TY - JOUR A1 - Rauch, Bernhard A1 - Salzwedel, Annett A1 - Bjarnason-Wehrens, Birna A1 - Albus, Christian A1 - Meng, Karin A1 - Schmid, Jean-Paul A1 - Benzer, Werner A1 - Hackbusch, Matthes A1 - Jensen, Katrin A1 - Schwaab, Bernhard A1 - Altenberger, Johann A1 - Benjamin, Nicola A1 - Bestehorn, Kurt A1 - Bongarth, Christa A1 - Dörr, Gesine A1 - Eichler, Sarah A1 - Einwang, Hans-Peter A1 - Falk, Johannes A1 - Glatz, Johannes A1 - Gielen, Stephan A1 - Grilli, Maurizio A1 - Grünig, Ekkehard A1 - Guha, Manju A1 - Hermann, Matthias A1 - Hoberg, Eike A1 - Höfer, Stefan A1 - Kaemmerer, Harald A1 - Ladwig, Karl-Heinz A1 - Mayer-Berger, Wolfgang A1 - Metzendorf, Maria-Inti A1 - Nebel, Roland A1 - Neidenbach, Rhoia Clara A1 - Niebauer, Josef A1 - Nixdorff, Uwe A1 - Oberhoffer, Renate A1 - Reibis, Rona A1 - Reiss, Nils A1 - Saure, Daniel A1 - Schlitt, Axel A1 - Völler, Heinz A1 - Känel, Roland von A1 - Weinbrenner, Susanne A1 - Westphal, Ronja T1 - Cardiac rehabilitation in German speaking countries of Europe — evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH — Part 1 JF - Journal of Clinical Medicine N2 - Background: Although cardiovascular rehabilitation (CR) is well accepted in general, CR-attendance and delivery still considerably vary between the European countries. Moreover, clinical and prognostic effects of CR are not well established for a variety of cardiovascular diseases. Methods: The guidelines address all aspects of CR including indications, contents and delivery. By processing the guidelines, every step was externally supervised and moderated by independent members of the “Association of the Scientific Medical Societies in Germany” (AWMF). Four meta-analyses were performed to evaluate the prognostic effect of CR after acute coronary syndrome (ACS), after coronary bypass grafting (CABG), in patients with severe chronic systolic heart failure (HFrEF), and to define the effect of psychological interventions during CR. All other indications for CR-delivery were based on a predefined semi-structured literature search and recommendations were established by a formal consenting process including all medical societies involved in guideline generation. Results: Multidisciplinary CR is associated with a significant reduction in all-cause mortality in patients after ACS and after CABG, whereas HFrEF-patients (left ventricular ejection fraction <40%) especially benefit in terms of exercise capacity and health-related quality of life. Patients with other cardiovascular diseases also benefit from CR-participation, but the scientific evidence is less clear. There is increasing evidence that the beneficial effect of CR strongly depends on “treatment intensity” including medical supervision, treatment of cardiovascular risk factors, information and education, and a minimum of individually adapted exercise volume. Additional psychologic interventions should be performed on the basis of individual needs. Conclusions: These guidelines reinforce the substantial benefit of CR in specific clinical indications, but also describe remaining deficits in CR-delivery in clinical practice as well as in CR-science with respect to methodology and presentation. KW - cardiac rehabilitation standards KW - scientific guidelines KW - secondary prevention KW - coronary artery disease KW - chronic heart failure KW - heart valve repair KW - ICD-CRT KW - ventricular assist device KW - heart transplantation KW - peripheral artery disease KW - pulmonary hypertension KW - myocarditis KW - adults with congenital heart disease Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-239709 SN - 2077-0383 VL - 10 IS - 10 ER - TY - THES A1 - Auinger, Julia T1 - Gezielte linksventrikuläre Endomyokardbiopsie unter Einsatz eines 3D Mapping-Systems und einer navigierten steuerbaren Schleuse ‒ Entwicklung und experimentelle Validierung der Methode T1 - Targeted Leftventricular Endomyocardial Biopsy by Application of a 3D Mapping System and a Navigated Steerable Sheath N2 - Zielsetzung: In dieser Machbarkeitsstudie evaluierten wir den aktuellen