1
|
Siegmund AS, Bilardo CM, van Veldhuisen DJ, Dickinson MG, Gyselaers W. Right-heart dysfunction in women with congenital heart disease and pre-eclampsia. Ultrasound Obstet Gynecol 2022; 59:406. [PMID: 35239218 DOI: 10.1002/uog.24867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 06/14/2023]
Affiliation(s)
- A S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M G Dickinson
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Department of Obstetrics, Ziekenhuis Oost Limburg, Genk, Belgium
- Department of Physiology, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| |
Collapse
|
2
|
Meems L, van Veldhuisen DJ, de Boer RA. Underestimation of circulatory congestion in very obese HFpEF patients: EAT your heart out..?! Eur J Heart Fail 2021; 24:362-364. [PMID: 34969170 DOI: 10.1002/ejhf.2415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 12/23/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lmg Meems
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen
| | - R A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen
| |
Collapse
|
3
|
Siegmund AS, Pieper PG, Bouma BJ, Rosenberg FM, Groen H, Bilardo CM, van Veldhuisen DJ, Dickinson MG. Early N-terminal pro-B-type natriuretic peptide is associated with cardiac complications and function during pregnancy in congenital heart disease. Neth Heart J 2021; 29:262-272. [PMID: 33534113 PMCID: PMC8062639 DOI: 10.1007/s12471-021-01540-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 12/12/2022] Open
Abstract
Background Elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels at 20 weeks’ gestation predict adverse cardiovascular (CV) complications during pregnancy in women with congenital heart disease (CHD). To improve early risk assessment in these women, we investigated the predictive value of first-trimester NT-proBNP for CV complications and its association with ventricular function during pregnancy. Methods Pregnant women with CHD, previously enrolled in a prospective national study or evaluated by an identical protocol, were included. Clinical data, echocardiographic evaluation and NT-proBNP measurements were obtained at 12, 20 and 32 weeks’ gestation. Elevated NT-proBNP was defined as > 235 pg/ml (95th percentile reference value of healthy pregnant women in the literature). Results We examined 126 females (mean age 29 years). Elevated NT-proBNP at 12 weeks was associated with CV complications (n = 7, 5.6%, odds ratio 10.9, p = 0.004). Arrhythmias were the most common complication (71%). The negative predictive value of low NT-proBNP to exclude CV complications was 97.2%. In women with CV complications, NT-proBNP levels remained high throughout pregnancy, while a decrease was seen in women without CV complications (p < 0.001 for interaction between group and time). At 12 weeks, higher NT-proBNP levels were associated with impaired subpulmonary ventricular function (p < 0.001) and also with a decline in subpulmonary ventricular function later in pregnancy (p = 0.012). Conclusions In this study, first-trimester NT-proBNP levels were associated with adverse CV complications and a decline in subpulmonary ventricular function later in pregnancy in women with CHD. Early NT-proBNP evaluation is useful for tailored care in pregnant women with CHD.
Collapse
Affiliation(s)
- A S Siegmund
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B J Bouma
- Department of Cardiology, Heart Centre, Amsterdam UMC, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - F M Rosenberg
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M G Dickinson
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
4
|
Shi C, van der Wal HH, Silljé HHW, Dokter MM, van den Berg F, Huizinga L, Vriesema M, Post J, Anker SD, Cleland JG, Ng LL, Samani NJ, Dickstein K, Zannad F, Lang CC, van Haelst PL, Gietema JA, Metra M, Ameri P, Canepa M, van Veldhuisen DJ, Voors AA, de Boer RA. Tumour biomarkers: association with heart failure outcomes. J Intern Med 2020; 288:207-218. [PMID: 32372544 PMCID: PMC7496322 DOI: 10.1111/joim.13053] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 02/18/2020] [Accepted: 02/25/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND There is increasing recognition that heart failure (HF) and cancer are conditions with a number of shared characteristics. OBJECTIVES To explore the association between tumour biomarkers and HF outcomes. METHODS In 2,079 patients of BIOSTAT-CHF cohort, we measured six established tumour biomarkers: CA125, CA15-3, CA19-9, CEA, CYFRA 21-1 and AFP. RESULTS During a median follow-up of 21 months, 555 (27%) patients reached the primary end-point of all-cause mortality. CA125, CYFRA 21-1, CEA and CA19-9 levels were positively correlated with NT-proBNP quartiles (all P < 0.001, P for trend < 0.001) and were, respectively, associated with a hazard ratio of 1.17 (95% CI 1.12-1.23; P < 0.0001), 1.45 (95% CI 1.30-1.61; P < 0.0001), 1.19 (95% CI 1.09-1.30; P = 0.006) and 1.10 (95% CI 1.05-1.16; P < 0.001) for all-cause mortality after correction for BIOSTAT risk model (age, BUN, NT-proBNP, haemoglobin and beta blocker). All tumour biomarkers (except AFP) had significant associations with secondary end-points (composite of all-cause mortality and HF hospitalization, HF hospitalization, cardiovascular (CV) mortality and non-CV mortality). ROC curves showed the AUC of CYFRA 21-1 (0.64) had a noninferior AUC compared with NT-proBNP (0.68) for all-cause mortality (P = 0.08). A combination of CYFRA 21-1 and NT-proBNP (AUC = 0.71) improved the predictive value of the model for all-cause mortality (P = 0.0002 compared with NT-proBNP). CONCLUSIONS Several established tumour biomarkers showed independent associations with indices of severity of HF and independent prognostic value for HF outcomes. This demonstrates that pathophysiological pathways sensed by these tumour biomarkers are also dysregulated in HF.
Collapse
Affiliation(s)
- C Shi
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H H van der Wal
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - H H W Silljé
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M M Dokter
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - F van den Berg
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - L Huizinga
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Vriesema
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Post
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - S D Anker
- Department of Cardiology, Berlin-Brandenburg Center for Regenerative Therapies, German Centre for Cardiovascular Research (DZHK) Partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - J G Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK.,Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - L L Ng
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - N J Samani
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
| | - K Dickstein
- University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - F Zannad
- Clinical Investigation Center 1433, French Clinical Research Infrastructure Network, Investigation Network Initiative-Cardiovascular and Renal Clinical Trialists, Centre Hospitalier Regional et Universitaire de Nancy, Vandoeuvre les Nancy, France
| | - C C Lang
- Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
| | - P L van Haelst
- F. Hoffmann-La Roche Ltd. Diagnostics Division, Basel, Switzerland
| | - J A Gietema
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - M Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - P Ameri
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - D J van Veldhuisen
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - A A Voors
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - R A de Boer
- From the, Department of Cardiology, Uni, University Medical Center Groningen, Groningen, the Netherlands.,University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
5
|
