Translational Cardiovascular Outcomes Research
We are committed to improving outcomes of patients with cardiovascular disease by linking clinical cohorts, biobanking and large-scale data with mechanistic research.
Dr. Annette Büllesbach
Section co-lead Cardiogenic shock & Heart failure
Dr. Adrian Heidenreich
Section co-lead Cardiogenic shock & Heart failure
Dr. Jonas Salm, MSc
Section lead Cardio-Obstetrics and CV risk
Section lead Vascular medicine
Dr. Sebastian König
Investigator (Cardiogenic shock)
Dr. Philipp Albrecht
Investigator (Cardiogenic shock)
Dr. Leonie Ziegler
Investigator (Cardiogenic shock)
Eva Herrmann
Investigator (Cardio-Obstetrics)
Marion Klima
Study Nurse
Niklas Hempfling
MD student (ARCTIC)
Luca Rappold
MD student (MIRACLE)
Philipp Domke
MD student (MIRACLE)
Leonie Walz
MD student (MIRACLE)
Alexander Baßler
MD student (MIRACLE)
Jakob Madlinger
MD student (MIRACLE)
Johanna Weigold
MD student (MIRACLE)
Clara-Mina Aug
MD student (MIRACLE)
Anna Kopetschke
Midwife & MD student (CHYBS)
Mirjam Paul
MD student (PRECARD)
Stefanie Kleeb
MD student (PRECARD)
Debora Ehrhardt
Student researcher (TWILIGHT)
Cardiogenic shock (CS) is a life-threatening state of severely reduced cardiac output that leads to tissue hypoperfusion and multiorgan failure; in-hospital mortality still exceeds 30%. Most cases are caused by acute myocardial infarction or acutely decompensated heart failure, but CS due to arrhythmias, valvular disease, right ventricular failure or septic overlap is increasingly recognized. Survivors remain at high risk: many face substantial long-term morbidity and excess mortality, yet little is known about who is most vulnerable and how follow-up care should be organized.
To enhance precision phenotyping and risk stratification, we designed MIRACLE (Multimodal phenotyping in patients referred with acute cardiac failure), a multicenter, prospective, longitudinal cohort study with sequential biobanking. Our goal is a comprehensive clinical and molecular characterization of patients with CS across all etiologies and severities. The substudy MIRACLE-SurvivorS focuses on CS survivors. It tracks patient-reported outcomes and clinical endpoints through the first year, including a dedicated outpatient visit with repeat biobanking six months after the event.
Registration: ClinicalTrials.gov NCT07515508
Funding: Start-up funding from Programm Klinische Studien of the Medical Faculty of the University of Freiburg, and from the Else Kröner-Fresenius-Foundation
Recruitment status: REDCap live status
Collaboration: We welcome collaborations. Data and biomaterial sharing with international partners is possible on request.
Man versus machine in advanced heart failure: Can AI beat clinicians?; Eur J Heart Fail, 2025
Bacmeister, L, Codina, P, Westermann, D
Serum Concentrations of Matrix Metalloproteinase-1 and Procollagen Type I Carboxy Terminal Propeptide Discriminate Infarct-Like Myocarditis and Non-ST-Segment-Elevation Myocardial Infarction; J Am Heart Association, 2024
Bacmeister, L*, Cavus, E*, …, Buellesbach, A, Heidenreich, A,…, Lindner, D
Chronic Activation of Tubulin Tyrosination Improves Heart Function; Circ Res, 2024
Pietsch, N, …, Bacmeister, L, …, Lindner,D, …, Carrier,L
Inflammation and fibrosis in murine models of heart failure; Bas Res Cardiol, 2019
Bacmeister, L, …, Westermann, D, Lindner, D
Pregnancy is a cardiovascular stress test. Hypertensive disorders of pregnancy (HDPs), including conditions such as preeclampsia, are major causes of maternal morbidity and are strongly linked to an increased risk of future cardiovascular disease in women. While many studies have demonstrated this association, the underlying mechanisms remain unclear, and there is limited understanding of the specific biomarkers and phenotypes during pregnancy that may predict premature cardiovascular disease in women—an area that has not received the attention it deserves until recently.
Through the TWILIGHT project, we aim to leverage pregnancy as an early window to investigate long-term cardiovascular health in women by integrating a Danish, population-based pregnancy cohort with national level registry data. In CHYBS, a prospective registry of women after HDP, we focus on the early postpartum period to understand who develops chronic hypertension and how this risk can be modified. In addition, we use large population-based cohorts such as UK Biobank and the German National Cohort (NAKO) to study how gestational health relates to women’s cardiovascular health later in life. Our goal is to translate these findings into targeted prevention strategies that start right after delivery, for women at the highest cardiovascular risk.
