D Haghi

Publications of D Haghi

• Insights into the location of type I ECG in patients with Brugada syndrome: Correlation of ECG and cardiovascular magnetic resonance imaging.

  Authors: C Veltmann, T Papavassiliu, T Konrad, C Doesch, J Kuschyk, F Streitner, D Haghi, H J Michaely, S O Schoenberg, M Borggrefe, C Wolpert, R Schimpf

  Heart rhythm : the official journal of the Heart Rhythm Society. 11/2011; 9(3):414-21.

  Brugada syndrome is characterized by ST-segment abnormalities in V1-V3. Electrocardiogram (ECG) leads placed in the 3rd and 2nd intercostal spaces (ICSs) increased the sensitivity for the detectionBrugada syndrome is characterized by ST-segment abnormalities in V1-V3. Electrocardiogram (ECG) leads placed in the 3rd and 2nd intercostal spaces (ICSs) increased the sensitivity for the detection of a type I ECG pattern. The anatomic explanation for this finding is pending. The purpose of the study was to correlate the location of the Brugada type I ECG with the anatomic location of the right ventricular outflow tract (RVOT). Twenty patients with positive ajmaline challenge and 10 patients with spontaneous Brugada type I ECG performed by using 12 right precordial leads underwent cardiovascular magnetic resonance imaging (CMRI). The craniocaudal and lateral extent of the RVOT and maximal RVOT area were determined. Type I ECG pattern and maximal ST-segment elevation were correlated to extent and maximal RVOT area, respectively. In all patients, Brugada type I pattern was found in the 3rd ICS in sternal and left-parasternal positions. RVOT extent determined by using CMRI included the 3rd ICS in all patients. Maximal RVOT area was found in 3 patients in the 2nd ICS, in 5 patients in the 4th ICS, and in 22 patients in the 3rd ICS. CMRI predicted type I pattern with a sensitivity of 97.2%, specificity of 91.7%, positive predictive value of 88.6%, and negative predictive value of 98.0%. Maximal RVOT area coincided with maximal ST-segment elevation in 29 of 30 patients. RVOT localization determined by using CMRI correlates highly with the type I Brugada pattern. Lead positioning according to RVOT location improves the diagnosis of Brugada syndrome.

• Pulmonary embolism: ct signs and cardiac biomarkers for predicting right ventricular dysfunction.

  Authors: T Henzler, S Roeger, M Meyer, U J Schoepf, J W Nance, D Haghi, W E Kaminski, M Neumaier, S O Schoenberg, C Fink

  The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology. 09/2011;

  To prospectively evaluate the accuracy of quantitative cardiac CT parameters and two cardiac biomarkers (NT-pro-Brain Natriuretic Peptide (NT-pro-BNP); troponin I), alone and in combination, forTo prospectively evaluate the accuracy of quantitative cardiac CT parameters and two cardiac biomarkers (NT-pro-Brain Natriuretic Peptide (NT-pro-BNP); troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism (PE).557 consecutive patients with suspected PE underwent pulmonary CTA. Patients with PE also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. 3 different CT measurements were obtained (RV/LVaxial, RV/LV4-CH), and RV/LVvolume). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography.Patients with RVD (n=77) showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LVaxial 1.68±0.84 vs. 1.00±0.21; RV/LV4ch 1.52±0.45 vs. 1.01±0.21; RV/LVvolume 1.97±0.53 vs. 1.07±0.52; serum NT-pro-BNP 6372±2319 vs. 1032±1559 ng·L(-1); troponin I 0.18±0.41 vs. 0.06±0.18). The area under the curve for the detection of RVD of RV/LVaxial, RV/LV4Ch, RV/LVvolume, NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LVvolume increased the AUC to 0.95 (RV/LVvolume with NT-pro-BNP) and 0.93 (RV/LVvolume with troponin I).RV/LVvolume is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LVvolume with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone.

• Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism.