Standard der linksventrikulären Endomyokardbiopsie in einem Modellversuch. Wir entwickelten und überprüften mögliche Verbesserungen hinsichtlich ihrer Sicherheit und Punktionsgenauigkeit, indem wir eine steuerbare Schleuse und ein 3D Mapping-System zum Einsatz brachten. Hintergrund: Die Endomyokardbiopsie gilt als Goldstandard zur Diagnostik von Myokarditiden und Kardiomyopathien, da sie histochemische, histologische und molekularbiologische Analysen ermöglicht, die für eine korrekte Diagnose und Therapie wichtig sind. Die Methodik hat eine verhältnismäßig geringe Sensitivität und einen niedrigen negativen prädiktiven Wert, da das Myokard derzeit unter Röntgendurchleuchtung biopsiert wird, ohne eine genaue Orientierung im dreidimensionalen Raum oder eine Kenntnis der z.T. diskontinuierlich betroffenen Myokardareale zu haben (sogenannter „sampling error“). Methoden: Wir testeten die Steuerbarkeit und die Punktionsgenauigkeit der Endomyokardbiopsie im Modellversuch, indem wiederholt Biopsien von acht verschiedenen linksventrikulären Herzregionen genommen werden. In einer dreiarmigen Studie optimierten wir zum einen die invasiv-apparative Ausrüstung und zum anderen die verfügbare Bildgebungsmodalität. Der Kontrollversuch I repräsentiert eine Analyse des aktuellen Standards, da hier Biopsien mit konventionellen Führungskathetern unter Röntgendurchleuchtung erfolgen. Der Kontrollversuch II untersucht, ob mittels einer steuerbaren Schleuse unter konventioneller Bildgebung eine Verbesserung erzielt werden kann. Im dritten Teil der Studie wurde die Röntgendurchleuchtung durch ein 3D elektroanatomisches Mapping-System ersetzt. Hiermit kann erstmalig die Machbarkeit der Navigation einer steuerbaren Schleuse in einem 3D Mapping-System geprüft werden. Ergebnisse: Jeder der eingesetzten konventionellen Führungskatheter ist für die Biopsie einer bestimmten Herzregionen geeignet, jedoch hat die konventionelle Methodik bei wiederholten Messungen allgemein eine niedrige Präzision (JR 4.0 Führungskatheter: 17,4 ± 4 mm, AL 1.0 Führungskatheter: 18,7 ± 5,7 mm, EBU 3.5 Führungskatheter: 18,3 ± 8,2 mm). Durch den Einsatz der neu entwickelten steuerbaren Schleuse konnten einige der gewünschten Stellen zwar korrekter biopsiert werden, aber eine allgemein sichere Ansteuerung aller Positionen war damit noch nicht möglich (9,5 ± 5,8 mm). Die bildliche Darstellung der steuerbaren Schleuse im 3D Mapping-System gelang sehr gut, die Biopsiezange konnte mit der Schleuse leicht und mit einer höheren Präzision an fast alle gewünschten Herzregionen navigiert werden (3,6 ± 2 mm). Fazit: Die hier vorgelegte Machbarkeitsstudie zeigt, dass der Einsatz einer neuentwickelten steuerbaren Schleuse in Kombination mit einem 3D Mapping-System möglich und erfolgversprechend ist. Die Ergebnisse der Biopsien im elektroanatomischen Mapping-Versuch wiesen im Mittel eine deutlich geringere Abweichung beim wiederholten Ansteuern der jeweilig gewünschten Zielregion auf. Mittels der neuentwickelten Technik kann somit die Endomyokardbiopsie im Vergleich zum Standardverfahren präziser und mit einer potentiell höheren Patientensicherheit durchgeführt werden. N2 - Objectives: In this proof of principle study we evaluated the current standard of leftventricular endomyocardial biopsy in an in-vitro test and developed and assessed improvements concerning safety and accurateness by making use of a steerable sheath and a 3D mapping system. Background: Endomyocardial biopsy represents the gold standard for diagnosing myocarditis and certain cardiomyopathies as it allows histology, immunhistochemistry and molecular biology studies which add to diagnosis and therapy. Nevertheless, the sensitivity and negative predictive value are comparatively low, as the biopsy is currently performed under fluorescence imaging without three-dimensional orientation and without exact knowledge of the partly discontinuously affected myocardium (so called sampling error). Methods: We tested the controllability and accuracy of endomyocardial biopsy in simulation tests by taking