Frank Breuckmann

Publications (56)141.67 Total impact

• Article: Akuter Thoraxschmerz: Chest-Pain-Unit – die Zertifizierungskampagne der Deutschen Gesellschaft für Kardiologie

  Frank Breuckmann, Felix Post, Raimund Erbel, Thomas Münzel
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  ABSTRACT: Anfang 2007 wurde von der Deutschen Gesellschaft für Kardiologie (DGK) die Task Force Chest-Pain-Unit (CPU) zur Erarbeitung eines national verbindlichen Mindeststandards einer CPU gegründet. Im Oktober 2008 wurden erstmals Empfehlungen zum notwendigen Mindeststandard einer CPU in Deutschland publiziert. In den nächsten Jahren sollen mit Hilfe der DGK insgesamt etwa 300 Zentren deutschlandweit zertifiziert werden, um eine flächendeckende Versorgung des akuten Brustschmerzes zu erzielen. Nach Bewerbung und Prüfung der formalen Voraussetzungen werden die Mindestkriterien der DGK anhand der eingereichten Dokumentation durch ein Expertengremium geprüft. Die Mindestkriterien umfassen spezielle räumliche und apparative Voraussetzungen, diagnostische und therapeutische Maßnahmen, Kooperationen, Ausbildungskriterien und organisatorische Erfordernisse. Nach erfolgreichem Durchlaufen der Dokumentationsprüfung erfolgt im Rahmen eines Audits die Prüfung von Qualifikation, Ausstattung und Abläufen detailliert vor Ort. Nach eingehender Prüfung aller Unterlagen und der Empfehlungen der Auditoren entscheidet das Expertengremium der DGK schließlich über die mögliche Zertifizierung. Der Aufbau einer CPU mit Hilfe einer koordinierten Zertifizierungskampagne bietet eine Optimierung der Patientenversorgung und eine Ökonomisierung der Arbeitsschritte. Die DGK unterstreicht durch ihre Kampagne die Bedeutung, die CPUs für die Versorgung von Patienten mit akutem Thoraxschmerz in Deutschland haben, und bietet Raum für weitere Entwicklungen und Innovationen. The Chest Pain Unit (CPU) Task Force of the German Society of Cardiology inaugurated elaborated prerequisites for a CPU certification program to evaluate CPUs across the country. For this reason, a consensus document including criteria for CPUs was developed and published in October 2008. Aim of this effort is to ensure a network of elaborated centers which meet or exceed quality-of-care measures in order to improve the standard of care of patients with acute thoracic pain. After application and a formal checkup of the institution, the minimum requirements are assessed by an expert committee of the German Society of Cardiology according to presubmitted documentation of the care processes for patients with acute thoracic pain. Components of certification include characteristic locations, equipment, diagnostic and therapeutic strategies, cooperations, staff education, and organization. Certification specifically implies algorithms for ST segment elevation myocardial infarction, non-ST segment elevation myocardial infarction, unstable angina, stable angina, hypertensive crisis, acute pulmonary embolism, acute aortic syndrome, cardiogenic shock, and resuscitation. Availability of a catheter laboratory ready within the facility is mandatory. The CPU and the cath lab are obliged to be available 24 h per day over 365 days per year. After successful documentation review, a certification audit team reviews the facility’s application, infrastructure, patient care, and each of the requirements according to the consensus document on site and makes recommendations to the expert committee. Certification is finally awarded by the expert committee of the German Society of Cardiology to those CPUs which fulfill the dedicated requirements and successfully run through the complete certification process. Within this process, CPUs can plan and organize the delivery of care in a systematic manner, and the differentiation between minimum requirements and best practice allows further developments and innovations.
  Herz 04/2012; 34(3):218-223. · 0.92 Impact Factor
• Article: 1083 Reproducibility of right atrial volume and ejection fraction in healthy subjects and patients with right heart failure using the standard short axis and area-length method

  Burkhard Sievers, Marvin Addo, Frank Breuckmann, Joerg Barkhausen, Raimund Erbel
  Journal of Cardiovascular Magnetic Resonance 04/2012; 10:1-3. · 3.72 Impact Factor
• Article: Recovery of Myocardial Hibernation after Percutaneous Coronary Intervention

  Frank Breuckmann, Kai Nassenstein, Jörg Barkhausen, Gerd Heusch, Raimund Erbel
  Herz 04/2012; 34(3):240-240. · 0.92 Impact Factor
• Article: [Acute thoracic pain: Chest Pain Unit - the certification campaign of the German Society of Cardiology].

