44 results on '"Heiner Latus"'
Search Results
2. Le Cœur en Sabot: shape associations with adverse events in repaired tetralogy of Fallot
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Anna Mîra, Pablo Lamata, Kuberan Pushparajah, Georgina Abraham, Charlène A. Mauger, Andrew D. McCulloch, Jeffrey H. Omens, Malenka M. Bissell, Zach Blair, Tyler Huffaker, Animesh Tandon, Sandy Engelhardt, Sven Koehler, Thomas Pickardt, Philipp Beerbaum, Samir Sarikouch, Heiner Latus, Gerald Greil, Alistair A. Young, and Tarique Hussain
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Tetralogy of Fallot ,Biventricular shape ,Magnetic resonance imaging ,Biomarker ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Maladaptive remodelling mechanisms occur in patients with repaired tetralogy of Fallot (rToF) resulting in a cycle of metabolic and structural changes. Biventricular shape analysis may indicate mechanisms associated with adverse events independent of pulmonary regurgitant volume index (PRVI). We aimed to determine novel remodelling patterns associated with adverse events in patients with rToF using shape and function analysis. Methods Biventricular shape and function were studied in 192 patients with rToF (median time from TOF repair to baseline evaluation 13.5 years). Linear discriminant analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events. Adverse events included death, arrhythmias, and cardiac arrest with median follow-up of 10 years. Results LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular left ventricle (LV) (decreased eccentricity), dilated (increased sphericity) LV base, increased right ventricular (RV) apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.77). PRVI did not add value, and shape changes associated with increased PRVI were not predictive of adverse outcomes. Conclusion Pathological remodelling patterns in patients with rToF are significantly associated with adverse events, independent of PRVI. Mechanisms related to incident events include LV basal dilation with a reduced RV apical ejection fraction.
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- 2022
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3. Left Ventricular Physiology and Ventricular‐Vascular Interactions in Young Patients After Heart Transplantation
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Heiner Latus, Ramona Raap, Karin Klingel, Christoph Happel, Axel Moysich, Markus Khalil, Gunter Kerst, Jakob Milla, Susanne Skrzypek, Josef Thul, Christian Jux, Dietmar Schranz, and Christian Apitz
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heart transplantation ,pressure‐volume loops ,ventricular dysfunction ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background In patients after heart transplantation, systemic arterial hypertension and enhanced central aortic stiffness contribute to increased ventricular afterload, which might lead to graft dysfunction. The aim of our study was to characterize systemic arterial elastance and its impact on left ventricular function and ventriculo‐arterial coupling in a cohort of children, adolescents, and young adults after heart transplantation using invasive conductance catheter technique. Methods and Results Thirty patients who had heart transplants (age, 20.0±6.5 years, 7 female) underwent invasive cardiac catheterization including pressure‐volume loop analysis. Load‐independent parameters of systolic (ventricular elastance [Ees]) and diastolic (ventricular compliance) function as well as systemic arterial elastance (Ea, end‐systolic pressure/stroke volume) and ventriculo‐arterial coupling (Ea/Ees) were assessed at baseline level and during dobutamine infusion (10 μg/kg/min). Ees showed an appropriate increase under inotropic stimulation from 0.43 (0.11–2.52) to 1.00 (0.20–5.10) mm Hg/mL/m2 (P
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- 2023
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4. Impact of Right Ventricular Pressure Load After Repair of Tetralogy of Fallot
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Heiner Latus, Jana Stammermann, Inga Voges, Birgit Waschulzik, Matthias Gutberlet, Gerhard‐Paul Diller, Dietmar Schranz, Peter Ewert, Philipp Beerbaum, Titus Kühne, and Samir Sarikouch
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magnetic resonance imaging ,prognosis ,right ventricular pressure overload ,strain ,tetralogy of Fallot ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Background Right ventricular outflow tract (RVOT) stenosis after repair of tetralogy of Fallot has been linked with favorable right ventricular remodeling but adverse outcomes. The aim of our study was to assess the hemodynamic impact and prognostic relevance of right ventricular pressure load in this population. Methods and Results A total of 296 patients with repaired tetralogy of Fallot (mean age, 17.8±7.9 years) were included in a prospective cardiovascular magnetic resonance multicenter study. Myocardial strain was quantified by feature tracking technique at study entry. Follow‐up, including the need for pulmonary valve replacement, was assessed. The combined end point consisted of ventricular tachycardia and cardiac death. A higher echocardiographic RVOT peak gradient was significantly associated with smaller right ventricular volumes and less pulmonary regurgitation, but lower biventricular longitudinal strain. During a follow‐up of 10.1 (0.1–12.9) years, the primary end point was reached in 19 of 296 patients (cardiac death, n=6; sustained ventricular tachycardia, n=2; and nonsustained ventricular tachycardia, n=11). A higher RVOT gradient was associated with the combined outcome (hazard ratio [HR], 1.03; 95% CI, 1.00–1.06; P=0.026), and a cutoff gradient of ≥25 mm Hg was predictive for cardiovascular events (HR, 3.69; 95% CI, 1.47–9.27; P=0.005). In patients with pulmonary regurgitation ≥25%, a mild residual RVOT gradient (15–30 mm Hg) was not associated with a lower risk for pulmonary valve replacement. Conclusions Higher RVOT gradients were associated with less pulmonary regurgitation and smaller right ventricular dimensions but were related to reduced biventricular strain and emerged as univariate predictors of adverse events. Mild residual pressure gradients did not protect from pulmonary valve replacement. These results may have implications for the indication for RVOT reintervention in this population.
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- 2022
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5. Aortic elasticity after aortic coarctation relief: comparison of surgical and interventional therapy by cardiovascular magnetic resonance imaging
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Theresa Pieper, Heiner Latus, Dietmar Schranz, Joachim Kreuder, Bettina Reich, Kerstin Gummel, Helge Hudel, and Inga Voges
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Coarctation of the aorta ,Cardiovascular magnetic resonance imaging ,Aortic elasticity ,Endovascular stent implantation ,T1 mapping ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
Abstract Background Patients after aortic coarctation (CoA) repair show impaired aortic bioelasticity and altered left ventricular (LV) mechanics, predisposing diastolic dysfunction. Our purpose was to assess aortic bioelasticity and LV properties in CoA patients who underwent endovascular stenting or surgery using cardiovascular magnetic resonance (CMR) imaging. Methods Fifty CoA patients (20.5 ± 9.5 years) were examined by 3-Tesla CMR. Eighteen patients had previous stent implantation and 32 had surgical repair. We performed volumetric analysis of both ventricles (LV, RV) and left atrium (LA) to measure biventricular volumes, ejection fractions, left atrial (LA) volumes, and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir). Aortic distensibility and pulse wave velocity (PWV) were assessed. Native T1 mapping was applied to examine LV tissue properties. In twelve patients post-contrast T1 mapping was performed. Results LV, RV and LA parameters did not differ between the surgical and stent group. There was also no significant difference for aortic distensibility, PWV and T1 relaxation times. Aortic root distensibility correlated negatively with age, BMI, BSA and weight (p
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- 2019
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6. Potts Shunt to Be Preferred Above Atrial Septostomy in Pediatric Pulmonary Arterial Hypertension Patients: A Modeling Study
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Tammo Delhaas, Yvette Koeken, Heiner Latus, Christian Apitz, and Dietmar Schranz
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computer modeling ,pulmonary arterial hypertension ,Potts shunt ,atrial septostomy ,exercise ,pump work ,Physiology ,QP1-981 - Abstract
Aims: To quantitatively evaluate the basic pathophysiological process involved in the creation of Eisenmenger syndrome in pediatric pulmonary arterial hypertension (PAH) patients by either atrial septostomy (AS) or Potts shunt (PS) as well as to predict the effects of AS or PS in future PAH patients.Methods: The multi-scale lumped parameter CircAdapt model of the cardiovascular system was used to investigate the effects of AS and PS on cardiovascular hemodynamics and mechanics, as well as on oxygen saturation in moderate to severe PAH. The reference simulation, with cardiac output set to 2.1 l/min and mean systemic pressure to 61 mmHg, was used to create a compensated moderate PAH simulation with mPAP 50 mmHg. Thereupon we created a range of decompensated PAH simulations in which mPAP was stepwise increased from 50 to 80 mmHg. Then we simulated for each level of mPAP the acute effects of either PS or AS with connection diameters ranging between 0–16 mm.Results: For any mPAP level, the effect on shunt flow size is much larger for the PS than for AS. Whereas right ventricular pump work in PS is mainly dependent on mPAP, in AS it depends on both mPAP and the size of the defect. The effects on total cardiac pump work were similar for PS and AS. As expected, PS resulted in a drastic decrease of lower body oxygen saturation, whereas in AS both the upper and lower body oxygen saturation decreased, though not as drastically as in PS.Conclusion: Our simulations support the opinion that a PS can transfer suprasystemic PAH to an Eisenmenger physiology associated with a right-to-left shunt at the arterial level. Contrary to the current opinion that PS in PAH will decompress and unload the right ventricle, we show that while a PS does lead to a decrease in mPAP toward mean systemic arterial pressure, it does not unload the right ventricle because it mainly diverts flow from the pulmonary arterial system toward the lower body systemic arteries.
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- 2018
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7. Aortopulmonary collateral flow is related to pulmonary artery size and affects ventricular dimensions in patients after the fontan procedure.
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Heiner Latus, Kerstin Gummel, Tristan Diederichs, Anna Bauer, Stefan Rupp, Gunter Kerst, Christian Jux, Hakan Akintuerk, Dietmar Schranz, and Christian Apitz
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Medicine ,Science - Abstract
BACKGROUND: Aortopulmonary collaterals (APCs) are frequently found in patients with a single-ventricle (SV) circulation. However, knowledge about the clinical significance of the systemic-to-pulmonary shunt flow in patients after the modified Fontan procedure and its potential causes is limited. Accordingly, the aim of our study was to detect and quantify APC flow using cardiovascular magnetic resonance (CMR) and assess its impact on SV volume and function as well as to evaluate the role of the size of the pulmonary arteries in regard to the development of APCs. METHODS: 60 patients (mean age 13.3 ± 6.8 years) after the Fontan procedure without patent tunnel fenestration underwent CMR as part of their routine clinical assessment that included ventricular functional analysis and flow measurements in the inferior vena cava (IVC), superior vena cava (SVC) and ascending aorta (Ao). APC flow was quantified using the systemic flow estimator: (Ao) - (IVC + SVC). Pulmonary artery index (Nakata index) was calculated as RPA + LPA area/body surface area using contrast enhanced MR angiography. The patient cohort was divided into two groups according to the median APC flow: group 1 < 0.495 l/min/m(2) and group 2 > 0.495 l/min/m(2). RESULTS: Group 1 patients had significant smaller SV enddiastolic (71 ± 16 vs 87 ± 25 ml/m(2); p=0.004) and endsystolic volumes (29 ± 11 vs 40 ± 21 ml/m(2); p=0.02) whereas ejection fraction (59 ± 9 vs 56 ± 13%; p=0.38) differed not significantly. Interestingly, pulmonary artery size showed a significant inverse correlation with APC flow (r=-0.50, p=0.002). CONCLUSIONS: Volume load due to APC flow in Fontan patients affected SV dimensions, but did not result in an impairment of SV function. APC flow was related to small pulmonary artery size, suggesting that small pulmonary arteries represent a potential stimulus for the development of APCs.
