for detection of atrial cardiomyopathy. Europace 2022. [DOI: 10.1093/europace/euac053.175] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Medtronic
Background/Introduction
Atrial cardiomyopathy (ACM) is associated with the progression from paroxysmal through persistent to permanent atrial fibrillation (AF) and increased arrhythmia recurrence rates after pulmonary vein isolation (PVI).
Purpose
We compare the most common left atrial (LA) late gadolinium enhancement magnetic resonance imaging (LGE-MRI)-methods (Utah-method and image-intensity-ratio (IIR)-methods) and endocardial voltage mapping for ACM-detection and outcome prediction after PVI for AF.
Methods
In this prospective study, 37 ablation-naive patients (66±9 years, 84% male) with persistent AF were included and electrically cardioverted into sinus rhythm. Subsequently, they underwent LA-LGE-MRI and high-definition voltage and activation mapping (2129±484 sites) in sinus rhythm prior to PVI. MRI-post-processing-analyses were performed by two independent expert laboratories (Marrek for the Utah segmentation as describers of this methodology and Adas 3D medical as developers of the Adas software for the IIR-methods) which were blinded to any clinical data. Arrhythmia recurrence was recorded within 12 months following PVI.
Results
The global ACM-extent was highly variable: median LA low-voltage substrate (LA-LVS) was 12.9% at <1.0mV and 2.7% at <0.5mV; median LA-LGE-extent using the Utah-method was 18.3% and 0.03%-93.1% using the IIR-methods. LA activation time was significantly correlated with LA-LVS (r=0.76 at <0.5mV and r=0.82 at <1.0mV, both p<0.0001), but not with LA-LGE-extent.
The highest regional matching between LA-LVS <0.5mV and LA-LGE was found for the anterior wall in 57% of patients using the Utah-method and in 59% using IIR 1.20. The corresponding values for the posterior wall were 19% and 38%, respectively.
Arrhythmia recurrence occurred in 15 (41%) patients. Freedom from arrhythmia was significantly lower in those with relevant LA-LVS (≥2cm2 at 0.5mV) but not in those with relevant LGE (Utah-stages III&IV): 43% versus 81%, p=0.009 and 50% versus 67%, p=0.338, respectively. Furthermore, relevant
LA-LVS was the only predictor for arrhythmia recurrence in multivariate regression analysis.
Conclusion
The different LA-LGE-MRI methods have large dicrepancies regarding extent and distribution of ACM and are different to the extent and regional distribution of LA-LVS as assessed in endocardial high-definition voltage mapping in sinus rhythm. Further improvements of the LA-LGE-MRI-methods are required to enable correct diagnosis of ACM and for future evaluation of MRI-guided ablation protocols.
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Affiliation(s)
- M Eichenlaub
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - J Minners
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - M Hein
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - P Ruile
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - H Lehrmann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - S Schoechlin
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - J Allgeier
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - M Bohnen
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - F-J Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Huang T, Patrick S, Mayer LK, Müller-Edenborn B, Eichenlaub M, Allgeier M, Allgeier J, Lehrmann H, Ahlgrim C, Bohnen M, Schoechlin S, Trenk D, Jander N, Neumann FJ, Arentz T, Jadidi A. Echocardiographic and Electrocardiographic Determinants of Atrial Cardiomyopathy Identify Patients with Atrial Fibrillation at Risk for Left Atrial Thrombogenesis. J Clin Med 2022; 11:jcm11051332. [PMID: 35268425 PMCID: PMC8911088 DOI: 10.3390/jcm11051332] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 02/23/2022] [Indexed: 02/05/2023] Open
Abstract
Objective: Atrial cardiomyopathy (ACM) is associated with development of AF, left atrial (LA) thrombogenesis, and stroke. Diagnosis of ACM is feasible using both echocardiographic LA strain imaging and measurement of the amplified p-wave duration (APWD) in digital 12-lead-ECG. We sought to determine the thresholds of LA global longitudinal strain (LA-GLS) and APWD that identify patients with AF at risk for LA appendage (LAA) thrombogenesis. Methods: One hundred and twenty-eight patients with a history of AF were included. Left atrial appendage maximal flow velocity (LAA-Vel, in TEE), LA-GLS (TTE), and APWD (digital 12-lead-ECG) were measured in all patients. ROC analysis was performed for each method to determine the thresholds for LA-GLS and the APWD, enabling diagnosis of patients with LAA-thrombus. Results: Significant