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203. CARDIAC MAGNETIC RESONANCE IMAGING AND PROGNOSIS IN ST-ELEVATION MYOCARDIAL INFARCTION: DATA FROM 1217 PATIENTS DERIVED FROM MULTICENTER STUDIES

Author

Waha, Suzanne de, primary, Eitel, Ingo, additional, Fuernau, Georg, additional, Lurz, Philipp, additional, Woehrle, Jochen, additional, Suenkel, Henning, additional, Meissner, Josefine, additional, Kerber, Sebastian, additional, Lauer, Bernward, additional, Pauschinger, Matthias, additional, Birkemeyer, Ralf, additional, Axthelm, Christoph, additional, Zimmermann, Rainer, additional, Desch, Steffen, additional, Gutberlet, Matthias, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2013
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204. Cardioprotection by combined intrahospital remote ischaemic perconditioning and postconditioning in ST-elevation myocardial infarction: the randomized LIPSIA CONDITIONING trial.

Author

Eitel, Ingo, Stiermaier, Thomas, Rommel, Karl P., Fuernau, Georg, Sandri, Marcus, Mangner, Norman, Linke, Axel, Erbs, Sandra, Lurz, Phillip, Boudriot, Enno, Mende, Meinhard, Desch, Steffen, Schuler, Gerhard, and Thiele, Holger

Abstract

Aims Remote ischaemic conditioning (RIC) and postconditioning (PostC) are both potent activators of innate protection against ischaemia-reperfusion injury and have demonstrated cardioprotection in experimental and clinical ST-elevation myocardial infarction (STEMI) trials. However, their combined effects have not been studied in detail. The aim of this study was to evaluate if the co-application of intrahospital RIC and PostC has a more powerful effect on myocardial salvage compared with either PostC alone or control. Methods and results This prospective, controlled, single-centre study randomized 696 STEMI patients to one of the following three groups: (i) combined intrahospital RIC + PostC in addition to primary percutaneous coronary intervention (PCI); (ii) PostC in addition to PCI; and (iii) conventional PCI (control). The primary endpoint myocardial salvage index was assessed by cardiac magnetic resonance (CMR) imaging within 3 days after infarction. Secondary endpoints included infarct size and microvascular obstruction (MVO) assessed by CMR. The combined clinical endpoint consisted of death, reinfarction, and new congestive heart failure within 6 months. The primary endpoint myocardial salvage index was significantly greater in the combined RIC + PostC group when compared with the control group (49 [interquartile range 30-72] vs. 40 [interquartile range 16-68], P = 0.02). Postconditioning alone failed to improve myocardial salvage when compared with conventional PCI (P = 0.39). The secondary endpoints, including infarct size and MVO, showed no significant differences between groups. Clinical follow-up at 6 months revealed no differences in the combined clinical endpoint between groups (P = 0.44).Conclusion Combined intrahospital RIC + PostC in conjunction with PCI in STEMI significantly improves myocardial salvage in comparison with control and PostC.ClinicalTrials.gov NCT02158468 [ABSTRACT FROM AUTHOR]

Published
2015
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205. Angiopoietin-2 in acute myocardial infarction complicated by cardiogenic shock--a biomarker substudy of the IABP-SHOCK II-Trial.

Author

Pöss, Janine, Fuernau, Georg, Denks, Daniel, Desch, Steffen, Eitel, Ingo, de Waha, Suzanne, Link, Andreas, Schuler, Gerhard, Adams, Volker, Böhm, Michael, and Thiele, Holger

Subjects
*ANGIOPOIETIN-2, *MYOCARDIAL infarction, *CARDIOGENIC shock, *BIOMARKERS, *DISEASE complications, *CLINICAL trials, *PILOT projects, *HEALTH outcome assessment, *MYOCARDIAL infarction complications, *COMPARATIVE studies, *HEART failure, *INTRA-aortic balloon counterpulsation, *RESEARCH methodology, *MEDICAL cooperation, *PROTEINS, *RESEARCH, *TIME, *EVALUATION research, *RANDOMIZED controlled trials, *TREATMENT effectiveness, *PREDICTIVE tests, *PROPORTIONAL hazards models, *STROKE volume (Cardiac output), MYOCARDIAL infarction-related mortality
Abstract

