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1. Soluble ST2 Receptor: Biomarker of Left Ventricular Impairment and Functional Status in Patients with Inflammatory Cardiomyopathy

Author

Obradovic, Danilo Momira, Büttner, Petra, Rommel, Karl-Philipp, Blazek, Stephan, Loncar, Goran, von Haehling, Stephan, von Roeder, Maximilian, Lücke, Christian, Gutberlet, Matthias, Thiele, Holger, Lurz, Philipp, Besler, Christian, Obradovic, Danilo Momira, Büttner, Petra, Rommel, Karl-Philipp, Blazek, Stephan, Loncar, Goran, von Haehling, Stephan, von Roeder, Maximilian, Lücke, Christian, Gutberlet, Matthias, Thiele, Holger, Lurz, Philipp, and Besler, Christian

Abstract

Introduction: Inflammatory cardiomyopathy (ICM) frequently leads to myocardial fibrosis, resulting in permanent deterioration of the left ventricular function and an unfavorable outcome. Soluble suppression of tumorigenicity 2 receptor (sST2) is a novel marker of inflammation and fibrosis in cardiovascular tissues. sST2 was found to be helpful in predicting adverse outcomes in heart failure patients with reduced ejection fraction. The aim of this study was to determine the association of sST2 plasma levels with cardiac magnetic resonance (CMR) and echocardiography imaging features of left ventricular impairment in ICM patients, as well as to evaluate the applicability of sST2 as a prognosticator of the clinical status in patients suffering from ICM. Methods: We used plasma samples of 89 patients presenting to the Heart Center Leipzig with clinically suspected myocardial inflammation. According to immunohistochemical findings in endomyocardial biopsies (EMB) conducted in the context of patients’ diagnostic work-up, inflammatory cardiomyopathy was diagnosed in 60 patients (ICM group), and dilated cardiomyopathy in 29 patients (DCM group). All patients underwent cardiac catheterization for exclusion of coronary artery disease and CMR imaging on 1.5 or 3 Tesla. sST2 plasma concentration was determined using ELISA. Results: Mean plasma concentration of sST2 in the whole patient cohort was 45.8 ± 26.4 ng/mL (IQR 27.5 ng/mL). In both study groups, patients within the highest quartile of sST2 plasma concentration had a significantly lower left ventricular ejection fraction (LV-EF) compared to patients within the lowest sST2 plasma concentration quartile (26 ± 11% vs. 40 ± 13%, p = 0.05 for ICM and 24 ± 13% vs. 51 ± 10%, p = 0.004 for DCM). sST2 predicted New York Heart Association (NYHA) class III/IV at 12 months follow-up more efficiently in ICM compared to DCM patients (AUC 0.85 vs. 0.61, p = 0.02) and was in these terms superior to NT-proBNP and cardiac troponin T. ICM p

Published
2022

2. Soluble ST2 Receptor: Biomarker of Left Ventricular Impairment and Functional Status in Patients with Inflammatory Cardiomyopathy

Author

Obradovic, Danilo Momira, Büttner, Petra, Rommel, Karl-Philipp, Blazek, Stephan, Loncar, Goran, von Haehling, Stephan, von Roeder, Maximilian, Lücke, Christian, Gutberlet, Matthias, Thiele, Holger, Lurz, Philipp, Besler, Christian, Obradovic, Danilo Momira, Büttner, Petra, Rommel, Karl-Philipp, Blazek, Stephan, Loncar, Goran, von Haehling, Stephan, von Roeder, Maximilian, Lücke, Christian, Gutberlet, Matthias, Thiele, Holger, Lurz, Philipp, and Besler, Christian

Abstract

Introduction: Inflammatory cardiomyopathy (ICM) frequently leads to myocardial fibrosis, resulting in permanent deterioration of the left ventricular function and an unfavorable outcome. Soluble suppression of tumorigenicity 2 receptor (sST2) is a novel marker of inflammation and fibrosis in cardiovascular tissues. sST2 was found to be helpful in predicting adverse outcomes in heart failure patients with reduced ejection fraction. The aim of this study was to determine the association of sST2 plasma levels with cardiac magnetic resonance (CMR) and echocardiography imaging features of left ventricular impairment in ICM patients, as well as to evaluate the applicability of sST2 as a prognosticator of the clinical status in patients suffering from ICM. Methods: We used plasma samples of 89 patients presenting to the Heart Center Leipzig with clinically suspected myocardial inflammation. According to immunohistochemical findings in endomyocardial biopsies (EMB) conducted in the context of patients’ diagnostic work-up, inflammatory cardiomyopathy was diagnosed in 60 patients (ICM group), and dilated cardiomyopathy in 29 patients (DCM group). All patients underwent cardiac catheterization for exclusion of coronary artery disease and CMR imaging on 1.5 or 3 Tesla. sST2 plasma concentration was determined using ELISA. Results: Mean plasma concentration of sST2 in the whole patient cohort was 45.8 ± 26.4 ng/mL (IQR 27.5 ng/mL). In both study groups, patients within the highest quartile of sST2 plasma concentration had a significantly lower left ventricular ejection fraction (LV-EF) compared to patients within the lowest sST2 plasma concentration quartile (26 ± 11% vs. 40 ± 13%, p = 0.05 for ICM and 24 ± 13% vs. 51 ± 10%, p = 0.004 for DCM). sST2 predicted New York Heart Association (NYHA) class III/IV at 12 months follow-up more efficiently in ICM compared to DCM patients (AUC 0.85 vs. 0.61, p = 0.02) and was in these terms superior to NT-proBNP and cardiac troponin T. ICM p

