Performance figures of invasive cardiology in Germany 2006 and 2007 focussing on coronary artery disease

Horstkotte, Dieter; Wiemer, Marcus; Buuren, Frank van

doi:10.1007/s00392-010-0244-5

Cited by 8 publications

(5 citation statements)

References 28 publications

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“…Albeit an increased rate of such events was not detectable in human patients in short- [44] and long-term [45] observations, these findings cannot simply be transferred to the situation in the brain. Thus, thorough assessment of possibly enhanced mineralisation, its precise location (intra- versus extravascular, grey versus white matter) and its relevance will be important in further translational studies, as intracerebral mineral deposits represent a risk factor for ischaemic stroke [46] and thus may be detrimental for functional recovery following cerebral ischaemia.…”

Section: Discussionmentioning

confidence: 99%

Histopathological Investigation of Different MCAO Modalities and Impact of Autologous Bone Marrow Mononuclear Cell Administration in an Ovine Stroke Model

Boltze

Nitzsche

Geiger

et al. 2011

Transl. Stroke Res.

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Translational researchers and clinicians recommend the use of large animal models in preclinical stroke research. This represents an important part of a strategy aiming to prevent past translational failures in future therapeutic developments. Thirty-five Merino rams were subjected to sham surgery (n = 3), one-branch middle cerebral artery occlusion (MCAO, n = 8) or total MCAO (n = 24). Twelve animals from the latter group received intravenous administration of 4 × 106 autologous mononuclear bone marrow cells (BM MNC) per kilogram 24 h after total MCAO. Animals were sacrificed at day 49 post MCAO. Histological investigations were performed to reveal (1) the impact of different MCAO modalities on a cellular level and (2) the influence of BM MNC therapy following stroke. Clear differences between one-branch and total MCAO were observed histologically with results being comparable to those seen in human patients. BM MNC treatment reduced final lesion extension, lymphocytic infiltration and axonal degeneration after MCAO. The sheep model may represent a feasible tool for translational stroke research as pathohistological findings mimic the situation in humans. Histological evidence was found for beneficial impact of autologous BM MNC therapy. Further studies are needed to assess the neurofunctional impact of the approach in the gyrencephalic brain.

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Section: Discussionmentioning

confidence: 99%

Histopathological Investigation of Different MCAO Modalities and Impact of Autologous Bone Marrow Mononuclear Cell Administration in an Ovine Stroke Model

Boltze

Nitzsche

Geiger

et al. 2011

Transl. Stroke Res.

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“…Such improvements could fuel a number of cardiovascular MR (CMR) applications, including the characterization of ischemic and inflammatory disorders on the myocardial tissue level, mapping myocardial microstructure and parametric imaging [3]–[9]. However, intracoronary stents commonly used in percutaneous interventions – a revascularization procedure for treatment of acute and chronic coronary artery disease (CAD) [10]–[12] - are currently considered to be contra-indications for MRI using magnetic field strengths of 7.0 T and higher. This is of profound relevance for the development of CMR applications at ultrahigh fields and their transfer into clinical practice due to an increasing patient population that underwent percutaneous coronary interventions and stent implementation with stent implantation rates of up to 91% [13].…”

Section: Introductionmentioning

confidence: 99%

Detailing Radio Frequency Heating Induced by Coronary Stents: A 7.0 Tesla Magnetic Resonance Study

et al. 2012

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The sensitivity gain of ultrahigh field Magnetic Resonance (UHF-MR) holds the promise to enhance spatial and temporal resolution. Such improvements could be beneficial for cardiovascular MR. However, intracoronary stents used for treatment of coronary artery disease are currently considered to be contra-indications for UHF-MR. The antenna effect induced by a stent together with RF wavelength shortening could increase local radiofrequency (RF) power deposition at 7.0 T and bears the potential to induce local heating, which might cause tissue damage. Realizing these constraints, this work examines RF heating effects of stents using electro-magnetic field (EMF) simulations and phantoms with properties that mimic myocardium. For this purpose, RF power deposition that exceeds the clinical limits was induced by a dedicated birdcage coil. Fiber optic probes and MR thermometry were applied for temperature monitoring using agarose phantoms containing copper tubes or coronary stents. The results demonstrate an agreement between RF heating induced temperature changes derived from EMF simulations versus MR thermometry. The birdcage coil tailored for RF heating was capable of irradiating power exceeding the specific-absorption rate (SAR) limits defined by the IEC guidelines by a factor of three. This setup afforded RF induced temperature changes up to +27 K in a reference phantom. The maximum extra temperature increase, induced by a copper tube or a coronary stent was less than 3 K. The coronary stents examined showed an RF heating behavior similar to a copper tube. Our results suggest that, if IEC guidelines for local/global SAR are followed, the extra RF heating induced in myocardial tissue by stents may not be significant versus the baseline heating induced by the energy deposited by a tailored cardiac transmit RF coil at 7.0 T, and may be smaller if not insignificant than the extra RF heating observed under the circumstances used in this study.

