Christina Doesch

Universität Heidelberg · I. Medical Clinic

Background: Arterial stiffness has emerged as a strong predictor of cardiovascular disease, end-organ damage and all-cause mortality. Although increased arterial stiffness has been described as a predictor of atrial fibrillation, the relationship between arterial stiffness and atrial fibrillation is uncertain. Aim: We assessed arterial stiffness...

Background: Increased arterial stiffness (AS) has been described as a predictor of atrial fibrillation (AF). This study was performed to assess whether increased AS leads to a higher symptom burden in patients with AF. Methods: 162 consecutive patients (104 male, 58 female) with diagnosed AF (paroxysmal or persistent) were enrolled. Symptoms mos...

Objective Atrial fibrillation (AF) is associated with a varying symptom burden, which ranges from completely unawareness to disabling conditions. The present cross-sectional study tried to assess if neuroticism is associated with a greater degree of perception of AF related symptoms. Methods 162 patients who were considered for catheter ablation o...

Background:Thromboembolic complications such as ischemic stroke or peripheral arterial thromboembolism are known complications in hypertrophic cardiomyopathy (HCM). We sought to assess the clinical and cardiovascular magnetic resonance (CMR) characteristics of patients with HCM suffering from thromboembolic events and analyzed the predictors of the...

Background/aim: Despite advances in the treatment strategies of patients with atrial fibrillation (AF), the risk of AF recurrences is still over 50%. An increased left atrial volume index (LAVI) reflects left ventricular diastolic dysfunction (DD) and deterioration of the LA function. This study aims to determine AF recurrence following cardiovers...

In postural stress, an increased preload volume leads to higher stroke volume (SV) according to the Frank-Starling law of the heart. The present study aimed to evaluate the hemodynamic response to postural stress using non-invasive inert gas rebreathing (IGR) in patients with normal as well as impaired left ventricular function. Hemodynamic measure...

Airways obstruction is frequent in patients with pulmonary hypertension (PH). Small airway disease (SAD) was identified as a major contributor to resistance and symptoms. However, it is easily missed using current diagnostic approaches. We aimed to evaluate more elaborate diagnostic tests such as impulse oscillometry (IOS) and SF6-multiple-breath-w...

Hypertrophic cardiomyopathy (HCM) has a low risk for sudden cardiac death (SCD). The ESC clinical risk prediction model estimates the risk of SCD using clinical and echocardiographical parameters without taking into account cardiac magnetic resonance (CMR) parameters. Therefore, we compared the CMR characteristics of 149 patients with low, intermed...

Background Up to 40% of patients with transvenous implantable cardioverter‐defibrillator (ICD) experience lead‐associated complications and may suffer from high complication rates when lead extraction is indicated. Subcutaneous ICD may represent a feasible alternative; however, the efficacy of the subcutaneous ICD in the detection and treatment of...

Background: While coronary artery bypass grafting remains the standard treatment of complex multivessel coronary artery disease, the advent of peripheral ventricular assist devices has enhanced the safety of percutaneous coronary intervention. We therefore evaluated the safety in terms of inhospital outcome comparing protected high-risk percutaneo...

To generate a patient-friendly, time-efficient cardiac MRI examination protocol, a highly accelerated real-time CINE MR sequence (SSIR) was acquired in the idle time in between contrast injection and late gadolinium enhancement phase. 20 consecutive patients underwent a cardiac MRI examination including a multi-breath-hold sequence as gold standard...

Video S2. LAO projection of the reconstructed 3D heart model in a control, without overt ECG abnormalities is shown. Different voltage gradients between the epicardium and endocardium are color coded from +28.3 (red) to −28.3 mV (purple) and shown in slow motion, based on 1 heartbeat (depolarization and repolarization). During the terminal portion...

Video S3. LAO projection of the reconstructed 3D heart model in a patient with a typical RBBB is shown. Different voltage gradients between the epicardium and endocardium are color coded from +12 (red) to −12 mV (purple) and shown in slow motion, based on 1 heartbeat (depolarization and repolarization). During the terminal portion of the QRS, a pos...