Aims: Angiopoietin-2 (Ang-2) is a mediator of capillary leakage, and increased Ang-2 levels were associated with poor in-hospital outcome in a pilot study in cardiogenic shock (CS). In this larger study, we followed this hypothesis and aimed at assessing the predictive role of Ang-2 on short- and long-term mortality, investigating the effect of intra-aortic balloon pump (IABP) treatment on Ang-2 levels, and identifying clinical and procedural predictors of increased Ang-2.Methods and Results: In the IABP-SHOCK II-trial, 600 patients with CS complicating acute myocardial infarction were assigned to therapy with or without IABP. This substudy included 189 randomized patients with serial blood sampling performed at days 1, 2, and 3. No significant differences in Ang-2 levels were found between patients with or without IABP. The Ang-2 levels above the median at day 1 were associated with 30-day [hazard ratio (HR) 1.98, 95% confidence interval (CI) 1.26-3.10, P = 0.002) and 1-year mortality (HR 2.21, 95% CI 1.49-3.27, P < 0.001). Stratification of patients according to Ang-2 levels at day 3 increased these associations (30 days HR 5.15, 95% CI 2.80-9.45, P < 0.001; 1 year HR 5.24, 95% CI 3.19-8.58, P < 0.001). The Ang-2 concentrations were independent predictors for mortality in multivariate analysis (30 days HR 4.82, 95% CI 1.52-15.23, P = 0.007; 1 year HR 2.01, 95%CI 1.24-3.24, P = 0.005). Predictors of increased Ang-2 levels at day 3 were baseline Ang-2, development of acute kidney injury, bleeding events or transfusion, and impaired reperfusion.Conclusion: In CS, high levels of Ang-2 are independently associated with poor short- and long-term outcome and associated with the reperfusion success as well as complications.Clinical Trial Registration: URL: www.clinicaltrials.gov; unique identifier: NCT00491036. [ABSTRACT FROM AUTHOR]

Published
2015
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208. Diagnostic Performance of CMR Imaging Compared With EMB in Patients With Suspected Myocarditis

Author

Lurz, Philipp, primary, Eitel, Ingo, additional, Adam, Julia, additional, Steiner, Julia, additional, Grothoff, Matthias, additional, Desch, Steffen, additional, Fuernau, Georg, additional, de Waha, Suzanne, additional, Sareban, Mahdi, additional, Luecke, Christian, additional, Klingel, Karin, additional, Kandolf, Reinhard, additional, Schuler, Gerhard, additional, Gutberlet, Matthias, additional, and Thiele, Holger, additional

Published
2012
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212. Relationship and prognostic value of microvascular obstruction and infarct size in ST-elevation myocardial infarction as visualized by magnetic resonance imaging

Author

de Waha, Suzanne, primary, Desch, Steffen, additional, Eitel, Ingo, additional, Fuernau, Georg, additional, Lurz, Philipp, additional, Leuschner, Anja, additional, Grothoff, Matthias, additional, Gutberlet, Matthias, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2012
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218. Time-dependency, predictors and clinical impact of infarct transmurality assessed by magnetic resonance imaging in patients with ST-elevation myocardial infarction reperfused by primary coronary percutaneous intervention

Author

de Waha, Suzanne, primary, Eitel, Ingo, additional, Desch, Steffen, additional, Fuernau, Georg, additional, Lurz, Philipp, additional, Haznedar, Deniz, additional, Grothoff, Matthias, additional, Gutberlet, Matthias, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2011
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221. Myocardium at Risk in ST-Segment Elevation Myocardial Infarction

Author

Fuernau, Georg, primary, Eitel, Ingo, additional, Franke, Vinzenz, additional, Hildebrandt, Lysann, additional, Meissner, Josefine, additional, de Waha, Suzanne, additional, Lurz, Philipp, additional, Gutberlet, Matthias, additional, Desch, Steffen, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2011
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223. MYOCARDIUM AT RISK IN ST-ELEVATION MYOCARDIAL INFARCTION: COMPARISON OF T2-WEIGHTED EDEMA IMAGING WITH THE ENDOCARDIAL SURFACE AREA ASSESSED BY MAGNETIC RESONANCE AND VALIDATION AGAINST ANGIOGRAPHIC SCORING

