Dirk Westermann

Universitäts-Herzzentrum Freiburg - Bad Krozingen · Department of Cardiology and Angiology

Purpose: To evaluate the potential differences in characteristics of femoropopliteal in-stent restenosis (ISR) stratified by stent design with a focus on the swirling flow-inducing BioMimics 3D helical centerline stent. Methods: Patients with ISR of the superficial femoral and popliteal arteries undergoing reintervention were included in this study...

BACKGROUND Preeclampsia shares numerous risk factors with cardiovascular diseases. Here, we aimed to assess the potential utility of high-sensitivity cardiac troponin I (hs-cTnI) values during pregnancy in predicting preeclampsia occurrence. METHODS This study measured hs-cTnI levels in 3721 blood samples of 2245 pregnant women from 4 internationa...

Background Previously, overall comparable outcomes were seen for balloon-expandable (BE) or self-expanding (SE) transfemoral transcatheter aortic valve replacement (TAVR). However, subgroup analyses based on large case numbers are still needed. Methods German national data of all BE and SE transfemoral TAVR treating aortic valve stenosis in 2019 a...

Aims Patients with acute or chronic myocardial injury are frequently identified in the context of suspected myocardial infarction (MI). We aimed to investigate their long-term follow-up. Methods and results We prospectively enrolled 2714 patients with suspected MI and followed them for all-cause mortality and a composite cardiovascular endpoint (C...

Background Currently, use of mechanical circulatory support (MCS) in non-ischaemic cardiogenic shock (CS) is predominantly guided by shock-specific markers, and not by markers of cardiac function. We hypothesise that left ventricular ejection fraction (LVEF) can identify patients with a higher likelihood to benefit from MCS and thus help to optimis...

Background Mortality in cardiogenic shock (CS) remains high even when mechanical circulatory support (MCS) restores adequate circulation. To detect a potential contribution of systemic inflammation to shock severity, this study determined associations between C-reactive protein (CRP) concentrations and outcomes in patients with CS. Methods Unselec...

Aims Literature on percutaneous coronary intervention (PCI) stated an inverse relationship between hospital volume and mortality, but the effects on other characteristics are unclear. Methods Using German national records, all coronary angiographies with coronary artery disease in 2017 were identified. We applied risk-adjustment to account for dif...

Introduction Transthoracic bedside echocardiography (TTE) in the emergency department is recommended in patients with suspected myocardial infarction (MI), who do not qualify for early discharge using accelerated protocols. The prognostic value of routine echocardiographic parameters like wall motion abnormalities in patients with suspected MI, has...

Introduction Patients with symptoms indicative of acute myocardial infarction (MI) frequently present to the emergency department (ED) and undergo a structured diagnostic assessment. Apart from MI, other diagnoses are frequently identified, including myocardial injury. In these patients estimation of long-term risk is crucial to guide preventive st...

Background The European Society of Cardiology (ESC) recommends the application of 0/1h-algorithms for rapid triage of patients with suspected myocardial infarction (MI). These algorithms enable rule-out or rule-in of MI at presentation and after 1 hour (h), depending on absolute high-sensitivity cardiac troponin (hs-cTn) concentrations and changes....

Background Balancing the risk of bleeding and thrombosis after acute myocardial infarction (AMI) is challenging and the optimal antithrombotic therapy remains uncertain. The potential of NOACs to prevent ischaemic cardiovascular events is promising but evidence remains limited. Purpose To assess the efficacy and safety of NOACs in addition to back...

Introduction Paradoxically, recent population-based studies reported lower levels of high-sensitivity cardiac troponin (hs-cTn) in current smokers than in never and former smokers. This counterintuitive finding raises questions about the yet not investigated association between smoking and hs-cTn levels and its potential impact on the safety and ac...

Introduction The diagnostic management of patients with symptoms indicative of acute myocardial infarction (MI) is largely based on the clinical assessment of symptoms, ECG and diagnostic algorithms based on high-sensitivity cardiac troponin (hs-cTn). Additionally, guidelines recommend transthoracic echocardiography (TTE) for patients neither eligi...

Background In patients with acute chest pain, hypertensive crisis is a common possible diagnosis. Severe hypertension may even cause elevated levels of cardiac troponin indicating myocardial injury. Whether this biomarker response is linked to poorer outcome is unknown. Methods We included patients presenting to the emergency department with suspe...

Background Elevated concentrations of C-reactive protein (CRP) and other circulating cytokines are often found in cardiogenic shock (CS). The role of systemic inflammation in the pathogenesis of cardiogenic shock remains unclear. To address this, associations between elevated plasma CRP concentrations upon admission with shock severity, 30-day mort...