Data S1. Supplemental methods. Table S1. Demographic Data of Patients With Bundle Branch Block Table S2. Demographic Data of Control Subjects Table S3. Morphology of Local Unipolar EGs in Control Subjects Table S4. Morphology of Local Unipolar EGs in BrS Patients With Type 1 ECG Table S5. Comparison of Electrograms Obtained in the Right Ventri...

Video S1. LAO projection of the reconstructed 3D heart model in a patient with a spontaneous type 1 Brugada ECG is shown. Different voltage gradients between the epicardium and endocardium are color coded from +11.4 (red) to −11.4 mV (purple) and shown in slow motion, based on 1 heartbeat (depolarization and repolarization). During the terminal por...

Background. The underlying mechanisms of Brugada syndrome (BrS) are not completely understood. Recent studies provided evidence that the electrophysiological substrate, leading to electrocardiogram abnormalities and/or ventricular arrhythmias, is located in the right ventricular outflow tract (RVOT). The purpose of this study was to examine abnorma...

Impedance cardiography measurement of cardiac output gained wide interest due to its ease of use and non-invasiveness. However, validation studies of different algorithms yielded diverging results. Bioreactance (BR) as a recent adaption differs fundamentally as the flow signal is derived from phase shifts. Our aim was to assess the accuracy and rep...

Background Recurrence of takotsubo cardiomyopathy (TTC) is a well-known complication. However, current literature lists only a few isolated cases. We aimed to determine the incidence and clinical significance of recurrent TTC. Methods & Results Our institutional database constituted a collective of 114 patients diagnosed with TTC since 2003. Close...

Rationale and objectives: Despite ongoing technical refinements, coronary computed tomography angiography (cCTA) remains challenging in its diagnostic value by electrocardiographic (ECG) misregistration and motion artifacts, which commonly occur in patients with atrial fibrillation and high or irregular heart rates. The aim of this study was to ev...

Electrical velocimetry (EV) is one of the most recent adaptions of impedance cardiography. Previous studies yielded diverging results identifying several factors negatively influencing accuracy. Although electrode arrangement is suspected to be an influencing factor for impedance cardiography in general, no data for EV is available. We aimed to pro...

Background: Takotsubo cardiomyopathy (TTC) is a relevant differential diagnosis in patients presenting with signs of an acute coronary syndrome. Although recent literature has highlighted some salient features of this disorder, there has been little information elucidating the differences in clinical features, electrocardiographic findings, echocar...

Objective: Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy (SCM) resembles a reversible cardiomyopathy that is characterized by localized wall motion abnormalities in the absence of stenotic coronary vascular disease. Patients typically present with apical ballooning of the left ventricle (LV), however the right ventricle (RV...

Hintergrund: Die Impedanzkardiografie ist ein einfaches und nicht-invasives Verfahren zur Bestimmung des Herzzeitvolumens (HZV). Veranderungen des thorakalen Flussigkeitsgehalts, Arrhythmien, Bewegungsartefakte und Elektrodenposition beeinflussen jedoch die Messgenauigkeit. Dies hat zu zahlreichen Anpassungen des Algorithmus gefuhrt, von denen eine...

Objectives and Background: Atrial fibrillation (AF) is associated with clinical deterioration, stroke and disability in patients with hypertrophic cardiomyopathy (HCM). Therefore, the objective of this study was to evaluated cardiac magnetic resonance (CMR)-derived determinants for the occurrence of AF in patients with HCM. Methods: 98 Patients wit...

Increased sympathetic nerve activity and reduced vagal activity are associated with increased mortality in patients after myocardial infarction and patients with chronic heart failure; furthermore, vagal withdrawal has been documented to precede acute decompensation. Experimental studies have indicated that increased parasympathetic activity by mea...

