Jutta Bergler-Klein

Medical University of Vienna, Wien, Vienna, Austria

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Publications (62)412.54 Total impact

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    ABSTRACT: The objective of this study was to examine the impact of left ventricular (LV) global longitudinal strain (GLS) measured at rest and at dobutamine stress echocardiography on the outcome of patients with low LV ejection fraction and low-gradient aortic stenosis. Among the 202 patients with low LV ejection fraction (≤40%), low-gradient aortic stenosis (mean transvalvular gradient <40 mm Hg and indexed aortic valve area ≤0.6 cm(2)/m(2)) prospectively enrolled in the multicenter True or Pseudo-Severe Aortic Stenosis study, 126 patients with resting GLS and 73 patients with stress GLS available were included in this substudy. Three-year survival rate was 49% in patients with rest GLS <|9|% compared with 68% in patients with GLS >|9|% (P=0.02). In a multivariable Cox model adjusted for age, coronary artery disease, projected aortic valve area at a normal flow rate and type of treatment (aortic valve replacement versus conservative), rest GLS <|9|% (hazard ratio, 2.18; P=0.015) remained independently associated with all-cause mortality. GLS <|10|% measured during dobutamine stress echocardiography was also independently associated with mortality (hazard ratio, 2.67; P=0.01). In the subset of patients with stress GLS (n=73), the χ(2) of the multivariable model to predict all-causes mortality was 21.96 for stress GLS versus 17.78 for rest GLS. GLS is independently associated with mortality in patients with low LV ejection fraction, low-gradient aortic stenosis. Stress GLS measured during dobutamine stress echocardiography may provide incremental prognostic value beyond GLS measured at rest. Hence, measurement of GLS at rest and during dobutamine stress echocardiography may be helpful to enhance risk stratification in low LV ejection fraction, low-gradient aortic stenosis. http://www.clinicaltrials.gov. Unique identifier: NCT01835028. © 2015 American Heart Association, Inc.
    Circulation Cardiovascular Imaging 03/2015; 8(3):e002117. · 5.80 Impact Factor
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    ABSTRACT: Rationale: The ACCRUE (Meta-Analysis of Cell-based CaRdiac stUdiEs) is the first prospectively declared collaborative multinational database including individual data of patients (IPD) with ischemic heart disease treated with cell therapy. Objective: We analyzed the safety and efficacy of intracoronary cell therapy after acute myocardial infarction (AMI) including IPDs from 12 randomized trials (ASTAMI, Aalst, BOOST, BONAMI, CADUCEUS, FINCELL, REGENT, REPAIR-AMI, SCAMI, SWISS-AMI, TIME, LATE-TIME; n=1252). Methods and Results: The primary endpoint was freedom from combined major adverse cardiac and cerebrovascular events (MACCE; including all-cause death, re-AMI, stroke, and target vessel revascularization). The secondary endpoint was freedom from hard clinical endpoints (death, re-AMI, or stroke), assessed with random-effects meta-analyses and Cox regressions for interactions. Secondary efficacy endpoints included changes in end-diastolic volume (ΔEDV), end-systolic volume (ΔESV), and ejection fraction (ΔEF), analyzed with random-effects meta-analyses and analysis of covariance. We reported weighted mean differences between cell therapy and control groups. No effect of cell therapy on MACCE (14.0% vs. 16.3%, hazard ratio 0.86, 95%CI: 0.63;1.18) or death (1.4% vs 2.1%) or death/re-AMI/stroke (2.9% vs 4.7%) was identified in comparison to controls. No change in ΔEF (mean difference: 0.96%, 95%CI: -0.2;2.1), ΔEDV, or ΔESV was observed compared to controls. These results were not influenced by anterior AMI location, reduced baseline EF, or the use of MRI for assessing left ventricular parameters. Conclusions: This meta-analysis of IPD from randomized trials in patients with recent AMI revealed that intracoronary cell therapy provided no benefit, in terms of clinical events or changes in left ventricular function.