Siegmund AS, Kampman MAM, Oudijk MA, Mulder BJM, Sieswerda GTJ, Koenen SV, Hummel YM, de Laat MWM, Sollie-Szarynska KM, Groen H, van Dijk APJ, van Veldhuisen DJ, Bilardo CM, Pieper PG. Maternal right ventricular function, uteroplacental circulation in first trimester and pregnancy outcome in women with congenital heart disease. Ultrasound Obstet Gynecol 2019; 54:359-366. [PMID: 30334300 DOI: 10.1002/uog.20148] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/25/2018] [Accepted: 10/11/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Pregnant women with congenital heart disease (CHD) have an increased risk of abnormal uteroplacental flow, measured from the second trimester onwards, which is associated with pregnancy complications affecting the mother and the fetus. Maternal right ventricular (RV) dysfunction has been suggested as a predisposing factor for impaired uteroplacental flow in these women. The aim of this study was to investigate the association of first-trimester uteroplacental flow measurements with prepregnancy maternal cardiac function and pregnancy complications in women with CHD, with particular focus on the potential role of RV (dys)function. METHODS This study included 138 pregnant women with CHD from the prospective ZAHARA III study (Zwangerschap bij Aangeboren HARtAfwijkingen; Pregnancy and CHD). Prepregnancy clinical and echocardiographic data were collected. Clinical evaluation, echocardiography (focused on RV function, as assessed by tricuspid annular plane systolic excursion (TAPSE)) and uterine artery (UtA) pulsatility index (PI) measurements were performed at 12, 20 and 32 weeks of gestation. Univariable and multivariable regression analyses were performed to assess the association between prepregnancy variables and UtA-PI during pregnancy. The association between UtA-PI at 12 weeks and cardiovascular, obstetric and neonatal complications was also assessed. RESULTS On multivariable regression analysis, prepregnancy TAPSE was associated negatively with UtA-PI at 12 weeks of gestation (β = -0.026; P = 0.036). Women with lower prepregnancy TAPSE (≤ 20 mm vs > 20 mm) had higher UtA-PI at 12 weeks (1.5 ± 0.5 vs 1.2 ± 0.6; P = 0.047). Increased UtA-PI at 12 weeks was associated with obstetric complications (P = 0.003), particularly hypertensive disorders (pregnancy-induced hypertension and pre-eclampsia, P = 0.019 and P = 0.026, respectively). CONCLUSIONS In women with CHD, RV dysfunction before pregnancy seems to impact placentation, resulting in increased resistance in UtA flow, which is detectable as early as in the first trimester. This, in turn, is associated with pregnancy complications. Early monitoring of uteroplacental flow might be of value in women with CHD with pre-existing subclinical RV dysfunction to identify pregnancies that would benefit from close obstetric surveillance. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- A S Siegmund
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A M Kampman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M A Oudijk
- Department of Obstetrics, University of Amsterdam, Amsterdam Universities Medical Centre, location Academic Medical Center, Amsterdam, The Netherlands
| | - B J M Mulder
- Department of Cardiology, University of Amsterdam, Amsterdam Universities Medical Centre, location Academic Medical Center, Amsterdam, The Netherlands
| | - G T J Sieswerda
- Department of Cardiology, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S V Koenen
- Department of Obstetrics, University of Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Y M Hummel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - M W M de Laat
- Department of Obstetrics, University of Amsterdam, Amsterdam Universities Medical Centre, location Academic Medical Center, Amsterdam, The Netherlands
| | - K M Sollie-Szarynska
- Department of Obstetrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - H Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A P J van Dijk
- Department of Cardiology, Radboud University, Radboud University Medical Center, Nijmegen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
6
|
Tromp J, Ouwerkerk W, Demissei BG, Anker SD, Cleland JG, Dickstein K, Filippatos G, van der Harst P, Hillege HL, Lang CC, Metra M, Ng LL, Ponikowski P, Samani NJ, van Veldhuisen DJ, Zannad F, Zwinderman AH, Voors AA, van der Meer P. Novel endotypes in heart failure: effects on guideline-directed medical therapy. Eur Heart J 2018; 39:4269-4276. [DOI: 10.1093/eurheartj/ehy712] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 10/14/2018] [Indexed: 12/28/2022] Open
Affiliation(s)
- J Tromp
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
- National Heart Centre Singapore, 5 Hospital Drive, Singapore
- Duke-NUS Medical School, 8 College Road, Singapore
| | - W Ouwerkerk
- National Heart Centre Singapore, 5 Hospital Drive, Singapore
- Department of Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, Amsterdam, Meibergdreef 9, AZ, The Netherlands
| | - B G Demissei
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - S D Anker
- Division of Cardiology and Metabolism—Heart Failure, Cachexia & Sarcopenia, Department of Cardiology (CVK); Berlin-Brandenburg Center for Regenerative Therapies (BCRT), at Charité University Medicine, Charitépl. 1 Berlin, Germany
- Department of Cardiology and Pneumology, University Medicine Göttingen (UMG), DZHK (German Center for Cardiovascular Research), Robert-Koch-Straße 40, Göttingen, Germany
| | - J G Cleland
- National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, Sydney St, Chelsea, London, UK
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, University Avenue, Glasgow, UK
| | - K Dickstein
- University of Bergen, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate 8, Stavanger, Norway
| | - G Filippatos
- School of Medicine, Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon, National and Kapodistrian University of Athens, 1, Rimini Str, Haidari, Athens Greece
| | - P van der Harst
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - H L Hillege
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - C C Lang
- Division of Molecular & Clinical Medicine, University of Dundee, Dundee, UK
| | - M Metra
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Piazza del Mercato, 15, Brescia, Italy
| | - L L Ng
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, UK
| | - P Ponikowski
- Department of Heart Diseases, Wroclaw Medical University, Rudolfa Weigla 5, Wroclaw, Poland
- Cardiology Department, Military Hospital, Rudolfa Weigla, Wroclaw, Poland
| | - N J Samani
- Department of Cardiovascular Sciences, University of Leicester, Glenfield Hospital, Groby Road, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester, UK
| | - D J van Veldhuisen
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - F Zannad
- CHU de Nancy, Inserm CIC 1433, Université de Lorrain, CHRU de Nancy, F-CRIN INI-CRCT Nancy, France
| | - A H Zwinderman
- Department of Epidemiology, Biostatistics & Bioinformatics, Academic Medical Center, Amsterdam, Meibergdreef 9, AZ, The Netherlands
| | - A A Voors
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| | - P van der Meer
- Department of Cardiology, University of Groningen, Hanzeplein 1, GZ, Groningen, the Netherlands
| |
Collapse
|
7
|
Linssen GCM, Jaarsma T, Hillege HL, Voors AA, van Veldhuisen DJ. A comparison of the prognostic value of BNP versus NT-proBNP after hospitalisation for heart failure. Neth Heart J 2018; 26:486-492. [PMID: 30088253 PMCID: PMC6150877 DOI: 10.1007/s12471-018-1145-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aims Concentrations of circulating B‑type natriuretic peptides provide important prognostic information in heart failure (HF) patients. We directly compared the prognostic performance of brain natriuretic peptide (BNP) versus N‑terminal-proBNP (NT-proBNP) measurements in a large population of HF patients at hospital discharge after an admission for decompensated HF. Methods and results BNP and NT-proBNP were measured in 563 stable HF patients before discharge. All patients were followed for a fixed period of 18 months. The primary endpoint was time to first major event (HF hospitalisation or death). Patients were in NYHA class II (47%) or III/IV (53%) at discharge and the mean age of the patients was 71 ± 11 years, 217 (39%) females, mean left ventricular ejection fraction was 0.32 ± 0.14 and 234 (42%) had an ischaemic aetiology of HF. During the study, 236 patients (42%) reached the primary endpoint. Multivariate odds ratios of the primary endpoint for doubling of baseline levels of BNP and NT-proBNP were 1.46 (95% CI 1.19–1.80, p < 0.001) and 1.45 (95% CI 1.18–1.78, p < 0.001), respectively. The multivariable adjusted areas under the receiver-operating characteristic curve for prediction of the primary endpoint for doubling of BNP and NT-proBNP were 0.69 and 0.68, respectively. Direct comparison of the prognostic value of BNP and NT-proBNP did not reveal significant differences. Conclusions BNP and NT-proBNP at discharge for hospitalisation for HF are powerful, and equally strong and independent predictors of all-cause death and HF rehospitalisation.
Collapse
Affiliation(s)
- G C M Linssen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Department of Cardiology, Hospital Group Twente, Almelo and Hengelo, The Netherlands.