Background: In patients with coronary artery disease (CAD), risk stratification remains a challenge. Recently, epicardial adipose tissue (EAT) assessed by cardiovascular magnetic resonance imaging (CMRI) has emerged as a new marker in patients with CAD. Thus, we aimed to investigate the association of CMR parameters with all-cause and cardiac mort...

Aims The purpose of the this study was to evaluate a possible genotype–phenotype correlation in BrS patients and to analyze possible associations with clinical events in affected patients. SCN5A gene encodes the alpha-subunit of the voltage-gated sodium channel NaV1.5. Its mutations are associated with a broad spectrum of hereditary arrhythmias suc...

Nowadays, CT pulmonary angiography (CTPA) is the diagnostic imaging modality of choice for acute and chronic pulmonary embolism (PE) in order to assess vascular anatomy and parenchymal morphology. Over the past decade, several prognostic CTPA markers associated with an increased risk of adverse clinical events and in-hospital mortality have been ev...

Purpose Breast intensity modulated radiation therapy (IMRT) reduces high-dose heart volumes but increases low-dose volumes. We prospectively assessed heart changes after 3D conformal RT (3DCRT) and IMRT for left-sided breast cancer. Heart dose was analyzed individually, 3DCRT patients were moderately exposed, and IMRT was performed only in patients...

A novel algorithm of impedance cardiography referred to as electrical velocimetry (EV) has been introduced for non-invasive determination of cardiac output (CO). Previous validation studies yielded diverging results and no comparison with the non-invasive gold standard cardiac magnetic resonance imaging (CMR) has been performed. We therefore aimed...

Zielsetzung: Die Erprobung einer 2D real-time CINE TrueFISP Sequenz, welche mit Unterabtastung des k-Raumes und compressed sensing Bildrekonstruktion (CS) akquiriert wurde im Hinblick auf die potenzielle Beeinflussung der Genauigkeit der LV-Volumetrie in der Kardio-MRT bei nachgewiesenem late-gadolinium enhancement (LGE+) beim Patienten als bildmor...

Hypertrophic cardiomyopathy (HCM) causes various degrees of fibrosis resulting in left ventricular function impairment, which can be measured using mitral annular plane systolic excursion (MAPSE). To determine the values for septal, lateral and average MAPSE using cardiovascular magnetic resonance (CMR) in healthy controls and patients with HCM; an...

This handout describes the simulation dataset KIT-20-PVC_Simulation-1906-10-30, which was contributed by the Karlsruhe Institute of Technology (KIT) to the Experimental Data and Geometric Analysis Repository (EDGAR) database.

Coronary artery disease (CAD) represents an important cause of mortality. Cardiovascular magnetic resonance (CMR) imaging evolved as an imaging modality that allows the assessment of myocardial function, perfusion, contractile reserve and extent of fibrosis in a single comprehensive exam. This review highlights the role of CMR in the differential d...

Introduction: Cardiotoxic side effects are of concern in long-term survivors of left-sided breast cancer therapy. 3-dimensional conventional radiotherapy (3DCRT) deposits high doses in defined regions of the heart. Intensity modulated radiotherapy (IMRT) reduces local high-dose exposition at the expense of exposing more heart tissue to lower doses....

Aim To compare cardiovascular magnetic resonance (CMR)-derived right ventricular fractional shortening (RVFS), tricuspid annular plane systolic excursion with a reference point within the right ventricular apex (TAPSEin) and with one outside the ventricle (TAPSEout) with the standard volumetric approach in patients with hypertrophic cardiomyopathy...

Aims: Dilated cardiomyopathy (DCM) shows a variable disease course and is associated with significant morbidity and mortality. So far, left ventricular function (LVF) is the major determinant for risk stratification. However, since it has shown to be a poor guide to individual outcome, we studied the prognostic value of cardiovascular magnetic res...

