Tim Süselbeck

Publications of Tim Süselbeck

• Tackling myocardial metabolism: One year evaluation of free fatty acids, norephinephrine and NT-proBNP in ventricular fibrillation during STEMI.

  Authors: Michael Behnes, Thorsten Kälsch, Siegfried Lang, Tim Süselbeck, Martin Borggrefe, Elif Elmas

  International journal of cardiology. 01/2012; 155(2):291-3.

• Cellular imaging of human atherosclerotic lesions by intravascular electric impedance spectroscopy.

  Authors: Ines Streitner, Markus Goldhofer, Sungbo Cho, Ralf Kinscherf, Hagen Thielecke, Martin Borggrefe, Tim Süselbeck, Florian Streitner

  PloS one. 01/2012; 7(4):e35405.

  Newer techniques are required to identify atherosclerotic lesions that are prone to rupture. Electric impedance spectroscopy (EIS) is able to provide information about the cellular composition ofNewer techniques are required to identify atherosclerotic lesions that are prone to rupture. Electric impedance spectroscopy (EIS) is able to provide information about the cellular composition of biological tissue. The present study was performed to determine the influence of inflammatory processes in type Va (lipid core, thick fibrous cap) and Vc (abundant fibrous connective tissue while lipid is minimal or even absent) human atherosclerotic lesions on the electrical impedance of these lesions measured by EIS. EIS was performed on 1 aortic and 3 femoral human arteries at 25 spots with visually heavy plaque burden. Severely calcified lesions were excluded from analysis. A highly flexible micro-electrode mounted onto a balloon catheter was placed on marked regions to measure impedance values at 100 kHz. After paraffin embedding, visible marked cross sections (n = 21) were processed. Assessment of lesion types was performed by Movats staining. Immunostaining for CD31 (marker of neovascularisation), CD36 (scavenger cells) and MMP-3 (matrix metalloproteinase-3) was performed. The amount of positive cells was assessed semi-quantitatively. 15 type Va lesions and 6 type Vc lesions were identified. Lesions containing abundant CD36-, CD31- and MMP-3-positive staining revealed significantly higher impedance values compared to lesions with marginal or without positive staining (CD36+455±50 Ω vs. CD36- 346±53 Ω, p = 0.001; CD31+436±43 Ω vs. CD31- 340±55 Ω, p = 0.001; MMP-3+ 400±68 Ω vs. MMP-3- 323±33 Ω, p = 0.03). Atherosclerotic lesions with abundant neovascularisation (CD31), many scavenger receptor class B expressing cells (CD36) or high amount of MMP-3 immunoreactivity reveal significantly higher impedance values compared to lesions with marginal or no detection of immunoreactivity. Findings suggest that inflammatory processes in vulnerable plaques affect the impedance of atherosclerotic lesions and might therefore be detected by EIS.

• Incidence and severity of coronary artery disease in patients with atrial fibrillation undergoing first-time coronary angiography.

  Authors: Stefan Kralev, Kathrin Schneider, Siegfried Lang, Tim Süselbeck, Martin Borggrefe

  PloS one. 01/2011; 6(9):e24964.

  In standard reference sources, the incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. Since then, the incidence of cardiovascular riskIn standard reference sources, the incidence of coronary artery disease (CAD) in patients with atrial fibrillation (AF) ranged between 24 and 46.5%. Since then, the incidence of cardiovascular risk factors (CRF) has increased and modern treatment strategies ("pill in the pocket") are only applicable to patients without structural heart disease. The aim of this study was to investigate the incidence and severity of CAD in patients with AF. From January 2005 until December 2009, we included 261 consecutive patients admitted to hospital with paroxysmal, persistent or permanent AF in this prospective study. All patients underwent coronary angiography and the Framingham risk score (FRS) was calculated. Patients with previously diagnosed or previously excluded CAD were excluded. The overall incidence of CAD in patients presenting with AF was 34%; in patients >70 years, the incidence of CAD was 41%. The incidence of patients undergoing a percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) was 21%. Patients with CAD were older (73±8 years vs 68±10 years, p = 0.001), had significantly more frequent hypercholesterolemia (60% vs 30%, p<0.001), were more frequent smokers (26% vs 13%, p = 0.017) and suffered from angina more often (37% vs 2%, p<0.001). There was a significant linear trend among the FRS categories in percentage and the prevalence of CAD and PCI/CABG (p<0.0001). The overall incidence of CAD in patients presenting with AF was relatively high at 34%; the incidence of PCI/CABG was 21%. Based upon increasing CRF in the western world, we recommend a careful investigation respecting the FRS to either definitely exclude or establish an early diagnosis of CAD--which could contribute to an early and safe therapeutic strategy considering type Ic antiarrhythmics and oral anticoagulation.