| | - T Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
| | - H L Hillege
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A A Voors
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
8
|
Meijers WCFW, Jaarsma T, van Veldhuisen DJ, Hoekstra T, de Boer RA. Awareness of atrial fibrogenesis and natriuretic peptide release. Neth Heart J 2017; 25:225-226. [PMID: 28185065 PMCID: PMC5313455 DOI: 10.1007/s12471-017-0955-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- W C F W Meijers
- Department of Cardiology, University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - T Jaarsma
- Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - T Hoekstra
- Department of Cardiology, University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - R A de Boer
- Department of Cardiology, University Medical Centre, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
9
|
Kampman MAM, Siegmund AS, Bilardo CM, van Veldhuisen DJ, Balci A, Oudijk MA, Groen H, Mulder BJM, Roos-Hesselink JW, Sieswerda G, de Laat MWM, Sollie-Szarynska KM, Pieper PG. Uteroplacental Doppler flow and pregnancy outcome in women with tetralogy of Fallot. Ultrasound Obstet Gynecol 2017; 49:231-239. [PMID: 27071979 DOI: 10.1002/uog.15938] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 04/01/2016] [Accepted: 04/07/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Pregnancy in women with surgically corrected tetralogy of Fallot (ToF) is associated with cardiac, obstetric and neonatal complications. We compared uteroplacental Doppler flow (UDF) measurements and pregnancy outcome in women with ToF and in healthy women and aimed to assess whether a relationship exists between cardiac function and UDF in women with ToF. METHODS We evaluated prospectively pregnant women with ToF and healthy pregnant women from the ZAHARA studies. Clinical evaluation, standardized echocardiography and UDF measurements were performed at 20 and 32 weeks' gestation. RESULTS We included 62 women with ToF and 69 healthy controls. Cardiac complications, mostly arrhythmia, occurred in 8.1% of women with ToF. There was a higher incidence of small-for-gestational age (21.0% vs 4.4%, P = 0.004) and low birth weight (16.1% vs 2.9%, P = 0.009) in the group of women with ToF than in healthy controls. In women with ToF, early diastolic notching of uterine artery waveform at 20 and 32 weeks occurred more frequently (9.8% vs 1.5%, P = 0.034 and 7.0% vs 0%, P = 0.025, respectively) and the umbilical artery pulsatility index at 32 weeks was higher (1.02 ± 0.20 vs 0.94 ± 0.17, P = 0.015) than in healthy controls. Right ventricular function parameters prepregnancy and at 20 weeks' gestation were significantly associated with abnormal UDF. UDF parameters were associated with adverse neonatal outcome. CONCLUSION The majority of women with surgically corrected ToF tolerate pregnancy well. However, UDF indices are more frequently abnormal in these women, suggesting impaired placentation. The association of impaired right ventricular function parameters with abnormal UDF suggests that cardiac dysfunction contributes to defective placentation or placental perfusion mismatch and may explain the increased incidence of obstetric and neonatal complications. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- M A M Kampman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - A S Siegmund
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A Balci
- Department of Cardiology, Isala, Zwolle, The Netherlands
| | - M A Oudijk
- Department of Obstetrics, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - H Groen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, University of Rotterdam, Rotterdam, The Netherlands
| | - G Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M W M de Laat
- Department of Obstetrics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - K M Sollie-Szarynska
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
10
|
Abstract
PURPOSE Heart failure (HF) care in the Netherlands is going through a lot of changes. Nurses have increasingly important roles in providing optimal care for these chronically ill patients. In this study, we describe the current number of HF management programs and the role of the nurses in these programs. METHOD Data were collected by a national survey as part of a European HF clinic survey of the UNITE study group of the Working Group on Cardiovascular Nursing between February and March 2003 to 142 hospitals in the Netherlands. RESULTS In 60% of the hospital locations, there is a HF management program. Most of the programs are organized as HF outpatient clinics. In all HF programs, cardiologists and nurses are involved. Other health care providers involved are, amongst others, general practitioners (29%), dieticians (59%), physical therapists (47%), social workers (30%) and psychologists (17%). All programs offer follow-up after discharge from the hospitals and in most of the programs patients have increased access to a health care provider. Behavioural interventions (68%), psychosocial counselling (64%), patient education (88%) and support of the informal caregivers (59%) are important components. In 90% of the programs (restricted), physical examination is the responsibility of the HF nurse and in 65% of the programs nurses are involved in optimizing medical treatment. Financial support and education of HF nurses is still unstructured and diverse. CONCLUSION There is a rise in the number of HF programs in the Netherlands. There is diversity in content and intensity of these programs and the role of the nurse is not clearly defined yet. Research and discussion on the subject of optimal effective HF care and the role of the HF nurse is still needed.
Collapse
Affiliation(s)
- T Jaarsma
- Department of Cardiology, University Hospital Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
| | | | | | | |
Collapse
|
11
|
van der Wal MHL, Strömberg A, van Veldhuisen DJ, Jaarsma T. Heart failure patients' future expectations and their association with disease severity, quality of life, depressive symptoms and clinical outcomes. Int J Clin Pract 2016; 70:469-76. [PMID: 27125731 DOI: 10.1111/ijcp.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Although treatment of heart failure (HF) patients has improved, prognosis still remains poor. Current HF Guidelines recommend communication about prognosis with all patients. Little is known about HF patients' awareness of their shortened life expectancy. AIM To explore HF patients' future expectations and to examine whether these expectations are associated with disease severity, quality of life, depressive symptoms and clinical outcomes. METHOD Patients randomised to the intervention groups of the COACH study, who were at the end of HF hospitalisation, were asked about their future expectations. Patients were divided into three groups: patients expecting improvement/stabilisation, patients expecting deterioration and those not knowing what to expect. Depressive symptoms were measured by CES-D and quality of life with the Ladder of Life and RAND-36. RESULTS Six hundred and seventy eight patients (age 70 ± 12; 41% female patients; LVEF 33% ± 15) participated in the study. Most patients (56%, N = 380) expected improvement or stabilisation, 8% (N = 55) expected deterioration and 21% (N = 144) did not know what to expect for the future. Patients who expected to deteriorate were significantly older, experienced a lower quality of life and more depressive symptoms compared with patients in the other two groups. They also had a higher mortality rate, both after 18 and 36 months, and had more HF admissions. No association with severity of the disease (NYHA-class, LVEF, BNP levels) was found. CONCLUSION Many hospitalised HF patients are not aware of their poor prognosis. Depressive symptoms, poor quality of life, increased mortality and rehospitalisation were related to expected deterioration. Improvement of communication about prognosis with HF patients is needed in the future.
Collapse
Affiliation(s)
- M H L van der Wal
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A Strömberg
- Department of Medical and Health Sciences, Division of Nursing and Department of Cardiology, Linköping University, Linköping, Sweden
- UCI Program in Nursing Science, University of California Irvine, Irvine, CA, USA
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - T Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic., Australia
| |
Collapse
|
12
|
Meijers WC, Hoekstra T, Jaarsma T, van Veldhuisen DJ, de Boer RA. Patients with heart failure with preserved ejection fraction and low levels of natriuretic peptides. Neth Heart J 2016; 24:287-95. [PMID: 26940695 PMCID: PMC4796061 DOI: 10.1007/s12471-016-0816-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) is common and its management remains difficult. B-type natriuretic peptide (BNP) levels are used to diagnose heart failure, and as an entry criterion for inclusion into trials. We investigated a population of HFpEF patients who had been randomised into a study based on clinical parameters, and compared those with low BNP levels to those with elevated BNP levels. METHODS We examined patients who had been enrolled in the Coordinating study evaluating Outcomes of Advising and Counselling in Heart Failure (COACH), with preserved left ventricular ejection fraction (LVEF ≥ 40 %), and compared those with low BNP (< 100 pg/ml; n = 30) to those with elevated BNP (≥ 100 pg/ml; n = 127). Baseline characteristics, comorbidities, biomarkers, quality of life, and outcome parameters (hospitalisations and death) were compared between the groups. To validate our findings, we repeated all analyses for NT-proBNP (< 300 pg/ml and ≥ 300 pg/ml). RESULTS Patients were similar with regard to most clinical characteristics (including age, sex, and LVEF), biomarkers, and comorbidities. In contrast, patients with a low BNP had higher body mass index levels (31 kg/m(2) vs. 27 kg/m(2); p < 0.01) and lower cardiac troponin I (9 pg/ml vs. 15 pg/ml; p = 0.02). In addition, these patients were less frequently prescribed diuretics and beta-blockers. No differences in quality of life, heart failure related symptoms and the primary and secondary outcomes were observed between these groups. These observations were confirmed for NT-proBNP. CONCLUSION Among the patients with clinically diagnosed HFpEF, those with low BNP are strikingly similar to those with elevated BNP levels, except for BMI, which was significantly higher in these patients.
Collapse
Affiliation(s)
- W C Meijers
- Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - T Hoekstra
- Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - T Jaarsma
- Faculty of health sciences, Linköping University, Linköping, Sweden
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - R A de Boer
- Department of Cardiology, University Medical Center, University of Groningen, Groningen, The Netherlands.
| |
Collapse
|
13
|
Kampman MAM, Bilardo CM, Mulder BJM, Aarnoudse JG, Ris-Stalpers C, van Veldhuisen DJ, Pieper PG. Maternal cardiac function, uteroplacental Doppler flow parameters and pregnancy outcome: a systematic review. Ultrasound Obstet Gynecol 2015; 46:21-28. [PMID: 25320041 DOI: 10.1002/uog.14697] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/27/2014] [Accepted: 10/04/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To investigate the existing evidence for a link between maternal cardiac function, abnormal uteroplacental flow and poor perinatal outcome in women with and without known cardiac disease. METHODS PubMed and EMBASE databases were searched systematically for studies relating cardiac functional parameters and uteroplacental Doppler flow with pregnancy outcome in women with pre-existing congenital cardiac disease and women without known cardiac disease. Only studies based on echocardiography were included. RESULTS From 1732 citations, 10 articles were included. In women with known congenital heart disease, a relationship was found between abnormal uteroplacental Doppler flow patterns and cardiac function before and during pregnancy. Conversely, women without a history of congenital heart disease, but with abnormal uterine artery resistance and pregnancy complications, more often showed global left ventricular diastolic dysfunction (33%; P = 0.0001), impaired myocardial relaxation (72%; P < 0.0001) and left ventricular systolic dysfunction (17%; P = 0.006), even up to 1 year postpartum. CONCLUSION There is increasing evidence for an association between pre-existing subclinical cardiac dysfunction, poor placentation (reflected by uteroplacental Doppler flow abnormalities) and poor pregnancy outcome. It may be postulated that pre-existing suboptimal cardiac performance, as a result of either congenital heart disease or a subclinical latent condition, is one of the common denominators of poor placentation, leading to poor pregnancy outcome.