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- 2013
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8. Aortic wall shear stress in bicuspid aortic valve disease—10-year follow-up
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Michael Hanigk, Elisabeth Burgstaller, Heiner Latus, Nerejda Shehu, Judith Zimmermann, Stefan Martinoff, Anja Hennemuth, Peter Ewert, Heiko Stern, and Christian Meierhofer
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Cardiology and Cardiovascular Medicine - Published
- 2023
9. Exercise-dependent changes in ventricular–arterial coupling and aortopulmonary collateral flow in Fontan patients: a real-time CMR study
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Heiner Latus, Lucas Hofmann, Kerstin Gummel, Markus Khalil, Can Yerebakan, Birgit Waschulzik, Dietmar Schranz, Inga Voges, Christian Jux, and Bettina Reich
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cardiovascular system ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine - Abstract
Aims Inefficient ventricular–arterial (V–A) coupling has been described in Fontan patients and may result in adverse haemodynamics. A varying amount of aortopulmonary collateral (APC) flow is also frequently present that increases volume load of the single ventricle. The aim of the study was to assess changes in V–A coupling and APC flow during exercise CMR. Methods and results Eighteen Fontan patients (age 24 ± 3 years) and 14 controls (age 23 ± 4 years) underwent exercise CMR using a cycle ergometer. Ventricular volumetry and flow measurements in the ascending aorta (AAO), inferior (IVC), and superior (SVC) vena cava were assessed using real-time sequences during stepwise increases in work load. Measures of systemic arterial elastance Ea, ventricular elastance Ees, and V–A coupling (Ea/Ees) were assessed. APC flow was quantified as AAO − (SVC + IVC). Ea remained unchanged during all levels of exercise in both groups (P = 0.39 and P = 0.11). Ees increased in both groups (P = 0.001 and P < 0.001) with exercise but was lower in the Fontan group (P = 0.04). V–A coupling was impaired in Fontan patients at baseline (P = 0.04). Despite improvement during exercise (P = 0.002) V–A coupling remained impaired compared with controls (P = 0.001). Absolute APC flow in Fontan patients did not change during exercise even at maximum work load (P = 0.98). Conclusions Inefficient V–A coupling was already present at rest in Fontan patients and aggravated during exercise due to a limited increase in ventricular contractility which demonstrates the importance of a limited functional reserve of the single ventricle. APC flow remained unchanged suggesting no further increase in volume load during exercise.
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- 2022
10. Aortic diameter assessment by cardiovascular magnetic resonance: do we really need contrast enhanced images?
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Heiko Stern, Peter Ewert, Stefan Martinoff, Nerejda Shehu, Christian Meierhofer, Irene Ferrari, Naira Mkrtchyan, and Heiner Latus
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Original Article on Current Management Aspects in Adult Congenital Heart Disease (ACHD): Part IV ,Nuclear magnetic resonance ,medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,medicine ,Contrast (vision) ,Magnetic resonance imaging ,Aortic diameter ,Cardiology and Cardiovascular Medicine ,business ,media_common - Abstract
BACKGROUND: Cardiovascular magnetic resonance (CMR) is widely used for aortic diameter assessment but there is no consensus on the sequence or cardiac cycle phase in which the measures should be taken. The most used sequence is contrast-enhanced-magnetic-resonance-angiography (angiography), usually non-ECG-triggered. An alternative is a navigated 3D-whole-heart-steady-state-free-precession sequence which is contrast-free and breath- and ECG-gated (mostly diastolic gating), producing very sharp anatomical rendering. Nonetheless, its routine use has not yet spread. Our aim was evaluating aortic diameters by a systolic-gated 3D and put additional effort in the validation of diastolic-gated 3D as alternative to angiography. METHODS: We retrospectively analysed 30 patients scheduled for routine Angiography. We measured the aorta at 9 standard positions by three different sequences (angiography, 3D-diastole and 3D-systole) and compared the diameters obtained by calculating the differences and by paired t-test analysis. RESULTS: Diameters by 3D-systole were larger than by 3D-diastole and angiography (P
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- 2021
11. Hemodynamic and prognostic impact of the diastolic pulmonary arterial pressure in children with pulmonary arterial hypertension-a registry-based analysis
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D. Dunbar Ivy, Heiner Latus, Tilman Humpl, Dietmar Schranz, Damien Bonnet, Rolf M. F. Berger, Christian Apitz, Maurice Beghetti, and Cardiovascular Centre (CVC)
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Diastole ,Hemodynamics ,medicine.disease ,Pulmonary hypertension ,ddc ,Transplantation ,medicine.anatomical_structure ,Blood pressure ,Original Article on Pediatric Pulmonary Hypertension ,Internal medicine ,medicine ,Vascular resistance ,Cardiology ,Lung transplantation ,Cardiology and Cardiovascular Medicine ,business ,Cardiac catheterization - Abstract
Background: Diastolic pulmonary arterial pressure (dPAP) is regarded to be less sensitive to flow metrics as compared to mean PAP (mPAP), and was therefore proposed for the assessment of a precapillary component in patients with postcapillary pulmonary hypertension (PH). To analyze the diagnostic and prognostic impact of dPAP in patients with pure precapillary PH, we purposed to compare the correlation between dPAP and mPAP, as well as hemodynamically-derived calculations [ratio of PAP to systemic arterial pressure (PAP/SAP), pulmonary vascular resistance index (PVRI), transpulmonary gradient (TPG)], using both dPAP and mPAP, at rest and during acute vasoreactivity testing (AVT) in children with idiopathic or heritable pulmonary arterial hypertension (IPAH/HPAH). Furthermore, we aimed to assess the association of these metrics (at baseline and changes after AVT) with transplant-free survival.Methods: We conducted a retrospective analysis of the TOPP (Tracking Outcomes and Practice in Pediatric Pulmonary Hypertension) registry including 246 IPAH/HPAH patients. Of these, 45 children (18.3%) died, and 13 (5.3%) received lung transplantation during the observation period.Results: dPAP and mPAP-derived variables showed almost linear relationship. Higher mPAP/mSAP, and dPAP-/mPAP-derived PVRI at rest was associated with time to death/transplantation. At maximum AVT-response, the decrease of dPAP and mPAP, diastolic pulmonary gradient (DPG) and TPG, as well as dPAP/dSAP and mPAP/mSAP was associated with time to death/transplantation, showing higher significance than corresponding baseline values. Remarkably, no predictive value was found for PVRI-reduction during AVT, neither dPAP- nor mPAP-derived.Conclusions: There is a strong relationship between dPAP and mPAP-derived variables. According to our results, hemodynamics during AVT (irrespectively of dPAP- or mPAP-derived) may have more prognostic implications than resting hemodynamics in children with IPAH/HPAH, except for PVRI.
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- 2021
12. Heart failure therapy based on interventricular mechanics and cardio-vascular communications
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Christian Apitz, Dietmar Schranz, Hakan Akintuerk, Anoosh Esmaeili, and Heiner Latus
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Cardiac output ,Vascular disease ,business.industry ,Diastole ,Mechanics ,medicine.disease ,medicine.anatomical_structure ,Review Article on Pediatric Pulmonary Hypertension ,Afterload ,Ventricle ,Heart failure ,Heart rate ,cardiovascular system ,medicine ,cardiovascular diseases ,Interventricular septum ,Cardiology and Cardiovascular Medicine ,business - Abstract
The heart should not be divided in right and left, whether in health nor in disease. However, the morphological and functional differences between the right and left ventricle should be known and the impact of the ventricle's position considered. Further, the parameters beyond heart rate, contractility, pre- and afterload guaranteeing a sufficient systemic cardiac output have to be integrated in therapeutic measures; preferentially the influence of interventricular mechanics. Despite of recent developments of specific drug therapies, heart failure is associated with a high rate of morbidity and mortality in children. During the progression of heart failure, pulmonary vascular disease is the consequence or the reason for further failing. Clinical symptoms are associated with congestion and low cardiac output at rest or exercise. Improved understanding of the pathophysiological mechanisms particularly of ventricular failure has resulted in the development of innovative therapies that target atrial/ventricular/arterial interactions. Recent advances in interventional and surgical approaches provide promising new strategies to deal with right and left ventricular deterioration. These techniques may delay listing for heart and (heart-) lung transplantation or even make redundant in individual cases. The beneficial effects of these ventricular interaction strategies are mainly based on the mechanics of the interventricular septum and improvement of systolic and diastolic ventricular performance.
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- 2021
13. Family screening of hypertrophic cardiomyopathy in children: a case report
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Inga Voges and Heiner Latus
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Cardiology and Cardiovascular Medicine - Abstract
BackgroundPaediatric hypertrophic cardiomyopathy (HCM) caused by sarcomere protein gene mutations is more common than previously thought. We present the case of a 9-year-old boy that was diagnosed with HCM during family screening.Case summaryWe present a case of a 9-year-old boy with a family history of sarcomeric HCM who was diagnosed with hypertrophic obstructive cardiomyopathy (HOCM) during clinical screening. Echocardiography and cardiovascular magnetic resonance imaging revealed asymmetric left ventricular hypertrophy with a maximum wall thickness of 18–19 mm. Cardiovascular magnetic resonance late gadolinium enhancement imaging showed patchy fibrosis within the area of maximum wall thickness. Genetic testing confirmed the presence of the familial mutation in the MYL2 gene. The patient was started on bisoprolol. Furthermore, risk stratification was performed and a recommendation for implantable cardioverter-defibrillator implantation was made.DiscussionThis case demonstrates that significant HCM can already start in childhood and discusses the recommendations for family screening on the basis of recently published studies and the present European Society of Cardiology guideline.