    Circulation Research 02/2015; · 11.09 Impact Factor
  • Jutta Bergler-Klein, Mariann Gyöngyösi, Gerald Maurer
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    ABSTRACT: The optimal timing of valve surgery remains controversial. Biomarkers can be serially monitored and are objective laboratory measurements. Plasma B-type natriuretic peptide (BNP) and its N-terminal pro-form are well known predictors in heart failure. Diastolic stretch induces cardiomyocyte BNP expression in volume-loaded conditions like aortic or mitral regurgitation (MR) or pressure-loaded conditions like aortic stenosis (AS). Here, we review the value of natriuretic peptide measurements in valve disease. Cardiac decompensation is reflected by increased BNP in AS and in MR. Repeated marked increases in natriuretic peptides are a potential indication for valve replacement in severe asymptomatic AS with normal ejection fraction and exercise test results. High BNP level also predicts postoperative outcome. Increased BNP level is associated with low-flow AS, impaired left ventricular longitudinal strain, and myocardial fibrosis. The BNP ratio to the reference value for age and sex incrementally predicts mortality in AS. Increased BNP reflects the hemodynamic consequences of MR and is associated with exercise-induced pulmonary-arterial hypertension and reduced contractile reserve. In severe primary MR, increased and serially increasing BNP or N-terminal pro-form BNP might be helpful in guiding early mitral replacement. In conclusion, baseline (N-terminal pro-form) BNP should be obtained in all severe valve disease patients and interpreted together with clinical and echocardiography findings. Very high BNP values are associated with increased mortality and should lead to close monitoring peri- and postoperatively. Progressively increasing BNP in asymptomatic patients points to advancing valve disease. BNP adds important incremental prognostic information that is useful for valve patient management and for optimal timing of surgery in particular.
    The Canadian journal of cardiology 09/2014; 30(9):1027-1034. · 3.12 Impact Factor
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    ABSTRACT: A decade ago, stem or progenitor cells held the promise of tissue regeneration in human myocardium, with the expectation that these therapies could rescue ischemic myocyte damage, enhance vascular density and rebuild injured myocardium. The accumulated evidence in 2014 indicates, however, that the therapeutic success of these cells is modest and the tissue regeneration involves much more complex processes than cell-related biologics. As the quest for the ideal cell or combination of cells continues, alternative cell types, such as resident cardiac cells, adipose-derived or phenotypic modified stem or progenitor cells have also been applied, with the objective of increasing both the number and the retention of the reparative cells in the myocardium. Two main delivery routes (intracoronary and percutaneous intramyocardial) of stem cells are currently used preferably for patients with recent acute myocardial infarction or ischemic cardiomyopathy. Other delivery modes, such as surgical or intravenous via peripheral veins or coronary sinus have also been utilized with less success. Due to the difficult recruitment of patients within conceivable timeframe into cardiac regenerative trials, meta-analyses of human cardiac cell-based studies have tried to gather sufficient number of subjects to present a statistical compelling statement, reporting modest success with a mean increase of 0.9-6.1% in left ventricular global ejection fraction. Additionally, nearly half of the long-term studies reported the disappearance of the initial benefit of this treatment. Beside further extensive efforts to increase the efficacy of currently available methods, pre-clinical experiments using new techniques such as tissue engineering or exploiting paracrine effect hold promise to regenerate injured human cardiac tissue.
