Search

Aims Cardiovascular magnetic resonance feature tracking (CMR-FT) global longitudinal strain (GLS) provides incremental prognostic value following acute myocardial infarction (AMI) but requires substantial post-processing. Alternatively, manual global long-axis strain (LAS) can be easily assessed from standard steady state free precession images. We aimed to define the prognostic value of LAS in a large multicentre study in patients following AMI. Methods and results A total of 1235 patients with myocardial infarction [ n  = 795 with ST-elevation myocardial infarction (STEMI) and 440 with non-ST-elevation myocardial infarction (NSTEMI)] underwent cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention in eight centres across Germany. Assessment of LAS was performed in a blinded core-laboratory measuring the systolic shortening between the epicardial apical border and the middle of a line connecting the origins of the mitral leaflets. Primary clinical endpoint was the occurrence of major adverse clinical events (MACE) including death, reinfarction, and congestive heart failure within 1 year after AMI. During 1-year follow-up, 76 patients suffered from MACE. Impaired LAS was associated with higher MACE occurrence both in STEMI (P  < 0.001) and NSTEMI (P  = 0.001) patients. Association of LAS remained significant (P  = 0.017) after correction for univariate significant parameters for MACE prediction. C-statistics revealed incremental value of additional LAS assessment for optimized event prediction compared with left ventricular ejection fraction (MACE P  = 0.044; mortality P  = 0.013) and a combination of established clinical and imaging parameters (MACE P  = 0.084; mortality P  = 0.027), but not CMR-FT GLS (MACE P  = 0.075; mortality P  = 0.380). Conclusion LAS provides software independent, widely available, easy and fast approximation of longitudinal left ventricular shortening early after reperfused AMI with incremental prognostic value beyond established risk stratification parameters. Clinical Trials.gov NCT00712101 and NCT01612312. [ABSTRACT FROM AUTHOR]

Background: Right ventricular (RV) function is a known predictor of adverse events in heart failure and following acute myocardial infarction (AMI). While right atrial (RA) involvement is well characterized in pulmonary arterial hypertension, its relative contributions to adverse events following AMI especially in patients with heart failure and congestion need further evaluation. Methods: In this cardiovascular magnetic resonance (CMR)-substudy of AIDA STEMI and TATORT NSTEMI, 1235 AMI patients underwent CMR after primary percutaneous coronary intervention (PCI) in 15 centers across Germany (n = 795 with ST-elevation myocardial infarction and 440 with non-ST-elevation MI). Right atrial (RA) performance was evaluated using CMR myocardial feature tracking (CMR-FT) for the assessment of RA reservoir (total strain εs), conduit (passive strain εe), booster pump function (active strain εa), and associated strain rates (SR) in a blinded core-laboratory. The primary endpoint was the occurrence of major adverse cardiac events (MACE) 12 months post AMI. Results: RA reservoir (εsp = 0.061, SRs p = 0.049) and conduit functions (εep = 0.006, SRe p = 0.030) were impaired in patients with MACE as opposed to RA booster pump (εap = 0.579, SRa p = 0.118) and RA volume index (p = 0.866). RA conduit function was associated with the clinical onset of heart failure and MACE independently of RV systolic function and atrial fibrillation (AF) (multivariable analysis hazard ratio 0.95, 95% confidence interval 0.92 to 0.99, p = 0.009), while RV systolic function and AF were not independent prognosticators. Furthermore, RA conduit strain identified low- and high-risk groups within patients with reduced RV systolic function (p = 0.019 on log rank testing). Conclusions: RA impairment is a distinct feature and independent risk factor in patients following AMI and can be easily assessed using CMR-FT-derived quantification of RA strain. [ABSTRACT FROM AUTHOR]

