Stephan Achenbach

Justus-Liebig-Universität Gießen, Gieben, Hesse, Germany

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Publications (673)3782.33 Total impact

  • Heart, Lung and Circulation 12/2015; 24:S334-S335. DOI:10.1016/j.hlc.2015.06.521 · 1.44 Impact Factor
  • Jeroen J. Bax · Victoria Delgado · Stephan Achenbach · Udo Sechtem · Juhani Knuuti ·

    Journal of Nuclear Cardiology 11/2015; 22(6). DOI:10.1007/s12350-015-0322-1 · 2.94 Impact Factor
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    ABSTRACT: Objectives: Although regular physical exercise clearly reduces cardiovascular morbidity risk, long-term endurance sports practice has been recognized as a risk factor for atrial fibrillation (AF). However, the mechanisms how endurance sports can lead to AF are not yet clear. The aim of our present study was to investigate the influence of long-term endurance training on vagal tone, atrial size, and inflammatory profile in professional elite soccer players. Methods: A total of 25 professional major league soccer players (mean age 24±4 years) and 20 sedentary controls (mean age 26±3 years) were included in the study and consecutively examined. All subjects underwent a sports cardiology check-up with physical examination, electrocardiography, echocardiography, exercise testing on a bicycle ergometer, and laboratory analysis [standard laboratory and cytokine profile: interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-8, IL-10]. Results: Athletes were divided into two groups according to presence or absence of an early repolarization (ER) pattern, defined as a ST-segment elevation at the J-point (STE) ≥0.1mm in 2 leads. Athletes with an ER pattern showed significantly lower heart rate and an increased E/e' ratio compared to athletes without an ER pattern. STE significantly correlated with E/e' ratio as well as with left atrial (LA) volume. The pro-inflammatory cytokines IL-6, IL-8, TNF-α as well as the anti-inflammatory cytokine IL-10 were significantly elevated in all soccer players. However, athletes with an ER pattern had significantly higher IL-6 plasma levels than athletes without ER pattern. Furthermore, athletes with "high" level IL-6 had significantly larger LA volumes than players with "low" level IL-6. Conclusions: Athletes with an ER pattern had significantly higher E/e' ratios, reflecting higher atrial filling pressures, higher LA volume, and higher IL-6 plasma levels. All these factors may contribute to atrial remodeling over time and thus increase the risk of AF in long-term endurance sports.
    Journal of Cardiology 11/2015; DOI:10.1016/j.jjcc.2015.08.013 · 2.78 Impact Factor
  • Harvey S. Hecht · Stephan Achenbach · Takeshi Kondo · Jagat Narula ·