  Frank Breuckmann, Felix Post, Raimund Erbel, Thomas Münzel
  [show abstract] [hide abstract]
  ABSTRACT: The Chest Pain Unit (CPU) Task Force of the German Society of Cardiology inaugurated elaborated prerequisites for a CPU certification program to evaluate CPUs across the country. For this reason, a consensus document including criteria for CPUs was developed and published in October 2008. Aim of this effort is to ensure a network of elaborated centers which meet or exceed quality-of-care measures in order to improve the standard of care of patients with acute thoracic pain. After application and a formal checkup of the institution, the minimum requirements are assessed by an expert committee of the German Society of Cardiology according to presubmitted documentation of the care processes for patients with acute thoracic pain. Components of certification include characteristic locations, equipment, diagnostic and therapeutic strategies, cooperations, staff education, and organization. Certification specifically implies algorithms for ST segment elevation myocardial infarction, non-ST segment elevation myocardial infarction, unstable angina, stable angina, hypertensive crisis, acute pulmonary embolism, acute aortic syndrome, cardiogenic shock, and resuscitation. Availability of a catheter laboratory ready within the facility is mandatory. The CPU and the cath lab are obliged to be available 24 h per day over 365 days per year. After successful documentation review, a certification audit team reviews the facility's application, infrastructure, patient care, and each of the requirements according to the consensus document on site and makes recommendations to the expert committee. Certification is finally awarded by the expert committee of the German Society of Cardiology to those CPUs which fulfill the dedicated requirements and successfully run through the complete certification process. Within this process, CPUs can plan and organize the delivery of care in a systematic manner, and the differentiation between minimum requirements and best practice allows further developments and innovations.
  Herz 06/2009; 34(3):218-23. · 0.92 Impact Factor
• Article: Image of the month. Recovery of myocardial hibernation after percutaneous coronary intervention. Repetitive assessment by magnetic resonance imaging.

  Frank Breuckmann, Kai Nassenstein, Jörg Barkhausen, Gerd Heusch, Raimund Erbel
  Herz 06/2009; 34(3):240. · 0.92 Impact Factor
• Article: Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners.

  Frank Breuckmann, Stefan Möhlenkamp, Kai Nassenstein, Nils Lehmann, Susanne Ladd, Axel Schmermund, Burkhard Sievers, Thomas Schlosser, Karl-Heinz Jöckel, Gerd Heusch, Raimund Erbel, Jörg Barkhausen
  [show abstract] [hide abstract]
  ABSTRACT: To prospectively analyze the myocardial distribution of late gadolinium enhancement (LGE) with delayed-enhancement cardiac magnetic resonance (MR) imaging, to compare the prevalence of this distribution in nonprofessional male marathon runners with that in asymptomatic control subjects, and to examine the prognostic role of LGE. Institutional review board and ethics committee approval were obtained for this study, and all subjects provided written informed consent. Two-dimensional inversion-recovery segmented k-space gradient-echo MR sequences were performed after administration of a gadolinium-containing contrast agent in 102 ostensibly healthy male runners aged 50-72 years who had completed at least five marathons during the past 3 years and in 102 age-matched control subjects. Predominantly subendocardial regions of LGE typical of myocardial infarction (hereafter, coronary artery disease [CAD] pattern) were distinguished from a predominantly midmyocardial patchy pattern of LGE (hereafter, non-CAD pattern). Marathon runners with LGE underwent repeat cardiac MR imaging and additional adenosine perfusion imaging. Runners were followed up for a mean of 21 months +/- 3 (standard deviation) after initial presentation. The chi(2), Fisher exact, and McNemar exact tests were used for comparisons. Event-free survival rates were estimated with the Kaplan-Meier method, and overall group differences were evaluated with log-rank statistics. Of the 102 runners, five had a CAD pattern of LGE, and seven had a non-CAD pattern of LGE. The CAD pattern of LGE was located in the territory of the left anterior descending coronary artery more frequently than was the non-CAD pattern (P = .0027, Fisher exact test). The prevalence of LGE in runners was higher than that in age-matched control subjects (12% vs 4%; P = .077, McNemar exact test). The event-free survival rate was lower in runners with myocardial LGE than in those without myocardial LGE (P < .0001, log-rank test). Ostensibly healthy marathon runners have an unexpectedly high rate of myocardial LGE, and this may have diagnostic and prognostic relevance.
  Radiology 05/2009; 251(1):50-7. · 5.73 Impact Factor
• Article: Systematic analysis of functional and structural changes after coronary microembolization: a cardiac magnetic resonance imaging study.