repetitive biopsies of 8 different leftventricular cardiac regions. In a three-arm study we first optimized the invasive technical equipment and second the available imaging technique. Control experiment one illustrates an analysis of the current standard as biopsies were taken with conventional diagnostic catheters under fluorescence imaging. In control experiment two the ability of improvement by the use of a steerable sheath under conventional imaging was checked. In part three of the study the fluorescence imaging was replaced by a three-dimensional electroanatomical mapping system. This simulation test represents a proof of principle for the first time navigation of a steerable sheath in a 3D mapping system. Results: Each tested standard guiding catheter was suited for biopsy of a particular part of the myocardium, although the conventional method in general proved to have a low accuracy in repetitive measurements (e.g. JR 4.0 guiding catheter: 17.4 ± 4 mm, AL 1.0 guiding catheter: 18.7 ± 5.7 mm, EBU 3.5 guiding catheter: 18.3 ± 8.2 mm). By the use of the newly developed steerable sheath in some requested regions the biopsy could be taken with higher precision, but a general save approach to all regions was still not possible (9.5 ± 5.8 mm). The electroanatomical mapping experiment revealed an excellent visualization of the steerable sheath in the 3D mapping system, allowing the biopsy forceps to be easily navigated by the sheath to almost all of the requested areas with higher precision (3.6 ± 2 mm). Conclusions: The use of a steerable sheath in combination with a 3D mapping system is possible and promising. The biopsy results of the electroanatomical mapping experiments showed on average clearly less deviation in repetitive approaches to the respective target areas. With the newly developed technique endomyocardial biopsy can be realized with higher accuracy and potentially more patient safety compared to the standard procedure. KW - Myokard KW - Schleuse KW - Navigation KW - Endomyokardbiopsie KW - steuerbare Schleuse KW - 3D Mapping System KW - endomyocardial biopsy KW - steerable sheath KW - 3D mapping system KW - Myokarditis KW - myocarditis Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-90321 ER - TY - THES A1 - Panjwani, Priyadarshini T1 - Induction, Imaging, Histo-morphological and Molecular Characterization of Myocarditis in the Rat to Explore Novel Diagnostic Strategies for the Detection of Myocardial Inflammation T1 - Induktion, Bildgebung und, Histo-morphologische sowie Molekulare Charakterisierung der Myokarditis im Rattenmodell zur Entwicklung neuer diagnostischer Strategien zum Nachweis von Herzmuskelentzündungen N2 - Fulminant myocarditis is rare but a potentially life-threatening disease. Acute or mild myocarditis following acute ischemia is generally associated with a profound activation of the host’s immune system. On one hand this is mandatory to protect the host’s heart by fighting the invading agents (i.e., bacteria, viruses or other microbial agents) and/or to induce healing and repair processes in the damaged myocardium. On other hand, uncontrolled activation of the immune system may result in the generation of auto-reactive (not always beneficial) immune cells. Myocarditis or inflammatory cardiomyopathy is characterized by focal or diffuse infiltrates, myocyte necrosis and/or apoptosis and subsequent fibrotic replacement of the heart muscle. In humans, about 30% of the myocarditis-patients develop dilated cardiomyopathy. As the clinical picture of myocarditis is multifaceted, it is difficult to diagnose the disease. Therefore, the main goal of the present work was to test and further develop novel non-invasive methods for the detection of myocardial inflammation by employing both contrast enhanced MRI techniques as well as novel nuclear tracers that are suitable for in vivo PET/ SPECT imaging. As a part of this thesis, a pre-clinical animal model was successfully established by immunizing female Lewis rats with whole-porcine cardiac myosin (CM). Induction of