Collapse
Affiliation(s)
- M A M Kampman
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- The Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - C M Bilardo
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Aarnoudse
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C Ris-Stalpers
- Women's and Children's Clinic, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Reproductive Biology Laboratory, Academic Medical Center, Amsterdam, The Netherlands
| | - D J van Veldhuisen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - P G Pieper
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
14
|
Badar AA, Perez-Moreno AC, Jhund PS, Wong CM, Hawkins NM, Cleland JGF, van Veldhuisen DJ, Wikstrand J, Kjekshus J, Wedel H, Watkins S, Gardner RS, Petrie MC, McMurray JJV. Relationship between angina pectoris and outcomes in patients with heart failure and reduced ejection fraction: an analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Eur Heart J 2014; 35:3426-33. [DOI: 10.1093/eurheartj/ehu342] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Huzen J, Wong LSM, van Veldhuisen DJ, Samani NJ, Zwinderman AH, Codd V, Cawthon RM, Benus GFJD, van der Horst ICC, Navis G, Bakker SJL, Gansevoort RT, de Jong PE, Hillege HL, van Gilst WH, de Boer RA, van der Harst P. Telomere length loss due to smoking and metabolic traits. J Intern Med 2014; 275:155-63. [PMID: 24118582 DOI: 10.1111/joim.12149] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Human age-dependent telomere attrition and telomere shortening are associated with several age-associated diseases and poorer overall survival. The aim of this study was to determine longitudinal leucocyte telomere length dynamics and identify factors associated with temporal changes in telomere length. DESIGN AND METHODS Leucocyte telomere length was measured by quantitative polymerase chain reaction in 8074 participants from the Prevention of Renal and Vascular End-stage Disease (PREVEND) study, an ongoing community-based prospective cohort study initiated in 1997. Follow-up data were available at two time-points up to 2007. Leucocyte telomere length was measured, on between one and three separate occasions, in a total of 16 783 DNA samples. Multilevel growth models were created to identify the factors that influence leucocyte telomere dynamics. RESULTS We observed an average attrition rate of 0.47 ± 0.16 relative telomere length units (RTLUs) per year in the study population aged 48 (range 39-60) years at baseline. Annual telomere attrition rate increased with age (P < 0.001) and was faster on average in men than in women (P for interaction 0.043). The major independent factors determining telomere attrition rate were active smoking (approximately tripled the loss of RTLU per year, P < 0.0001) and multiple traits of the metabolic syndrome (waist-hip ratio, P = 0.007; blood glucose level, P = 0.045, and HDL cholesterol level, P < 0.001). CONCLUSIONS Smoking and variables linked to the metabolic syndrome are modifiable lifestyle factors that accelerate telomere attrition in humans. The higher rate of cellular ageing may mediate the link between smoking and the metabolic syndrome to an increased risk of several age-associated diseases.
Collapse
Affiliation(s)
- J Huzen
- University Medical Center Groningen, University of Groningen, Department of Cardiology, Groningen, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Kampman MAM, Balci A, van Veldhuisen DJ, van Dijk APJ, Roos-Hesselink JW, Sollie-Szarynska KM, Ludwig-Ruitenberg M, van Melle JP, Mulder BJM, Pieper PG. N-terminal pro-B-type natriuretic peptide predicts cardiovascular complications in pregnant women with congenital heart disease. Eur Heart J 2013; 35:708-15. [DOI: 10.1093/eurheartj/eht526] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
17
|
Meyer S, van der Meer P, van Deursen VM, Jaarsma T, van Veldhuisen DJ, van der Wal MHL, Hillege HL, Voors AA. Neurohormonal and clinical sex differences in heart failure. Eur Heart J 2013; 34:2538-47. [DOI: 10.1093/eurheartj/eht152] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
18
|
Nieuwenhuis MMW, Jaarsma T, van Veldhuisen DJ, van der Wal MHL. Self-reported versus 'true' adherence in heart failure patients: a study using the Medication Event Monitoring System. Neth Heart J 2012; 20:313-9. [PMID: 22527915 PMCID: PMC3402572 DOI: 10.1007/s12471-012-0283-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Adherence to (non)pharmacological treatment is important in heart failure (HF) patients, since it leads to better clinical outcome. Although self-reported and objectively measured medication adherence in HF patients have been compared in previous studies, none of these studies have used an evidence-based cutpoint to differentiate between adherence and non-adherence. METHODS In 37 HF patients (mean age 68 ± 10 years, 27 % female, 40 % NYHA functional class III-IV), medication (ACEi/ARB) adherence was objectively measured using the Medication Event Monitoring System (MEMS). Adherence to and importance of taking medication was also assessed by self-report using the Revised HF Compliance Questionnaire. RESULTS All patients reported that adherence was (highly) important to them and that they 'always' took their medication as prescribed (i.e. 100 % adherence). However, when measured by the MEMS, only 76 % of all patients were adherent. Non-adherent patients more often had a complex medication regimen (78 % vs. 21 %, P < .01), more often depressive symptoms (75 % vs. 29 %, P = .04) and a shorter history of HF (8 vs. 41 months, P = .04), compared with adherent patients. CONCLUSIONS Medication adherence measured by the MEMS was remarkably lower than self-reported adherence. Given the evidence of its importance, further efforts are needed to improve adherence to the pharmacological regimen in HF patients.
Collapse
Affiliation(s)
- M M W Nieuwenhuis
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, the Netherlands,
| | | | | | | |
Collapse
|
19
|
Luttik MLA, Brons M, Jaarsma T, Hillege HL, Hoes A, de Jong R, Linssen G, Lok DJ, Berger M, van Veldhuisen DJ. Design and methodology of the COACH-2 (Comparative study on guideline adherence and patient compliance in heart failure patients) study: HF clinics versus primary care in stable patients on optimal therapy. Neth Heart J 2012; 20:307-12. [PMID: 22527916 DOI: 10.1007/s12471-012-0284-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Since the number of heart failure (HF) patients is still growing and long-term treatment of HF patients is necessary, it is important to initiate effective ways for structural involvement of primary care services in HF management programs. However, evidence on whether and when patients can be referred back to be managed in primary care is lacking. AIM To determine whether long-term patient management in primary care, after initial optimisation of pharmacological and non-pharmacological treatment in a specialised HF clinic, is equally effective as long-term management in a specialised HF clinic in terms of guideline adherence and patient compliance. METHOD The study is designed as a randomised, controlled, non-inferiority trial. Two-hundred patients will be randomly assigned to be managed and followed in primary care or in a HFclinic. Patients are eligible to participate if they are (1) clinically stable, (2) optimally up-titrated on medication (according to ESC guidelines) and, (3) have received optimal education and counselling on pre-specified issues regarding HF and its treatment. Furthermore, close cooperation between secondary and primary care in terms of back referral to or consultation of the HF clinic will be provided.The primary outcome will be prescriber adherence and patient compliance with medication after 12 months. Secondary outcomes measures will be readmission rate, mortality, quality of life and patient compliance with other lifestyle changes. EXPECTED RESULTS The results of the study will add to the understanding of the role of primary care and HF clinics in the long-term follow-up of HF patients.