differences in LA-GLS were found during both rhythms (SR and AF) between the thrombus group and control group: LA-GLS in SR: 14.3 ± 7.4% vs. 24.6 ± 9.0%, p < 0.001 and in AF: 11.4 ± 4.2% vs. 16.1 ± 5.0%, p = 0.045. ROC analysis revealed a threshold of 17.45% for the entire cohort (AUC 0.82, sensitivity: 84.6%, specificity: 63.6%, Negative Predictive Value (NPV): 94.3%) with additional rhythm-specific thresholds: 19.1% in SR and 13.9% in AF, and a threshold of 165 ms for APWD (AUC 0.90, sensitivity: 88.5%, specificity: 75.5%, NPV: 96.2%) as optimal discriminators of LAA-thrombus. Moreover, both LA-GLS and APWD correlated well with the established contractile LA-parameter LAA-Vel in TEE (r = 0.39, p < 0.001 and r = −0.39, p < 0.001, respectively). Conclusion: LA-GLS and APWD are valuable diagnostic predictors of left atrial thrombogenesis in patients with AF.
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Affiliation(s)
- Taiyuan Huang
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
- Correspondence: (T.H.); (S.P.); (A.J.)
| | - Schurr Patrick
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
- Correspondence: (T.H.); (S.P.); (A.J.)
| | - Louisa Katharina Mayer
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Björn Müller-Edenborn
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Martin Eichenlaub
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Martin Allgeier
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Imaging, 79189 Bad Krozingen, Germany; (M.A.); (N.J.)
| | - Jürgen Allgeier
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Heiko Lehrmann
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Christoph Ahlgrim
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Marius Bohnen
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Simon Schoechlin
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Dietmar Trenk
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinical Pharmacology, 79189 Bad Krozingen, Germany;
| | - Nikolaus Jander
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Imaging, 79189 Bad Krozingen, Germany; (M.A.); (N.J.)
| | - Franz Josef Neumann
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Thomas Arentz
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
| | - Amir Jadidi
- University of Freiburg, Heart Center, Campus Bad Krozingen, Clinics for Cardiology and Angiology II, Division of Cardiac Arrhythmias, 79189 Bad Krozingen, Germany; (L.K.M.); (B.M.-E.); (M.E.); (J.A.); (H.L.); (C.A.); (M.B.); (S.S.); (F.J.N.); (T.A.)
- Correspondence: (T.H.); (S.P.); (A.J.)
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Müller-Edenborn B, Minners J, Keyl C, Eichenlaub M, Jander N, Abdelrazek S, Ahlgrim C, Allgeier J, Lehrmann H, Neumann FJ, Arentz T, Jadidi A. Electrocardiographic diagnosis of atrial cardiomyopathy to predict atrial contractile dysfunction, thrombogenesis and adverse cardiovascular outcomes. Sci Rep 2022; 12:576. [PMID: 35022443 PMCID: PMC8755780 DOI: 10.1038/s41598-021-04535-7] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/23/2021] [Indexed: 11/22/2022] Open
Abstract
Thromboembolism and stroke are dreaded complications in atrial fibrillation (AF). Established risk stratification models identify susceptible patients, but their discriminative properties are poor. Atrial cardiomyopathy (ACM) is associated to thromboembolism and stroke in smaller studies, but the modalities used for ACM-diagnosis (MRI and endocardial mapping) are unsuitable for widespread population screening. We aimed to investigate an ECG-based diagnosis of ACM using amplified p-wave analysis (APWA) for stratification of thromboembolic risk and cardiovascular outcome. In this case–control study, ACM-staging was performed using APWA on digital 12-lead sinus rhythm-ECGs in patients with LAA-thrombus and a propensity-score-matched control-cohort. Left atrial contractile function and thrombi were evaluated by transesophageal echocardiography (TEE). Outcome for MACCE including death was assessed using official registries and structured phone interviews. Left-atrial appendage [LAA]-thrombi and appropriate sinus rhythm-ECGs for ACM-staging were found in 109 of 4086 patients that were matched 1:1 to control patients without thrombus (218 patients in total). Both cohorts were comparable regarding cardiovascular risk factors, anticoagulants and CHA2DS2-VASC-score. ACM-stages 1 to 3 (equivalent to no, moderate and extensive ACM) were found in 63 (57.8%), 36 (33.0%) and 10 (9.2%) of patients without and 3 (2.8%), 23 (21.1%) and 83 (76.1%) of patients with LAA-thrombi. Atrial contractile function decreased from ACM-stages 1 to 3 (LAA-flow velocities 38 ± 16 cm/s, 31 ± 15 cm/s and 21 ± 12 cm/s; p < 0.0001), while the likelihood for LAA-thrombus increased (2.8%, 21.1% and 76.1%, p < 0.001). Multivariable analysis confirmed an independent odds ratio for LAA-thrombus of 24.6 (p < 0.001) per ACM-stage. Two-year survival free of stroke/TIA, hospitalization for heart failure, myocardial infarction or all-cause death was strongly reduced in ACM-stage 3 (53.8%) compared to no or moderate ACM (82.8% and 84.7%, respectively; p < 0.0001). Electrocardiographic diagnosis of ACM identifies patients with atrial contractile dysfunction and atrial thrombi at risk for adverse cardiovascular outcomes and death.