Author

Fuernau, Georg Friedrich, primary, Eitel, Ingo, additional, Franke, Vinzenz, additional, Hildebrandt, Lysann, additional, Meissner, Josefine, additional, de Waha, Suzanne, additional, Lurz, Philipp, additional, Gutberlet, Matthias, additional, Desch, Steffen, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2011
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224. IMPACT OF MICROVASCULAR OBSTRUCTION INFARCT SIZE AND THE RATIO OF MICROVASCULAR OBSTRUCTION AND INFARCT SIZE AS PREDICTORS FOR LONG-TERM OUTCOME AFTER ST-ELEVATION MYOCARDIAL INFARCTION

Author

De Waha, Suzanne, primary, Desch, Steffen, additional, Eitel, Ingo, additional, Fuernau, Georg, additional, Lurz, Philipp, additional, Grothoff, Matthias, additional, Gutberlet, Matthias, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2011
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226. MAGNETIC RESONANCE IMAGING ASSESSMENT OF MYOCARDIAL INFLAMMATION IN 132 CONSECUTIVE PATIENTS WITH CLINICAL SUSPICION OF ACUTE OR CHRONIC MYOCARDITIS: ARE WE AS GOOD AS WE THOUGHT?

Author

Lurz, Philipp, primary, Murawski, Julia, additional, Steiner, Julia, additional, Sareban, Mahdi, additional, Eitel, Ingo, additional, Desch, Steffen, additional, Fuernau, Georg, additional, de Waha, Suzanne, additional, Grothoff, Matthias, additional, Schuler, Gerhard, additional, Gutberlet, Matthias, additional, and Thiele, Holger, additional

Published
2011
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227. TIME-DEPENDENCY PREDICTORS AND IMPACT ON OUTCOME OF INFARCT TRANSMURALITY ASSESSED BY MAGNETIC RESONANCE IMAGING IN PATIENTS WITH ST-ELEVATION MYOCARDIAL INFARCTION REPERFUSED BY PRIMARY PERCUTANEOUS INTERVENTION

Author

De Waha, Suzanne, primary, Desch, Steffen, additional, Eitel, Ingo, additional, Fuernau, Georg, additional, Lurz, Philipp, additional, Grothoff, Matthias, additional, Gutberlet, Matthias, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2011
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228. Myocardium at risk in ST-elevation myocardial infarction: comparison of T2-weighted edema imaging with the endocardial surface area assessed by magnetic resonance and validation against angiographic scoring

Author

Fuernau, Georg F, primary, Eitel, Ingo, additional, Franke, Vinzenz, additional, Hildebrandt, Lysann, additional, Meissner, Josefine, additional, Gutberlet, Matthias, additional, Desch, Steffen, additional, Schuler, Gerhard C, additional, and Thiele, Holger, additional

Published
2011
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231. Magnetic resonance imaging assessment of myocardial inflammation in 132 unselected, consecutive patients with clinical suspicion of acute or chronic myocarditis - are we as good as we thought?

Author

Lurz, Philipp, primary, Murawski, Julia, additional, Steiner, Julia, additional, Sareban, Mahdi, additional, Eitel, Ingo, additional, Desch, Steffen, additional, Fuernau, Georg, additional, de Waha, Suzanne, additional, Grothoff, Matthias, additional, Luecke, Christian, additional, Nitzsche, Stephan, additional, Schuler, Gerhard, additional, Gutberlet, Matthias, additional, and Thiele, Holger, additional

Published
2011
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233. Reliability of myocardial salvage assessment by cardiac magnetic resonance imaging in acute reperfused myocardial infarction

Author

Desch, Steffen, primary, Engelhardt, Hubertus, additional, Meissner, Josefine, additional, Eitel, Ingo, additional, Sareban, Mahdi, additional, Fuernau, Georg, additional, de Waha, Suzanne, additional, Grothoff, Matthias, additional, Gutberlet, Matthias, additional, Schuler, Gerhard, additional, and Thiele, Holger, additional

Published
2011
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237. Impact of High-Dose N-Acetylcysteine Versus Placebo on Contrast-Induced Nephropathy and Myocardial Reperfusion Injury in Unselected Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