    Journal of Molecular and Cellular Cardiology 07/2014; · 5.15 Impact Factor
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    ABSTRACT: Objectives. Cost-effectiveness of percutaneous coronary intervention (PCI) using drug-eluting stents (DES) and coronary artery bypass surgery (CABG) was analysed in patients with multivessel coronary artery disease over a 5-year follow-up. Background. DES implantation reducing revascularization rate and associated costs might be attractive for health economics compared to CABG. Methods. Consecutive patients with multivessel DES-PCI (n=114, 3.3±1.2 DES/patient) or CABG (n=85, 2.7±0.9 grafts/patient) were included prospectively. Primary endpoint was cost-benefit of multivessel DES-PCI over CABG, and the incremental cost-effectiveness ratio (ICER) was calculated. Secondary endpoint was the incidence of major adverse cardiac and cerebrovascular events (MACCE), including acute myocardial infarction (AMI), all-cause death, revascularisation, and stroke. Results. Despite multiple uses for DES, in-hospital costs were significantly less for PCI than CABG, with 4551 Є/patient difference between the groups. At 5-years, the overall costs remained higher for CABG patients (mean difference 5400 Є between groups). Cost-effectiveness planes including all patients or subgroups of elderly patients, diabetic patients, or Syntax score >32 indicated that CABG is a more effective, more costly treatment mode for multivessel disease. At the 5-year follow-up, a higher incidence of MACCE (37.7% vs. 25.8%; log rank P=0.048) and a trend towards more AMI/death/stroke (25.4% vs. 21.2%, log rank p=0.359) was observed in PCI compared to CABG. ICER indicated 45615 Є or 126683 Є to prevent one MACCE or AMI/death/stroke if CABG is performed. Conclusions. Cost-effectiveness analysis of DES-PCI vs. CABG demonstrated that CABG is the most effective, but most costly, treatment for preventing MACCE in patients with multivessel disease. © 2013 Wiley Periodicals, Inc.
    Catheterization and Cardiovascular Interventions 01/2014; 84(7). · 2.51 Impact Factor
  • The Canadian journal of cardiology 10/2013; 29(10):S314. · 3.94 Impact Factor
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    ABSTRACT: BACKGROUND: -Decision-making in patients with low flow - low gradient aortic stenosis (LFAS) mainly depends on the actual stenosis severity and left ventricular function, which is of prognostic importance. We used two-dimensional strain parameters measured by speckle-tracking at rest and during dobutamine stress echocardiography to document the extent of myocardial impairment, its relationship with hemodynamic variables and its prognostic value. METHODS AND RESULTS: -In 47 patients with LFAS global peak systolic longitudinal strain (PLS) and strain rate (PLSR) were analyzed. PLS and PLSR at rest and at peak stress were -7.56±2.34% and -7.41±2.89 (p=n.s.), and -0.38±0.12s(-1) and -0.53±0.18s(-1) (p<0.001), respectively. PLS and PLSR inversely correlated with LV ejection fraction (LVEF) at rest (r(s)=-0.52 p<0.0001 and -0.38 p=0.008) and peak stress (r(s)=-0.39 p=0.007 and -0.45 p=0.002). The overall two-year survival rate was 60%. Univariate predictors of survival were peak stress LVEF (p=0.0026), peak stress PLS (p=0.0002), peak stress PLSR (p<0.0001) and N-terminal pro B-type natriuretic peptide (NT-proBNP) (p<0.0001). Three hierarchically nested multivariable Cox regression models were constructed: Model 1: The Society of Thoracic Surgeons score as an indicator of clinical risk (AUROC=0.59); Model 2: Model 1 plus NT-proBNP and peak stress LVEF (AUROC=0.83, incremental p-value<0.0001); Model 3: Model 2 plus peak stress PLSR (AUROC=0.89, incremental p-value=0.035). CONCLUSIONS: -In patients with LFAS two-dimensional strain parameters are strong predictors of outcome. Peak stress PLSR may add incremental prognostic value beyond what is obtained from NT-pro BNP and peak stress LVEF. A larger study is needed to confirm these findings.