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    ABSTRACT: Objectives: The intention this PEPCAD-DES (Treatment of Drug-elutingStent [DES] In-Stent Restenosis With SeQuentPlease Paclitaxel Eluting Percutaneous Transluminal Coronary Angioplasty [PTCA] Catheter) study update was to demonstrate the safety and efficacy of paclitaxel-coated balloon (PCB) angioplasty in patients with DES-ISR at 3 years. Background: In the PEPCAD-DES trial late lumen loss and the need for repeat target lesion revascularization (TLR) was significantly reduced with paclitaxel-coated balloon (PCB) angioplasty compared with plain old balloon angioplasty (POBA) in patients with drug-eluting stent in-stent restenosis (DES-ISR) at 6 months. We evaluated whether the clinical benefit of reduced TLR and major adverse cardiac events (MACE) was maintained up to 3 years. Methods: A total of 110 patients with DES-ISR in native coronary arteries with reference diameters ranging from 2.5 mm to 3.5 mm and lesion lengths ≤22 mm were randomized to treatment with either PCB or POBA in a multicenter, randomized, single-blind clinical study. With a 2:1 randomization, 72 patients were randomized to the PCB group and 38 patients to the POBA group. At baseline, there were lesions with at least 2 stent layers in PCB (52.8%, 38/72) and POBA (55.3%, 21/38) patients. Results: At 36 months, the TLR rates were significantly lower in the PCB group compared with the POBA control group (19.4% vs. 36.8%, p = 0.046). Multiple TLRs in individual patients were more frequent in the POBA group compared with the PCB group (more than 1 TLR: POBA, 13.2%; PCB, 1.4%; p = 0.021). The 36-month MACE rate was significantly reduced in the PCB group compared with the POBA group (20.8% vs. 52.6%, log-rank p = 0.001). Conclusions: PCB angioplasty was superior to POBA for the treatment of DES-ISR patients in terms of MACE and TLR for up to 36 months. There was no late catch-up phenomenon. (Treatment of Drug-eluting Stent [DES] In-Stent Restenosis With SeQuent® Please Paclitaxel Eluting Percutaneous Transluminal Coronary Angioplasty (PTCA) Catheter [PEPCAD-DES]; NCT00998439).
    JACC. Cardiovascular Interventions 10/2015; DOI:10.1016/j.jcin.2015.07.023 · 7.35 Impact Factor
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    ABSTRACT: BACKGROUND: We investigated the relationship of quantitative plaque features from coronary computed tomography (CT) angiography and coronary vascular dysfunction by impaired myocardial flow reserve (MFR) by (13)N-Ammonia positron emission tomography (PET). METHODS AND RESULTS: Fifty-one patients (32 men, 62.4+/-9.5 years) underwent combined rest-stress (13)N-ammonia PET and CT angiography scans by hybrid PET/CT. Regional MFR was measured from PET. From CT angiography, 153 arteries were evaluated by semiautomated software, computing arterial noncalcified plaque (NCP), low-density NCP (NCP<30 HU), calcified and total plaque volumes, and corresponding plaque burden (plaque volumex100%/vessel volume), stenosis, remodeling index, contrast density difference (maximum difference in luminal attenuation per unit area in the lesion), and plaque length. Quantitative stenosis, plaque burden, and myocardial mass were combined by boosted ensemble machine-learning algorithm into a composite risk score to predict impaired MFR (MFR</=2.0) by PET in each artery. Nineteen patients had impaired regional MFR in at least 1 territory (41/153 vessels). Patients with impaired regional MFR had higher arterial NCP (32.4% versus 17.2%), low-density NCP (7% versus 4%), and total plaque burden (37% versus 19.3%, P<0.02). In multivariable analysis with 10-fold cross-validation, NCP burden was the most significant predictor of impaired MFR (odds ratio, 1.35; P=0.021 for all). For prediction of impaired MFR with 10-fold cross-validation, receiver operating characteristics area under the curve for the composite score was 0.83 (95% confidence interval, 0.79-0.91) greater than for quantitative stenosis (0.66, 95% confidence interval, 0.57-0.76, P=0.005). CONCLUSIONS: Compared with stenosis, arterial NCP burden and a composite score combining quantitative stenosis and plaque burden from CT angiography significantly improves identification of downstream regional vascular dysfunction.
    Circulation Cardiovascular Imaging 10/2015; 8(10):003255. DOI:10.1161/CIRCIMAGING.115.003255 · 5.32 Impact Factor
  • Mohamed Marwan · Stephan Achenbach ·
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    ABSTRACT: Epicardial adipose tissue has been attracting increasing attention over the last decade with a large body of evidence pointing towards significant associations between the volume of epicardial fat and atherosclerotic and non-atherosclerotic heart diseases. On the other hand, recent data from relatively large studies question the hypothesis of epicardial fat as an independent risk factor for atherosclerosis. This article reviews the available literature concerning imaging and quantification of epicardial adipose tissue and its potential clinical significance.
    Current Cardiovascular Imaging Reports 10/2015; 8(10). DOI:10.1007/s12410-015-9354-9
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    ABSTRACT: Purpose To compare the diagnostic performance of 320-detector row computed tomography (CT) coronary angiography-derived computed fractional flow reserve (FFR; FFRCT), transluminal attenuation gradient (TAG; TAG320), and CT coronary angiography alone to diagnose hemodynamically significant stenosis as determined by invasive FFR. Materials and Methods This substudy of the prospective NXT study (no. NCT01757678) was approved by each participating institution's review board, and informed consent was obtained from all participants. Fifty-one consecutive patients who underwent 320-detector row CT coronary angiographic examination and invasive coronary angiography with FFR measurement were included. Independent core laboratories determined coronary artery disease severity by using CT coronary angiography, TAG320, FFRCT, and FFR. TAG320 is defined as the linear regression coefficient between luminal attenuation and axial distance from the coronary ostium. FFRCT was computed from CT coronary angiography data by using computational fluid dynamics technology. Diagnostic performance was evaluated and compared on a per-vessel basis by the area under the receiver operating characteristic (ROC) curve (AUC). Results Among 82 vessels, 24 lesions (29%) had ischemia by FFR (FFR ≤ 0.80). FFRCT exhibited a stronger correlation with invasive FFR compared with TAG320 (Spearman ρ, 0.78 vs 0.47, respectively). Overall per-vessel accuracy, sensitivity, specificity, and positive and negative predictive values for TAG320 (<15.37) were 78%, 58%, 86%, 64%, and 83%, respectively; and those of FFRCT were 83%, 92%, 79%, 65%, and 96%, respectively. ROC curve analysis showed a significantly larger AUC for FFRCT (0.93) compared with that for TAG320 (0.72; P = .003) and CT coronary angiography alone (0.68; P = .008). Conclusion FFRCT computed from 320-detector row CT coronary angiography provides better diagnostic performance for the diagnosis of hemodynamically significant coronary stenoses compared with CT coronary angiography and TAG320. (©) RSNA, 2015 Online supplemental material is available for this article.
    Radiology 10/2015; DOI:10.1148/radiol.2015150383 · 6.87 Impact Factor
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    ABSTRACT: Background/purpose: The implantation of bioresorbable scaffolds (BVSs) is an emerging technique in the treatment of coronary lesions and implantation of BVSs is different than that of metallic drug-eluting stents, however, due to different mechanical properties. This investigation focused on procedural and mid-term results and was designed to evaluate whether there is evidence of a learning curve with BVSs and how it might influence the clinical outcome. Methods/materials: In an all-comers registry, the first 100 consecutive patients were compared with the second 100 patients. Target parameters were major adverse cardiac events (MACEs), including cardiac death, any myocardial infarction, and percutaneous or surgical target lesion revascularization (TLR). Target vessel failure (TVF) comprised cardiac death, target vessel myocardial infarction, and percutaneous or surgical target vessel revascularization (TVR). Results: Baseline characteristics were not significantly different. Post-dilatation was used significantly more often in the second group (23.8% vs. 50.5%, p<0.05) as was intravascular imaging (9% vs. 19%, p<0.05). In-hospital MACEs (2.0% for both groups) and median duration of hospital stay (4 (2-6)days) did not differ significantly. During a follow-up of 210 (155-369) or 200 (176-286)days (p=n.s.) for the first and second groups, respectively, MACE (11.2% vs. 1.1%, p<0.01), TVF (10.1% vs. 1.1%, p<0.01), and TVR (9.9% vs. 1.1%, p<0.05) rates were significantly lower in the second group. Conclusion: There is evidence of a learning curve. Post-dilatation is most probably associated with an improved clinical result and intravascular imaging might be useful for further improvement.
    Cardiovascular revascularization medicine: including molecular interventions 10/2015; DOI:10.1016/j.carrev.2015.09.003

