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Helgason H, Eiriksdottir T, Ulfarsson MO, Choudhary A, Lund SH, Ivarsdottir EV, Hjorleifsson Eldjarn G, Einarsson G, Ferkingstad E, Moore KHS, Honarpour N, Liu T, Wang H, Hucko T, Sabatine MS, Morrow DA, Giugliano RP, Ostrowski SR, Pedersen OB, Bundgaard H, Erikstrup C, Arnar DO, Thorgeirsson G, Masson G, Magnusson OT, Saemundsdottir J, Gretarsdottir S, Steinthorsdottir V, Thorleifsson G, Helgadottir A, Sulem P, Thorsteinsdottir U, Holm H, Gudbjartsson D, Stefansson K. Evaluation of Large-Scale Proteomics for Prediction of Cardiovascular Events. JAMA 2023; 330:725-735. [PMID: 37606673 PMCID: PMC10445198 DOI: 10.1001/jama.2023.13258] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/29/2023] [Indexed: 08/23/2023]
Abstract
Importance Whether protein risk scores derived from a single plasma sample could be useful for risk assessment for atherosclerotic cardiovascular disease (ASCVD), in conjunction with clinical risk factors and polygenic risk scores, is uncertain. Objective To develop protein risk scores for ASCVD risk prediction and compare them to clinical risk factors and polygenic risk scores in primary and secondary event populations. Design, Setting, and Participants The primary analysis was a retrospective study of primary events among 13 540 individuals in Iceland (aged 40-75 years) with proteomics data and no history of major ASCVD events at recruitment (study duration, August 23, 2000 until October 26, 2006; follow-up through 2018). We also analyzed a secondary event population from a randomized, double-blind lipid-lowering clinical trial (2013-2016), consisting of individuals with stable ASCVD receiving statin therapy and for whom proteomic data were available for 6791 individuals. Exposures Protein risk scores (based on 4963 plasma protein levels and developed in a training set in the primary event population); polygenic risk scores for coronary artery disease and stroke; and clinical risk factors that included age, sex, statin use, hypertension treatment, type 2 diabetes, body mass index, and smoking status at the time of plasma sampling. Main Outcomes and Measures Outcomes were composites of myocardial infarction, stroke, and coronary heart disease death or cardiovascular death. Performance was evaluated using Cox survival models and measures of discrimination and reclassification that accounted for the competing risk of non-ASCVD death. Results In the primary event population test set (4018 individuals [59.0% women]; 465 events; median follow-up, 15.8 years), the protein risk score had a hazard ratio (HR) of 1.93 per SD (95% CI, 1.75 to 2.13). Addition of protein risk score and polygenic risk scores significantly increased the C index when added to a clinical risk factor model (C index change, 0.022 [95% CI, 0.007 to 0.038]). Addition of the protein risk score alone to a clinical risk factor model also led to a significantly increased C index (difference, 0.014 [95% CI, 0.002 to 0.028]). Among White individuals in the secondary event population (6307 participants; 432 events; median follow-up, 2.2 years), the protein risk score had an HR of 1.62 per SD (95% CI, 1.48 to 1.79) and significantly increased C index when added to a clinical risk factor model (C index change, 0.026 [95% CI, 0.011 to 0.042]). The protein risk score was significantly associated with major adverse cardiovascular events among individuals of African and Asian ancestries in the secondary event population. Conclusions and Relevance A protein risk score was significantly associated with ASCVD events in primary and secondary event populations. When added to clinical risk factors, the protein risk score and polygenic risk score both provided statistically significant but modest improvement in discrimination.
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Affiliation(s)
- Hannes Helgason
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | | | - Magnus O. Ulfarsson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Huei Wang
- Amgen, Inc, Thousand Oaks, California
| | | | - Marc S. Sabatine
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - David A. Morrow
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Robert P. Giugliano
- TIMI Study Group, Division of Cardiovascular Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sisse Rye Ostrowski
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ole Birger Pedersen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David O. Arnar
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
- Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | - Gudmundur Thorgeirsson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
- Landspitali—The National University Hospital of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | | | | | | | - Hilma Holm
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
| | - Daniel Gudbjartsson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Inc, Reykjavik, Iceland
- University of Iceland, Reykjavik, Iceland
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Nicholls SJ, Kataoka Y, Nissen SE, Prati F, Windecker S, Puri R, Hucko T, Aradi D, Herrman JPR, Hermanides RS, Wang B, Wang H, Butters J, Giovanni GD, Jones S, Pompili G, Wolski K, Psaltis PJ. Coronary Atheroma Regression With Evolocumab in Stable and Unstable Coronary Syndromes. JACC Cardiovasc Imaging 2023; 16:130-132. [PMID: 36599559 DOI: 10.1016/j.jcmg.2022.07.020] [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] [Received: 05/03/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022]