Published
2022

3. Invasive Right Ventricular Pressure-Volume Analysis:Basic Principles, Clinical Applications, and Practical Recommendations

Author

Brener, Michael I., Masoumi, Amirali, Ng, Vivian G., Tello, Khodr, Bastos, Marcelo B., Cornwell, William K., Hsu, Steven, Tedford, Ryan J., Lurz, Philipp, Rommel, Karl Philipp, Kresoja, Karl Patrik, Nagueh, Sherif F., Kanwar, Manreet K., Kapur, Navin K., Hiremath, Gurumurthy, Sarraf, Mohammad, Van Den Enden, Antoon J.M., Van Mieghem, Nicolas M., Heerdt, Paul M., Hahn, Rebecca T., Kodali, Susheel K., Sayer, Gabriel T., Uriel, Nir, Burkhoff, Daniel, Brener, Michael I., Masoumi, Amirali, Ng, Vivian G., Tello, Khodr, Bastos, Marcelo B., Cornwell, William K., Hsu, Steven, Tedford, Ryan J., Lurz, Philipp, Rommel, Karl Philipp, Kresoja, Karl Patrik, Nagueh, Sherif F., Kanwar, Manreet K., Kapur, Navin K., Hiremath, Gurumurthy, Sarraf, Mohammad, Van Den Enden, Antoon J.M., Van Mieghem, Nicolas M., Heerdt, Paul M., Hahn, Rebecca T., Kodali, Susheel K., Sayer, Gabriel T., Uriel, Nir, and Burkhoff, Daniel

Abstract

Right ventricular pressure-volume (PV) analysis characterizes ventricular systolic and diastolic properties independent of loading conditions like volume status and afterload. While long-considered the gold-standard method for quantifying myocardial chamber performance, it was traditionally only performed in highly specialized research settings. With recent advances in catheter technology and more sophisticated approaches to analyze PV data, it is now more commonly used in a variety of clinical and research settings. Herein, we review the basic techniques for PV loop measurement, analysis, and interpretation with the aim of providing readers with a deeper understanding of the strengths and limitations of PV analysis. In the second half of the review, we detail key scenarios in which right ventricular PV analysis has influenced our understanding of clinically relevant topics and where the technique can be applied to resolve additional areas of uncertainty. All told, PV analysis has an important role in advancing our understanding of right ventricular physiology and its contribution to cardiovascular function in health and disease.

Published
2022

4. Herzinsuffizienz mit erhaltener Pumpfunktion - Entwicklung therapeutischer Konzepte durch pathomechanistische Charakterisierung und klinische Phänotypisierung

Author

Medizinische Fakultät Universität Leipzig, Universität Leipzig, Rommel, Karl-Philipp, Medizinische Fakultät Universität Leipzig, Universität Leipzig, and Rommel, Karl-Philipp

Abstract

Die wissenschaftlichen Arbeiten in dieser Habilitationsschrift belegen die phänotypische Heterogenität der Herzinsuffizienz mit erhaltener Pumpfunktion (HFpEF) und zeigen, dass eine erweiterte pathomechanistische und klinische Phänotypisierung geeignet ist um homogenere Subgruppen und Therapieziele zu identifizieren. Eine erweiterte pathomechanistische Charakterisierung mittels kardialer Magnetresonanztomographie und invasiver Druck-Volumenanalyse ermöglichte dabei die Identifikation zweier hämodynamischer Phänotypen, die sich anhand des Ausmaßes der interstitiellen linksventrikulären (LV) Fibrosierung unterscheiden. Eine so durchgeführte Stratifizierung ermöglicht die Individualisierung potentieller Therapien anhand des Vorliegens einer LV Fibrose, wobei aktuelle Studien die Reduktion der myozytären Steifigkeit und Fibroseentwicklung in der einen und eine spezifische Fibrosereduktion in der anderen Gruppe untersuchen. Mittels pathomechanistischer Charakterisierung konnten außerdem potentiell neue Therapieziele identifiziert werden. So konnte gezeigt werden, dass eine Störung der phasischen linksatrialen (LA) Funktion unabhängig von LV Funktionsstörungen mit einer eingeschränkten Belastbarkeit in HFpEF assoziiert ist. Gemeinsam mit Untersuchungen anderer Gruppen wurde so das Konzept der LA Myopathie als maßgeblicher pathophysiologischer Faktor der HFpEF etabliert, auf deren Grundlage aktuell spezifische Therapien zur Modulation der LA Drücke in HFpEF untersucht werden. Außerdem wurde dargelegt, dass eine diastolische rechtsventrikuläre und rechtsatriale Dysfunktion bereits früh im Verlauf einer HFpEF auftreten und maßgeblich zur Unfähigkeit der Steigerung des Herzzeitvolumens unter Belastung beitragen. Dies legt zum einen nahe, dass zukünftig potentielle Therapien auch insbesondere hinsichtlich ihrer Effekte auf diese Funktionsstörungen beurteilt werden sollten und bildet zum anderen den Ausgangspunkt für weitere mechanistische Studien zur Entwicklung spezifischer T

Published
2021

5. Herzinsuffizienz mit erhaltener Pumpfunktion - Entwicklung therapeutischer Konzepte durch pathomechanistische Charakterisierung und klinische Phänotypisierung

Author

Universität Leipzig, Rommel, Karl-Philipp, Universität Leipzig, and Rommel, Karl-Philipp

