@article{SherifInceManiucetal.2015,
  author    = {Sherif, Mohammad A. and Ince, H{\"u}seyin and Maniuc, Octavian and Reiter, Therese and Voelker, Wolfram and Ertl, Georg and {\"O}ner, Alper},
  title     = {Two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation},
  series = {BMC Cardiovascular Disorders},
  volume    = {15},
  journal   = {BMC Cardiovascular Disorders},
  number    = {181},
  doi       = {10.1186/s12872-015-0181-3},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-136002},
  year      = {2015},
  abstract  = {Background: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we examined the accuracy of a novel method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus. Methods: We evaluated the theoretical impact of the measurement of the annulus diameter and area using the circumcircle of a triangle method on the decision to perform the procedure and choice of the prosthesis size. Results: Sixty-three consecutive patients were scheduled for TAVI. Mean age was 82 +/- 4 years, and 25 patients (55.6 \%) were female. Mean aortic annulus diameter was 20.3 +/- 2.2 mm assessed by TEE on the mid-esophageal long-axis view and 23.9 +/- 2.3 mm using CT (p < 0.001). There was a tendency for the TEE derived areas using the new method to be higher (p < 0.001). The TEE measurements were on average 42.33 mm(2) higher than the CT measurements without an evidence of a systematic over-or under-sizing (p = 1.00). Agreement between TEE and CT chosen valve sizes was good overall (kappa = 0.67 and weighted kappa = 0.71). For patients who turned out to have no AR, the two methods agreed in 84.6 \% of patients. Conclusions: CT remanis the gold standard in sizing of the aortic valve annulus. Nevertheless, sizing of the aortic valve annulus using TEE derived area may be helpful. The impact of integration of this method in the algorithm of aortic annulus sizing on the outcome of patients undergoing TAVI should be examined in future studies.},
  language  = {en}
}
@article{SherifHeroldVoelkeretal.2015,
  author    = {Sherif, Mohammad A. and Herold, Joerg and Voelker, Wolfram and Maniuc, Octavian and Ertl, Georg and Praast, Christian and Braun-Dullaeus, Ruediger Christian},
  title     = {Feasibility of a new method using two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation; a case-control study},
  series = {BMC Cardiovascular Disorders},
  volume    = {15},
  journal   = {BMC Cardiovascular Disorders},
  number    = {78},
  doi       = {10.1186/s12872-015-0072-7},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-148328},
  year      = {2015},
  abstract  = {Background: Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we validated a new method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus prior to TAVI. Methods: We analysed 124 patients who underwent successful TAVI using a self-expandable prosthesis, divided equally into two groups; in the study group we used the cross sectional short axis 2D-TEE for measurement of the aortic annulus and in the control group we used the long axis 2D-TEE. Results: Both groups were comparable regarding the clinical parameters. On the other hand, patients in the study group had less left ventricular ejection fraction (38.9 \% versus 45.6 \%, p = 0.01). The aortic valve annulus was, although not statistically significant, smaller in the study group (21.58 versus 23.28 mm, p = 0.25). Post procedural quantification of the aortic regurgitation revealed that only one patient in both groups had severe aortic regurgitation (AR), in this patient the valve was implanted deep. The incidence of significant AR was higher in the control group (29.0 \% versus 12.9 \%, p = 0.027). Conclusions: Sizing of the aortic valve annulus using cross-sectional 2D-TEE offers a safe and plausible method for patients undergoing TAVI using the self-expandable prosthesis and is significantly superior to using long axis 2D-TEE.},
  language  = {en}
}
@article{SchnabelCamenKnebeletal.2021,
  author    = {Schnabel, Renate B. and Camen, Stephan and Knebel, Fabian and Hagendorff, Andreas and Bavendiek, Udo and B{\"o}hm, Michael and Doehner, Wolfram and Endres, Matthias and Gr{\"o}schel, Klaus and Goette, Andreas and Huttner, Hagen B. and Jensen, Christoph and Kirchhof, Paulus and Korosoglou, Grigorius and Laufs, Ulrich and Liman, Jan and Morbach, Caroline and Navabi, Darius G{\"u}nther and Neumann-Haefelin, Tobias and Pfeilschifter, Waltraut and Poli, Sven and Rizos, Timolaos and Rolf, Andreas and R{\"o}ther, Joachim and Sch{\"a}bitz, Wolf R{\"u}diger and Steiner, Thorsten and Thomalla, G{\"o}tz and Wachter, Rolf and Haeusler, Karl Georg},