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Nicholls S, Kataoka Y, Nissen S, Prati F, Windecker S, Puri R, Hucko T, Aradi D, Herrman J, Hermanides R, Wang B, Wang H, Butters J, Di Giovanni G, Jones S, Pompili G, Psaltis P. Effect of Evolocumab on Changes in Coronary Plaque Phenotype in Statin-Treated Patients Following Myocardial Infarction: The HUYGENS Randomised Clinical Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Felker GM, Solomon SD, Claggett B, Diaz R, McMurray JJV, Metra M, Anand I, Crespo-Leiro MG, Dahlström U, Goncalvesova E, Howlett JG, MacDonald P, Parkhomenko A, Tomcsányi J, Abbasi SA, Heitner SB, Hucko T, Kupfer S, Malik FI, Teerlink JR. Assessment of Omecamtiv Mecarbil for the Treatment of Patients With Severe Heart Failure: A Post Hoc Analysis of Data From the GALACTIC-HF Randomized Clinical Trial. JAMA Cardiol 2021; 7:26-34. [PMID: 34643642 DOI: 10.1001/jamacardio.2021.4027] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [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: 01/10/2023]
Abstract
Importance Heart failure with reduced ejection fraction is a progressive clinical syndrome, and many patients' condition worsen over time despite treatment. Patients with more severe disease are often intolerant of available medical therapies. Objective To evaluate the efficacy and safety of omecamtiv mecarbil for the treatment of patients with severe heart failure (HF) enrolled in the Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure (GALACTIC-HF) randomized clinical trial. Design, Setting, and Participants The GALACTIC-HF study was a global double-blind, placebo-controlled phase 3 randomized clinical trial that was conducted at multiple centers between January 2017 and August 2020. A total of 8232 patients with symptomatic HF (defined as New York Heart Association symptom class II-IV) and left ventricular ejection fraction of 35% or less were randomized to receive omecamtiv mecarbil or placebo and followed up for a median of 21.8 months (range, 15.4-28.6 months). The current post hoc analysis evaluated the efficacy and safety of omecamtiv mecarbil therapy among patients classified as having severe HF compared with patients without severe HF. Severe HF was defined as the presence of all of the following criteria: New York Heart Association symptom class III to IV, left ventricular ejection fraction of 30% or less, and hospitalization for HF within the previous 6 months. Interventions Participants were randomized at a 1:1 ratio to receive either omecamtiv mecarbil or placebo. Main Outcomes and Measures The primary end point was time to first HF event or cardiovascular (CV) death. Secondary end points included time to CV death and safety and tolerability. Results Among 8232 patients enrolled in the GALACTIC-HF clinical trial, 2258 patients (27.4%; mean [SD] age, 64.5 [11.6] years; 1781 men [78.9%]) met the specified criteria for severe HF. Of those, 1106 patients were randomized to the omecamtiv mecarbil group and 1152 to the placebo group. Patients with severe HF who received omecamtiv mecarbil experienced a significant treatment benefit for the primary end point (hazard ratio [HR], 0.80; 95% CI, 0.71-0.90), whereas patients without severe HF had no significant treatment benefit (HR, 0.99; 95% CI, 0.91-1.08; P = .005 for interaction). For CV death, the results were similar (HR for patients with vs without severe HF: 0.88 [95% CI, 0.75-1.03] vs 1.10 [95% CI, 0.97-1.25]; P = .03 for interaction). Omecamtiv mecarbil therapy was well tolerated in patients with severe HF, with no significant changes in blood pressure, kidney function, or potassium level compared with placebo. Conclusions and Relevance In this post hoc analysis of data from the GALACTIC-HF clinical trial, omecamtiv mecarbil therapy may have provided a clinically meaningful reduction in the composite end point of time to first HF event or CV death among patients with severe HF. These data support a potential role of omecamtiv mecarbil therapy among patients for whom current treatment options are limited. Trial Registration ClinicalTrials.gov Identifier: NCT02929329.
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Affiliation(s)
- G Michael Felker
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina.,Duke Clinical Research Institute, Durham, North Carolina
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Rafael Diaz
- Instituto Cardiovascular de Rosario, Estudios Clínicos Latino América, Rosario, Argentina
| | - John J V McMurray
- Cardiovascular Research Centre, British Heart Foundation, Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Marco Metra
- Department of Medical and Surgical Specialties, University of Brescia, Brescia, Italy
| | - Inder Anand
- Division of Cardiovascular Medicine, University of Minnesota, Minneapolis
| | | | - Ulf Dahlström
- Department of Cardiology, Linköping University Hospital, Linköping, Sweden
| | - Eva Goncalvesova
- Department of Cardiology, Odd. Srdcovehozlyhavania a Transplantacie, Bratislava, Slovakia
| | - Jonathan G Howlett
- Division of Cardiology, Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Peter MacDonald
- Heart Transplant Unit, St. Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Alexander Parkhomenko
- Emergency Cardiology Department, Ukranian Strazhesko Institute of Cardiology, Kiev, Ukraine
| | - János Tomcsányi
- Cardiology Department, St. John of God Hospital, Budapest, Hungary
| | | | | | | | - Stuart Kupfer
