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Arnt V Kristen, Stephanie Lehrke,
Sebastian Buss,
Derliz Mereles,
Henning Steen,
Philipp Ehlermann,
Stefan Hardt,
Evangelos Giannitsis,
Rupert Schreiner,
Uwe Haberkorn,
Philipp A Schnabel,
Reinhold P Linke,
Christoph Röcken,
Erich E Wanker,
Thomas J Dengler,
Klaus Altland,
Hugo A Katus
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ABSTRACT: Treatment options in patients with amyloidotic transthyretin (ATTR) cardiomyopathy are limited. Epigallocatechin-3-gallate (EGCG), the most abundant catechin in green tea (GT), inhibits fibril formation from several amyloidogenic proteins in vitro. Thus, it might also halt progression of TTR amyloidosis. This is a single-center observational report on the effects of GT consumption in patients with ATTR cardiomopathy.
19 patients with ATTR cardiomyopathy were evaluated by standard blood tests, echocardiography, and cardiac MRI (n = 9) before and after consumption of GT and/or green tea extracts (GTE) for 12 months.
Five patients were not followed up for reasons of death (n = 2), discontinuation of GT/GTE consumption (n = 2), and heart transplantation (n = 1). After 12 months no increase of left ventricular (LV) wall thickness and LV myocardial mass was observed by echocardiography. In the subgroup of patients evaluated by cardiac MRI a mean decrease of LV myocardial mass (-12.5 %) was detected in all patients. This was accompanied by an increase of mean mitral annular systolic velocity of 9 % in all 14 patients. Total cholesterol (191.9 ± 8.9 vs. 172.7 ± 9.4 mg/dL; p < 0.01) and LDL cholesterol (105.8 ± 7.6 vs. 89.5 ± 8.0 mg/dL; p < 0.01) decreased significantly during the observational period. No serious adverse effects were reported by any of the participants.
Our observation suggests an inhibitory effect of GT and/or GTE on the progression of cardiac amyloidosis. We propose a randomized placebo-controlled investigation to confirm our observation.
Clinical Research in Cardiology 05/2012; 101(10):805-13. · 2.95 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 05/2012; 13:1-2. · 3.72 Impact Factor
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Clinical Research in Cardiology 04/2012; 96(2):122-124. · 2.95 Impact Factor
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ABSTRACT: BackgroundWhole-body magnetic resonance angiography (WB-MRA) has shown its potential for the non-invasive assessment of nearly the entire
arterial vasculature within one examination. Since the presence of extra-cardiac atherosclerosis is associated with an increased
risk of coronary events, our goal was to establish the relationship between WB-MRA findings, including a systemic atherosclerosis
score index, and the presence of significant coronary artery disease (CAD).
MethodsWB-MRA was performed on a 1.5T scanner in 50 patients scheduled to undergo elective cardiac catheterization for suspected
CAD. In each patient, 40 extra-cardiac vessel segments were evaluated and assigned scores according to their luminal narrowing.
The atherosclerosis score index (ASI) was generated as the ratio of summed scores to analyzable segments.
ResultsASI was higher in patients with significant (> 50% stenosis) CAD (n = 27) vs. patients without CAD (n = 22; 1.56 vs. 1.28,
p = 0.004). ASI correlated with PROCAM (R = 0.57, p < 0.001) and Framingham (R = 0.36, p = 0.01) risk scores as estimates
of the 10-year risk of coronary events. A ROC derived ASI of > 1.54 predicted significant CAD with a sensitivity of 59%, specificity
of 86% and a positive predictive value of 84%. Logistic regression revealed ASI > 1.54 as the strongest independent predictor
for CAD with a 11-fold increase in likelihood to suffer from significant coronary disease. On the contrary, while 15/27 (55%)
of patients with CAD exhibited at least one extra-cardiac stenosis > 50%, only 3/22 (14%) of those patients without CAD did
(p = 0.003). The likelihood for an extra-cardiac stenosis when CAD is present differed between vascular territories and ranged
from 15% for a carotid stenosis to 44% for a stenosis in the lower extremities.
ConclusionThis study provides important new evidence for the close association of extra-cardiac and coronary atherosclerosis. The novel
findings that a WB-MRA derived systemic atherosclerosis score index is not only associated with established cardiovascular
risk scores but is also predictive of significant CAD suggest its potential prognostic implications and underline the importance
to screen for coronary disease in patients with extra-cardiac manifestations of atherosclerosis.
Journal of Cardiovascular Magnetic Resonance 04/2012; 11(1):1-10. · 3.72 Impact Factor
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ABSTRACT: Cardiac troponins not only allow for risk stratification and guidance of therapy in unstable angina and non-Q-wave acute myocardial
infarction but also may be useful in the diagnostic workup and monitoring of patients with ST-segment elevation myocardial
infarction. In clinical practice, troponins are used for confirmation and monitoring of myocardial infarction, non-invasive
prediction of reperfusion success after thrombolytic therapy, and non-invasive estimation of infarct size. Accumulating evidence
suggests that the measurement of cardiac troponins on admission may represent a relatively novel application that is useful
for early risk stratification and prediction of reperfusion success after thrombolysis or primary percutaneous coronary interventions.
Potential mechanisms of the predictive power of cardiac troponins are discussed.
Cardiovascular Toxicology 04/2012; 1(2):99-104. · 2.07 Impact Factor
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ABSTRACT: Cardiovascular magnetic resonance (CMR) T2-imaging is oedema-sensitive and can detect increased myocardial water content to potentially distinguish acute from chronic myocardial infarction (AMI/CMI). Currently applied conventional black-blood T2-weighted-turbo-spin-echo (T2-BB-TSE)-sequences cause various artefacts which limit their image quality and possibly hamper their interpretation. Image contrast of conventional cine steady-state free precession (SSFP)-sequences partly consists of T2 oedema-sensitive information. We therefore sought to prospectively evaluate SSFP cine-imaging to detect myocardial oedema and differentiate AMI from CMI.