Experimental Autoimmune Myocarditis (EAM) is considered successful when anti-myosin antibody titers are increased more than 100-fold over control animals and pericardial effusion develops. In addition, cardiac tissues from EAM-rats versus controls were analyzed for the expression of various pro-inflammatory and fibrosis markers. To further exploit non-invasive MRI techniques for the detection of myocarditis, our EAM-rats were injected either with (1) ultra-small Paramagnetic iron oxide particles (USPIO’s; Feraheme®), allowing for in vivo imaging , (2) micron sized paramagnetic iron oxide particles (MPIO) for ex vivo inflammatory cell-tracking by cMRI, or (3) with different radioactive nuclear tracers (67gallium citrate, 68gallium-labeled somatostatin analogue, and 68gallium-labeled cyclic RGD-peptide) which in the present work have been employed for autoradiographic imaging, but in principle are also suitable for in vivo nuclear imaging (PET/SPECT). In order to compare imaging results with histology, consecutive heart sections were stained with hematoxylin & eosin (HE, for cell infiltrates) and Masson Goldner trichrome (MGT, for fibrosis); in addition, immuno-stainings were performed with anti-CD68 (macrophages), anti-SSRT2A (somatostatin receptor type 2A), anti-CD61 (β3-integrins) and anti-CD31 (platelet endothelial cell adhesion molecule 1). Sera from immunized rats strongly reacted with cardiac myosin. In immunized rats, echocardiography and subsequent MRI revealed huge amounts of pericardial effusion (days 18-21). Analysis of the kinetics of myocardial infiltrates revealed maximal macrophage invasion between days 14 and 28. Disappearance of macrophages resulted in replacement-fibrosis in formerly cell-infiltrated myocardial areas. This finding was confirmed by the time-dependent differential expression of corresponding cytokines in the myocardium. Immunized animals reacted either with an early or a late pattern of post-inflammation fibrosis. Areas with massive cellular infiltrates were easily detectible in autoradiograms showing a high focal uptake of 67gallium-citrate and 68gallium labeled somatostatin analogues (68Ga DOTA-TATE). Myocardium with a loss of cardiomyocytes presented a high uptake of 68gallium labeled cyclic RGD-peptide (68Ga NOTA-RGD). MRI cell tracking experiments with Feraheme® as the contrast-agent were inconclusive; however, strikingly better results were obtained when MPIOs were used as a contrast-agent: histological findings correlated well with in vivo and ex vivo MPIO-enhanced MRI images. Imaging of myocardial inflammatory processes including the kinetics of macrophage invasion after microbial or ischemic damage is still a major challenge in, both animal models and in human patients. By applying a broad panel of biochemical, histological, molecular and imaging methods, we show here that different patterns of reactivity may occur upon induction of myocarditis using one and the same rat strain. In particular, immunized Lewis rats may react either with an early or a late pattern of macrophage invasion and subsequent post-inflammation fibrosis. Imaging results achieved in the acute inflammatory phase of the myocarditis with MPIOs, 67gallium citrate and 68gallium linked to somatostatin will stimulate further development of contrast agents and radioactive-nuclear tracers for the non-invasive detection of acute myocarditis and in the near future perhaps even in human patients. N2 - Eine fulminant verlaufende Myokarditis ist eine seltene aber potentiell lebensbedrohliche Erkrankung. Akute oder chronische Myokarditis gehen generell mit einer starken Aktivierung des Immunsystems der Betroffenen einher. Zum einen ist dies notwendig, um das Herz durch Bekämpfung der Eindringlinge (z.B. Bakterien, Viren oder andere mikrobielle Erreger) zu schützen und/oder Heilungs- und Reparaturprozesse im geschädigten Myokard einzuleiten. Zum anderen kann eine unkontrollierte Aktivierung des Immunsystems aber auch zur Entstehung von (nicht immer vorteilhaften) auto-reaktiven Immunzellen führen. Eine