  Authors: P Apfaltrer, T Henzler, M Meyer, S Roeger, D Haghi, J Gruettner, T Süselbeck, R B Wilson, U J Schoepf, S O Schoenberg, C Fink

  European journal of radiology. 09/2011;

  OBJECTIVE: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). MATERIALS ANDOBJECTIVE: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS: In a prospective study of 50 patients (66±12.9 years) with PE pulmonary artery OS (Qanadli, Mastora, and Mastora central) were assessed by two radiologists. To assess RVD all patients underwent echocardiography within 24h. Furthermore, RVD on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans) and four-chamber views (RV/LV4ch) as well as the RV/LV volume ratio (RV/LVvol). OS were correlated with RVD and the occurrence of adverse clinical outcomes (defined as death, need for intensive care treatment, or cardiac insufficiency ≥NYHA III). RESULTS: Mean Mastora, Qanadli, and Mastora central OS were 26.4±17.7, 12.6±9.9 and 7.5±9, respectively. Echocardiography demonstrated moderate and severe RVD in 10 and 5 patients, respectively. Patients with moderate and severe RVD showed significantly higher Mastora central scores than patients without RVD (14±10.8 vs. 5.9±7.8 [p=0.05]; 17.6±13.2 vs. 5.9±7.8 [p=0.038]). A relevant correlation (i.e. r≥0.6) between OS and CT parameters for RVD were only found for the Mastora score and the Mastora central score (RV/LV4ch: r=0.61 and 0.68, RV/LVvol: r=0.61 and 0.6). 18 patients experienced an adverse clinical outcome. None of the OS differed significantly between patients with and without adverse clinical outcome. CONCLUSION: Pulmonary artery obstruction scores can differentiate between patients with and without RVD. However, in this study, obstruction scores were not correlated to adverse clinical outcome.

• Coincidence of coronary artery disease and Tako-Tsubo cardiomyopathy.

  Authors: D Haghi, K Hamm, F Heggemann, T Walter, T Suselbeck, T Papavassiliu, M Borggrefe

  Herz. 06/2010; 35(4):252-6.

  Tako-Tsubo cardiomyopathy (TTC) predominantly affects elderly people with a high prevalence of cardiovascular risk factors. Therefore, one would expect to encounter incidental coronary artery diseaseTako-Tsubo cardiomyopathy (TTC) predominantly affects elderly people with a high prevalence of cardiovascular risk factors. Therefore, one would expect to encounter incidental coronary artery disease in a significant number of cases. In fact, the prevalence of mild coronary artery disease (CAD), by angiography, has been reported to be in the range of 30%-60%. Similarly, more severe stenotic lesions in at least one coronary vessel were incidentally found in 10%-35% of patients with the disease. Using intravascular ultrasound in a series of 10 patients with TTC, coronary atherosclerosis was demonstrable in all patients, although five patients had normal coronary angiograms. Therefore, TTC and CAD are not mutually exclusive disease entities. The incidental finding of coronary lesions, even if significant, should not automatically lead to a dismissal of the diagnosis of TTC. Rather, a case-by-case approach using additional imaging modalities should be endorsed.

• Inappropriate placement of defibrillator self-adhesive electrode pads with possible fatal outcome.

  Authors: T Goksu, M Borggrefe, D Haghi

  Emergency medicine journal : EMJ. 04/2010; 28(2):158.

• Non-invasive measurement of cardiac output during atrial fibrillation: comparison between cardiac magnetic resonance imaging and inert gas rebreathing.

  Authors: J Saur, F Trinkmann, C Doesch, J Weissmann, K Hamm, S O Schoenberg, M Borggrefe, D Haghi, J J Kaden

  Cardiology. 02/2010; 115(3):212-6.