PRECARD evaluates clinical outcomes and the long-term cardiovascular impact of pregnancy in women with congenital or acquired heart disease.
TWILIGHT (The window into lifetime cardiovascular risk of women: gestational health) uses pregnancy as an early window to predict women’s short- and long-term cardiovascular health. Together with the Odense Child Cohort, we study women who were pregnant between 2010 and 2012. We link their pregnancy outcomes and blood samples drawn during gestation with long-term health data from the Danish National Patient Register to identify biomarkers and mechanisms of premature cardiovascular disease.
For recent publications, click here.
CHYBS is a prospective registry of women after a hypertensive disorder of pregnancy (HDP), integrated in our specialized outpatient clinic. We follow affected women from the immediate postpartum period onward to understand who develops chronic hypertension, which mechanisms are involved, and how this risk can be modified. Blood samples, including plasma, DNA and peripheral blood mononuclear cells, are biobanked alongside detailed cardiovascular phenotyping to enable molecular and epigenetic analyses.
PRECARD (Pregnancy in women with cardiac disease) evaluates clinical outcomes and the long-term cardiovascular impact of pregnancy in women with congenital or acquired heart disease. It also explores how women experience pregnancy and care, including their expectations, the collaboration among treating physicians, and their long-term quality of life. The aim is to improve care and outcomes in this population and to guide interdisciplinary patient management.
Project updates: Preliminary findings have been presented at the 9th International Congress on Cardiac Problems in Pregnancy (CPP 2025) and the German Cardiac Society’s annual congress in 2025.
High-Sensitivity Cardiac Troponin I Enhances Preeclampsia Prediction Beyond Maternal Factors and the sFlt-1/PlGF Ratio; Circulation, 2024
Bacmeister, L, …, Buellesbach, A, ... Dechend, R*, Westermann, D*, Zeller, T*
Third-Trimester NT-proBNP for Pre-eclampsia Risk Prediction: A Comparison with sFlt-1/PlGF in a Population-Based Cohort; JACC:Advances, 2025
Bacmeister, L, …, Buellesbach, A, …, Heidenreich, A,… Andersen, M*, Dechend, R*, Westermann, D*
Clinical Factors and Biomarkers During Pregnancy and Risk of Cardiovascular Disease; JAMA Cardiology, 2026
Bacmeister, L, …, Buellesbach, A, Heidenreich, A,… Dechend, R, Westermann, D*, Andersen, M*
Antenatal Care as a Strategic Window for Long-Term Cardiovascular Risk Assessment ; JACC:Advances, 2026
Ehrhardt, D, Salm, J, …, Bacmeister, L
Arterial disease is a systemic condition. Peripheral artery disease (PAD) affects more than 200 million people worldwide, and those affected face a high risk of myocardial infarction, stroke, amputation and death. Yet PAD remains underdiagnosed and undertreated, and many of the factors that shape outcomes, such as infection, inflammation, cardiac comorbidity and access to care, are poorly understood.
In WOUNDSinCLTI, a multinational prospective cohort with biobanking, we investigate why patients with infected chronic limb-threatening ischemia (CLTI) lose their limb despite revascularization. The randomized HFpAD-Pilot trial tests whether treating aorto-iliac stenosis improves cardiac function in patients with heart failure with preserved ejection fraction (HFpEF). ARCTIC uses sequential PET imaging to study arterial inflammation in cancer patients treated with immune checkpoint inhibitors. Through endovascular outcomes research, we turn real-world data from our interventional program into clinical decision tools, such as the multicenter bleeding-risk model REASON for catheter-directed thrombolysis. Finally, we use nationwide hospital statistics, health-insurance claims and international mortality data to describe the burden, treatment and outcomes of vascular disease at the population level.
Chronic limb-threatening ischemia (CLTI) is the most advanced stage of PAD. Once ischemic wounds become infected, the risk of amputation rises sharply; in our own retrospective cohort, limb outcomes after endovascular therapy depended on the causative pathogen. WOUNDSinCLTI is a prospective, multinational, multicenter cohort study of patients with infected CLTI undergoing revascularization. We combine standardized microbiological, vascular and clinical phenotyping with 24-month follow-up and pre-interventional biobanking. Our goal is to identify host and pathogen signals that predict limb loss and to define patients who may benefit from intensified treatment.
Recruitment status: Recruiting since August 2025; REDCap live status
Participating centers: University Medical Center Hamburg-Eppendorf, Medical University of Graz, University of Florence
Collaboration: We welcome additional centers. Data and biomaterial sharing is possible on reasonable request.