Background New catheter based left atrial appendage (LAA) occlusion devices were introduced in the past decade. Catheter based LAA occlusion can be performed through a permanently implanted intracardiac LAA occlusion device or a loop stitch around the base of the LAA via an additional pericardial access. Knowledge about recent in-hospital safety tr...

Aims Heart failure–related cardiogenic shock (HF‐CS) accounts for a significant proportion of CS cases. Whether patients with de novo HF and those with acute‐on‐chronic HF in CS differ in clinical characteristics and outcome remains unclear. The aim of this study was to evaluate differences in clinical presentation and mortality between patients wi...

Background: We aimed to evaluate the feasibility of a non-contrast time-of-flight magnetic resonance angiography (TOF-MRA) protocol for the pre-procedural access route assessment of transcatheter aortic valve implantation (TAVI) in comparison with contrast-enhanced cardiac dual-source computed tomography angiography (CTA). Methods and Results: In t...

Background: High-sensitivity cardiac troponin (hs-cTn) assays are used for detection of myocardial infarction (MI). 99th percentiles show wide inter-assay variation. Use of sex-specific cutoffs is recommended as definitory cutoff for MI. We compared diagnostic performance and prognostic value of sex-specific 99th percentiles of four hs-cTn assays...

Mortality prediction for patients with the severe acute respiratory distress syndrome (ARDS) supported with veno-venous extracorporeal membrane oxygenation (VV-ECMO) is challenging. Clinical variables at baseline and on day 3 after initiation of ECMO support of all patients treated from October 2010 through April 2020 were analyzed. Multivariate lo...

Background VA-ECMO restores circulation and tissue oxygenation in cardiogenic shock (CS) patients, but can also lead to complications. Objectives To quantify VA-ECMO complications and analyse their association with overall survival as well as favourable neurological outcome (CPC 1 + 2). Methods All-comer patients with CS treated with VA-ECMO were...

Clonal hematopoiesis of indeterminate potential (CHIP) is an acquired genetic risk factor for cardiovascular (CV) disease, supposedly mediated by pro-inflammatory recruited monocytes. However, how these cells and their progeny behave in the CV tissue remains unclear. Here, we studied human carotid artery plaque and heart tissue samples from DNMT3A...

Aims Electro-anatomical voltage, conduction velocity (CV) mapping, and late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) have been correlated with atrial cardiomyopathy (ACM). However, the comparability between these modalities remains unclear. This study aims to (i) compare pathological substrate extent and location between curren...

Background New and refined catheter based left atrial appendage (LAA) closure devices have been introduced in the past decade. The procedure can be performed using either an endocardial occlusion device or an epicardial loop stitch. We aimed to analyzed recent procedural safety. Methods Catheter based LAA closures were identified in a complete nat...

Accurate small vessel stent visualization using CT remains challenging. Photon-counting CT (PCD-CT) may help to overcome this issue. We systematically investigate PCD-CT impact on small vessel stent assessment compared to energy-integrating-CT (EID). 12 water-contrast agent filled stents (3.0–8 mm) were scanned with patient-equivalent phantom using...

Aims: This research aimed to give contemporary insight into the use of Impella and venoarterial extracorporeal membrane oxygenation (VA-ECMO) in myocardial infarction-related cardiogenic shock (AMICS) and into associated outcomes, adverse events, and resource demands. Methods and results: This nationwide observational cohort study describes all...

Clinical outcomes in patients with reduced left ventricular systolic function undergoing rotational atherectomy (RA) for percutaneous coronary intervention (PCI) remain understudied. Our study sought to evaluate the impact of RA-PCI in patients with LV systolic dysfunction on long-term outcomes. Between 2015 and 2019, 4941 patients with reduced LV...

Background Insights on the differences in clinical outcomes, quality of life (QoL) and health resource utilisation (HRU) with different levels of care available to post-acute myocardial infarction (AMI) populations in rural and urban settings are limited. Methods The long-Term rIsk, clinical manaGement, and healthcare Resource utilisation of stabl...

Background: In addition to manual compression, various vascular closure devices (VCD) are available to seal the puncture site following arterial vascular procedures. Purpose: To evaluate the efficacy and safety of the extravascular MYNX CONTROL closure system for achieving primary hemostasis after femoral arterial access following peripheral arteri...