  Frank Breuckmann, Kai Nassenstein, Christina Bucher, Ina Konietzka, Gernot Kaiser, Thomas Konorza, Christoph Naber, Andreas Skyschally, Petra Gres, Gerd Heusch, Raimund Erbel, Jörg Barkhausen
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  ABSTRACT: Our study aimed to detect the morphological und functional effects of coronary microembolization (ME) in vivo by cardiac magnetic resonance (CMR) imaging in an established experimental animal model. Post-mortem morphological alterations of coronary ME include perifocal inflammatory edema and focal microinfarcts. Clinically, the detection of ME after successful coronary interventions identifies a population with a worse long-term prognosis. In 18 minipigs, ME was performed by intracoronary infusion of microspheres followed by repetitive in vivo imaging on a 1.5-T MR system from 30 min to 8 h after ME. Additionally, corresponding ex vivo CMR imaging and histomorphology were performed. Cine CMR imaging demonstrated a time-dependent increase of wall motion abnormalities from 9 of 18 animals after 30 min to all animals after 8 h (0.5 h, 50%; 2 h, 78%; 4 h, 75%; 8 h, 100%). Whereas T2 images were negative 30 min after ME, 4 of 18 animals showed myocardial edema at follow-up (0.5 h, 0%; 2 h, 6%; 4 h, 25%; 8 h, 17%). In vivo late gadolinium enhancement (LGE) was observed in none of the animals after 30 min, but in 33%, 50%, and 83% of animals at 2 h, 4 h, and 8 h, respectively, after ME. Ex vivo CMR imaging showed patchy areas of LGE in all but 1 animal (2 h, 83%; 4 h, 100%; 8 h, 100%). A significant correlation was seen between the maximum troponin I level and LGE in vivo (r = 0.63) and the spatial extent of ex vivo LGE (r = 0.76). Our results show that in vivo contrast-enhanced CMR imaging allows us to detect functional and structural myocardial changes after ME with a high sensitivity. Ex vivo, the pattern of LGE of high-resolution, contrast-enhanced CMR imaging is different from the well-known pattern of LGE in compact myocardial damage. Thus, improvements in spatial resolution are thought to be necessary to improve its ability to visualize ME-induced structural alterations even in vivo.
  JACC. Cardiovascular imaging 03/2009; 2(2):121-30. · 14.29 Impact Factor
• Article: How much myocardial damage is necessary to enable detection of focal late gadolinium enhancement at cardiac MR imaging?

  Kai Nassenstein, Frank Breuckmann, Christina Bucher, Gernot Kaiser, Thomas Konorza, Lena Schäfer, Ina Konietzka, Armin de Greiff, Gerd Heusch, Raimund Erbel, Jörg Barkhausen
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  ABSTRACT: To assess the visibility of small myocardial lesions at magnetic resonance (MR) imaging and to estimate how much myocardial damage is necessary to enable detection of late gadolinium enhancement (LGE) in vivo. The study was approved by the local bioethics committee. Coronary microembolization was performed by injecting 300,000 microspheres into the distal portion of the left anterior descending artery in 18 anesthetized minipigs to create multifocal areas of myocardial damage. In vivo MR imaging was performed a mean of 6 hours after microembolization by using an inversion-recovery spoiled gradient-echo sequence (repetition time msec/echo time msec, 8/4; inversion time, 240-320 msec; flip angle, 20 degrees; spatial resolution, 1.3 x 1.7 x 5.0 mm(3)) after injection of 0.2 mmol gadopentetate dimeglumine per kilogram of body weight. High-spatial-resolution imaging of the explanted heart was performed by using the same sequence with a higher spatial resolution (0.5 x 0.5 x 2.0 mm(3)). Imaging results were verified with histologic examination. Signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of in vivo and ex vivo images were calculated, and a t test was used to analyze observed differences. Multifocal myocardial damage was successfully induced in all animals. Areas of LGE with low SNR (mean, 36.3 +/- 29.4 [standard deviation]) and CNR (23.7 +/- 19.8) were observed in vivo in 12 (67%) of 18 animals, whereas ex vivo imaging revealed spotted to streaky areas of LGE with higher SNR (91.4 +/- 27.8, P < .0001) and CNR (72.1 +/- 25.4, P < .0001) among normal-appearing myocardium in all cases (100%). Focal myocardial lesions exceeding 5% of myocardium per slice at histologic examination were detected in vivo with a sensitivity of 83%. Focal myocardial damage exceeding 5% of myocardium within the region of interest seems to be necessary for detection of LGE in vivo in an experimental model of coronary microembolization.
  Radiology 10/2008; 249(3):829-35. · 5.73 Impact Factor
• Article: Circulating progenitor cells decrease immediately after marathon race in advanced-age marathon runners.