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- 2022
14. A Comprehensive Functional Analysis in Patients after Atrial Switch Surgery
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G. Wiegand, Daniela Vollmer, Christian Apitz, Michael Hofbeck, Ludger Sieverding, Heiner Latus, and A. Hornung
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Time Factors ,Transposition of Great Vessels ,Ventricular Dysfunction, Right ,Pediatric and Congenital Cardiology ,Diastole ,heart failure ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Cardiac magnetic resonance imaging ,Predictive Value of Tests ,imaging (all modalities) ,medicine ,Ventricular Pressure ,Humans ,030212 general & internal medicine ,Prospective Studies ,Systole ,Prospective cohort study ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Middle Aged ,medicine.disease ,congenital heart disease ,Magnetic Resonance Imaging ,Surgery ,Arterial Switch Operation ,medicine.anatomical_structure ,CHD ,Cross-Sectional Studies ,Treatment Outcome ,Ventricle ,Heart failure ,Conductance ,Exercise Test ,Ventricular Function, Right ,Dobutamine ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Abstract
Background Long-term course after atrial switch operation is determined by increasing right ventricular (RV) insufficiency. The aim of our study was to investigate subtle functional parameters by invasive measurements with conductance technique and noninvasive examinations with cardiac magnetic resonance imaging (CMR). Methods We used invasive (pressure–volume loops under baseline conditions and dobutamine) and noninvasive techniques (CMR with feature tracking [FT] method) to evaluate RV function. All patients had cardiopulmonary exercise testing (CPET). Results From 2011 to 2013, 16 patients aged 28.2 ± 7.3 (22–50) years after atrial switch surgery (87.5% Senning and 12.5% Mustard) were enrolled in this prospective study. All patients were in New York Heart Association (NYHA) class I to II and presented mean peak oxygen consumption of 30.1 ± 5.7 (22.7–45.5) mL/kg/min. CMR-derived end-diastolic volume was 110 ± 22 (78–156) mL/m2 and RV ejection fraction 41 ± 8% (25–52%). CMR-FT revealed lower global systolic longitudinal, radial, and circumferential strain for the systemic RV compared with the subpulmonary left ventricle. End-systolic elastance (Ees) was overall reduced (compared with data from the literature) and showed significant increase under dobutamine (0.80 ± 0.44 to 1.89 ± 0.72 mm Hg/mL, p ≤ 0.001), whereas end-diastolic elastance (Eed) was not significantly influenced (0.11 ± 0.70 to 0.13 ± 0.15 mm Hg/mL, p = 0.454). We found no relevant relationship between load-independent conductance indices and strain or CPET parameters. Conductance analysis revealed significant mechanical dyssynchrony, higher during diastole (mean 30 ± 4% baseline, 24 ± 6% dobutamine) than during systole (mean 17 ± 6% baseline, 19 ± 7% dobutamine). Conclusions Functional assessment of a deteriorating systemic RV remains demanding. Conductance indices as well as the CMR-derived strain parameters showed overall reduced values, but a significant relationship was not present (including CPET). Our conductance analysis revealed intraventricular and predominantly diastolic RV dyssynchrony.
- Published
- 2021
15. Abstract 8928: Le Coeur En Sabot: Shape and Regional Function Predict Adverse Outcome in Patients with Repaired Tetralogy of Fallot
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Anna Mira, Pablo Lamata, Alistair Young, Thomas Pickardt, Animesh A Tandon, Samir Sarikouch, Jeff Omens, Heiner Latus, Philipp B Beerbaum, Sven Koehler, Malenka Bissell, Zachary Blair, Tyler Huffaker, Kuberan Pushparajah, Charlene Mauger, Georgina Abraham, Andrew McCulloch, Gerald Greil, Sandy Engelhardt, and Mohammad Hussain
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Physiology (medical) ,Cardiology and Cardiovascular Medicine - Abstract
Introduction: “Le Coeur en Sabot” (or the boot-shaped heart) is a radiological description of the appearance of the heart on a plain radiograph of a patient with Tetralogy of Fallot. This highlights the importance of the shape of the heart. Maladaptive remodeling is known to occur in patients with repaired Tetralogy of Fallot (rToF) due to residual lesions such as Pulmonary Regurgitant Fraction (PRF) Hypothesis: Shape and function analysis can reveal novel remodeling patterns associated with adverse events in patients with rToF Methods: Biventricular shape and function were studied in 192 patients with rToF (median age 15 years). Linear discriminative analysis (LDA) and principal component analysis (PCA) were used to identify shape differences between patients with and without adverse events (AE). AE included death, arrhythmias, and cardiac arrest (median follow-up 10 years) Results: LDA and PCA showed that shape characteristics pertaining to adverse events included a more circular LV (decreased eccentricity), dilated (increased sphericity) LV base, increased RV apical sphericity, and decreased RV basal sphericity. Multivariate LDA showed that the optimal discriminative model included only RV apical ejection fraction and one PCA mode associated with a more circular and dilated LV base (AUC = 0.78). PRF did not add value, and shape changes associated with increased PRF were not predictive of AE. Conclusions: Remodeling patterns in patients with rToF are associated with AE, independent of PRF. Mechanisms leading to AE include LV basal dilation with a reduced RV apical ejection fraction. That is to say that the old descriptor, “Le Coeur en Sabot'' may also describe that shape that is adverse in rTOF. The toe of this boot would be the dilated and poorly contractile RV apex and the ankle would be the spherical LV base (Figure 1: Top Row Diastole. Middle Systole. Posterior projection (a), anatomical position (b) and superior (c). LV is green)
- Published
- 2021
16. Favorable Atrial Remodeling After Percutaneous Pulmonary Valve Implantation and Its Association With Changes in Exercise Capacity and Right Ventricular Function
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Heiner, Latus, Danik, Born, Nerejda, Shehu, Heiko, Stern, Alfred, Hager, Stainimir, Georgiev, Daniel, Tanase, Christian, Meierhofer, Peter, Ewert, Andreas, Eicken, and Oktay, Tutarel
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Heart Valve Prosthesis Implantation ,Pulmonary Valve ,Exercise Tolerance ,Congenital Heart Disease ,Atrial Function, Right ,Atrial Remodeling ,Pulmonary Valve Insufficiency ,Remodeling ,Oxygen ,Valvular Heart Disease ,diastolic ventricular function ,cardiovascular system ,Ventricular Function, Right ,Humans ,percutaneous pulmonary valve implantation ,Original Research ,atrial dysfunction - Abstract
Background Right atrial (RA) dilatation and impaired right ventricular (RV) filling are common in patients with RV outflow tract dysfunction. We aimed to study potential correlations between atrial function with clinically relevant hemodynamic parameters and to assess the predictive impact of atrial performance on the recovery of exercise capacity and RV pump function after percutaneous pulmonary valve implantation (PPVI). Methods and Results Altogether, 105 patients with right ventricular outflow tract dysfunction (median age at PPVI, 19.2 years; range, 6.2–53.4 years) who underwent cardiac magnetic resonance imaging before and 6 months after PPVI were included. RA and left atrial maximal and minimal volumes as well as atrial passive and active emptying function were assessed from axial cine slices. RA emptying function was inversely related to invasive RV end‐diastolic pressure, and RA passive emptying correlated significantly with peak oxygen uptake. After PPVI, a significant decrease in RA minimum volume was observed, whereas RA passive emptying function improved, and RA active emptying function decreased significantly. Patients with predominant right ventricular outflow tract stenosis showed more favorable changes in RA active and left atrial passive emptying than those with primary volume overload. None of the RA and left atrial emptying parameters was predictive for recovery of peak oxygen uptake or RV ejection fraction. Conclusions In patients with right ventricular outflow tract dysfunction, impaired RA emptying assessed by cardiac magnetic resonance imaging was associated with increased RV filling pressures and lower exercise capacity. PPVI leads to a reduction in RA size and improved passive RA emptying function. However, RA function was not associated with improved exercise performance and RV pump function.
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- 2021
17. Neue hämodynamische Definition der pulmonalen Hypertonie
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Hashim Abdul-Khaliq, Matthias Gorenflo, Brigitte Stiller, Anne Hilgendorff, Oliver Miera, Sulaima Albinni, Ingram Schulze-Neick, Hannes Sallmon, Daniel Quandt, Dietmar Schranz, Joseph Pattathu, Martin Koestenberger, Philipp Beerbaum, Alfred Hager, Rainer Kozlik-Feldmann, Christian Apitz, Michael Kaestner, Astrid E. Lammers, Georg Hansmann, Ina Michel-Behnke, Gregor Warnecke, Tilmann Humpl, Heiner Latus, and Karl-Otto Dubowy
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medicine.medical_specialty ,business.industry ,Vascular disease ,Hemodynamics ,030204 cardiovascular system & hematology ,Pulmonary arterial pressure ,medicine.disease ,Pulmonary hypertension ,language.human_language ,German ,03 medical and health sciences ,Critical appraisal ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Internal medicine ,Pediatrics, Perinatology and Child Health ,language ,Cardiology ,Vascular resistance ,Medicine ,Surgery ,business ,Pediatric cardiology - Abstract
Zusammenfassung Eine pathologische Druckerhöhung im pulmonalen Gefäßsystem (pulmonale Hypertonie, PH) wurde bisher definiert durch einen invasiv gemessenen mittleren pulmonalarteriellen Druck (mPAP) ≥25 mm Hg in Ruhe. Auf dem 6th World Symposium on Pulmonary Hypertension (WSPH) in Nizza 2018 wurde eine neue Definition der PH vorgeschlagen, die die Senkung der Obergrenze des normalen mPAP von 24 auf 20 mm Hg beinhaltet. Obwohl keine Evidenz aus pädiatrischen Studien hierfür vorliegt, wurde diese neue PH-Definition (mPAP >20 mm Hg) aus Gründen der Einheitlichkeit auch von der pädiatrischen „Task Force“ des WSPH 2018 übernommen. Die vorliegende Stellungnahme der Arbeitsgemeinschaft Pulmonale Hypertonie (AGPH) der Deutschen Gesellschaft für Pädiatrische Kardiologie und angeborene Herzfehler e. V. (DGPK) erläutert die zugrunde liegende Rationale und mögliche Konsequenzen dieser Definitionsänderung. Insbesondere stellt sie klar, dass diese Änderung der Definition aktuell keinen Einfluss auf die Verschreibung von Medikamenten zur gezielten spezifischen Therapie der pulmonalarteriellen Hypertonie hat.