- Clinical Research, Cytokinetics, South San Francisco, California
| | - Fady I Malik
- Research and Development, Cytokinetics, South San Francisco, California
| | - John R Teerlink
- Division of Cardiology, San Francisco VA Medical Center, San Francisco, California.,Division of Cardiology, University of California San Francisco, San Francisco
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Nicholls SJ, Nissen SE, Prati F, Windecker S, Kataoka Y, Puri R, Hucko T, Kassahun H, Liao J, Somaratne R, Butters J, Di Giovanni G, Jones S, Psaltis PJ. Assessing the impact of PCSK9 inhibition on coronary plaque phenotype with optical coherence tomography: rationale and design of the randomized, placebo-controlled HUYGENS study. Cardiovasc Diagn Ther 2021; 11:120-129. [PMID: 33708484 DOI: 10.21037/cdt-20-684] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Technological advances in arterial wall imaging permit the opportunity to visualize coronary atherosclerotic plaque with sufficient resolution to characterize both its burden and compositional phenotype. These modalities have been used extensively in clinical trials to evaluate the impact of lipid lowering therapies on serial changes in disease burden. While the findings have unequivocally established that these interventions have the capacity to either slow disease progression or promote plaque regression, depending on the degree of lipid lowering achieved, their impact on plaque phenotype is less certain. More recently optical coherence tomography (OCT) has been employed with a number of studies demonstrating favorable effects on both fibrous cap thickness (FCT) and the size of lipid pools within plaque in response to statin treatment. Methods The phase 3, multi-center, double-blind HUYGENS study will assess the impact of incremental lipid lowering with the proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor, evolocumab, on plaque features using serial OCT imaging, in statin-treated patients following an acute coronary syndrome (ACS). Subjects with non-ST-elevation ACS (n=150) will be randomized 1:1 into two groups to receive monthly injections of evolocumab 420 mg or placebo. Results The primary endpoint is the effect of evolocumab on coronary atherosclerotic plaques will be assessed by OCT at baseline and at week 50. Conclusions The HUYGENS study will determine whether intensified lipid lowering therapy with evolocumab in addition to maximally tolerated statin therapy will have incremental benefits on high-risk features of coronary artery plaques. Trial registration This study was registered on Clinicaltrials.gov (NCT03570697).
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Affiliation(s)
| | | | | | | | - Yu Kataoka
- Monash Cardiovascular Research Centre, Clayton, Australia
| | - Rishi Puri
- Monash Cardiovascular Research Centre, Clayton, Australia
| | - Thomas Hucko
- Monash Cardiovascular Research Centre, Clayton, Australia
| | | | - Jason Liao
- Monash Cardiovascular Research Centre, Clayton, Australia
| | | | - Julie Butters
- Monash Cardiovascular Research Centre, Clayton, Australia
| | | | - Stephen Jones
- Monash Cardiovascular Research Centre, Clayton, Australia
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Koren MJ, Jones PH, Robinson JG, Sullivan D, Cho L, Hucko T, Lopez JAG, Fleishman AN, Somaratne R, Stroes E. A Comparison of Ezetimibe and Evolocumab for Atherogenic Lipid Reduction in Four Patient Populations: A Pooled Efficacy and Safety Analysis of Three Phase 3 Studies. Cardiol Ther 2020; 9:447-465. [PMID: 32564340 PMCID: PMC7584715 DOI: 10.1007/s40119-020-00181-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Clinicians, payers, guideline committees, and policymakers support the use of high-intensity statins in patients at high risk for complications of cardiovascular disease (CVD). Guidelines and recommendations provide guidance on next steps for patients with inadequate low-density lipoprotein cholesterol (LDL-C) control on maximally tolerated statin or for those who are statin-intolerant. Ezetimibe and evolocumab improve CV outcomes when added to statins in high-CV-risk populations. The aim of the study was to compare evolocumab and ezetimibe for lipid-lowering efficacy and safety. METHODS We summarized data from 1427 patients from three phase 3 evolocumab studies comparing double-blinded evolocumab vs. ezetimibe. These studies evaluated four distinct populations: those free of CVD receiving each agent as monotherapy, patients with CVD receiving add-on therapy to low- or high-intensity statin, and statin-intolerant patients. Lipid efficacy and safety were reported at week 12. RESULTS Across the studies, evolocumab reduced LDL-C by a mean 55-61% from baseline to week 12; ezetimibe lowered LDL-C by 18-20% from baseline (mean difference = 38-43% favoring evolocumab; p < 0.0001). This corresponded to absolute reductions in LDL-C of 60-104 mg/dL with evolocumab vs. 17-35 mg/dL with ezetimibe. Evolocumab also significantly improved other lipids and led to a higher percentage of patients achieving LDL-C goals vs. ezetimibe. Adverse events and discontinuation rates (oral and parenteral therapy) were balanced across groups, suggesting good tolerance and acceptance of both treatments. CONCLUSIONS Evolocumab outperformed ezetimibe in efficacy and lipid goal attainment. Both products demonstrated good safety/tolerability. These data may help guide access decisions for high-risk patients with inadequate treatment response or intolerance to statin therapy.