    Circulation Cardiovascular Imaging 12/2012; · 5.80 Impact Factor
  • JACC Cardiovascular Interventions 12/2012; · 7.44 Impact Factor
  • JACC Cardiovascular Interventions. 12/2012;
  • Jutta Bergler-Klein
    European heart journal cardiovascular Imaging. 10/2012;
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    ABSTRACT: This study sought to determine the time dependency of the endothelium-dependent and -independent vascular responses after percutaneous coronary intervention (PCI) with drug-eluting (DEB) or plain balloons, bare-metal (BMS), and drug-eluting (DES) stents, or controls. Long-term endothelial dysfunction after DES implantation is associated with delayed healing and late thrombosis. Domestic pigs underwent PCI using DEB or plain balloon, BMS, or DES. The dilated and stented segments, and the proximal reference segments of stents and control arteries were explanted at 5-h, 24-h, 1-week, and 1-month follow-up (FUP). Endothelin-induced vasoconstriction and endothelium-dependent and -independent vasodilation of the arterial segments were determined in vitro and were related to histological results. DES- and BMS-treated arteries showed proneness to vasoconstriction 5 h post-PCI. The endothelium-dependent vasodilation was profoundly (p < 0.05) impaired early after PCI (9.8 ± 3.7%, 13.4 ± 9.2%, 5.7 ± 5.3%, and 7.6 ± 4.7% using plain balloon, DEB, BMS, and DES, respectively), as compared with controls (49.6 ± 9.5%), with slow recovery. In contrast to DES, the endothelium-related vasodilation of vessels treated with plain balloon, DEB, and BMS was increased at 1 month, suggesting enhanced endogenous nitric oxide production of the neointima. The endothelium-independent (vascular smooth muscle-related) vasodilation decreased significantly at 1 day, with slow normalization during FUP. All PCI-treated vessels exhibited imbalance between vasoconstriction-vasodilation, which was more pronounced in DES- and BMS-treated vessels. No correlation between histological parameters and vasomotor function was found, indicating complex interactions between the healing neoendothelium and smooth muscle post-PCI. Coronary arteries treated with plain balloon, DEB, BMS, and DES showed time-dependent loss of endothelial-dependent and -independent vasomotor function, with imbalanced contraction/dilation capacity.
    JACC. Cardiovascular Interventions 07/2012; 5(7):741-51. · 1.07 Impact Factor
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    Manuela Schmidinger, Jutta Bergler-Klein
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    ABSTRACT: Targeted agents have significantly improved outcomes in patients with metastatic renal cell carcinoma, and are changing long-term expectations in these patients. Experience with these agents highlights a distinct safety and tolerability profile, differing from that observed with conventional chemotherapy and radiotherapy. Cardiovascular adverse events have been observed when treating with targeted agents. This is of particular importance for patients with metastatic renal cell carcinoma who are elderly and present with significant comorbidities. A multidisciplinary approach and close collaboration between oncologists and cardiologists is essential for optimal management of cardiovascular adverse events. Strategies for the management of these adverse events include assessment of cardiovascular status at baseline and at regular intervals, patient education, and the use of supportive medication. Effective therapy management allows patients with cardiovascular adverse events to receive and continue targeted therapy with careful monitoring. Implementation of therapy management measures contributes towards maximizing treatment outcomes with targeted agents in patients with metastatic renal cell carcinoma.
    International Journal of Urology 05/2012; 19(9):796-804; author reply 805. · 1.80 Impact Factor
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    ABSTRACT: The role of oxidative stress after radiofrequency ablation of atrial fibrillation (AF) has not yet been well characterized. We sought to evaluate the time course of biomarkers of oxidative stress and inflammation after AF ablation and their association with clinical variables. Thirty consecutive patients (57.9 ± 1.7 years, 63% males) with paroxysmal AF underwent pulmonary vein isolation and ablation of complex fractionated atrial electrograms. Biomarkers were determined in blood samples before ablation and 6 h, 1, 2, 7, 30, 90 and 180 days post-ablation. The pro-oxidant enzyme myeloperoxidase and oxidized low-density lipoprotein reflecting oxidant damage of lipoproteins increased 2.9 ± 0.2-fold and 1.2 ± 0.1-fold, respectively, and were significantly up-regulated until day 2 post-ablation. The anti-oxidant enzyme copper/zinc superoxide dismutase did not change significantly. Inflammatory markers significantly increased (high-sensitivity C-reactive protein (hs-CRP): 41 ± 8-fold; interleukin-6: 4.4 ± 0.7-fold) for 7 and 2 days, respectively. The increase of myeloperoxidase and hs-CRP was interrelated and both predicted early recurrence of AF within the first post-ablation week (both p < 0.05). The increase of both markers was associated with the amount of delivered radiofrequency energy (p < 0.05). The up-regulation of hs-CRP correlated with troponin T (p = 0.008), while myeloperoxidase and troponin T were borderline associated (p = 0.054). However, the oxidative and inflammatory responses did not predict long-term ablation outcome (p > 0.05). Markers of oxidative stress showed a significant up-regulation during the first 2 days after AF ablation. Their up-regulation was linked to inflammation, delivered radiofrequency energy, and early recurrence of AF, but did not predict long-term ablation outcome.