  Volker Adams, Axel Linke, Frank Breuckmann, Kirsten Leineweber, Sandra Erbs, Nicolle Kränkel, Martina Bröcker-Preuss, Felix Woitek, Raimund Erbel, Gerd Heusch, Rainer Hambrecht, Gerhard Schuler, Stefan Möhlenkamp
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  ABSTRACT: Exercise is thought to stimulate the release of hematopoietic and endothelial progenitor cells (EPC) from the bone marrow. Little is known about the influence of strenuous exercise on the content of circulating progenitor cells. The aim of this study was to investigate the influence of a marathon race on the amount of circulating progenitor cells immediately after the race in advanced-aged runners. Sixty-eight healthy marathon runners (age: 57+/-6 years) were included in this study. Blood cell counts were evaluated by standard methods, and circulating progenitor cells before and immediately after the race were quantified by fluorescence-activated cell sorter (FACS). Vascular endothelial growth factor (VEGF) and epidermal growth factor (EGF) was quantified by enzyme-linked immunosorbent assay. A marathon race led to a significant increase in white blood cell count (5283+/-155 vs. 13706+/-373 cells/mul; P<0.001). Fluorescence-activated cell sorter analysis revealed a significant decrease of CD34 cells (1829+/-115 vs. 1175+/-75 cells/ml blood; P<0.0001), CD117 cells (2478+/-245 vs. 2193+/-85 cells/ml blood; P<0.05), and CD133 cells (3505+/-286 vs. 2239+/-163 cells/ml blood; P<0.001). No significant change was observed for EPCs defined as CD34/VEGF-R2 cells (117+/-8 vs. 128+/-9 cells/ml blood; P=0.33). With respect to VEGF a significant downregulation was evident directly after the race (48.9+/-8.0 vs. 34.0+/-7.5 pg/ml; P<0.05), whereas no change was obvious in EGF levels. The results of our study suggest that finishing a marathon race will lead to an inflammatory response and downregulation of circulating hematopoietic stem cells. With respect to EPCs no change is observed, which may be because of a greater differentiation of the remaining CD34 cells towards EPCs.
  European Journal of Cardiovascular Prevention and Rehabilitation 09/2008; 15(5):602-7. · 2.63 Impact Factor
• Source

  Available from: Peter Hunold

  Article: Left ventricular volumes and mass in marathon runners and their association with cardiovascular risk factors.