  Atrial fibrillation (AF) is one of the most frequent heart rhythm disorders. It potentially influences cardiac function and its measurement. Cardiac magnetic resonance imaging (CMR) has become theAtrial fibrillation (AF) is one of the most frequent heart rhythm disorders. It potentially influences cardiac function and its measurement. Cardiac magnetic resonance imaging (CMR) has become the new gold standard for non-invasive assessment of cardiac output (CO). A novel inert gas rebreathing (IGR) device based on the Fick Principle also proved promising in patients in sinus rhythm (SR). The aim of our study was to compare the agreement of non-invasive CO measurements between CMR and IGR in AF patients. A total of 68 patients, 34 with AF and 34 pair-matched controls in SR, were included. Bland-Altman analysis showed good agreement between both methods, with an average deviation of 0.2 +/-1.2 l/min in the AF group versus 0.3 +/-1.0 l/min in the SR group (p = 0.77). IGR demonstrated good agreement for CO between 2.0 and 5.4 l/min. However, in hyperdynamic circulatory conditions (CO >5.5 l/min), the increasing disagreement of IGR and CMR measurements reached statistical significance. Non-invasive CO measurements using CMR and IGR are feasible in patients suffering from AF. Good agreement was found between the two methods in an unselected cohort. Hyperdynamic circulatory conditions can lead to significant measurement differences which, however, do not affect the reproducibility of IGR.

• Follow-up in Tako-tsubo cardiomyopathy by real-time three-dimensional echocardiography.

  Authors: O-A Breithardt, M Becker, T Kälsch, D Haghi

  BMJ case reports. 01/2009; 2009:bcr2006109413.

• Incidence and clinical significance of left ventricular thrombus in tako-tsubo cardiomyopathy assessed with echocardiography.

  Authors: D Haghi, T Papavassiliu, F Heggemann, J J Kaden, M Borggrefe, T Suselbeck

  QJM : monthly journal of the Association of Physicians. 06/2008; 101(5):381-6.

  BACKGROUND: Left ventricular (LV) thrombus is a known complication of tako-tsubo cardiomyopathy (TC). However, current literature almost exclusively consists of isolated case reports. The aim of thisBACKGROUND: Left ventricular (LV) thrombus is a known complication of tako-tsubo cardiomyopathy (TC). However, current literature almost exclusively consists of isolated case reports. The aim of this study was to determine the incidence and clinical significance of LV thrombus formation in TC. METHODS AND RESULTS: Over a 33-month period 52 patients with TC were assembled into a database at our institution. A retrospective database search was performed to identify patients with LV thrombus among these patients. LV thrombus, by echocardiography, was discovered in four patients[(8%); 95% confidence interval 3-19%]. Thrombus was present at the time of diagnosis in three patients. In one patient thrombus was absent initially and developed later. The LV apex was the site of thrombus formation in two patients, but the true apex was spared in the other two. All four patients had elevated serum levels of C-reactive protein (CRP). Two patients also had thrombocytosis. Treatment with low molecular weight heparin (LMWH) led to resolution of thrombus in all cases. CONCLUSION: Our findings suggest that LV thrombus is a noteworthy complication in TC. It can occur both at initial presentation or at anytime later during the disease course. Elevated CRP levels and thrombocytosis may indicate a higher risk of thrombus formation.

• Follow-up in Tako-tsubo cardiomyopathy by real-time three-dimensional echocardiography.

  Authors: O A Breithardt, M Becker, T Kälsch, D Haghi

  Heart (British Cardiac Society). 03/2008; 94(2):210.

• Variant form of the acute apical ballooning syndrome (takotsubo cardiomyopathy): observations on a novel entity.

  Authors: D Haghi, T Papavassiliu, S Flüchter, J J Kaden, T Pörner, M Borggrefe, T Suselbeck

  Heart (British Cardiac Society). 04/2006; 92(3):392-4.

• A hybrid approach for quantification of aortic valve stenosis using cardiac magnetic resonance imaging and echocardiography: comparison to right heart catheterization and standard echocardiography.

  Authors: D Haghi, T Suselbeck, S. Fluechter, G Kalmar, M Schroder, J J Kaden, T. Poerner, M Borggrefe, T Papavassiliu

  Clinical research in cardiology : official journal of the German Cardiac Society. 04/2006; 95(3):162-7.

  We replaced Doppler-derived stroke volume in the continuity equation (method A) by either right heart catheterization-derived stroke volume (method B) or cardiovascular magnetic resonance-derivedWe replaced Doppler-derived stroke volume in the continuity equation (method A) by either right heart catheterization-derived stroke volume (method B) or cardiovascular magnetic resonance-derived stroke volume (method C) to calculate aortic valve area in 20 consecutive patients with moderate or severe aortic stenosis. Comparison of both hybrid methods (methods B and C) by Bland-Altman analysis showed a mean difference near zero, a spread within two standard deviations and very similar limits of agreement. More importantly, all patients were classified into the same category of severity by both methods.

