Kardiovaskuläre Magnetresonanztomographie in der klinischen Routine - Etablierung zeiteffizienter Ansätze

Die zunehmende Bedeutung der kardiovaskulären Magnetresonanztomographie zur Diagnostik und Therapiesteuerung findet sich auch in den aktuellen Leitlinien der Kardiologie wieder. Dennoch ist ihre Anwendung noch nicht so routinemäßig verfügbar, wie es sich anbieten würde. Als ein limitierender Faktor gilt hierbei die Untersuchungsdauer. Für eine zeiteffizientere Untersuchung ist eine Nutzung bereits vorhandener Routineaufnahmen für weitere Fragestellungen sinnvoll. Gleichzeitig müssen neu entwickelte, schnellere Techniken validiert werden. Nur so können die Möglichkeiten der kardialen Magnetresonanztomographie, insbesondere die einzigartige Möglichkeit zur nicht-invasiven Gewebedifferenzierung, künftig eine breitere Anwendung finden. Ziel dieser Arbeit ist es, Möglichkeiten zur effizienteren und schnelleren Untersuchung aufzuzeigen, um die Möglichkeiten der kardialen Magnetresonanztomographie innovativ und in breiterer Anwendung nutzbar zu machen. Bei 203 gesunden Probanden wurde der linke Vorhof analysiert, um Normwerte basierend auf einem zeitsparenden klinischen Routineprotokoll zu erstellen. Abhängigkeiten von Alter, Geschlecht und Feldstärke wurden aufgezeigt.[1] Des weiteren wurden zwei neue, schnellere Aufnahmetechniken zur Narbendarstellung bei 312 Patienten mit verschiedenen Pathologien anhand des Vergleichs zur Referenzstandardsequenz evaluiert.[2] Außerdem wurden 23 Sarkompatienten vor und im Laufe ihrer Anthrazyklin-Therapie wiederholt untersucht, um einen potentiellen Markers einer anthrazyklin-induzierten Kardiomyopathie zu ermitteln.[3] Die Evaluierung der Normwerte des linken Vorhofs ergab einen Unterschied zwischen den Geschlechtern bezüglich der absoluten Volumina des linken Vorhofs. Dieser Unterschied war nicht mehr erkennbar nach Normierung der Werte auf Body-Surface-Area oder Körpergröße. Die Feldstärke hatte keinen Einfluss. Das enddiastolische Volumen des linken Vorhofs nahm mit zunehmendem Alter ab.[1] Die neuen Aufnahmetechniken hatten eine signifikant kürzere Aufnahmezeit und erlaubten darüber hinaus auch eine Auswertung bei Patienten mit arrhythmischem Herzschlag. Alle 201 in der Referenzstandardsequenz positiven Befunde wurden ebenfalls mit einer der neuen Aufnahmetechniken erkannt. In der anderen neuen Aufnahmetechnik wurden zwei kleine Narben (<1g) übersehen.[2] Sarkompatienten, die nach Beendigung der Anthrazyklintherapie eine anthrazyklin-induzierte Kardiomyopathie entwickelten, zeigten bereits 48h nach Therapiebeginn myokardiale Gewebeveränderungen, welche sich bis zum Ende der Therapie wieder erholten.[3] Zusammenfassend konnten durch die Etablierung von Normwerten des linken Vorhofs anhand eines zeitsparenden Routineprotokolls sowie der Validierung zeitsparender Aufnahmen zur Narbendarstellung Ansätze zur zeiteffizienteren und schnelleren Durchführung einer kardialen Magnetresonanztomographieuntersuchung gezeigt werden, durch die perspektivisch zeiteffizientere Untersuchungen möglich sind und somit eine breitere Anwendung auch innovativ zur Prädiktion von Kardiomyopathien möglich macht. 1. Funk S, Kermer J, Doganguezel S, Schwenke C, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Quantification of the left atrium applying cardiovascular magnetic resonance in clinical routine. Scand Cardiovasc J. 2018;52(2):85-92. 2. Muehlberg F, Arnhold K, Fritschi S, Funk S, Prothmann M, Kermer J, Zange L, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy - a prospective clinical cardiovascular magnetic resonance trial. J Cardiovasc Magn Reson. 2018;20(1):13. 3. Muehlberg F, Funk S, Zange L, von Knobelsdorff-Brenkenhoff F, Blaszczyk E, Schulz A, Ghani S, Reichardt A, Reichardt P, Schulz-Menger J. Native myocardial T1 time can predict development of subsequent anthracycline-induced cardiomyopathy. ESC Heart Fail. 2018.The increasing importance of cardiovascular magnetic resonance for diagnostics and therapy guiding is reflected in current guidelines of cardiology. The clinical application, however, is not as widely spread as could be expected from that. The length of the examination is often seen as one limitation. For a more time-efficient examination the use of already acquired images for additional information is sensible. Also, newly developed, faster sequences have to be validated for future routine use. Thereby the potential of cardiovascular magnetic resonance, especially the unique possibility of non-invasive myocardial tissue differentiation, can be spread more broadly. Aim of this work is to show possibilities for a more efficient and faster examination to use the full potential of cardiovascular magnetic resonance also innovatively and for a broader spectrum. Left atria of 203 healthy volunteers were analyzed to establish normal values based on a time-efficient clinical routine protocol. Influence of age, sex and field strengths was evaluated.[1] Additionally, two new, faster acquisition techniques for scar imaging were compared to a reference standard sequence in 312 patients with different pathologies.[2] Furthermore 23 patients with sarcoma were examined before, during and after their anthracyclin-therapy to find a potential marker of anthracyclin-induced cardiomyopathy.[3] Evaluation the newly established normal values of the left atria showed a significant difference of the absolute volumes between both sexes, which could not be observed anymore after adjusting to body-surface-area or height. Field strength did not influence the results. The enddiastolic volume of the left atria decreased with age.[1] The new acquisition techniques had a significantly shorter acquisition time and additionally allowed for evaluation in patients with arrhythmia. All 201 positive results as depicted by the standard reference sequence were also detectable by one technique. With the other technique two small scars (<1g) were missed.[2] Patients with sarcoma, who developed an anthracyclin-induced cardiomyopathy after the anthracyclin-therapy, already showed 48 hours after beginning of treatment changes in myocardial tissue differentiation, which recovered until the end of the therapy.[3] In summary by establishing normal values for the left atria in a fast routine protocol and by validating newer, faster techniques for scar detection approaches for a more time-efficient and faster application of cardiovascular magnetic resonance could be shown, which will help expanding the application also to innovatively predict cardiomyopathies. 1. Funk S, Kermer J, Doganguezel S, Schwenke C, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Quantification of the left atrium applying cardiovascular magnetic resonance in clinical routine. Scand Cardiovasc J. 2018;52(2):85-92. 2. Muehlberg F, Arnhold K, Fritschi S, Funk S, Prothmann M, Kermer J, Zange L, von Knobelsdorff-Brenkenhoff F, Schulz-Menger J. Comparison of fast multi-slice and standard segmented techniques for detection of late gadolinium enhancement in ischemic and non-ischemic cardiomyopathy - a prospective clinical cardiovascular magnetic resonance trial. J Cardiovasc Magn Reson. 2018;20(1):13. 3. Muehlberg F, Funk S, Zange L, von Knobelsdorff-Brenkenhoff F, Blaszczyk E, Schulz A, Ghani S, Reichardt A, Reichardt P, Schulz-Menger J. Native myocardial T1 time can predict development of subsequent anthracycline-induced cardiomyopathy. ESC Heart Fail. 2018