    Clinical Research in Cardiology 11/2011; 101(3):217-25. · 4.17 Impact Factor
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    ABSTRACT: AIMS: Non-invasive diagnosis of allograft dysfunction is a major objective in the management of heart transplant (HTX) recipients. Speckle tracking echocardiography (STE) permits comprehensive assessment of myocardial function. It is well established that deformation indices are reduced in HTXs when compared with control subjects. However, it is unclear if the reduction in strain is a chronic progressive phenomenon in HTX patients. Method and results Follow-up transthoracic echocardiography (TTE) was performed 3 years after initial TTE in 20 'healthy' HTX patients (13.2 years post-transplantation at time of follow-up) with normal ejection fraction and angiographically ruled out allograft vasculopathy. Grey-scale apical views were recorded and stored for automated offline speckle tracking (EchoPAC 7.0, GE) of the 16 segments of the left ventricle. Strain analysis was performed in 320 segments 34.3 ± 3.7 months after initial assessment. Automated tracking of myocardial deformation for determination of longitudinal systolic strain was not possible in 24 (7.5%) segments at baseline and in 32 (10.0%) segments at follow-up (P = ns). The left ventricular ejection fraction (LVEF) was 61.9 ± 8.1% at the initial examination vs. 62.8 ± 5.8% 3 years afterwards (P = ns). Global longitudinal peak systolic strain was -14.0 ± 4.0 vs. -14.4 ± 2.8%, respectively (P = ns). CONCLUSION: This is the first study describing follow-up deformation parameters in HTX patients undergoing STE. 'Healthy' HTX patients with normal coronary arteries and normal ejection fractions showed no deterioration of longitudinal strain values 3 years after the initial assessment. Apparently, deformation values remain stable over the years as long as the LVEF is preserved.
    European heart journal cardiovascular Imaging. 11/2011; 13(2):181-6.
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    ABSTRACT: Radiofrequency ablation of atrial fibrillation (AF) creates left atrial (LA) tissue damage with a subsequent healing process. We sought to prospectively assess the time course of biomarkers of tissue repair after ablation and to evaluate their association with clinical variables. 30 consecutive patients (57.9 ± 1.7 yrs, 63% males) with paroxysmal AF underwent a CARTO-guided LA circumferential ablation, Lasso-guided segmental pulmonary vein isolation and ablation of complex fractionated atrial electrograms. Matrix metalloproteinase-9 (MMP-9) and transforming growth factor-β1 (TGF-β1), both key regulators of tissue repair, and the aminoterminal propeptide of type III procollagen (PIIINP), reflecting collagen synthesis, were determined in blood samples before and 6h, 1, 2, 7, 30, 90 and 180 days post-ablation. All markers showed a significant ablation-induced up-regulation (MMP-9: 1.8 ± 0.1-fold, TGF-β1: 2.4 ± 0.4-fold, PIIINP: 1.3 ± 0.1-fold). MMP-9 was significantly up-regulated until day 90, TGF-β1 only on day 2. PIIINP increased from day 2 to 7. The area under the curve (AUC) of MMP-9 and TGF-β1 correlated with the ablation-induced reduction of LA volume (both p<0.05). The AUC of MMP-9 was additionally associated with the amount of radiofrequency energy delivered during ablation (p < 0.05). At 12 months of follow-up 57% of patients were free of AF off antiarrhythmic drugs. The AUC of PIIINP independently predicted recurrent AF (p < 0.05). Markers of healing showed a significant up-regulation after AF ablation detectable for up to 90 days. A more pronounced up-regulation of MMP-9 or TGF-β1 is associated with a greater reduction of LA size. High PIIINP levels after ablation predict a poor ablation outcome.