Aims This study sought to characterize global and regional right ventricular (RV) myocardial function in patients with Takotsubo cardiomyopathy (TC) using 2D strain imaging. Methods We compared various parameters of RV and left ventricular (LV) systolic function between 2 groups of consecutive patients with TC at initial presentation and upon foll...

Structural abnormalities of the right ventricular outflow tract (RVOT) have been described in several clinical conditions. The aim of our study was to prospectively compare the available approaches to measuring the RVOT area and diameter by cardiovascular magnetic resonance imaging (CMR) and establish reference values in healthy volunteers. In addi...

Purpose: Dilated cardiomyopathy (DCM) shows a variable disease course and is associated with significant morbidity and mortality. So far, left ventricular function (LVF) is the major determinant for risk stratification. However, since it has shown to be a poor guide to outcome, we studied the prognostic importance of other cardiovascular magnetic r...

Background: Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiomyopathy presenting with variable clinical symptoms and a heterogeneous prognosis. So far little is known about the impact of gender and age on the phenotype of patients with HCM. Objective: The aim of this study was to study gender- and age-related differences in a mult...

Background: SCN5A gene encodes the alpha-subunit of the voltage-gated sodium channel Nav1.5. Accordingly, its mutations are associated with a broad spectrum of hereditary arrhythmias like long QT syndrome, cardiac conduction diseases or Brugada syndrome. Genetic screening for a SCN5A mutation is increasingly being used in patients with Brugada synd...

Background: Increased left atrial (LA) size, advanced age and congestive heart failure symptoms are known predictors of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). Echocardiographically derived mitral annular plane systolic excursion (MAPSE) is a surrogate marker for left ventricular (LV) dysfunction in several card...

Purpose: Atrial fibrillation (AF) is the most common cardiac rhythm disorder. Pharmacological treatment of AF is hampered by ventricular pro-arrhythmia. Modulation of atrium-specific Kir3.x channels, which generate a constitutively active current (IK,ACh-c) after atrial remodeling, could possibly circumvent this problem. However, it is not yet know...

Emerging interest is seen in the paradox of defibrillator shocks for ventricular tachyarrhythmia and increased mortality risk. Particularly in patients with dilated cardiomyopathy (DCM), the prognostic importance of shocks is unclear. The purpose of this study was to compare the outcome after shocks in patients with ischemic cardiomyopathy (ICM) or...

Purpose: The purpose of this study was to compare automated, motion-corrected, color-encoded (AMC) perfusion maps with qualitative visual analysis of adenosine stress cardiovascular magnetic resonance imaging for detection of flow-limiting stenoses. Materials and methods: Myocardial perfusion measurements applying the standard adenosine stress i...

We sought to investigate the association of the EAT with CMR parameters of ventricular remodelling and left ventricular (LV) dysfunction in patients with non-ischemic dilated cardiomyopathy (DCM). One hundred and fifty subjects (112 consecutive patients with DCM and 48 healthy controls) underwent CMR examination. Function, volumes, dimensions, the...

Epicardial adipose tissue (EAT) is an active metabolic and endocrine organ. Previous studies focusing mainly on patients with preserved left ventricular function (LVF) could show a correlation between increased amounts of EAT and the extent and activity of coronary artery disease (CAD). However, to date, there are no data available about the relati...

Objectives: A growing interest in monitoring cardiac output (CO) noninvasively has emerged; however, its determination has been difficult using the standard approaches. The aim of this study was to evaluate the accuracy and precision of pulse contour analysis (PCA) compared with cardiac magnetic resonance imaging (CMR). Design: A single-center p...

Novel Regulators and Inhibitors of Aortic Valve Calcification –ESC-Congress 2012 ,Munich ,Germany

Background: Because a close relationship between epicardial adipose tissue (EAT) and coronary artery disease (CAD) has been shown, the impact of functional, morphological and clinical parameters to identify potential determinants of EAT was investigated. Methods and results: Clinical and cardiac magnetic resonance parameters were determined and...