• Expansion of the Multi-Link Frontier™ coronary bifurcation stent: micro-computed tomographic assessment in human autopsy and porcine heart samples.

  Authors: Stefan Kralev, Benjamin Haag, Jens Spannenberger, Siegfried Lang, Marc A Brockmann, Soenke Bartling, Alexander Marx, Karl-Konstantin Haase, Martin Borggrefe, Tim Süselbeck

  PloS one. 01/2011; 6(7):e21778.

  Treatment of coronary bifurcation lesions remains challenging, beyond the introduction of drug eluting stents. Dedicated stent systems are available to improve the technical approach to the treatmentTreatment of coronary bifurcation lesions remains challenging, beyond the introduction of drug eluting stents. Dedicated stent systems are available to improve the technical approach to the treatment of these lesions. However dedicated stent systems have so far not reduced the incidence of stent restenosis. The aim of this study was to assess the expansion of the Multi-Link (ML) Frontier™ stent in human and porcine coronary arteries to provide the cardiologist with useful in-vitro information for stent implantation and selection. Nine ML Frontier™ stents were implanted in seven human autopsy heart samples with known coronary artery disease and five ML Frontier™ stents were implanted in five porcine hearts. Proximal, distal and side branch diameters (PD, DD, SBD, respectively), corresponding opening areas (PA, DA, SBA) and the mean stent length (L) were assessed by micro-computed tomography (micro-CT). PD and PA were significantly smaller in human autopsy heart samples than in porcine heart samples (3.54±0.47 mm vs. 4.04±0.22 mm, p = 0.048; 10.00±2.42 mm(2) vs. 12.84±1.38 mm(2), p = 0.034, respectively) and than those given by the manufacturer (3.54±0.47 mm vs. 4.03 mm, p = 0.014). L was smaller in human autopsy heart samples than in porcine heart samples, although data did not reach significance (16.66±1.30 mm vs. 17.30±0.51 mm, p = 0.32), and significantly smaller than that given by the manufacturer (16.66±1.30 mm vs. 18 mm, p = 0.015). Micro-CT is a feasible tool for exact surveying of dedicated stent systems and could make a contribution to the development of these devices. The proximal diameter and proximal area of the stent system were considerably smaller in human autopsy heart samples than in porcine heart samples and than those given by the manufacturer. Special consideration should be given to the stent deployment procedure (and to the follow-up) of dedicated stent systems, considering final intravascular ultrasound or optical coherence tomography to visualize (and if necessary optimize) stent expansion.

• Sex-based differences in clinical and angiographic outcomes in patients with ST-elevation myocardial infarction treated with concomitant use of glycoprotein IIb/IIIa inhibitors.

  Authors: Stefan Kralev, Oliver Hennig, Siegfried Lang, Thorsten Kälsch, Martin Borggrefe, Carl-Erik Dempfle, Tim Süselbeck

  Cardiology journal. 01/2010; 17(6):580-6.

  The widespread use of primary coronary intervention (PCI) has significantly improved the prognosis of men presenting with acute coronary syndromes, but the cardiovascular event rate among women hasThe widespread use of primary coronary intervention (PCI) has significantly improved the prognosis of men presenting with acute coronary syndromes, but the cardiovascular event rate among women has either levelled off or increased. The purpose of the present prospective study was to compare the clinical outcome of women and men presenting with ST-elevation myocardial infarction (STEMI) undergoing primary PCI with concomitant usage of GP IIb/IIIa inhibitors. Between January 2006 and December 2007, 297 consecutive patients presenting with STEMI were prospectively included in this single center investigation. Overall, 82 (27.6%) women and 215 (72.4%) men were treated by PCI with additional bare metal stent implantation and a GP IIb/IIIa inhibitor. Women were significantly older (65 ± 10 vs 60 ± 12 years, p = 0.04), presented with a smaller reference luminal diameter (2.83 ± 0.51 vs 2.94 ± 0.43, p = 0.03) and had a higher prevalence of hypertension (68% vs 53%, p = 0.025) and obesity (30% vs 18%, p = 0.03). The incidence of major adverse cardiac events (MACE, defined as death, re-myocardial infarction, target lesion revascularization and coronary artery bypass graft) during long-term follow-up was similar in women and men (20% vs 26%, p = 0.29). Age, C-reactive protein, platelet count and cardiogenic shock were identified as independent predictors for MACE, whereas gender was not predictive. In this study, female gender did not emerge as an independent predictor for MACE, but women presenting with STEMI had a higher cardiovascular risk profile; this emphasizes the need for a more extensive therapeutic strategy. Combination therapy with primary PCI and GP IIb/IIIa inhibitors might mitigate gender-related differences in clinical outcomes.

