1
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Piek JJ. Einthoven Dissertation Prizes 2023. Neth Heart J 2023; 31:357-359. [PMID: 37581867 PMCID: PMC10444726 DOI: 10.1007/s12471-023-01803-1] [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] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- J J Piek
- Department of Cardiology, Heart Centre, Amsterdam University Medical Centres, location Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
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2
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van Nieuwkerk AC, Piek JJ. Transfemoral transcatheter aortic valve implantation: towards local anaesthesia for everyone? Neth Heart J 2022; 30:499-502. [PMID: 36280628 PMCID: PMC9590388 DOI: 10.1007/s12471-022-01728-1] [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] [Accepted: 10/12/2022] [Indexed: 11/03/2022] Open
Affiliation(s)
- A. C. van Nieuwkerk
- grid.7177.60000000084992262Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J. J. Piek
- grid.7177.60000000084992262Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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3
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Vink CEM, Hoef TP, Lee JM, Boerhout CKM, Koo BK, Escaned J, Piek JJ, Kakuta T, Appelman Y, De Waard G. Sex-differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome – analysis from the multi-center international ILIAS Registry. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
Guideline-directed management of chronic coronary syndrome (CCS) remains focused on obstructive causes of angina, and is based on established therapies derived from studies predominantly including men. This occurs despite documented higher mortality from cardiovascular causes in women compared to men, which is hypothesized to be related to a higher prevalence of coronary microvascular dysfunction (CMD) in women. However, data on the relationship between sex, the different endotypes of CCS, and related sex-specific clinical outcomes are limited.
Purpose
This study aimed to investigate the relationship between sex and the different endotypes of CCS, as well as sex-specific clinical outcomes of CCS endotypes.
Method
In patients with stable angina undergoing coronary angiography, the following invasive coronary hemodynamics were characterized: fractional flow reserve (FFR; <0.80 considered abnormal), coronary flow reserve (CFR; <2.0 considered abnormal) and microcirculatory resistance (MR) (hyperemic microvascular resistance; >2.5mmHg/cm/sec or index of microvascular resistance >25 considered abnormal). Patients were stratified into three groups: 1) hemodynamically significant obstructive coronary artery disease (oCAD) (FFR abnormal or a severe coronary stenosis requiring revascularization), 2) no-obstructive coronary artery disease but with CMD (FFR normal, but abnormal CFR and/or MR), or 3) no-obstructive coronary artery disease and no CMD (FFR normal, and normal CFR and MR). We assessed the prevalence of the CCS endotypes across sex, and sex-specific cardiovascular outcomes over a follow-up of 7 years defined as the composite endpoint of death or acute myocardial infarction.
Results
Amongst a total of 1987 included patients, 1435 (72.2%) were men and 552 (27.8%) were women. oCAD occurred in 904 (45.5%) patients, which was significantly more prevalent in men (48.9% (701/1435) of men vs. 36.8% (203/552) of women, p<0.001). In contrast, CMD was significantly more prevalent in women (19.6% (281/1435) of men vs. 24.1% (133/552) of women, p=0.031). Across the population, either oCAD or CMD occurred in 68.4% of men versus 60.9% of women (p=0.002). There were no sex-specific differences in cardiovascular outcomes across CCS entities (Figure 1).
Conclusion
In patients evaluated for CCS who underwent clinically indicated coronary angiography and physiological assessment, men were more likely to have oCAD and women were more likely to be classified as CMD. There were no sex-related differences in the prognosis associated with the individual CCS endotypes. Therefore, pathophysiological changes in the coronary circulation potentially underlying angina pectoris are similarly prevalent in men and women, but the high incidence of CMD in women makes women prone to underdiagnosis if no additional physiological measurements are assessed.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- C E M Vink
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - T P Hoef
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - J M Lee
- Samsung Medical Center, Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute , Seoul , Korea (Republic of)
| | - C K M Boerhout
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - B K Koo
- University of Ulsan, Cardiology , Ulsan , Korea (Republic of)
| | - J Escaned
- Hospital Clinico San Carlos , Madrid , Spain
| | - J J Piek
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Cardiology , Tsuchiura , Japan
| | - Y Appelman
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
| | - G De Waard
- Amsterdam University Medical Center, Cardiology , Amsterdam , The Netherlands
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4
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Feenstra RGT, Woudstra J, Bijloo I, Eringa EC, De Winter RJ, Van De Hoef TP, Appelman Y, Beijk MAM, Piek JJ. Post-occlusive reactive hyperaemia can objectify the occurrence of vasospasm induced ischemia during acetylcholine provocation testing. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Abstract
Abstract
Introduction
Acetylcholine (ACh) spasm provocation testing together with the diagnostic criteria published by the Coronary Vasomotor Disorders International Study Group (COVADIS) are considered the gold standard for the diagnosis of coronary vasospasm in contemporary clinical practice. In 20–29% of patients undergoing vasospasm provocation an equivocal test result occurs when these criteria are only partially met and poses a diagnostic dilemma. Post-occlusive reactive hyperaemia is a marker of acute myocardial ischemia and could serve as an added objective diagnostic criterium for the diagnosis of acetylcholine induced vasospasm.
Purpose
The aim of this study is therefore to evaluate the occurrence of post-occlusive reactive hyperaemia in the equivocal, positive and negative test result that follows acetylcholine vasospasm provocation.
Methods
66 patients with angina and non-obstructive coronary artery disease on angiography (ANOCA) who underwent the entire ACh spasm provocation testing protocol were included in this analysis. After each ACh dose angiography was performed and when vasospasm occurred 200 μg nitro-glycerine was administered intracoronary. Definitions and diagnostic criteria for CAS were in line with those used by the COVADIS working group to diagnose epicardial and microvascular vasospasm. An equivocal test result was defined as the induction of recognisable angina without ischemic ECG changes, in reaction to ACh. Doppler flow was continuously measured during the procedure. Changes in flow due to ACh mediated vasodilation quickly return to baseline values due to its short-half life. Therefore, the occurrence of post-ischemic reactive hyperaemia was assessed by the extended time to return to baseline flow, the so called “flow recovery time”.
Results
We analysed the flow recovery time in 21 patients with epicardial vasospasm, in 16 with microvascular spasm, in 14 with an equivocal test result and in 15 with a negative test result. Mean age of the entire study population was 56±11 years and 86% were female. In reaction to dose 1 to 3 flow recovery time was similar between all diagnostic endotypes. In reaction to the fourth dose flow recovery time was extended in the epicardial, microvascular and equivocal test result compared to the negative test result indicative of post-ischemic reactive hyperaemia.
Conclusion
Post-occlusive reactive hyperaemia occurs in patients with an equivocal test result similar to patients with microvascular vasospasm and epicardial vasospasm. These findings indicate the occurrence of acetylcholine induced vasospasm in the equivocal test result and these patients may benefit from medical treatment.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R G T Feenstra
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - J Woudstra
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - I Bijloo
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - E C Eringa
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - R J De Winter
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - T P Van De Hoef
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - Y Appelman
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - M A M Beijk
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
| | - J J Piek
- Amsterdam University Medical Centre , Amsterdam , The Netherlands
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5
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Boerhout CKM, Piek JJ. Pressure gradient post-percutaneous coronary intervention: beyond angiography. Neth Heart J 2022; 30:341-342. [PMID: 35788896 PMCID: PMC9270506 DOI: 10.1007/s12471-022-01709-4] [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] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Affiliation(s)
- C K M Boerhout
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC-location AMC, Amsterdam, The Netherlands
| | - J J Piek
- Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam UMC-location AMC, Amsterdam, The Netherlands.
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6
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Boerhout CKM, Feenstra RGT, Somsen GA, Appelman Y, Ong P, Beijk MAM, Hofstra L, van de Hoef TP, Piek JJ. Coronary computed tomographic angiography as gatekeeper for new-onset stable angina. Neth Heart J 2021; 29:551-556. [PMID: 34676522 PMCID: PMC8556428 DOI: 10.1007/s12471-021-01639-7] [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: 09/01/2021] [Indexed: 01/16/2023] Open
Abstract
Patients with new-onset stable angina constitute a substantial part of the population seen by cardiologists. Currently, the diagnostic workup of these patients depends on the pre-test probability of having obstructive coronary artery disease. It consists of either functional testing for myocardial ischaemia or anatomical testing by using coronary computed tomographic angiography (CCTA) or invasive coronary angiography. In case the pre-test probability is > 5%, the current guidelines for the management of chronic coronary syndromes do not state a clear preference for one of the noninvasive techniques. However, based on the recently published cost-effectiveness analysis of the PROMISE trial and considering the diagnostic yield in patients with angina and nonobstructive coronary artery disease, we argue a more prominent role for CCTA as a gatekeeper for patients with new-onset stable angina.
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Affiliation(s)
- C K M Boerhout
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - R G T Feenstra
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - G A Somsen
- Cardiology Centres of the Netherlands, Amsterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - P Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany
| | - M A M Beijk
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - L Hofstra
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - T P van de Hoef
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - J J Piek
- Department of Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
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7
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Feenstra RGT, Boerhout CKM, Woudstra J, Vink CEM, De Waard GA, Appelman Y, Eringa EC, Marques KMJ, De Winter RJ, Van De Hoef TP, Beijk MAM, Piek JJ. Simultaneous intracoronary testing for endothelial dysfunction and coronary vasospasm in patient with angina and non-obstructive coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Introduction
Currently, two different theories exist on testing for coronary functional disorders in patients with angina and no obstructive coronary artery disease (ANOCA) where either invasive testing for endothelial function or coronary spasm provocation is performed. In this study we aim to assess the concomitant occurrence of both conditions in a cohort of patients with ANOCA undergoing both endothelial function testing and spasm provocation.
Methods
In this retrospective study, we included 114 patients that have undergone invasive coronary vasomotor function testing for coronary endothelial function and coronary artery spasm provocation. Endothelial dysfunction was defined as a <50% increase in coronary blood flow and/or epicardial coronary diameter reduction compared to baseline in reaction coronary acetylcholine concentrations up to 10–6 mol/L. Coronary artery spasm (CAS), defined as VSA and/or MVA due to microvascular spasm, was defined according to the COVADIS criteria in reaction to coronary acetylcholine concentration up to 10–5 mol/L.