  Kai Nassenstein, Frank Breuckmann, Nils Lehmann, Axel Schmermund, Peter Hunold, Martina Broecker-Preuss, Torleif A Sandner, Martin Halle, Klaus Mann, Karl-Heinz Jöckel, Gerd Heusch, Thomas Budde, Raimund Erbel, Jörg Barkhausen, Stefan Möhlenkamp
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  ABSTRACT: To assess left ventricular volumes and mass by cardiac magnetic resonance imaging in relation to conventional cardiovascular risk factors and coronary atherosclerotic plaque burden in master marathon runners aged > or =50 years. Cardiac MRI was performed in 105 clinically healthy male marathon runners (mean age 57.3 +/- 5.7 years, range 50-71 years) on a 1.5 T MR system (Avanto, Siemens, Germany). Cine steady state free precession images in standard long and short axes views were acquired to assess left ventricular volumes and mass. Cardiovascular risk factors (blood pressure, HDL/LDL cholesterol, smoking, body mass index) were assessed and coronary artery calcification (CAC) was quantified by electron beam computed tomography. Left ventricular muscle mass (mean LVMM = 140 +/- 27 g; 73 +/- 13 g/m(2)) increased with increasing left ventricular end-diastolic volume (mean LVEDV = 137 +/- 32 ml; 72 +/- 15 ml/m(2)) (r = 0.41, P < 0.0001) and with systolic (r = 0.33, P = 0.005) and diastolic (r = 0.28, P = 0.005) blood pressures. Left ventricular EDV increased up to the age of 55 years, but decreased thereafter. Runners with LVMM > or =150 g had significantly higher CAC scores than runners with LVMM <150 g (median CAC score 110 vs. 25, P = 0.04). Increases in LVMM and LVEDV may not only represent a response to exercise but are dependent on age and blood pressure, also. In addition, a left ventricular hypertrophy without an increase in volume may be an indicator for early subclinical cardiac alterations in response to risk factor exposure.
  The international journal of cardiovascular imaging 08/2008; 25(1):71-9. · 2.15 Impact Factor
• Article: [Cardiac magnetic resonance imaging in the diagnosis of acute coronary syndrome. Basics and clinical value].

  Frank Breuckmann, Kai Nassenstein, Oliver Bruder, Christiane Buhr, Burkhard Sievers, Jörg Barkhausen, Raimund Erbel, Peter Hunold
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  ABSTRACT: In contrast to chronic myocardial infarction, data concerning the value of cardiac magnetic resonance imaging in patients with acute onset of chest pain are still rare. Even in the presence of characteristic clinical parameters, cardiac magnetic resonance imaging might provide independent evidence especially in the absence of typical ECG alterations and prior to biomarker elevation. Besides the ability to demonstrate wall motion abnormalities cardiac magnetic resonance imaging gains additional potential as to the detection of myocardial edema, microvascular obstruction (no-reflow) and myocardial necrosis. However, cardiac magnetic resonance imaging is expensive and time-consuming, and therefore may not be cost-effective. At present, a lack of sufficient diagnostic and prognostic data would make cardiac magnetic resonance imaging unsuitable for routine stratification of chest pain patients in an emergency department.
  Herz 04/2008; 33(2):129-35. · 0.92 Impact Factor
• Article: Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners.

  Stefan Möhlenkamp, Nils Lehmann, Frank Breuckmann, Martina Bröcker-Preuss, Kai Nassenstein, Martin Halle, Thomas Budde, Klaus Mann, Jörg Barkhausen, Gerd Heusch, Karl-Heinz Jöckel, Raimund Erbel
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  ABSTRACT: To quantify the prevalence of coronary artery calcification (CAC) in relation to cardiovascular risk factors in marathon runners, and to study its role for myocardial damage and coronary events. In 108 apparently healthy male marathon runners aged >or=50 years, with >or=5 marathon competitions during the previous three years, the running history, Framingham risk score (FRS), CAC, and presence of myocardial late gadolinium enhancement (LGE) were measured. Control groups were matched by age (8:1) and FRS (2:1) from the Heinz Nixdorf Recall Study. The FRS in marathon runners was lower than in age-matched controls (7 vs. 11%, P < 0.0001). However, the CAC distribution was similar in marathon runners and age-matched controls (median CAC: 36 vs. 38, P = 0.36) and higher in marathon runners than in FRS-matched controls (median CAC: 36 vs. 12, P = 0.02). CAC percentile values and number of marathons independently predicted the presence of LGE (prevalence = 12%) (P = 0.02 for both). During follow-up after 21.3 +/- 2.8 months, four runners with CAC >or= 100 experienced coronary events. Event-free survival was inversely related to CAC burden (P = 0.018). Conventional cardiovascular risk stratification underestimates the CAC burden in presumably healthy marathon runners. As CAC burden and frequent marathon running seem to correlate with subclinical myocardial damage, an increased awareness of a potentially higher than anticipated coronary risk is warranted.
  European Heart Journal 04/2008; 29(15):1903-10. · 10.48 Impact Factor
• Article: Prognostic impact of contrast-enhanced CMR early after acute ST segment elevation myocardial infarction (STEMI) in a regional STEMI network: results of the "Herzinfarktverbund Essen".