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Affiliation(s)
- Michael J Koren
- Jacksonville Center for Clinical Research, 4085 University Blvd. South, Suite 1, Jacksonville, FL, 32216, USA.
| | - Peter H Jones
- Baylor College of Medicine, 6655 Travis St., Suite 320, Houston, TX, 77030, USA
| | | | - David Sullivan
- Department of Clinical Biochemistry, Royal Prince Alfred Hospital, 50 Missenden Rd, Camperdown, NSW, 2050, Australia
| | - Leslie Cho
- Cleveland Clinic, 9500 Euclid Ave., Desk JB1, Cleveland, OH, 44195, USA
| | - Thomas Hucko
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | | | - Alex N Fleishman
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Ransi Somaratne
- Amgen Inc, One Amgen Center Drive, Thousand Oaks, CA, 91320, USA
| | - Erik Stroes
- Academic Medical Center of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, Amsterdam, The Netherlands
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Nicholls SJ, Anderson T, Ballantyne CM, Cho L, Kastelein JJ, Koenig W, Hucko T, Kassahun H, Liu Y, Wang H, Nissen SE. EFFECT OF LONGER-TERM ADMINISTRATION OF EVOLOCUMAB IN PATIENTS WITH ANGIOGRAPHIC CORONARY ARTERY DISEASE: RESULTS OF THE GLAGOV OPEN LABELLED EXTENSION STUDY. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)32496-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nicholls S, Anderson T, Ballantyne C, Cho L, Kastelein J, Koenig W, Hucko T, Kassahun H, Liu Y, Wang H, Nissen S. 484 Effect of Longer-Term Administration of Evolocumab in Patients With Angiographic Coronary Artery Disease: Results of the GLAGOV Open Label Extension Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dietrich T, Berndorff D, Heinrich T, Hucko T, Stepina E, Hauff P, Dinkelborg LM, Atrott K, Giovannoni L, Neri D, Fleck E, Graf K, Menssen HD. Targeted ED-B fibronectin SPECT in vivo imaging in experimental atherosclerosis. Q J Nucl Med Mol Imaging 2015; 59:228-237. [PMID: 25864530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The extracellular matrix protein ED-B fibronectin (ED-B) is upregulated in inflammatory atherosclerotic lesions. However, functional in vivo imaging of ED-B-containing plaques has not been explored. This study evaluated whether [(99m)Tc]-conjugated AP39 ([(99m)Tc]-AP39), a single-chain antibody specific to ED-B, can be used for in vivo detection of atherosclerotic plaques in Western diet (WD)-fed, apolipoprotein E-deficient (apoE-/-) mice as compared to wildtype (WT) control mice. METHODS Using SPECT, 12-month-old WD-fed apoE-/- and WT mice were studied 4 hours after injecting [(99m)Tc]-AP39 (148 MBq). Subsequently, mice were sacrificed, thoracic aortas measured in a g-counter, and plaques analyzed using histology, immuno-histochemistry, autoradiography, and morphometry. RESULTS In vivo [(99m)Tc]-AP39-SPECT imaging of apoE-/- mice demonstrated a significant signal activity in the plaque-ridden thoracic aorta (52.236 ± 40.646 cpm/cm³) that co-localized with the aortic arch and the supra-aortic arteries in MRI scans. Low signal activity (9.468 ± 4.976 cpm/cm³) was observed in WT mice. In apoE-/- mice, the strongest signals were detected in the aortic root, aortic arch and along the abdominal aorta. Autoradiography analysis of aortas from apoE-/- mice confirmed the in vivo observation by demonstrating signal localization in atherosclerotic plaques. The size of autoradiography-positive plaque areas correlated significantly with the size of ED-B-positive (r=0.645, P=0.044) or macrophage-infiltrated (r=0.84, P<0.002) plaques. A significant correlation was found between the sizes of ED-B-positive and macrophage-infiltrated plaque areas (r=0.93, P<0.01). CONCLUSION [(99m)Tc]-AP39-SPECT in vivo imaging detects inflammatory plaque lesions in WD-fed apoE-/- mice.
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Schneeweis C, Lapinskas T, Schnackenburg B, Berger A, Hucko T, Kelle S, Fleck E, Gebker R. Comparison of myocardial tagging and feature tracking in patients with severe aortic stenosis. J Heart Valve Dis 2014; 23:432-440. [PMID: 25803969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Transcatheter aortic valve implantation (TAVI) has become an effective treatment for severe aortic stenosis (AS) in patients considered to be at high surgical risk. However, data relating to myocardial function and deformation in these patients are rare. Cardiovascular magnetic resonance (CMR) tagging has been established as non-invasive technique for the accurate measurement of myocardial motion. However, additional tagging datasets are necessary and the post-processing procedure is time-consuming. Recently, the novel technique of feature tracking (FT) was introduced, with which myocardial strain can be derived directly from balanced steady-state free precession (bSSFP) cine sequences. The study aim was to compare tagging with FT in patients with high-grade AS and who had been considered for TAVI. METHODS Thirty patients with severe AS underwent cardiac magnetic resonance imaging at 1.5 T (Philips Achieva). A stack of serial short-axis slices was used to assess left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV), and LV mass and function. TomTec 2D Cardiac Performance Analysis software was used to derive myocardial deformation parameters from three short-axis cine views (basal, medial and apical levels) using bSSFP. All patients also underwent myocardial tagging on identical short-axis views, and data acquired from FT and tagging were compared. RESULTS The mean left ventricular ejection fraction (LVEF), LVEDV and LVESV (57 ± 14%, 158 ± 58 ml, and 74 ± 48 ml, respectively) were all normal. All patients demonstrated concentric hypertrophy of the left ventricle with an increased basal septal thickness (16 ± 3 mm), LV mass (126 ± 40 g) and indexed LV mass (68 ± 23 g/m2, papillary muscles excluded). Bland-Altman analysis revealed a reasonable agreement between basal and medial circumferential strain (cc), and a good correlation was observed between tagging and FT for the derived basal and medial cc (Pearson's correlation coefficient 0.83 for basal, 0.74 for medial). Basal rotation was impaired compared to previous studies in patients with AS, but medial and apical rotations were comparable. The apical peak diastolic rotation velocity was faster compared to earlier analyses. Rotation, peak systolic and end-diastolic rotation velocity did not demonstrate any correlation or acceptable agreement between FT and tagging. The inter-observer agreement as assessed by the intra- class correlation coefficient for FT showed good results for the cc (basal 0.94, medial 0.83, apical 0.75). CONCLUSION To the present authors' knowledge, this is the first study to assess myocardial motion using tagging and FT in patients with AS prior to TAVI. A reasonable agreement was found for the basal and medial cc between both techniques. Estimated cc-values using FT were systematically higher than those with tagging, but this might have been due to the different techniques employed. Although FT is a promising method to assess cc, further studies including the evaluation of standard values--and investigations with different diseases are necessary.