• Global and regional myocardial function quantification by two-dimensional strain in Takotsubo cardiomyopathy.

  Authors: Felix Heggemann, Christel Weiss, Karsten Hamm, Jens Kaden, Tim Süselbeck, Theano Papavassiliu, Martin Borggrefe, Dariusch Haghi

  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology. 05/2009;

  AIMS: This study sought to characterize global and regional systolic function in Takotsubo cardiomyopathy (TC) using two-dimensional (2D) strain imaging. METHODS AND RESULTS: Twelve consecutiveAIMS: This study sought to characterize global and regional systolic function in Takotsubo cardiomyopathy (TC) using two-dimensional (2D) strain imaging. METHODS AND RESULTS: Twelve consecutive patients (11 women, 1 man) underwent 2D echocardiography on admission and on early follow-up (34 +/- 16 days). Two-dimensional images were analysed to measure longitudinal and radial strain and to calculate post-systolic shortening (PSS) and the post-systolic index (PSI). Mean age was 64 +/- 14 years. Upon presentation ejection fraction, average longitudinal and radial strains were 42 +/- 9%, -10.6 +/- 5.5%, and 20.1 +/- 17.3%, respectively. Values improved to 59 +/- 8%, -17.6 +/- 3.0%, and 50.2 +/- 17.0%, respectively (all P < 0.001). PSS was present in 69% of segments upon presentation and in 53% of segments upon follow-up. PSI was -0.16 at baseline and improved to -0.06 upon follow-up (P < 0.001). CONCLUSION: Patients with TC show abnormal global and regional strain patterns during the acute phase of the disease which improve over time. However, subtle abnormalities of regional LV function seem to persist into the early follow-up period as suggested by the presence of PSS in more than half of LV segments. Long-term follow-up studies are needed to clarify whether these subtle abnormalities will further improve.

• Clinical outcome of patients with diabetes presenting with ST-elevation myocardial infarction and treated with concomitant use of glycoprotein IIb/IIIa inhibitors.

  Authors: Stefan Kralev, Barbara Krause, Theano Papavassiliu, Siegfried Lang, Dariusch Haghi, Thorsten Kälsch, Carl-Erik Dempfle, Martin Borggrefe, Tim Süselbeck

  Cardiology journal. 02/2009; 16(3):234-40.

  BACKGROUND: Percutaneous coronary intervention (PCI) with stent implantation is considered to be the standard treatment in patients presenting with ST-elevation myocardial infarction (STEMI).BACKGROUND: Percutaneous coronary intervention (PCI) with stent implantation is considered to be the standard treatment in patients presenting with ST-elevation myocardial infarction (STEMI). According to the American Heart Association (AHA)/American College of Cardiology (ACC) guidelines for STEMI, there is a class IIa recommendation (treatment reasonable) for platelet glycoprotein (GP) IIb/IIIa inhibitors. This study aims to compare the clinical outcome of patients with and without diabetes, presenting with STEMI undergoing primary PCI with concomitant usage of GP IIb/IIIa inhibitors in real clinical practice. METHODS: Over the course of three years (2004-2006) 394 consecutive patients presenting with STEMI were included in this single centre experience. There were 95 patients (24%) with, and 299 patients (76%) without, diabetes. A GP IIb/IIIa inhibitor was administered to all patients without contraindications (316 patients, 80%). RESULTS: Patients with diabetes were significantly older, more often suffered from hypertension and had a higher incidence of obesity. The rate of administration of GP IIb/IIIa inhibitors was similar in both groups (74% vs. 82%, p = 0.14). The in-hospital incidence of major adverse cardiac events (MACE, defined as death, re-myocardial infarction, target lesion revascularisation and coronary artery bypass graft) was similar in both patient groups (18 [19%] diabetics vs. 51 [17%] non-diabetics, p = 0.65). Hypertension, age and obesity were identified as predictors for MACE, whereas diabetes was not predictive. CONCLUSIONS: In this single centre experience, in diabetic and non-diabetic patients presenting with STEMI, combination therapy with primary PCI and GP IIb/IIIa inhibitors might have contributed to a similar clinical outcome.

