Aims Anxiety, depression, and reduced quality of life (QoL) are common in patients with implantable cardioverter-defibrillators (ICDs). Treatment options are limited and insufficiently defined. We evaluated the efficacy of a web-based intervention (WBI) vs. usual care (UC) for improving psychosocial well-being in ICD patients with elevated psychosocial distress. Methods and results This multicentre, randomized controlled trial (RCT) enrolled 118 ICD patients with increased anxiety or depres- ant sion [>= 6 points on either subscale of the Hospital Anxiety and Depression Scale (HADS)] or reduced QoL [<= 16 points on the Satisfaction with Life Scale (SWLS)] from seven German sites (mean age 58.8 +/- 11.3 years, 22% women). The primary outcome was a composite assessing change in heart-focused fear, depression, and mental QoL 6 weeks after randomization to WBI or UC, stratified for age, gender, and indication for ICD placement. Web-based intervention consisted of 6 weeks' access to a structured interactive web-based programme (group format) including self-help interventions based on cognitive behaviour therapy, a virtual self-help group, and on-demand support from a trained psychologist. Linear mixed-effects models analyses showed that the primary outcome was similar between groups (eta(2)(p) = 0.001). Web-based intervention was superior to UC in change from pre-intervention to 6 weeks (overprotective support; P= 0.004, eta(2)(p) =0.036), pre-intervention to 1 year (depression, P= 0.004, eta(2)(p) =0.032; self-management, P = 0.03, eta(2)(p) = 0.015; overprotective support; P = 0.02, eta(2)(p) = 0.031), and 6 weeks to 1 year (depression, P = 0.02, = 0.026; anxiety, P = 0.03, eta(2)(p) = 0.022; mobilization of social support, P= 0.047, eta(2)(p) = 0.018). Conclusion Although the primary outcome was neutral, this is the first RCT showing that WBI can improve psychosocial well- being in ICD patients.

Introduction: Sterile inflammation and activation of the NLRP3-Inflammosome have been implicated in diabetes. Mitochondrial ROS are a known trigger of the inflammasome. Whether inflammosome activation is causally involved in the pathogenesis of diabetic nephropathy and whether resident or bone marrow derived inflammatory cells are involved remains unkown.

Perfusion-cardiovascular magnetic resonance (CMR) is generally accepted as an alternative to SPECT to assess myocardial ischemia non-invasively. However its performance vs gated-SPECT and in sub-populations is not fully established. The goal was to compare in a multicenter setting the diagnostic performance of perfusion-CMR and gated-SPECT for the detection of CAD in various populations using conventional x-ray coronary angiography (CXA) as the standard of reference.

AIMS To determine in a multicentre, multivendor trial the diagnostic performance for perfusion-cardiac magnetic resonance (perfusion-CMR) in comparison with coronary X-ray angiography (CXA) and single-photon emission computed tomography (SPECT). METHODS AND RESULTS Of 241 eligible patients from 18 centres, 234 were randomly dosed with 0.01, 0.025, 0.05, 0.075, or 0.1 mmol/kg Gd-DTPA-BMA (Omniscantrade mark, GE-Healthcare) per stress (0.42 mg/kg adenosine) and rest perfusion study. Coronary artery disease (CAD) was defined as diameter stenosis > or =50% on quantitative CXA. Five CMR and eight SPECT studies (of 225 complete studies) were excluded from analyses due to inadequate quality (three blinded readers scored per modality). The comparison of CMR vs. SPECT was based on receiver operating characteristic (ROC) analysis. Perfusion-CMR at the optimal CM dose (0.1 mmol/kg) had similar performance as SPECT, if only the SPECT studies of the 42 patients with this dose were considered [area under ROC curve (AUC): 0.86 +/- 0.06 vs. 0.75 +/- 0.09 for SPECT, P = 0.12]; however, diagnostic performance of perfusion-CMR was better vs. the entire SPECT population (AUC: 0.67 +/- 0.05, n = 212, P = 0.013). CONCLUSIONS In this multicentre, multivendor trial, ROC analyses suggest perfusion-CMR as a valuable alternative to SPECT for CAD detection showing equal performance in the head-to-head comparison. Comparing perfusion-CMR with the entire SPECT population suggests CMR superiority over SPECT, which warrants further evaluation in larger trials.