Results
Among the 114 patients, 90 (78%) could be diagnosed with endothelial dysfunction and 71 (62%) with CAS. In most patients, 60 (54%), endothelial dysfunction and CAS can be diagnosed concurrently, whereas only 30 had endothelial dysfunction without CAS and 11 patients had CAS with a normal endothelial function.
Conclusion
In this cohort of ANOCA patients undergoing testing for coronary endothelial function and spasm provocation a large overlap of concurrent endothelial dysfunction and spasm provocation was found. These findings suggest a role for simultaneous endothelial function testing and spasm provocation in coronary vasomotor function protocols in order to adequately identify endotypes of ANOCA.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R G T Feenstra
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - C K M Boerhout
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - J Woudstra
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - C E M Vink
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - G A De Waard
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - Y Appelman
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - E C Eringa
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - K M J Marques
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - R J De Winter
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | | | - M A M Beijk
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - J J Piek
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
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8
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Feenstra RGT, Seitz A, Boerhout CKM, De Winter RJ, Ong P, Beijk MAM, Piek JJ, Sechtem U, Van De Hoef TP. Reference values for intracoronary doppler flow velocity-derived hyperaemic microvascular resistance index. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Background
Invasive assessments of microvascular function are rapidly becoming an integral part of physiological assessment in chronic coronary syndromes.
Objective
We aimed to establish a reference range for Doppler flow velocity-derived hyperaemic microvascular resistance index in a cohort of ANOCA patients with no structural pathophysiological alterations in the coronary circulation.
Methods
The reference population consisted of ANOCA patients undergoing invasive coronary vasomotor function assessment who had a coronary flow reserve (CFR) >2.5, and had either (1) tested negatively for spasm provocation (n=12) or (2) tested positively with only angina at rest (n=29). A reference range for HMR was established using a non-parametric method and correlations with clinical characteristics were determined using a spearman rank correlation analysis.
Results
In 41 patients median HMR amounted to 1.6 mmHg/cm/s [Q1, Q3: 1.3, 2.2 mmHg/cm/s]. The reference range for HMR that is applicable to 95% of the population was 0.8 mmHg/cm/s (90% CI: 0.8–1.0 mmHg/cm/s) to 2.7 mmHg/cm/s (90% CI: 2.6–2.7 mmHg/cm/s). No significant correlations were found between HMR and clinical characteristics.
Conclusion
In this reference population undergoing invasive coronary vasomotor function testing, the 90% confidence interval of the HMR upper limit of normal ranges from 2.6 to 2.7 mmHg/cm/s. A >2.5 mmHg/cm/s HMR threshold can be used to identify abnormal microvascular resistance in daily clinical practice.
Funding Acknowledgement
Type of funding sources: None. Example of HMR measurement
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Affiliation(s)
- R G T Feenstra
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - A Seitz
- Robert Bosch Hospital, Stuttgart, Germany
| | - C K M Boerhout
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - R J De Winter
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - P Ong
- Robert Bosch Hospital, Stuttgart, Germany
| | - M A M Beijk
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - J J Piek
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - U Sechtem
- Robert Bosch Hospital, Stuttgart, Germany
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9
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Piek JJ. Einthoven Dissertation Prizes 2020. Neth Heart J 2021; 29:468-470. [PMID: 34387822 PMCID: PMC8397811 DOI: 10.1007/s12471-021-01601-7] [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] [Accepted: 07/06/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- J J Piek
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
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10
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Demirkiran A, Hassell MECJ, Garg P, Elbaz MSM, Delewi R, Greenwood JP, Piek JJ, Plein S, Van Der Geest RJ, Nijveldt R. Left ventricular four-dimensional blood flow energetics and vorticity in chronic myocardial infarction patients with/without left ventricular thrombus. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): The British Heart Foundation [FS/10/62/28409] and Dutch ZonMw [104003001].
Background
Left ventricular thrombus (LVT) formation is a frequent and serious complication of myocardial infarction (MI). How global LV flow characteristics are related to this phenomenon is yet uncertain. In this study, we investigated LV flow differences using 4D flow cardiovascular magnetic resonance (CMR) between chronic MI patients with LVT [MI-LVT(+)] and without LVT [MI-LVT(-)], and healthy controls.
Methods
In this prospective cohort study, the 4D flow CMR data were acquired in 19 chronic MI patients (MI-LVT(+), n= 9 and MI-LVT(-), n= 10) and 9 age-matched controls. All included subjects were in sinus rhythm. The following LV flow parameters were obtained: LV flow components (direct, retained, delayed, residual), mean and peak KE values (indexed to instantaneous LV volume), mean and peak vorticity values, and diastolic vortex ring properties (position, orientation, shape).
Results
The MI patients demonstrated a significantly larger amount of delayed and residual flow, and a smaller amount of direct flow compared to controls (p = 0.02, p = 0.03, and p < 0.001, respectively). The MI-LVT(+) patients demonstrated numerically increased residual flow and reduced retained and direct flow in comparison to MI-LVT(-) patients. Systolic mean and peak LV blood flow KE values were significantly lower in MI patients compared to controls (p = 0.04, p = 0.03, respectively). Overall, the mean and peak LV vorticity values were significantly lower in MI patients compared to controls. The mean vorticity at the basal level was significantly higher in MI-LVT(+) than in MI-LVT(-) patients (p < 0.01). The vortex ring core during E-wave in MI-LVT(-) group was located closer to the mitral annulus and in a less tilted orientation to the LV compared to MI-LVT(+) group (p = 0.05, p < 0.01, respectively).
Conclusion
Chronic MI patients with LVT express a different distribution of LV flow components, irregular vorticity vector fields, and altered diastolic vortex ring geometric properties as assessed by 4D flow CMR. Larger prospective studies are warranted to further evaluate these initial observations.
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Affiliation(s)
- A Demirkiran
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - M ECJ Hassell
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - P Garg
- University of Leeds, Cardiology, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - M SM Elbaz
- Northwestern University, Radiology, Chicago, United States of America
| | - R Delewi
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - JP Greenwood
- University of Leeds, Cardiology, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - JJ Piek
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - S Plein
- University of Leeds, Cardiology, Leeds, United Kingdom of Great Britain & Northern Ireland
| | - RJ Van Der Geest
- Leiden University Medical Center, Radiology, Leiden, Netherlands (The)
| | - R Nijveldt
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
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11
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Jorstad HT, Piek JJ. Physical inactivity in times of a pandemic: another curve to flatten. Neth Heart J 2021; 29:241-242. [PMID: 33855691 PMCID: PMC8045580 DOI: 10.1007/s12471-021-01576-5] [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] [Accepted: 04/07/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- H T Jorstad
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J J Piek
- Department of Cardiology, Heart Centre, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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12
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Damman P, Piek JJ. The Coronary Sinus Reducer for refractory angina. Neth Heart J 2021; 29:177-178. [PMID: 33675522 PMCID: PMC7990976 DOI: 10.1007/s12471-021-01557-8] [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] [Accepted: 02/18/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- P Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - J J Piek
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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13
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Jørstad HT, Piek JJ. COVID-19, sports, and myocardial consequences. Neth Heart J 2020; 28:563-564. [PMID: 33030658 PMCID: PMC7543669 DOI: 10.1007/s12471-020-01499-7] [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] [Accepted: 09/30/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- H T Jørstad
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - J J Piek
- Department of Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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14
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Konst RE, Meeder JG, Wittekoek ME, Maas AHEM, Appelman Y, Piek JJ, van de Hoef TP, Damman P, Elias-Smale SE. Ischaemia with no obstructive coronary arteries. Neth Heart J 2020; 28:66-72. [PMID: 32780334 PMCID: PMC7419395 DOI: 10.1007/s12471-020-01451-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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] [Indexed: 12/30/2022] Open
Abstract
Ischaemia with no obstructive coronary arteries (INOCA) is a common ischaemic heart disease with a female preponderance, mostly due to underlying coronary vascular dysfunction comprising coronary microvascular dysfunction and/or epicardial coronary vasospasm. Since standard ischaemia detection tests and coronary angiograms are not suitable to diagnose coronary vascular dysfunction, INOCA is often overlooked in current cardiology practice. Future research, including large outcome trials, is much awaited. Yet, adequate diagnosis is possible and treatment options are available and vital to reduce symptoms and most probably improve cardiovascular prognosis. This review intends to give a brief overview of the clinical presentation, underlying pathophysiology, and the diagnostic and treatment options in patients with suspected INOCA.
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Affiliation(s)
- R E Konst
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J G Meeder
- Department of Cardiology, VieCuri Medical Center, Venlo, The Netherlands
| | | | - A H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam UMC, Location VUMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T P van de Hoef
- Department of Clinical and Experimental Cardiology, Heart Center, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - P Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S E Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
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15
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Abstract
Invasive coronary physiology has been applied since the early days of percutaneous transluminal coronary angioplasty, and has become a rapidly emerging field of research. Many physiology indices have been developed, tested in clinical studies, and are now applied in daily clinical practice. Recent clinical practice guidelines further support the use of advanced invasive physiology methods to optimise the diagnosis and treatment of patients with acute and chronic coronary syndromes. This article provides a succinct review of the history of invasive coronary physiology, the basic concepts of currently available physiological parameters, and will particularly highlight the Dutch contribution to this field of invasive coronary physiology.