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Manka R, Jahnke C, Hucko T, Dietrich T, Gebker R, Schnackenburg B, Graf K, Paetsch I. Reproducibility of small animal cine and scar cardiac magnetic resonance imaging using a clinical 3.0 tesla system. BMC Med Imaging 2013; 13:44. [PMID: 24345214 PMCID: PMC3878577 DOI: 10.1186/1471-2342-13-44] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 12/04/2013] [Indexed: 11/12/2022] Open
Abstract
Background To evaluate the inter-study, inter-reader and intra-reader reproducibility of cardiac cine and scar imaging in rats using a clinical 3.0 Tesla magnetic resonance (MR) system. Methods Thirty-three adult rats (Sprague–Dawley) were imaged 24 hours after surgical occlusion of the left anterior descending coronary artery using a 3.0 Tesla clinical MR scanner (Philips Healthcare, Best, The Netherlands) equipped with a dedicated 70 mm solenoid receive-only coil. Left-ventricular (LV) volumes, mass, ejection fraction and amount of myocardial scar tissue were measured. Intra-and inter-observer reproducibility was assessed in all animals. In addition, repeat MR exams were performed in 6 randomly chosen rats within 24 hours to assess inter-study reproducibility. Results The MR imaging protocol was successfully completed in 32 (97%) animals. Bland-Altman analysis demonstrated high intra-reader reproducibility (mean bias%: LV end-diastolic volume (LVEDV), -1.7%; LV end-systolic volume (LVESV), -2.2%; LV ejection fraction (LVEF), 1.0%; LV mass, -2.7%; and scar mass, -1.2%) and high inter-reader reproducibility (mean bias%: LVEDV, 3.3%; LVESV, 6.2%; LVEF, -4.8%; LV mass, -1.9%; and scar mass, -1.8%). In addition, a high inter-study reproducibility was found (mean bias%: LVEDV, 0.1%; LVESV, -1.8%; LVEF, 1.0%; LV mass, -4.6%; and scar mass, -6.2%). Conclusions Cardiac MR imaging of rats yielded highly reproducible measurements of cardiac volumes/function and myocardial infarct size on a clinical 3.0 Tesla MR scanner system. Consequently, more widely available high field clinical MR scanners can be employed for small animal imaging of the heart e.g. when aiming at serial assessments during therapeutic intervention studies.
