T Sueselbeck

Publications of T Sueselbeck

• Clinical assessment of chest pain and guidelines for imaging.

  Authors: J Gruettner, T Henzler, T Sueselbeck, C Fink, M Borggrefe, T Walter

  European journal of radiology. 03/2011;

  For many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societiesFor many emergency facilities, risk assessment of patients with diffuse chest pain still poses a major challenge. In their currently valid recommendations, the international cardiological societies have defined a standardized assessment of the prognostically relevant cardiac risk criteria. Here the classic sequence of basic cardiac diagnostics including case history (cardiac risk factors), physical examination (haemodynamic and respiratory vital parameters), ECG (ST segment analysis) and laboratory risk markers (troponin levels) is paramount. The focus is, on the one hand, on timely indication for percutaneous catheterization, especially in patients at high cardiac risk with or without ST-segment elevation in the ECG, and, on the other hand, on the possibility of safely discharging patients with intermediate or low cardiac risk after non-invasive exclusion of a coronary syndrome. For patients in the intermediate or low risk group, physical or pharmacological stress testing in combination with scintigraphy, echocardiography or magnetic resonance imaging is recommended in addition to basic diagnostics. Moreover, the importance of non-invasive coronary imaging, primarily cardiac CT angiography (CCTA), is increasing. Current data show that in intermediate or low risk patients this method is suitable to reliably rule out coronary heart disease. In addition, attention is paid to the major differential diagnoses of acute coronary syndrome, particularly pulmonary embolism and aortic dissection. Here the diagnostic method of choice is thoracic CT, possibly also in combination with CCTA aiming at a triple rule-out.

• [Magnetic navigation in invasive electrophysiological diagnostic and therapy]

  Authors: R Schimpf, T Reents, G Hessling, I Deisenhofer, A Pflaumer, H Estner, J Wu, E Ucer, B Zrenner, T Sueselbeck, J Kuschyk, C Veltmann, M Borggrefe, C Wolpert

  Herzschrittmachertherapie & Elektrophysiologie. 10/2007; 18(3):157-65.

  Electrophysiological stimulation and ablation is currently performed with manually deflectable catheters of different lengths and curves. Disadvantages of conventional therapy are catheter stiffness,Electrophysiological stimulation and ablation is currently performed with manually deflectable catheters of different lengths and curves. Disadvantages of conventional therapy are catheter stiffness, limited local stability, risk of dislocation or perforation, and reduced tissue contact in regions with difficult access. Fluoroscopy to control catheter movement and position may require substantial radiation times. Magnetic navigation was first applied for right heart catherization in congenital heart disease in 1991; the first electrophysiological application took place in 2003. Today, an ablation electrode with small magnets is aligned in the patient's heart by two external magnets positioned at both sides of the thorax. Antegrade and retrograde movement of the distal catheter tip are performed via an external device on the patient's thigh. Three-dimensional MRI scans acquired before intervention can be merged with electroanatomical reconstruction, leading to further reductions of radiation burden. During treatment of supraventricular tachyarrhythmias high local precision of magnetically guided catheters, good local stability, and a substantially reduced radiation time have been reported. First applications in ventricular tachyarrhythmias and complex congenital cardiac defects indicate a comparable effect. Limitations of this therapy are the application in left atrial procedures (open irrigated ablation catheters not yet available), difficult transaortic retrograde approach (high lead flexibility), and the considerable costs. Magnet-assisted navigation is feasible during percutaneous coronary interventions of tortuous coronary arteries and in positioning guidewires in coronary sinus side branches for resynchronisation therapy. Future applications will be complex left atrial procedures, magnetically guided cardiac stem cell therapy, local drug application, and extracardiac vessel therapy.

• Diagnostic value of stress echocardiography for the detection of restenosis after PTCA.

  Authors: A Scherhag, S Pfleger, K K Haase, T Sueselbeck, M Borggrefe

  International journal of cardiology. 03/2005; 98(2):191-7.

  Stress echocardiography (SE) has become a widely accepted clinical tool for the non-invasive diagnosis of coronary artery disease (CAD). Previous studies have confirmed that SE has superiorStress echocardiography (SE) has become a widely accepted clinical tool for the non-invasive diagnosis of coronary artery disease (CAD). Previous studies have confirmed that SE has superior diagnostic value compared to exercise ECG testing. SE has also emerged as a cost-effective alternative to nuclear imaging techniques in patients where symptoms and/or conventional ECG stress testing have provided ambiguous results. Several studies have investigated the value of SE to detect significant restenosis after PTCA. However, in these studies, different methods have been used to induce cardiovascular stress such as physical exercise by bicycle or treadmill, pharmacologic stress testing (with dipyridamole or dobutamine) or transoesphageal atrial pacing. This review evaluates the published database of SE to detect restenosis in patients after successful PTCA. It includes 13 studies with a total of 989 patients performed at 3-6 months after the primary intervention. The diagnostic value, utility and limitations of SE is presented and discussed. The data show that SE has a high diagnostic value for detecting significant restenosis after PTCA. Mean sensitivity of SE was 74% (CI 69-79%), mean specificity was 87% (CI 84-89%). The positive predictive value (PPV) of SE was 83%, the overall negative predictive value (NPV) 97%. We conclude that, in the follow-up of patients after PTCA, SE has distinct advantages over other non-invasive methods and is a recommended method for the detection of those to be considered for repeat angiography.