  title     = {Expert opinion paper on cardiac imaging after ischemic stroke},
  series = {Clinical Research in Cardiology},
  volume    = {110},
  journal   = {Clinical Research in Cardiology},
  number    = {7},
  issn      = {1861-0692},
  doi       = {10.1007/s00392-021-01834-x},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-266662},
  pages     = {938-958},
  year      = {2021},
  abstract  = {This expert opinion paper on cardiac imaging after acute ischemic stroke or transient ischemic attack (TIA) includes a statement of the "Heart and Brain" consortium of the German Cardiac Society and the German Stroke Society. The Stroke Unit-Commission of the German Stroke Society and the German Atrial Fibrillation NETwork (AFNET) endorsed this paper. Cardiac imaging is a key component of etiological work-up after stroke. Enhanced echocardiographic tools, constantly improving cardiac computer tomography (CT) as well as cardiac magnetic resonance imaging (MRI) offer comprehensive non- or less-invasive cardiac evaluation at the expense of increased costs and/or radiation exposure. Certain imaging findings usually lead to a change in medical secondary stroke prevention or may influence medical treatment. However, there is no proof from a randomized controlled trial (RCT) that the choice of the imaging method influences the prognosis of stroke patients. Summarizing present knowledge, the German Heart and Brain consortium proposes an interdisciplinary, staged standard diagnostic scheme for the detection of risk factors of cardio-embolic stroke. This expert opinion paper aims to give practical advice to physicians who are involved in stroke care. In line with the nature of an expert opinion paper, labeling of classes of recommendations is not provided, since many statements are based on expert opinion, reported case series, and clinical experience.},
  language  = {en}
}
@phdthesis{Saleh2019,
  author    = {Saleh, Ahmed},
  title     = {The emerging role of stress speckle tracking in viability world},
  doi       = {10.25972/OPUS-18053},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-180536},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2019},
  abstract  = {Introduction: Speckle-tracking echocardiography has recently emerged as a quantitative ultrasound technique for accurately evaluating myocardial function by analyzing the motion of speckles identified. Speckle-tracking obtained under stress may offer an opportunity to improve the detection of dynamic regional abnormalities and myocardial viability. Objective: To evaluate stress speckle tracking as tool to detect myocardial viability in comparison to cardiac MRI in post-STEMI patients. Methods: 49 patients were prospectively enrolled in our 18-month's study. Dobutamin stress echocardiography was performed 4 days post-infarction accompanied with automated functional imaging (Speckle tracking) analysis of left ventricle during rest and then during low dose stress. All patients underwent a follow up stress echocardiography at 6 weeks with speckle tracking analysis. Cardiac MRI took place concomitantly at 4 days post-infarction and 6 weeks. We carried out an assessment of re-admission with acute coronary syndrome (ACS) after one year of enrollment. Results: Investigating strain rate obtained with stress speckle tracking after revascularization predicted the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging. A good correlation was found between the global strain and total infarct size (R 0.75, p< 0.001). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment. (R -0.69, p<0.01). Meanwhile it provided 81.82\% sensitivity and 82.6\% specificity to detect transmural from non-transmural infarction at a cut-off value of -10.15. Global stress strain rate showed 80\% sensitivity and 77.5\% specificity at a cut-off value of -9.1 to predict hospital re-admission with ACS. A cut-off value of -8.4 had shown a 69.23\% sensitivity and 73.5\% specificity to predict the re-admission related to other cardiac symptoms. Conclusion: Strain rate obtained from speckle tracking during stress is a novel method of detecting myocardial viability after STEMI .Moreover it carries a promising role in post-myocardial infarction risk stratification with a reasonable prediction of reversible cardiac-related hospital re-admission.},