• Elevation of the glycoxidation product N(epsilon)-(carboxymethyl)lysine in patients presenting with acute myocardial infarction.

  Authors: Stefan Kralev, Elke Zimmerer, Martina Brueckmann, Siegfried Lang, Thorsten Kälsch, Anja Rippert, Jihong Lin, Martin Borggrefe, Hans-Peter Hammes, Tim Süselbeck

  Clinical chemistry and laboratory medicine : CCLM / FESCC. 01/2009; 47(4):446-51.

  Abstract Background: An important role in the acceleration of vascular disease has been previously suggested for advanced glycation end products. N(epsilon)-(carboxymethyl)lysine (CML) is an advancedAbstract Background: An important role in the acceleration of vascular disease has been previously suggested for advanced glycation end products. N(epsilon)-(carboxymethyl)lysine (CML) is an advanced glycation end product formed on protein by combined non-enzymatic glycation and glycoxidation reactions. CML reacts with the receptor of advanced glycation end products inducing impairment of endothelium dependent relaxation and is a marker of oxidative stress. Methods: A total of 40 patients with acute myocardial infarction (17 patients with ST-elevation myocardial infarction, 23 patients with non-ST-elevation myocardial infarction) and 40 patients with stable coronary artery disease were included consecutively in this study. During coronary angiography, peripheral venous blood sample was taken for measuring CML. Results: Serum levels of CML were significantly increased in patients with acute myocardial infarction [17.9+/-10.7 vs. 6.6+/-3.1 arbitrary units (AU)/mg protein, p<0.001]. A cut-off value of CML>9.5 AU/mg protein was associated with an odds ratio of acute myocardial infarction of 39.7 [95% confidence interval (CI): 11.1-142, p<0.001], a sensitivity of 0.85 (95% CI: 0.70-0.94) and a specificity of 0.88 (95% CI: 0.73-0.96). Conclusions: CML levels are significantly elevated in patients presenting with acute myocardial infarction. These results suggest the involvement of endothelial dysfunction (through receptor interaction) and oxidative stress in acute myocardial infarction. Clin Chem Lab Med 2009;47:446-51.

• First report on the effect of thrombin and factor Xa on cardiomyocytes in a three-dimensional cell culture model.

  Authors: Sonja Alesci, Pia Bartholomae, Jens J Kaden, Hagen Thieleke, Tim Süselbeck, Christian Wolpert, Andrea Robitzki, Alexandra Reiniger-Mack, Martin Borggrefe, Carl-Erik Dempfle

  Thrombosis research. 01/2009;

• CMR findings in patients with hypertrophic cardiomyopathy and atrial fibrillation

  Authors: Theano Papavassiliu, Tjeerd Germans, Stephan Flüchter, Christina Doesch, Anton Suriyakamar, Dariusch Haghi, Tim Süselbeck, Christian Wolpert, Dietmar Dinter, Stefan Schoenberg, van Rossum Albert, Martin Borggrefe

  Journal of Cardiovascular Magnetic Resonance. 01/2009;

  Abstract Objectives We sought to evaluate the relation between atrial fibrillation (AF) and the extent of myocardial scarring together with left ventricular (LV) and atrial parameters assessed byAbstract Objectives We sought to evaluate the relation between atrial fibrillation (AF) and the extent of myocardial scarring together with left ventricular (LV) and atrial parameters assessed by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM). Background AF is the most common arrhythmia in HCM. Myocardial scarring is also identified frequently in HCM. However, the impact of myocardial scarring assessed by LGE CMR on the presence of AF has not been evaluated yet. Methods 87 HCM patients underwent LGE CMR, echocardiography and regular ECG recordings. LV function, volumes, myocardial thickness, left atrial (LA) volume and the extent of LGE, were assessed using CMR and correlated to AF. Additionally, the presence of diastolic dysfunction and mitral regurgitation were obtained by echocardiography and also correlated to AF. Results Episodes of AF were documented in 37 patients (42%). Indexed LV volumes and mass were comparable between HCM patients with and without AF. However, indexed LA volume was significantly higher in HCM patients with AF than in HCM patients without AF (68 ± 24 ml·m^-2versus 46 ± 18 ml·m^-2, p = 0.0002, respectively). The mean extent of LGE was higher in HCM patients with AF than those without AF (12.4 ± 14.5% versus 6.0 ± 8.6%, p = 0.02). When adjusting for age, gender and LV mass, LGE and indexed LA volume significantly correlated to AF (r = 0.34, p = 0.02 and r = 0.42, p < 0.001 respectively). By echocardiographic examination, LV diastolic dysfunction was evident in 35 (40%) patients. Mitral regurgitation greater than II was observed in 12 patients (14%). Multivariate analysis demonstrated that LA volume and presence of diastolic dysfunction were the only independent determinant of AF in HCM patients (p = 0.006, p = 0.01 respectively). Receiver operating characteristic curve analysis indicated good predictive performance of LA volume and LGE (AUC = 0.74 and 0.64 respectively) with respect to AF. Conclusion HCM patients with AF display significantly more LGE than HCM patients without AF. However, the extent of LGE is inferior to the LA size for predicting AF prevalence. LA dilation is the strongest determinant of AF in HCM patients, and is related to the extent of LGE in the LV, irrespective of LV mass.

