[Precision medicine enhances personalized medicine in cardiology]. / Präzisionsmedizin vertieft die personalisierte Medizin in der Kardiologie.

Personalized medicine and precision medicine, frequently used synonymously, shall be clearly differentiated. Accordingly, personalization in cardiac medicine is based on the clinical presentation of a patient, as well as his/her cardiovascular risk factors and comorbidities, electrocardiography, imaging, and biomarkers for myocardial load and ischemia. Personalization is based on large clinical trials with detailed subgroup analyses and is practiced on the basis of guidelines. Further in depth personalization is achieved by precision medicine, which is based on innovative imaging for myocardial structure, coronary morphology, and electrophysiology. From the clinical perspective, genome analyses are relevant for comparatively rare monogenetic cardiovascular diseases. While these as well as transcriptome and metabolome analyses play a significant role in cardiovascular research with great translation potential, they have not yet been broadly introduced in the diagnosis, prevention, and treatment of complex cardiovascular diseases. Furthermore, digital technologies have considerable potential in cardiovascular precision medicine. On the one hand, this is based on the frequency of the diseases with the availability of Big Data and, on the other hand, on the availability of bio-signals and sensors of those signals in cardiovascular diseases.

[MRI-based catheter ablation : Current status and outlook]. / MRT-basierte Katheterablation : Aktueller Stand und Ausblick.

Fluoroscopy-based catheter ablation has established itself as a standard procedure for the treatment of patients with cardiac arrhythmias. However, it is subject to certain limitations with regard to the visualization of arrhythmogenic substrate and ablation lesions and is associated with radiation exposure. Within the framework of studies, initial experience with MRI-based, radiation-free electrophysiological examinations and ablations could be gained. The integration of MRI technology into electrophysiological procedures promises numerous advantages. The ability to operate in a radiation-free environment during MRI-based catheter ablation is significant and promising. Furthermore, MRI provides important procedure-relevant information in terms of visualization of individual arrhythmogenic substrate. In order to further improve immediate and long-term ablation success, especially in the context of complex arrhythmias and structural heart disease, the direct and successful integration of MRI-generated findings into the ablation process is of utmost importance. The future of MRI-based catheter ablation could thus lie in particular in the treatment of more complex cardiac arrhythmias, which require personalized therapy paths. In this respect, however, the data situation is still extremely limited. Further technical developments and larger studies are indispensable in order to gain further important insights into the feasibility, safety and success rate of MRI-based invasive electrophysiological diagnostics and therapy in comparison to conventional ablation methods.

[Treatment of premature ventricular contractions in patients with structural heart disease : Insights from imaging]. / Therapie der ventrikulären Extrasystolen bei strukturellen Herzerkrankungen : Welchen Mehrwert hat die Bildgebung?

The diagnosis of premature ventricular contractions (PVC) is presumptively based on the presence of frequent symptoms. Particularly in patients with a relatively low PVC burden, the relationship between the PVCs and an individual arrhythmia substrate can be challenging to ascertain. Late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (CMR) has been found to be beneficial in identifying the presence of potential individual arrhythmia substrates even in patients with normal left ventricular function. Consequently, CMR has been useful in risk stratification of patients with PVCs. The authors aimed to demonstrate and discuss the current role and future use of CMR in the diagnostic algorithm to guide PVC ablation.

[Coherent mapping in adults with congenital heart disease : Role of the novel coherent mapping technique for treatment of atrial tachycardia in adults with congenital heart disease]. / Coherent-Mapping bei angeborenen Herzfehlern : Stellenwert des neuen Coherent-Modules zur Behandlung von atrialen Tachykardien bei Erwachsenen mit angeborenen Herzfehlern.

A 31-year-old woman with a surgically corrected double outlet right ventricle and recurrent narrow QRS complex tachycardia was admitted to our hospital. The patient was scheduled for electrophysiology study. Coherent mapping identified the critical isthmus as a slow conduction area within posterolateral intercaval scar tissue. A continuous line of ablation was applied resulting in termination of the atrial tachycardia at the site of the critical isthmus from coherent mapping. Thus, coherent mapping facilitates complex ablation procedures and improves efficacy and efficiency.

Current role of cardiac and extra-cardiac pathologies in clinically indicated cardiac computed tomography with emphasis on status before pulmonary vein isolation.