  language  = {en}
}
@phdthesis{Saleh2021,
  author    = {Saleh, Ahmed},
  title     = {The emerging role of stress speckle tracking in viability world},
  doi       = {10.25972/OPUS-22344},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-223447},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2021},
  abstract  = {Introduction: Speckle-tracking echocardiography has recently emerged as a quantitative ultrasound technique for accurately evaluating myocardial function by analyzing the motion of speckles identified. Speckle-tracking obtained under stress may offer an opportunity to improve the detection of dynamic regional abnormalities and myocardial viability. Objective: To evaluate stress speckle tracking as tool to detect myocardial viability in comparison to cardiac MRI in post-STEMI patients. Methods: 49 patients were prospectively enrolled in our 18-month's study. Dobutamin stress echocardiography was performed 4 days post-infarction accompanied with automated functional imaging (Speckle tracking) analysis of left ventricle during rest and then during low dose stress. All patients underwent a follow up stress echocardiography at 6 weeks with speckle tracking analysis. Cardiac MRI took place concomitantly at 4 days post-infarction and 6 weeks. We carried out an assessment of re-admission with acute coronary syndrome (ACS) after one year of enrollment. Results: Investigating strain rate obtained with stress speckle tracking after revascularization predicted the extent of myocardial scar, determined by contrast-enhanced magnetic resonance imaging. A good correlation was found between the global strain and total infarct size (R 0.75, p< 0.001). Furthermore, a clear inverse relationship was found between the segmental strain and the transmural extent of infarction in each segment. (R -0.69, p<0.01). Meanwhile it provided 81.82\% sensitivity and 82.6\% specificity to detect transmural from non-transmural infarction at a cut-off value of -10.15. Global stress strain rate showed 80\% sensitivity and 77.5\% specificity at a cut-off value of -9.1 to predict hospital re-admission with ACS. A cut-off value of -8.4 had shown a 69.23\% sensitivity and 73.5\% specificity to predict the re-admission related to other cardiac symptoms. Conclusion: Strain rate obtained from speckle tracking during stress is a novel method of detecting myocardial viability after STEMI .Moreover it carries a promising role in post-myocardial infarction risk stratification with a reasonable prediction of reversible cardiac-related hospital re-admission.},
  language  = {en}
}
@phdthesis{Niemann2009,
  author    = {Niemann, Markus},
  title     = {Der Einfluss langj{\"a}hriger Enzymersatztherapie auf die Morphologie und Funktion des linken Ventrikels bei Patienten mit Morbus Fabry},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-35710},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2009},
  abstract  = {Der Morbus Fabry ist eine X-chromosomal rezessive lysosomale Speicherkrankheit, es resultiert eine verminderte Aktivit{\"a}t des Enzyms alpha-Galaktosidase-A. Diese f{\"u}hrt zu einer Einlagerung von Globotriaosylceramiden in verschiedenen Organsystemen. Neben Niere und Nervensystem ist das Herz einer der Hauptmanifestationsorte der Erkrankung. Der Morbus Fabry f{\"u}hrt unbehandelt zu einer ventrikul{\"a}ren Hypertrophie, verminderten linksventrikul{\"a}ren Funktion und schließlich zu einer myokardialen Fibrosierung. Viele Patienten sterben aufgrund einer progredienten Herzinsuffizienz. Seit 2001 steht mit der Enzymersatztherapie (ERT), die alpha-Galaktosidase substituiert, eine kausale Behandlung des Enzymdefekts zur Verf{\"u}gung. Erste, auf einen kurzen Zeitraum (bis zu 12 Monate) angelegte, klinische Studien bei Patienten mit Morbus Fabry haben positive Effekte in Hinblick auf die Funktion und Morphologie des Herzens bei Fabry-Patienten gezeigt. Jedoch zeigten die untersuchten Patienten untereinander oft deutlich unterschiedliche Therapieeffekte. Die