    International journal of cardiology 10/2011; 152(2):231-6. · 6.18 Impact Factor
  • The Canadian journal of cardiology 09/2011; 27(5):S108. · 3.94 Impact Factor
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    ABSTRACT: Longitudinal strain determined by speckle tracking is a sensitive parameter to detect systolic left ventricular dysfunction. In this study, we assessed regional and global longitudinal strain values in long-term heart transplants and compared deformation indices with ejection fraction as determined by transthoracic echocardiography (TTE) and multislice computed tomographic coronary angiography (MSCTA). TTE and MSCTA were prospectively performed in 31 transplant patients (10.6 years post-transplantation) and in 42 control subjects. Grey-scale apical views were recorded for speckle tracking (EchoPAC 7.0, GE) of the 16 segments of the left ventricle. The presence of coronary artery disease (CAD) was assessed by MSCTA. Strain analysis was performed in 1168 segments [496 in transplant patients (42.5%), 672 in control subjects (57.7%)]. Global longitudinal peak systolic strain was significantly lower in the transplant recipients than in the healthy population (-13.9 ± 4.2 vs. -17.4 ± 5.8%, P< 0.01). This was still the case after exclusion of the nine transplant patients with CAD (-14.1 ± 4.4 vs. -17.4 ± 5.8%, P=0.03). Transplant patients exhibited significantly lower regional strain values in 9 of the 16 segments. Left ventricular ejection fraction (%) (MSCTA/Simpsons method) was 60.7 ± 10.1%/60.2 ± 6.7% in transplant recipients vs. 64.7 ± 6.4%/63.0 ± 6.2% in the healthy population, P=ns. Even though 'healthy' heart transplants without CAD exhibit normal ejection fraction, deformation indices are reduced in this population when compared with control subjects. Our findings suggests that strain analysis is more sensitive than assessment of ejection fraction for the detection of abnormalities of systolic function.
    European Heart Journal – Cardiovascular Imaging 06/2011; 12(7):490-6. · 2.65 Impact Factor
  • Jutta Bergler-Klein
    European Heart Journal – Cardiovascular Imaging 06/2011; 12(6):411-3. · 2.65 Impact Factor
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    ABSTRACT: N-terminal pro-BNP (NtBNP) has attracted attention as a biomarker for heart failure. The aims of our study are (a) to characterize the role of NtBNP as a biological marker in the setting of alcoholism; (b) to describe potential gender differences with respect to NtBNP; (c) to correlate NtBNP with other clinical and haemodynamic variables. We examined 83 alcohol-dependent patients according to International Classification of Disease 10th Revision (ICD-10) and Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV; 59 males and 24 females, age: 50 ± 10.5 years) referred to the department of psychiatry for alcohol withdrawal therapy. In these patients, we determined NtBNP, markers of alcohol abuse and transthoracic echocardiography to determine systolic left ventricular ejection fraction (EF). These measurements were repeated after alcohol withdrawal. At Day 1 of alcohol withdrawal, 43 patients (52%; 27 males and 16 females) had elevated NtBNP levels (394.4 ± 438.7 pg/ml) despite normal EF (64.7 ± 6.2%). After withdrawal therapy (16.6 ± 7.8 days), NtBNP decreased significantly (228.6 ± 251.2 pg/ml; P < 0.01), despite unchanged EF (65.0 ± 5.8%; P = ns). This was the case in both males and females (328.9 ± 235.5 to 216.7 ± 194.3 pg/ml; P < 0.05 vs. 492.7 ± 635.7 to 246.6 ± 327.7 pg/ml; P < 0.05). Elevated NtBNP levels were related significantly to the history of arterial hypertension (P < 0.05). This study highlights the fact that NtBNP can be elevated in the setting of alcoholism. The elevation in NtBNP is unrelated to EF and is reversible after alcohol withdrawal. We suggest a subclinical detrimental effect of alcohol abuse on cardiac function.
    Alcohol and Alcoholism 04/2011; 46(3):247-52. · 1.96 Impact Factor
  • Journal of The American College of Cardiology - J AMER COLL CARDIOL. 01/2011; 57(14).

Publication Stats

1k Citations
412.54 Total Impact Points

Institutions

  • 2007–2014
    • Medical University of Vienna
      • Department of Radiology
      Wien, Vienna, Austria
  • 2010
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 2004
    • IST Austria
      Klosterneuberg, Lower Austria, Austria
  • 1992–2004
    • University of Vienna
      • Department of Internal Medicine III
      Wien, Vienna, Austria