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Affiliation(s)
- T P van de Hoef
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - G A de Waard
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S A J Chamuleau
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
| | - N van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, The Netherlands
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16
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Piek JJ, van Rossum AC. ESC Congress 2020—Cardiology in the Netherlands. Neth Heart J 2020; 28:1-2. [PMID: 32780324 PMCID: PMC6940396 DOI: 10.1007/s12471-020-01483-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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17
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Vendrik J, Vlastra W, van Mourik MS, Delewi R, Beijk MA, Lemkes J, Wykrzykowska JJ, de Winter RJ, Henriques JS, Piek JJ, Vis MM, Koch KT, Baan J. Early mobilisation after transfemoral transcatheter aortic valve implantation: results of the MobiTAVI trial. Neth Heart J 2020; 28:240-248. [PMID: 32112292 PMCID: PMC7190768 DOI: 10.1007/s12471-020-01374-5] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Immobilisation of patients after transfemoral transcatheter aortic valve implantation (TF-TAVI) is the standard of care, mostly to prevent vascular complications. However, immobilisation may increase post-operative complications such as delirium and infections. In this trial, we determine whether it is feasible and safe to implement early ambulation after TF-TAVI. Methods We prospectively included TF-TAVI patients from 2016 to 2018. Patients were assessed for eligibility using our strict safety protocol and were allocated (based on the time at which the procedure ended) to the EARLY or REGULAR group. Results A total of 150 patients (49%) were deemed eligible for early mobilisation, of which 73 were allocated to the EARLY group and 77 to the REGULAR group. The overall population had a mean age of 80 years, 48% were male with a Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) score of 3.8 ± 1.8. Time to mobilisation was 4 h 49 min ± 31 min in the EARLY group versus 20 h 7 min ± 3 h 6 min in the REGULAR group (p < 0.0001). There were no differences regarding the primary endpoint. No major vascular complications occurred and a similar incidence of minor vascular complications was seen in both groups (4/73 [5.5%] vs 6/77 [7.8%], p = 0.570). The incidence of the combined secondary endpoint was lower in the EARLY group (p = 0.034), with a numerically lower incidence for all individual outcomes (delirium, infections, pain and unplanned urinary catheter use). Conclusion Early mobilisation (ambulation 4–6 h post-procedure) of TF-TAVI patients is feasible and safe. Early ambulation decreases the combined incidence of delirium, infections, pain and unplanned urinary catheter use, and its adoption into contemporary TAVI practice may therefore be beneficial. Electronic supplementary material The online version of this article (10.1007/s12471-020-01374-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J Vendrik
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands.
| | - W Vlastra
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M S van Mourik
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - R Delewi
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M A Beijk
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J Lemkes
- Heart Centre, Amsterdam University Medical Centres (location VUMC), Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - R J de Winter
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J S Henriques
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J J Piek
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - M M Vis
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - K T Koch
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Amsterdam University Medical Centres (location AMC), Amsterdam, The Netherlands
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18
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van Lavieren MA, Bax M, Stegehuis VE, van de Hoef TP, Wijntjens GWM, de Winter RJ, Koch KT, Henriques JPS, Meuwissen M, Sjauw KD, Piek JJ. Acute alterations in glucose homeostasis impact coronary microvascular function in patients presenting with ST-segment elevation myocardial infarction. Neth Heart J 2020; 28:161-170. [PMID: 31953778 PMCID: PMC7052118 DOI: 10.1007/s12471-020-01366-5] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Microvascular dysfunction in the setting of ST-segment myocardial infarction (STEMI) is thought to be related to stress-related metabolic changes, including acute glucose intolerance. The aim of this study was to assess the relationship between admission glucose levels and microvascular function in non-diabetic STEMI patients. Methods 92 consecutive patients with a first anterior-wall STEMI treated with primary percutaneous coronary intervention (PPCI) were enrolled. Blood glucose levels were determined immediately prior to PPCI. After successful PPCI, at 1‑week and 6‑month follow-up, Doppler flow was measured in culprit and reference coronary arteries to calculate coronary flow velocity reserve (CFVR), baseline (BMR) and hyperaemic (HMR) microvascular resistance. Results The median admission glucose was 8.3 (7.2–9.6) mmol/l respectively 149.4 mg/dl [129.6–172.8] and was significantly associated with peak troponin T (standardised beta coefficient [std beta] = 0.281; p = 0.043). Multivariate analysis revealed that increasing glucose levels were significantly associated with a decrease in reference vessel CFVR (std beta = −0.313; p = 0.002), dictated by an increase in rest average peak velocity (APV) (std beta = 0.216; p = 0.033), due to a decreasing BMR (std beta = −0.225; p = 0.038) in the acute setting after PPCI. These associations disappeared at follow-up. These associations were not found for the infarct-related artery. Conclusion Elevated admission glucose levels are associated with impaired microvascular function assessed directly after PPCI in first anterior-wall STEMI. This influence of glucose levels is an acute phenomenon and contributes to microvascular dysfunction through alterations in resting flow and baseline microvascular resistance.
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Affiliation(s)
- M A van Lavieren
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M Bax
- Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - V E Stegehuis
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - T P van de Hoef
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - G W M Wijntjens
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - K T Koch
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - K D Sjauw
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.,Heart Center, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - J J Piek
- Amsterdam UMC, Heart Center, Department of Interventional Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
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19
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Tijssen RYG, Annink ME, Kraak RP, Koch KT, Baan J, Vis MM, Piek JJ, Henriques JPS, de Winter RJ, Beijk MAM, Wykrzykowska JJ. The Absorb bioresorbable vascular scaffold in real-world practice: long-term follow-up of the AMC Single Centre Real World PCI Registry. Neth Heart J 2020; 28:153-160. [PMID: 31953774 PMCID: PMC7052095 DOI: 10.1007/s12471-019-01362-4] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Bioresorbable scaffolds have been introduced to overcome the shortcomings of drug-eluting stents. Higher rates of device thrombosis, however, have been reported up to 3 years after implantation of the Absorb bioresorbable vascular scaffold (BVS). In the current article, we therefore report long-term clinical outcomes of the AMC Absorb Registry. METHODS AND RESULTS In the AMC Absorb Registry, all patients who underwent a percutaneous coronary intervention with Absorb BVS implantation between 30 August 2012 and 5 August 2013 at the Amsterdam University Medical Centre-Academic Medical Centre were included. The composite endpoint of this analysis was target-vessel failure (TVF). The median follow-up of the study cohort of the AMC Absorb Registry was 1534 days. At the time of the cross-sectional data sweep the clinical status at 4 years was known in 124 of 135 patients (91.9%). At long-term follow-up, the composite endpoint of TVF had occurred in 27 patients. The 4‑year Kaplan-Meier estimate of TVF was 19.8%. At 4 years cardiac death had occurred in 4 patients (3.2%) and target-vessel myocardial infarction in 9 (6.9%) patients. Definite scaffold thrombosis occurred in 5 (3.8%) patients. We found 1 case of very late scaffold thrombosis that occurred at 911 days after device implantation in a patient who was not on dual anti-platelet therapy. CONCLUSION In a patient population reflecting routine clinical practice, we found that cases of TVF continued to accrue beyond 2 years after Absorb BVS implantation.
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Affiliation(s)
- R Y G Tijssen
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M E Annink
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R P Kraak
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - K T Koch
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Vis
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M A M Beijk
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Heart Centre, University of Amsterdam, Amsterdam, The Netherlands.
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20
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Dedic A, Piek JJ. Coronary artery calcium score: old faithful delivers again. Neth Heart J 2019; 28:73-74. [PMID: 31865612 PMCID: PMC6977801 DOI: 10.1007/s12471-019-01361-5] [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: 11/30/2022] Open
Affiliation(s)
- A Dedic
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, The Netherlands.
| | - J J Piek
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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21
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Affiliation(s)
- M J Schuuring
- Department of Cardiology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands. .,Department of Cardiology, Haga Teaching Hospital, The Hague, The Netherlands.
| | - D Robbers-Visser
- Department of Cardiology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - A H G Driessen
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
| | - J J Piek
- Department of Cardiology, Amsterdam University Medical Centre, location AMC, Amsterdam, The Netherlands
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22
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Tijssen RYG, Van Der Schaaf RJ, Vink MA, Kraak RP, Hofma SH, Arkenbout EK, Weevers APJD, Kerkmeijer LS, Onuma Y, Serruys PWJC, Piek JJ, Tijssen JGP, Henriques JP, De Winter RJ, Wykrzykowska JJ. 126Clinical outcomes at two years of the Absorb BRS vs. the Xience metallic DES in patients presenting with ACS vs. stable coronary disease - AIDA trial substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Abstract
Abstract
AIMS Patients with acute coronary syndrome (ACS) might represent a specific subgroup, in which bioresorbable scaffold implantation in percutaneous coronary intervention, might lead to better outcomes when compared to conventional treatment. ACS patients (STE-ACS patients in particular) are generally younger, and most often have lesions with softer plaques, a lower plaque burden and less extensive coronary artery disease. In this pre-specified subgroup analysis of the AIDA trial, we evaluated the clinical outcomes of Absorb BVS versus Xience EES treated patients presenting with or without ACS.
Methods and results
This analysis includes the 2-year outcomes of all 1845 patients randomized in the AIDA trial subdivided by clinical presentation, a pre-specified subgroup analysis. We compared patients presenting with ACS with those presenting without ACS (ACS versus no-ACS patients). Patients presenting with ACS were further sub-categorized according to the presence or absence of ST-segment elevation at presentation (STE-ACS versus NSTE-ACS patients). Baseline status by clinical presentation was known in all patients, and 842 (45.6%) patients presented with ACS, 456 (25.2%) with STE-ACS and 377 (20.4%) with NSTE-ACS.The rate of the 2-year primary endpoint of target vessel failure (TVF) was similar after treatment with Absorb BVS or Xience EES in ACS patients (10.2% versus 9.0% respectively; p=0.49) and in no-ACS patients (11.7% versus 10.7% respectively; p=0.67) Definite or probable device thrombosis occurred more frequently with Absorb BVS compared to Xience EES in ACS patients (4.3% versus 1.7% respectively, p=0.03) as well as in no-ACS patients (2.4% versus 0.2% respectively; p=0.002). There were no statistically significant interactions between clinical presentation and randomized device modality for TVF (p=0.80) and for the endpoint of definite or probable device thrombosis (p=0.17).
Conclusions
In ACS patients within AIDA, we found no difference in rates of target vessel failure between the Absorb BVS and Xience EES groups. Rates of definite or definite/probable device thrombosis were higher in the Absorb BVS group throughout all clinical presentations. No significant interaction between ACS and no-ACS patients and the occurrence of TVF
Acknowledgement/Funding
The AIDA trial was financially supported by an unrestricted research grant from Abbott Vascular.