  • Der Kardiologe 10/2015; 9(5). DOI:10.1007/s12181-015-0024-6
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    ABSTRACT: Fractional flow reserve derived from coronary computed tomography angiography enables noninvasive assessment of the hemodynamic significance of coronary artery lesions and coupling of the anatomic severity of a coronary stenosis with its physiological effects. Since its initial demonstration of feasibility of use in humans in 2011, a significant body of clinical evidence has developed to evaluate the diagnostic performance of coronary computed tomography angiography-derived fractional flow reserve compared with an invasive fractional flow reserve reference standard. The purpose of this paper was to describe the scientific principles and to review the clinical data of this technology recently approved by the U.S. Food and Drug Administration.
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    ABSTRACT: Invasive fractional flow reserve (FFRinvasive), although gold standard to identify hemodynamically relevant coronary stenoses, is time consuming and potentially associated with complications. We developed and evaluated a new approach to determine lesion-specific FFR on the basis of coronary anatomy as visualized by invasive coronary angiography (FFRangio): 100 coronary lesions (50% to 90% diameter stenosis) in 73 patients (48 men, 25 women; mean age 67 ± 9 years) were studied. On the basis of coronary angiograms acquired at rest from 2 views at angulations at least 30° apart, a PC-based computational fluid dynamics modeling software used personalized boundary conditions determined from 3-dimensional reconstructed angiography, heart rate, and blood pressure to derive FFRangio. The results were compared with FFRinvasive. Interobserver variability was determined in a subset of 25 narrowings. Twenty-nine of 100 coronary lesions were hemodynamically significant (FFRinvasive ≤0.80). FFRangio identified these with an accuracy of 90%, sensitivity of 79%, specificity of 94%, positive predictive value of 85%, and negative predictive value of 92%. The area under the receiver operating characteristic curve was 0.93. Correlation between FFRinvasive (mean: 0.84 ± 0.11) and FFRangio (mean: 0.85 ± 0.12) was r = 0.85. Interobserver variability of FFRangio was low, with a correlation of r = 0.88. In conclusion, estimation of coronary FFR with PC-based computational fluid dynamics modeling on the basis of lesion morphology as determined by invasive angiography is possible with high diagnostic accuracy compared to invasive measurements.
    The American journal of cardiology 10/2015; DOI:10.1016/j.amjcard.2015.10.008 · 3.28 Impact Factor
  • H. M. Nef · H. Möllmann · T. Gori · A. Elsässer · S. Achenbach ·