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Affiliation(s)
- Björn Müller-Edenborn
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany.
| | - Jan Minners
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Cornelius Keyl
- Department of Cardiology and Angiology II, Heart Center, Section of Anesthesiology, University of Freiburg, Bad Krozingen, Germany
| | - Martin Eichenlaub
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Nikolaus Jander
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Sherif Abdelrazek
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Christoph Ahlgrim
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Jürgen Allgeier
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, Heart Center, University of Freiburg, Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Cardiology and Angiology II, Heart Center, Section of Electrophysiology, University of Freiburg, Südring 15, 79189, Bad Krozingen, Germany
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Müller-Edenborn B, Chen J, Allgeier J, Didenko M, Moreno-Weidmann Z, Neumann FJ, Lehrmann H, Weber R, Arentz T, Jadidi A. Amplified sinus-P-wave reveals localization and extent of left atrial low-voltage substrate: implications for arrhythmia freedom following pulmonary vein isolation. Europace 2021; 22:240-249. [PMID: 31782781 DOI: 10.1093/europace/euz297] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 10/18/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Presence of arrhythmogenic left atrial (LA) low-voltage substrate (LVS) is associated with reduced arthythmia freedom rates following pulmonary vein isolation (PVI) in persistent atrial fibrillation (AF). We hypothesized that LA-LVS modifies amplified sinus-P-wave (APW) characteristics, enabling identification of patients at risk for arrhythmia recurrences following PVI. METHODS AND RESULTS Ninety-five patients with persistent AF underwent high-density (>1200 sites) voltage mapping in sinus rhythm. Left atrial low-voltage substrate (<0.5 and <1.0 mV) was quantified in a 10-segment LA model. Amplified sinus-P-wave-morphology and -duration were evaluated using digitized 12-lead electrocardiograms (40-80 mm/mV, 100-200 mm/s). 12-months arrhythmia freedom following circumferential PVI was assessed in 139 patients with persistent AF. Left atrial low-voltage substrate was most frequently (84%) found at the anteroseptal LA. Characteristic changes of APW were related to the localization and extent of LA-LVS. At an early stage, LA-LVS predominantly located to the LA-anteroseptum and was associated with APW-prolongation (≥150 ms). More extensive LA-LVS involved larger areas of LA-anteroseptum, leading to morphological changes of APW (biphasic positive-negative P-waves in inferior leads). Severe LA-LVS involved the LA-anteroseptum, roof and posterior LA, but spared the inferior LA, lateral LA, and LA appendage. In this advanced stage, widespread LVS at the posterior LA abolished the negative portion of P-wave in the inferior leads. The delayed activation of the lateral LA and LA appendage produced the late positive deflections in the anterolateral leads, resulting in the "late-terminal P"-pattern. Structured analysis of APW-duration and -morphology stratified patients to their individual extent of LA-LVS (Grade 1: mean LA-LVS 4.9 cm2 at <1.0 mV; Grade 2: 28.6 cm2; Grade 3: 42.3 cm2; P < 0.01). The diagnostic value of APW-duration for identification of LA-LVS was significantly superior to standard P-wave-amplification (c-statistic 0.945 vs. 0.647). Arrhythmia freedom following PVI differed significantly between APW-predicted grades of LA-LVS-severity [hazard ratio (HR) 2.38, 95% confidence interval (CI) 1.18-4.83; P = 0.015 for Grade 1 vs. Grade 2; HR 1.79, 95% CI 1.00-3.21, P = 0.049 for Grade 2 vs. Grade 3). Arrhythmia freedom 12 months after PVI was 77%, 53%, and 33% in Grades 1, 2 and 3, respectively. CONCLUSION Localization and extent of LA-LVS modifies APW-morphology and -duration. Analysis of APW allows accurate prediction of LA-LVS and enables rapid and non-invasive estimation of arrhythmia freedom following PVI.