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Affiliation(s)
- R Y G Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R J Van Der Schaaf
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - M A Vink
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - R P Kraak
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - S H Hofma
- Medical Center Leeuwarden, Cardiology, Leeuwarden, Netherlands (The)
| | - E K Arkenbout
- Tergooi Hospital, Cardiology, Blaricum, Netherlands (The)
| | | | - L S Kerkmeijer
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | | | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - J G P Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - J P Henriques
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R J De Winter
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - J J Wykrzykowska
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
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23
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Zeymer U, Desch S, Akin I, Ouarrak T, De Waha-Thiele S, Montalescot G, Piek JJ, Zahn R, Thiele H. P5737Use of the IMPELLA mechanical support device in patients with acute myocardial infarction complicated by cardiogenic shock - Results of the CULPRIT-SHOCK trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Background
Mortality in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) is still high despite the use of early revascularization therapy. While IABP support has been shown not improve outcome more effective mechanical support devices such as the IMPELLA are increasingly used. We sought to study the use of the IMPELLA device in patients with multivessel coronary artery disease and CS.
Methods
The CULPRIT-SHOCK shock trial included 686 patients with AMI complicated by cardiogenic shock and multivessel coronary artery disease treated with early PCI. Patients were randomized to immediate multivessel PCI or culprit lesion only PCI. In the current subanalysis, we investigated the patients treated with an IMPELLA support device compared these to patients without IMPELLA.
Results
Of the 686 patients 82 (12%) were treated with an IMPELLA device, 32 (39%) with IMPELLA 2.5 and 50 (61%) with IMPELLA CP. The device has been implanted in 34 patients before and 48 patients after PCI. The table shows the baseline characteristics of the patients with and without IMPELLA. In an unadjusted analysis mortality was higher with IMPELLA (63% versus 45.5%). Patients with IMPELLA CP had somewhat lower mortality than IMPELLA 2.5 (59.2% versus 68.8%), while there was no difference for pre- and post-PCI implantation.
IMPELLA (n=82) No IMPELLA (n=606) p-value Age (years) 70 68 0.17 Women 22.2% 23.3% 0.88 Diabetes 37.7% 31.8% 0.30 Triple vessel disease 66.7% 62.9% 0.13 Left main disease 28.4% 14.1% 0.001 LV-EF 31% 34% 0.18 Lactate on admission 20 mmol/l 8 mmol/l 0.0001 Multivessel PCI 50.6% 51.1% 0.9 Mechanical ventilation 88.9% 80.2% 0.06 SAPS-2 score 65 55 0.0008
Conclusion
Currently the IMPELLA support device is used primarily in patients with higher risk indicated by a higher incidence of left main disease, higher lactate on admission and higher SAPS II scores. This is associated with a higher mortality. Therefore randomized trials are needed to determine the effect of IMPELLA on outcome in patients with cardiogenic shock.
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Affiliation(s)
- U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | - T Ouarrak
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | | | | | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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24
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Murai T, Van De Hoef TP, Stegehuis VE, Wijntjens GWM, Yonetsu T, Hoshino M, Kanaji Y, Lee T, Kirkeeide RL, Johnson NP, Kakuta T, Piek JJ. P5618Coronary flow capacity to identify stenosis associated with coronary flow improvement after coronary revascularization. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Background
Coronary flow capacity (CFC) has recently been introduced as a comprehensive assessment of the coronary circulation by combining coronary flow reserve (CFR) and maximal coronary flow velocity to overcome the limitations of using CFR alone, and was reported to provide enhanced risk stratification compared with CFR. However, its potential to identify stenosis that would be associated with clinically relevant flow coronary flow improvement after revascularization has not been investigated.
Aims
The aim of this study is to quantify coronary flow changes after revascularization in relation to CFC and CFR.
Methods and results
Using a combined dataset of DEFINE FLOW and the Amsterdam UMC prospective ComboWire database, a total of 133 patients (135 vessels) with intermediate coronary artery lesions who underwent intracoronary physiologic assessment including intracoronary Doppler flow measurement before and after PCI were analyzed. The median values of fractional flow reserve (FFR) and CFR before PCI were 0.70 (Q1–3: 0.56–0.80) and 1.64 (Q1–3: 1.30–2.06). The number of lesions classified by CFC before PCI were 14 for normal CFC, 40 for mildly reduced CFC, 33 for moderately reduced CFC and 48 for severely reduced CFC. The lesions with larger impairment of CFC showed greater increase in coronary flow, and vice versa (median percent increase in coronary flow by revascularization: 4.2% for normal CFC; 25.9% for mildly reduced; 50.1% for moderately reduced; 145.5% for severely reduced, P<0.0001). Using the same CFR distribution based on CFC criteria showed that only lesions with severely reduced CFR showed a significantly higher coronary flow increase after PCI (−2.6% for CFR in the normal zone; 26.6% for CFR in the mildly reduced zone; 33.3% for CFR in the moderately reduced zone; 81.7% for CFR in the severely reduced zone, P=0.0007). Compared with the established CFR cut-off value of 2.0, moderate to severely reduced CFC showed higher specificity and positive predictive value (PPV) to predict at least 20% increase in coronary flow after PCI (specificity and PPV: 86.4% and 72.5% for ischemic CFC vs. 75.8% and 40% for CFR cut-off value 2.0). Multivariate logistic regression analysis revealed that the lesions with moderately or severely reduced CFC (odd ratio [OR] = 7.606 95%interconfidence interval [CI]: 2.834–20.412, P<0.001) and pre-PCI FFR (OR=0.0002, 95% CI: 0.0002–0.0204, P<0.001) were the independent predictors of coronary flow increase after PCI.
Conclusion
CFC showed a higher diagnostic efficiency for identification of lesions which benefit from revascularization compared to CFR with respect to coronary flow improvement. This study provides the physiological rational of revascularization for the lesions with moderately to severely reduced CFC from the perspective of coronary flow increase.
Acknowledgement/Funding
Philips Volcano
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Affiliation(s)
- T Murai
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - T P Van De Hoef
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - V E Stegehuis
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - G W M Wijntjens
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - T Yonetsu
- Tokyo Medical and Dental University, Department of Cardiology, Tokyo, Japan
| | - M Hoshino
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - Y Kanaji
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - T Lee
- Tokyo Medical and Dental University, Department of Cardiology, Tokyo, Japan
| | - R L Kirkeeide
- University of Texas Health Science Center at Houston, Department of Internal Medicine, Houston, United States of America
| | - N P Johnson
- University of Texas Health Science Center at Houston, Department of Internal Medicine, Houston, United States of America
| | - T Kakuta
- Tsuchiura Kyodo Hospital, Tsuchiura, Japan
| | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
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25
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Stegehuis VE, Wijntjens GWM, Bax M, Meuwissen M, Chamuleau SAJ, Voskuil M, Di Mario C, Vrints C, Haude M, Boersma H, Serruys PW, Piek JJ, Van De Hoef TP. P5620Clinical and hemodynamic determinants of coronary flow reserve in non-obstructed coronary arteries - A patient level pooled analysis of the DEBATE and ILIAS studies. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0564] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aim
Coronary Flow Reserve (CFR) is a valuable physiological index for the assessment of myocardial flow impairment due to focal or microcirculatory coronary artery disease (CAD). Coronary flow capacity (CFC) is another flow-based concept in diagnosing ischemic heart disease (IHD), based on hyperemic average peak velocity (hAPV) and CFR. We evaluated clinical and hemodynamic factors which potentially influence CFR and CFC in non-obstructed coronary arteries.
Methods
We analysed CFR and CFC of 396 non-obstructed vessels of patients from two large multi-center trials (DEBATE and ILIAS) with stable CAD who were scheduled for percutaneous coronary intervention (PCI). Doppler flow measurements were performed after inducing hyperemia with either intracoronary or intravenous infusion of adenosine.
Results
Akaike's Information Criterion (AIC) revealed the parameters age, female gender, a history of myocardial infarction, hypercholesterolemia, current or previous smoking and rate pressure product (RPP) as independent predictors in the best model of fit for CFR in an angiographically non-obstructed vessel. After multivariate regression analysis age, female gender and RPP remained as determinants of CFR in angiographically non-obstructed vessels. Subsequently, ordered logistic regression analysis revealed that age is associated with a worse CFC.
Conclusion
Clinical and hemodynamic parameters are associated with CFR and to a lesser extent CFC in an angiographically non-obstructed coronary artery. CFC is less sensitive to variations in clinical and hemodynamic parameters than CFR and therefore a promising tool in contemporary clinical decision making in the cardiac catheterization laboratory.
Acknowledgement/Funding
DEBATE: Cardiometrics INC. ILIAS: Dutch Health Insurance Board; RADI Medical Systems, Uppsala, Sweden; and Endosonics, Rancho Cordova, CA.
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Affiliation(s)
- V E Stegehuis
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands (The)
| | - G W M Wijntjens
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands (The)
| | - M Bax
- Hagaziekenhuis, Cardiology, Den Haag, Netherlands (The)
| | - M Meuwissen
- Amphia Hospital, Cardiology, Breda, Netherlands (The)
| | - S A J Chamuleau
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
| | - M Voskuil
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
| | - C Di Mario
- Careggi University Hospital (AOUC), Cardiology, Florence, Italy
| | - C Vrints
- University of Antwerp, Cardiology, Antwerp, Belgium
| | - M Haude
- Lukas Hospital GmbH, Cardiology, Neuss, Germany
| | - H Boersma
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - P W Serruys
- Imperial College London, Cardiology, London, United Kingdom
| | - J J Piek
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands (The)
| | - T P Van De Hoef
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands (The)
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Zeymer U, Desch S, Ouarrak T, Akin I, De Waha-Thiele S, Montalescot G, Piek JJ, Huber K, Thiele H. P1725Current spectrum and 1-year mortality of cardiogenic shock in Europe. Results of the CULPRIT-SHOCK randomized clinical trial and registry. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/14/2022] Open
Abstract
Abstract
Background
An early invasive strategy with coronary revascularization has been shown to improve prognosis in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). Little is known about the current spectrum, treatment and 1-year mortality in patients with CS undergoing early angiography in Europe.