    Der Kardiologe 09/2015; DOI:10.1007/s12181-015-0015-7
  • J Röther · M Tröbs · J Ludwig · S Achenbach · C Schlundt ·
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    ABSTRACT: To evaluate the success rate and outcome of coronary artery perforation treatment using a dual guiding catheter technique. Coronary artery perforation is a rare but severe complication during percutaneous coronary intervention (PCI) with high mortality. The use of a second guiding catheter is a helpful technique to minimize hemorrhage through the perforation during interventional repair. We screened all patients between March 2004 and December 2014 who underwent PCI in our department for the occurrence of peri-interventional coronary perforation that was treated using a dual catheter technique. Patient and lesion characteristics as well as outcome were determined. We identified 8 patients who experienced coronary artery perforations (Ellis grade III) during coronary intervention and were treated using a dual guiding catheter approach. The procedure was technically successful (placement of covered stent and sealing of perforation) in 6 patients. Pericardiocentesis was required in 3 patients (38%). Total mortality was 12% (n=1). No coronary or peripheral vascular access complication occurred due to the use of a second guiding catheter. We suggest that the dual guiding catheter technique is a useful and alternative approach to treat severe Ellis grade III coronary artery perforations that occur in the context of percutaneous coronary interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    International journal of cardiology 08/2015; 201:479-483. DOI:10.1016/j.ijcard.2015.08.138 · 4.04 Impact Factor
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    ABSTRACT: The goal of this study was to examine the diagnostic performance of noninvasive fractional flow reserve (FFR) derived from coronary computed tomography angiography (CTA) (FFRCT) in relation to coronary calcification severity. FFRCT has shown promising results in identifying lesion-specific ischemia. The extent to which the severity of coronary calcification affects the diagnostic performance of FFRCT is not known. Coronary calcification was assessed by using the Agatston score (AS) in 214 patients suspected of having coronary artery disease who underwent coronary CTA, FFRCT, and FFR (FFR examination was performed in 333 vessels). The diagnostic performance of FFRCT (≤0.80) in identifying vessel-specific ischemia (FFR ≤0.80) was investigated across AS quartiles (Q1 to Q4) and for discrimination of ischemia in patients and vessels with a low-mid AS (Q1 to Q3) versus a high AS (Q4). Coronary CTA stenosis was defined as lumen reduction >50%. Mean ± SD per-patient and per-vessel AS were 302 ± 468 (range 0 to 3,599) and 95 ± 172 (range 0 to 1,703), respectively. There was no statistical difference in diagnostic accuracy, sensitivity, or specificity of FFRCT across AS quartiles. Discrimination of ischemia by FFRCT was high in patients with a high AS (416 to 3,599) and a low-mid AS (0 to 415), with no difference in area under the receiver-operating characteristic curve (AUC) (0.86 [95% confidence interval (CI): 0.76 to 0.96] vs. 0.92 [95% CI: 0.88 to 0.96]) (p = 0.45). Similarly, discrimination of ischemia by FFRCT was high in vessels with a high AS (121 to 1,703) and a low-mid AS (0 to 120) (AUC: 0.91 [95% CI: 0.85 to 0.97] vs. 0.95 [95% CI: 0.91 to 0.98]; p = 0.65). Diagnostic accuracy and specificity of FFRCT were significantly higher than for stenosis assessment in each AS quartile at the per-patient (p < 0.001) and per-vessel (p < 0.05) level with similar sensitivity. In vessels with a high AS, FFRCT exhibited improved discrimination of ischemia compared with coronary CTA alone (AUC: 0.91 vs. 0.71; p = 0.004), whereas on a per-patient level, the difference did not reach statistical significance (AUC: 0.86 vs. 0.72; p = 0.09). FFRCT provided high and superior diagnostic performance compared with coronary CTA interpretation alone in patients and vessels with a high AS. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
    JACC. Cardiovascular imaging 08/2015; 8(9). DOI:10.1016/j.jcmg.2015.06.003 · 7.19 Impact Factor
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    ABSTRACT: Coronary computed tomography angiography (CTA) is being increasingly used for direct, noninvasive evaluation of the coronary arteries. Beyond stenosis, coronary CTA also permits assessment of atherosclerotic plaque (including total and noncalcified plaque burden) and coronary artery remodeling, previously only measurable through invasive techniques. It has been shown that coronary plaque volume for noncalcified and mixed plaques and the arterial remodeling index correlate closely with corresponding measures from invasive intravascular ultrasound. Several studies have also shown a strong relationship between adverse plaque features imaged by coronary CTA and acute coronary syndrome, major adverse cardiovascular events, and ischemia. The aim of this review is to summarize current methods for quantitative measurement of atherosclerotic plaque features from coronary CTA and to discuss the clinical implications of noncalcified plaque as detected by CTA and reported in the current literature.
    Current Cardiovascular Imaging Reports 08/2015; 8(8). DOI:10.1007/s12410-015-9343-z