Abstract

Die wissenschaftlichen Arbeiten in dieser Habilitationsschrift belegen die phänotypische Heterogenität der Herzinsuffizienz mit erhaltener Pumpfunktion (HFpEF) und zeigen, dass eine erweiterte pathomechanistische und klinische Phänotypisierung geeignet ist um homogenere Subgruppen und Therapieziele zu identifizieren. Eine erweiterte pathomechanistische Charakterisierung mittels kardialer Magnetresonanztomographie und invasiver Druck-Volumenanalyse ermöglichte dabei die Identifikation zweier hämodynamischer Phänotypen, die sich anhand des Ausmaßes der interstitiellen linksventrikulären (LV) Fibrosierung unterscheiden. Eine so durchgeführte Stratifizierung ermöglicht die Individualisierung potentieller Therapien anhand des Vorliegens einer LV Fibrose, wobei aktuelle Studien die Reduktion der myozytären Steifigkeit und Fibroseentwicklung in der einen und eine spezifische Fibrosereduktion in der anderen Gruppe untersuchen. Mittels pathomechanistischer Charakterisierung konnten außerdem potentiell neue Therapieziele identifiziert werden. So konnte gezeigt werden, dass eine Störung der phasischen linksatrialen (LA) Funktion unabhängig von LV Funktionsstörungen mit einer eingeschränkten Belastbarkeit in HFpEF assoziiert ist. Gemeinsam mit Untersuchungen anderer Gruppen wurde so das Konzept der LA Myopathie als maßgeblicher pathophysiologischer Faktor der HFpEF etabliert, auf deren Grundlage aktuell spezifische Therapien zur Modulation der LA Drücke in HFpEF untersucht werden. Außerdem wurde dargelegt, dass eine diastolische rechtsventrikuläre und rechtsatriale Dysfunktion bereits früh im Verlauf einer HFpEF auftreten und maßgeblich zur Unfähigkeit der Steigerung des Herzzeitvolumens unter Belastung beitragen. Dies legt zum einen nahe, dass zukünftig potentielle Therapien auch insbesondere hinsichtlich ihrer Effekte auf diese Funktionsstörungen beurteilt werden sollten und bildet zum anderen den Ausgangspunkt für weitere mechanistische Studien zur Entwicklung spezifischer T

Published
2021

6. Herzinsuffizienz mit erhaltener Pumpfunktion - Entwicklung therapeutischer Konzepte durch pathomechanistische Charakterisierung und klinische Phänotypisierung

Author

Medizinische Fakultät Universität Leipzig, Universität Leipzig, Rommel, Karl-Philipp, Medizinische Fakultät Universität Leipzig, Universität Leipzig, and Rommel, Karl-Philipp

Abstract

Die wissenschaftlichen Arbeiten in dieser Habilitationsschrift belegen die phänotypische Heterogenität der Herzinsuffizienz mit erhaltener Pumpfunktion (HFpEF) und zeigen, dass eine erweiterte pathomechanistische und klinische Phänotypisierung geeignet ist um homogenere Subgruppen und Therapieziele zu identifizieren. Eine erweiterte pathomechanistische Charakterisierung mittels kardialer Magnetresonanztomographie und invasiver Druck-Volumenanalyse ermöglichte dabei die Identifikation zweier hämodynamischer Phänotypen, die sich anhand des Ausmaßes der interstitiellen linksventrikulären (LV) Fibrosierung unterscheiden. Eine so durchgeführte Stratifizierung ermöglicht die Individualisierung potentieller Therapien anhand des Vorliegens einer LV Fibrose, wobei aktuelle Studien die Reduktion der myozytären Steifigkeit und Fibroseentwicklung in der einen und eine spezifische Fibrosereduktion in der anderen Gruppe untersuchen. Mittels pathomechanistischer Charakterisierung konnten außerdem potentiell neue Therapieziele identifiziert werden. So konnte gezeigt werden, dass eine Störung der phasischen linksatrialen (LA) Funktion unabhängig von LV Funktionsstörungen mit einer eingeschränkten Belastbarkeit in HFpEF assoziiert ist. Gemeinsam mit Untersuchungen anderer Gruppen wurde so das Konzept der LA Myopathie als maßgeblicher pathophysiologischer Faktor der HFpEF etabliert, auf deren Grundlage aktuell spezifische Therapien zur Modulation der LA Drücke in HFpEF untersucht werden. Außerdem wurde dargelegt, dass eine diastolische rechtsventrikuläre und rechtsatriale Dysfunktion bereits früh im Verlauf einer HFpEF auftreten und maßgeblich zur Unfähigkeit der Steigerung des Herzzeitvolumens unter Belastung beitragen. Dies legt zum einen nahe, dass zukünftig potentielle Therapien auch insbesondere hinsichtlich ihrer Effekte auf diese Funktionsstörungen beurteilt werden sollten und bildet zum anderen den Ausgangspunkt für weitere mechanistische Studien zur Entwicklung spezifischer T

Published
2021

7. Cardiac output states in patients with severe functional tricuspid regurgitation: impact on treatment success and prognosis

Author

Unterhuber, Matthias, Kresoja, Karl-Patrik, Besler, Christian, Rommel, Karl-Philipp, Orban, Mathias, von Roeder, Maximilian, Braun, Daniel, Stolz, Lukas, Massberg, Steffen, Trebicka, Jonel, Zachäus, Markus, Hausleiter, Jörg, Thiele, Holger, Lurz, Philipp, Unterhuber, Matthias, Kresoja, Karl-Patrik, Besler, Christian, Rommel, Karl-Philipp, Orban, Mathias, von Roeder, Maximilian, Braun, Daniel, Stolz, Lukas, Massberg, Steffen, Trebicka, Jonel, Zachäus, Markus, Hausleiter, Jörg, Thiele, Holger, and Lurz, Philipp