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Affiliation(s)
- Björn Müller-Edenborn
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Juan Chen
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Jürgen Allgeier
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Maxim Didenko
- Cardiovascular Surgery Department, Military Medical Academy Named After S.M. Kirov, Saint-Petersburg, Russia.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, The Netherlands
| | - Zoraida Moreno-Weidmann
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Reinhold Weber
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Electrophysiology, University Heart Center Freiburg - Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189 Bad Krozingen, Germany
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Eichenlaub M, Lehrmann H, Mueller-Edenborn B, Allgeier J, Weber R, Trenk D, Neumann FJ, Arentz T, Jadidi A. 55Non-invasive ECG-imaging for identification of atrial arrhythmogenic low voltage substrate in patients with persistent atrial fibrillation. Europace 2020. [DOI: 10.1093/europace/euaa162.285] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Left atrial (LA) fibrosis is associated with increased arrhythmia recurrence rates after pulmonary vein isolation (PVI) and increased stroke risk in patients with atrial fibrillation (AF). So far, detection and quantification of LA fibrosis is only feasible by invasive electrophysiological mapping of low-voltage-substrate (LVS) or delayed enhancement areas in MRI.
Purpose
The aim of this study was to assess the distribution and extent of atrial fibrosis by non-invasive ECG-Imaging (ECGI) in patients with persistent AF prior to PVI.
Methods
Thirty-seven consecutive patients (66 ± 9 years, 84% male) presenting for their first PVI were included. Patients with AF were cardioverted into sinus rhythm (SR). One day prior to AF ablation procedure, patients underwent ECGI in SR using the 252-electrode-array (CardioInsight) and a low-X-ray-dose, non-injected cardiac CT-scan to assess the relationship between ECGI-electrodes and cardiac epicardial structures. Prior to PVI, high-density biatrial voltage and activation maps were acquired in SR (CARTO-3). Localization and extent of atrial LVS (relevant fibrosis: LA-LVS: ≥5cm2 at <0.5mV threshold) and biatrial activation times depicted by CARTO were compared with atrial activation/conduction times assessed by non-invasive ECGI. Presence of LA-LVS was classified according to its extent into 3 stages and compared to the inter- and intraatrial conduction delay in ECGI.
Results
Relevant atrial fibrosis was found in 17/37(46%) patients. Presence of biatrial LVS resulted in a linear increase of the biatrial activation time in CARTO-SR-maps (146 ± 18ms in patients without LVS vs 184 ± 27ms in patients with LVS, p < 0.001) and in non-invasive ECGI (133 ± 11ms vs 170 ± 20ms, p < 0.001).
Both the extent of biatrial LVS and invasively measured total activation time correlated well with non-invasive total atrial conduction time (TACT) in ECGI (r = 0.91 and r = 0.82, respectively, figure). Moreover, the extent of LA-LVS showed an excellent correlation to TACT in ECGI (r = 0.89).