  Oliver Bruder, Frank Breuckmann, Christoph Jensen, Markus Jochims, Christoph K Naber, Jörg Barkhausen, Raimund Erbel, Georg V Sabin
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  ABSTRACT: In acute ST segment elevation myocardial infarction (STEMI), rapid restoration of epicardial coronary blood flow and myocardial perfusion limits infarct size and improves survival. Primary percutaneous coronary intervention (PCI) is superior to systemic fibrinolysis when instantly performed by experienced operators. The "Herzinfarktverbund Essen" (HIVE) is an urban STEMI network supporting direct patient transfer for primary PCI to four PCI centers covering a city area of 600,000 inhabitants. Integrated health care is an optional part of the HIVE allowing for reimbursement of medical innovations such as the evaluation of infarct size and the presence and extent of microvascular obstruction by contrast-enhanced cardiac magnetic resonance (CMR). The aim of this study was to assess the prognostic impact of contrast-enhanced CMR in the patient cohort of a regional STEMI network. Within the 1st year (09/2004 to 08/2005) of the HIVE registry, 489 patients with acute myocardial infarction were treated in the four primary PCI centers. In one of the centers, including 143 patients, early CMR imaging using a standardized MR protocol for infarct quantification was performed whenever possible. Patients with hemodynamic instability, emergency coronary artery bypass grafting, resuscitation or death prior to CMR, claustrophobia, and other general contraindications to MRI had to be excluded, leaving 67 patients (54 male; mean age 61 +/- 12 years) for final evaluation. CMR was performed 4.5 +/- 2.5 days after admission on a 1.5-T MR scanner (Sonata, Siemens Medical Solutions, Erlangen, Germany) including steady-state free precession (SSFP) cine imaging for left ventricular function and single-shot inversion-recovery SSFP imaging for delayed enhancement (DE) and no-reflow (NR) evaluation following injection of 0.2 mmol/kg body weight gadodiamide (Omniscan, GE Healthcare Buchler, Munich, Germany). NR and DE volumes were calculated from single-shot short-axis stacks taken within the 1st minute following gadodiamide infusion by manual planimetry and summation of disks. 1-year follow-up data (telephone interview) for major adverse cardiac events (MACE: cardiac death, myocardial infarction, and rehospitalization for congestive heart failure, angina pectoris, or revascularization) were available for all patients. DE as a measure of infarct size was 9% +/- 7% (range 0-33%) of left ventricular mass (LVM), and mean volume of microvascular obstruction was 2% +/- 3% (range 0-17%). Microvascular obstruction was present in 61% of patients. 16 MACE (one cardiac death, one myocardial infarction, and 14 rehospitalizations for congestive heart failure or unstable angina pectoris with PCI in six cases) occurred within the follow-up period of 430 +/- 63 days. Patients with MACE had larger infarcts (14% +/- 10% vs. 8% +/- 6% DE), lower left ventricular ejection fraction (LVEF 44% +/- 17% vs. 48% +/- 14%) and larger NR (3% +/- 5% vs. 2% +/- 3%). Using a stepwise logistic regression model, only NR > 0.5% of LVM was independently related to outcome (odds ratio = 3.9, confidence interval 1.1-13.9). NR as a correlate of microvascular obstruction remains independently related to prognosis in patients with acute myocardial infarction treated by PCI.
  Herz 03/2008; 33(2):136-42. · 0.92 Impact Factor
• Article: Kardiale Magnetresonanztomographie in der Diagnostik des akuten Koronarsyndroms