Abstract

Aims To investigate whether there is evidence for distinct cardiac output (CO) based phenotypes in patients with chronic right heart failure associated with severe tricuspid regurgitation (TR) and to characterize their impact on TR treatment and outcome. Methods and results A total of 132 patients underwent isolated transcatheter tricuspid valve repair (TTVR) for functional TR at two centres. Patients were clustered according to k-means clustering into low [cardiac index (CI) < 1.7 L/min/m2], intermediate (CI 1.7–2.6 L/min/m2) and high CO (CI > 2.6 L/min/m2) clusters. All-cause mortality and clinical characteristics during follow-up were compared among different CO clusters. Mortality rates were highest for patients in a low (24%) and high CO state (42%, log-rank P < 0.001). High CO state patients were characterized by larger inferior vena cava diameters (P = 0.003), reduced liver function, higher incidence of ascites (P = 0.006) and markedly reduced systemic vascular resistance (P < 0.001) as compared to TTVR patients in other CO states. Despite comparable procedural success rates, the extent of changes in right atrial pressures (P = 0.01) and right ventricular dimensions (P < 0.001) per decrease in regurgitant volume following TTVR was less pronounced in high CO state patients as compared to other CO states. Successful TTVR was associated with the smallest prognostic benefit among low and high CO state patients. Conclusions Patients with chronic right heart failure and severe TR display distinct CO states. The high CO state is characterized by advanced congestive hepatopathy, a substantial decrease in peripheral vascular tone, a lack of response of central venous pressures to TR reduction, and worse prognosis. These data are relevant to the pathophysiological understanding and management of this important clinical syndrome. Graphical Abstract Proposed mechanism of hypercirculatory tricuspid regurgitation. Tricuspid regurgitation related backward failure causes liv

Published
2021

8. Cardiac output states in patients with severe functional tricuspid regurgitation: impact on treatment success and prognosis

Author

Unterhuber, Matthias, Kresoja, Karl-Patrik, Besler, Christian, Rommel, Karl-Philipp, Orban, Mathias, von Roeder, Maximilian, Braun, Daniel, Stolz, Lukas, Massberg, Steffen, Trebicka, Jonel, Zachäus, Markus, Hausleiter, Jörg, Thiele, Holger, Lurz, Philipp, Unterhuber, Matthias, Kresoja, Karl-Patrik, Besler, Christian, Rommel, Karl-Philipp, Orban, Mathias, von Roeder, Maximilian, Braun, Daniel, Stolz, Lukas, Massberg, Steffen, Trebicka, Jonel, Zachäus, Markus, Hausleiter, Jörg, Thiele, Holger, and Lurz, Philipp

Abstract

Aims To investigate whether there is evidence for distinct cardiac output (CO) based phenotypes in patients with chronic right heart failure associated with severe tricuspid regurgitation (TR) and to characterize their impact on TR treatment and outcome. Methods and results A total of 132 patients underwent isolated transcatheter tricuspid valve repair (TTVR) for functional TR at two centres. Patients were clustered according to k-means clustering into low [cardiac index (CI) < 1.7 L/min/m2], intermediate (CI 1.7–2.6 L/min/m2) and high CO (CI > 2.6 L/min/m2) clusters. All-cause mortality and clinical characteristics during follow-up were compared among different CO clusters. Mortality rates were highest for patients in a low (24%) and high CO state (42%, log-rank P < 0.001). High CO state patients were characterized by larger inferior vena cava diameters (P = 0.003), reduced liver function, higher incidence of ascites (P = 0.006) and markedly reduced systemic vascular resistance (P < 0.001) as compared to TTVR patients in other CO states. Despite comparable procedural success rates, the extent of changes in right atrial pressures (P = 0.01) and right ventricular dimensions (P < 0.001) per decrease in regurgitant volume following TTVR was less pronounced in high CO state patients as compared to other CO states. Successful TTVR was associated with the smallest prognostic benefit among low and high CO state patients. Conclusions Patients with chronic right heart failure and severe TR display distinct CO states. The high CO state is characterized by advanced congestive hepatopathy, a substantial decrease in peripheral vascular tone, a lack of response of central venous pressures to TR reduction, and worse prognosis. These data are relevant to the pathophysiological understanding and management of this important clinical syndrome. Graphical Abstract Proposed mechanism of hypercirculatory tricuspid regurgitation. Tricuspid regurgitation related backward failure causes liv

Published
2021

9. Herzinsuffizienz mit erhaltener Pumpfunktion - Entwicklung therapeutischer Konzepte durch pathomechanistische Charakterisierung und klinische Phänotypisierung

Author

Universität Leipzig, Rommel, Karl-Philipp, Universität Leipzig, and Rommel, Karl-Philipp