Heart failure with preserved ejection fraction (HFpEF) is common, difficult to treat and frequently coexists with PAD. We hypothesize that flow-limiting stenoses of the pelvic arteries add to the diastolic load and that relieving them can improve cardiac function and exercise capacity. This would open an interventional approach to a heart failure phenotype with few effective treatment options. The randomized HFpAD-Pilot trial tests this concept as a first step towards a multicenter outcomes trial.
Registration: DRKS00041450
Funding: Start-up funding from the Programm Klinische Studien of the Medical Faculty of the University of Freiburg
Recruitment status: Start of recruitment planned for January 2027
Project updates:
Recent findings have been published in Circulation: Cardiovascular Imaging
Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment by enhancing antitumor T-cell activity, leading to significant improvements in outcomes across various cancers. Over the past decade, eligibility for ICI therapy has expanded rapidly. However, concerns about the cardiovascular risks of ICIs have emerged, particularly the potential for accelerated vascular atherosclerosis. ICIs may trigger T-cell autoreactivity against autoantigens, leading to arterial inflammation and an increased risk of long-term cardiovascular events in treated patients.
The ARCTIC project aims to investigate the ability of arterial arterial 2-deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) uptake in routine staging positron emission tomography (PET) scans to detect arterial inflammation in cancer patients treated with ICIs. By comparing changes in arterial tracer uptake between ICI-treated patients and non-treated controls across repeated scans, our goal is to assess the impact of ICIs on arterial inflammation and to better understand the mechanisms by which ICIs may increase atherosclerosis.
ARCTIC is a collaborative effort with PD Dr. Dr. Christian Goetz from the Department of Nuclear Medicine and Prof. Dr. Dennis Wolf from the Vascular Immunology Lab.
The high-volume interventional angiology program of the Unviversity Heart Center Freiburg-Bad Krozingen generates a large body of real-world data on endovascular therapy. Together with partner centers, we use these data to build tools that support treatment decisions and to identify the questions that need prospective trials. Current work addresses long-term outcomes in severely calcified aorto-iliac disease, including coral reef aorta, and the performance of contemporary stent and drug-coated device strategies.
REASON (From Risk to Reason: predicting bleeding during catheter-directed thrombolysis)
Catheter-directed thrombolysis can restore perfusion and save limbs in acute and subacute arterial occlusion, but major bleeding remains its main limitation. Bleeding scores established for anticoagulation and coronary interventions were not developed for this setting. In REASON, we combine data from high-volume vascular centers to develop and externally validate a dedicated bleeding-risk model, turning real-world data into a practical tool for treatment decisions.
Participating centers: University Heart Center Freiburg – Bad Krozingen (coordinating), Medical University of Graz, University of Leipzig Medical Center
Collaboration: Additional centers are welcome to contribute data.
We study vascular disease at the population level using German nationwide hospital statistics (Destatis), health-insurance claims and WHO mortality data. We examine how PAD and related conditions are treated in routine care, where outcomes differ between patient groups, regions, and level of care, and how disease burden changes over time.
Endovascular versus open repair for aortoiliac occlusive disease – nationwide in-hospital outcomes by sex; Vasa, 2026
Salm, J, Böhme, T, …, Bacmeister, L, …, Westermann, D, Zeller, T, Kaier, K
Endovascular treatment of severely calcified aortoiliac occlusive disease: long-term outcomes from a single-centre cohort; Vasa, 2026
Salm, J, Jurina, S, …, Westermann, D, Zeller, T
Antibiotic Consumption and Bloodstream Infections in Patients With Chronic-limb Threatening Ischemia Following Endovascular Therapy in East-west Germany, 2019–2020; Angiology, 2026
Salm, J, Hofbauer-Milan, V, …, Westermann, D, Zeller, T
Longitudinal Assessment of Subclinical Arterial Inflammation in Patients Receiving Immune Checkpoint Inhibitors by Sequential [18F]FDG PET Scans; Circulation:Cardiovasc Imaging, 2025
Bacmeister, L, Hempfling, N, …, Buellesbach, A, Heidenreich, A, …, Wolf, D
Clinical outcomes in patients with chronic limb-threatening ischemia and infected ulcers following endovascular therapy are pathogen dependent: A single-center experience from 2012 to 2021; Vasc Med, 2024
Salm, J, Ikker, F, …, Westermann, D, Zeller, T
P2X7 Deficiency Blocks Lesional Inflammasome Activity and Ameliorates Atherosclerosis in Mice; Circulation, 2017
Stachon, P*, Heidenreich, A*, …, Idzko, M*, Zirlik, A*