• Percutaneous treatment of a coronary aneurysm by stent graft and drug-eluting stent implantation: a potential method to reduce stent graft restenosis.

  Authors: Tim Süselbeck, Dariusch Haghi, Martin Borggrefe, Jens J Kaden

  Journal of interventional cardiology. 09/2008; 21(4):325-8.

  Coronary artery aneurysms (CAAs) can occur congenitally or secondary to specific disorders such as Kawasaki disease or atherosclerosis. Apart from a surgical approach, CAA can be treated by coronaryCoronary artery aneurysms (CAAs) can occur congenitally or secondary to specific disorders such as Kawasaki disease or atherosclerosis. Apart from a surgical approach, CAA can be treated by coronary stent graft (CSG) implantation. However, restenosis is frequent after CSG placement, precluding a wider use of this technique. We hypothesized that implantation of a drug-eluting stent (DES) within a CSG could be of use to avoid CSG restenosis. We report the case of a patient with a large aneurysm of the right coronary artery who underwent CSG implantation followed by DES placement. The immediate angiographic result showed complete exclusion of the aneurysm. Intravascular ultrasound confirmed good apposition of both the CSG and DES. Follow-up angiography after 23 weeks demonstrated a good long-term result without restenosis. The patient has remained asymptomatic during 12 months of follow-up. In conclusion, the present case suggests that CSG placement followed by DES implantation is a safe and effective approach to treat coronary aneurysms interventionally.

• Local paclitaxel delivery after coronary stenting in an experimental animal model.

  Authors: Christoph Dommke, Karl K Haase, Tim Süselbeck, Ines Streitner, Dariush Haghi, Jürgen Metz, Martin Borggrefe, Christian Herdeg

  Thrombosis and haemostasis. 09/2007; 98(3):674-80.

  The goal of this study was to test the safety and efficacy of local paclitaxel delivery via a newly designed application catheter in an experimental animal study. Drug-eluting stents reduceThe goal of this study was to test the safety and efficacy of local paclitaxel delivery via a newly designed application catheter in an experimental animal study. Drug-eluting stents reduce restenosis in comparison to bare-metal stents. The drug-eluting polymer, however, may exert potential thrombogenic and inflammatory effects. A catheter-based local paclitaxel delivery offers further advantages, particularly a homogenous drug transfer into the vessel wall and a pharmacotherapy of the stent edges. In 30 pigs, both bare-metal stent (3.0 x 13 mm) implantation and balloon angioplasty were performed. Ten pigs received subsequent local delivery of paclitaxel-solution via a newly designed catheter (Genie, ACROSTAK corp., Switzerland), 10 animals served as a sham group and received vehicle (0.9% NaCl solution) and 10 animals were used as a control group. All animals were treated with aspirin and clopidogrel to prevent stent thrombosis. After final angiography the vessels were excised 42 days after intervention and prepared for histological and histomorphometric analysis. All coronary arteries showed complete endothelialization 42 days following treatment. Paclitaxel treatment led to a marked reduction of neointimal proliferation either post stent implantation (neointimal area: 1.04 +/- 0.10 mm(2) vs. 2.37 +/- 0.23 mm(2), p < 0.001) or post balloon dilatation (neontimal area: 0.35 +/- 0.14 mm(2), vs. 0.68 +/- 0.24 mm(2), p < 0.01). There were no significant angiographic or histomorphometric differences between the control and the sham group. In both paclitaxel groups neither angiographic edge phenomena nor a significant histomorphometric inflammatory response were found in the treated vessel segments. In conclusion, the local application of paclitaxel via the Genie catheter is safe and effective to significantly reduce the proliferative response post-stent implantation or balloon dilatation in an experimental animal model.

