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De Pooter J, Timmers L, Boveda S, Combes S, Knecht S, Almorad A, De Asmundis C, Duytschaever M. Validation of a Machine Learning Algorithm to Identify Pulmonary Vein Isolation during Ablation Procedures for the Treatment of Atrial Fibrillation: Results of the PVISION Study. Europace 2024:euae116. [PMID: 38682165 DOI: 10.1093/europace/euae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND AND AIMS Pulmonary Vein Isolation (PVI) is the cornerstone of ablation for atrial fibrillation. Confirmation of PVI can be challenging due to far field electrograms and sometimes requires additional pacing maneuvers or mapping. This prospective multicenter study assessed the agreement between a previously trained automated algorithm designed to determine vein isolation status with expert opinion in real-world clinical setting. METHOD Consecutive patients scheduled for PVI were recruited at four centers. The ECGenius electrophysiology recording system (CathVision ApS, Denmark) was connected in parallel with the lab's existing system. Electrograms from a circular mapping catheter were annotated during sinus rhythm at baseline pre-ablation, time of isolation, and post-ablation. The ground truth for isolation status was based on operator opinion. The algorithm was applied to the collected PV signals off-line and compared to expert opinion. The primary endpoint was a sensitivity and specificity exceeding 80%. RESULTS Overall, 498 electrograms (248 at baseline and 250 at PVI) with 5,473 individual PV beats from 89 patients (32 females, 62 ±12 years) were analyzed. The algorithm performance reached an area under curve (AUC) of 92% and met the primary study endpoint with a sensitivity and specificity of 86% and 87%, respectively (p = 0.005; p = 0.004). The algorithm had an accuracy of 87% in classifying the time of isolation. CONCLUSION This study validated an automated algorithm using machine learning (ML) to assess the isolation status of pulmonary veins in patients undergoing PVI with different ablation modalities. The algorithm reached an AUC of 92% with both sensitivity and specificity exceeding the primary study endpoints.
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Affiliation(s)
| | - L Timmers
- Heart Center UZ Ghent, Ghent, Belgium
| | - S Boveda
- Clinique Pasteur, Toulouse, France
| | - S Combes
- Clinique Pasteur, Toulouse, France
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Van Ginkel DJ, Brouwer J, Nijenhuis VJ, Delewi R, Swaans MJ, Timmers L, Rensing BJWM, Baan J, Ten Berg JM. Determinants of myocardial injury following transcatheter aortic valve implantation: a pre-specified substudy from the POPular TAVI trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2106] [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
Myocardial injury is frequently observed in patients undergoing transcatheter aortic valve implantation (TAVI) and has been linked to worse prognosis [1,2]. Yet, knowledge concerning the underlying mechanisms and preventive strategies is scarce.
Purpose
To identify clinical determinants and the effect of periprocedural antithrombotic strategies on markers of myocardial injury after TAVI.
Methods
The POPular TAVI trial was a prospective, open label, multicentre randomized controlled trial, investigating the addition of clopidogrel to aspirin (cohort A) or oral anticoagulation (OAC) (cohort B) in patients undergoing TAVI [3] Patients randomised to clopidogrel received a 300mg loading dose before TAVI, followed by a 75mg maintenance dose once daily. In patients using OAC, this was continued during TAVI with an international normalized ratio aimed at 2.0. All OAC patients used a vitamin-K antagonist. Blood samples were taken at baseline, 6, 24, 48, and 72 hours following TAVI to determine myocardial injury using Creatine Kinase-MB (CK-MB) and high-sensitive cardiac troponin T (hs-cTnT) according to the VARC-2 criteria. Also, baseline and procedural variables were collected in detail. A linear mixed effects model was used for pair-wise analysis of the changes in enzyme levels at different time points between groups. Regression analysis was performed using the logistic regression model. Statistical analyses were performed using R (version 3.4.1).
Results
In total, 131 patients undergoing transfemoral TAVI were included at two study sites, of whom 63 (48%) received clopidogrel and 68 (52%) did not. Almost half of the patients (45%) were on OAC. The rise in CK-MB (mean peak 23.4±13.3 U/l) and hs-cTnT (mean peak of 0.23±0.33 ug/) was maximal at 6 and 24 hours, respectively. The CK-MB and hs-cTnT levels did not differ between the clopidogrel and no clopidogrel group at any time point (figure 1). Myocardial injury occurred in 18 (30.1%) patients receiving OAC versus 39 (54.2%) patients not receiving OAC (p=0.007). The course of hs-cTnT reached higher levels in patients with chronic kidney disease (p<0.001) and in patients with a preserved left ventricular ejection fraction (LVEF) (p=0.008). Also, the use of a controlled mechanical expanding prosthesis was associated with a higher rise of hs-cTnT (p=0.007). (Figure 2) In multivariable analysis, predictors of a maximal increase in hs-cTnT were a preserved LVEF (OR 1.15, 95% CI 1.02–1.30) and chronic kidney disease (OR 1.13, 95% CI 1.01–1.28). Other procedural factors, like balloon dilation and rapid ventricular pacing, were not associated with myocardial injury.