A combination of inter-atrial (RA-LA) conduction delay and TACT in ECGI allowed to quantify the extent of LA-LVS and to distinguish between three stages of LA-LVS: Stage 1 (minimal LA-LVS: 1 ± 2cm2): ECGI revealed rapid RA&LA activation with short TACT 132 ± 9ms; Stage 2 (moderate LA-LVS: 14 ± 8cm2 involving the anteroseptal LA) was associated with delayed LA activation and prolonged TACT measuring 161 ± 7ms; Stage 3 (extensive LA-LVS involving the anteroseptal and posterior LA: 26 ± 17cm2) was characterized by a significantly delayed LA activation with a TACT of 178 ± 24ms in ECGI.
Conclusion
Analysis of interatrial conduction delay and total atrial conduction time (TACT) in non-invasive ECGI allows accurate staging of patients with arrhythmogenic atrial LVS who present an increased risk for arrhythmia recurrences and stroke.
Abstract Figure.
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Affiliation(s)
- M Eichenlaub
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - H Lehrmann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | | | - J Allgeier
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - R Weber
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - F-J Neumann
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
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Müller-Edenborn B, Minners J, Kocher S, Chen J, Zeh W, Lehrmann H, Allgeier J, Neumann FJ, Arentz T, Jadidi A. Amplified P-wave duration predicts new-onset atrial fibrillation in patients with heart failure with preserved ejection fraction. Clin Res Cardiol 2019; 109:978-987. [PMID: 31863175 DOI: 10.1007/s00392-019-01590-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 05/08/2019] [Accepted: 12/11/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) increases morbidity and mortality in heart failure with preserved ejection fraction (HFpEF), yet identification of HFpEF-patients at risk for new-onset AF is challenging. Amplified P-wave duration (APWD) non-invasively detects arrhythmogenic atrial substrate with high accuracy. We hypothesized that APWD may help in the prediction of new-onset AF in HFpEF. METHODS Patients with suspected HFpEF (n = 99, left ventricular ejection fraction > 50%, no evidence of valvulopathy, coronary artery disease, or non-cardiac dyspnea) underwent exercise testing with concomitant right-heart catheterization. Normal resting pulmonary capillary wedge pressure (PCWP; < 12 mmHg) with an increase during exercise > 25.5 mmHg/W/kg defined early HFpEF. Advanced HFpEF was diagnosed with PCWP > 12 mmHg at rest. Arrhythmogenic atrial substrate (defined as APWD > 150 ms) was investigated on digitized standard 12-lead ECGs and patients were followed for new-onset AF at 6-month intervals. RESULTS Forty-seven patients had normal exercise haemodynamics and served as controls. Early and advanced HFpEF was diagnosed in 29 and 23 patients, respectively. Eighty-seven per cent of patients with advanced HFpEF had evidence of arrhythmogenic atrial substrate, (APWD 175 ± 29 ms vs. 132 ± 14 ms in controls, p < 0.0001), which was associated with a tenfold increased risk for new-onset AF during 4.6 years of follow-up (hazard ratio [HR] 9.684, 95% CI 2.61-35.89, p < 0.0001). Early HFpEF was neither related to APWD (p = 0.395), nor to a higher risk for AF (HR 3.44, 95% CI 0.57-20.72, p = 0.178). Importantly, the presence of arrhythmogenic substrate was independent of left atrial indexed volume. CONCLUSION The analysis of amplified P-wave duration (APWD) allows for the prediction of new-onset AF in patients with advanced HFpEF.
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Affiliation(s)
- Björn Müller-Edenborn
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany. .,Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany.