Collapse
Affiliation(s)
- M L A Luttik
- Department of Cardiology, University Medical Center Groningen, University of Groningen, PO BOX 30.001, 9700, RB, Groningen, the Netherlands,
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Gullestad L, Ueland T, Kjekshus J, Nymo SH, Hulthe J, Muntendam P, Adourian A, Bohm M, van Veldhuisen DJ, Komajda M, Cleland JGF, Wikstrand J, McMurray JJV, Aukrust P. Galectin-3 predicts response to statin therapy in the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Eur Heart J 2012; 33:2290-2296. [DOI: 10.1093/eurheartj/ehs077] [Citation(s) in RCA: 113] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
21
|
Affiliation(s)
| | | | - D J van Veldhuisen
- Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands
| | | |
Collapse
|
22
|
de Boer RA, Schroten NF, Bakker SJL, Mahmud H, Szymanski MK, van der Harst P, Gansevoort RT, van Veldhuisen DJ, van Gilst WH, Hillege HL. Plasma renin and outcome in the community: data from PREVEND. Eur Heart J 2012; 33:2351-9. [DOI: 10.1093/eurheartj/ehs198] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
23
|
de Boer RA, van Veldhuisen DJ, Gansevoort RT, Muller Kobold AC, van Gilst WH, Hillege HL, Bakker SJL, van der Harst P. The fibrosis marker galectin-3 and outcome in the general population. J Intern Med 2012; 272:55-64. [PMID: 22026577 DOI: 10.1111/j.1365-2796.2011.02476.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Galectin-3 is involved in fibrosis and inflammation and plays a role in heart failure, renal disease, obesity and cancer. We aimed to establish the relationship between galectin-3 and cardiovascular (CV) risk factors and mortality in the general population. DESIGN AND SUBJECTS This study included 7968 subjects from the Prevention of REnal and Vascular ENd-stage Disease (PREVEND) cohort, with a median follow-up of approximately 10 years. Plasma galectin-3 was measured in baseline samples. MAIN OUTCOME MEASURES We investigated the relationships between galectin-3 levels, demographic characteristics and risk factors of CV disease. We determined the prognostic value for all-cause, CV and cancer mortality. RESULTS The mean age of the population was 50 ± 13 years. Mean blood pressure was 129/74 mmHg, mean cholesterol was 5.7 ± 1.1 mmol L(-1) and median galectin-3 was 10.9 ng mL(-1) [interquartile range (IQR) 9.0-13.1]. Galectin-3 levels correlated with a wide range of risk factors of CV disease, including blood pressure, serum lipids, body mass index, renal function and N-terminal pro-B-type natriuretic peptide (P < 0.0001). We observed a strong association between galectin-3 and age. Furthermore, we found a gender interaction, with female subjects (n = 4001) having higher median galectin-3 levels (11.0 ng mL(-1) , IQR 9.1-13.4 vs. men (n = 3967) 10.7 ng mL(-1) , IQR 8.9-12.8; P < 0.0001), and galectin-3 levels in women more strongly correlated with risk factors of CV disease. After correction for the classical CV risk factors (smoking, blood pressure, cholesterol and diabetes), galectin-3 levels independently predicted all-cause mortality (hazard ratio per SD galectin-3 1.09, 95% CI 1.01-1.19; P = 0.036), but not CV and cancer mortality separately. CONCLUSIONS Galectin-3 is associated with age and risk factors of CV disease, with a strong gender interaction for these correlations. Galectin-3 predicts all-cause mortality in the general population.
Collapse
Affiliation(s)
- R A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Bergstra A, Svilaas T, van Veldhuisen DJ, van den Heuvel AFM, van der Horst ICC, Zijlstra F. Haemodynamic patterns in ST-elevation myocardial infarction: incidence and correlates of elevated filling pressures. Neth Heart J 2011; 15:95-9. [PMID: 17612667 PMCID: PMC1847759 DOI: 10.1007/bf03085962] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES.: We sought to study the incidence and clinical correlates of elevated filling pressures in ST-elevation myocardial infarction (STEMI) patients, without physical signs of heart failure and treated with primary coronary angioplasty. BACKGROUND.: Haemodynamic data, as measured with a Swan-Ganz catheter, are not routinely obtained in STEMI patients. At admission, low blood pressure, increased heart rate, sweating, increased respiration rate, rales, oedema, and a third heart sound are indicative of heart failure. METHODS.: All consecutive STEMI patients were monitored by a Swan-Ganz catheter and central venous pressure (CVP), pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAS) and cardiac index (CI) were measured. To investigate the clinical correlates of the haemodynamic status patients were classified according to previously defined haemodynamic criteria. RESULTS.: We studied 90 patients, aged 60.5+/-13.1 year, 76% were male. Mortality at 30 days was 2/90 (2.2%). Patients with impaired haemodynamics presented later and had larger myocardial infarct sizes. CVP, PCWP and PAS were above normal in 36 (40%) patients. CONCLUSION.: A large proportion of STEMI patients without physical signs of heart failure have elevation of right- as well as left-sided cardiac filling pressures. (Neth Heart J 2007;15:95-9.).
Collapse
Affiliation(s)
- A Bergstra
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | | | | | | | | |
Collapse
|
25
|
Bogale N, Priori S, Gitt A, Alings M, Linde C, Dickstein K, Dickstein K, Priori S, Auricchio A, Bogale N, Brugada J, Cleland JG, Derumeaux G, Gitt A, Gras D, Komajda M, Linde C, Morgan J, van Veldhuisen DJ, Fruhwald F, Strohmer B, Goethals M, Vijgen J, Trochu JN, Gras D, Kindermann M, Stellbrink C, McDonnald K, Keane D, Ben Gal T, Glikson M, Metra M, Gasparini M, Maass A, Jordaens L, Alings M, Larsen AI, Faerestrand S, Delgado J, Mont L, Persson H, Gadler F, Rocca HPBL, Osswald S, Squire I, Morgan J, Brant J, Gadler F, Linde C, Andresen D, Butter C, Gonska B, Jung W, Kuck KH, Senges J, Stellbrink C. The European cardiac resynchronization therapy survey: patient selection and implantation practice vary according to centre volume. Europace 2011; 13:1445-53. [DOI: 10.1093/europace/eur173] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
26
|
van Veldhuisen DJ, Swedberg K. Treatment of chronic heart failure with aldosterone-blocking agents. Eur Heart J Suppl 2011. [DOI: 10.1093/eurheartj/sur011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
27
|
Maass AH, van Veldhuisen DJ. Heart rates in cardiac resynchronization: the art of optimal device programming. Europace 2011; 13:157-8. [DOI: 10.1093/europace/euq446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
28
|
Ambrosio G, Flather MD, Bohm M, Cohen-Solal A, Murrone A, Mascagni F, Spinucci G, Conti MG, van Veldhuisen DJ, Tavazzi L, Coats AJS. -blockade with nebivolol for prevention of acute ischaemic events in elderly patients with heart failure. Heart 2010; 97:209-14. [DOI: 10.1136/hrt.2010.207365] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
29
|
Slart RHJA, Tio RA, van der Vleuten PA, Willems TP, Lubbers DD, Dierckx RA, van Veldhuisen DJ. Myocardial perfusion reserve and contractile pattern after beta-blocker therapy in patients with idiopathic dilated cardiomyopathy. J Nucl Cardiol 2010; 17:479-85. [PMID: 20238193 PMCID: PMC2866962 DOI: 10.1007/s12350-010-9216-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 02/23/2010] [Indexed: 11/01/2022]
Abstract
BACKGROUND In Idiopathic Dilated Cardiomyopathy (IDC) an imbalance between myocardial oxygen consumption and supply has been postulated. The ensuing subclinical myocardial ischemia may contribute to progressive deterioration of LV function. beta-blocker is the therapy of choice in these patients. However, not all patients respond to the same extent. The aim of this study was to elucidate whether differences between responders and non-responders can be identified with respect to regional myocardial perfusion reserve (MPR) and contractile performance. METHODS Patients with newly diagnosed IDC underwent Positron Emission Tomography (PET) scanning using both (13)N-ammonia as a perfusion tracer (baseline and dipyridamole stress), and (18)F-fluoro-deoxyglucose as a metabolism tracer, and a dobutamine stress MRI. MRI and PET were repeated 6 months after maximal beta-blocker therapy. MPR (assessed by PET) as well as wall motion score (WMS, assessed by MRI) were evaluated in a 17 segment-model. Functional response to beta-blocker therapy was assigned as a stable or improved LVEF or diminished LVEF. RESULTS Sixteen patients were included (age 47.9 +/- 11.5 years; 12 males, LVEF 28.6 +/- 8.4%). Seven patients showed improved LVEF (9.7 +/- 3.1%), and nine patients did not show improved LVEF (-3.4 +/- 3.9%). MPR improved significantly in responders (1.56 +/- .23 to 1.93 +/- .49, P = .049), and MPR decreased in non-responders; however, not significantly (1.98 +/- .70 to 1.61 +/- .28, P = .064), but was significantly different between both groups (P = .017) after beta-blocker therapy. A significant correlation was found between change in perfusion reserve and change in LVEF: a decrease in perfusion reserve was associated with a decrease in LVEF and vice versa. Summed rest score of wall motion in responders improved from 26 to 21 (P = .022) whereas in non-responders no change was observed from 26 to 25) (P = ns). Summed stress score of wall motion in responders improved from 23 to 21 (P = .027) whereas in non-responders no change was observed from 27 to 26) (P = ns). CONCLUSION In IDC patients, global as well as regional improvement after initiation of beta-blocker treatment is accompanied by an improvement in regional perfusion parameters. On the other hand in IDC patients with further left ventricular function deterioration after initiation of beta-blocker therapy this is accompanied by a decrease in perfusion reserve.