Methods
We evaluated baseline characteristics, treatments and 1-year outcome in a large number of patients with CS included into the prospective CULPRIT-SHOCK randomized trial and the accompanying registry. Between April 2013 and April 2017, a total of 1075 patients with cardiogenic shock were screened at 83 European centers, of whom 706 (65.6%) were included in the randomized trial RCTand 369 into the registry.
Results
The median age was 67 years and 25% were female. In total, 55% of patients had pre-hospital resuscitation, 6% underwent fibrinolysis before angiography, 65% presented with ST-elevation myocardial infarction, 15% with left bundle branch block, and 20% with non-ST-elevation myocardial infarction. The majority of patients (80%) needed mechanical ventilation. Catecholamines were used in 90% and mechanical support in 29.5% of the patients (IABP 38.5%, ECMO 22%, Impella 33%, other 7%). Total 30-day and 1-year mortality was 46% and 52%, respectively. Mechanical complications were observed in 2.1% of patients, the latter had a 30-day and 1-year mortality of 62% and 67%, respectively. The mortality related to the extent of coronary artery disease is shown in the table.
1-vessel (14%) 2-vessel (31%) 3-vessel (55%) Left main (15%) 30-day mortality 36% 44% 51% 53% 1-year mortality 39% 50% 57% 64%
Conclusions
This first report including data of the prospective CULPRIT-SHOCK randomized trial as well as the accompanying registry demonstrates the high-risk clinical characteristics of patients with AMI complicated by CS undergoing contemporary treatment. Despite an early invasive strategy mortality in patients with AMI complicated by CS in Europe is still high and is related to the extent of coronary artery disease.
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Affiliation(s)
- U Zeymer
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - S Desch
- Heart Center of Leipzig, Leipzig, Germany
| | - T Ouarrak
- Institut für Herzinfarktforschung, Ludwigshafen Am Rhein, Germany
| | - I Akin
- University Medical Centre of Mannheim, Mannheim, Germany
| | | | | | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - K Huber
- Wilhelminen Hospital, Vienna, Austria
| | - H Thiele
- Heart Center of Leipzig, Leipzig, Germany
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Vendrik J, Vlastra W, Koch KT, Vis MM, Wykryzkowska JJ, De Winter RJ, Henriques JPS, Piek JJ, Baan J, Delewi R. P1849Predictors of high radiation exposure in patients undergoing contemporary transfemoral transcatheter aortic valve implantation (TF-TAVI). Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/12/2022] Open
Abstract
Abstract
Background
Transfemoral transcatheter aortic valve implantation (TF-TAVI) is a minimally invasive and life-saving treatment option in patients with severe aortic valve stenosis. The number of TAVI procedures has rapidly expanded over the past decade and will continue to expand, as will the total occupational radiation exposure for the interventional cardiologist. Therefore, interventional cardiologist are at increasing risk for developing radiation induced diseases like cataract, premature vascular aging and left-sided brain tumors.
Objectives
In the current study we determined pre-procedural characteristics associated with high radiation exposure during transfemoral TAVI to raise awareness and increase the use of adequate radiation protection.
Methods
Radiation exposure (patient exposure in DAP in mGy·cm2) was collected during (TF)-TAVI procedures (July 2014- August 2018). Univariate and multiple regression analyses were performed to identify pre-procedural factors associated with high radiation exposure.
Results
A total of 654 TF-TAVI procedures were included. Patients had a median STS-score of 4% and 47% was male. The median radiation exposure was 38,016 mGy·cm2 (24,451–55,747) and the median fluoroscopy time was 16 minutes (IQR: 11–19). During the four year study period, the mean radiation exposure per TAVI procedure decreased with 30%, while the total fluoroscopy time declined with 28%.
The majority of the population underwent the TAVI procedure under local anesthesia (99%) and were implanted with the Edwards SAPIEN 3 valve (92%). Balloon predilatation was used during 88% and balloon post-dilatation was performed in only 5% of the procedures.
Patient characteristics associated with high radiation exposure included BMI >25 (OR: 6.0, 95% CI: 3.9–9.4, p<0.001), male gender (OR: 2.8, 95% CI: 1.8–4.4, p<0.001), a large pre-procedural CT-measured valve area (>450 mm2) (OR: 1.8, 95% CI: 1.1–2.8, p=0.01), presence of a pacemaker or ICD (OR: 2.0, 95% CI: 1.0–3.9, p=0.04) and a history of atrial fibrillation (OR: 1.5, 95% CI: 1.0–2.3, p=0.04). Moreover, the performance of predilatation (OR: 2.7, 95% CI: 1.5–4.8, p=0.001) and valve-in-valve procedures (OR: 3.3, 95% CI: 1.1–10.2, p=0.04) was associated to high radiation exposure.
Predictors of radiation exposure
Conclusions
The performance of transfemoral TAVI in patients with a large stature (male, BMI >25, valve area >450 mm2), in certain groups of fragile patients (presence of pacemaker or ICD, atrial fibrillation), and performing relatively complex procedures (predilatation and valve-in-valve) was associated with high radiation exposure. These patient characteristics and procedural strategies are known before the patient enters the catheterization laboratory. Hence, in the current era of a rapidly expanding number of TAVI procedures, operators should minimize their own health risk in these high-radiation-exposure-risk TAVI procedures.
Acknowledgement/Funding
None
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Affiliation(s)
- J Vendrik
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - W Vlastra
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - K T Koch
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - M M Vis
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - J J Wykryzkowska
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - R J De Winter
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - J J Piek
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - J Baan
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - R Delewi
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
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Tijssen RYG, Kraak RP, Van Dongen IM, Elias J, Hofma SH, Van Der Schaaf RJ, Arkenbout EK, Weevers APJD, Tijssen JGP, Piek JJ, De Winter RJ, Henriques JP, Wykrzykowska JJ. P2808Absorb bioresorbable scaffold vs. Xience metallic stent: outcomes in the AIDA trial stratified by SYNTAX score. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/13/2022] Open
Abstract
Abstract
Aims
Extent of coronary artery disease (CAD) may affect outcomes after percutaneous coronary intervention (PCI). In this pre-specified subgroup analysis of the AIDA trial we evaluated the impact of SXscore on clinical outcomes
Methods and results
AIDA was a multicenter trial comparing Absorb with Xience. SX score was assessed using the baseline diagnostic angiograms. Each coronary lesion with diameter stenosis ≥50% in vessels ≥1.5 mm was scored. All lesion scores were combined to provide the overall SXscore. The angiographic SXscore calculations were performed by core laboratory analysts who were blinded for clinical events (Cardialysis B.V., Rotterdam, The Netherlands). Clinical outcomes were subsequently stratified according to SXscore tertiles: SXlow (SXcore ≤8), SXmid (SXscore >8 and ≤15) and SXhigh (>15). The primary endpoint of this AIDA-trial substudy was target vessel failure (TVF), defined as a composite of cardiac death, target vessel myocardial infarction and target vessel revascularization.
The SXscore was prospectively calculated in 1661 of the 1845 patients (90%). The SXscore ranged from 1 to 57, with a mean±SD of 12.9±8.5 and a median of 11 (Q1-Q3 7–17). In this analysis the SXscore tertiles were defined as SXlow (SXcore ≤8) (n=589), SXmid (SXscore >8 and ≤15) (n=538), and SXhigh (>15) (n=534). Patients in the SXhigh group were older, had a more extensive medical history for previous revascularizations (both PCI and coronary artery bypass grafting), and were more likely to present with a ST-elevation myocardial infarction.
At 2 follow-up the Kaplan-Meier estimates of TVF for the overall AIDA study population was 15.5% in the SXhigh tertile, 10.4% in the SXmid tertile and 4.7% in the SXlow tertile (hazard ratio (HR) 3.53 95% CI 2.28–5.45; P<0.001). The event rate of the primary endpoint of TVF was numerically lower in Absorb when compared to Xience (3.7% versus 5.6%; HR 0.64; 95% CI 0.29 - 1.40; p=0.257) in the SXlow tertile. Patients treated with Absorb and a SXscore >8 had significantly higher event rates as compared to patients with a SXscore ≤8. The rates of TVF in the Absorb BVS population are 15.5% (SXhigh), 11.4% (SXmid), and 3.7% (SXlow), with a significant difference between the SXlow versus SXmid (HR 3.27; 95% CI 1.61–6.68; p=0.001) and SXlow versus SXhigh (HR 4.57; 95% CI 2.29–9.10; p<0.001).
Target Vessel Failure in Absorb BVS
Conclusions
This study demonstrates that implantation of the Absorb in patients with a SXscore ≤8 is associated with numerically lower TVF rates as compared to the Xience drug-eluting stent. The rate of scaffold thrombosis in this SXlow tertile, while still higher for Absorb, is more acceptable than in SXmid and SXhigh score tertiles. Higher SXscore (i.e. >8), both Sxmid and SXhigh, however, appears to be associated with markedly increased risk of device thrombosis, revascularization and myocardial infarction in patients treated with the Absorb.