Aspekte des aktuellen, zeitgenössischen Musiktheaterschaffens in Wien

In der hier vorliegenden Arbeit werden Aspekte der zeitgenössischen Musiktheaterlandschaft Wiens thematisiert und im Zuge dessen vor allem der Kulturvereins progetto semiserio und seine drei bisher verwirklichten Musiktheaterproduktionen "Il Trionfo", "Romeo +/- Julia" und "Gain extra inches! Die [SPAM]Oper" stellvertretend dargestellt

Shearlet-based compressed sensing for fast 3D cardiac MR imaging using iterative reweighting

High-resolution three-dimensional (3D) cardiovascular magnetic resonance (CMR) is a valuable medical imaging technique, but its widespread application in clinical practice is hampered by long acquisition times. Here we present a novel compressed sensing (CS) reconstruction approach using shearlets as a sparsifying transform allowing for fast 3D CMR (3DShearCS). Shearlets are mathematically optimal for a simplified model of natural images and have been proven to be more efficient than classical systems such as wavelets. Data is acquired with a 3D Radial Phase Encoding (RPE) trajectory and an iterative reweighting scheme is used during image reconstruction to ensure fast convergence and high image quality. In our in-vivo cardiac MRI experiments we show that the proposed method 3DShearCS has lower relative errors and higher structural similarity compared to the other reconstruction techniques especially for high undersampling factors, i.e. short scan times. In this paper, we further show that 3DShearCS provides improved depiction of cardiac anatomy (measured by assessing the sharpness of coronary arteries) and two clinical experts qualitatively analyzed the image quality