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- 2019
18. Unsupervised Domain Adaptation from Axial to Short-Axis Multi-Slice Cardiac MR Images by Incorporating Pretrained Task Networks
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Gerald F. Greil, Thomas Pickardt, Sandy Engelhardt, Samir Sarikouch, Tyler Huffaker, Ivo Wolf, Heiner Latus, Zach Blair, Sven Koehler, Florian Ritzmann, Tarique Hussain, and Animesh Tandon
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FOS: Computer and information sciences ,Computer Science - Machine Learning ,Heart Diseases ,Computer science ,Computer Vision and Pattern Recognition (cs.CV) ,Heart Ventricles ,Stability (learning theory) ,Computer Science - Computer Vision and Pattern Recognition ,Magnetic Resonance Imaging, Cine ,Article ,Domain (software engineering) ,Machine Learning (cs.LG) ,Medical imaging ,medicine ,FOS: Electrical engineering, electronic engineering, information engineering ,Humans ,Electrical and Electronic Engineering ,Radiation treatment planning ,Rigid transformation ,Radiological and Ultrasound Technology ,business.industry ,Orientation (computer vision) ,Deep learning ,Image and Video Processing (eess.IV) ,Pattern recognition ,Heart ,Image segmentation ,Electrical Engineering and Systems Science - Image and Video Processing ,Magnetic Resonance Imaging ,Computer Science Applications ,medicine.anatomical_structure ,Ventricle ,Artificial intelligence ,business ,Cardiac magnetic resonance ,Software - Abstract
Anisotropic multi-slice Cardiac Magnetic Resonance (CMR) Images are conventionally acquired in patient-specific short-axis (SAX) orientation. In specific cardiovascular diseases that affect right ventricular (RV) morphology, acquisitions in standard axial (AX) orientation are preferred by some investigators, due to potential superiority in RV volume measurement for treatment planning. Unfortunately, due to the rare occurrence of these diseases, data in this domain is scarce. Recent research in deep learning-based methods mainly focused on SAX CMR images and they had proven to be very successful. In this work, we show that there is a considerable domain shift between AX and SAX images, and therefore, direct application of existing models yield sub-optimal results on AX samples. We propose a novel unsupervised domain adaptation approach, which uses task-related probabilities in an attention mechanism. Beyond that, cycle consistency is imposed on the learned patient-individual 3D rigid transformation to improve stability when automatically re-sampling the AX images to SAX orientations. The network was trained on 122 registered 3D AX-SAX CMR volume pairs from a multi-centric patient cohort. A mean 3D Dice of $0.86\pm{0.06}$ for the left ventricle, $0.65\pm{0.08}$ for the myocardium, and $0.77\pm{0.10}$ for the right ventricle could be achieved. This is an improvement of $25\%$ in Dice for RV in comparison to direct application on axial slices. To conclude, our pre-trained task module has neither seen CMR images nor labels from the target domain, but is able to segment them after the domain gap is reduced. Code: https://github.com/Cardio-AI/3d-mri-domain-adaptation, Accepted for IEEE Transaction on Medical Imaging (TMI) 2021 on 13.01.2021
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- 2021
19. How well do U-Net-based segmentation trained on adult cardiac magnetic resonance imaging data generalize to rare congenital heart diseases for surgical planning?
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Animesh Tandon, Gerald F. Greil, Philipp Beerbaum, Sandy Engelhardt, Thomas Pickardt, Sven Koehler, Samir Sarikouch, Tarique Hussain, Ivo Wolf, and Heiner Latus
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FOS: Computer and information sciences ,Computer Science - Machine Learning ,Computer science ,Computer Vision and Pattern Recognition (cs.CV) ,Computer Science - Computer Vision and Pattern Recognition ,Machine Learning (stat.ML) ,Overfitting ,Surgical planning ,Cross-validation ,Machine Learning (cs.LG) ,Statistics - Machine Learning ,Cardiac magnetic resonance imaging ,FOS: Electrical engineering, electronic engineering, information engineering ,medicine ,Segmentation ,Tetralogy of Fallot ,Data collection ,medicine.diagnostic_test ,business.industry ,Image and Video Processing (eess.IV) ,Pattern recognition ,Electrical Engineering and Systems Science - Image and Video Processing ,medicine.disease ,Data set ,Artificial intelligence ,business - Abstract
Planning the optimal time of intervention for pulmonary valve replacement surgery in patients with the congenital heart disease Tetralogy of Fallot (TOF) is mainly based on ventricular volume and function according to current guidelines. Both of these two biomarkers are most reliably assessed by segmentation of 3D cardiac magnetic resonance (CMR) images. In several grand challenges in the last years, U-Net architectures have shown impressive results on the provided data. However, in clinical practice, data sets are more diverse considering individual pathologies and image properties derived from different scanner properties. Additionally, specific training data for complex rare diseases like TOF is scarce. For this work, 1) we assessed the accuracy gap when using a publicly available labelled data set (the Automatic Cardiac Diagnosis Challenge (ACDC) data set) for training and subsequent applying it to CMR data of TOF patients and vice versa and 2) whether we can achieve similar results when applying the model to a more heterogeneous data base. Multiple deep learning models were trained with four-fold cross validation. Afterwards they were evaluated on the respective unseen CMR images from the other collection. Our results confirm that current deep learning models can achieve excellent results (left ventricle dice of $0.951\pm{0.003}$/$0.941\pm{0.007}$ train/validation) within a single data collection. But once they are applied to other pathologies, it becomes apparent how much they overfit to the training pathologies (dice score drops between $0.072\pm{0.001}$ for the left and $0.165\pm{0.001}$ for the right ventricle)., Accepted for SPIE Medical Imaging 2020
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- 2020
20. Aortic elasticity after aortic coarctation relief: comparison of surgical and interventional therapy by cardiovascular magnetic resonance imaging
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Bettina Reich, Helge Hudel, Dietmar Schranz, Heiner Latus, Theresa Pieper, Kerstin Gummel, Joachim Kreuder, and Inga Voges
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Male ,Aortic arch ,lcsh:Diseases of the circulatory (Cardiovascular) system ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Aortic elasticity ,Ventricular Function, Left ,030218 nuclear medicine & medical imaging ,Endovascular stent implantation ,0302 clinical medicine ,Prospective Studies ,Child ,Pulse wave velocity ,Aorta ,Ejection fraction ,Cardiac surgery ,Treatment Outcome ,Child, Preschool ,cardiovascular system ,Cardiology ,Atrial Function, Left ,Female ,Stents ,Cardiology and Cardiovascular Medicine ,Vascular Surgical Procedures ,Research Article ,Adult ,medicine.medical_specialty ,Adolescent ,Diastole ,Coarctation of the aorta ,Magnetic Resonance Imaging, Cine ,Aortic Coarctation ,Young Adult ,03 medical and health sciences ,Vascular Stiffness ,Predictive Value of Tests ,Internal medicine ,medicine.artery ,medicine ,Humans ,cardiovascular diseases ,Angiology ,Cardiovascular magnetic resonance imaging ,business.industry ,Stent ,Recovery of Function ,T1 mapping ,medicine.disease ,Elasticity ,lcsh:RC666-701 ,business ,Angioplasty, Balloon - Abstract
Background Patients after aortic coarctation (CoA) repair show impaired aortic bioelasticity and altered left ventricular (LV) mechanics, predisposing diastolic dysfunction. Our purpose was to assess aortic bioelasticity and LV properties in CoA patients who underwent endovascular stenting or surgery using cardiovascular magnetic resonance (CMR) imaging. Methods Fifty CoA patients (20.5 ± 9.5 years) were examined by 3-Tesla CMR. Eighteen patients had previous stent implantation and 32 had surgical repair. We performed volumetric analysis of both ventricles (LV, RV) and left atrium (LA) to measure biventricular volumes, ejection fractions, left atrial (LA) volumes, and functional parameters (LAEFPassive, LAEFContractile, LAEFReservoir). Aortic distensibility and pulse wave velocity (PWV) were assessed. Native T1 mapping was applied to examine LV tissue properties. In twelve patients post-contrast T1 mapping was performed. Results LV, RV and LA parameters did not differ between the surgical and stent group. There was also no significant difference for aortic distensibility, PWV and T1 relaxation times. Aortic root distensibility correlated negatively with age, BMI, BSA and weight (p p p Conclusions CoA patients after surgery or stent implantation did not show significant difference of aortic elasticity. Thus, presumably other factors like intrinsic aortic abnormalities might have a greater impact on aortic elasticity than the approach of repair. Interestingly, our data suggest that native T1 values are influenced by demographic characteristics.
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- 2019
21. Exercise-Induced Pulmonary Hypertension
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Christian Apitz and Heiner Latus
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medicine.medical_specialty ,Text mining ,business.industry ,Vascular disease ,Internal medicine ,medicine ,MEDLINE ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.disease ,Pulmonary hypertension - Published
- 2021
22. Invasive Assessment of Pulmonary Endothelial Function in Fontan Patients
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Christian Apitz, D. Schranz, Markus Khalil, G. Kerst, Heiner Latus, and A. Lederle
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,media_common.quotation_subject ,Medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Intensive care medicine ,Function (engineering) ,media_common - Published
- 2017
23. Impaired Cardiac Dimensions and Function in Children and Adolescents after Heart Transplantation Assessed by Cardiac Magnetic Resonance
- Author
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K. Behnke-Hall, P. Hachmann, D. Schranz, Hakan Akintuerk, Juergen Bauer, N. Mazhari, Josef Thul, Christian Apitz, Samir Sarikouch, Inga Voges, Heiner Latus, and Brigitte Peters
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Pulmonary and Respiratory Medicine ,Heart transplantation ,medicine.medical_specialty ,business.industry ,Internal medicine ,medicine.medical_treatment ,Cardiology ,medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,Cardiac magnetic resonance ,business - Published
- 2017
24. 2019 updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension: The European Pediatric Pulmonary Vascular Disease Network (EPPVDN), endorsed by AEPC, ESPR and ISHLT
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Peter Zartner, Håkan Wåhlander, Nicholas W. Morrell, Astrid E. Lammers, Guido E Pieles, R. Kozlik-Feldmann, Oliver Miera, Damien Bonnet, Daniel Quandt, Sven C. Weber, Hannes Sallmon, Karin Tran-Lundmark, Babar Hasan, Eric D. Austin, Gregor Warnecke, Tero-Pekka Alastalo, Michele D'Alto, Ina Michel-Behnke, Werner Budts, Martin Koestenberger, Robert Tulloh, Michael A. Gatzoulis, R. Krishna Kumar, Georg Hansmann, Dietmar Schranz, Christian Apitz, Heiner Latus, University of Zurich, and Hansmann, Georg
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Heart disease ,2747 Transplantation ,medicine.medical_treatment ,MEDLINE ,610 Medicine & health ,030204 cardiovascular system & hematology ,2705 Cardiology and Cardiovascular Medicine ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,030225 pediatrics ,Medicine ,Lung transplantation ,Cardiac catheterization ,Transplantation ,business.industry ,Evidence-based medicine ,medicine.disease ,Pulmonary hypertension ,Intensive care unit ,2746 Surgery ,Clinical trial ,10036 Medical Clinic ,2740 Pulmonary and Respiratory Medicine ,Emergency medicine ,Surgery ,Cardiology and Cardiovascular Medicine ,business - Abstract
The European Pediatric Pulmonary Vascular Disease Network is a registered, non-profit organization that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of pediatric pulmonary hypertensive vascular disease, including pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, PH associated with congenital heart disease (CHD), persistent PH of the newborn, and related cardiac dysfunction. The executive writing group members conducted searches of the PubMed/MEDLINE bibliographic database (1990-2018) and held face-to-face and web-based meetings. Ten section task forces voted on the updated recommendations, based on the 2016 executive summary. Clinical trials, meta-analyses, guidelines, and other articles that include pediatric data were searched using the term "pulmonary hypertension" and other keywords. Class of recommendation (COR) and level of evidence (LOE) were assigned based on European Society of Cardiology/American Heart Association definitions and on pediatric data only, or on adult studies that included >10% children or studies that enrolled adults with CHD. New definitions by the World Symposium on Pulmonary Hypertension 2018 were included. We generated 10 tables with graded recommendations (COR/LOE). The topics include diagnosis/monitoring, genetics/biomarkers, cardiac catheterization, echocardiography, cardiac magnetic resonance/chest computed tomography, associated forms of PH, intensive care unit/lung transplantation, and treatment of pediatric PH. For the first time, a set of specific recommendations on the management of PH in middle- and low-income regions was developed. Taken together, these executive, up-to-date guidelines provide a specific, comprehensive, detailed but practical framework for the optimal clinical care of children and young adults with PH.