  Frank Breuckmann, Kai Nassenstein, Oliver Bruder, Christiane Buhr, Burkhard Sievers, Jörg Barkhausen, Raimund Erbel, Peter Hunold
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  ABSTRACT: Im Gegensatz zum chronischen Infarkt sind bisher nur wenige Daten über die Anwendung der kardialen Magnetresonanztomographie bei Patienten mit akutem Brustschmerz vorhanden. Bei Vorliegen üblicher klinischer Parameter könnte die kardiale Magnetresonanztomographie insbesondere bei Patienten ohne typische EKG-Veränderungen und vor Anstieg kardialer Biomarker zusätzlich eine unabhängige Aus sage bieten. Neben detektierbaren Wandbewegungsstörungen in der Funktionsanalyse verfügt die kardiale Magnetresonanztomographie insbesondere durch den Nachweis von myokardialem Ödem, Zonen der mikrovaskulären Obstruktion und später Kontrastmittelanreicherung in der Diagnostik der Myokardischämie über ein außerordentliches Potential. Dem steht jedoch sowohl der hohe zeitliche als auch finanzielle Aufwand gegenüber. Für eine genaue Bewertung der diagnostischen Wertigkeit und des Nutzens in der Prognosefestlegung in der Notaufnahme fehlen weiterhin große klinische Studien. In contrast to chronic myocardial infarction, data concerning the value of cardiac magnetic resonance imaging in patients with acute onset of chest pain are still rare. Even in the presence of characteristic clinical parameters, cardiac magnetic resonance imaging might provide independent evidence especially in the absence of typical ECG alterations and prior to biomarker elevation. Besides the ability to demonstrate wall motion abnormalities cardiac magnetic resonance imaging gains additional potential as to the detection of myocardial edema, microvascular obstruction (no-reflow) and myocardial necrosis. However, cardiac magnetic resonance imaging is expensive and time-consuming, and therefore may not be cost-effective. At present, a lack of sufficient diagnostic and prognostic data would make cardiac magnetic resonance imaging unsuitable for routine stratification of chest pain patients in an emergency department.
  Herz 02/2008; 33(2):129-135. · 0.92 Impact Factor
• Article: Magnetic resonance coronary angiography with Vasovist: in-vivo T1 estimation to improve image quality of navigator and breath-hold techniques.

  Kai Nassenstein, Kai-Uwe Waltering, Sebastian Kelle, Thomas Schlosser, Frank Breuckmann, Stefan Maderwald, Peter Hunold, Eike Nagel, Jörg Barkhausen
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  ABSTRACT: The purpose of the study was to estimate T1 values of blood and myocardium after a single injection of Vasovist and to assess Vasovist for magnetic resonance coronary angiography (MRCA). For all exams 0.05 mmol/kg of Vasovist was injected. T1 values of blood and myocardium were estimated over 30 min after injection. Twelve volunteers were examined on a 1.5-T Siemens system using a SSFP sequence with incrementally increasing inversion times for T1-estimation and a breath-hold 3D IR-FLASH sequence for MRCA. Eleven examinations were performed on 1.5-T Philips system using the Look-Locker approach for T1 estimation and a whole-heart inversion-prepared, 3D SSFP sequence for MRCA. SNR, CNR and image quality were assessed. T1 values of blood (5 min: 230 ms vs. 30 min: 275 ms) and myocardium (5 min: 99 ms vs. 30 min: 130 ms) increased over time. Whereas the blood SNR (1 min: 23.6 vs. 30 min: 21.2) showed no significant differences, the blood-to-myocardium CNR (1 min: 18.1 vs. 30 min: 13.8) and the image quality (1 min: 2.9 vs. 30 min: 3.8) degraded over time. Due to long plasma half-time the T1-shortening effect of Vasovist remains effective over 30 min, which allows for multiple breath-hold or high-resolution MRCA.
  European Radiology 02/2008; 18(1):103-9. · 3.22 Impact Factor
• Article: 1044 High spatial and temporal resolution MRA (TWIST) in acute aortic dissection

  Florian Vogt, Stefan Maderwald, Holger Eggebrecht, Frank Breuckmann, Randall Kroeker, Jörg Barkhausen
  Journal of Cardiovascular Magnetic Resonance. 01/2008;
• Article: 2099 Cardiac MRI @ 7-Tesla: initial experiments in pigs

  Harald Quick, Frank Breuckmann, Kai Nassenstein, Stefan Maderwald, Lena Schäfer, Mark Ladd, Jörg Barkhausen
  Journal of Cardiovascular Magnetic Resonance. 01/2008;
• Article: 2029 Systemic sclerosis: detection of myocardial fibrosis by contrast-enhanced MRI

  Kai Nassenstein, Frank Breuckmann, Michael Huger, Susanne Ladd, Peter Hunold, Raimund Erbel, Peter Altmeyer, Alexander Kreuter, Joerg Barkhausen
  Journal of Cardiovascular Magnetic Resonance. 01/2008;
• Article: Quantification of aortic valve stenosis in MRI-comparison of steady-state free precession and fast low-angle shot sequences.