• Comparison of impedance cardiography and thermodilution-derived measurements of stroke volume and cardiac output at rest and during exercise testing.

  Authors: A Scherhag, J J Kaden, E Kentschke, T Sueselbeck, M Borggrefe

  Cardiovascular drugs and therapy / sponsored by the International Society of Cardiovascular Pharmacotherapy. 03/2005; 19(2):141-7.

  BACKGROUND: Non-invasive evaluation of haemodynamic variables remains a preferable and attractive option in both pharmacologic research and clinical cardiology. OBJECTIVES: The objective of thisBACKGROUND: Non-invasive evaluation of haemodynamic variables remains a preferable and attractive option in both pharmacologic research and clinical cardiology. OBJECTIVES: The objective of this study was to evaluate the correlation, feasibility and diagnostic value of haemodynamic measurements by ICG with the thermodilution (TD) method at rest and during exercise testing. METHODS: We measured stroke volume (SV) and cardiac output (CO) with both methods in 20 patients with suspected coronary artery disease (CAD). All measurements were performed simultaneously at rest and during bicycle exercise. RESULTS: There was a highly significant correlation (p < 0.001) for measurements of SV between both methods at rest (r = 0.83) and during exercise (r = 0.85-0.87) with 50-100 watts. For measurements of CO, the respective correlations were r = 0.85 at rest and r = 0.92-0.94 during exercise. The mean difference for measurements of SV were 3.8 +/- 12.6 ml at rest and 6.5+/- 11.4 ml during exercise. For measurements of CO, the mean difference between both methods was 0.9 +/- 1.0 l/min at rest and 1.0+/- 0.8 l/min during exercise. Compared to TD measurements, ICG had a bias to overestimate SV and CO of approximately by 5-10%. One patient had to be excluded because of inappropriate quality of the ICG signals during exercise. CONCLUSIONS: ICG is a feasible and accurate method for non-invasive measurements of SV and CO. Haemodynamic measurements by ICG were correlated highly significant to simultaneous measurements by the TD method.

• Automated impedance cardiography for detecting ischemic left ventricular dysfunction during exercise testing.

  Authors: A Scherhag, S Pfleger, E Garbsch, J Buss, T Sueselbeck, M Borggrefe

  Kidney & blood pressure research. 02/2005; 28(2):77-84.

  Automated impedance cardiography (ICG) is an attractive method for noninvasive hemodynamic evaluation. The objective of our study was to evaluate the feasibility and diagnostic value automated ICG inAutomated impedance cardiography (ICG) is an attractive method for noninvasive hemodynamic evaluation. The objective of our study was to evaluate the feasibility and diagnostic value automated ICG in patients with suspected coronary artery disease (CAD). We measured stroke index (SI) and cardiac index (CI) in 65 patients with suspected CAD at rest and during bicycle exercise testing. All patients underwent subsequent cardiac catheterization including coronary angiography (CA). Depending on the results of CA, patients were divided into three groups, patients without significant CAD (group 0), single vessel disease (group 1) or multivessel disease (group 2-3). In a subset of 20 patients, automated ICG was compared to measurements of CI by the thermodilution (TD) method. Results: There were no significant differences in SI and CI at baseline between the three groups. At 75- and 100-watt exercise, patients in group 2-3 showed significantly lower mean values of SI and CI as compared to patients of group 0 and group 1 (all p < 0.05), indicating exercise-induced ischaemic left ventricular (LV) dysfunction. Three patients had to be excluded because of inappropriate quality of the ICG signals during exercise. Comparison of automated ICG with TD measurements of CI showed good correlations between both methods at rest (r = 0.73) and during exercise (r = 0.89-0.91). Conclusions: We conclude that hemodynamic monitoring by automated ICG is both feasible and practical during exercise testing. Automated ICG can provide reliable and valuable additional diagnostic information on LV function during exercise which is helpful for selecting those patients for angiography who are likely to benefit from coronary interventions.

• Paradoxical coronary embolism causing non-ST segment elevation myocardial infarction in a case of pulmonary embolism.

  Authors: D Haghi, T Sueselbeck, T Papavassiliu, K K Haase, M Borggrefe

  Zeitschrift für Kardiologie. 11/2004; 93(10):824-8.