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- 2019
25. Impaired Biventricular Filling and Response to Percutaneous Pulmonary Valve Implantation in Patients with RVOT Dysfunction
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Oktay Tutarel, Stanimir Georgiev, Naira Mkrtchyan, Andreas Eicken, D. Born, Christian Meierhofer, P. Ewert, Heiko Stern, A. Hager, Daniel Tanase, and Heiner Latus
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medicine.medical_specialty ,business.industry ,Internal medicine ,Percutaneous pulmonary valve implantation ,medicine ,Cardiology ,In patient ,business - Published
- 2019
26. Potts Shunt to Be Preferred Above Atrial Septostomy in Pediatric Pulmonary Arterial Hypertension Patients: A Modeling Study
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Christian Apitz, Dietmar Schranz, Heiner Latus, Tammo Delhaas, Yvette Koeken, Biomedische Technologie, RS: CARIM - R2.09 - Cardiovascular system dynamics, and Promovendi CD
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medicine.medical_specialty ,Cardiac output ,Physiology ,medicine.medical_treatment ,FLOW ,CHILDREN ,030204 cardiovascular system & hematology ,lcsh:Physiology ,pump work ,03 medical and health sciences ,0302 clinical medicine ,shunt flow ,Physiology (medical) ,Internal medicine ,pulmonary arterial hypertension ,medicine ,Atrial septostomy ,ADAPTATION ,computer modeling ,Potts shunt ,lcsh:QP1-981 ,exercise ,business.industry ,PALLIATION ,atrial septostomy ,medicine.disease ,oxygen saturation ,Shunt (medical) ,CREATION ,Blood pressure ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Mean circulatory filling pressure ,Eisenmenger syndrome ,Cardiology ,HEART ,business - Abstract
Aims: To quantitatively evaluate the basic pathophysiological process involved in the creation of Eisenmenger syndrome in pediatric pulmonary arterial hypertension (PAH) patients by either atrial septostomy (AS) or Potts shunt (PS) as well as to predict the effects of AS or PS in future PAH patients. Methods: The multi-scale lumped parameter CircAdapt model of the cardiovascular system was used to investigate the effects of AS and PS on cardiovascular hemodynamics and mechanics, as well as on oxygen saturation in moderate to severe PAH. The reference simulation, with cardiac output set to 2.1 l/min and mean systemic pressure to 61 mmHg, was used to create a compensated moderate PAH simulation with mPAP 50 mmHg. Thereupon we created a range of decompensated PAH simulations in which mPAP was stepwise increased from 50 to 80 mmHg. Then we simulated for each level of mPAP the acute effects of either PS or AS with connection diameters ranging between 0-16 mm. Results: For any mPAP level, the effect on shunt flow size is much larger for the PS than for AS. Whereas right ventricular pump work in PS is mainly dependent on mPAP, in AS it depends on both mPAP and the size of the defect. The effects on total cardiac pump work were similar for PS and AS. As expected, PS resulted in a drastic decrease of lower body oxygen saturation, whereas in AS both the upper and lower body oxygen saturation decreased, though not as drastically as in PS. Conclusion: Our simulations support the opinion that a PS can transfer suprasystemic PAH to an Eisenmenger physiology associated with a right-to-left shunt at the arterial level. Contrary to the current opinion that PS in PAH will decompress and unload the right ventricle, we show that while a PS does lead to a decrease in mPAP toward mean systemic arterial pressure, it does not unload the right ventricle because it mainly diverts flow from the pulmonary arterial system toward the lower body systemic arteries.
- Published
- 2018
27. Evaluation of pulmonary endothelial function in Fontan patients
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Christian Apitz, Gunter Kerst, Heiner Latus, Andrea Lederle, Dietmar Schranz, and Markus Khalil
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Pulmonary and Respiratory Medicine ,Adult ,Male ,medicine.medical_specialty ,Cardiac Catheterization ,Pulmonary Circulation ,Adolescent ,medicine.medical_treatment ,Pulsatile flow ,Hemodynamics ,Vasodilation ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Fontan Procedure ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Endothelial dysfunction ,Pulmonary wedge pressure ,Child ,Cardiac catheterization ,business.industry ,Blood flow ,medicine.disease ,Magnetic Resonance Imaging ,medicine.anatomical_structure ,030228 respiratory system ,Child, Preschool ,Vascular resistance ,Cardiology ,Surgery ,Female ,Vascular Resistance ,Endothelium, Vascular ,Cardiology and Cardiovascular Medicine ,business - Abstract
Pulmonary endothelial dysfunction due to a loss of pulsatile pulmonary blood flow is thought to be a major contributor in the development of increased pulmonary vascular resistance (PVR) in patients with a Fontan circulation. We sought to evaluate pulmonary endothelial dysfunction by vasodilator response to acetylcholine in children and adolescents with Fontan hemodynamics.Twenty-one Fontan patients with a median age of 10.7 years (range, 3.4-30.0 years) underwent invasive cardiac catheterization, including intra-arterial Doppler and pressure measurements in a segmental pulmonary artery. Pulmonary flow reserve (PFR) was quantified as the change of average peak velocity in response to acetylcholine infusion. Local PVR was assessed by the ratio of local pressure and blood flow velocity.Average peak velocity significantly increased from 16.4 ± 6.6 cm/s to 20.1 ± 6.4 cm/s (P = .002) resulting in a mean PFR of 1.28 ± 0.37. Local PVR dropped from 0.72 ± 0.32 mm Hg/cm/s to 0.57 ± 0.20 mm Hg/cm/s (n = 19; P = .01). A significant relationship was found between baseline local PVR and PFR (r = 0.73; P = .0006) as well as between PFR and the percent decrease in local PVR (r = 0.85; P .0001). In addition, percentage decrease in local PVR correlated with New York Heart Association functional class, whereas neither PFR nor local PVR correlated with global PVR.The assessment of PFR and local PVR may help to evaluate adverse pulmonary vascular remodeling in Fontan patients as an adjunct to the usual catheterization protocol, particularly given the difficulties in assessing global PVR in these patients. Future research is required to study whether impaired local pulmonary endothelial function may be associated with Fontan failure.
- Published
- 2018
28. Effects of pulmonary artery banding in doxorubicin-induced left ventricular cardiomyopathy
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Hakan Akintuerk, U. Yörüker, H. Elmontaser, Can Yerebakan, Kristin Mueller, Marcel Suchowski, Dietmar Schranz, Rita Ruetten, Matthias Schneider, Johannes Boltze, Gunther Kerst, Christian Apitz, Heiner Latus, Stefan Ostermayer, Blanca Steinbrenner, Markus Khalil, and Publica
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Pulmonary and Respiratory Medicine ,Cardiomyopathy, Dilated ,medicine.medical_specialty ,Cardiomyopathy ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Coronary Angiography ,Ventricular Function, Left ,Pulmonary artery banding ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Animals ,Ejection fraction ,Sheep ,business.industry ,Sham surgery ,Hemodynamics ,Dilated cardiomyopathy ,medicine.disease ,Disease Models, Animal ,medicine.anatomical_structure ,030228 respiratory system ,Ventricle ,Doxorubicin ,Heart failure ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Transesophageal ,Artery - Abstract
Objective Central pulmonary banding has been proposed as a novel alternative for the treatment of left ventricular dilated cardiomyopathy in children. We sought to investigate the effects of central pulmonary banding in an experimental model of doxorubicin-induced left ventricular dilated cardiomyopathy. Methods Four-month-old sheep (n = 28) were treated with intermittent intracoronary injections of doxorubicin (0.75 mg/kg/dose) into the left main coronary artery. A total dose of up to 2.15 mg/kg of doxorubicin was administered until signs of left ventricular dilation with functional impairment occurred by transthoracic echocardiography evaluation. Animals that survived were treated with surgical central pulmonary banding through a left anterior thoracotomy or sham surgery. Transthoracic echocardiography and pressure-volume loop measurements were used to compare left ventricular function preoperatively and 3 months later. Macroscopic and microscopic histologic examinations followed after hearts were harvested. Results Nine animals from the central pulmonary banding group and 8 animals from the sham group survived and were included in the final analysis. Both groups showed similar inflammation and fibrosis upon histologic examination consistent with the toxic myocardial effects of doxorubicin. There were no differences in the echocardiographic measurements before central pulmonary banding or sham operation. Baseline measurements before the central pulmonary banding/sham operation were considered as 100%. The central pulmonary banding group had better left ventricular ejection fraction (102.5% ± 21.6% vs 76.7% ± 11.7%, P = .01), with a tendency for smaller left ventricular end-diastolic (101.2% ± 7.4% vs 120.4% ± 10.8%, P = .18) and significantly smaller end-systolic (100.3% ± 12.9% vs 116.5 ± 9.6%, P = .02) diameter of the left ventricle in comparison with the sham animals at 3 months. The end-systolic volume (101.4% ± 31.6% vs 143.4% ± 28.6%, P = .02) was significantly lower in the central pulmonary banding group 3 months postoperatively. Fractional shortening in the long axis (118.5% ± 21.5% vs 85.2% ± 22.8%, P = .016) and short axis (122.5% ± 18% vs 80.9% ± 13.6%, P = .0005) revealed significantly higher values in the central pulmonary banding group. In the conductance catheter measurements, no significant differences were seen between the groups for the parameters of systolic and diastolic function. Conclusions Central pulmonary artery banding in the setting of experimental toxic left ventricular dilated cardiomyopathy improved left ventricular echocardiographic function and dimensions.