Introduction: There is evidence for the impact of gender with higher rates of major adverse clinical events (MACE) being reported in women following myocardial infarction (MI). Since the mechanisms behind these observations are not fully understood we aimed to quantify the underlying pathophysiology on ventricular and atrial level using cardiovascular magnetic resonance (CMR) quantitative deformation imaging. Methods: In total 795 patients with ST-elevation MI (STEMI) treated by primary percutaneous coronary intervention (PCI) underwent CMR imaging amongst 8 centres across Germany. CMR feature tracking (FT) analyses were performed in a blinded core-laboratory evaluating cardiac function by the means of left ventricular global longitudinal strain (GLS) as well as left atrial (LA) reservoir (total strain εs), conduit (passive strain εe) and booster pump function (active strain εa). Primary clinical endpoint was the occurrence of major adverse clinical events (MACE) within 30 days and 1 year after MI. Results: Female gender was associated with increased short- (HR 2.96, 95% CI 1.39-6.30, p=0.005) and long-term events (HR 1.96, 95% CI 1.13-3.42, p=0.017). However, when correcting for baseline confounders with women being older (p<0.001), more often diabetic and hypertensive (p<0.001) but less frequently smokers (p=0.002) female gender was not independently associated with MACE after 30 days (HR 1.78, 95% CI 0.725-4.379, p=0.208) and 1 year (HR 1.23, 95% CI 0.65-2.36, p=0.527). Notwithstanding, compared to male patients, atrial mechanics were distinctly lower (εs p=0.011 and εe p<0.001) and systolic ventricular function was higher (LV GLS p=0.001 and LVEF p=0.048) in women. Impaired atrial function independently predicted MACE occurrence after 30 days (εs HR 1.14, 95% CI 1.01-1.30, p=0.041) and 1 year (εs HR 1.10, 95% CI 1.01-1.21, p=0.027). Conclusions: Atrial reservoir and conduit functions are distinctly worse in female patients following STEMI with impaired atrial conduit strain indicating ventricular diastolic failure, potentially compensated by increased systolic contractility. Over time complete atrial mechanical failure may occur and explain worse outcomes in the female population with total atrial strain representing an independent risk factor for short- and long-term event rate. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular magnetic resonance feature tracking (CMR-FT) global longitudinal strain (GLS) provides incremental diagnostic and prognostic value following myocardial infarction (MI) but requires substantial post processing. Since manual global long axis strain (LAS) can be easily assessed from standard SSFP images we aimed to define its prognostic value in a large multi-centre study in patients after MI. Methods: 1235 patients with MI (n=795 with ST-elevation MI and 440 with non ST-elevation MI) underwent CMR imaging after primary percutaneous coronary intervention in 8 centres across Germany. Assessment of LAS was performed in a blinded core-laboratory measuring the systolic shortening between the epicardial apical border and the middle of a line connecting the origins of the mitral leaflets. Primary clinical endpoint was the occurrence of major adverse clinical events (MACE) within 1 year after MI. Results: Impaired LAS was associated with higher MACE occurrence both in STEMI (p<0.001) and NSTEMI (p=0.001) patients. Association of LAS remained significant (p=0.017) after correction for univariate significant parameters for MACE prediction. C-statistics revealed incremental value of LAS for optimized event prediction compared to the combination of microvascular obstruction and infarct size (MACE p=0.019; mortality p=0.007) as well as LVEF (MACE p=0.044; mortality p=0.013) but not FT GLS (MACE p=0.075; mortality p=0.380). Conclusions: LAS provides software independent, widely available, easy and fast approximation of longitudinal LV shortening early after reperfused MI with incremental prognostic value beyond established risk stratification parameters. [ABSTRACT FROM AUTHOR]