Objective: Severe wound infections in patients with peripheral artery disease (PAD) are common, potentially life- and limb-threatening, and difficult to treat. Evidence on patients with infected leg ulcers in PAD is scarce. This study aims to provide insight into the microbiological patterns and antimicrobial resistance (AMR) of specific pathogens...

Background Estimation of regurgitant fraction by videodensitometry (VD-AR) of aortic root angiograms is a new tool for objective grading of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI). Stratification with boundaries at 6% and 17% has been proposed to reflect “none/trace”, “mild” and “moderate or higher” PVR...

Present research on the influence of gender on the treatment of coronary artery disease (CAD) and the outcome after percutaneous coronary intervention (PCI) is inconsistent. Sex differences in the presentation of CAD and the success after treatment have been described. We intend to compare the male and female sex in the procedure and the long-term...

Background The GRACE risk score is generically recommended by guidelines for timing of invasive coronary angiography without stating which score should be used. The aim was to determine the diagnostic performance of different GRACE risk scores in comparison to the ESC 0/1 h-algorithm using high-sensitivity cardiac troponin (hs-cTn). Methods Prospe...

Aims To determine the conditions under which early hypoattenuated leaflet thickening (HALT) after transcatheter aortic valve implantation (TAVI) becomes hemodynamically relevant. Methods and results The study included 100 patients (age: 81.5 ± 5.5 years; female 63%), thereof 50 patients with HALT. After anonymization and randomization, blinded rea...

The NLRP3-inflammasome is a cytosolic multiprotein complex that triggers an inflammatory response to certain danger signals. Recently adenosine diphosphate (ADP) was found to activate the NLRP3-inflammasome in murine macrophages via the P2Y1 receptor. Blockade of this signaling pathway reduced disease severity in a murine colitis-model. However, th...

Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolys...

The association between socioeconomic status (SES) and alcohol-related diseases has been widely explored. Less is known, however, on whether the association of moderate drinking with all-cause mortality is modified by educational level (EL). Using harmonized data from 16 cohorts in the MORGAM Project (N = 142,066) the association of pattern of alco...

(1) Background: Inflammatory bowel diseases are complex and multifactorial disorders of unknown etiology. The extravasation of activated leukocytes is a critical step in the pathogenesis of these diseases. Leukocyte integrin Mac-1 (αMβ2; CD11b/CD18) is crucial for the extravasation of myeloid cells, and a novel activation-specific anti-Mac-1 Design...

Introduction: Improved sinus rhythm (SR) maintenance rates have been achieved in patients with persistent atrial fibrillation (AF) undergoing pulmonary vein isolation plus additional ablation of low voltage substrate (LVS) during SR. However, voltage mapping during SR may be hindered in persistent and long-persistent AF patients by immediate AF re...

Digital twins of patients' hearts are a promising tool to assess arrhythmia vulnerability and to personalize therapy. However, the process of building personalized computational models can be challenging and requires a high level of human interaction. We propose a patient-specific Augmented Atria generation pipeline (AugmentA) as a highly automated...

Recent data suggest that uric acid (UA) might be an independent predictor of clinical outcomes following percutaneous coronary intervention (PCI). The predictive value of uric acid in patients undergoing PCI for chronic total occlusions (CTO) is unknown. We included patients with CTO who underwent PCI at our center in 2005 and 2012, with available...

Rationale Hypertrophic cardiomyopathy (HCM) is the most common cardiac genetic disorder caused by sarcomeric gene variants and associated with left ventricular (LV) hypertrophy and diastolic dysfunction. The role of the microtubule network has recently gained interest with the findings that α-tubulin detyrosination (dTyr-tub) is markedly elevated i...

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Medtronic Background Atrial cardiomyopathy (ACM) is associated with an increased risk for new-onset atrial fibrillation (AF), progression from paroxysmal to persistent AF-forms and higher arrhythmia recurrence rates after PVI. Therefore, the current ESC guid...

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): Abbott Introduction Novel catheter ablation technologies (e.g. RF with contiguous lesions) for pulmonary vein isolation (PVI) achieve high (80-85%) arrhythmia freedom rates at 12 months in both paroxysmal and persistent AF. However, success rates are importa...

Funding Acknowledgements Type of funding sources: None. Introduction / Aims This study sought to develop and validate diagnostic models to identify individuals with atrial fibrillation (AF) using amplified p-wave analysis or neural-network-trained p-wave-analysis during sinus rhythm (SR). Methods 1492 patients (491 healthy controls, 499 with paro...