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- 2018
29. Diffuse and Focal Myocardial Fibrosis Late after Norwood Procedure
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P. Ewert, Naira Mkrtchyan, Heiko Stern, S. Brodkorb, Nerejda Shehu, Christian Meierhofer, and Heiner Latus
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,Cardiology ,Medicine ,Norwood procedure ,Myocardial fibrosis ,business - Published
- 2018
30. Ventricular function and vascular dimensions after Norwood and hybrid palliation of hypoplastic left heart syndrome
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Hakan Akintuerk, Christian Apitz, Juergen Bauer, Reza Razavi, Tarique Hussain, Conal Austin, Pauline Hachmann, Caner Salih, Dietmar Schranz, David Anderson, Hannah Bellsham-Revell, Mohamed S. Nassar, Gerald F. Greil, Heiner Latus, Can Yerebakan, and James Wong
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Male ,Reoperation ,medicine.medical_specialty ,Heart Ventricles ,Population ,Aorta, Thoracic ,Kaplan-Meier Estimate ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Fontan Procedure ,Norwood Procedures ,030218 nuclear medicine & medical imaging ,Pulmonary artery banding ,Hypoplastic left heart syndrome ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Hypoplastic Left Heart Syndrome ,Heart rate ,medicine ,Journal Article ,Humans ,education ,Blalock-Taussig Procedure ,education.field_of_study ,Ventricular function ,business.industry ,Palliative Care ,Infant ,medicine.disease ,Norwood Operation ,Surgery ,Child, Preschool ,Pulmonary artery ,Ventricular Function, Right ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Magnetic Resonance Angiography ,Shunt (electrical) - Abstract
ObjectiveNorwood and hybrid procedure are two options available for initial palliation of patients with hypoplastic left heart syndrome (HLHS). Our study aimed to assess potential differences in right ventricular (RV) function and pulmonary artery dimensions using cardiac magnetic resonance (CMR) in survivors with HLHS.Methods42 Norwood (mean age 2.4±0.8) and 44 hybrid (mean age 2.0±1.0 years) patients were evaluated by CMR after stage II palliation prior to planned Fontan completion. Initial stage I Norwood procedure was performed using a modified Blalock-Taussig shunt, while the hybrid procedure consisted of bilateral pulmonary artery banding and arterial duct stenting. Need for reinterventions and subsequent outcomes were also assessed.ResultsNorwood patients had larger RV end-diastolic dimensions (91±23 vs 80±31 mL/m2, p=0.004) and lower heart rate (90±15 vs 102±13, p2/m2, p=0.02), and reintervention rate was significantly higher in the hybrid group whereas subsequent outcome did not differ significantly (p=0.24).ConclusionsNorwood and hybrid strategy were associated with equivalent and preserved global RV pump function while development of the pulmonary arteries and reintervention rate were superior using the Norwood approach. Impaired RV myocardial deformation as a potential marker of early RV dysfunction in the hybrid group may have a negative long-term impact in this population.
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- 2017
31. Right ventricular failure from severe pulmonary hypertension after surgery for shone complex: Back to fetal physiology with reducting, atrioseptectomy, and bilateral pulmonary arterial banding
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Hakan Akintuerk, Heiner Latus, Can Yerebakan, and Dietmar Schranz
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Heart Defects, Congenital ,Male ,Reoperation ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Pulmonary Artery ,Shone complex ,Severity of Illness Index ,Blood Vessel Prosthesis Implantation ,Internal medicine ,medicine ,Humans ,Abnormalities, Multiple ,Cardiac Surgical Procedures ,business.industry ,Palliative Care ,Hemodynamics ,Infant ,medicine.disease ,Fetal physiology ,Pulmonary hypertension ,Magnetic Resonance Imaging ,Surgery ,Treatment Outcome ,Anesthesia ,cardiovascular system ,Cardiology ,Ventricular Function, Right ,Right ventricular failure ,business ,Cardiology and Cardiovascular Medicine - Published
- 2014
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32. Impaired cardiac growth and function in children and adolescents after heart transplantation assessed by cardiac magnetic resonance
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Nona Mazhari, Kachina Behnke-Hall, Brigitte Peters, Heiner Latus, Christian Apitz, J. Thul, Juergen Bauer, Hakan Akintuerk, Dietmar Schranz, Samir Sarikouch, Inga Voges, and Pauline Hachmann
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Heart transplantation ,medicine.medical_specialty ,Radiological and Ultrasound Technology ,business.industry ,medicine.medical_treatment ,030209 endocrinology & metabolism ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Internal medicine ,Cardiology ,medicine ,Oral Presentation ,Radiology, Nuclear Medicine and imaging ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance ,Myocardial mass ,Angiology - Published
- 2016
33. Assessment of Pulmonary Endothelial Function During Invasive Testing in Children and Adolescents With Idiopathic Pulmonary Arterial Hypertension
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Christian Apitz, Joern Pons-Kühnemann, Ina Michel-Behnke, Ines Kock, Christian Jux, Joachim Kreuder, Dietmar Schranz, Heiner Latus, Peter Bride, Rainer Zimmermann, and Karsten grosse Kreymborg
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Male ,medicine.medical_specialty ,Adolescent ,Endothelium ,Hypertension, Pulmonary ,Vasodilator Agents ,medicine.medical_treatment ,Vasodilation ,Disease ,Pulmonary Artery ,World health ,endothelial function ,pulmonary arterial hypertension ,Internal medicine ,Laser-Doppler Flowmetry ,Humans ,Medicine ,Lung transplantation ,Familial Primary Pulmonary Hypertension ,Endothelial dysfunction ,Child ,Lung ,business.industry ,Idiopathic Pulmonary Arterial Hypertension ,Laser Doppler velocimetry ,Calcium Channel Blockers ,Prognosis ,medicine.disease ,Acetylcholine ,Surgery ,medicine.anatomical_structure ,Cardiovascular Diseases ,Regional Blood Flow ,Child, Preschool ,Cardiology ,pediatric cardiology ,Female ,Endothelium, Vascular ,vasoreactivity ,business ,Cardiology and Cardiovascular Medicine - Abstract
ObjectivesThe purpose of our study was to assess pulmonary endothelial function by vasodilator response to acetylcholine (Ach) administered in segmental pulmonary arteries in children with idiopathic pulmonary arterial hypertension (IPAH). We hypothesized that there was a relationship among pulmonary endothelial response to Ach, severity of the disease, and clinical outcome.BackgroundIPAH may be associated with pulmonary endothelial dysfunction; however, data regarding the impact of endothelial dysfunction on severity and prognosis of this disease are limited.MethodsForty-three children and adolescents (mean age: 10.4 ± 5.5 years) with IPAH were included in the study. Changes in pulmonary blood flow in response to Ach were determined using intravascular Doppler flow measurements. Pulmonary flow reserve (PFR) was calculated as the ratio of pulmonary blood flow velocity in response to Ach relative to baseline values.ResultsMean PFR of all patients was 1.58 ± 0.67. Mean follow-up after catheterization was 55.7 ± 41.9 months. Freedom from serious cardiovascular events (lung transplantation or death) was 83% after 2 years, 76% after 3 years, and 57% after 5 years. PFR was related significantly to World Health Organization functional class. Receiver-operating characteristic curves revealed a PFR of 1.4 as the best cutoff value. Kaplan-Meier analysis demonstrated that a PFR of
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- 2012
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34. Executive summary. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK
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Titus Kuehne, Vivek Muthurangu, Heiner Latus, Karl-Otto Dubowy, Peter Zartner, Astrid E. Lammers, Martin Koestenberger, R. Kozlik-Feldmann, Ina Michel-Behnke, Damien Bonnet, Tero-Pekka Alastalo, Georg Hansmann, Hashim Abdul-Khaliq, Gregor Warnecke, Joseph Pattathu, Juha Koskenvuo, P. Beerbaum, Michael Kaestner, Anne Hilgendorff, Oliver Miera, Christian Apitz, Matthias Gorenflo, Alfred Hager, Shahin Moledina, and Dietmar Schranz
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medicine.medical_specialty ,Heart disease ,Adolescent ,medicine.medical_treatment ,Hypertension, Pulmonary ,MEDLINE ,030204 cardiovascular system & hematology ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,law ,medicine ,Lung transplantation ,Humans ,Intensive care medicine ,Child ,Societies, Medical ,business.industry ,Infant, Newborn ,Infant ,Evidence-based medicine ,medicine.disease ,Intensive care unit ,Pulmonary hypertension ,3. Good health ,Clinical trial ,Europe ,030228 respiratory system ,Ventricular assist device ,Child, Preschool ,Cardiology and Cardiovascular Medicine ,business - Abstract
The European Paediatric Pulmonary Vascular Disease (PVD) Network is a registered, non-profit organisation that strives to define and develop effective, innovative diagnostic methods and treatment options in all forms of paediatric pulmonary hypertensive vascular disease, including specific forms such as pulmonary arterial hypertension (PAH)-congenital heart disease, pulmonary hypertension (PH) associated with bronchopulmonary dysplasia, persistent PH of the newborn, and related cardiac dysfunction. Methods The writing group members conducted searches of the PubMed/MEDLINE bibliographic database (1990–2015) and held five face-to-face meetings with votings. Clinical trials, guidelines, and reviews limited to paediatric data were searched using the terms ‘pulmonary hypertension’ and 5–10 other keywords, as outlined in the other nine articles of this special issue. Class of recommendation (COR) and level of evidence (LOE) were assigned based on European Society of Cardiology/American Heart Association definitions and on paediatric data only, or on adult studies that included >10% children. Results A total of 9 original consensus articles with graded recommendations (COR/LOE) were developed, and are summarised here. The topics included diagnosis/monitoring, genetics/biomarker, cardiac catheterisation, echocardiography, cardiac magnetic resonance/chest CT, associated forms of PH, intensive care unit/ventricular assist device/lung transplantation, and treatment of paediatric PAH. Conclusions The multipaper expert consensus statement of the European Paediatric PVD Network provides a specific, comprehensive, detailed but practical framework for the optimal clinical care of children with PH.