Langzeiteffekte einer Enzymersatztherapie, insbesondere in Hinblick auf eine zunehmende Fibrosierung des Herzens als Prognose-Parameter im Laufe der Erkrankung, wurden bisher nicht untersucht. Auch fehlen Daten f{\"u}r eine Aussage {\"u}ber den fr{\"u}hestn{\"o}tigen Therapiezeitpunkt. Diese Untersuchungen erfolgen zum ersten Mal im Rahmen dieser Studie. Es wurden 30 Patienten (42±7 Jahre) mit genetisch gesichertem Morbus Fabry vor Therapie und nach 1, 2 und 3 Jahren unter Enzymersatztherapie untersucht. Behandelt wurde mit 1.0 mg/kg K{\"o}rpergewicht rekombinanter alpha-Galaktosidase A (agalsidase ß, Fabrazyme®). Es erfolgten Magnetresonanztomographie- und echokardiographische Untersuchungen. Die echokardiographischen Untersuchungsergebnisse wurden mit einer Kohorte von 20 Herzgesunden verglichen. Neben der Bestimmung echokardiographischer Standardwerte wie der Septum- und Hinterwandst{\"a}rke und der diastolischen Funktion erfolgte eine Evaluierung der regionalen myokardialen Funktion mittels Gewebedoppler (Strain und Strain Rate Imaging sowie Double Peak-Technik). Im Magnetresonanztomographen (MRT) erfolgte die Detektion eines eventuellen Late Enhancements als Marker f{\"u}r myokardiale Fibrose. Die Patienten wurden anhand des Late Enhancements im MRT in drei Gruppen eingeteilt: Keine Fibrose (n=12), Fibrose in einer (n=9) und Fibrose in mehreren Regionen (n=9). Nur die Gruppe, die Baseline keine Fibrose aufwies zeigte unter dreij{\"a}hriger ERT eine Normalisierung der Wanddicke und eine funktionelle Normalisierung der regionalen Herzfunktion (Strain Rate radial: von 2,3±0,4s-1 auf 2,9±0,7s-1; p<0,05; Vergleichskollektiv: 2,8±0,5s-1). Die anderen beiden Gruppen zeigten zwar einen R{\"u}ckgang der Hypertrophie, hinsichtlich der Herzfunktion konnten sie jedoch bei bereits deutlich erniedrigten Funktionswerten zum Baseline-Zeitpunkt lediglich stabilisiert werden. Bei rechtzeitigem Therapiebeginn scheint die Enzymersatztherapie eine effektive Behandlung des Herzens bei Morbus Fabry zu erm{\"o}glichen. Diese Langzeitstudie zur Enzymersatztherapie bei Morbus Fabry {\"u}ber 3 Jahre zeigt jedoch deutlich, dass dies nur bei noch nicht fibrotisch ver{\"a}ndertem Herzen gilt. Die Indikation zur Enzymersatztherapie sollte daher aus kardiologischer Sicht fr{\"u}hzeitig gestellt werden.},
  subject      = {Doppler-Echokardiographie},
  language  = {de}
}
@article{MontellanoKluterRueckeretal.2022,
  author    = {Montellano, Felipe A. and Kluter, Elisabeth J. and R{\"u}cker, Viktoria and Ungeth{\"u}m, Kathrin and Mackenrodt, Daniel and Wiedmann, Silke and Dege, Tassilo and Quilitzsch, Anika and Morbach, Caroline and Frantz, Stefan and St{\"o}rk, Stefan and Haeusler, Karl Georg and Kleinschnitz, Christoph and Heuschmann, Peter U.},
  title     = {Cardiac dysfunction and high-sensitive C-reactive protein are associated with troponin T elevation in ischemic stroke: insights from the SICFAIL study},
  series = {BMC Neurology},
  volume    = {22},
  journal   = {BMC Neurology},
  number    = {1},
  doi       = {10.1186/s12883-022-03017-1},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-300119},
  year      = {2022},
  abstract  = {Background Troponin elevation is common in ischemic stroke (IS) patients. The pathomechanisms involved are incompletely understood and comprise coronary and non-coronary causes, e.g. autonomic dysfunction. We investigated determinants of troponin elevation in acute IS patients including markers of autonomic dysfunction, assessed by heart rate variability (HRV) time domain variables. Methods Data were collected within the Stroke Induced Cardiac FAILure (SICFAIL) cohort study. IS patients admitted to the Department of Neurology, W{\"u}rzburg University Hospital, underwent baseline investigation including cardiac history, physical examination, echocardiography, and blood sampling. Four HRV time domain variables were calculated in patients undergoing electrocardiographic Holter monitoring. Multivariable logistic regression with corresponding odds ratios (OR) and 95\% confidence intervals (CI) was used to investigate the determinants of high-sensitive troponin T (hs-TnT) levels ≥14 ng/L. Results We report results from 543 IS patients recruited between 01/2014-02/2017. Of those, 203 (37\%) had hs-TnT ≥14 ng/L, which was independently