Abstract

Die wissenschaftlichen Arbeiten in dieser Habilitationsschrift belegen die phänotypische Heterogenität der Herzinsuffizienz mit erhaltener Pumpfunktion (HFpEF) und zeigen, dass eine erweiterte pathomechanistische und klinische Phänotypisierung geeignet ist um homogenere Subgruppen und Therapieziele zu identifizieren. Eine erweiterte pathomechanistische Charakterisierung mittels kardialer Magnetresonanztomographie und invasiver Druck-Volumenanalyse ermöglichte dabei die Identifikation zweier hämodynamischer Phänotypen, die sich anhand des Ausmaßes der interstitiellen linksventrikulären (LV) Fibrosierung unterscheiden. Eine so durchgeführte Stratifizierung ermöglicht die Individualisierung potentieller Therapien anhand des Vorliegens einer LV Fibrose, wobei aktuelle Studien die Reduktion der myozytären Steifigkeit und Fibroseentwicklung in der einen und eine spezifische Fibrosereduktion in der anderen Gruppe untersuchen. Mittels pathomechanistischer Charakterisierung konnten außerdem potentiell neue Therapieziele identifiziert werden. So konnte gezeigt werden, dass eine Störung der phasischen linksatrialen (LA) Funktion unabhängig von LV Funktionsstörungen mit einer eingeschränkten Belastbarkeit in HFpEF assoziiert ist. Gemeinsam mit Untersuchungen anderer Gruppen wurde so das Konzept der LA Myopathie als maßgeblicher pathophysiologischer Faktor der HFpEF etabliert, auf deren Grundlage aktuell spezifische Therapien zur Modulation der LA Drücke in HFpEF untersucht werden. Außerdem wurde dargelegt, dass eine diastolische rechtsventrikuläre und rechtsatriale Dysfunktion bereits früh im Verlauf einer HFpEF auftreten und maßgeblich zur Unfähigkeit der Steigerung des Herzzeitvolumens unter Belastung beitragen. Dies legt zum einen nahe, dass zukünftig potentielle Therapien auch insbesondere hinsichtlich ihrer Effekte auf diese Funktionsstörungen beurteilt werden sollten und bildet zum anderen den Ausgangspunkt für weitere mechanistische Studien zur Entwicklung spezifischer T

Published
2021

10. Impact of Massive or Torrential Tricuspid Regurgitation in Patients Undergoing Transcatheter Tricuspid Valve Intervention

Author

Miura, Mizuki, Alessandrini, Hannes, Alkhodair, Abdullah, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Jorg, Himbert, Dominique, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickenig, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schafer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Rommel, Karl-Philipp, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Maisano, Francesco, Hahn, Rebecca T., Taramasso, Maurizio, Miura, Mizuki, Alessandrini, Hannes, Alkhodair, Abdullah, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Jorg, Himbert, Dominique, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickenig, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schafer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Rommel, Karl-Philipp, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Maisano, Francesco, Hahn, Rebecca T., and Taramasso, Maurizio

Abstract

OBJECTIVES The aim of this study was to assess the clinical outcome of baseline massive or torrential tricuspid regurgitation (TR) after transcatheter tricuspid valve intervention (TTVI). BACKGROUND The use of TTVI to treat symptomatic severe TR has been increasing rapidly, but little is known regarding the impact of massive or torrential TR beyond severe TR. METHODS The study population comprised 333 patients with significant symptomatic TR from the TriValve Registry who underwent TTVI. Mid-term outcomes after TTVI were assessed according to the presence of massive or torrential TR, defined as vena contracta width >= 14 mm. Procedural success was defined as patient survival after successful device implantation and delivery system retrieval, with residual TR <= 2+. The primary endpoint comprised survival rate and freedom from rehospitalization for heart failure, survival rate, and rehospitalization at 1 year. RESULTS Baseline massive or torrential TR and severe TR were observed in 154 patients (46.2%) and 179 patients (53.8%), respectively. Patients with massive or torrential TR had a higher prevalence of ascites than those with severe TR (27.3% vs. 20.4%, respectively; p = 0.15) and demonstrated a similar procedural success rate (83.2% vs. 77.3%, respectively; p = 0.21). The incidence of peri-procedural adverse events was low, with no significant between-group differences. Freedom from the composite endpoint was significantly tower in patients with massive or torrential TR than in those with severe TR, which was significantly associated with an increased risk for 1-year death of any cause or rehospitalization for heart failure (adjusted hazard ratio:1.91; 95% confidence interval:1.10 to 3.34; p = 0.022). Freedom from the composite endpoint was significantly higher in patients with massive or torrential TR when procedural success was achieved (69.9% vs. 54.2%, p = 0.048). CONCLUSIONS Baseline massive or torrential TR is associated with an increased risk for all-caus

Published
2020

11. Impact of Massive or Torrential Tricuspid Regurgitation in Patients Undergoing Transcatheter Tricuspid Valve Intervention

Author

Miura, Mizuki, Alessandrini, Hannes, Alkhodair, Abdullah, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Jorg, Himbert, Dominique, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickenig, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schafer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Rommel, Karl-Philipp, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Maisano, Francesco, Hahn, Rebecca T., Taramasso, Maurizio, Miura, Mizuki, Alessandrini, Hannes, Alkhodair, Abdullah, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Jorg, Himbert, Dominique, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickenig, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schafer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Rommel, Karl-Philipp, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Maisano, Francesco, Hahn, Rebecca T., and Taramasso, Maurizio

Abstract

OBJECTIVES The aim of this study was to assess the clinical outcome of baseline massive or torrential tricuspid regurgitation (TR) after transcatheter tricuspid valve intervention (TTVI). BACKGROUND The use of TTVI to treat symptomatic severe TR has been increasing rapidly, but little is known regarding the impact of massive or torrential TR beyond severe TR. METHODS The study population comprised 333 patients with significant symptomatic TR from the TriValve Registry who underwent TTVI. Mid-term outcomes after TTVI were assessed according to the presence of massive or torrential TR, defined as vena contracta width >= 14 mm. Procedural success was defined as patient survival after successful device implantation and delivery system retrieval, with residual TR <= 2+. The primary endpoint comprised survival rate and freedom from rehospitalization for heart failure, survival rate, and rehospitalization at 1 year. RESULTS Baseline massive or torrential TR and severe TR were observed in 154 patients (46.2%) and 179 patients (53.8%), respectively. Patients with massive or torrential TR had a higher prevalence of ascites than those with severe TR (27.3% vs. 20.4%, respectively; p = 0.15) and demonstrated a similar procedural success rate (83.2% vs. 77.3%, respectively; p = 0.21). The incidence of peri-procedural adverse events was low, with no significant between-group differences. Freedom from the composite endpoint was significantly tower in patients with massive or torrential TR than in those with severe TR, which was significantly associated with an increased risk for 1-year death of any cause or rehospitalization for heart failure (adjusted hazard ratio:1.91; 95% confidence interval:1.10 to 3.34; p = 0.022). Freedom from the composite endpoint was significantly higher in patients with massive or torrential TR when procedural success was achieved (69.9% vs. 54.2%, p = 0.048). CONCLUSIONS Baseline massive or torrential TR is associated with an increased risk for all-caus