Hintergrund: Bei der Beurteilung der Funktion des Herzkreislaufssystems stellt das Herzzeitvolumen (HZV) einen wichtigen Parameter dar, dessen Bestimmung diagnostische sowie therapeutische Implikationen hat. Neue Methoden sollten vor allem nicht-invasiv, aber auch genau, reproduzierbar, einfach und gunstig sein. Als Goldstandard hat sich die kardia...

Brugada syndrome is characterized by ST-segment abnormalities in V1-V3. Electrocardiogram (ECG) leads placed in the 3rd and 2nd intercostal spaces (ICSs) increased the sensitivity for the detection of a type I ECG pattern. The anatomic explanation for this finding is pending. The purpose of the study was to correlate the location of the Brugada typ...

Implantable cardioverter-defibrillator (ICD) therapy for primary prevention is well established in ischemic cardiomyopathy (ICM). Data on the role of ICDs in patients with dilated cardiomyopathy (DCM) and no history of ventricular tachyarrhythmia (VT/VF) are more limited. DCM patients with an impaired left ventricular ejection fraction (LVEF) still...

We aimed to determine the diagnostic performance of biomarkers in predicting myocardial fibrosis assessed by late gadolinium enhancement (LGE) cardiovascular magnetic resonance imaging (CMR) in patients with hypertrophic cardiomyopathy (HCM). LGE CMR was performed in 40 consecutive patients with HCM. Left and right ventricular parameters, as well a...

Patients with Brugada syndrome (BrS) and a spontaneous type 1 ECG are considered to be at greater increased risk for sudden cardiac death than are patients with an abnormal ECG only after administration of sodium channel blockers and therefore represent a more severe phenotype. Thus, it can be hypothesized that in the presence of a more severe elec...

To determine prevalence and predictors of electrical storm recurrences (ES-Rs) in patients with implantable cardioverter-defibrillators (ICDs) as electrical storms (ESs) represent serious clinical events carrying a high risk of mortality. Single-centre study analysing data of consecutive patients receiving an ICD between 1993 and 2008. Electrical s...

In this work we present a prototype of a precise freehand 3D/4D ultrasound imaging system equipped with an universal wireless 3D tracker for digitizing spatial coordinates of an ultrasonic transducer, consider the system calibration using a plane phantom and carry out validation of the setup on a pig heart specimen. The system basic functionality,...

Cardiac output (CO) is an important parameter for diagnosis and therapy of heart diseases, but it is still difficult to determine. Innocor, a novel noninvasive inert gas rebreathing (IGR) system, has shown promising results. However, the impact of pulmonary diseases on IGR remains unclear. The aim of the study therefore was to assess the accuracy a...

The aim of this study was to evaluate the extent of epicardial adipose tissue (EAT) and its relationship with left ventricular (LV) parameters assessed by cardiovascular magnetic resonance (CMR) in patients with congestive heart failure (CHF) and healthy controls. EAT is the true visceral fat deposited around the heart which generates various bioac...

So far different approaches have been used to quantify late gadolinium enhancement (LGE) in patients with hypertrophic cardiomyopathy (HCM), but there is no general consensus on the gold standard, since histological data are scarce. The aim of our study was to investigate whether the determination of LGE in patients with HCM using a semiquantitativ...

Myocardial fibrosis is frequently identified in patients with hypertrophic cardiomyopathy (HCM). The aim of this study was to investigate the role of myocardial fibrosis detected by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) as a potential arrhythmogenic substrate in HCM. We hypothesized that the extent of LGE might b...

There is increasing evidence that body composition should be considered as a systemic marker of disease severity in congestive heart failure (CHF). Prior studies established bioelectrical impedance analysis (BIA) as an objective indicator of body composition. Epicardial adipose tissue (EAT) quantified by cardiac magnetic resonance (CMR) is the visc...