| | - Jan Minners
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany
| | - Sascha Kocher
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany
| | - Juan Chen
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
| | - Wolfgang Zeh
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany
| | - Heiko Lehrmann
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany.,Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
| | - Jürgen Allgeier
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany.,Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany.,Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Cardiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Südring 15, 79189, Bad Krozingen, Germany.,Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen Campus, Bad Krozingen, Germany
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Müller-Edenborn B, Minners J, Allgeier J, Burkhardt T, Lehrmann H, Ruile P, Merz S, Allgeier M, Neumann FJ, Arentz T, Jadidi A, Jander N. Rapid improvement in left ventricular function after sinus rhythm restoration in patients with idiopathic cardiomyopathy and atrial fibrillation. Europace 2019; 21:871-878. [DOI: 10.1093/europace/euz013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/31/2019] [Indexed: 12/19/2022] Open
Affiliation(s)
- Björn Müller-Edenborn
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Jan Minners
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Jürgen Allgeier
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Thilo Burkhardt
- Department of Cardiology, University Hospital, Basel, Switzerland
| | - Heiko Lehrmann
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Philipp Ruile
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Sebastian Merz
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Martin Allgeier
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Thomas Arentz
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Amir Jadidi
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
- Department of Electropyhsiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
| | - Nikolaus Jander
- Department of Cardiology, University Heart Center Freiburg—Bad Krozingen, Südring 15, Bad Krozingen, Germany
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Jadidi A, Müller-Edenborn B, Chen J, Keyl C, Weber R, Allgeier J, Moreno-Weidmann Z, Trenk D, Neumann FJ, Lehrmann H, Arentz T. The Duration of the Amplified Sinus-P-Wave Identifies Presence of Left Atrial Low Voltage Substrate and Predicts Outcome After Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2018; 4:531-543. [DOI: 10.1016/j.jacep.2017.12.001] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
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Chen J, Jadidi A, Moreno-Weidmann Z, Mueller-Edenborn B, Lehrmann H, Markstein V, Allgeier J, Weber R, Trenk D, Arentz T. 525Correlation of left atrial low voltage and fractionation substrate between sinus rhythm and atrial fibrillation: high density mapping study in persistent AF. Europace 2018. [DOI: 10.1093/europace/euy015.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Chen
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - Z Moreno-Weidmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - B Mueller-Edenborn
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - H Lehrmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - V Markstein
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - J Allgeier
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - R Weber
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
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Chen J, Arentz T, Moreno-Weidmann Z, Mueller-Edenborn B, Lehrmann H, Kim S, Weber R, Markstein V, Allgeier J, Trenk D, Werner D, Hocini M, Jais P, Haissaguerre M, Jadidi A. P1148Spatial correlation of rotational and continuous electrical activities to late gadolinlium enhancement at left atrial MRI and low voltage areas in persistent atrial fibrillation. Europace 2018. [DOI: 10.1093/europace/euy015.634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Chen
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - T Arentz
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - Z Moreno-Weidmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - B Mueller-Edenborn
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - H Lehrmann
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - S Kim
- St. Jude Medical, St. Paul, American Samoa
| | - R Weber
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | | | - J Allgeier
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - D Trenk
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
| | - D Werner
- St. Jude Medical, St. Paul, American Samoa
| | - M Hocini
- University Hospital of Haut Leveque, Bordeaux-Pessac, France
| | - P Jais
- University Hospital of Haut Leveque, Bordeaux-Pessac, France
| | - M Haissaguerre
- University Hospital of Haut Leveque, Bordeaux-Pessac, France
| | - A Jadidi
- University Heart Center Freiburg-Bad Krozingen, Arrhythima Department, Freiburg, Germany