• Impact of mitral E/A ratio on the accuracy of different echocardiographic indices to estimate left ventricular end-diastolic pressure.

  Authors: Tudor C Poerner, Björn Goebel, Stefan Kralev, Jens J Kaden, Tim Süselbeck, Karl K Haase, Martin Borggrefe, Dariusch Haghi

  Ultrasound in medicine & biology. 06/2007; 33(5):699-707.

  The objective was to determine the influence of left ventricular (LV) inflow pattern on the accuracy of different echocardiographic indices for estimation of LV end-diastolic pressure (LVEDP).The objective was to determine the influence of left ventricular (LV) inflow pattern on the accuracy of different echocardiographic indices for estimation of LV end-diastolic pressure (LVEDP). Echocardiography with color tissue Doppler imaging (TDI) and LVEDP measurements using fluid-filled catheters were performed in 176 consecutive patients on the same day. Mitral peak diastolic velocities (E, A) and the difference in duration between pulmonary venous retrograde velocity and mitral A-velocity (PV(R)-A) were recorded by pulsed Doppler. Propagation velocity of the early mitral inflow (V(P)) was assessed using color M-mode. Early diastolic longitudinal (E'(lat)) and radial (E'(radial)) velocities of mitral annulus were measured by TDI. Area under ROC curve (AUC) for prediction of elevated LVEDP (> or =15 mm Hg) was computed for each parameter. For E/A > or =1 (98 patients, 46 with elevated LVEDP), the AUC values were: PV(R)-A: 0.914; E/E'(lat): 0.780; E/E'(radial): 0.729; E/V(P): 0.712 (p < 0.001). When E/A <1 (78 patients, 26 with elevated LVEDP), only PV(R)-A reached statistical significance (AUC = 0.893, p < 0.001). The conclusions were: PV(R)-A enabled the most accurate noninvasive estimation of LVEDP irrespective of LV filling profile and combined indices E/V(P), E/E'(lat) and E/E'(radial) represent more feasible alternatives for patients with mitral E/A-1.

• Extent of myocardial hyperenhancement on late gadolinium-enhanced cardiovascular magnetic resonance correlates with q waves in hypertrophic cardiomyopathy.

  Authors: Theano Papavassiliu, Stephan Flüchter, Dariusch Haghi, Tim Süselbeck, Christian Wolpert, Dietmar Dinter, Harald Kühl, Martin Borggrefe

  Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance. 02/2007; 9(3):595-603.

  PURPOSE: Despite several electrocardiographic, echocardiographic, electrophysiologic and pathologic studies, the cause of abnormal Q waves in patients with HCM remains unclear. CardiovascularPURPOSE: Despite several electrocardiographic, echocardiographic, electrophysiologic and pathologic studies, the cause of abnormal Q waves in patients with HCM remains unclear. Cardiovascular magnetic resonance (CMR) is a powerful in vivo diagnostic tool for evaluating cardiac morphology and function. We hypothesized that estimation of segmental and transmural extent of myocardial enhancement by late gadolinium enhancement (LGE) CMR could clarify the basis of Q waves. The purpose of this prospective study was to evaluate the morphological basis of abnormal Q waves in hypertrophic cardiomyopathy (HCM) as assessed by CMR. METHODS: Thirty-eight patients with HCM underwent gadolinium-enhanced CMR and 12 lead electrocardiography (ECG). Left ventricular function, volumes, segmental and transmural extent of myocardial LGE were assessed and analysed in relation to the presence of abnormal Q waves. RESULTS: Twelve (31%) of the 38 patients had abnormal Q waves on the ECG. Patients with Q waves exhibited significantly more myocardial LGE segmentally as well as transmurally than patients without Q waves. As the segmental and the transmural extent of LGE increased, the probability of Q wave increased (anterior: segmental extent chi2 = 10, p = 0.0013, transmural extent chi2 = 10, p = 0.0013; inferior: segmental extent chi2 = 13, p = 0.0003, transmural extent chi2 = 15, P < 0.0001: lateral: segmental extent chi2 = 10, p = 0.0016, transmural extent chi2 = 10, p = 0.0012). Additionally, the ratio of septal to posterior wall thickness was significantly higher in patients with Q waves than in patients without Q waves (2.3 vs. 1.6, p = 0.012). CONCLUSIONS: It seems that segmental and transmural extent rather than the mere presence of myocardial LGE is the underlying mechanism of abnormal Q waves in HCM. Additionally, distribution of hypertrophy as indicated by differences in the ratio of septal to posterior wall thickness seems to play an important role.