Acknowledgement/Funding
The AIDA trial was financially supported by an unrestricted research grant from Abbott Vascular
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Affiliation(s)
- R Y G Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R P Kraak
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - I M Van Dongen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - J Elias
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - S H Hofma
- Medical Center Leeuwarden, Cardiology, Leeuwarden, Netherlands (The)
| | - R J Van Der Schaaf
- Hospital Onze Lieve Vrouwe Gasthuis, Cardiology, Amsterdam, Netherlands (The)
| | - E K Arkenbout
- Tergooi Hospital, Cardiology, Blaricum, Netherlands (The)
| | - A P J D Weevers
- Albert Schweitzer Hospital, Cardiology, Dordrecht, Netherlands (The)
| | - J G P Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - R J De Winter
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - J P Henriques
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - J J Wykrzykowska
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
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Piek JJ. NVVC/NHJ Durrer prizes 2018. Neth Heart J 2019; 27:229-230. [PMID: 30969395 PMCID: PMC6470225 DOI: 10.1007/s12471-019-1278-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Aribas E, Elias-Smale SE, Duncker DJ, Piek JJ, Ikram MA, Appelman Y, Roeters van Lennep JE, Kavousi M. Questionnaire survey on cardiologists' view and management of coronary microvascular disease in clinical practice. Neth Heart J 2019; 27:252-262. [PMID: 30980346 PMCID: PMC6470226 DOI: 10.1007/s12471-019-1274-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 01/08/2023] Open
Abstract
Objective We aimed to assess the opinion of Dutch cardiologists on coronary microvascular disease (CMD) and its management in clinical practice, and to assess the need for a CMD guideline among Dutch cardiologists. Methods We developed an online questionnaire including different aspects of CMD which was reviewed by an expert panel. The questionnaire was distributed by e‑mail among all members of the Dutch Society of Cardiology. Results A total of 103 cardiologists (70% male) completed the questionnaire (response rate: 10%). Median age and years of experience as a cardiologist were 49 ± 15 and 12 ± 12 years, respectively. Overall, 93% of the cardiologists had considered the CMD diagnosis, 85% had ever made such a diagnosis, 90% had treated a patient with CMD, and 61% had referred patients to tertiary care. The median (interquartile range) self-rated knowledge level was 7.0 (2.0) (scale of 0–10). 84% rated their knowledge as sufficient (>5.5) and 58% viewed CMD as a disease entity. Overall, 61% and 17%, respectively, agreed that evidence-based diagnostic and treatment modalities for CMD do not exist, while 56% believed that CMD patients have a higher risk for cardiovascular disease and mortality. Finally, 82% of the responders stated that a CMD guideline is needed, and 91% wanted to receive the guideline once developed. Discussion Fifty-eight per cent of the responders recognise CMD as a separate disease entity. Our study underscores the need for a dedicated CMD guideline for Dutch cardiology practice. However, the response rate was low (10%), and it is likely that mainly cardiologists interested in CMD have participated in our study. Electronic supplementary material The online version of this article (10.1007/s12471-019-1274-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Aribas
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - S E Elias-Smale
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - D J Duncker
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J J Piek
- Department of Cardiology, Amsterdam University Medical Centres, location AMC, Amsterdam, The Netherlands
| | - M A Ikram
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Y Appelman
- Department of Cardiology, Amsterdam University Medical Centres, location VU University Medical Centre, Amsterdam, The Netherlands
| | - J E Roeters van Lennep
- Department of Internal Medicine, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - M Kavousi
- Department of Epidemiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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31
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Velu JF, Piek JJ. The mitral paradox of choice. Neth Heart J 2019; 27:167-168. [PMID: 30788776 PMCID: PMC6439057 DOI: 10.1007/s12471-019-1246-1] [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: 11/25/2022] Open
Affiliation(s)
- J F Velu
- Amsterdam Medical Centre, Amsterdam, The Netherlands.
| | - J J Piek
- Amsterdam Medical Centre, Amsterdam, The Netherlands
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Damman P, Piek JJ. Treatment strategies and outcomes in patients with non-ST-elevation acute coronary syndrome in the Netherlands. Neth Heart J 2019; 27:61-63. [PMID: 30552571 PMCID: PMC6352624 DOI: 10.1007/s12471-018-1218-x] [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: 10/30/2022] Open
Affiliation(s)
- P Damman
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - J J Piek
- Department of Cardiology, Academic Medical Centre, Location Meibergdreef, University of Amsterdam, Amsterdam, The Netherlands
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Beijk MA, Vlastra WV, Delewi R, van de Hoef TP, Boekholdt SM, Sjauw KD, Piek JJ. Myocardial infarction with non-obstructive coronary arteries: a focus on vasospastic angina. Neth Heart J 2019; 27:237-245. [PMID: 30689112 PMCID: PMC6470236 DOI: 10.1007/s12471-019-1232-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 12/22/2022] Open
Abstract
Vasospastic angina (VSA) is considered a broad diagnostic category including documented spontaneous episodes of angina pectoris produced by coronary epicardial vasospasm as well as those induced during provocative coronary vasospasm testing and coronary microvascular dysfunction due to microvascular spasm. The hallmark feature of VSA is rest angina, which promptly responds to short-acting nitrates; however, VSA can present with a great variety of symptoms, ranging from stable angina to acute coronary syndrome and even ventricular arrhythmia. VSA is more prevalent in females, who can present with symptoms different from those among male patients. This may lead to an underestimation of cardiac causes of chest-related symptoms in female patients, in particular if the coronary angiogram (CAG) is normal. Evaluation for the diagnosis of VSA includes standard 12-lead ECG during the attack, Holter monitoring, exercise testing, and echocardiography. Patients suspected of having VSA with a normal CAG without a clear myocardial or non-cardiac cause are candidates for provocative coronary vasospasm testing. The gold standard method for provocative coronary vasospasm testing involves the administration of a provocative drug during CAG while monitoring patient symptoms, ECG and documentation of the coronary artery. Treatment of VSA consists of lifestyle adaptations and pharmacotherapy with calcium channel blockers and nitrates.
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Affiliation(s)
- M A Beijk
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - W V Vlastra
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R Delewi
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - T P van de Hoef
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Boekholdt
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - K D Sjauw
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.,Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - J J Piek
- Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Velu JF, Baan J, de Bruin-Bon HACM, van Mourik MS, Nassif M, Koch KT, Vis MM, van den Brink RB, Boekholdt SM, Piek JJ, Bouma BJ. Can stress echocardiography identify patients who will benefit from percutaneous mitral valve repair? Int J Cardiovasc Imaging 2018; 35:645-651. [PMID: 30499057 PMCID: PMC6482124 DOI: 10.1007/s10554-018-1507-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 10/05/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022]
Abstract
The aim of the current study was to investigate whether stress echocardiography improves selection of patients who might have clinical benefit from percutaneous mitral valve repair with the MitraClip. In total, 39 patients selected for MitraClip implantation underwent preprocedural low-dose stress (dobutamine or handgrip) echocardiography from which stroke volume, ejection fraction and MR grade were measured. Outcome after MitraClip implantation was determined by New York Heart Association classification and Quality of Life questionnaires. Clinical benefit from MitraClip treatment was defined as survival and NYHA class I–II at 6 months follow-up. In total, 36 patients with a technically successful procedure were included in the analysis (mean age 79 ± 8 years, 47% male, 50% functional MR). Clinical benefit was achieved in 18 patients. All seven patients with MR decreasing during stress remained in NYHA III–IV or died within 6 months, while 62% (18 out of 29) of the patients with stable or increased MR during stress had clinical benefit (p = 0.008). Significant increase in Quality of Life on 4/8 subscales of the RAND Short Form-36 questionnaire was observed: Physical Functioning (p < 0.001), Social Functioning (p < 0.001), Mental Health (p = 0.022) and Vitality (p = 0.026) was seen in patients with an increase in stroke volume during stress echocardiography. Patients with a decreased MR during preprocedural stress echocardiography remained more symptomatic than patients with a stable or increased MR during stress. Stress echocardiography may support patient selection for percutaneous mitral valve repair.
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Affiliation(s)
- J F Velu
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - H A C M de Bruin-Bon
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M S van Mourik
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M Nassif
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - K T Koch
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Vis
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R B van den Brink
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Boekholdt
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - B J Bouma
- Amsterdam UMC, Heart Center, Department of Cardiology, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Cardiology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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36
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van Mourik MS, van Kesteren F, Planken RN, Stoker J, Wiegerinck EMA, Piek JJ, Tijssen JG, Koopman MG, Henriques JPS, Baan J, Vis MM. Short versus conventional hydration for prevention of kidney injury during pre-TAVI computed tomography angiography. Neth Heart J 2018; 26:425-432. [PMID: 30039383 PMCID: PMC6115307 DOI: 10.1007/s12471-018-1133-1] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) is required in the work-up for transcatheter aortic valve implantation (TAVI). However, CTA may cause contrast-induced acute kidney injury (CI-AKI). We hypothesised that a short (1 h, 3 ml/kg/h sodium bicarbonate) hydration protocol is not inferior to conventional (24 h, 1 ml/kg/h saline) hydration in avoiding a decline in renal function in patients with impaired renal function. METHODS AND RESULTS Single-centre randomised non-inferiority trial in patients with impaired renal function who underwent pre-TAVI CTA. Patients were randomised on a 1:1 ratio to short hydration (SHORT; 1 h sodium bicarbonate, 3 ml/kg/h) or conventional hydration (CONV; 24 h saline, 1 ml/kg/h). Outcomes included percentage change in serum creatinine until 2-6 days after CTA with a non-inferiority margin of 10% and an increase on the Borg dyspnoea scale ≥1 point. Seventy-four patients were included. Increase in creatinine was 6 µmol/l (95% CI 2.5-9.3) in the SHORT versus 2 µmol/l (95% CI-1.4 to 6.3) in the CONV arm (p = 0.167). The percentage change was 4.6% (95% CI 2.0-7.3%) in the SHORT arm versus 2.5% (95% CI: 0.8 to 5.8%) in the CONV arm. The difference in percentage increase in creatinine between the two arms was 2.1% (95% CI: 2.0-6.2%; p-value non-inferiority: <0.001). CI-AKI and a need for dialysis were not observed. An increase of ≥1 point on the Borg scale (dyspnoea scale ranging from 1 (lowest) to 10 (highest)) was seen in 1 patient in the SHORT arm versus 5 patients in the CONV arm (2.9% vs 16.1%, p = 0.091). CONCLUSION For patients with impaired renal function undergoing pre-TAVI CTA, a short 1‑h, low-volume hydration protocol with sodium bicarbonate is not inferior to conventional 24-h, high-volume saline hydration.
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Affiliation(s)
- M S van Mourik
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - F van Kesteren
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Stoker
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Wiegerinck
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Tijssen
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M G Koopman
- Department of Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Vis
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
- F van Kesteren
- Heart Centre, Amsterdam University Medical Centre, AMC, Amsterdam, The Netherlands.