Zusammenfassung Die kardiale Magnetresonanztomographie (CMR) ist ein vielversprechendes Verfahren, um verschiedene Aspekte der koronaren Herzerkrankung (KHK) zu detektieren. Während die MR-Koronarangiographie trotz beeindruckender Bildqualität noch nicht mit der konventionellen Koronarangiographie konkurrieren kann, liegen für die MR-Ischämie- und -Vitalitätsdiagnostik bereits gute klinische Daten vor. Die CMR-Narbendarstellung mittels „late enhancement“ ist inzwischen als Goldstandard etabliert, die MR-Plaquecharakterisierung im Bereich der Koronarien aktuell noch experimentell. Die CMR könnte zukünftig als nichtinvasives Screening-Verfahren eine signifikante KHK ausschließen, insbesondere bei asymptomatischen Patienten mit hohem Risiko, bei Vorliegen atypischer Beschwerden oder als Kontrolluntersuchung nach erfolgter PTCA oder operativer Revaskularisierung.

Objective: The aim of this prospective clinical study was to follow up patients with acute myocardial infarction from the ischemic event, over the primary coronary intervention (PCI), up to the chronic phase after survived myocardial infarction by non-invasive strain rate (SR) imaging and to determine its role in the assessment of transmurality of infarction.Methods: In all, 41 patients with acute S-T elevation infarction were examined immediately before, 3 days after, and 5 months after PCI. Regional myocardial function was assessed by the use of ultrasonic SR imaging and peak systolic SR and systolic strain were extracted. In addition, late-enhancement (LE) imaging with magnetic resonance imaging was done after 5 months to assess the transmurality of residual scar distribution.Results: Magnetic resonance imaging showed that 8 patients had no LE (complete recovery = no-scar group), 16 patients had subendocardial LE (non-transmural infarction = NT group), and 17 patients had a transmural LE (transmural infarction = T group) in the region of interest. Before PCI both SR and strain were markedly reduced in the ischemic segments compared with the nonischemic remote region in all 3 groups (SR: ischemia = -0.6 +/- 0.3 s(-1); remote = -1.3 +/- 0.4 s(-1), P <.001). Three days after PCI, systolic SR only increased significantly in the regions that were not transmurally infarcted. After 5 months the measurement of systolic strain could accurately distinguish the different groups. (no-scar group = -24 +/- 5%, NT group = -13 +/- 4%, T group = -1 +/- 3%).Conclusions: This clinical study shows that with SR imaging: (1) the ischemic segment can be precisely detected; (2) the absence of transmurality early after coronary intervention can be predicted; and (3) in the chronic phase the transmurality of scar distribution can be assessed.

Perfusion-cardiac magnetic resonance (CMR) has emerged as a potential alternative to single-photon emission computed tomography (SPECT) to assess myocardial ischaemia non-invasively. The goal was to compare the diagnostic performance of perfusion-CMR and SPECT for the detection of coronary artery disease (CAD) using conventional X-ray coronary angiography (CXA) as the reference standard.In this multivendor trial, 533 patients, eligible for CXA or SPECT, were enrolled in 33 centres (USA and Europe) with 515 patients receiving MR contrast medium. Single-photon emission computed tomography and CXA were performed within 4 weeks before or after CMR in all patients. The prevalence of CAD in the sample was 49. Drop-out rates for CMR and SPECT were 5.6 and 3.7, respectively (P 0.21). The primary endpoint was non-inferiority of CMR vs. SPECT for both sensitivity and specificity for the detection of CAD. Readers were blinded vs. clinical data, CXA, and imaging results. As a secondary endpoint, the safety profile of the CMR examination was evaluated. For CMR and SPECT, the sensitivity scores were 0.67 and 0.59, respectively, with the lower confidence level for the difference of 0.02, indicating superiority of CMR over SPECT. The specificity scores for CMR and SPECT were 0.61 and 0.72, respectively (lower confidence level for the difference: 0.17), indicating inferiority of CMR vs. SPECT. No severe adverse events occurred in the 515 patients.In this large multicentre, multivendor study, the sensitivity of perfusion-CMR to detect CAD was superior to SPECT, while its specificity was inferior to SPECT. Cardiac magnetic resonance is a safe alternative to SPECT to detect perfusion deficits in CAD.