USCOM, a novel continuous wave Doppler (CWD) device, has been introduced for noninvasive determination of cardiac output (CO). The present study aimed to compare the accuracy and reproducibility of the new device, using cardiovascular magnetic resonance imaging (CMR) as the noninvasive gold standard. The CO of 56 consecutive patients was prospectiv...

Atrial fibrillation (AF) is one of the most frequent heart rhythm disorders. It potentially influences cardiac function and its measurement. Cardiac magnetic resonance imaging (CMR) has become the new gold standard for non-invasive assessment of cardiac output (CO). A novel inert gas rebreathing (IGR) device based on the Fick Principle also proved...

We sought to evaluate the relation between atrial fibrillation (AF) and the extent of myocardial scarring together with left ventricular (LV) and atrial parameters assessed by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR) in patients with hypertrophic cardiomyopathy (HCM). AF is the most common arrhythmia in HCM. Myocard...

Stress perfusion magnetic resonance imaging (MSPMRI) is an established technique for the assessment of myocardial perfusion. Shortcomings at 1.5 T are low signal to noise ratio (SNR) and contrast to noise ratio (CNR). One approach to overcome these shortcomings is to increase field strength and contrast concentration. The aim of our study was to in...

The purpose of this study was to determine the role of adenosine stress cardiac magnetic resonance (CMR) for risk stratification in patients with coronary artery stenoses of intermediate angiographic severity. Coronary angiography only provides a morphological description of coronary lesions. As the patient's prognosis is closely related to the fun...

A 76-year-old man with coronary artery disease and a history of aortocoronary bypass surgery seven years previously presented with symptomatic bradycardia and atrial fibrillation. After evaluation of the coronary status by cardiac catheterization, the decision was made to implant a ventricular rate responsive demand (VVIR) pacemaker. Positioning of...

A 60-year-old woman presented to the emergency department with acute onset of severe chest pain. The pain started that morning, after witnessing the sudden cardiac death of a coworker. The electrocardiogram did not reveal evidence of ischemic ST segment deviations. Creatinine kinase was within the normal range but cardiac troponin T was elevated (2...

This prospective study was designed to determine the diagnostic value of adenosine stress cardiac magnetic resonance imaging (CMRI) in patients referred to elective coronary angiography. Myocardial perfusion measurements at rest and adenosine stress were performed in 141 patients (105 men, 36 women, mean age 63.4 years) at 1.5 T with a Turbo Flash...

To evaluate residual platelet activity in a consecutive cohort of patients treated with dual antiplatelet therapy after coronary stent implantation Prospective single-centre cohort study. University hospital in Germany. 480 patients with symptomatic coronary artery disease (n = 221 (46%) or acute coronary syndrome (ACS; n = 259 (54%) stable angina)...

Essential thrombocythemia (ET) is an acquired clonal hematological stem-cell disorder that is characterized by a persistent increase in platelet count over 600,000/microl and elevated megakaryocyte levels in the bone marrow. Patients with ET are on the one hand at risk of thrombosis and on the other hand of hemorrhagic events especially in patients...

A 48-year-old man presented with acute chest pain and a greatly increased platelet count. Emergency coronary angiographic revealed thrombotic occlusion of the right coronary artery. Coronary angioplasty and stenting were successfully combined with intracoronary abciximab administration. Due to inadequate postinterventional platelet inhibition an in...

Ein 48-jähriger Patient wird mit plötzlich aufgetretenen thorakalen Beschwerden sowie einer Thrombozytose notfallmäßig aufgenommen. In der Koronarangiographie zeigte sich ein Verschluss der rechten Herzkranzarterie durch thrombotisches Material, der erfolgreich mittels PTCA, Stenting und intrakoronarer Abciximabgabe versorgt werden konnte. Postinte...

The aim of the present study was to determine the correlation of myocardial perfusion MR imaging (MPMRI) and coronary angiography for the detection of flow-limiting stenosis in symptomatic patients with known coronary artery disease and a history of intervention. MPMRI was performed in 51 symptomatic patients (44 male, 64.7 +/- 9.5 years) with know...