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centre, AMC, Amsterdam, The Netherlands.
| | - J J Piek
- Heart Centre, Amsterdam University Medical Centre, AMC, Amsterdam, The Netherlands
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Farag ES, Vendrik J, van Ooij P, Poortvliet QL, van Kesteren F, Wollersheim LW, Kaya A, Driessen AHG, Piek JJ, Koch KT, Baan J, Planken RN, Kluin J, Nederveen AJ, de Mol BAJM. Transcatheter aortic valve replacement alters ascending aortic blood flow and wall shear stress patterns: A 4D flow MRI comparison with age-matched, elderly controls. Eur Radiol 2018; 29:1444-1451. [PMID: 30132105 PMCID: PMC6510864 DOI: 10.1007/s00330-018-5672-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 11/01/2022]
Abstract
BACKGROUND With the implementation of transcatheter aortic valve replacement (TAVR) in lower-risk patients, evaluation of blood flow characteristics and the effect of TAVR on aortic dilatation becomes of considerable interest. We employed 4D flow MRI in the ascending aorta of patients after TAVR to assess wall shear stress (WSS) and compare blood flow patterns with surgical aortic valve replacement (SAVR) and age- and gender-matched controls. METHODS Fourteen post-TAVR patients and ten age- and gender-matched controls underwent kt-PCA accelerated 4D flow MRI of the thoracic aorta at 3.0 Tesla. Velocity and wall shear stress was compared between the two groups. In addition, aortic flow eccentricity and displacement was assessed and compared between TAVR patients, controls and 14 SAVR patients recruited as part of an earlier study. RESULTS Compared to controls, abnormally elevated WSS was present in 30±10% of the ascending aortic wall in TAVR patients. Increased WSS was present along the posterior mid-ascending aorta and the anterior distal-ascending aorta in all TAVR patients. TAVR results in eccentric and displaced flow in the mid- and distal-ascending aorta, whereas blood flow displacement in SAVR patients occurs only in the distal-ascending aorta. CONCLUSION This study shows that TAVR results in increased blood flow velocity and WSS in the ascending aorta compared to age- and gender-matched elderly controls. This finding warrants longitudinal assessment of aortic dilatation after TAVR in the era of potential TAVR in lower-risk patients. Additionally, TAVR results in altered blood flow eccentricity and displacement in the mid- and distal-ascending aorta, whereas SAVR only results in altered blood flow eccentricity and displacement in the distal-ascending aorta. KEY POINTS • TAVR results in increased blood flow velocity and WSS in the ascending aorta. • Longitudinal assessment of aortic dilatation after TAVR is warranted in the era of potential TAVR in lower-risk patients. • Both TAVR and SAVR result in altered blood flow patterns in the ascending aorta when compared to age-matched controls.
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Affiliation(s)
- E S Farag
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J Vendrik
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P van Ooij
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Q L Poortvliet
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - F van Kesteren
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - L W Wollersheim
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A Kaya
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A H G Driessen
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J Piek
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - K T Koch
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J Baan
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Kluin
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - B A J M de Mol
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Piek JJ. Coronary pressure-derived parameters. Neth Heart J 2018; 26:375-376. [PMID: 29943116 PMCID: PMC6046663 DOI: 10.1007/s12471-018-1128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Vlastra W, Sjauw KD, Claessen BE, Beijk MA, Streekstra GJ, Wykrzykowska JJ, Vis MM, Koch KT, De Winter RJ, Piek JJ, Henriques JPS, Delewi R. P3581Identification of patient and procedural characteristics associated with high radiation exposure of the interventional cardiologist. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p3581] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- W Vlastra
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - K D Sjauw
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - B E Claessen
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - M A Beijk
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - G J Streekstra
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J J Wykrzykowska
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - M M Vis
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - K T Koch
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - R J De Winter
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J J Piek
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - R Delewi
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
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Stegehuis VE, Wijntjens GWM, Van De Hoef TP, Nijjer SS, De Waard GA, Sen S, Petraco R, Echavarria-Pinto M, Meuwissen M, Danad I, Knaapen P, Escaned J, Davies JE, Van Royen N, Piek JJ. P4623Objective identification of stenoses inducing myocardial ischemia using sequential iFR, FFR and intracoronary flow measurements. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4623] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- V E Stegehuis
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - G W M Wijntjens
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - T P Van De Hoef
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - S S Nijjer
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - G A De Waard
- VU University Medical Center, Department of Cardiology, Amsterdam, Netherlands
| | - S Sen
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - R Petraco
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - M Echavarria-Pinto
- Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado
- ISSSTE, Cardiology, Queretaro, Mexico
| | - M Meuwissen
- Amphia Hospital, Department of Cardiology, Breda, Netherlands
| | - I Danad
- VU University Medical Center, Department of Cardiology, Amsterdam, Netherlands
| | - P Knaapen
- VU University Medical Center, Department of Cardiology, Amsterdam, Netherlands
| | - J Escaned
- Hospital Clinic San Carlos, Department of Cardiology, Madrid, Spain
| | - J E Davies
- Hammersmith Hospital, Imperial College London, London, United Kingdom
| | - N Van Royen
- Radboud University Medical Centre, Department of Cardiology, Nijmegen, Netherlands
| | - J J Piek
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
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Elias J, Van Dongen IM, Hoebers LP, Ouweneel DM, Claessen BEPM, Ramunddal T, Laanmets P, Eriksen E, Piek JJ, Van Der Schaaf RJ, Ioanes D, Nijveldt R, Tijssen JGP, Henriques JPS, Hirsch A. P4677Segmental strain predicts functional recovery incremental to infarct in patients with a concurrent chronic total occlusion after primary percutaneous coronary intervention for STEMI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4677] [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] [Indexed: 11/15/2022] Open
Affiliation(s)
- J Elias
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - I M Van Dongen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - L P Hoebers
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - D M Ouweneel
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | | | | | - P Laanmets
- North Estonia Medical Centre, Tallinn, Estonia
| | - E Eriksen
- Haukeland University Hospital, Bergen, Norway
| | - J J Piek
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | | | - D Ioanes
- Sahlgrenska Academy, Gothenburg, Sweden
| | - R Nijveldt
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - J G P Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - A Hirsch
- Erasmus Medical Center, Rotterdam, Netherlands
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Vendrik J, Van Mourik MS, Vlastra W, Vis MM, Piek JJ, Koch KT, Baan J. 3069Safety and feasibility of an early ambulation protocol after transfemoral transcatheter aortic valve implantation: results of the early mobilisation after TF-TAVI (MobiTAVI) trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3069] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- J Vendrik
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - M S Van Mourik
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - W Vlastra
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - M M Vis
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J J Piek
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - K T Koch
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J Baan
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
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Katagiri Y, Serruys PW, Tenekecioglu E, Asano T, Collet C, Miyazaki Y, Piek JJ, Wykrzykowska J, Chevalier B, Mintz G, Onuma Y. P6374Acute and long-term relocation of minimal lumen area after Absorb bioresorbable scaffold or Xience metallic stent implantation. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6374] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Katagiri
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - P W Serruys
- Imperial College London, London, United Kingdom
| | | | - T Asano
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - C Collet
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - Y Miyazaki
- Erasmus Medical Center, Rotterdam, Netherlands
| | - J J Piek
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - J Wykrzykowska
- Academic Medical Center of Amsterdam, Department of Cardiology, Amsterdam, Netherlands
| | - B Chevalier
- Institut Hospitalier Jacques Cartier, Massy, France
| | - G Mintz
- Cardiovascular Research Foundation, New York, United States of America
| | - Y Onuma
- Erasmus Medical Center, Rotterdam, Netherlands
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Van Mourik MS, Vendrik J, Abdelghani M, Van Kesteren F, Henriques JPS, Driessen AHG, Wykrzykowska JJ, De Winter RJ, Piek JJ, Tijssen JG, Koch KT, Baan Jr J, Vis MM. P1675Futility of tavi according to clinical and patient-reported outcomes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1675] [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] [Indexed: 11/13/2022] Open
Affiliation(s)
- M S Van Mourik
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J Vendrik
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - M Abdelghani
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - F Van Kesteren
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - A H G Driessen
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J J Wykrzykowska
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - R J De Winter
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J J Piek
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J G Tijssen
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - K T Koch
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - J Baan Jr
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
| | - M M Vis
- Academic Medical Center of Amsterdam, Heart Center, Amsterdam, Netherlands
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46
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Escaned J, Collet C, Ryan N, De Maria GL, Walsh S, Sabate M, Davies J, Lesiak M, Moreno R, Cruz-Gonzalez I, Hoole SP, Ej West N, Piek JJ, Zaman A, Fath-Ordoubadi F, Stables RH, Appleby C, van Mieghem N, van Geuns RJ, Uren N, Zueco J, Buszman P, Iñiguez A, Goicolea J, Hildick-Smith D, Ochala A, Dudek D, Hanratty C, Cavalcante R, Kappetein AP, Taggart DP, van Es GA, Morel MA, de Vries T, Onuma Y, Farooq V, Serruys PW, Banning AP. Clinical outcomes of state-of-the-art percutaneous coronary revascularization in patients with de novo three vessel disease: 1-year results of the SYNTAX II study. Eur Heart J 2018; 38:3124-3134. [PMID: 29020367 PMCID: PMC5837643 DOI: 10.1093/eurheartj/ehx512] [Citation(s) in RCA: 200] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022] Open