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Affiliation(s)
- Robert Manka
- Department of Cardiology, University Hospital Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
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Hucko T, Klein C, Schnackenburg B, Schneeweis C, Kelle S, Berger A, Fleck E, Gebker R. Cardiovascular magnetic resonance stress perfusion imaging in patients with atrial fibrillation. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559362 DOI: 10.1186/1532-429x-15-s1-e59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Thomas Hucko
- Internal Medicine - Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Christoph Klein
- Internal Medicine - Cardiology, German Heart Institute Berlin, Berlin, Germany
| | | | | | - Sebastian Kelle
- Internal Medicine - Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Alexander Berger
- Internal Medicine - Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Eckart Fleck
- Internal Medicine - Cardiology, German Heart Institute Berlin, Berlin, Germany
| | - Rolf Gebker
- Internal Medicine - Cardiology, German Heart Institute Berlin, Berlin, Germany
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Schneeweis C, Schnackenburg B, Stoeck CT, Berger A, Hucko T, Kelle S, Messroghli D, Fleck E, Gebker R. Characterization of myocardium and myocardial motion in patients considered for transaortic valve implantation (TAVI). J Cardiovasc Magn Reson 2013. [PMCID: PMC3559574 DOI: 10.1186/1532-429x-15-s1-p113] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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14
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Schneeweis C, Lapinskas T, Schnackenburg B, Berger A, Hucko T, Kelle S, Fleck E, Gebker R. Comparison of myocardial tagging and feature tracking in patients with severe aortic stenosis. J Cardiovasc Magn Reson 2013. [PMCID: PMC3559629 DOI: 10.1186/1532-429x-15-s1-p100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Gebker R, Jahnke C, Manka R, Frick M, Hucko T, Kozerke S, Schnackenburg B, Fleck E, Paetsch I. High spatial resolution myocardial perfusion imaging during high dose dobutamine/atropine stress magnetic resonance using k–t SENSE. Int J Cardiol 2012; 158:411-6. [DOI: 10.1016/j.ijcard.2011.01.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 01/17/2011] [Accepted: 01/23/2011] [Indexed: 11/26/2022]
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Messroghli D, Nordmeyer S, Buehrer M, Kozerke S, Dietrich T, Hucko T, Berger F, Klein C, Kuehne T. Small animal look-locker inversion recovery (SALLI). J Cardiovasc Magn Reson 2011. [PMCID: PMC3106947 DOI: 10.1186/1532-429x-13-s1-p24] [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: 11/10/2022] Open
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17
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Gebker R, Jahnke C, Manka R, Hucko T, Kelle S, Klein C, Schnackenburg B, Fleck E, Paetsch I. The role of dobutamine stress magnetic resonance in the clinical management of patients with coronary artery disease. J Cardiovasc Magn Reson 2011. [PMCID: PMC3106761 DOI: 10.1186/1532-429x-13-s1-o64] [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: 11/10/2022] Open
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18
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Dietrich T, Hucko T, Schneemann C, Neumann M, Menrad A, Willuda J, Atrott K, Stibenz D, Fleck E, Graf K, Menssen HD. Local delivery of IL-2 reduces atherosclerosis via expansion of regulatory T cells. Atherosclerosis 2011; 220:329-36. [PMID: 22062588 DOI: 10.1016/j.atherosclerosis.2011.09.050] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 09/20/2011] [Accepted: 09/27/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Recent studies indicate that regulatory T cells (Tregs) attenuate murine atherosclerosis. Since interleukin (IL)-2 induces Tregs proliferation, we tested the impact of L19-IL2, a fusion antibody specific to extra-domain B of fibronectin (ED-B) containing an active human IL-2 molecule, in experimental atherosclerosis. METHODS AND RESULTS L19-IL2 or appropriate controls were given intravenously to 6 month old Western diet-fed apoE(-/-) mice on day 1, 3, and 5. Human IL-2 was detected on day 7 within atherosclerotic plaques of L19-IL2-treated mice, and magnetic resonance imaging of the plaques showed a significant adventitial gadolinium enhancement on day 7 and 13, suggesting microvascular leakage as a result of the pharmacodynamic activity of L19-IL2. Treatment with L19-IL2 significantly reduced the size of pre-established atherosclerotic plaques at the thoracic aorta (Sudan III stained area) and in the aortic root area (microscopic, morphometric analysis) on day 7 as compared to controls (L19, D1.3-IL2, NaCl) as well as compared to baseline (day 0). Tregs markers Foxp3 and CTLA4 were highly increased in plaques after L19-IL2 treatment compared to controls (p<0.01), whereas the macrophage marker Mac3 was significantly reduced (p<0.03). Co-treatment with IL-2-receptor blocking antibody PC61 abrogated L19-IL2-induced plaque reduction compared with IgG control (p<0.03). CONCLUSION L19-IL2 delivers functional IL-2 to pre-established atherosclerotic plaques of WD-fed apoE(-/-) mice resulting in significant plaque size reduction mediated by local Tregs.
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Affiliation(s)
- Thore Dietrich
- Department of Medicine-Cardiology, Deutsches Herzzentrum, Berlin, Germany.
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Gebker R, Jahnke C, Manka R, Hucko T, Schnackenburg B, Kelle S, Klein C, Fleck E, Paetsch I. The role of dobutamine stress cardiovascular magnetic resonance in the clinical management of patients with suspected and known coronary artery disease. J Cardiovasc Magn Reson 2011; 13:46. [PMID: 21910881 PMCID: PMC3184068 DOI: 10.1186/1532-429x-13-46] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 09/12/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated the consistently high diagnostic and prognostic value of dobutamine stress cardiovascular magnetic resonance (DCMR). The value of DCMR for clinical decision making still needs to be defined. Hence, the purpose of this study was to assess the utility of DCMR regarding clinical management of patients with suspected and known coronary artery disease (CAD) in a routine setting. METHODS AND RESULTS We prospectively performed a standard DCMR examination in 1532 consecutive patients with suspected and known CAD. Patients were stratified according to the results of DCMR: DCMR-positive patients were recommended to undergo invasive coronary angiography and DCMR-negative patients received optimal medical treatment. Of 609 (40%) DCMR-positive patients coronary angiography was performed in 478 (78%) within 90 days. In 409 of these patients significant coronary stenoses ≥ 50% were present (positive predictive value 86%). Of 923 (60%) DCMR-negative patients 833 (90%) received optimal medical therapy. During a mean follow-up period of 2.1 ± 0.8 years (median: 2.1 years, interquartile range 1.5 to 2.7 years) 8 DCMR-negative patients (0.96%) sustained a cardiac event.In 131 DCMR-positive patients who did not undergo invasive angiography, 20 patients (15%) suffered cardiac events. In 90 DCMR-negative patients (10%) invasive angiography was performed within 2 years (range 0.01 to 2.0 years) with 56 patients having coronary stenoses ≥ 50%. CONCLUSION In a routine setting DCMR proved a useful arbiter for clinical decision making and exhibited high utility for stratification and clinical management of patients with suspected and known CAD.