Published
2020

12. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control After Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial

Author

Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, Renkin, Jean, Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, and Renkin, Jean

Published
2019

13. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control After Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial

Author

Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, Renkin, Jean, Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, and Renkin, Jean

Published
2019

14. Cardiac MRI and Texture Analysis of Myocardial T1 and T2 Maps in Myocarditis with Acute versus Chronic Symptoms of Heart Failure

Author

Baessler, Bettina, Luecke, Christian, Lurz, Julia, Klingel, Karin, Das, Arijit, von Roeder, Maximilian, de Waha-Thiele, Suzanne, Besler, Christian, Rommel, Karl-Philipp, Maintz, David, Gutberlet, Matthias, Thiele, Hoker, Lurz, Philipp, Baessler, Bettina, Luecke, Christian, Lurz, Julia, Klingel, Karin, Das, Arijit, von Roeder, Maximilian, de Waha-Thiele, Suzanne, Besler, Christian, Rommel, Karl-Philipp, Maintz, David, Gutberlet, Matthias, Thiele, Hoker, and Lurz, Philipp

Abstract

Background: The establishment of a timely and correct diagnosis in heart failure-like myocarditis remains one of the most challenging in clinical cardiology. Purpose: To assess the diagnostic potential of texture analysis in heart failure-like myocarditis with comparison to endomyocardial biopsy (EMB) as the reference standard. Materials and Methods: Seventy-one study participants from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial(ClinicalTrials.gov registration no. NCT02177630) with clinical suspicion for myocarditis and symptoms of heart failure were prospectively included (from August 2012 to May 2015) in the study. Participants underwent biventricular EMB and cardiac MRI at 1.5 T, including native T1 and T2 mapping and standard Lake Louise criteria. Texture analysis was applied on T1 andT2 maps by using an open-source software. Stepwise dimension reduction was performed for selecting features enabling the diagnosis of myocarditis. Diagnostic performance was assessed from the area under the curve (AUC) from receiver operating characteristic analyses with 10-fold cross validation. Results: In participants with acute heart failure-like myocarditis (n = 31; mean age, 47 years +/- 17; 10 women), the texture feature GrayLevelNonUniformity from T2 maps (T2_GLNU) showed diagnostic performance similar to that of mean myocardial T2 time(AUC, 0.69 for both). The combination of mean T2 time and T2_GLNU had the highest AUC (0.76; 95% confidence interval[CI]: 0.43, 0.95), with sensitivity of 81% (25 of 31) and specificity of 71% (22 of 31). In patients with chronic heart failure-like myocarditis (n = 40; mean age, 48 years +/- 13; 12 women), the histogram feature T2_kurtosis demonstrated superior diagnostic performance compared to that of all other single parameters (AUC, 0.81; 95% CI: 0.66, 0.96). The combination of the two texture features, T2_kurtosis and the GrayLevelNonUniformity from T1, had the highest diagnostic performance (AUC, 0.85; 95% CI:0.57, 0.

Published
2019

15. Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation

Author

Taramasso, Maurizio, Benfari, Giovanni, van der Bijl, Pieter, Alessandrini, Hannes, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Joerg, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickening, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schaefer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Topilsky, Yan, Rommel, Karl-Philipp, Delgado, Victoria, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Hahn, Rebecca T., Bax, Jeroen J., Enriquez-Sarano, Maurice, Maisano, Francesco, Taramasso, Maurizio, Benfari, Giovanni, van der Bijl, Pieter, Alessandrini, Hannes, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Joerg, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickening, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schaefer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Topilsky, Yan, Rommel, Karl-Philipp, Delgado, Victoria, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Hahn, Rebecca T., Bax, Jeroen J., Enriquez-Sarano, Maurice, and Maisano, Francesco

Abstract

BACKGROUND Tricuspid regurgitation is associated with increased rates of heart failure (HF) and mortality. Transcatheter tricuspid valve interventions (TTVI) are promising, but the clinical benefit is unknown. OBJECTIVES The purpose of this study was to investigate the potential benefit of TTVI over medical therapy in a propensity score matched population. METHODS The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected 472 patients from 22 European and North American centers who underwent TTVI from 2016 to 2018. A control cohort formed by 2 large retrospective registries enrolling medically managed patients with >= moderate tricuspid regurgitation in Europe and North America (n = 1,179) were propensity score 1:1 matched (distance +/- 0.2 SD) using age, EuroSCORE II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. Primary endpoint was 1-year mortality or HF rehospitalization or the composite. RESULTS After matching, 268 adequately matched pairs of patients were identified. Compared with control subjects, TTVI patients had lower 1-year mortality (23 +/- 3% vs. 36 +/- 3%; p = 0.001), rehospitalization (26 +/- 3% vs. 47 +/- 3%; p < 0.0001), and composite endpoint (32 +/- 4% vs. 49 +/- 3%; p = 0.0003). TTVI was associated with greater survival and freedom from HF rehospitalization (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.79; p = 0.003 unadjusted), which remained significant after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction, and atrial fibrillation (HR: 0.39; 95% CI: 0.26 to 0.59; p < 0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR: 0.35; 95% CI: 0.23 to 0.54; p < 0.0001). CONCLUSIONS In this propensity-matched case-control study, TTVI is associated with greater survival and reduced HF rehospitalization compared with medical therapy alone. Randomized trials should be performed to confirm these