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- 2015
35. Heart Rate Variability is Related to Disease Severity in Children and Young Adults with Pulmonary Hypertension
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Heiner, Latus, Dirk, Bandorski, Friederike, Rink, Henning, Tiede, Jannos, Siaplaouras, Ardeschir, Ghofrani, Werner, Seeger, Dietmar, Schranz, and Christian, Apitz
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pediatrics ,pulmonary hypertension ,lcsh:RJ1-570 ,heart rate variability ,Paediatrics ,lcsh:Pediatrics ,pediatric cardiology ,arrhythmias ,Holter electrocardiogram ,Original Research ,circulatory and respiratory physiology - Abstract
Background Pulmonary hypertension (PH) is frequently associated with an increase in sympathetic tone. This may adversely affect cardiac autonomic control. Knowledge about the clinical impact of autonomic dysfunction in patients with PH is limited. We aimed to assess whether parameters of heart rate variability (HRV) are related to disease severity in children with PH. Methods Parameters of HRV [SDNN, standard deviation of normal-to-normal intervals and SDANN, standard deviation of mean values for normal-to-normal intervals over 5 min] were determined from Holter electrocardiograms of 17 patients with PH without active intracardial shunt (10 female, mean age 12.8 ± 8.7 years). Patients were allocated to two groups according to their disease severity: patients with moderate PH [ratio of pulmonary to systemic arterial pressure (PAP/SAP ratio) 0.75) (n = 6). An additional group of five adolescents with Eisenmenger syndrome (PAP/SAP ratio 1.13 ± 0.36) was included. Results Children with severe PH had significantly lower values of HRV [SDNN (73.8 ± 21.1 vs. 164.9 ± 38.1 ms), SDANN (62.2 ± 19.0 vs. 139.5 ± 33.3 ms)] compared to patients with moderate PH (p = 0.0001 for all). SDNN inversely correlated with ratio of PAP/SAP of PH patients without shunt (r = −0.82; p = 0.0002). Eisenmenger patients showed no significant difference of HRV [SDNN 157.6 ± 43.2 ms, SDANN 141.2 ± 45.3 ms] compared to patients with moderate PH without shunt (p > 0.05 for all). Conclusion According to our results, children with severe PH may have alterations in HRV. Since HRV appears to be related to disease severity, it may therefore serve as an additional diagnostic marker of PH. Remarkably, although Eisenmenger patients have systemic pulmonary arterial pressures, they seem to have preserved HRV, which might reflect a more favorable autonomic adaptation.
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- 2015
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36. Cardiac MR and CT imaging in children with suspected or confirmed pulmonary hypertension/pulmonary hypertensive vascular disease. Expert consensus statement on the diagnosis and treatment of paediatric pulmonary hypertension. The European Paediatric Pulmonary Vascular Disease Network, endorsed by ISHLT and DGPK
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Philipp Beerbaum, Georg Hansmann, Shahin Moledina, Heiner Latus, Christian Apitz, Titus Kuehne, and Vivek Muthurangu
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medicine.medical_specialty ,Pulmonary Circulation ,Consensus ,Adolescent ,Heart Ventricles ,Hypertension, Pulmonary ,Ventricular Dysfunction, Right ,Hemodynamics ,Magnetic Resonance Imaging, Cine ,Disease ,030204 cardiovascular system & hematology ,Pulmonary Artery ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Afterload ,medicine.artery ,Internal medicine ,medicine ,Humans ,Child ,Radionuclide Imaging ,medicine.diagnostic_test ,business.industry ,Vascular disease ,Magnetic resonance imaging ,medicine.disease ,Pulmonary hypertension ,Magnetic Resonance Imaging ,Pulmonary artery ,Cardiology ,Ventricular Function, Right ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed ,Perfusion - Abstract
Childhood pulmonary hypertension (PH) is a heterogenous disease associated with considerable morbidity and mortality. Invasive assessment of haemodynamics is crucial for accurate diagnosis and guidance of medical therapy. However, adequate imaging is increasingly important in children with PH to evaluate the right heart and the pulmonary vasculature. Cardiac MR (CMR) and computed tomography (CT) represent important non-invasive imaging modalities that may enable comprehensive assessment of right ventricular (RV) function and pulmonary haemodynamics. Here, we present graded consensus recommendations for the evaluation of children with PH by CMR and CT. The article provides a structured approach for the use of CMR and CT imaging, emphasises non-invasive variables of RV function, myocardial tissue and afterload parameters that may be useful for initial diagnosis and monitoring. Furthermore, assessment of pulmonary perfusion and characterisation of the lung parenchyma provides structural information about processes that may cause or be due to PH.
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- 2015
37. Hybrid therapy for hypoplastic left heart syndrome: Myth, alternative, or standard?
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Anika Villanueva, Can Yerebakan, Karoline Hofmann, H. Elmontaser, Valesco Mann, Dietmar Schranz, Matthias Mueller, Heiner Latus, Klaus Valeske, Josef Thul, U. Yörüker, and Hakan Akintuerk
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Pulmonary and Respiratory Medicine ,Aortic arch ,Reoperation ,medicine.medical_specialty ,Pulmonary Circulation ,Palliative care ,Time Factors ,Adolescent ,medicine.medical_treatment ,Aorta, Thoracic ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Pulmonary Artery ,Fontan Procedure ,Norwood Procedures ,Hypoplastic left heart syndrome ,Fontan procedure ,03 medical and health sciences ,Blood Vessel Prosthesis Implantation ,0302 clinical medicine ,Risk Factors ,medicine.artery ,Internal medicine ,Germany ,Hypoplastic Left Heart Syndrome ,medicine ,Thoracic aorta ,Humans ,Child ,Retrospective Studies ,Heart transplantation ,business.industry ,Palliative Care ,Infant ,medicine.disease ,Surgery ,Treatment Outcome ,030228 respiratory system ,Child, Preschool ,Pulmonary artery ,Cardiology ,Norwood procedure ,Cardiology and Cardiovascular Medicine ,business - Abstract
This retrospective study presents our operative results, mortality, and morbidity with regard to pulmonary artery growth and reinterventions on the pulmonary artery and aortic arch, including key features of our institutional standards for the 3-stage hybrid palliation of patients with hypoplastic left heart syndrome.Between June 1998 and February 2015, 182 patients with hypoplastic left heart structures underwent the Giessen hybrid stage I procedure. Among these, 126 patients with hypoplastic left heart syndrome who received a univentricular palliation or heart transplantation were included in the main analysis. Median age and body weight of patients at hybrid stage I were 6 days (0-237) and 3.2 kg (1.2-7), respectively. Comprehensive stage II operation was performed at 4.5 months (2.9-39.5), and Fontan completion was established at 33.7 months (21.1-108.2). Operative and interstage mortality, morbidity, growth and reinterventions on the pulmonary arteries, and long-term operative results of the aortic arch reconstruction were assessed.Median follow-up time after Giessen hybrid stage I palliation was 4.6 years (0-16.8). Operative mortality at hybrid stage I, comprehensive stage II, and Fontan completion was 2.5%, 4.9%, and 0%, respectively. Cumulative interstage mortality was 14.2%. At 10 years, the probability of survival is 77.8%. Body weight (2.5 kg) and aortic atresia had no significant impact on survival. McGoon ratio did not differ at comprehensive stage II and Fontan completion (P = .991). Freedom from pulmonary artery intervention was estimated to be 32.2% at 10 years. Aortic arch reinterventions were needed in 16.7% of patients; 2 reoperations on the aortic arch were necessary.In view of the early results and long-term outcome, the hybrid approach has become an alternative to the conventional strategy to treat neonates with hypoplastic left heart syndrome and variants. Further refinements are warranted to decrease patient morbidity.
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- 2015
38. Impact of residual right ventricular outflow tract obstruction on biventricular strain and synchrony in patients after repair of tetralogy of Fallot: a cardiac magnetic resonance feature tracking study
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Can Yerebakan, Heiner Latus, Markus Khalil, Pauline Hachmann, Dietmar Schranz, K. Gummel, Juergen Bauer, and Christian Apitz
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Adolescent ,Ventricular Dysfunction, Right ,Strain (injury) ,Right ventricular outflow tract obstruction ,Ventricular Outflow Obstruction ,Internal medicine ,medicine ,Ventricular outflow tract ,Humans ,In patient ,Tetralogy of Fallot ,medicine.diagnostic_test ,Strain (chemistry) ,business.industry ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Pulmonary Valve Insufficiency ,Stenosis ,Treatment Outcome ,Echocardiography ,Cardiology ,Feature tracking ,Female ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Cardiac magnetic resonance - Abstract
Objectives Residual right ventricular outflow tract (RVOT) obstruction (RVOTO) is considered beneficial in patients after repair of tetralogy of Fallot (TOF) although underlying mechanisms are unknown. We sought to elucidate differences in myocardial strain and dyssynchrony parameters in patients after TOF repair with and without residual RVOTO using cardiovascular magnetic resonance (CMR) feature-tracking (CMR-FT) analysis. Methods Fifty-four patients (mean age 16.4 ± 8.4 years) were assessed by CMR 14.2 ± 7.3 years after repair of TOF. Residual RVOTO on echocardiography was defined as a peak systolic RVOT gradient >25 mmHg and was present in 27 patients (no RVOTO in n = 27 patients). Right ventricular (RV) and left ventricular (LV) strain measurements were performed using CMR-FT software. Results The two groups were well matched for age at CMR scan, time and type of surgical repair. There was no difference in the degree of pulmonary regurgitation (PR) and RV end-diastolic volume. Patients with RVOTO showed significant higher RV circumferential strain (CS) (P = 0.02) and RV radial strain (RS) (P = 0.02) values, whereas RV longitudinal strain (LS) did not differ between the two groups (P = 0.39). The degree of RVOTO showed a significant correlation with RV-CS (r = 0.37; P = 0.006) and RV-RS (r = 0.30; P = 0.03) while RV-LS was unrelated to RVOTO (r = 0.06; P = 0.68). Significant relationships between RV and LV strain parameters were only found in the RVOTO group. Interventricular dyssynchrony was significantly higher in the group without RVOTO (P = 0.03) while LV-LS (P = 0.03) and LV intraventricular synchrony (P = 0.05) were impaired in the RVOTO group. Conclusions In patients after TOF repair, residual RVOTO seems to preserve RV strain and results in stronger RV-LV interactions and less interventricular dyssynchrony and may therefore possess an early protective effect on RV remodelling. However, the potential negative impact of residual pulmonary stenosis on LV strain and intraventricular synchrony needs further investigation.