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    ABSTRACT: Background IABP is routinely used to support coronary blood flow and systemic circulation in patients with cardiogenic shock. Our aim was to explore the incidence of vascular complications associated with the use of IABP in this scenario and their influence on mortality. Methods Therefor we analysed 204 consecutive patients between 2002 and 2013 treated with IAPB in cardiogenic shock for vascular complications and mortality within 30 days after implantation of IAPB. Primary endpoints were severe bleeding (TIMI-definition: intracranial bleeding, loss of haemoglobin (Hb) > 5 g/dl or haematocrit (PCV) > 15%), vascular complications with therapeutic consequence (venous thrombosis, arterial embolism) and stroke. Results 80 (39%) patients died within 30 days after implantation of IABP. In 42 (21%) patients, vascular complications occurred: severe bleeding was present in 26 patients (62% of all complications), 13 (31%) patients suffered from venous thrombosis or arterial embolism and 3 (7%) patients from stroke. 25% of the patients who died had a vascular complication. The rate in patients who overcame cardiogenic shock was 17.7% (p = 0.22). Multivariate analyses showed treatment with Glycoprotein (GP) IIb/IIIa- inhibitors to be an independent risk factor for the occurrence of vascular complications (p = 0.04). Conclusion Vascular events with the use of IABP are common but in our study, not significantly associated with a higher mortality. Treatment with GP IIb/IIIa-antagonists is associated with a higher risk of vascular events.
    08/2015; 8. DOI:10.1016/j.ctrsc.2015.08.008
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    ABSTRACT: Purpose To evaluate the ability of magnetic resonance (MR) imaging to induce deoxyribonucleic acid (DNA) damage in patients who underwent cardiac MR imaging in daily routine by using γ-H2AX immunofluorescence microscopy. Materials and Methods This study complies with the Declaration of Helsinki and was performed according to local ethics committee approval. Informed patient consent was obtained. Blood samples from 45 patients (13 women, 32 men; mean age, 50.3 years [age range, 20-89 years]) were obtained before and after contrast agent-enhanced cardiac MR imaging. MR imaging-induced double-strand breaks (DSBs) were quantified in isolated blood lymphocytes by using immunofluorescence microscopy after staining the phosphorylated histone variant γ-H2AX. Twenty-nine patients were examined with a myocarditis protocol (group A), 10 patients with a stress-testing protocol (group B), and six patients with flow measurements and angiography (group C). Paired t test was performed to compare excess foci before and after MR imaging. Results The mean baseline DSB level before MR imaging and 5 minutes after MR imaging was, respectively, 0.116 DSB per cell ± 0.019 (standard deviation) and 0.117 DSB per cell ± 0.019 (P = .71). There was also no significant difference in DSBs in these subgroups (group A: DSB per cell before and after MR imaging, respectively, 0.114 and 0.114, P = .91; group B: DSB per cell before and after MR imaging, respectively, 0.123 and 0.124, P = .78; group C: DSB per cell before and after MR imaging, respectively, 0.114 and 0.115, P = .36). Conclusion By using γ-H2AX immunofluorescence microscopy, no DNA DSBs were detected after cardiac MR imaging. (©) RSNA, 2015 Online supplemental material is available for this article.
    Radiology 07/2015; 277(2):150555. DOI:10.1148/radiol.2015150555 · 6.87 Impact Factor
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    ABSTRACT: Pericoronary adipose tissue (PCAT) can promote atherosclerosis. Metabolically active and inactive PCAT may display different CT densities. However, CT density could be influenced by partial volume effects and image interpolation. To investigate whether PCAT density values in CT displays differences that are larger than those attributable to interpolation and partial volume effects, which would manifest themselves through the relationship between PCAT density and distance from the contrast-enhanced coronary lumen. PCAT density analysis was performed (417 non-atherosclerotic segments, 63 patients) using dual-source CT with a threshold-based measurement method. Changes in PCAT density values depending on distance from the contrast-enhanced coronary lumen and the influence of cardiovascular risk profile were analyzed. Mean PCAT density was -78.1 ± 5.6 HU. PCAT density decreased from proximal to distal segments in the LAD (-78.0 ± 7.3 vs. -82.4 ± 7.7 HU; p < 0.001). PCAT density was higher close to the lumen compared to more peripheral locations (-76.0 ± 6.7 vs. -78.5 ± 5.4 HU; p < 0.001). Decreasing PCAT density was significantly associated with higher epicardial adipose tissue (EAT) volume and body mass index. There was a trend of lower PCAT values with a family history of coronary artery disease. CT-measured attenuation of PCAT is influenced by EAT volume and body mass index. A decrease of PCAT attenuation with increasing distance from the vessel and from proximal to distal segments may suggest variations in CT density of PCAT due to partial volume effects and image interpolation rather than solely due to differences in tissue composition or metabolic activity. Copyright © 2015 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.
    Journal of cardiovascular computed tomography 07/2015; DOI:10.1016/j.jcct.2015.07.011 · 2.29 Impact Factor
  • K. Urschel · N. Schacher · A. Winterpacht · F. Pasutto · S. Achenbach · B. Dietel ·