  Thomas Schlosser, Nasser Malyar, Markus Jochims, Frank Breuckmann, Peter Hunold, Oliver Bruder, Raimund Erbel, Jörg Barkhausen
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  ABSTRACT: We compared two different magnetic resonance (MR) sequences [steady-state free precession (SSFP) and gradient echo fast low-angle shot (FLASH)] for the assessment of aortic valve areas in aortic stenosis using transesophageal echocardiography (TEE) as the standard of reference. Thirty-two patients with known aortic stenosis underwent MR (1.5 T) using a cine SSFP sequence and a cine FLASH sequence. Planimetry was performed in cross-sectional images and compared to the results of the TEE. In seven patients the grade of stenosis was additionally assessed by invasive cardiac catheterization (ICC). The mean aortic valve area measured by TEE was 0.97+/-0.19 mm(2), 1.00+/-0.25 mm(2) for SSFP and 1.25+/-0.23 mm(2) based on FLASH images. The mean difference between the valve areas assessed based on SSFP and TEE images was 0.15+/-0.13 cm(2) (FLASH vs TEE: 0.29+/-0.17 cm(2)). Bland-Altman analysis demonstrated that measurements using FLASH images overestimated the aortic valve area compared to TEE. Comparing ICC with MRI and TEE, only a weak to moderate correlation was found (ICC vs TEE: R=0.52, p=0.22; ICC vs SSFP: R=0.20, p=0.65; ICC vs FLASH: R=0.16, p=0.70). Measurements of the aortic valve area based on SSFP images correlate better with TEE compared to FLASH images.
  European Radiology 06/2007; 17(5):1284-90. · 3.22 Impact Factor
• Source

  Available from: Wolfgang Herzog

  Article: Prevalence and natural history of heart failure in outpatient HIV-infected subjects: rationale and design of the HIV-HEART study.

  Till Neumann, Stefan Esser, Anja Potthoff, Sabine Pankuweit, Anja Neumann, Frank Breuckmann, Katrin Neuhaus, Jana Kondratieva, Thomas Buck, Thomas Müller-Tasch, [......], Wolfgang Herzog, Burkert Pieske, Mathias Rauchhaus, Markus Löffler, Bernhard Maisch, Andreas Mügge, Jürgen Wasem, Guido Gerken, Norbert H Brockmeyer, Raimund Erbel
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  ABSTRACT: HIV infection is a global public health issue that is frequently associated with cardiac involvement. However, myocardial dysfunction and heart failure are often clinically occult or attributed incorrectly to other non-cardiac disease processes even a heightened awareness and knowledge for these cardiac diseases in HIV-infected patients may lead to earlier detection and a reduction in morbidity and mortality. The present study evaluates the frequency and clinical course of myocardial dysfunction and heart failure in a HIV-infected population. The HIV-HEART (HIV-infection and HEART disease) study is a prospective, long-term cohort study. The study is designed and powered to define prevalence and natural history of chronic heart failure. Following a pilot-study of 105 HIV-infected subjects the HIV-HEART trial will contain 802 HIV-infected males and females with and without antiretroviral therapy in an urban population. HIV-HEART is performed by using non-invasive techniques for the quantification of exercise intolerance and ventricular dysfunction, including concentration of B-type natriretic peptide (BNP), transthoracal echocardiography and endurance testing. Patients with BNP >100 pg/ml achieve a magnetic resonance tomography of the heart for characterization of myocardial dysfunction and type of cardiomyopathy. To determine incidence and natural history of myocardial dysfunction and heart failure, a 2 year follow-up started in September 2006. The HIV-HEART study will define the significance of myocardial dysfunction and heart failure in a HIV-infected urban population and classify appropriate methods for identifying high-risk patients, the basis for risk stratification and therapy.
  European journal of medical research 06/2007; 12(6):243-8. · 1.13 Impact Factor