• Midwall myocardial fibrosis in Becker-Kiener muscular dystrophy.

  Authors: T Süselbeck, D Haghi, W Neff, M Borggrefe, T Papavassiliu

  Zeitschrift für Kardiologie. 08/2005; 94(7):465-8.

  We report on a 38- year-old man with Becker-Kiener muscular dystrophy (BMD) and dilated cardiomyopathy without clinical symptoms of congestive heart failure who was referred for risk evaluation ofWe report on a 38- year-old man with Becker-Kiener muscular dystrophy (BMD) and dilated cardiomyopathy without clinical symptoms of congestive heart failure who was referred for risk evaluation of sudden cardiac death. The degree of cardiac involvement in BMD varies greatly from no or hardly any cardiac abnormality to severe arrhythmias, dilatative cardiomyopathy and heart failure to heart transplantation or sudden cardiac death. These cardiac abnormalities have been related to replacement of the cardiomyocytes by connecting tissue or fat. In the clinical setting, cardiovascular magnetic resonance (CMR) has been proved to be a valid non-invasive method for obtaining anatomical and structural information of the heart. Furthermore, gadolinium-enhanced CMR can also characterize areas of myocardial fibrosis. Demonstration of extensive areas of fibrosis in an early stage of the disease might be a surrogate marker for an impaired clinical outcome. Therefore, serial CMR examinations starting upon diagnosis of the disease should be considered, as this may lead to an earlier recognition of cardiac involvement and may affect further management of the patient.

• 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.

• Current management of symptomatic atrial fibrillation.

  Authors: D Haghi, B Schumacher

  American journal of cardiovascular drugs : drugs, devices, and other interventions. 02/2001; 1(2):127-39.

  Atrial fibrillation (AF) is the most commonly encountered sustained arrhythmia. Heart rate control, reduction of symptoms, and prevention of embolism are major goals of treatment. Whether theAtrial fibrillation (AF) is the most commonly encountered sustained arrhythmia. Heart rate control, reduction of symptoms, and prevention of embolism are major goals of treatment. Whether the strategy of cardioversion with subsequent maintenance of sinus rhythm has an advantage over heart rate control is under active investigation. Digoxin, non-dihydropyridine calcium channel antagonists, beta-adrenoceptor antagonists (beta-blockers), and amiodarone are the pharmacologic agents most commonly used to achieve rate control. In patients with drug-resistant AF, atrioventricular nodal ablation (or modification) with implantation of a permanent pacemaker is an alternative therapy. Conversion to sinus rhythm can best be achieved by electrical cardioversion. In selected patients, pharmacologic cardioversion can also be attempted. The use of antiarrhythmic drugs for the maintenance of sinus rhythm depends on several factors: (i) the nature of the arrhythmia (first attack, paroxysmal AF with frequent attacks, paroxysmal AF with infrequent attacks, or persistent AF); (ii) the associated symptoms; (iii) and the risk of severe adverse effects associated with the chosen drug. If the administration of an antiarrhythmic drug is appropriate, the choice of the drug must be tailored to the specific characteristics of the given patient. In lone AF, class Ic antiarrhythmic drugs are the best tolerated. These agents should be combined with a calcium channel antagonist or a beta-blocker to prevent rapid ventricular response in the case of conversion of AF to atrial flutter. In this situation, catheter ablation of atrial flutter at the isthmus (hybrid therapy) should be performed. All class I antiarrhythmic agents should be avoided in patients with structural heart disease. Alternative approaches that may be used if sinus rhythm cannot be maintained with drug therapy include: (i) the ablation of arrhythmogenic pulmonary veins; (ii) the implantation of an atrial defibrillator; (iii) the use of specific pacing sites; (iv) or pacing modes. Whether these approaches will reach clinical relevance merits further investigation. Intraoperative catheter ablation or surgical ablation (maze procedure) seems a promising approach for curing AF in patients undergoing cardiac surgery. Among all of the available treatment options, the most consistent proof of efficacy in reducing mortality and morbidity from AF exists for antithrombotic treatment.