• Coagulation activation and expression of CD40 ligand on platelets upon in vitro lipopolysaccharide-challenge in patients with unstable angina.

  Authors: Thorsten Kälsch, Xuan Duc Nguyen, Elif Elmas, Nadine Grebert, Tim Süselbeck, Harald Klüter, Martin Borggrefe, Carl-Erik Dempfle

  International journal of cardiology. 09/2006; 111(2):217-23.

  BACKGROUND: Elevated markers of inflammation and coagulation are found in patients with coronary heart disease. A role of inflammatory stimulation on coagulation time and expression of CD40 ligand onBACKGROUND: Elevated markers of inflammation and coagulation are found in patients with coronary heart disease. A role of inflammatory stimulation on coagulation time and expression of CD40 ligand on platelets in acute coronary syndromes has not been described yet. METHODS AND RESULTS: Whole blood samples of 9 patients with coronary heart disease and stable angina, 10 patients with unstable angina, 7 patients with acute myocardial infarction and 7 patients without coronary heart disease were incubated with lipopolysaccharide (LPS). Coagulation time was measured in arterial and coronary blood with the ReoRox(R), a viscometric whole blood coagulometer. CD40L and CD62P expression on platelets and platelet-monocyte aggregates were measured by flow cytometry. Without LPS, patients with unstable angina showed a significantly decreased coagulation time in arterial and coronary blood compared to patients without coronary heart disease. After incubation with LPS, in patients with unstable angina, a significantly decreased coagulation time in coronary blood was observed compared to patients with stable angina or patients without coronary heart disease. CD40L expression on platelets in patients with unstable angina was significantly higher in arterial and coronary blood compared to patients with stable angina. No significant differences between the patient groups were observed concerning CD62P expression on platelets, tissue factor binding on monocytes, platelet-monocyte aggregates and plasma levels of platelet factor 4. CONCLUSIONS: Patients with unstable angina show an enhanced coagulation activation and an upregulation of CD40L on platelets. This may be of importance in the understanding of coronary plaque rupture and formation of coronary thrombosis.

• Direct stenting appears as effective as stenting following predilatation.

  Authors: Tim Süselbeck, Debbie Singh

  Evidence-based cardiovascular medicine. 07/2006; 10(2):119-20.

• Side branch occlusion after coronary stent implantation in patients presenting with ST-elevation myocardial infarction: clinical impact and angiographic predictors.

  Authors: Stefan Kralev, Tudor C Poerner, Daniel Basorth, Siegfried Lang, Christian Wolpert, Dariusch Haghi, Martin Borggrefe, Karl K Haase, Tim Süselbeck

  American heart journal. 02/2006; 151(1):153-7.

  BACKGROUND: The aim of this study was to assess the incidence and clinical outcome of the occlusion of major (> 1 mm) side branches following coronary stenting in patients undergoing percutaneousBACKGROUND: The aim of this study was to assess the incidence and clinical outcome of the occlusion of major (> 1 mm) side branches following coronary stenting in patients undergoing percutaneous coronary intervention for acute ST-elevation myocardial infarction (STEMI). METHODS: Among 276 consecutive patients presenting with STEMI, we found 80 patients (29%) with 101 stent-covered side branches. Clinical data and quantitative angiographic analysis were evaluated. Angiographic follow-up was available in 56 (70%) patients, and clinical follow-up could be completed in all patients. RESULTS: Acute side branch occlusion after stent implantation (SBO) was observed in 10 (12.5%) patients involving 11 (10.9%) side branches. Predictors for SBO were: (1) reference side branch diameter at baseline < or = 1.4 mm; (2) ostial side branch stenosis > 50%; and (3) minimal side branch diameter at baseline < or = 0.6 mm. During hospitalization, in the SBO group, 2 patients died in cardiogenic shock and 1 underwent bypass surgery; no events were causally related to SBO. During long-term follow-up, 1 patient with SBO developed repeat MI as opposed to 7 patients in the non-SBO group who developed major adverse cardiac events (1 death, 6 repeat revascularizations). CONCLUSIONS: The presence of a side branch originating from the target lesion in patients undergoing coronary stenting for acute STEMI is a frequent observation (29%) and is associated with a low incidence of side branch occlusion. Major predictors for SBO are the side branch size and the presence of an ostial side branch stenosis.