Myokarditis oder entzündliche Kardiomyopathie ist charakterisiert durch fokale oder diffuse Infiltrate, Nekrose und/oder Apoptose der Myozyten und einen fortschreitenden fibrotischen Ersatz des Herzmuskelgewebes. Beim Menschen entwickeln etwa 30% der Myokarditis-Patienten eine dilatative Kardiomyopathie. Da das klinische Bild der Myokarditis sehr vielfältig sein kann, ist die Diagnosestellung dieser Erkrankung schwierig. Deshalb war es das Kernziel dieser Arbeit, nicht-invasive Methoden zum Nachweis myokardialer Entzündungen zu testen, und dabei neue Bildgebungsverfahren unter Einsatz von neuen MRT-Kontrastmitteln sowie neuen nuklearen Tracern, die auch für PET/SPECT geeignet wären, zu entwickeln. Diese Verfahren wurden von uns zunächst an einem human-analogen Ratten-Modell evaluiert, mit dem Ziel später evtl. auch einmal beim Menschen eingesetzt werden zu können. Für unser präklinisches Tiermodell wurden weibliche Lewis-Ratten mit kardialem Myosin aus Schweinen immunisiert. Die erfolgreiche Induktion einer „Experimentellen Autoimmunen Myokarditis (EAM)“ wurde durch einen signifikanten Anstieg der Anti-Myosin Antikörpertiter in immunisierten Tieren und die Ausbildung eines Perikardergusses (Echokardiographie) bestätigt. Zusätzlich wurde aus apikalem kardialem Gewebe RNA isoliert und die Expression verschiedener pro-inflammatorischer und pro-fibrotischer molekularer Marker untersucht. Um die Bildgebung mittels kontrast-verstärktem cMRT zu optimieren, wurden den Tieren entweder kleine Eisenoxid-Nanopartikel (Ultra small paramagnetic iron oxide particles, USPIO; Feraheme®), oder sog. ,,Micronsized paramagnetic iron oxide particles (MPIO)‘‘ für das Tracking inflammatorischer Zellen injiziert. Im daraufolgenden Schritt wurden radioaktive nukleare Tracer (67Gallium-Citrat, 68Gallium-markierte Somatostatin-Analoga und 68Gallium-markierte zyklische RGD-Peptide) injiziert, um dann Autoradiogramme von Herzschnitten zu gewinnen. KW - Ratte KW - inflammation KW - Myokarditis KW - Kernspintomografie KW - myocarditis KW - MRI KW - cardiovascular KW - Entzündung Y1 - 2015 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-122469 ER - TY - JOUR A1 - Werner, Rudolf A1 - Wakabayashi, Hiroshi A1 - Bauer, Jochen A1 - Schütz, Claudia A1 - Zechmeister, Christina A1 - Hayakawa, Nobuyuki A1 - Javadi, Mehrbod S. A1 - Lapa, Constantin A1 - Jahns, Roland A1 - Ergün, Süleyman A1 - Jahns, Valerie A1 - Higuchi, Takahiro T1 - Longitudinal \(^{18}\)F-FDG PET imaging in a Rat Model of Autoimmune Myocarditis JF - European Heart Journal Cardiovascular Imaging N2 - Aims: Although mortality rate is very high, diagnosis of acute myocarditis remains challenging with conventional tests. We aimed to elucidate the potential role of longitudinal 2-Deoxy-2-\(^{18}\)F-fluoro-D-glucose (\(^{18}\)F-FDG) positron emission tomography (PET) inflammation monitoring in a rat model of experimental autoimmune myocarditis. Methods and results: Autoimmune myocarditis was induced in Lewis rats by immunizing with porcine cardiac myosin emulsified in complete Freund’s adjuvant. Time course of disease was assessed by longitudinal \(^{18}\)F-FDG PET imaging. A correlative analysis between in- and ex vivo \(^{18}\)F-FDG signalling and macrophage infiltration using CD68 staining was conducted. Finally, immunohistochemistry analysis of the cell-adhesion markers CD34 and CD44 was performed at different disease stages determined by longitudinal \(^{18}\)F-FDG PET imaging. After immunization, myocarditis rats revealed a temporal increase in 18F-FDG uptake (peaked at week 3), which was followed by a rapid decline thereafter. Localization of CD68 positive cells was well correlated with in vivo \(^{18}\)F-FDG PET signalling (R\(^2\) = 0.92) as well as with ex vivo 18F-FDG autoradiography (R\(^2\) = 0.9, P < 0.001, respectively). CD44 positivity was primarily observed at tissue samples obtained at acute phase (i.e. at peak 18F-FDG uptake), while CD34-positive staining areas were predominantly identified in samples harvested at both sub-acute and chronic phases (i.e. at \(^{18}\)F-FDG decrease). Conclusion: \(^{18}\)F-FDG PET imaging can provide non-invasive serial monitoring of cardiac inflammation in a rat model of acute myocarditis. KW - positron emission tomography KW - Myokarditis KW - myocarditis KW - inflammation KW - 18F-FDG KW - PET KW - personalized treatment Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-165601 SN - 2047-2404 ER - TY - JOUR A1 - Howangyin, Kiave-Yune A1 - Zlatanova, Ivana A1 - Pinto, Cristina A1 - Ngkelo, Anta A1 - Cochain, Clément A1 - Rouanet, Marie A1 - Vilar, José A1 - Lemitre, Mathilde A1 - Stockmann, Christian A1 - Fleischmann, Bernd K. A1 - Mallat, Ziad A1 - Silvestre, Jean-Sébastien T1 - Myeloid-epithelial-reproductive receptor tyrosine kinase and milk fat globule epidermal growth factor 8 coordinately improve remodeling after myocardial infarction via local delivery of vascular endothelial growth factor JF - Circulation N2 - Background: In infarcted heart, improper clearance of dying cells by activated neighboring phagocytes may precipitate the transition to heart failure. We analyzed the coordinated role of 2 major mediators of efferocytosis, the myeloid-epithelial-reproductive protein tyrosine kinase (Mertk) and the milk fat globule epidermal growth factor (Mfge8), in directing cardiac remodeling by skewing the inflammatory response after myocardial infarction. Methods and Results: We generated double-deficient mice for Mertk and Mfge8 (Mertk\(^{-/-}\)/Mfge8\(^{-/-}\)) and challenged them with acute coronary ligature. Compared with wild-type, Mertk-deficient (Mertk\(^{-/-}\)), or Mfge8-deficient (Mfge8\(^{-/-}\)) animals, Mertk\(^{-/-}\)/Mfge8\(^{-/-}\) mice displayed greater alteration in cardiac function and remodeling. Mertk and Mfge8 were expressed mainly by cardiac Ly6C\(^{High and Low}\) monocytes and macrophages. In parallel, Mertk\(^{-/-}\)/Mfge8\(^{-/-}\) bone marrow chimeras manifested increased accumulation of apoptotic cells, enhanced fibrotic area, and larger infarct size, as well as reduced angiogenesis. We found that the abrogation of efferocytosis affected neither the ability of circulating monocytes to infiltrate cardiac tissue nor the number of resident Ly6C\(^{High}\) and Ly6C\(^{Low}\) monocytes/macrophages populating the infarcted milieu. In contrast, combined Mertk and Mfge8 deficiency in Ly6C\(^{High}\)/Ly6C\(^{Low}\) monocytes/macrophages either obtained from in vitro differentiation of bone marrow cells or isolated from infarcted hearts altered their capacity of efferocytosis and subsequently blunted vascular endothelial growth factor A (VEGFA) release. Using LysMCre\(^+\)/VEGFA\(^{fl/fl}\) mice, we further identified an important role for myeloid-derived VEGFA in improving cardiac function and angiogenesis. Conclusions: After myocardial infarction, Mertk- and Mfge8-expressing monocyte/macrophages synergistically engage the clearance of injured cardiomyocytes, favoring the secretion of VEGFA to locally repair the dysfunctional heart. KW - inflammation KW - macrophages KW - myocardial infarction KW - myocarditis KW - neovascularization, physiologic Y1 - 2016 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-190755 VL - 133 IS - 9 ER - TY - CHAP A1 - Werner, Rudolf A1 - Wakabayashi, Hiroshi A1 - Jahns, Roland A1 - Ergün, Süleyman A1 - Jahns, Valerie A1 - Higuchi, Takahiro T1 - PET-Guided Histological Characterization of Myocardial Infiltrating Cells in a Rat Model of Myocarditis T2 - European Heart Journal - Cardiovascular Imaging N2 - No abstract available. KW - Myokarditis KW - positron emission tomography KW - myocarditis KW - PET KW - 18F-FDG Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-161127 SN - 2047-2404 N1 - This is a pre-copyedited, author-produced version of an article accepted for publication in European Heart Journal Cardiovascular Imaging following peer review. The version of record . Eur Heart J Cardiovasc Imaging. ISSN: 2047-2404. Supplement, vol. 18, i1-i3, May 2017 is available online at: 10.1093/ehjci/jex071. VL - 18 IS - Supplement PB - Oxford University Press ER -