Published
2019

16. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control After Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial

Author

Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, Renkin, Jean, Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, and Renkin, Jean

Published
2019

17. Six-Month Results of Treatment-Blinded Medication Titration for Hypertension Control After Randomization to Endovascular Ultrasound Renal Denervation or a Sham Procedure in the RADIANCE-HTN SOLO Trial

Author

MS Nefrologie, Circulatory Health, Team Medisch, Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, Renkin, Jean, MS Nefrologie, Circulatory Health, Team Medisch, Azizi, Michel, Schmieder, Roland E., Mahfoud, Felix, Weber, Michael A., Daemen, Joost, Lobo, Melvin D., Sharp, Andrew S.P., Bloch, Michael J., Basile, Jan, Wang, Yale, Saxena, Manish, Lurz, Philipp, Rader, Florian, Sayer, Jeremy, Fisher, Naomi D.L., Fouassier, David, Barman, Neil C., Reeve-Stoffer, Helen, Mcclure, Candace, Kirtane, Ajay J., Jay, Desmond, Skeik, Nedaa, Schwartz, Robert, Dohad, Suhail, Victor, Ronald, Sanghvi, Kintur, Costello, Josh, Walsh, Courtney, Abraham, Josephine, Owan, Theophilus, Abraham, Anu, Mauri, Laura, Sobieszczky, Piotr, Williams, Jonathan, Roongsritong, Chanwit, Todoran, Thomas, Powers, Eric, Hodskins, Emily, Fong, Pete, Laffer, Cheryl, Gainer, James, Robbins, Mark, Reilly, John, Cash, Michael, Goldman, Jessie, Aggarwal, Sandeep, Ledley, Gary, His, David, Martin, Scott, Portnay, Edward, Calhoun, David, Mcelderry, Thomas, Maddox, William, Oparil, Suzanne, Huang, Pei Hsiu, Jose, Powell, Khuddus, Matheen, Zentko, Suzanne, O'meara, James, Barb, Ilie, Garasic, Joseph, Drachman, Doug, Zusman, Randy, Rosenfield, Kenneth, Devireddy, Chandan, Lea, Janice, Wells, Bryan, Stouffer, Rick, Hinderliter, Alan, Pauley, Eric, Potluri, Srinivasa, Biedermann, Scott, Bangalore, Sripal, Williams, Stephen, Zidar, David, Shishehbor, Mehdi, Effron, Barry, Costa, Marco, Radhakrishnan, Jai, Mathur, Anthony, Jain, Ajay, Iyer, Sudha Ganesh, Robinson, Nicholas, Edroos, Sadat Ali, Levy, Terry, Patel, Amit, Beckett, David, Bent, Clare, Davies, Justin, Chapman, Neil, Shin, Matthew Shun, Howard, James, Joseph, Anil, D'souza, Richard, Gerber, Robert, Faris, Mohamad, Marshall, Andrew John, Elorz, Cristina, Höllriegel, Robert, Fengler, Karl, Rommel, Karl Philipp, Böhm, Michael, Ewen, Sebastian, Lucic, Jelena, Ott, Christian, Schmid, Axel, Uder, Michael, Rump, Christian, Stegbauer, Johannes, Kröpil, Patric, Sapoval, Marc, Cornu, Erika, Lorthioir, Aurélien, Gosse, Philippe, Cremer, Antoine, Trillaud, Hervé, Papadopoulos, Panteleimon, Pathak, Atul, Honton, Benjamin, Lantelme, Pierre, Berge, Constance, Courand, Pierre Yves, Feyz, Lida, Blankestijn, Peter, Voskuil, Michiel, Rittersma, Zwaantina, Kroon, A. A., Van Zwam, W. H., Persu, Alexandre, and Renkin, Jean

Published
2019

18. Cardiac MRI and Texture Analysis of Myocardial T1 and T2 Maps in Myocarditis with Acute versus Chronic Symptoms of Heart Failure

Author

Baessler, Bettina, Luecke, Christian, Lurz, Julia, Klingel, Karin, Das, Arijit, von Roeder, Maximilian, de Waha-Thiele, Suzanne, Besler, Christian, Rommel, Karl-Philipp, Maintz, David, Gutberlet, Matthias, Thiele, Hoker, Lurz, Philipp, Baessler, Bettina, Luecke, Christian, Lurz, Julia, Klingel, Karin, Das, Arijit, von Roeder, Maximilian, de Waha-Thiele, Suzanne, Besler, Christian, Rommel, Karl-Philipp, Maintz, David, Gutberlet, Matthias, Thiele, Hoker, and Lurz, Philipp