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Mueller-Edenborn B, Chen J, Lehrmann H, Keyl C, El-Omri Y, Weber R, Allgeier J, Trenk D, Neumann FJ, Arentz T, Jadidi A. P2646P-wave duration in sinus rhythm correlates to extent of left atrial low-voltage and predicts outcome of pulmonary vein isolation in persistent atrial fibrillation. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Chen J, Arentz T, Lehrmann H, Kim S, Weber R, Allgeier J, Hocini M, Jais P, Haissaguerre M, Jadidi A. P2661Spatial relationship of rotational and rapid sources in persistent atrial fibrillation to atrial delayed enhancement and low voltage areas. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Jadidi A, Chen J, Lehrmann H, Mueller-Edenborn B, Allgeier J, Weber R, Trenk D, Arentz T. P3629Rotational and Focal AF Sources Localize to Low Voltage Areas Displaying Slow Conduction in Sinus Rhythm. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Müller-Edenborn B, Allgeier J, Hartmann R, Zeller T, Arentz T. High-output heart failure due to subclavian vessel fistula as a late complication following implantation of a biventricular pacemaker. HeartRhythm Case Rep 2016; 2:425-427. [PMID: 28507903 PMCID: PMC5426421 DOI: 10.1016/j.hrcr.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Allgeier J, Buntkowsky G, Hentrich S, Hoffmann W, Vieth HM. Optical Nuclear Polarization of Deuterium Spins: Mechanisms and Applications in Solid State NMR. Isr J Chem 2013. [DOI: 10.1002/ijch.199200028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Park CI, Lehrmann H, Keyl C, Weber R, Allgeier J, Schiebeling J, Herrera-Siklody C, Arentz T, Jadidi A. Mechanisms of pulmonary vein reconnection: insufficient catheter tissue contact and long lesion-to-lesion distance. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Park CI, Lehrmann H, Keyl C, Weber R, Schiebeling J, Allgeier J, Herrerra-Siklody C, Shah D, Arentz T, Jadidi A. Enhanced efficiency of a novel porous irrigated RF ablation catheter for pulmonary vein isolation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p4124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Lehrmann H, Weber R, Park CI, Allgeier J, Schiebeling-Römer J, Arentz T, Jadidi A. “Dormant transisthmus conduction” revealed by adenosine after cavotricuspid isthmus ablation. Heart Rhythm 2012; 9:1942-6. [DOI: 10.1016/j.hrthm.2012.08.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2012] [Indexed: 11/26/2022]
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Allgeier J, Buntkowsky G, Hentrich S, Nack M, Vieth HM. Mobility in Single Crystals Studied by Optical Nuclear Polarization. ACTA ACUST UNITED AC 2010. [DOI: 10.1002/bbpc.19890931128] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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König D, Deibert P, Vogt S, Hirschmüller A, Fürmaier R, Allgeier J, Dickhuth HH. Ungewöhnliche Ursache rezidivierender AP-Beschwerden bei einem Ausdauersportler. Herz 2007; 32:665-8. [DOI: 10.1007/s00059-008-2974-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Accepted: 04/14/2007] [Indexed: 10/22/2022]
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Richter D, Monkenbusch M, Allgeier J, Arbe A, Colmenero J, Farago B, Cheol Bae Y, Faust R. From Rouse dynamics to local relaxation: A neutron spin echo study on polyisobutylene melts. J Chem Phys 1999. [DOI: 10.1063/1.479907] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Finckh M, Hellmann W, Ganten D, Furtwängler A, Allgeier J, Boltz M, Holtz J. Enhanced cardiac angiotensinogen gene expression and angiotensin converting enzyme activity in tachypacing-induced heart failure in rats. Basic Res Cardiol 1991; 86:303-16. [PMID: 1659803 DOI: 10.1007/bf02191528] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of the study was to analyze changes in myocardial angiotensinogen gene expression and myocardial angiotensin converting enzyme activity in slowly progressing low-output failure. In adult, male Wistar rats, acute ventricular tachypacing by 610 to 620 impulses per minute lowered end-diastolic external diameter of the left ventricle by 2.6% (p less than 0.01), but did not lower cardiac output or abolish coronary reserve, since left-ventricular subendocardial blood flow of paced rats increased under dipyridamole (2 mg/kg i.v.) by 56% (p less than 0.01). Systemic neuroendocrine activation and ventricular dilation without enlargement of ventricular mass developed subsequent to chronic tachypacing, but left-ventricular diameter during pacing never exceeded the value of sham rats on sinus rhythm. After 2 weeks, cardiac output was lowered by 14% (p less than 0.001), cardiopulmonary blood volume was elevated by 30% (p less than 0.001), and angiotensinogen mRNA and angiotensin converting enzyme activity in ventricular myocardium were doubled. We conclude that conditions for an enhanced intracardiac angiotensin II-formation developed in tachypacing-induced heart failure, but that enhanced systolic wall stress or myocardial ischemia are not required for this activation of the local cardiac renin-angiotensin system.
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Affiliation(s)
- M Finckh
- Institute of Applied Physiology, University of Freiburg, FRG
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Allgeier J, Macho V, Stehlik D, Vieth H, Auch W, Von Schütz J. Optical nuclear polarization via hyperfine relaxation. Polarization mechanism in anthracene/tetracyanobenzene charge-transfer crystals. Chem Phys Lett 1982. [DOI: 10.1016/0009-2614(82)80185-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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