We examined 60 patients with AMI, 30 patients with CMI and 30 healthy volunteers using a 1.5 Tesla-MR whole body scanner. In a blinded fashion, myocardial oedema was assessed with T2-BB-TSE and SSFP-sequences, late gadolinium contrast-enhanced (LGE) CMR images being deemed as the standard reference for identification of infarcted myocardium. Assessment of presence of CMR detectable myocardial oedema was performed visually and quantitatively. P < 0.05 was considered statistically significant.
The contrast-to-noise ratio (CNR) in AMI patients was significantly higher (SSFP-STEMI and SSFP-NSTEMI: 19 ± 12 and 20 ± 14; T2-BB-TSE STEMI and T2-BB-TSE-NSTEMI: 33 ± 16 and 31 ± 13) than in CMI for both MR-sequences (SSFP-STEMI and NSTEMI: 3.5 ± 1.5 and T2-BB-TSE:9.3 ± 9.6, p for all <0.001). By visual analysis, SSFP images achieved a sensitivity of 96%, a specificity of 87%, positive and negative predictive values of 95 and 92% when compared to the existence of gadolinium contrast-enhanced scar imaging. Similarly, for T2-BB-TSE, sensitivity and specificity were 93 and 83% with positive and negative predictive values of 92 and 90%. Inter-observer variability was 0.90 for SSFP and 0.83 for T2-BB-TSE images.
A standard clinical SSFP sequence is not inferior to T2-BB-TSE for the detection of myocardial oedema and can be used to reliably distinguish AMI from CMI. Especially in patients with insufficient T2-BB-TSE image quality, the SSFP sequence may be an alternative for the detection of myocardial oedema.
Clinical Research in Cardiology 02/2012; 101(2):125-31. · 2.95 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:O100. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P164. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P173. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P223. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:M7. · 3.72 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P168. · 3.72 Impact Factor
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ABSTRACT: To assess coronary artery image quality and patient radiation exposure in patients who underwent clinically indicated 256-slice CTA.
Consecutive patients (n=193) underwent 256-slice CTA, using (1) retrospective gating without radiation dose modulation, (2) retrospective gating with radiation dose modulation and (3) prospective gating. Image quality was determined by consensus of two experienced observers using a 5-grade scale. The effective dose was calculated.
In all patients, CTA was performed without adverse events. Retrospective CTA was assessed in 39 patients with and 39 without dose modulation, while 115 patients underwent prospective CTA. Heart rate was related to image quality with all protocols (r=0.46, p<0.001). Up to a heart rate of 75 bpm no significant difference in overall image quality was observed for all three protocols, while no significant differences could be observed between retrospective CTA with and without dose modulation for any segments or heart rates. Prospective and retrospective CTA with dose modulation showed radiation savings of ∼75 % and ∼30 %, respectively compared to retrospective CTA without dose modulation (p<0.001).
In patients with heart rates up to 75 bpm prospective CTA should be the first choice acquisition protocol. For heart rates >75 bpm, retrospective CTA with dose modulation should be considered.
European journal of radiology 10/2011; 80(1):127-35. · 2.65 Impact Factor
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ABSTRACT: The purpose of this study was to determine the prognostic value of strain-encoded magnetic resonance imaging (SENC) during high-dose dobutamine stress cardiac magnetic resonance imaging (DS-MRI) compared with conventional wall motion readings.
Detection of inducible ischemia by DS-MRI on the basis of assessing cine images is subjective and depends on the experience of the readers, which may influence not only the diagnostic classification but also the risk stratification of patients with ischemic heart disease.
In all, 320 consecutive patients with suspected or known coronary artery disease underwent DS-MRI, using a standard protocol in a 1.5T MR scanner. Wall motion abnormalities (WMA) and myocardial strain were assessed at baseline and during stress, and outcome data including cardiac deaths, nonfatal myocardial infarctions ("hard events"), and revascularization procedures performed >90 days after the MR scans were collected.
Thirty-five hard events occurred during a 28 ± 9 month follow-up period, including 10 cardiac deaths and 25 nonfatal myocardial infarctions, and 32 patients underwent coronary revascularization. Using a series of Cox proportional-hazards models, both resting and inducible WMA offered incremental information for the assessment of hard cardiac events compared to clinical variables (chi-square = 13.0 for clinical vs. chi-square = 26.1 by adding resting WMA, p < 0.001, vs. chi-square = 39.3 by adding inducible WMA, p < 0.001). Adding visual SENC or quantitative strain rate reserve to this model further improved the prediction of outcome (chi-square = 50.7 vs. chi-square = 52.5, p < 0.001 for both). In a subset of patients (n = 175) who underwent coronary angiography, SENC yielded significantly higher sensitivity for coronary artery disease detection (96% vs. 84%, p < 0.02), whereas specificity and accuracy were not significantly different (88% vs. 94% and 93% vs. 88%, p = NS for both).
Strain-encoded MRI aids the accurate identification of patients at high risk for future cardiac events and revascularization procedures, beyond the assessment of conventional atherogenic risk factors and resting or inducible WMA on cine images. (Strain-Encoded Cardiac Magnetic Resonance Imaging as an Adjunct for Dobutamine Stress Testing; NCT00758654).
Journal of the American College of Cardiology 09/2011; 58(11):1140-9. · 14.16 Impact Factor
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Clinical Research in Cardiology 02/2011; 100(6):547-51. · 2.95 Impact Factor
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
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Journal of Cardiovascular Magnetic Resonance. 01/2011;