Collapse
Affiliation(s)
- R H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30001, 9700 RB Groningen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
30
|
van der Wal MHL, van Veldhuisen DJ, Veeger NJGM, Rutten FH, Jaarsma T. Compliance with non-pharmacological recommendations and outcome in heart failure patients. Eur Heart J 2010; 31:1486-93. [DOI: 10.1093/eurheartj/ehq091] [Citation(s) in RCA: 143] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
|
31
|
Hummel YM, Klip IJT, de Jong RM, Pieper PG, van Veldhuisen DJ, Voors AA. Diastolic function measurements and diagnostic consequences: a comparison of pulsed wave- and color-coded tissue Doppler imaging. Clin Res Cardiol 2010; 99:453-8. [PMID: 20221616 PMCID: PMC2898098 DOI: 10.1007/s00392-010-0141-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2009] [Accepted: 02/23/2010] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Tissue Doppler imaging (TDI) plays an important role in assessing diastolic function using echocardiography. However, two different methods [pulsed wave (PW-TDI) and color-coded (CC-TDI)] are currently used. We aimed to compare both measurements. METHODS We included 114 patients that were referred to our echocardiography department for evaluation of diastolic left ventricular function. In these patients, we sequentially measured tissue velocities of basal lateral and septal myocardium of the left ventricle in an apical four-chamber view with both PW-TDI and CC-TDI. RESULTS Our cohort consisted of a heterogeneous group of patients with and without a history of cardiac disease. Mean age of the patients was 52 +/- 16.7 years, and 62% were males. We found a strong correlation between PW-TDI- and CC-TDI-derived myocardial velocities (r = 0.93; p = 0.001). However, E' (mean of lateral and septal) velocities measured with PW-TDI were consistently higher compared to CC-TDI values [PW-TDI E' 10.3 +/- 3.9 (SD) cm/s vs. CC-TDI E' 7.7 +/- 3.1 cm/s; p < 0.001]. From these data, we calculated that the relation between E' measured with PW-TDI and CC-TDI can be described as: E' (PW-TDI) = 1.25 + 1.17 x E' (CC-TDI). Consequently, E/E' measured with PW-TDI was consistently lower compared with CC-TDI (9.1 +/- 3.1 vs. 12.5 +/- 5.7; p < 0.001) From these data, we calculated that the relation between E/E' measured with PW-TDI and CC-TDI can be described as: E/E' (PW-TDI) = 2.13 + 0.56 x E/E' (CC-TDI). CONCLUSIONS Despite a strong correlation, tissue velocities measured with PW-TDI will yield higher values as compared with CC-TDI. This should be taken into account when defining cut-off values for the evaluation of diastolic function.
Collapse
Affiliation(s)
- Y M Hummel
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, 9700 RB Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
32
|
Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P, Poole-Wilson PA, Stromberg A, van Veldhuisen DJ, Atar D, Hoes AW, Keren A, Mebazaa A, Nieminen M, Priori SG, Swedberg K. Corrigendum to: ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008. The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM) [Eur Heart J 2008;29:2388-2442]. Eur Heart J 2010. [DOI: 10.1093/eurheartj/ehq027] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
33
|
de Jong RM, Westerhof BE, Voors AA, van Veldhuisen DJ. Noninvasive haemodynamic monitoring using finger arterial pressure waveforms. Neth J Med 2009; 67:372-375. [PMID: 20009113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Haemodynamic monitoring may potentially lead to improved quality of care in haemodynamic compromised patients. However, the usefulness of invasive techniques using the pulmonary artery catheter is questioned. Noninvasive techniques which provide data on haemodynamics might provide a good alternative. New techniques have been developed in recent years to monitor cardiac output and other parameters of cardiac performance continuously and noninvasively. Recently, a new technique has become available that assesses these haemodynamic data from finger arterial pressure waveforms obtained noninvasively. Although an invasively derived calibration is still needed to obtain absolute data on cardiac output, relative changes in cardiac output can be accurately monitored using this method. Currently, the device can be used in patients to continuously monitor haemodynamic data and guide therapy. Furthermore, it might have a role in clinical research to noninvasively assess cardiac output, as a surrogate endpoint, before and after interventions. Although this new method seems promising, the clinical value has to be proven.
Collapse
Affiliation(s)
- R M de Jong
- Department of Cardiology, University Medical Centre Groningen/University of Groningen, the Netherlands.
| | | | | | | |
Collapse
|
34
|
Linssen GC, Bakker SJ, Voors AA, Gansevoort RT, Hillege HL, de Jong PE, van Veldhuisen DJ, Gans RO, de Zeeuw D. N-terminal pro-B-type natriuretic peptide is an independent predictor of cardiovascular morbidity and mortality in the general population. Eur Heart J 2009; 31:120-7. [DOI: 10.1093/eurheartj/ehp420] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
35
|
van Deursen VM, Damman K, Hillege HL, van Beek AP, van Veldhuisen DJ, Voors AA. Abnormal liver function in relation to hemodynamic profile in heart failure patients. J Card Fail 2009; 16:84-90. [PMID: 20123323 DOI: 10.1016/j.cardfail.2009.08.002] [Citation(s) in RCA: 156] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/10/2009] [Accepted: 08/03/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND We studied the relation between liver function abnormalities and hemodynamic profile in patients with heart failure (HF). METHODS AND RESULTS In 323 HF patients, liver function was determined by aspartate and alanine aminotransferase (AST, ALT), alkaline phosphatase, gamma-glutamyl transpeptidase (GGT), lactate dehydrogenase, and direct and total bilirubin (Bili dir, Bili tot). Central venous pressure (CVP) and cardiac index (CI) were determined invasively. Follow-up consisted of time to all-cause mortality. Mean age was 53 +/- 15 years, and 60% were male. In multivariable analysis, all liver function tests related to CVP, but higher CVP was predominantly related to GGT (r = 0.336, P < .001) and Bili dir (r = 0.370, P < .001). Only elevated AST (r =-0.177, P < .01), ALT (r = -0.130, P < .05), and Bili tot (r = -0.158, P < .01) were associated with both low CI and elevated CVP. The prognostic value of abnormal liver function tests was related to their interaction with CI and CVP. CONCLUSIONS Elevated liver function tests mainly indicate higher CVP, whereas only the presence of elevated AST, ALT, or Bili dir may indicate a low CI. The absence of prognostic information in the presence of invasive hemodynamic measurements suggests that abnormal liver function tests in HF reflect a poor hemodynamic status.