Funding Acknowledgements Type of funding sources: None. Introduction Left atrial cardiomyopathy (ACM) is invasively diagnosed by presence of low voltage substrate (LVS) in electro-anatomical mapping. ACM is associated with high (50%) AF recurrence rates after PVI, but also with increased risk for de-novo AF and ischemic stroke. Aims We establish...

The study sought to assess the procedural success of rotational atherectomy (RA) in coronary chronic total occlusion (CTO) and to investigate the in-hospital and one-year outcomes following RA. From 2015 to 2019, patients undergoing percutaneous coronary intervention for CTO (CTO PCI) were retrospectively included into the hospital database. The pr...

Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is applied in patients with refractory hemodynamic failure. Exposure of blood components to high shear stress and the large extracorporeal surfaces in the ECMO circuit trigger a complex inflammatory response syndrome and coagulopathy which are believed to worsen the already poor...

Background High‐sensitivity cardiac troponin (hs‐cTn)‐based diagnostic algorithms are recommended for the management of patients with suspected myocardial infarction (MI) without ST elevation. Although mirroring different phases of myocardial injury, falling and rising troponin patterns (FPs and RPs, respectively) are equally considered by most alg...

Cardiovascular diseases (CVDs) remain the leading cause of death worldwide. Most cardiovascular deaths are caused by ischaemic heart diseases such as myocardial infarction (MI). Hereby atherosclerosis in the coronary arteries often precedes disease manifestation. Since tissue remodelling plays an important role in the development and progression of...

Background: Transaxillary (TAx) transcatheter aortic valve implantation (TAVI) is a preferred alternative access in patients ineligible for transfemoral TAVI. Aims: This study used the Trans-AXillary Intervention (TAXI) registry to compare procedural success according to different types of transcatheter heart valves (THV). Methods: For the TAX...

Background: In pure aortic regurgitation, transcatheter aortic valve replacement (TAVR) is not yet used on a regular base. Due to constant development of TAVR, it is necessary to analyze current data. Methods: By use of health records, we analyzed all isolated TAVR or surgical aortic valve replacements (SAVR) for pure aortic regurgitation betwee...

Introduction: A rapid diagnosis of myocardial infarction (MI) is of utmost importance in order to provide adequate therapy for patients that suffer from acute ischemic cardiac injury. Cardiac troponin has evolved as the most significant biomarker in the diagnostic assessment of MI, but its evaluation and management can be challenging. Different tr...

Aims: The role of biomarkers in predicting cardiovascular outcomes in high-risk individuals is not well established. We aimed to investigate benefits of adding biomarkers to cardiovascular risk assessment in individuals with and without diabetes. Methods: We used individual-level data of 95,292 individuals of the European population harmonized i...

Background COVID-19 has caused the deferral of millions of elective procedures, likely resulting in a backlog of cases. We estimate the number of postponed surgical aortic valve replacement (sAVR) and transcatheter aortic valve replacement (TAVR) procedures during the first two waves of the COVID-19 pandemic in Germany. Methods Using German nation...

Background: In light of overlapping symptoms, discrimination between non-ST-elevation (NSTE) acute coronary syndrome (ACS) and acute heart failure (HF) is challenging, particularly in patients with equivocal clinical presentation for suspected ACS. We sought to evaluate the diagnostic and prognostic properties of copeptin in this scenario. Method...

Background: Current guidelines recommend 0/1 h algorithms using high-sensitivity cardiac troponin (hs-cTn) for fast diagnosis of myocardial infarction (MI). Yet, for some assays, existing data is limited. We aimed to evaluate the diagnostic performance and the prognostic value of a rapid 0/1 h algorithm for the Access hs-cTnI assay. Methods: In...

The coxsackievirus and adenovirus receptor (CAR) mediates homo- and heterotopic interactions between neighboring cardiomyocytes at the intercalated disc. CAR is upregulated in the hypoxic areas surrounding myocardial infarction (MI). To elucidate whether CAR contributes to hypoxia signaling and MI pathology, we used a gain- and loss-of-function app...

Background Evidence on the optimal timing of RA is scarce, although increased periprocedural complications for unplanned procedures have been reported. Aims To compare planned versus unplanned use of rotational atherectomy (RA) for plaque modification in patients with severely calcified coronary lesions. Methods Procedural and 1-year follow-up da...

Background and Aims One of the most important complications of heart transplantation is organ rejection, which is diagnosed on endomyocardial biopsies by pathologists. Computer-based systems could assist in the diagnostic process and potentially improve reproducibility. Here, we evaluated the feasibility of using deep learning in predicting the deg...