PURPOSE: The aim of this study was to assess the incidence of cardiac and significant extra-cardiac findings in clinical computed tomography of the heart in patients with atrial fibrillation before pulmonary vein isolation (PVI). MATERIALS AND METHODS: 224 patients (64 ±â€Š10 years; male 63 %) with atrial fibrillation were examined by cardiac 64-slice multidetector CT before PVI. Extra-cardiac findings were classified as "significant" if they were recommended to additional diagnostics or therapy, and otherwise as "non-significant". Additionally, cardiac findings were documented in detail. RESULTS: A total of 724 cardiac findings were identified in 203 patients (91 % of patients). Additionally, a total of 619 extra-cardiac findings were identified in 179 patients (80 % of patients). Among these extra-cardiac findings 196 (32 %) were "significant", and 423 (68 %) were "non-significant". In 2 patients (1 %) a previously unknown malignancy was detected (esophageal cancer and lung cancer, local stage, no metastasis). 203 additional imaging diagnostics followed to clarify the "significant" findings (124 additional CT, costs 38 314.69 US dollars). Overall, there were 3.2 cardiac and 2.8 extra-cardiac findings per patient. Extra-cardiac findings appear significantly more frequently in patients over 60 years old, in smokers and in patients with a history of cardiac findings (p <0.05). CONCLUSION: Cardiac CT scans before PVI should be screened for extracardiac incidental findings that could have important clinical implications for each patient.

[Radiation exposure and air quality aboard commercial airplanes]. / Strahlenexposition und Luftqualität an Bord von Verkehrsflugzeugen.

The amount of exposure to cosmic radiation during air travel is next to a number of additional factors mainly dependent on the flight level of the aircraft. Flying in an altitude of 41,000 feet equaling 12,800 meters the amount of radiation exposure is of course considerable higher than on the ground. The overall exposure of flying personnel to cosmic radiation flying about 600-700 hours per year can be estimated between 3 and 6 mSv (300-600 mrem). According to the flight hours of passengers, the radiation exposure is much lower and can be neglected for most of the travelers final judgement about the possible risks for flying personnel as far as a higher incident of malignant tumors is concerned has not jet been finally made. Talking of cabin air quality compromises have to be made and thus the well-being of the passengers can be negatively influenced. Air pressure and oxygen partial pressure correspond to an altitude of 2400 meters (8,000 feet) above sea level with possible consequences to the cardiopulmonary system. Increased level of ozone can lead to respiratory problems of the upper airways, increased carbon dioxide may cause hyperventilation. The mucous membranes of the respiratory tract are dried out due to the extremely low humidity of the cabin air. Smoking during flight results in an increase of the nicotine blood levels even in passengers sitting in the non-smoking areas. In modern aircraft the fresh-air flow cannot be regulated individually any more, this may lead to an insufficient circulation of used air in relation to fresh air and could cause the phenomena of hanging smoke. There has always been the idea that there is an increased risk for passengers for acquiring infectious diseases. However this is not the case. Modern HEPA-filter prevent an accumulation even of the smallest particles including bacteria and viruses within the recirculation flow in the cabin air. The overall risk of getting an infectious disease is significantly lower than in other ground operated public means of transportation.

Cytogenetic investigations in flight personnel.

During long-distance flights at high altitudes flight personnel are exposed to cosmic radiation. In order to determine whether there are biological effects of such low dose radiation exposure in aircrew, chromosomal aberrations were investigated in 59 female cabin attendants and a matched control group of 31 members of station personnel. The mean number of dicentric chromosomes amounts to 1.3 (95% CI 1.0-1.6) per 1000 cells in cabin attendants and 1.4 (95% CI 1.0-1.9) per 1000 cells in controls. In an additional control group of 56 female clerks from Berlin the mean frequency of dicentric chromosomes was 1.3 (95% CI 1.0-1.6). Neither in dicentric frequency and distribution nor in other aberrations was a significant difference between the groups of flight and station personnel found. The high frequency of multi-aberrant cells was remarkable in flight personnel as well as in station personnel. The reason for this phenomenon is unknown and needs further investigation.

Economy class syndrome: rheology, fluid balance, and lower leg edema during a simulated 12-hour long distance flight.

In order to study pathological changes that might lead to deep vein thrombosis and pulmonary embolism in long-distance air travel passengers, 12 healthy volunteers were investigated during 4 simulated 12-h flights (day and night). The influence of repeated leg exercise was compared with constant sitting. Plasma viscosity, hematocrit, albumin, fluid balance, and lower leg swelling were measured. Rheological studies showed only circadian rhythm alterations. An average of 1150 ml fluid was retained, which correlated with an increase in body weight. The lower leg volume increase was significant, but not pathological. Periodic leg exercising showed no measurable preventive effects. These changes in healthy human volunteers are within physiological variations and are not sufficient to provide a definitive cause of venous thrombosis in healthy passengers. They do, however, suggest alterations produced by long-distance air travel that could intensify the risk of developing deep venous thrombosis in passengers with predisposing risk factors.