Aims: Cardiovascular magnetic resonance feature tracking (CMR-FT) global longitudinal strain (GLS) provides incremental prognostic value following acute myocardial infarction (AMI) but requires substantial post-processing. Alternatively, manual global long-axis strain (LAS) can be easily assessed from standard steady state free precession images. We aimed to define the prognostic value of LAS in a large multicentre study in patients following AMI., Methods and Results: A total of 1235 patients with myocardial infarction [n = 795 with ST-elevation myocardial infarction (STEMI) and 440 with non-ST-elevation myocardial infarction (NSTEMI)] underwent cardiovascular magnetic resonance imaging after primary percutaneous coronary intervention in eight centres across Germany. Assessment of LAS was performed in a blinded core-laboratory measuring the systolic shortening between the epicardial apical border and the middle of a line connecting the origins of the mitral leaflets. Primary clinical endpoint was the occurrence of major adverse clinical events (MACE) including death, reinfarction, and congestive heart failure within 1 year after AMI. During 1-year follow-up, 76 patients suffered from MACE. Impaired LAS was associated with higher MACE occurrence both in STEMI (P < 0.001) and NSTEMI (P = 0.001) patients. Association of LAS remained significant (P = 0.017) after correction for univariate significant parameters for MACE prediction. C-statistics revealed incremental value of additional LAS assessment for optimized event prediction compared with left ventricular ejection fraction (MACE P = 0.044; mortality P = 0.013) and a combination of established clinical and imaging parameters (MACE P = 0.084; mortality P = 0.027), but not CMR-FT GLS (MACE P = 0.075; mortality P = 0.380)., Conclusion: LAS provides software independent, widely available, easy and fast approximation of longitudinal left ventricular shortening early after reperfused AMI with incremental prognostic value beyond established risk stratification parameters., Clinical Trials.gov: NCT00712101 and NCT01612312., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Background: Pregnancy-associated plasma protein A (PAPP-A) has been suggested as a candidate marker for the identification of unstable plaques in coronary arteries. We assessed the value of PAPP-A for predicting short-term cardiovascular events in a large cohort of patients presenting with cardiac chest pain., Methods: We included consecutive patients who presented to a teaching hospital in Germany with chest pain of cardiac origin confirmed by coronary angiography. We analyzed PAPP-A levels from serum samples drawn within 30 minutes after arrival in the emergency department or in the catheterization laboratory. Patients were followed for 90 days or until death for major adverse cardiovascular events, defined as the combined outcome of stent thrombosis, myocardial (re)infarction, ischemic stroke or cardiovascular-related death., Results: A total of 2568 patients (mean age [± standard deviation (SD)] 68 ± 11 years; 74% male) presented with cardiac chest pain: 55% had stable angina and 45% had acute coronary syndrome. The PAPP-A levels ranged from 4 to 2154 mIU/L (median 14.0 mIU/L, interquartile range 9.3-25.2 mIU/L). Major adverse cardiovascular events occurred in 203 patients (7.9%). The mean PAPP-A level was higher among patients who had an event than among those who did not (62 ± 156 v. 21 ± 23 mIU/L, p < 0.001). In a multivariable analysis, PAPP-A remained a significant independent predictor of the primary outcome within 90 days (hazard ratio per 1 SD increase in PAPP-A level 1.96, 95% confidence interval 1.74-2.21). The optimal prognostic cutoff value was a PAPP-A level of 34.6 mIU/L., Interpretation: Higher levels of serum PAPP-A were independently associated with an increased short-term risk of cardiovascular events in patients presenting with cardiac chest pain. Further studies are required to validate the use of PAPP-A in routine clinical practice to predict future cardiovascular events.

Thrombocytopenia, fever, and acute renal failure are characteristic features of nephropathia epidemica, the predominant hantavirus infection in Europe. However, clinical presentation and blood cell counts may point to other disorders, such as a hematologic disease, particularly when impairment of renal function is not evident. This differential diagnosis often results in further extensive and unnecessary testing. We describe 3 patients with hantavirus infection with no renal failure, in whom a hematologic disorder was initially suspected. Serologic testing of hantavirus finally unraveled the mystery, and outcome of the patients was excellent. It is conceivable that similar cases often remain undiagnosed. Thus, testing for hantavirus should always be considered in cases of thrombocytopenia and fever of unknown origin, especially in areas endemic for the infection.