    Atherosclerosis 07/2015; 241(1):e74. DOI:10.1016/j.atherosclerosis.2015.04.257 · 3.99 Impact Factor

Publication Stats

21k Citations
3,782.33 Total Impact Points


  • 2011-2015
    • Justus-Liebig-Universität Gießen
      Gieben, Hesse, Germany
    • University of Ottawa
      • Division of Medical Oncology
      Ottawa, Ontario, Canada
    • Weill Cornell Medical College
      New York, New York, United States
    • Robert-Bosch Krankenhaus
      Stuttgart, Baden-Württemberg, Germany
    • The Prince Charles Hospital (Queensland Health)
      Brisbane, Queensland, Australia
  • 1991-2015
    • Universitätsklinikum Erlangen
      • Department of Medicine 2 – Cardiology and Angiology
      Erlangen, Bavaria, Germany
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • • Institute for Biomedicine of Aging
      • • Department of Cardiac Surgery
      • • Institute of Physics
      Erlangen, Bavaria, Germany
  • 2011-2013
    • Universitätsklinikum Gießen und Marburg
      Marburg, Hesse, Germany
  • 2012
    • Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung e.V.
      Crefeld, North Rhine-Westphalia, Germany
    • Vitos Gießen-Marburg
      Giessen, Hesse, Germany
    • Eastern Heart Clinic
      Randwick, New South Wales, Australia
  • 2010-2012
    • Cedars-Sinai Medical Center
      • Cedars Sinai Medical Center
      Los Ángeles, California, United States
    • University of Maryland, Baltimore
      Baltimore, Maryland, United States
    • Emory University
      • Division of Cardiology
      Atlanta, GA, United States
  • 2009
    • Harvard University
      Cambridge, Massachusetts, United States
    • Nuremberg University of Music
      Nuremberg, Bavaria, Germany
  • 2008
    • University of Dallas
      Irving, Texas, United States
  • 2003-2008
    • Massachusetts General Hospital
      • • Division of Cardiology
      • • Department of Radiology
      Boston, Massachusetts, United States
  • 2003-2006
    • Harvard Medical School
      • Department of Radiology
      Boston, Massachusetts, United States
  • 1998
    • Edel&weiss Clinic, Germany, Nuremberg
      Nuremberg, Bavaria, Germany