Clinical Research

Basis for our clinical research is the recently established cardio-oncological service at the University Hospital in Heidelberg, challenges in setting up a cardio-oncological sercvice. Modified from ->

Immune-Checkpoint-Inhibitor (ICI) – associated myocarditis – We are currently investigating predicting factors of ICI – associated myocarditis. We collaborate with the UCSF (San Francisco) and the Hopital Salpetière (Paris) and a group of international partners in order to establish standardized operating procedures for the diagnosis of ICI – associated myocarditis. (Finke et al. Front Cardiovasc Med 2021; Finke et al. Cancers 2021; Lehmann et al. JAMA Cardiol 2021; Lehmann et al. Circulation 2023)

Heatmap of differentially regulated genes in ICIM in comparison with DCM and VIM. The cluster of genes that is upregulated the most in ICIM is marked with a red square as ‘ICIM-specific gene program’. The top 10 genes of this gene program are listed on the right side. DCM: dilated cardiomyopathy; ICI: immune checkpoint inhibitor; ICIM: ICI-associated myocarditis; VIM: virus-induced myocarditis. Modified from Finke et al..

Advanced cardiac imaging in Cardio-Oncology – In collaboration with the Department of Nuclear Medicine at the University Hospital of Heidelberg we investigate the opportunities of established and novel tracer for the us of cardiovascular pathologies. Current projects are focused on the activation of cardiac fibroblasts and metabolic imaging by the use of 18F-FDG. Beside nuclear imaging techniques, we investigate the use of early cardiac magnetic resonance imaging (cMRI) to determine individual risk for cardiac side effects of oncological therapies. (Heckmann et al. Circ Cardiovasc Imaging 2020; Heckmann et al. ESC Heart Failure 2019; Finke et al. Front Cardiovasc Med 2021)

FAPI PET/CT illustrates ICI-associated myocarditis. (A) Bulls Eye Illustration of standardized uptake values (SUVs) showing their distribution in the myocardium of the left ventricle in 17 defined areas. The enrichment is shown for ICI-associated myocarditis patients #1–#3. (B) In comparison, the median signal of patients which have received immune checkpoint inhibitors (n = 23) without signs of myocarditis is summarized. Modified from Finke et al..

Cardiac biomarker in Cardio-Oncology – Based on data from our HEidelberg Cardio-Oncology REgistry (HEartCORE), we investigate the use of cardiac troponin (hs-cTnT) to identify high-risk patients. We are further conducting prospective clinical trials to investigate biomarker-driven surveillance strategies for cancer patients. (Lehmann et al. Clin Res Cardiol 2021; Finke et al. ESCHF 2021; Lehmann et al. Circulation 2023)

Number of patients according to their visit as indicated with ordinary numbers. Shown are the years 2016–2021. Violin blot of the 1st follow-up visit. 43 follow-up visits were excluded (> 365 days after initial visit). modified from ->.
Kaplan–Meier curves on all-cause mortality (ACM). Patients are divided into two groups according to their hs-cTnT level (≥/< median of 7 ng/L). Log rank test P-value as indicated. Hs-cTnT, high sensitivity cardiac troponin T. modified from ->

Standardized workflows in clinical Cardio-Oncology – Together with our national and international network, we establish standardized operating procedures for surveillance of oncological patients who receive potential cardiotoxic treatments. We further develop strategies for the diagnosis and treatment of cardiac side effects of oncological diseases. We further work on establishing a german-wide network of cardio-oncology units. (Rassaf et al. Clin Res Cardiol 2020; Lehmann et al. JAMA Cardiol 2021)

Basic recommendation for the assessment of cancer patients. Modified from ->.

Contact Person: Daniel Finke, Markus Heckmann, Frederic Stein