Pathological changes in tissue often manifest themselves in an altered sodium gradient between intra- and extracellular space due to a malfunctioning Na + –K + pump, resulting in an increase in total sodium concentration in ischaemic regions. Therefore, 23 Na-MRI has the potential to non-invasively differentiate viable from non-viable tissue by detecting concentration changes of intra- and extracellular sodium. As the in vivo sodium signal shows a bi-exponential T 2 decay, with a short component of less than 1 ms, the accurate quantification of the total sodium content requires imaging techniques with ultra-short echo times (TE) below 0.5 ms. A 3D-radial projection technique has been developed which allows the acquisition of ECG-triggered sodium images of the human heart with a TE of 0.4 ms. With this pulse sequence 23 Na-MRI volunteer measurements of the head or the heart were performed in less than 18 min on a 1.5-T clinical scanner with an isotropic resolution of 10 mm 3 . The signal to noise ratio of the radial projection technique is twofold higher than that of a Cartesian gradient echo pulse sequence (TE = 3.2 ms). Radial 23 Na-MRI provides a tool for clinical studies, aiming at the differentiation of viable and non-viable tissue.

In this study absolute myocardial perfusion was determined using a spin-labeling magnetic resonance imaging (MRI) technique at 2 Tesla. The technique was applied to 16 healthy volunteers at resting conditions, adenosine-induced stress, and oxygen breathing. Overall myocardial quantitative perfusion was determined as 2.3 +/- 0.8 mL/g/min (rest), 4.2 +/- 1.0 mL/g/min (adenosine), and 1.6 +/- 0.6 mL/g/min (oxygen), respectively. T1 of left ventricular blood pool decreased from 1709 +/- 101 ms (rest) to 1423 +/- 61 ms (oxygen), whereas T1 of right ventricular blood did not change significantly (1586 +/- 126 ms and 1558 +/- 150 ms). In conclusion, the presented technique for quantification of myocardial perfusion is an alternative to contrast agent-based methods. The spin labeling method is noninvasive and easily repeatable and it could therefore become an important tool to study changes in myocardial perfusion under different vasodynamic states.

Purpose: To determine perfusion and coronary reserve in human myocardium. without contrast agent using a spin labeling technique. Materials and Methods: Assessment of myocardial perfusion is based on T1 measurements after global and slice-selective spin preparation. This magnetic resonance imaging (MRI) technique was applied to 12 healthy volunteers and 16 patients with suspected coronary artery disease under resting conditions and adenosine-induced vasodilatation. Results: In volunteers, quantitative perfusion was calculated as 2.4 +/- 1.2 mL/g/minute (rest) and 3.9 +/- 1.3 mL/g/minute (adenosine), respectively. Perfusion reserve was 2.1 +/- 0.6. In patients, when comparing perfusion reserve in the anterior and posterior myocardium, reduced values according to a stenotic supplying vessel could be seen in seven of 11 patients who underwent stress testing. In these patients, the relative difference of coronary reserve was 44% +/- 18%. Two patients without stenosis of coronary arteries showed no differences in coronary reserve (with a relative change of 2 +/- 2%). Conclusion: In patients with single-vessel coronary artery disease, differences in coronary reserve were clearly detectable when comparing anterior and posterior myocardium. The spin labeling method is noninvasive and easily repeatable, and it could therefore become an important tool to study changes in myocardial perfusion.