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Messroghli DR, Nordmeyer S, Buehrer M, Kozerke S, Dietrich T, Kaschina E, Becher PM, Hucko T, Berger F, Klein C, Kuehne T. Small animal Look-Locker inversion recovery (SALLI) for simultaneous generation of cardiac T1 maps and cine and inversion recovery-prepared images at high heart rates: initial experience. Radiology 2011; 261:258-65. [PMID: 21788528 DOI: 10.1148/radiol.11101943] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To develop a single magnetic resonance (MR) imaging approach for comprehensive assessment of cardiac function and tissue properties in small animals with high heart rates. MATERIALS AND METHODS All animal studies were approved by the local animal care committee. Small animal Look-Locker inversion recovery (SALLI) was implemented on a clinical 3.0-T MR unit equipped with a 70-mm solenoid coil. SALLI combines a segmented, electrocardiographically gated, inversion recovery-prepared Look-Locker-type pulse sequence with a multimodal reconstruction framework. Temporal undersampling and radial nonbalanced steady-state free precession enabled acceleration of data acquisition and reduction of motion artifacts, respectively. Nine agarose gel phantoms were used to investigate different sequence settings. For in vivo studies, 10 Sprague-Dawley rats were evaluated to establish normal T1 values before and after injection of gadopentetate dimeglumine. Seven rats with surgically induced acute myocardial infarction were examined to test the feasibility of detecting myocardial injury. In vitro T1 behavior was studied with linear regression analysis, and in vivo T1 differences between infarcted and remote areas were tested by using the Wilcoxon signed rank test. RESULTS Phantom studies demonstrated systematic behavior of the T1 measurements, and T1 error could be reduced to 1.3% ± 7.4 by using a simple linear correction algorithm. The pre- and postcontrast T1 of myocardium and blood showed narrow normal ranges. In the area of infarction, SALLI demonstrated hypokinesia (on cine images), myocardial edema (on precontrast T1 maps), and myocardial necrosis (on postcontrast T1 maps and late gadolinium enhancement images). CONCLUSION An MR imaging method enabling simultaneous generation of cardiac T1 maps and cine and inversion recovery-prepared images at high heart rates is presented. SALLI allows for simultaneous and time-efficient assessment of cardiac T1 behavior, function, and late gadolinium enhancement at high heart rates.
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Affiliation(s)
- Daniel R Messroghli
- Department of Congenital Heart Defects, Deutsches Herzzentrum Berlin, Berlin, Germany.
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Gebker R, Mirelis JG, Jahnke C, Hucko T, Manka R, Hamdan A, Schnackenburg B, Fleck E, Paetsch I. Influence of left ventricular hypertrophy and geometry on diagnostic accuracy of wall motion and perfusion magnetic resonance during dobutamine stress. Circ Cardiovasc Imaging 2010; 3:507-14. [PMID: 20576810 DOI: 10.1161/circimaging.109.923672] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The purpose of this study was to determine the influence of left ventricular (LV) hypertrophy and geometry on the diagnostic accuracy of wall motion and additional perfusion imaging during high-dose dobutamine/atropine stress magnetic resonance for the detection of coronary artery disease. METHODS AND RESULTS Combined dobutamine stress magnetic resonance (DSMR)-wall motion and DSMR-perfusion imaging was performed in a single session in 187 patients scheduled for invasive coronary angiography. Patients were classified into 4 categories on the basis of LV mass (normal, ≤ 81 g/m(2) in men and ≤ 62 g/m(2) in women) and relative wall thickness (RWT) (normal, <0.45) as follows: normal geometry (normal mass, normal RWT), concentric remodeling (normal mass, increased RWT), concentric hypertrophy (increased mass, increased RWT), and eccentric hypertrophy (increased mass, normal RWT). Wall motion and perfusion images were interpreted sequentially, with observers blinded to other data. Significant coronary artery disease was defined as ≥ 70% stenosis. In patients with increased LV concentricity (defined by an RWT ≥ 0.45), sensitivity and accuracy of DSMR-wall motion were significantly reduced (63% and 73%, respectively; P<0.05) compared with patients without increased LV concentricity (90% and 88%, respectively; P<0.05). Although accuracy of DSMR-perfusion was higher than that of DSMR-wall motion in patients with concentric hypertrophy (82% versus 71%; P < 0.05), accuracy of DSMR-wall motion was superior to DSMR-perfusion (90% versus 85%; P < 0.05) in patients with eccentric hypertrophy. CONCLUSIONS The accuracy of DSMR-wall motion is influenced by LV geometry. In patients with concentric remodeling and concentric hypertrophy, additional first-pass perfusion imaging during high-dose dobutamine stress improves the diagnostic accuracy for the detection of coronary artery disease.