• Direct versus conventional stent implantation in patients with acute coronary syndrome just before the era of drug-eluting stents.

  Authors: Tim Süselbeck, Aysegül Türkoglu, Siegfried Lang, Barbara Krause, Stefan Kralev, Dariusch Haghi, Tudor Poerner, Jens Kaden, Martin Borggrefe, Karl K Haase

  International journal of cardiology. 11/2005; 105(1):85-9.

  BACKGROUND: Direct stent implantation in patients, who undergo elective percutaneous coronary intervention (PCI) can be performed with a high success rate and clinical results that are comparable toBACKGROUND: Direct stent implantation in patients, who undergo elective percutaneous coronary intervention (PCI) can be performed with a high success rate and clinical results that are comparable to those after predilatation. It was the aim of this prospective study to compare clinical, angiographic and procedural parameter of direct stent implantation (DS) and conventional stent implantation (CS) in patients with acute coronary syndrome (ACS). PATIENTS AND METHODS: We analysed 194 patients with ACS (ST-elevation myocardial infarction 66%, non-ST-elevation myocardial infarction 18%, unstable angina 16%), in whom primary PCI was performed between January and December 2002. In 156 (80%) patients glycoprotein IIb/IIIa inhibitors were administered during the procedure. In 73 patients (38%) direct stent implantation could be performed successfully. In 12 patients (6%) direct stent implantation failed due to the inability to pass the stenosis. In 121 patients (62%) the stent was implanted after predilatation. RESULTS: The clinical parameters were comparable in both groups. Reference luminal diameter before stent implantation did not differ in both groups (DS 3.01+/-0.54 vs. CS 2.84+/-0.43 mm). The final minimal luminal diameter was significantly higher in the DS group (DS 2.95+/-0.45 vs. CS 2.77+/-0.47 mm, p=0.01). The procedural time (DS 41.0+/-14.1 vs. CS 46.8+/-16.9 min, p=0.02), radiation exposure time (DS 7.3+/-4.6 vs. CS 8.9+/-4.6 min, p=0.002) and the amount of contrast agent (DS 216+/-90 vs. CS 235+/-79 ml, p=0.03) could be decreased by the technique of direct stent implantation. The incidence of major adverse cardiac events (death, myocardial infarction, CABG) during hospitalization was 4.1% in the DS group and 11.5% in the CS group (p=0.11). CONCLUSIONS: Direct stent implantation is safe and feasible in patients with acute coronary syndromes. The procedural time, radiation exposure time and the amount of contrast agent can be significantly decreased using the technique of direct stent implantation. The incidence of major adverse cardiac events was not significantly different in this subset of patients.

• Variant angina with recurrent ventricular tachycardia successfully treated by stent implantation of a moderate ostial lesion of the right coronary artery.

  Authors: Tudor C Poerner, Dariusch Haghi, Tim Süselbeck, Christian Wolpert, Martin Borggrefe, Karl K Haase

  Clinical cardiology. 09/2005; 28(8):394-5.

• [Chlamydia pneumoniae--a new risk factor for calcific aortic stenosis?]

  Authors: Jens J Kaden, Dariusch Haghi, Daniela C Vocke, Martina Brueckmann, Tim Süselbeck, Martin Borggrefe

  Medizinische Klinik (Munich, Germany : 1983). 07/2005; 100(6):334-9.

  BACKGROUND: Nonrheumatic, calcific aortic stenosis is the main heart valve disease and the main cause of heart valve replacement in the elderly. Recent studies suggest that it is based on a chronicBACKGROUND: Nonrheumatic, calcific aortic stenosis is the main heart valve disease and the main cause of heart valve replacement in the elderly. Recent studies suggest that it is based on a chronic inflammatory process. The pathogenetic mechanisms, however, are unclear. METHODS: A MEDLINE search was conducted for the phrases "chlamydia pneumoniae" and "aortic valve", and all articles published between 1966 and May 2004 were evaluated. Data presented as letter or congress abstract was also included. RESULTS: Clinical and histopathologic studies demonstrate an association of calcific aortic stenosis and cardiovascular risk factors similar to atherosclerosis. As for atherosclerosis, infection with Chlamydia (C.) pneumoniae is also discussed as a further potential risk factor for calcific aortic stenosis. Previous seroepidemiologic and pathologic studies using various detection methods yielded heterogeneous results. CONCLUSION: Thus, data suggesting a pathogenetic association of C. pneumoniae and calcific aortic stenosis should be interpreted cautiously.