Web-based intervention for depressive symptoms in adults with types 1 and 2 diabetes mellitus:A health economic evaluation

Background: Web-based interventions are effective in reducing depression. However, the evidence for the cost-effectiveness of these interventions is scarce. Aims: The aim is to assess the cost-effectiveness of a web-based intervention (GET.ON M.E.D.) for individuals with diabetes and comorbid depression compared with an active control group receiving web-based psychoeducation. Method: We conducted a cost-effectiveness analysis with treatment response as the outcome and a cost-utility analysis with qualityadjusted life-years (QALYs) alongside a randomised controlled trial with 260 participants. Results: At a willingness-to-pay ceiling of €5000 for a treatment response, the intervention has a 97% probability of being regarded as costeffective compared with the active control group. If society is willing to pay €14 000 for an additional QALY, the intervention has a 51% probability of being cost-effective. Conclusions: This web-based intervention for individuals with diabetes and comorbid depression demonstrated a high probability of being cost-effective compared with an active control group

Cross-Sectional Comparison to Siblings and Peers

Objectives. To investigate self-reported health-related quality of life (HrQoL) in children and adolescents with chronic medical conditions compared with siblings/peers. Methods. Group 1 (6 treatment centers) consisted of 74 children/adolescents aged 8–16 years with hereditary bleeding disorders (HBD), 12 siblings, and 34 peers. Group 2 (one treatment center) consisted of 70 children/adolescents with stroke/transient ischemic attack, 14 siblings, and 72 peers. HrQoL was assessed with the “revised KINDer Lebensqualitätsfragebogen” (KINDL-R) questionnaire. Multivariate analyses within groups were done by one-way ANOVA and post hoc pairwise single comparisons by Student’s -tests. Adjusted pairwise comparisons were done by hierarchical linear regressions with individuals nested within treatment centers (group 1) and by linear regressions (group 2), respectively. Results. No differences were found in multivariate analyses of self-reported HrQoL in group 1, while in group 2 differences occurred in overall wellbeing and all subdimensions. These differences were due to differences between patients and peers. After adjusting for age, gender, number of siblings, and treatment center these differences persisted regarding self-worth () and friend-related wellbeing (). Conclusions. In children with HBD, HrQoL was comparable to siblings and peers. In children with stroke/TIA HrQoL was comparable to siblings while peers, independently of relevant confounder, showed better self-worth and friend-related wellbeing

Health-Related Quality of Life in Children and Adolescents with Hereditary Bleeding Disorders and in Children and Adolescents with Stroke: Cross-Sectional Comparison to Siblings and Peers

Objectives. To investigate self-reported health-related quality of life (HrQoL) in children and adolescents with chronic medical conditions compared with siblings/peers. Methods. Group 1 (6 treatment centers) consisted of 74 children/adolescents aged 8-16 years with hereditary bleeding disorders (HBD), 12 siblings, and 34 peers. Group 2 (one treatment center) consisted of 70 children/adolescents with stroke/transient ischemic attack, 14 siblings, and 72 peers. HrQoL was assessed with the "revised KINDer Lebensqualitatsfragebogen" (KINDL-R) questionnaire. Multivariate analyses within groups were done by one-way ANOVA and post hoc pairwise single comparisons by Student's t-tests. Adjusted pairwise comparisons were done by hierarchical linear regressions with individuals nested within treatment centers (group 1) and by linear regressions (group 2), respectively. Results. No differences were found in multivariate analyses of self-reported HrQoL in group 1, while in group 2 differences occurred in overall wellbeing and all subdimensions. These differences were due to differences between patients and peers. After adjusting for age, gender, number of siblings, and treatment center these differences persisted regarding self-worth (p =.0040) and friend-related wellbeing (p <.001). Conclusions. In children with HBD, HrQoL was comparable to siblings and peers. In children with stroke/TIA HrQoL was comparable to siblings while peers, independently of relevant confounder, showed better self-worth and friend-related wellbeing

Health-Related Quality of Life in Children and Adolescents with Hereditary Bleeding Disorders and in Children and Adolescents with Stroke: Cross-Sectional Comparison to Siblings and Peers