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“…In the German health care system, the optimum pre-test likelihood of CAD for a CMR-based strategy is below 65%. However, in 2008, only 43% of patients after CXA were revascularized [17], indicating that an invasive approach was applied in a patient population with a relatively low CAD prevalence of approximately 43%. Finally, in Switzerland, the theoretical threshold for a directly invasive strategy is at 62% CAD prevalence.…”

Section: Discussionmentioning

confidence: 99%

“…However, the invasive nature and radiation exposure of CXA and FFR limit their usefulness in a screening process [16]. Considering the fact that CXA is still extensively used in many industrialized countries as an early step in the work-up of suspected CAD [17,18], and further considering that FFR is recommended in recent guidelines, the combination of CXA + FFR was one diagnostic strategy to be assessed in the current study with respect to its cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Comparative cost-effectiveness analyses of cardiovascular magnetic resonance and coronary angiography combined with fractional flow reserve for the diagnosis of coronary artery disease

Moschetti

Favre

Pinget

et al. 2014

Journal of Cardiovascular Magnetic Resonance

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AbstractsBackgroundAccording to recent guidelines, patients with coronary artery disease (CAD) should undergo revascularization if significant myocardial ischemia is present. Both, cardiovascular magnetic resonance (CMR) and fractional flow reserve (FFR) allow for a reliable ischemia assessment and in combination with anatomical information provided by invasive coronary angiography (CXA), such a work-up sets the basis for a decision to revascularize or not. The cost-effectiveness ratio of these two strategies is compared.MethodsStrategy 1) CMR to assess ischemia followed by CXA in ischemia-positive patients (CMR + CXA), Strategy 2) CXA followed by FFR in angiographically positive stenoses (CXA + FFR). The costs, evaluated from the third party payer perspective in Switzerland, Germany, the United Kingdom (UK), and the United States (US), included public prices of the different outpatient procedures and costs induced by procedural complications and by diagnostic errors. The effectiveness criterion was the correct identification of hemodynamically significant coronary lesion(s) (= significant CAD) complemented by full anatomical information. Test performances were derived from the published literature. Cost-effectiveness ratios for both strategies were compared for hypothetical cohorts with different pretest likelihood of significant CAD.ResultsCMR + CXA and CXA + FFR were equally cost-effective at a pretest likelihood of CAD of 62% in Switzerland, 65% in Germany, 83% in the UK, and 82% in the US with costs of CHF 5′794, € 1′517, £ 2′680, and $ 2′179 per patient correctly diagnosed. Below these thresholds, CMR + CXA showed lower costs per patient correctly diagnosed than CXA + FFR.ConclusionsThe CMR + CXA strategy is more cost-effective than CXA + FFR below a CAD prevalence of 62%, 65%, 83%, and 82% for the Swiss, the German, the UK, and the US health care systems, respectively. These findings may help to optimize resource utilization in the diagnosis of CAD.

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Performance figures of invasive cardiology in Germany 2006 and 2007 focussing on coronary artery disease

Cited by 8 publications

References 28 publications

Histopathological Investigation of Different MCAO Modalities and Impact of Autologous Bone Marrow Mononuclear Cell Administration in an Ovine Stroke Model

Histopathological Investigation of Different MCAO Modalities and Impact of Autologous Bone Marrow Mononuclear Cell Administration in an Ovine Stroke Model

Detailing Radio Frequency Heating Induced by Coronary Stents: A 7.0 Tesla Magnetic Resonance Study

Comparative cost-effectiveness analyses of cardiovascular magnetic resonance and coronary angiography combined with fractional flow reserve for the diagnosis of coronary artery disease

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