• 227 Strain rate imaging reveals myocardial ischemia as mechanism of right ventricular dysfunction after acute pulmonary embolism

  Authors: T. Poerner, B. Goebel, I. Boehnisch, E. Koletzki, S. Vilardi, D Haghi, M Borggrefe

• 1107 Impact of mitral E/A-ratio on the accuracy of different echocardiographic indices to estimate left ventricular filling pressure

  Authors: T. Poerner, B. Goebel, S. Vilardi, S. Kralev, P. Unglaub, D Haghi

• Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism

  Authors: P. Apfaltrer, T. Henzler, M. Meyer, S. Roeger, D. Haghi, J. Gruettner, T. Suselbeck, R. B. Wilson, U. J. Schoepf, S. O. Schoenberg, C. Fink

  Eur J Radiol.

  OBJECTIVE: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). MATERIALS ANDOBJECTIVE: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS: In a prospective study of 50 patients (66+/-12.9 years) with PE pulmonary artery OS (Qanadli, Mastora, and Mastora central) were assessed by two radiologists. To assess RVD all patients underwent echocardiography within 24h. Furthermore, RVD on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans) and four-chamber views (RV/LV4ch) as well as the RV/LV volume ratio (RV/LVvol). OS were correlated with RVD and the occurrence of adverse clinical outcomes (defined as death, need for intensive care treatment, or cardiac insufficiency >/=NYHA III). RESULTS: Mean Mastora, Qanadli, and Mastora central OS were 26.4+/-17.7, 12.6+/-9.9 and 7.5+/-9, respectively. Echocardiography demonstrated moderate and severe RVD in 10 and 5 patients, respectively. Patients with moderate and severe RVD showed significantly higher Mastora central scores than patients without RVD (14+/-10.8 vs. 5.9+/-7.8 [p=0.05]; 17.6+/-13.2 vs. 5.9+/-7.8 [p=0.038]). A relevant correlation (i.e. r>/=0.6) between OS and CT parameters for RVD were only found for the Mastora score and the Mastora central score (RV/LV4ch: r=0.61 and 0.68, RV/LVvol: r=0.61 and 0.6). 18 patients experienced an adverse clinical outcome. None of the OS differed significantly between patients with and without adverse clinical outcome. CONCLUSION: Pulmonary artery obstruction scores can differentiate between patients with and without RVD. However, in this study, obstruction scores were not correlated to adverse clinical outcome.

• Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction

  Authors: T. Henzler, S. Roeger, M. Meyer, U. J. Schoepf, J. W. Nance, D. Haghi, W. E. Kaminski, M. Neumaier, S. O. Schoenberg, C. Fink

  Eur Respir J. 39(4):919-26.

  The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptideThe aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism. 557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)(axial), RV/LV(4-CH) and RV/LV(volume)). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography. 77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LV(axial) 1.68+/-0.84 versus 1.00+/-0.21; RV/LV(4-CH) 1.52+/-0.45 versus 1.01+/-0.21; RV/LV(volume) 1.97+/-0.53 versus 1.07+/-0.52; serum NT-pro-BNP 6,372+/-2,319 versus 1,032+/-1,559 ng.L(-1); troponin I 0.18+/-0.41 versus 0.06+/-0.18 g.L(-1)). The area under the curve for the detection of RVD of RV/LV(axial), RV/LV(4-CH), RV/LV(volume), NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LV(volume) increased the AUC to 0.95 (RV/LV(volume) with NT-pro-BNP) and 0.93 (RV/LV(volume) with troponin I). RV/LV(volume) is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LV(volume) with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone.

• Correlation of CT angiographic pulmonary artery obstruction scores with right ventricular dysfunction and clinical outcome in patients with acute pulmonary embolism

  Authors: P. Apfaltrer, T. Henzler, M. Meyer, S. Roeger, D. Haghi, J. Gruettner, T. Suselbeck, R. B. Wilson, U. J. Schoepf, S. O. Schoenberg, C. Fink

  Eur J Radiol.