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- 2014
39. Aortopulmonary Collateral Flow is Related to Pulmonary Artery Size and Affects Ventricular Dimensions in Patients After the Fontan Procedure
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Juergen Bauer, Stefan Rupp, D. Schranz, Christian Apitz, K. Gummel, Heiner Latus, G Kerst, T Diederichs, and Christian Jux
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Fontan procedure ,Collateral flow ,medicine.artery ,Internal medicine ,Pulmonary artery ,medicine ,Cardiology ,Surgery ,In patient ,Cardiology and Cardiovascular Medicine ,business - Published
- 2013
40. Potts shunt and atrial septostomy in pulmonary hypertension caused by left ventricular disease
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Juergen Bauer, Christian Jux, Hakan Akintuerk, Heiner Latus, Dorle Schmidt, Matthias Mueller, Martin Schneider, Dietmar Schranz, and Christian Apitz
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Pulmonary and Respiratory Medicine ,Male ,medicine.medical_specialty ,Pulmonary Circulation ,medicine.medical_treatment ,Hypertension, Pulmonary ,Diastole ,Magnetic Resonance Imaging, Cine ,Heart Septal Defects, Atrial ,Diagnosis, Differential ,Young Adult ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Atrial septostomy ,Heart Atria ,Cardiac Surgical Procedures ,Pulmonary wedge pressure ,Atrial Septum ,business.industry ,Anastomosis, Surgical ,Left pulmonary artery ,medicine.disease ,Pulmonary hypertension ,Transplantation ,Preload ,medicine.anatomical_structure ,Ventricle ,Echocardiography ,cardiovascular system ,Cardiology ,Surgery ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
We report a 20-year-old patient with Shone's complex and severe diastolic dysfunction of his small left ventricle (LV) in whom severe pulmonary hypertension and biventricular failure developed while he was awaiting combined heart-lung transplantation. We performed a percutaneous balloon atrial septostomy and a modified Potts shunt (13-mm graft from left pulmonary artery to descending aorta), with the aim of decompressing the hypertensive right ventricle (RV) by reducing left ventricular preload and left atrial hypertension. The procedures were uneventful. The patient's condition improved rapidly and biventricular function was restored. In contrast to a Potts shunt in other conditions, patients with pulmonary hypertension caused by left ventricular disease may benefit from an additional atrial left-to-right shunt.
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- 2012
41. Every X-ray needs an indication!
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Heiner Latus and Thomas Krasemann
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Heart Defects, Congenital ,Postoperative Care ,medicine.medical_specialty ,business.industry ,Diagnostic Tests, Routine ,General Medicine ,Patient Discharge ,Cardiac surgery ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Radiography, Thoracic ,Radiology ,Cardiac Surgical Procedures ,Cardiology and Cardiovascular Medicine ,business - Published
- 2011
42. Long-term results of biventricular repair after initial Giessen hybrid approach for hypoplastic left heart variants
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Hakan Akintuerk, Can Yerebakan, H. Elmontaser, Christian Apitz, Josef Thul, Matthias Mueller, Valesco Mann, Dietmar Schranz, Klaus Valeske, Stefan Ostermayer, Josephine Murray, and Heiner Latus
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Aortic arch ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac Catheterization ,Palliative care ,Time Factors ,Heart Ventricles ,Kaplan-Meier Estimate ,Pulmonary Artery ,Norwood Procedures ,Ventricular Function, Left ,Pulmonary artery banding ,Hypoplastic left heart syndrome ,Risk Factors ,Internal medicine ,medicine.artery ,Hypoplastic Left Heart Syndrome ,medicine ,Humans ,cardiovascular diseases ,Retrospective Studies ,business.industry ,Interrupted aortic arch ,Palliative Care ,Infant, Newborn ,Infant ,medicine.disease ,Surgery ,Stenosis ,Treatment Outcome ,Great arteries ,cardiovascular system ,Cardiology ,Hypoplastic aortic arch ,Feasibility Studies ,Stents ,business ,Cardiology and Cardiovascular Medicine - Abstract
Objective This article presents the long-term results of our patients with a diagnosis of hypoplastic left heart syndrome (HLHS), hypoplastic left heart complex (HLHC), and variants who received a biventricular repair following hybrid stage I with ductal stenting and bilateral pulmonary artery banding. Methods Between June 1998 and June 2013, a total of 154 patients with hypoplastic left heart structures underwent a hybrid stage I procedure. Forty patients were definitely treated by creating a biventricular circulation. Median age and body weight of patients before hybrid stage I were 8.5 days (2-40) and 3.0 kg (1.6-3.8), respectively. The diagnoses were HLHS with mitral and aortic stenosis (n = 7), HLHC (n = 15), HLHC with interrupted aortic arch (n = 9), critical aortic stenosis with hypoplastic aortic arch (n = 4), imbalanced atrioventricular septal defect with hypoplastic aortic arch (n = 2), double-outlet right ventricle with hypoplastic aortic arch (n = 2), and d-transposition of the great arteries with interrupted aortic arch (n = 1). Median age at the time of biventricular correction was 6.7 months (1.6-13.8). The patients were treated with direct biventricular correction, including repair of intracardiac defects (n = 32), Norwood/Rastelli or Yasui (n = 4), arterial switch (n = 2), Rastelli (n = 1), and Ross–Konno (n = 1) operations with ascending aortic/aortic arch reconstruction. Results All patients survived hybrid stage I. Median survival after biventricular correction is 7.9 years (0.9-14.9). Overall mortality was 10% (4 patients) at 4 weeks, 5 weeks, 6 weeks, and 4 months after biventricular correction, respectively. One patient had to be switched to univentricular circulation and another patient underwent orthotopic heart transplantation 3 and 4 months after biventricular correction, respectively. Conclusions The Giessen hybrid approach is an alternative to the conventional strategy to treat neonates with HLHS, HLHC, and variants. Biventricular repair after hybrid stage I is feasible and can be performed with satisfactory long-term survival.
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- 2015
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43. Right ventricular–pulmonary arterial coupling in patients after repair of tetralogy of Fallot
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Christian Apitz, Wolfhard Binder, Michael Hofbeck, Gunter Kerst, Ludger Sieverding, and Heiner Latus
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Inotrope ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Cardiac Catheterization ,Surgical strategy ,Cardiotonic Agents ,Adolescent ,Ventricular Dysfunction, Right ,Pulmonary Artery ,Contractility ,Young Adult ,Vascular Stiffness ,Predictive Value of Tests ,Internal medicine ,Dobutamine ,medicine ,Humans ,In patient ,Cardiac Surgical Procedures ,Child ,Tetralogy of Fallot ,Heart Failure ,business.industry ,medicine.disease ,Magnetic Resonance Imaging ,Myocardial Contraction ,medicine.anatomical_structure ,Treatment Outcome ,Ventricle ,Cardiology ,Ventricular Function, Right ,Female ,Surgery ,Transannular patch ,business ,Cardiology and Cardiovascular Medicine ,medicine.drug ,Compliance - Abstract
ObjectiveRight ventricular–pulmonary arterial coupling is an important determinant in the development of right ventricular failure. The purpose of our study was to assess right ventricular–pulmonary arterial coupling in children and adolescents with dilatation of the right ventricle after repair of tetralogy of Fallot.MethodsRight ventricular–pulmonary arterial coupling was quantified as the ratio of pulmonary arterial elastance (an index of arterial load) and right ventricular end-systolic elastance (an index of contractility) using pressure-volume loops with conductance catheters at the baseline level and during dobutamine infusion.ResultsA total of 24 patients (mean age, 16.7 ± 7.0 years) after tetralogy of Fallot repair were enrolled in the present study. End-systolic elastance showed an appropriate increase under inotropic stimulation from 0.24 ± 0.18 to 0.47 ± 0.39 mm Hg/mL/m2 (P
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44. Cardiovascular magnetic resonance assessment of ventricular function and myocardial scarring before and early after repair of anomalous left coronary artery from the pulmonary artery
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Matthias Mueller, Gunter Kerst, Stefan Rupp, Juergen Bauer, K. Gummel, Christian Jux, Heiner Latus, Hakan Akintuerk, Christian Apitz, and Dietmar Schranz
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Male ,medicine.medical_specialty ,Time Factors ,Myocardial Infarction ,Magnetic Resonance Imaging, Cine ,Infarction ,Ventricular Function, Left ,Ventricular Dysfunction, Left ,Left coronary artery ,Predictive Value of Tests ,Hibernation ,Internal medicine ,medicine.artery ,Bland White Garland Syndrome ,Myocardial scarring ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,ALCAPA syndrome ,Myocardial infarction ,Cardiac Surgical Procedures ,Ventricular remodeling ,Medicine(all) ,Ventricular Remodeling ,Radiological and Ultrasound Technology ,business.industry ,Research ,Myocardium ,Infant, Newborn ,Infant ,Stroke Volume ,Recovery of Function ,Stroke volume ,medicine.disease ,Magnetic Resonance Imaging ,Surgery ,Treatment Outcome ,Coronary steal ,Left ventricular remodelling ,Pulmonary artery ,Cardiology ,Cardiovascular magnetic resonance ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: In patients with anomalous left coronary artery from the pulmonary artery (ALCAPA) left ventricular (LV) dilatation and dysfunction evolves due to diminished myocardial perfusion caused by coronary steal phenomenon. Using late gadolinium enhanced cardiovascular magnetic resonance (LGE-CMR) imaging, myocardial scarring has been shown in ALCAPA patients late after repair, however the incidence of scarring before surgery and its impact on postoperative course after surgical repair remained unknown. Methods: 8 ALCAPA-patients (mean age 10.0 ± 5.8 months) underwent CMR before and early after (mean 4.9 ± 2.5 months) coronary reimplantation procedures. CMR included functional analysis and LGE for detection of myocardial scars. Results: LV dilatation (mean LVEDVI 171 ± 94 ml/m 2 ) and dysfunction (mean LV-EF 22 ± 10 %) was present in all patients and improved significantly after surgery (mean LVEDV 68 ± 42 ml/m 2 , p = 0.02; mean LV-EF 58 ± 19 %, p
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