Objectives. To investigate self-reported health-related quality of life (HrQoL) in children and adolescents with chronic medical conditions compared with siblings/peers. Methods. Group 1 (6 treatment centers) consisted of 74 children/adolescents aged 8-16 years with hereditary bleeding disorders (HBD), 12 siblings, and 34 peers. Group 2 (one treatment center) consisted of 70 children/adolescents with stroke/transient ischemic attack, 14 siblings, and 72 peers. HrQoL was assessed with the "revised KINDer Lebensqualitatsfragebogen" (KINDL-R) questionnaire. Multivariate analyses within groups were done by one-way ANOVA and post hoc pairwise single comparisons by Student's t-tests. Adjusted pairwise comparisons were done by hierarchical linear regressions with individuals nested within treatment centers (group 1) and by linear regressions (group 2), respectively. Results. No differences were found in multivariate analyses of self-reported HrQoL in group 1, while in group 2 differences occurred in overall wellbeing and all subdimensions. These differences were due to differences between patients and peers. After adjusting for age, gender, number of siblings, and treatment center these differences persisted regarding self-worth (p =.0040) and friend-related wellbeing (p <.001). Conclusions. In children with HBD, HrQoL was comparable to siblings and peers. In children with stroke/TIA HrQoL was comparable to siblings while peers, independently of relevant confounder, showed better self-worth and friend-related wellbeing

Rehabilitation following rotator cuff repair: A multi-centre pilot & feasibility randomised controlled trial (RaCeR)

Objective: To evaluate the feasibility of a multi-centre randomised controlled trial to compare the clinical and cost-effectiveness of early patient-directed rehabilitation versus standard rehabilitation following surgical repair of the rotator cuff of the shoulder. Design: Two-arm, multi-centre pilot and feasibility randomised controlled trial. Setting: Five National Health Service hospitals in England. Participants: Adults (n = 73) with non-traumatic rotator cuff tears scheduled for repair were recruited and randomly allocated remotely prior to surgery. Interventions: Early patient-directed rehabilitation (n = 37); advised to remove their sling as soon as able and move as symptoms allow. Standard rehabilitation (n = 36); sling immobilisation for four weeks. Measures: (1) Randomisation of 20% or more eligible patients. (2) Difference in time out of sling of 40% or more between groups. (3) Follow-up greater than 70%. Results: 73/185 (39%) potentially eligible patients were randomised. Twenty participants were withdrawn, 11 due to not receiving rotator cuff repair. The between-group difference in proportions of participants who exceeded the cut-off of 222.6 hours out of the sling was 50% (80% CI = 29%, 72%), with the early patient-directed rehabilitation group reporting greater time out of sling. 52/73 (71%) and 52/53 (98%) participants were followed-up at 12 weeks when withdrawals were included and excluded respectively. Eighteen full-thickness re-tears were reported (early patient-directed rehabilitation = 7, standard rehabilitation = 11). Five serious adverse events were reported. Conclusion: A main randomised controlled trial is feasible but would require allocation of participants following surgery to counter the issue of withdrawal due to not receiving surgery

An Empirical Comparison of Tree-Based Methods for Propensity Score Estimation

To illustrate the use of ensemble tree-based methods (random forest classification [RFC] and bagging) for propensity score estimation and to compare these methods with logistic regression, in the context of evaluating the effect of physical and occupational therapy on preschool motor ability among very low birth weight (VLBW) children

Resolving an inflammatory concept: the importance of inflammation and resolution in tendinopathy

Injuries to the superficial digital flexor tendon (SDFT) are an important cause of morbidity and mortality in equine athletes, but the healing response is poorly understood. One important drive for the healing of connective tissues is the inflammatory cascade, but the role of inflammation in tendinopathy has been contentious in the literature. This article reviews the processes involved in the healing of tendon injuries in natural disease and experimental models. The importance of inflammatory processes known to be active in tendon disease is discussed with particular focus on recent findings related specifically to the horse. Whilst inflammation is necessary for debridement after injury, persistent inflammation is thought to drive fibrosis, a perceived adverse consequence of tendon healing. Therefore the ability to resolve inflammation by the resident cell populations in tendons at an appropriate time would be crucial for successful outcome. This review summarises new evidence for the importance of resolution of inflammation after tendon injury. Given that many anti-inflammatory drugs suppress both inflammatory and resolving components of the inflammatory response, prolonged use of these drugs may be contraindicated as a therapeutic approach. We propose that these findings have profound implications not only for current treatment strategies but also for the possibility of developing novel therapeutic approaches involving modulation of the inflammatory process