Author

Thiele, Holger, primary, Hildebrand, Lysann, additional, Schirdewahn, Carmen, additional, Eitel, Ingo, additional, Adams, Volker, additional, Fuernau, Georg, additional, Erbs, Sandra, additional, Linke, Axel, additional, Diederich, Klaus-Werner, additional, Nowak, Marek, additional, Desch, Steffen, additional, Gutberlet, Matthias, additional, and Schuler, Gerhard, additional

Published
2010
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247. Intravenous morphine administration and reperfusion success in ST-elevation myocardial infarction: insights from cardiac magnetic resonance imaging.

Author

Waha, Suzanne, Eitel, Ingo, Desch, Steffen, Fuernau, Georg, Lurz, Philipp, Urban, Daniel, Schuler, Gerhard, and Thiele, Holger

Abstract

Aims: Intravenous (IV) morphine has been shown to be independently associated with adverse clinical outcome in patients with non-STEMI. Currently, there are no data on the association of IV morphine and reperfusion success in STEMI. Thus, we thought to analyse the impact of IV morphine on ischemic injury and salvaged myocardium assessed by cardiac magnetic resonance imaging (CMR) in patients with STEMI reperfused by primary coronary intervention (PCI). Methods and results: STEMI patients reperfused by primary PCI ( n = 276) within 12 h after symptom onset underwent CMR 3 days after the index event [interquartile range (IQR) 2-4]. IV morphine administration was recorded in all patients. IV morphine was administered in 44.7 % ( n = 123) of all patients. Patients in the IV morphine group displayed larger infarct size, higher extent of MO and lower myocardial salvage index (MSI) in comparison to the non-IV morphine group (all p < 0.05). In multivariable logistic regression analysis adjusted for TIMI-flow pre-PCI, time from symptom onset to PCI, Killip class and left ventricular ejection fraction, IV morphine was identified as an independent predictor for MSI

Published
2015
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248. Intraaortic balloon counterpulsation and microcirculation in cardiogenic shock complicating myocardial infarction: an IABP-SHOCK II substudy.

Author

Jung, Christian, Fuernau, Georg, de Waha, Suzanne, Eitel, Ingo, Desch, Steffen, Schuler, Gerhard, Figulla, Hans, and Thiele, Holger

Abstract

Objectives: This study sought to evaluate the influence of intraaortic balloon pump (IABP) counterpulsation on the microcirculation in patients with cardiogenic shock (CS) complicating acute myocardial infarction. Background: In patients with shock profound alterations of the microcirculation have been observed and their clinical relevance has been described. Different treatment strategies exist to improve microvascular perfusion in patients with CS; however, the role of IABP treatment is not clearly defined. Methods: A predefined substudy of the randomized Intraaortic Balloon Pump in Cardiogenic Shock II trial (IABP-SHOCK II) investigated the sublingual microcirculation using a sidestream darkfield intravital microscope on days 1, 2 and 4 after the onset of shock. Perfused capillary (<20 µm, PCD) and vessel densities (<100 µm, PVD), total capillary (TCD) and vessel (TVD) densities were determined. In addition, the proportion of perfused vessels was assessed. Results: Forty-one patients were included in this substudy ( n = 24 with IABP support vs. n = 17 without IABP support). No significant differences between treatment with or without IABP regarding PCD, PVD, TCD, TVD and the proportion of perfused vessels were evident on all three timepoints ( p = n.s. for all). Microvascular perfusion showed inverse correlation with subsequent serum lactate levels (−0.366; p = 0.02) without being significantly correlated with lactate levels at the timepoint of the microcirculatory investigation. In Kaplan-Meier analysis microcirculatory parameters showed significant discrimination of prediction for time to death ( p < 0.05 for all). Conclusions: In patients with CS, there is no effect of IABP treatment on microvascular perfusion. Parameters of the microcirculation might be helpful to identify high risk patients. [ABSTRACT FROM AUTHOR]

Published
2015
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249. Prognostic impact of established and novel renal function biomarkers in myocardial infarction with cardiogenic shock: A biomarker substudy of the IABP-SHOCK II-trial .