Collapse
Affiliation(s)
- V M van Deursen
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | | | | | | | | |
Collapse
|
36
|
Procter MJ, Suter T, de Azamuja E, Muehlbauer S, Dafni U, van Veldhuisen DJ, Muscholl M, Piccart-Gebhart M. Assessment of trastuzumab-related cardiac dysfunction in the Herceptin Adjuvant (HERA) Trial with 3.6 years median follow- up. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
540 Background: The Herceptin Adjuvant (HERA) Trial is a three-group randomized trial that compared 1 year or 2 years trastuzumab with observation. We investigated cardiac dysfunction in HERA patients randomized to observation or 1 year trastuzumab and report results at a median follow-up of 3.6 years. Methods: Only patients who after completion of (neo)adjuvant chemotherapy with or without radiotherapy had normal left ventricular ejection fraction (LVEF > 55%) were eligible. Cardiac function was monitored throughout the trial. A repeat LVEF assessment was required in case of cardiac dysfunction. Results: There were 1,698 patients randomized to observation and 1,703 randomized to 1 year trastuzumab. The incidence of discontinuation of trastuzumab due to cardiac disorders was low (5.1%). The incidence of cardiac endpoints was low (severe CHF 0.77% in the trastuzumab group). The incidence of cardiac endpoints was higher in the trastuzumab group compared to observation (severe CHF 0.77% vs 0.00%; confirmed significant LVEF drops 3.57% vs 0.64%). In the trastuzumab group, there were no occurrences of severe CHF after the end of the scheduled treatment period of 1 year. Among the patients in the trastuzumab group with confirmed significant LVEF drop, the first occurrence was within the scheduled treatment period of 1 year for 55 out of 60 patients (91.7%). In the trastuzumab group, 59 of 73 patients (80.8%) with a cardiac endpoint reached acute recovery and of these 59 patients 52 (88.1%) were consider to have a favourable long term outcome. Conclusions: The incidence of cardiac endpoints remains low even with longer term follow-up. The cumulative incidence of any type of cardiac endpoint increases during the scheduled treatment period of 1 year, but appears to remain approximately constant after the scheduled treatment period of 1 year is completed. [Table: see text]
Collapse
Affiliation(s)
- M. J. Procter
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| | - T. Suter
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| | - E. de Azamuja
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| | - S. Muehlbauer
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| | - U. Dafni
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| | - D. J. van Veldhuisen
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| | - M. Muscholl
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| | - M. Piccart-Gebhart
- Frontier Science Scotland, Kincraig, Kingussie, United Kingdom; Swiss Cardiovascular Centre, University Hospital, Bern, Switzerland; Jules Bordet Institute, Brussels, Belgium; F. Hoffmann-La Roche, Basel, Switzerland; Frontier Science Foundation-Hellas, Athens, Greece; University Medical Center Groningen, Groningen, Netherlands; Kardiologische Praxis, Munich, Germany; Jules Bordet Institue, Brussels, Belgium
| |
Collapse
|
37
|
Broers CJM, Sinclair N, van der Ploeg TJ, Jaarsma T, van Veldhuisen DJ, Umans VAWM. The post-infarction nurse practitioner project: A prospective study comparing nurse intervention with conventional care in a non-high-risk myocardial infarction population. Neth Heart J 2009; 17:61-7. [PMID: 19247468 PMCID: PMC2644381 DOI: 10.1007/bf03086219] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To confirm the feasibility of nurse practitioner interventionin non-high-risk patients with recent myocardial infarction (MI). DESIGN Observational study. SETTING Acute coronary care unit in a teaching hospital. METHODS We performed an open-label feasibility study to identify non-high-risk MI patients and evaluate the outcome of a new nurse practitioner intervention programme. The initial pilot phase served to identify the non-high-risk population. In the subsequent confirmation phase, 500 consecutive non-high-risk post-MI patients with preserved LV function without heart failure were included to receive nurse practitioner management. The nurse practitioner intervention started on transfer from the coronary care unit to the cardiology ward and continued thereafter for up to 30 days. MAIN OUTCOME MEASURES Time to first event analysis of death from all causes or repeat myocardial infarction. RESULTS 500 Patients without signs of heart failure or depressed LV function were identified as nonhigh- risk and eligible for inclusion in the nurse practitioner intervention programme. In the implementation phase, none of the patients died and 0.9% developed a repeat myocardial infarction after 30 days of follow-up. Compared with the pilot phase, patients in the implementation phase spent fewer days in hospital (mean 11.1 versus 6.2 days; p<0.001). CONCLUSION It is feasible to identify non-high-risk post-MI patients, who can be managed adequately by a nurse practitioner. Embedding experienced nurse practitioners within critical care pathways may result in significant decreases in length of hospital stay. (Neth Heart J 2009;17:61-7.Neth Heart J 2009;17:61-7.).
Collapse
Affiliation(s)
- C J M Broers
- Department of Cardiology, Medical Centre Alkmaar, Alkmaar, the Netherlands
| | | | | | | | | | | |
Collapse
|
38
|
Abstract
BACKGROUND Anaemia is common in patients with chronic heart failure (HF), and erythropoiesis stimulating proteins (ESPs) are frequently used for its treatment. However, recent studies in patients with malignancies and renal failure have raised concerns about the safety of these agents. OBJECTIVE To determine whether treatment of anaemic patients with chronic HF with ESPs is associated with an effect on morbidity and mortality. DATA SOURCES A systematic literature search in Medline, the Cochrane Controlled Trials Register Database and ClinicalTrials.gov through July 2008 was performed. STUDY SELECTION Randomised clinical trials comparing the effect of ESP treatment with placebo or usual care in anaemic patients with HF were included. RESULTS Seven randomised controlled trials were identified that enrolled 650 patients, of whom 363 were treated with ESPs and 287 with placebo. ESP treatment had a significantly lower risk of HF hospitalisation (risk ratio (RR) = 0.59; 95% CI 0.41 to 0.86; p = 0.006).There was no significant difference in the mortality risk between the two groups (RR = 0.69; 95% CI 0.39 to 1.23; p = 0.21). No significant differences were observed in the occurrence of hypertension or venous thrombosis. CONCLUSIONS In chronic HF, treatment with ESPs is not associated with a higher mortality rate or more adverse events, whereas a beneficial effect on HF hospitalisation is seen. These outcomes are in contrast with studies in cancer and kidney disease, and support a large phase III morbidity and mortality trial of anaemia correction in patients with chronic HF.
Collapse
Affiliation(s)
- P van der Meer
- Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands.
| | | | | | | |
Collapse
|
39
|
Wong LS, Oeseburg H, de Boer RA, van Gilst WH, van Veldhuisen DJ, van der Harst P. Telomere biology in cardiovascular disease: the TERC-/- mouse as a model for heart failure and ageing. Cardiovasc Res 2008; 81:244-52. [DOI: 10.1093/cvr/cvn337] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
40
|
Winter MM, Bouma BJ, Groenink M, Konings TC, Tijssen JGP, van Veldhuisen DJ, Mulder BJM. Latest insights in therapeutic options for systemic right ventricular failure: a comparison with left ventricular failure. Heart 2008; 95:960-3. [DOI: 10.1136/hrt.2008.156265] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
41
|
Jaarsma T, van der Wal MHL, Lesman-Leegte I, Luttik ML, Hogenhuis J, Veeger NJ, Sanderman R, Hoes AW, van Gilst WH, Lok DJA, Dunselman PHJM, Tijssen JGP, Hillege HL, van Veldhuisen DJ. [Value of basic and intensive management of patients with heart failure; results of a randomised controlled clinical trial]. Ned Tijdschr Geneeskd 2008; 152:2016-2021. [PMID: 18825890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To determine the efficacy of 2 nurse-directed programmes of different intensity for the counselling and follow-up of patients hospitalised for heart failure, compared with standard care by a cardiologist. DESIGN Multicentre randomised clinical trial (www.trialregister.nl: NCT 98675639). METHOD A total of 1023 patients were randomized after hospitalisation for heart failure to 1 of 3 treatment strategies: standard care provided by a cardiologist, follow-up care from a cardiologist with basic counselling and support by a nurse specialising in heart failure, or follow-up care from a cardiologist with intensive counselling and support by a nurse specialising in heart failure. Primary end points were the time to rehospitalisation due to heart failure or death and the number of days lost to rehospitalisation or death during the 18-month study period. Data were analysed on an intent-to-treat basis. RESULTS Mean patient age was 71 years, 38% were women, 50% had mild heart failure and 50% had severe heart failure. During the study, 411 patients (40%) were rehospitalised due to heart failure or died from any cause: 42% in the control group, and 41% and 38% in the basic and intensive support groups, respectively (differences not significant). The time to rehospitalisation or death was similar in the 3 groups: hazard ratios for the basic and intensive support groups versus the control group were 0.96 (95% CI: 0.76-1.21; p = 0.73) and 0.93 (95% CI: 0.73-1.17; p = 0.53), respectively. The number of days lost to rehospitalisation or death was 39,960 in the control group; this number was 15% less in the intervention groups, but the difference was not significant. However, there was a trend toward lower mortality in the intervention groups. In all 3 groups, more visits occurred than planned, which may have had a considerable effect on care, notably in the control group. CONCLUSION The results of this study indicated that the provision of additional counselling and support by a nurse specialising in heart failure as an adjuvant to intensive follow-up care provided by a cardiologist does not always lead to a reduction in rehospitalisation frequency.