  OBJECTIVE: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). MATERIALS ANDOBJECTIVE: To correlate CTA pulmonary artery obstruction scores (OS) with right ventricular dysfunction (RVD) and clinical outcome in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS: In a prospective study of 50 patients (66+/-12.9 years) with PE pulmonary artery OS (Qanadli, Mastora, and Mastora central) were assessed by two radiologists. To assess RVD all patients underwent echocardiography within 24h. Furthermore, RVD on CT was assessed by calculating the right ventricular/left ventricular (RV/LV) diameter ratios on transverse (RV/LVtrans) and four-chamber views (RV/LV4ch) as well as the RV/LV volume ratio (RV/LVvol). OS were correlated with RVD and the occurrence of adverse clinical outcomes (defined as death, need for intensive care treatment, or cardiac insufficiency >/=NYHA III). RESULTS: Mean Mastora, Qanadli, and Mastora central OS were 26.4+/-17.7, 12.6+/-9.9 and 7.5+/-9, respectively. Echocardiography demonstrated moderate and severe RVD in 10 and 5 patients, respectively. Patients with moderate and severe RVD showed significantly higher Mastora central scores than patients without RVD (14+/-10.8 vs. 5.9+/-7.8 [p=0.05]; 17.6+/-13.2 vs. 5.9+/-7.8 [p=0.038]). A relevant correlation (i.e. r>/=0.6) between OS and CT parameters for RVD were only found for the Mastora score and the Mastora central score (RV/LV4ch: r=0.61 and 0.68, RV/LVvol: r=0.61 and 0.6). 18 patients experienced an adverse clinical outcome. None of the OS differed significantly between patients with and without adverse clinical outcome. CONCLUSION: Pulmonary artery obstruction scores can differentiate between patients with and without RVD. However, in this study, obstruction scores were not correlated to adverse clinical outcome.

• Pulmonary embolism: CT signs and cardiac biomarkers for predicting right ventricular dysfunction

  Authors: T. Henzler, S. Roeger, M. Meyer, U. J. Schoepf, J. W. Nance, D. Haghi, W. E. Kaminski, M. Neumaier, S. O. Schoenberg, C. Fink

  Eur Respir J. 39(4):919-26.

  The aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptideThe aim of this study was to prospectively evaluate the accuracy of quantitative cardiac computed tomography (CT) parameters and two cardiac biomarkers (N-terminal-pro-brain natriuretic peptide (NT-pro-BNP) and troponin I), alone and in combination, for predicting right ventricular dysfunction (RVD) in patients with acute pulmonary embolism. 557 consecutive patients with suspected pulmonary embolism underwent pulmonary CT angiography. Patients with pulmonary embolism also underwent echocardiography and NT-pro-BNP/troponin I serum level measurements. Three different CT measurements were obtained (right ventricular (RV)/left ventricular (LV)(axial), RV/LV(4-CH) and RV/LV(volume)). CT measurements and NT-pro-BNP/troponin I serum levels were correlated with RVD at echocardiography. 77 patients with RVD showed significantly higher RV/LV ratios and NT-pro-BNP/troponin I levels compared to those without RVD (RV/LV(axial) 1.68+/-0.84 versus 1.00+/-0.21; RV/LV(4-CH) 1.52+/-0.45 versus 1.01+/-0.21; RV/LV(volume) 1.97+/-0.53 versus 1.07+/-0.52; serum NT-pro-BNP 6,372+/-2,319 versus 1,032+/-1,559 ng.L(-1); troponin I 0.18+/-0.41 versus 0.06+/-0.18 g.L(-1)). The area under the curve for the detection of RVD of RV/LV(axial), RV/LV(4-CH), RV/LV(volume), NT-pro-BNP and troponin I were 0.84, 0.87, 0.93, 0.83 and 0.70 respectively. The combination of biomarkers and RV/LV(volume) increased the AUC to 0.95 (RV/LV(volume) with NT-pro-BNP) and 0.93 (RV/LV(volume) with troponin I). RV/LV(volume) is the most accurate CT parameter for identifying patients with RVD. A combination of RV/LV(volume) with NT-pro-BNP or troponin I measurements improves the diagnostic accuracy of either test alone.