Author

Fuernau, Georg, Poenisch, Christian, Eitel, Ingo, Denks, Daniel, de Waha, Suzanne, Pöss, Janine, Heine, Gunnar H., Desch, Steffen, Schuler, Gerhard, Adams, Volker, Werdan, Karl, Zeymer, Uwe, and Thiele, Holger

Subjects
*KIDNEY function tests, *BIOMARKERS, *CARDIOGENIC shock, *CLINICAL trials, *HEALTH outcome assessment, *DIAGNOSIS, MYOCARDIAL infarction diagnosis
Abstract

Background In cardiogenic shock (CS) renal dysfunction is an important parameter of inadequate end-organ perfusion and an independent predictor of adverse outcome. Early detection of renal dysfunction is therefore important, and novel biomarkers such as Neutrophil Gelatinase-Associated Lipocalin (NGAL), Kidney Injury Molecule 1 (KIM1) and Cystatin C (CysC) have been suggested. However, in high-risk CS patients their role for assessing renal injury has not yet been investigated in comparison to the most widely used serum creatinine. Methods This predefined substudy included 190 patients of the randomized Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II)-trial. Blood samples were collected directly during primary percutaneous coronary intervention, one day and two days after randomization. The primary endpoint for outcome assessment was 1 year mortality. Results Creatinine, NGAL and KIM-1 were significantly higher in non-survivors in comparison to survivors over time in ANOVA (p < 0.001; p = 0.002 and p = 0.04, respectively). In contrast, CysC levels were not associated with the primary endpoint (p = 0.15). Receiver operator characteristics revealed that creatinine at any time point had the best predictive value for 1 year mortality. This was also true when comparing creatinine to different equations for glomerular filtration rate. In multivariable Cox-regression analysis creatinine remained the only significant independent predictor of kidney biomarkers of time to death during the first year. Conclusions Assessment of novel biomarkers such as CysC, NGAL and KIM-1 or calculation of glomerular filtration rate provide no additional prognostic information in patients with CS complicating acute myocardial infarction in comparison to creatinine. [ABSTRACT FROM AUTHOR]

Published
2015
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250. Angiopoietin-2 and outcome in patients with acute decompensated heart failure.

Author

Pöss, Janine, Ukena, Christian, Kindermann, Ingrid, Ehrlich, Peter, Fuernau, Georg, Ewen, Sebastian, Mahfoud, Felix, Kriechbaum, Steffen, Böhm, Michael, and Link, Andreas

Abstract

Purpose: Angiopoietin-2 (Ang-2) impairs endothelial integrity. The association of Ang-2 in the presence of oedema and outcome of patients with acute decompensated heart failure (ADHF) has not been investigated. Methods and results: Angiopoietin-2 was measured in 132 ADHF patients, which were included in a monocentric, prospective trial (Clinicaltrials.gov: NCT01429857). Primary endpoint was all-cause death at 6-months. 20 healthy persons served as control group (HC). In ADHF patients, mean Ang-2 concentration at admission was significantly increased compared to HC (2,111 ± 117 vs. 971 ± 46 pg/ml, p = 0.0002). Ang-2 was increased in patients with compared to those without peripheral oedema (2,294 ± 140 vs. 1,540 ± 170 pg/ml; p = 0.009) and in patients with NYHA class III or IV symptoms compared to those with NYHA class II symptoms (2,256 ± 132 vs. 1,341 ± 380 pg/ml, p = 0.023). During the 6-month follow-up, 10 patients died. In survivors, Ang-2 significantly decreased at discharge compared to admission (2,046 ± 118 vs. 1,431 ± 93 pg/ml; p < 0.0001). Non-survivors showed no difference between Ang-2 concentration at admission and discharge (3,296 ± 594 vs. 2,909 ± 536 pg/ml). Ang-2 concentrations at discharge above 2,500 pg/ml were associated with an increased risk of death compared to Ang-2 concentrations below this threshold (Hazard ratio 8.8; 95 % confidence interval; 2.48-31.16, p < 0.001). Conclusion: In ADHF patients, Ang-2 is significantly increased compared to healthy controls, shows a relationship in the presence of oedema and is a predictor of poor outcome. [ABSTRACT FROM AUTHOR]

Published
2015
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