Collapse
Affiliation(s)
- T Jaarsma
- Universitair Medisch Centrum Groningen, afd. Cardiologie, Postbus 30.001, 9700 RB Groningen.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Huzen J, van Veldhuisen DJ, van Gilst WH, van der Harst P. [Telomeres and biological ageing in cardiovascular disease]. Ned Tijdschr Geneeskd 2008; 152:1265-1270. [PMID: 18590060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The striking variability in the age of onset of and the manifestation/ absence of manifestation of cardiovascular diseases is inadequately explained by conventional risk factors, but may be explained by variation in biological age. Telomere length is possibly a reliable marker of biological age, shorter telomeres reflecting more advanced age. The initial telomere length ofa person is mainly determined by genetic factors. Moreover, the telomere length shortens with each cell division, and exposition to harmful environmental factors also results in shorter telomeres. Leukocytes of patients with atherosclerosis and heart failure display remarkably shorter telomeres compared to leukocytes of healthy subjects of similar age. Conventional cardiovascular risk factors are also associated with telomere length. If telomeres are indeed causally involved in the pathogenesis of cardiovascular disease, this might provide new avenues for future preventive and therapeutic strategies.
Collapse
Affiliation(s)
- J Huzen
- Universitair Medisch Centrum Groningen, afd. Cardiologie, Postbus 30.001, 9700 RB Groningen
| | | | | | | |
Collapse
|
43
|
van der Meer P, Januzzi JL, van Veldhuisen DJ. Erythropoietin, haemoglobin, heart failure, and mortality: reply. Eur Heart J 2008. [DOI: 10.1093/eurheartj/ehn400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
44
|
van der Meer P, van Veldhuisen DJ. [New applications of erythropoietin in cardiovascular disease: from haematopoiesis to cardiac protection]. Ned Tijdschr Geneeskd 2008; 152:923-927. [PMID: 18561787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Anaemia is common in patients with heart failure and is associated with poorer prognosis. The aetiology of anaemia in heart failure is diverse and includes renal failure, iron and vitamin deficiency, the use of medication, and insensitivity of the bone marrow to erythropoietin. Recently, small-scale clinical trials investigating the effect of erythropoietin on anaemia showed an improvement in the surrogate cardiovascular endpoints exercise tolerance, haemodynamics and number of hospitalisations. Erythropoietin also has non-haematopoietic (pleiotropic) effects, such as inhibition of apoptosis and neovascularisation. In preclinical studies, erythropoietin had a beneficial effect on heart function following acute myocardial infarction and in heart failure. Currently, these pleiotropic effects are being studied in patients with acute myocardial infarction.
Collapse
Affiliation(s)
- P van der Meer
- Universitair Medisch Centrum Groningen, Thoraxcentrum, afd. Cardiologie, Postbus 30.001, 9700 RB Groningen.
| | | |
Collapse
|
45
|
Jaarsma T, Lesman I, van Veldhuisen DJ. Psychology and cardiology: do not forget the heart failure patient. Eur Heart J 2008; 29:1208; author reply 1208-9. [DOI: 10.1093/eurheartj/ehn120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
46
|
van der Meer P, Lok DJ, Januzzi JL, de la Porte PWBA, Lipsic E, van Wijngaarden J, Voors AA, van Gilst WH, van Veldhuisen DJ. Adequacy of endogenous erythropoietin levels and mortality in anaemic heart failure patients. Eur Heart J 2008; 29:1510-5. [DOI: 10.1093/eurheartj/ehn205] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
47
|
van Veldhuisen DJ, Wasserman SM, Baker N. Randomized, double-blind, placebo-controlled study to evaluate the effect of two dosing regiments of darbepoetin alfa in patients with heart failure and anaemia: reply. Eur Heart J 2008. [DOI: 10.1093/eurheartj/ehm600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
48
|
Brügemann J, de Jonge-Weber ATG, Rienstra M, van den Broek SAJ, Zijlstra F, van Veldhuisen DJ. [Dobutamine therapy at home under the guidance of a nurse practitioner, either as a bridge to cardiac transplantation or as destination therapy in severe heart failure]. Ned Tijdschr Geneeskd 2007; 151:2460-2465. [PMID: 18064867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To evaluate the results of intravenous dobutamine therapy at home for ambulatory patients with severe heart failure. DESIGN Retrospective. METHOD Data were retrieved for the 40 patients that had been treated with intravenous dobutamine at home during the period from 1 January 1994 until mid-November 2006 at the Thorax Centre of Groningen University Medical Centre, The Netherlands. The patients were guided by a nurse practitioner. RESULTS The study group comprised 31 men and 9 women. The 22 patients on the waiting list for a heart transplant had an average age of 49 years. For the other 18 patients, on average 63 years old, it was destination therapy. The mean administered dosage ofdobutamine was 4 microg/kg/ min (range: 2-10). Pre-transplantation and destination therapy were given for an average of 3.5 and 1.5 months, respectively. A successful transplantation was performed in 14 (64%) of the 22 waiting-list candidates; 2 patients were still on the waiting list and 6 died while on the waiting list. Intravenous access complications and ICD shocks each occurred in 6 (15%) patients. The quality of life was reasonable to fair in the waiting-list patients and moderate to reasonable in those given destination therapy. The costs for medication and hire of the infusion pump were Euro 450 per month. CONCLUSION Dobutamine infusion therapy at home under the guidance of a nurse practitioner, either as a bridge to cardiac transplantation or as destination therapy in patients with severe heart failure, appeared safe, feasible and not expensive.
Collapse
Affiliation(s)
- J Brügemann
- Universitair Medisch Centrum Groningen, Thoraxcentrum, onderafd. Cardiologie, Postbus 30.001, 9700 RB Groningen.
| | | | | | | | | | | |
Collapse
|
49
|
Hartog JW, Voors AA, Schalkwijk CG, Scheijen J, Smilde TD, Damman K, Bakker SJ, Smit AJ, van Veldhuisen DJ. Clinical and prognostic value of advanced glycation end-products in chronic heart failure. Eur Heart J 2007; 28:2879-85. [DOI: 10.1093/eurheartj/ehm486] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
50
|
de Korte MA, de Vries EGE, Lub-de Hooge MN, Jager PL, Gietema JA, van der Graaf WTA, Sluiter WJ, van Veldhuisen DJ, Suter TM, Sleijfer DT, Perik PJ. 111Indium-trastuzumab visualises myocardial human epidermal growth factor receptor 2 expression shortly after anthracycline treatment but not during heart failure: a clue to uncover the mechanisms of trastuzumab-related cardiotoxicity. Eur J Cancer 2007; 43:2046-51. [PMID: 17719768 DOI: 10.1016/j.ejca.2007.06.024] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2007] [Revised: 05/12/2007] [Accepted: 06/25/2007] [Indexed: 11/16/2022]
Abstract
AIM Trastuzumab can induce cardiotoxicity, particularly when combined with anthracyclines. Myocardial human epidermal growth factor receptor 2 (HER2) expression may be transiently upregulated by a compensatory mechanism following cardiac stress. 111In-DTPA-trastuzumab, scintigraphy can detect HER2 positive tumour lesions, however previously, we found myocardial uptake in only 1 of the 15 anthracycline-pre-treated patients with a median of 11 months after the last anthracycline administration. To evaluate whether myocardial HER2 expression is upregulated by anthracycline-induced cardiac stress or in case of heart failure by chronic pressure or volume overload, we performed 111In-DTPA-trastuzumab scans in patients shortly after anthracyclines and with non-anthracycline-related heart failure. METHODS Patients within 3 weeks after undergoing 4-6 cycles first-line anthracycline-based chemotherapy and patients with heart failure due to cardiac disease underwent gammacamera imaging 48 and 96 h after 111In-DTPA-trastuzumab intravenously. RESULTS Myocardial 111In-DTPA-trastuzumab uptake was observed in 5 out of 10 anthracycline-treated patients, who all were without symptomatic cardiac dysfunction. None of the 10 heart failure patients showed myocardial uptake. CONCLUSION Shortly after completion of anthracycline treatment, myocardial HER2 over-expression was detectable in 50% of the patients. 111In-DTPA-trastuzumab scintigraphy after anthracyclines prior to adjuvant trastuzumab potentially identifies patients susceptible for trastuzumab-related cardiotoxicity and thus may facilitate the optimal timing of trastuzumab therapy.
Collapse
Affiliation(s)
- M A de Korte
- Department of Medical Oncology, University of Groningen and University Medical Centre Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|