  We describe the case of a 61-year-old woman who simultaneously suffered a pulmonary embolism and a myocardial infarction due to paradoxical coronary artery embolism. Transesophageal echocardiographyWe describe the case of a 61-year-old woman who simultaneously suffered a pulmonary embolism and a myocardial infarction due to paradoxical coronary artery embolism. Transesophageal echocardiography with injection of agitated hydroxyethyl starch revealed a patent foramen ovale. Thrombophlebistis of the left saphenous vein with extension of thrombus into the femoral vein could be identified as the source of embolism. Paradoxical coronary embolism is an underrecognized cause of MI. Diagnosis is particularly difficult, when MI and PE coincide, because of the similarity in clinical signs and symptoms of both entities. A high level of clinical suspicion and echocardiography, especially if performed soon after presentation, can be the clue to early diagnosis of PDE.

• Attenuation-based characterization of coronary atherosclerotic plaque: comparison of dual source and dual energy CT with single-source CT and histopathology

  Authors: T. Henzler, S. Porubsky, H. Kayed, N. Harder, U. R. Krissak, M. Meyer, T. Sueselbeck, A. Marx, H. Michaely, U. J. Schoepf, S. O. Schoenberg, C. Fink

  Eur J Radiol. 80(1):54-9.

  OBJECTIVE: To compare different CT acquisition techniques regarding for attenuation-based characterization of coronary atherosclerotic plaques using histopathology as the standard of reference.OBJECTIVE: To compare different CT acquisition techniques regarding for attenuation-based characterization of coronary atherosclerotic plaques using histopathology as the standard of reference. MATERIALS AND METHODS: In a post mortem study 17 human hearts were studied with dual-source CT (DSCT) and dual energy CT (DECT) mode on a DSCT as well as with 16-slice single-source CT (SSCT). At autopsy, atherosclerotic lesions were cut at 5 mum sections. Histopathologic classification of the plaques according to the American Heart Association (AHA) criteria was performed by two pathologists. Attenuation values of all plaques were measured in DSCT, DECT and SSCT studies, respectively and classified based on attenuation according to modified AHA criteria. RESULTS: 58 coronary plaques were identified at autopsy. Regardless of the CT technique only 52/58 plaques were found at CT (sensitivity=89.6%). There was no significant difference between the mean attenuation values of different plaque types between DSCT, DECT, and SSCT: type IV: 11HU/8HU/19HU; type Va: 44HU/45HU/52HU; type Vb: 1088HU/966HU/1079HU). The sensitivity for correct classification varied depending on the plaque type (type II=0%, type III=0%, type IV=43%, type Va=58%, Vb=97%). CONCLUSION: Independent of the used acquisition technique, SSCT, DSCT and DECT show similar results for attenuation-based characterization of atherosclerotic coronary plaques.

• Attenuation-based characterization of coronary atherosclerotic plaque: comparison of dual source and dual energy CT with single-source CT and histopathology

  Authors: T. Henzler, S. Porubsky, H. Kayed, N. Harder, U. R. Krissak, M. Meyer, T. Sueselbeck, A. Marx, H. Michaely, U. J. Schoepf, S. O. Schoenberg, C. Fink

  Eur J Radiol. 80(1):54-9.

  OBJECTIVE: To compare different CT acquisition techniques regarding for attenuation-based characterization of coronary atherosclerotic plaques using histopathology as the standard of reference.OBJECTIVE: To compare different CT acquisition techniques regarding for attenuation-based characterization of coronary atherosclerotic plaques using histopathology as the standard of reference. MATERIALS AND METHODS: In a post mortem study 17 human hearts were studied with dual-source CT (DSCT) and dual energy CT (DECT) mode on a DSCT as well as with 16-slice single-source CT (SSCT). At autopsy, atherosclerotic lesions were cut at 5 mum sections. Histopathologic classification of the plaques according to the American Heart Association (AHA) criteria was performed by two pathologists. Attenuation values of all plaques were measured in DSCT, DECT and SSCT studies, respectively and classified based on attenuation according to modified AHA criteria. RESULTS: 58 coronary plaques were identified at autopsy. Regardless of the CT technique only 52/58 plaques were found at CT (sensitivity=89.6%). There was no significant difference between the mean attenuation values of different plaque types between DSCT, DECT, and SSCT: type IV: 11HU/8HU/19HU; type Va: 44HU/45HU/52HU; type Vb: 1088HU/966HU/1079HU). The sensitivity for correct classification varied depending on the plaque type (type II=0%, type III=0%, type IV=43%, type Va=58%, Vb=97%). CONCLUSION: Independent of the used acquisition technique, SSCT, DSCT and DECT show similar results for attenuation-based characterization of atherosclerotic coronary plaques.

• 439 Validation of the ratio of transaortic Doppler-derived peak to mean pressure gradient as a new method for assessing aortic stenosis using the Gorlin formula

  Authors: D Haghi, J J Kaden, T Sueselbeck, S. Fluechter, O A Breithardt, M Borggrefe, T Papavassiliu

• 214 Can stress echocardiography with tissue characterization evaluate non-critical coronary stenosis? A validation study against simultaneous measurement of fractional flow reserve

  Authors: T.C. Poerner, S. Vilardi, B. Goebel, D Haghi, T Sueselbeck