associated with older age (OR per year 1.05; 95\% CI 1.02-1.08), male sex (OR 2.65; 95\% CI 1.54-4.58), decreasing estimated glomerular filtration rate (OR per 10 mL/min/1.73 m2 0.71; 95\% CI 0.61-0.84), systolic dysfunction (OR 2.79; 95\% CI 1.22-6.37), diastolic dysfunction (OR 2.29; 95\% CI 1.29-4.02), atrial fibrillation (OR 2.30; 95\% CI 1.25-4.23), and increasing levels of C-reactive protein (OR 1.48 per log unit; 95\% CI 1.22-1.79). We did not identify an independent association of troponin elevation with the investigated HRV variables. Conclusion Cardiac dysfunction and elevated C-reactive protein, but not a reduced HRV as surrogate of autonomic dysfunction, were associated with increased hs-TnT levels in IS patients independent of established cardiovascular risk factors.},
  language  = {en}
}
@article{LiuHuStoerketal.2014,
  author    = {Liu, Dan and Hu, Kai and St{\"o}rk, Stefan and Herrmann, Sebastian and Kramer, Bastian and Cikes, Maja and Gaudron, Philipp Daniel and Knop, Stefan and Ertl, Georg and Bijnens, Bart and Weidemann, Frank},
  title     = {Predictive Value of Assessing Diastolic Strain Rate on Survival in Cardiac Amyloidosis Patients with Preserved Ejection Fraction},
  series = {PLOS ONE},
  volume    = {9},
  journal   = {PLOS ONE},
  number    = {12},
  issn      = {1932-6203},
  doi       = {10.1371/journal.pone.0115910},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-118024},
  year      = {2014},
  abstract  = {Objectives: Since diastolic abnormalities are typical findings of cardiac amyloidosis (CA), we hypothesized that speckle-tracking-imaging (STI) derived longitudinal early diastolic strain rate (LSRdias) could predict outcome in CA patients with preserved left ventricular ejection fraction (LVEF >50\%). Background: Diastolic abnormalities including altered early filling are typical findings and are related to outcome in CA patients. Reduced longitudinal systolic strain (LSsys) assessed by STI predicts increased mortality in CA patients. It remains unknown if LSRdias also related to outcome in these patients. Methods: Conventional echocardiography and STI were performed in 41 CA patients with preserved LVEF (25 male; mean age 65±9 years). Global and segmental LSsys and LSRdias were obtained in six LV segments from apical 4-chamber views. Results: Nineteen (46\%) out of 41 CA patients died during a median of 16 months (quartiles 5-35 months) follow-up. Baseline mitral annular plane systolic excursion (MAPSE, 6±2 vs. 8±3 mm), global LSRdias and basal-septal LSRdias were significantly lower in non-survivors than in survivors (all p<0.05). NYHA class, number of non-cardiac organs involved, MAPSE, mid-septal LSsys, global LSRdias, basal-septal LSRdias and E/LSRdias were the univariable predictors of all-cause death. Multivariable analysis showed that number of non-cardiac organs involved (hazard ratio [HR] = 1.96, 95\% confidence interval [CI] 1.17-3.26, P = 0.010), global LSRdias (HR = 7.30, 95\% CI 2.08-25.65, P = 0.002), and E/LSRdias (HR = 2.98, 95\% CI 1.54-5.79, P = 0.001) remained independently predictive of increased mortality risk. The prognostic performance of global LSRdias was optimal at a cutoff value of 0.85 S-1 (sensitivity 68\%, specificity 67\%). Global LSRdias <0.85 S-1 predicted a 4-fold increased mortality in CA patients with preserved LVEF. Conclusions: STI-derived early diastolic strain rate is a powerful independent predictor of survival in CA patients with preserved LVEF.},
  language  = {en}
}
@article{LiuHuNiemannetal.2013,
  author    = {Liu, Dan and Hu, Kai and Niemann, Markus and Herrmann, Sebastian and Cikes, Maja and St{\"o}rk, Stefan and Beer, Meinrad and Gaudron, Philipp Daniel and Morbach, Caroline and Knop, Stefan and Geissinger, Eva and Ertl, Georg and Bijnens, Bart and Weidemann, Frank},
  title     = {Impact of Regional Left Ventricular Function on Outcome for Patients with AL Amyloidosis},
  series = {PLoS ONE},
  volume    = {8},
  journal   = {PLoS ONE},
  number    = {3},
  doi       = {10.1371/journal.pone.0056923},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-130293},
  pages     = {e56923},
  year      = {2013},