Abstract

Background: The establishment of a timely and correct diagnosis in heart failure-like myocarditis remains one of the most challenging in clinical cardiology. Purpose: To assess the diagnostic potential of texture analysis in heart failure-like myocarditis with comparison to endomyocardial biopsy (EMB) as the reference standard. Materials and Methods: Seventy-one study participants from the Magnetic Resonance Imaging in Myocarditis (MyoRacer) trial(ClinicalTrials.gov registration no. NCT02177630) with clinical suspicion for myocarditis and symptoms of heart failure were prospectively included (from August 2012 to May 2015) in the study. Participants underwent biventricular EMB and cardiac MRI at 1.5 T, including native T1 and T2 mapping and standard Lake Louise criteria. Texture analysis was applied on T1 andT2 maps by using an open-source software. Stepwise dimension reduction was performed for selecting features enabling the diagnosis of myocarditis. Diagnostic performance was assessed from the area under the curve (AUC) from receiver operating characteristic analyses with 10-fold cross validation. Results: In participants with acute heart failure-like myocarditis (n = 31; mean age, 47 years +/- 17; 10 women), the texture feature GrayLevelNonUniformity from T2 maps (T2_GLNU) showed diagnostic performance similar to that of mean myocardial T2 time(AUC, 0.69 for both). The combination of mean T2 time and T2_GLNU had the highest AUC (0.76; 95% confidence interval[CI]: 0.43, 0.95), with sensitivity of 81% (25 of 31) and specificity of 71% (22 of 31). In patients with chronic heart failure-like myocarditis (n = 40; mean age, 48 years +/- 13; 12 women), the histogram feature T2_kurtosis demonstrated superior diagnostic performance compared to that of all other single parameters (AUC, 0.81; 95% CI: 0.66, 0.96). The combination of the two texture features, T2_kurtosis and the GrayLevelNonUniformity from T1, had the highest diagnostic performance (AUC, 0.85; 95% CI:0.57, 0.

Published
2019

19. Transcatheter Versus Medical Treatment of Patients With Symptomatic Severe Tricuspid Regurgitation

Author

Taramasso, Maurizio, Benfari, Giovanni, van der Bijl, Pieter, Alessandrini, Hannes, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Joerg, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickening, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schaefer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Topilsky, Yan, Rommel, Karl-Philipp, Delgado, Victoria, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Hahn, Rebecca T., Bax, Jeroen J., Enriquez-Sarano, Maurice, Maisano, Francesco, Taramasso, Maurizio, Benfari, Giovanni, van der Bijl, Pieter, Alessandrini, Hannes, Attinger-Toller, Adrian, Biasco, Luigi, Lurz, Philipp, Braun, Daniel, Brochet, Eric, Connelly, Kim A., de Bruijn, Sabine, Denti, Paolo, Deuschl, Florian, Estevez-Loureiro, Rodrigo, Fam, Neil, Frerker, Christian, Gavazzoni, Mara, Hausleiter, Joerg, Ho, Edwin, Juliard, Jean-Michel, Kaple, Ryan, Besler, Christian, Kodali, Susheel, Kreidel, Felix, Kuck, Karl-Heinz, Latib, Azeem, Lauten, Alexander, Monivas, Vanessa, Mehr, Michael, Muntane-Carol, Guillem, Nazif, Tamin, Nickening, Georg, Pedrazzini, Giovanni, Philippon, Francois, Pozzoli, Alberto, Praz, Fabien, Puri, Rishi, Rodes-Cabau, Josep, Schaefer, Ulrich, Schofer, Joachim, Sievert, Horst, Tang, Gilbert H. L., Thiele, Holger, Topilsky, Yan, Rommel, Karl-Philipp, Delgado, Victoria, Vahanian, Alec, Von Bardeleben, Ralph Stephan, Webb, John G., Weber, Marcel, Windecker, Stephan, Winkel, Mirjam, Zuber, Michel, Leon, Martin B., Hahn, Rebecca T., Bax, Jeroen J., Enriquez-Sarano, Maurice, and Maisano, Francesco

Abstract

BACKGROUND Tricuspid regurgitation is associated with increased rates of heart failure (HF) and mortality. Transcatheter tricuspid valve interventions (TTVI) are promising, but the clinical benefit is unknown. OBJECTIVES The purpose of this study was to investigate the potential benefit of TTVI over medical therapy in a propensity score matched population. METHODS The TriValve (Transcatheter Tricuspid Valve Therapies) registry collected 472 patients from 22 European and North American centers who underwent TTVI from 2016 to 2018. A control cohort formed by 2 large retrospective registries enrolling medically managed patients with >= moderate tricuspid regurgitation in Europe and North America (n = 1,179) were propensity score 1:1 matched (distance +/- 0.2 SD) using age, EuroSCORE II, and systolic pulmonary artery pressure. Survival was tested with Cox regression analysis. Primary endpoint was 1-year mortality or HF rehospitalization or the composite. RESULTS After matching, 268 adequately matched pairs of patients were identified. Compared with control subjects, TTVI patients had lower 1-year mortality (23 +/- 3% vs. 36 +/- 3%; p = 0.001), rehospitalization (26 +/- 3% vs. 47 +/- 3%; p < 0.0001), and composite endpoint (32 +/- 4% vs. 49 +/- 3%; p = 0.0003). TTVI was associated with greater survival and freedom from HF rehospitalization (hazard ratio [HR]: 0.60; 95% confidence interval [CI]: 0.46 to 0.79; p = 0.003 unadjusted), which remained significant after adjusting for sex, New York Heart Association functional class, right ventricular dysfunction, and atrial fibrillation (HR: 0.39; 95% CI: 0.26 to 0.59; p < 0.0001) and after further adjustment for mitral regurgitation and pacemaker/defibrillator (HR: 0.35; 95% CI: 0.23 to 0.54; p < 0.0001). CONCLUSIONS In this propensity-matched case-control study, TTVI is associated with greater survival and reduced HF rehospitalization compared with medical therapy alone. Randomized trials should be performed to confirm these

Published
2019

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