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Gebker R, Mirelis JG, Jahnke C, Hucko T, Manka R, Haan A, Schnackenburg B, Fleck E, Paetsch I. Influence of left ventricular hypertrophy and geometry on diagnostic accuracy of wall motion and perfusion analysis during dobutamine stress magnetic resonance. J Cardiovasc Magn Reson 2010. [DOI: 10.1186/1532-429x-12-s1-p213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Gebker R, Jahnke C, Hucko T, Manka R, Mirelis JG, Hamdan A, Schnackenburg B, Fleck E, Paetsch I. Dobutamine stress magnetic resonance imaging for the detection of coronary artery disease in women. Heart 2009; 96:616-20. [PMID: 19687013 DOI: 10.1136/hrt.2009.175521] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [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: 11/03/2022] Open
Abstract
BACKGROUND Dobutamine stress magnetic resonance (DSMR) imaging represents an excellent imaging approach for the detection of coronary artery disease (CAD). However, most studies have predominantly reported the utility of DSMR in men. OBJECTIVE To evaluate the diagnostic value of DSMR in men and women. METHODS AND RESULTS High-dose dobutamine/atropine stress magnetic resonance imaging was performed and new or worsening wall motion abnormalities evaluated in 745 consecutive patients (204 women, 541 men). Invasive coronary angiography was performed within 30 days and served as the reference standard (> or =70% stenosis). DSMR was technically successful and had diagnostic image quality in all patients except one woman and three men (p=NS). In the absence of ischaemia, target heart rate was not reached in 9.3% of women and 8.5% of men (P=NS) despite maximum pharmacological infusion (1% and 2.2%, respectively, p=NS) or owing to limiting side effects (8.3% and 6.3%, respectively, p=NS). Diagnostic values (sensitivity/specificity/accuracy) for the detection of significant coronary stenoses were similar for men (86%/83%/85%) and women (85%/86%/85%). There was no gender-based difference in regional diagnostic accuracy of DSMR for all three coronary vascular territories in patients with single-vessel CAD (81% vs 81%, p=NS, respectively). CONCLUSION The diagnostic capability of DSMR for the detection of haemodynamically relevant, obstructive CAD is independent of gender.
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Affiliation(s)
- R Gebker
- Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin, Germany.
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Dietrich T, Hucko T, Bourayou R, Jahnke C, Paetsch I, Atrott K, Stawowy P, Gräfe M, Klein C, Schnackenburg B, Fleck E, Graf K. High resolution magnetic resonance imaging in atherosclerotic mice treated with ezetimibe. Int J Cardiovasc Imaging 2009; 25:827-36. [DOI: 10.1007/s10554-009-9487-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 07/27/2009] [Indexed: 11/24/2022]
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Kaschina E, Grzesiak A, Li J, Foryst-Ludwig A, Timm M, Rompe F, Sommerfeld M, Kemnitz UR, Curato C, Namsolleck P, Tschöpe C, Hallberg A, Alterman M, Hucko T, Paetsch I, Dietrich T, Schnackenburg B, Graf K, Dahlöf B, Kintscher U, Unger T, Steckelings UM. Angiotensin II type 2 receptor stimulation: a novel option of therapeutic interference with the renin-angiotensin system in myocardial infarction? Circulation 2008; 118:2523-32. [PMID: 19029468 DOI: 10.1161/circulationaha.108.784868] [Citation(s) in RCA: 210] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND This study is the first to examine the effect of direct angiotensin II type 2 (AT(2)) receptor stimulation on postinfarct cardiac function with the use of the novel nonpeptide AT(2) receptor agonist compound 21 (C21). METHODS AND RESULTS Myocardial infarction (MI) was induced in Wistar rats by permanent ligation of the left coronary artery. Treatment with C21 (0.01, 0.03, 0.3 mg/kg per day IP) was started 24 hours after MI and was continued until euthanasia (7 days after MI). Infarct size was assessed by magnetic resonance imaging, and hemodynamic measurements were performed via transthoracic Doppler echocardiography and intracardiac Millar catheter. Cardiac tissues were analyzed for inflammation and apoptosis markers with immunoblotting and real-time reverse transcription polymerase chain reaction. C21 significantly improved systolic and diastolic ventricular function. Scar size was smallest in the C21-treated rats. In regard to underlying mechanisms, C21 diminished MI-induced Fas-ligand and caspase-3 expression in the peri-infarct zone, indicating an antiapoptotic effect. Phosphorylation of the p44/42 and p38 mitogen-activated protein kinases, both involved in the regulation of cell survival, was strongly reduced after MI but almost completely rescued by C21 treatment. Furthermore, C21 decreased MI-induced serum monocyte chemoattractant protein-1 and myeloperoxidase as well as cardiac interleukin-6, interleukin-1beta, and interleukin-2 expression, suggesting an antiinflammatory effect. CONCLUSIONS Direct AT(2) receptor stimulation may be a novel therapeutic approach to improve post-MI systolic and diastolic function by antiapoptotic and antiinflammatory mechanisms.
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Affiliation(s)
- Elena Kaschina
- Center for Cardiovascular Research, Institute of Pharmacology, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Affiliation(s)
- Kristof Graf
- From the Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Thomas Hucko
- From the Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Philipp Stawowy
- From the Department of Medicine/Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
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