  abstract  = {Objectives The aim of this study was to explore the left ventricular (LV) deformation changes and the potential impact of deformation on outcome in patients with proven light-chain (AL) amyloidosis and LV hypertrophy. Background Cardiac involvement in AL amyloidosis patients is associated with poor outcome. Detecting regional cardiac function by advanced non-invasive techniques might be favorable for predicting outcome. Methods LV longitudinal, circumferential and radial peak systolic strains (Ssys) were assessed by speckle tracking imaging (STI) in 44 biopsy-proven systemic AL amyloidosis patients with LV hypertrophy (CA) and in 30 normal controls. Patients were divided into compensated (n = 18) and decompensated (n = 26) group based on clinical assessment and followed-up for a median period of 345 days. Results Ejection fraction (EF) was preserved while longitudinal Ssys (LSsys) was significantly reduced in both compensated and decompensated groups. Survival was significantly reduced in decompensated group (35\% vs. compensated 78\%, P = 0.001). LSsys were similar in apical segments and significantly reduced in basal segments between two patient groups. LSsys at mid-segments were significantly reduced in all LV walls of decompensated group. Patients were further divided into 4 subgroups according to the presence or absence of reduced LSsys in no (normal), only basal (mild), basal and mid (intermediate) and all segments of the septum (severe). This staging revealed continuously worse prognosis in proportion to increasing number of segments with reduced LSsys (mortality: normal 14\%, mild 27\%, intermediate 67\%, and severe 64\%). Mid-septum LSsys<11\% suggested a 4.8-fold mortality risk than mid-septum LSsys≥11\%. Multivariate regression analysis showed NYHA class and mid-septum LSsys were independent predictors for survival. Conclusions Reduced deformation at mid-septum is associated with worse prognosis in systemic amyloidosis patients with LV hypertrophy.},
  language  = {en}
}
@article{LiuHuLauetal.2021,
  author    = {Liu, Dan and Hu, Kai and Lau, Kolja and Kiwitz, Tobias and Robitzkat, Katharina and Hammel, Clara and Lengenfelder, Bj{\"o}rn Daniel and Ertl, Georg and Frantz, Stefan and Nordbeck, Peter},
  title     = {Impact of diastolic dysfunction on outcome in heart failure patients with mid-range or reduced ejection fraction},
  series = {ESC Heart Failure},
  volume    = {8},
  journal   = {ESC Heart Failure},
  number    = {4},
  doi       = {10.1002/ehf2.13352},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-258894},
  pages     = {2802-2815},
  year      = {2021},
  abstract  = {Aims The role of diastolic dysfunction (DD) in prognostic evaluation in heart failure (HF) patients with impaired systolic function remains unclear. We investigated the impact of echocardiography-defined DD on survival in HF patients with mid-range (HFmrEF, EF 41-49\%) and reduced ejection fraction (HFrEF, EF < 40\%). Methods and results A total of 2018 consecutive hospitalized HF patients were retrospectively included and divided in two groups based on baseline EF: HFmrEF group (n = 951, aged 69 ± 13 years, 74.2\% male) and HFrEF group (n = 1067, aged 68 ± 13 years, 76.3\% male). Clinical data were collected and analysed. All patients completed ≥1 year clinical follow-up. The primary endpoint was defined as all-cause death (including heart transplantation) and cardiovascular (CV)-related death. All-cause mortality (30.8\% vs. 24.9\%, P = 0.003) and CV mortality (19.1\% vs. 13.5\%, P = 0.001) were significantly higher in the HFrEF group than the HFmrEF group during follow-up [median 24 (13-36) months]. All-cause mortality increased in proportion to DD severity (mild, moderate, and severe) in either HFmrEF (17.1\%, 25.4\%, and 37.0\%, P < 0.001) or HFrEF (18.9\%, 30.3\%, and 39.2\%, P < 0.001) patients. The risk of all-cause mortality [hazard ratio (HR) = 1.347, P = 0.015] and CV mortality (HR = 1.508, P = 0.007) was significantly higher in HFrEF patients with severe DD compared with non-severe DD after adjustment for identified clinical and echocardiographic covariates. For HFmrEF patients, severe DD was independently associated with increased all-cause mortality (HR = 1.358, P = 0.046) but not with CV mortality (HR = 1.155, P = 0.469). Conclusions Echocardiography-defined severe DD is independently associated with increased all-cause mortality in patients with HFmrEF and HFrEF.},
  language  = {en}
}