Abstract
Aims To investigate if recent technical and procedural developments in percutaneous coronary intervention (PCI) significantly influence outcomes in appropriately selected patients with three-vessel (3VD) coronary artery disease. Methods and results The SYNTAX II study is a multicenter, all-comers, open-label, single arm study that investigated the impact of a contemporary PCI strategy on clinical outcomes in patients with 3VD in 22 centres from four European countries. The SYNTAX-II strategy includes: heart team decision-making utilizing the SYNTAX Score II (a clinical tool combining anatomical and clinical factors), coronary physiology guided revascularisation, implantation of thin strut bioresorbable-polymer drug-eluting stents, intravascular ultrasound (IVUS) guided stent implantation, contemporary chronic total occlusion revascularisation techniques and guideline-directed medical therapy. The rate of major adverse cardiac and cerebrovascular events (MACCE [composite of all-cause death, cerebrovascular event, any myocardial infarction and any revascularisation]) at one year was compared to a predefined PCI cohort from the original SYNTAX-I trial selected on the basis of equipoise 4-year mortality between CABG and PCI. As an exploratory endpoint, comparisons were made with the historical CABG cohort of the original SYNTAX-I trial. Overall 708 patients were screened and discussed within the heart team; 454 patients were deemed appropriate to undergo PCI. At one year, the SYNTAX-II strategy was superior to the equipoise-derived SYNTAX-I PCI cohort (MACCE SYNTAX-II 10.6% vs. SYNTAX-I 17.4%; HR 0.58, 95% CI 0.39–0.85, P = 0.006). This difference was driven by a significant reduction in the incidence of MI (HR 0.27, 95% CI 0.11–0.70, P = 0.007) and revascularisation (HR 0.57, 95% CI 0.37–0.9, P = 0.015). Rates of all-cause death (HR 0.69, 95% CI 0.27–1.73, P = 0.43) and stroke (HR 0.69, 95% CI 0.10–4.89, P = 0.71) were similar. The rate of definite stent thrombosis was significantly lower in SYNTAX-II (HR 0.26, 95% CI 0.07–0.97, P = 0.045). Conclusion At one year, clinical outcomes with the SYNTAX-II strategy were associated with improved clinical results compared to the PCI performed in comparable patients from the original SYNTAX-I trial. Longer term follow-up is awaited and a randomized clinical trial with contemporary CABG is warranted. ClinicalTrials.gov Identifier NCT02015832
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Affiliation(s)
- Javier Escaned
- Hospital Cliinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain; Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Carlos Collet
- Department of Cardiology, Academic Medical Center of Amsterdam, Cardiology, Amsterdam, the Netherlands; Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands
| | - Nicola Ryan
- Hospital Cliinico San Carlos IDISSC and Universidad Complutense de Madrid, Madrid, Spain; Calle Profesor Martín Lagos s/n, 28040 Madrid, Spain
| | - Giovanni Luigi De Maria
- Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, UK; Headley Way, Headington, Oxford OX3 9DU, UK
| | - Simon Walsh
- Department of Cardiology Belfast Health & Social Care Trust, Belfast, UK; Knockbracken Healthcare Park, Saintfield Rd, Belfast BT8 8BH, UK
| | - Manel Sabate
- Hospital Clinic I Provincial de Barcelona, Barcelona, Spain; Carrer de Villarroel, 170, 08036 Barcelona, Spain
| | - Justin Davies
- Department of Cardiology, Imperial College London, London, UK; Kensington, London SW7 2AZ, UK
| | - Maciej Lesiak
- 1st Department of Cardiology, University of Medical Sciences, Poznan, Poland; Collegium Maius, Fredry 10, 61-701 Poznan, Poland
| | - Raul Moreno
- Department of Cardiology, Hospital Universitario la Paz, Madrid, Spain; Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Ignacio Cruz-Gonzalez
- Department of Cardiology, Hospital Universitario de Salamanca, IBSAL, Salamanca, Spain; Paseo de San Vicente, 58, 37007 Salamanca, Spain
| | - Stephan P Hoole
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK; Papworth Everard, Cambridge CB23 3RE, UK
| | - Nick Ej West
- Department of Cardiology, Papworth Hospital NHS Foundation Trust, Cambridge, UK; Papworth Everard, Cambridge CB23 3RE, UK
| | - J J Piek
- Department of Cardiology, Academic Medical Center of Amsterdam, Cardiology, Amsterdam, the Netherlands; Meibergdreef 9, 1105 AZ Amsterdam-Zuidoost, the Netherlands
| | - Azfar Zaman
- Department of Cardiology, Freeman Hospital and Newcastle University, Newcastle-upon-Tyne, UK; High Heaton, Newcastle upon Tyne NE7 7DN, UK
| | - Farzin Fath-Ordoubadi
- Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK; Oxford Rd, Manchester M13 9WL, UK
| | - Rodney H Stables
- Liverpool Heart and Chest Hospital, Liverpool, UK; Thomas Dr, Liverpool L14 3PE, UK
| | - Clare Appleby
- Liverpool Heart and Chest Hospital, Liverpool, UK; Thomas Dr, Liverpool L14 3PE, UK
| | - Nicolas van Mieghem
- Thoraxcenter, Erasmus MC, the Netherlands; 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Robert Jm van Geuns
- Thoraxcenter, Erasmus MC, the Netherlands; 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Neal Uren
- The Royal Infirmary of Edinburgh, Edinburgh, UK; 51 Little France Dr, Edinburgh EH16 4SA, UK
| | - Javier Zueco
- Department of Cardiology, Hospital Universitario Valdecilla, Cantabria, Spain; Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain
| | - Pawel Buszman
- American Heart of Poland (PAK), Ustrón, Poland; Sanatoryjna 1, 43-450 Ustrón, Poland
| | - Andres Iñiguez
- Department of Cardiology, Hospital Meixoeiro, Pontevedra, Spain; Camiño Meixoeiro, s/n, 36214 Vigo, Pontevedra, Spain
| | - Javier Goicolea
- Department of Cardiology, Hospital Meixoeiro, Pontevedra, Spain; Camiño Meixoeiro, s/n, 36214 Vigo, Pontevedra, Spain
| | - David Hildick-Smith
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK; Barry Building, Eastern Rd, Brighton BN2 5BE, UK
| | - Andrzej Ochala
- Gornoslaskie Centrum Medycnze, Poland; 45/47, 40-635 Katowice, Poland
| | - Dariusz Dudek
- Department of Interventional Cardiology, Jagiellonian University, Krakow, Poland; Gol?bia 24, 31-007 Kraków, Poland
| | - Colm Hanratty
- Department of Cardiology Belfast Health & Social Care Trust, Belfast, UK; Knockbracken Healthcare Park, Saintfield Rd, Belfast BT8 8BH, UK
| | - Rafael Cavalcante
- Thoraxcenter, Erasmus MC, the Netherlands; 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - Arie Pieter Kappetein
- Thoraxcenter, Erasmus MC, the Netherlands; 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands
| | - David P Taggart
- Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, UK; Headley Way, Headington, Oxford OX3 9DU, UK
| | - Gerrit-Anne van Es
- Cardialysis BV, Rotterdam, the Netherlands; Westblaak 98, 3012 KM, Rotterdam, the Netherlands.,European Cardiovascular Research Institute, Westblaak 98, 3012 KM, Rotterdam, the Netherlands
| | - Marie-Angèle Morel
- Cardialysis BV, Rotterdam, the Netherlands; Westblaak 98, 3012 KM, Rotterdam, the Netherlands
| | - Ton de Vries
- Cardialysis BV, Rotterdam, the Netherlands; Westblaak 98, 3012 KM, Rotterdam, the Netherlands
| | - Yoshinobu Onuma
- Thoraxcenter, Erasmus MC, the Netherlands; 's-Gravendijkwal 230, 3015 CE Rotterdam, the Netherlands.,Cardialysis BV, Rotterdam, the Netherlands; Westblaak 98, 3012 KM, Rotterdam, the Netherlands
| | - Vasim Farooq
- Manchester Heart Centre, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK; Oxford Rd, Manchester M13 9WL, UK
| | - Patrick W Serruys
- Department of Cardiology, Imperial College London, London, UK; Kensington, London SW7 2AZ, UK
| | - Adrian P Banning
- Department of Cardiology, John Radcliffe Hospital, Cardiology, Oxford, UK; Headley Way, Headington, Oxford OX3 9DU, UK
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van Kesteren F, van Mourik MS, Wiegerinck EMA, Vendrik J, Piek JJ, Tijssen JG, Koch KT, Henriques JPS, Wykrzykowska JJ, de Winter RJ, Driessen AHG, Kaya A, Planken RN, Vis MM, Baan J. Trends in patient characteristics and clinical outcome over 8 years of transcatheter aortic valve implantation. Neth Heart J 2018; 26:445-453. [PMID: 29943117 PMCID: PMC6115311 DOI: 10.1007/s12471-018-1129-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Aim In the evolving field of transcatheter aortic valve implantations (TAVI) we aimed to gain insight into trends in patient and procedural characteristics as well as clinical outcome over an 8‑year period in a real-world TAVI population. Methods We performed a single-centre retrospective analysis of 1,011 consecutive patients in a prospectively acquired database. We divided the cohort into tertiles of 337 patients; first interval: January 2009–March 2013, second interval: March 2013–March 2015, third interval: March 2015–October 2016. Results Over time, a clear shift in patient selection was noticeable towards lower surgical risks including Society of Thoracic Surgeons predicted risk of mortality score and comorbidity. The frequency of transfemoral TAVI increased (from 66.5 to 77.4%, p = 0.0015). Device success improved (from 62.0 to 91.5%, p < 0.0001) as did the frequency of symptomatic relief (≥1 New York Heart Association class difference) (from 73.8 to 87.1%, p = 0.00025). Complication rates decreased, including in-hospital stroke (from 5.0 to 2.1%, p = 0.033) and pacemaker implantations (from 10.1 to 5.9%, p = 0.033). Thirty-day mortality decreased (from 11.0 to 2.4%, p < 0.0001); after adjustment for patient characteristics, a mortality-risk reduction of 72% was observed (adjusted hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.13–0.62). One-year mortality rates decreased (from 23.4 to 11.4%), but this was no longer significant after a landmark point was set at 30 days (mortality from 31 days until 1 year) (adjusted HR: 0.69, 95% CI: 0.41–1.16, p = 0.16). Conclusion A clear shift towards a lower-risk TAVI population and improved clinical outcome was observed over an 8‑year period. Survival after TAVI improved impressively, mainly as a consequence of decreased 30-day mortality. Electronic supplementary material The online version of this article (10.1007/s12471-018-1129-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F van Kesteren
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - M S van Mourik
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Wiegerinck
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Vendrik
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Tijssen
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - K T Koch
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A H G Driessen
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Kaya
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Vis
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Panhuyzen-Goedkoop NM, Piek JJ. Resuscitation on the pitch with cardiac massage and on-site AED. Neth Heart J 2018; 26:286. [PMID: 29619672 PMCID: PMC5910315 DOI: 10.1007/s12471-018-1109-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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49
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Delewi R, Piek JJ. Healing in the colourful HELIUS experience. Neth Heart J 2018; 26:229-230. [PMID: 29644502 PMCID: PMC5910314 DOI: 10.1007/s12471-018-1108-2] [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: 11/30/2022] Open
Affiliation(s)
- R Delewi
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - J J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Affiliation(s)
| | - J J Piek
- AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands
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