Ziel: Die Beschreibung der myokardialen Mikrozirkulation ist von entscheidender Bedeutung in der Diagnostik und Therapie der koronaren Herzkrankheit (KHK). Dies beruht darauf, dass sich die funktioneile Bedeutung einer Koronarstenose weitaus mehr in Veränderungen der Mikrozirkulation als in der Morphologie der Stenose widerspiegelt. Die myokardiale Perfusion (P) ist ein wichtiger Parameter der Mikrozirkulation, ihre Bestimmung mithilfe sogenannter First-pass Techniken ist verbreitet und in einzelnen Zentren auch in der klinischen Routine etabliert. Neben der qualitativen Abschätzung der Perfusion ist die Bestimmung der Perfusionsreserve ein guter Indikator für die Vitalität des Myokards. Die meisten MRT-Techniken zur Perfusionsbestimmung arbeiten jedoch mit Kontrastmitteln (KM), was eine begrenzte Anwendbarkeit und Wiederholbarkeit dieser Methoden beinhaltet. Darüberhinaus erlauben viele First-pass Ansätze nur die qualitative nicht aber quantitative Bestimmung der Perfusion. Ziel der vorliegenden Studie ist die KM-freie Bestimmung von myokardialer Absolutperfusion und Perfusionsreserve bei Probanden und Patienten mit KHK.

OBJECTIVES Evaluation of the severity of a coronary artery stenosis is of paramount importance for therapy. A relevant stenosis provokes post-stenotic microvascular dilation with capillary recruitment. This autoregulatory response was investigated in the present study by use of susceptibility-sensitive magnetic resonance imaging (MRI) without contrast agents.BACKGROUND Functional alterations of the microvascular system may be studied noninvasively and without a contrast agent by susceptibility-sensitive MRI, which is based on the paramagnetic property of deoxyhemoglobin. This effect, also referred to as the "blood oxygenation level-dependent (BOLD) effect," is investigated by phase relaxation (T-2*) measurements.METHODS In patients (n = 16) with single-vessel coronary artery disease, no history of myocardial infarction, normal left ventricular function at rest, and a positive stress echocardiogram, the susceptibility-sensitive parameter T-2* was assessed in the myocardium.RESULTS In regions associated with the stenotic artery, T-2* was significantly lower than in residual myocardium (p < 0.01). This difference in T-2* increased after application of the vasodilator dipyridamole (p < 0.001). In patients being re-investigated after therapeutic interventions, the microvascular dilation was partly removed.CONCLUSIONS For the first time, we could show that myocardial BOLD MRI detects post-stenotic capillary recruitment dependent on coronary artery stenosis. (C) 2003 by the American College of Cardiology Foundation.

Zusammenfassung. Die Beschreibung der myokardialen Mikrozirkulation ist von entscheidender Bedeutung in der Diagnostik und Therapie der koronaren Herzkrankheit (KHK). Dies beruht darauf, dass sich die funktionelle Bedeutung einer Koronarstenose weitaus mehr in Veränderungen der Mikrozirkulation als in der Morphologie der Stenose widerspiegelt. In unserer Arbeitsgruppe wurden verschiedene Techniken der Magnetresonanztomographie (MRT) zur Bestimmung der Myokardperfusion, des myokardialen Intrakapillarvolumens und der Kapillarrekrutierung entwickelt. Diese überwiegend kontrastmittelfrei arbeitenden Methoden wurden an Probanden optimiert und klinisch in ersten Studien an Patienten mit KHK eingesetzt. Durch diese, morphologische Messungen und Koronardarstellung ergänzenden, funktionellen MRT-Untersuchungsmethoden ist ein weiterer Schritt in Richtung eines “One-Stop-Shop” der Kardiologie möglich.