Conclusions
The addition of clopidogrel to aspirin or OAC during TAVI was not associated with a reduction in myocardial injury. Instead, OAC therapy, as compared to aspirin, was associated with a reduction in rise and fall of hs-cTnT. Also, patients with a preserved LVEF or chronic kidney disease observed higher levels of hs-cTnT.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): ZonMWSt. Antonius Research Fund
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Affiliation(s)
- D J Van Ginkel
- St Antonius Hospital, Cardiology , Nieuwegein , The Netherlands
| | - J Brouwer
- St Antonius Hospital, Cardiology , Nieuwegein , The Netherlands
| | - V J Nijenhuis
- St Antonius Hospital, Cardiology , Nieuwegein , The Netherlands
| | - R Delewi
- Amsterdam UMC - Location Academic Medical Center, Cardiology , Amsterdam , The Netherlands
| | - M J Swaans
- St Antonius Hospital, Cardiology , Nieuwegein , The Netherlands
| | - L Timmers
- St Antonius Hospital, Cardiology , Nieuwegein , The Netherlands
| | - B J W M Rensing
- St Antonius Hospital, Cardiology , Nieuwegein , The Netherlands
| | - J Baan
- Amsterdam UMC - Location Academic Medical Center, Cardiology , Amsterdam , The Netherlands
| | - J M Ten Berg
- St Antonius Hospital, Cardiology , Nieuwegein , The Netherlands
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van Waalwijk van Doorn-Khosrovani S, Pisters A, Breugel E, Timmers L, Voest E, Bloemendal H, Eskens F, Wymenga M. 1312O From regulating off-label use to creating an environment for drug repurposing in oncology. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mekke J, Verwer M, Stroes E, Kroon J, Timmers L, Pasterkamp G, De Borst G, Van Der Laan S, De Kleijn D. High plasma lipoprotein lipase is associated with a lower risk for future major adverse cardiovascular events in patients following carotid endarterectomy. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Rooijakkers MJP, Li WWL, Stens NA, Vis MM, Tonino PAL, Timmers L, Van Mieghem NM, den Heijer P, Kats S, Stella PR, Roolvink V, van der Werf HW, Stoel MG, Schotborgh CE, Amoroso G, Porta F, van der Kley F, van Wely MH, Gehlmann H, van Garsse LAFM, Geuzebroek GSC, Verkroost MWA, Mourisse JM, Medendorp NM, van Royen N. Transcatheter aortic valve implantation amid the COVID-19 pandemic: a nationwide analysis of the first COVID-19 wave in the Netherlands. Neth Heart J 2022; 30:503-509. [PMID: 35648264 PMCID: PMC9158307 DOI: 10.1007/s12471-022-01704-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 05/15/2022] [Indexed: 12/19/2022] Open
Abstract
Introduction The coronavirus disease 2019 (COVID-19) pandemic has put tremendous pressure on healthcare systems. Most transcatheter aortic valve implantation (TAVI) centres have adopted different triage systems and procedural strategies to serve highest-risk patients first and to minimise the burden on hospital logistics and personnel. We therefore assessed the impact of the COVID-19 pandemic on patient selection, type of anaesthesia and outcomes after TAVI. Methods We used data from the Netherlands Heart Registration to examine all patients who underwent TAVI between March 2020 and July 2020 (COVID cohort), and between March 2019 and July 2019 (pre-COVID cohort). We compared patient characteristics, procedural characteristics and clinical outcomes. Results We examined 2131 patients who underwent TAVI (1020 patients in COVID cohort, 1111 patients in pre-COVID cohort). EuroSCORE II was comparable between cohorts (COVID 4.5 ± 4.0 vs pre-COVID 4.6 ± 4.2, p = 0.356). The number of TAVI procedures under general anaesthesia was lower in the COVID cohort (35.2% vs 46.5%, p < 0.001). Incidences of stroke (COVID 2.7% vs pre-COVID 1.7%, p = 0.134), major vascular complications (2.3% vs 3.4%, p = 0.170) and permanent pacemaker implantation (10.0% vs 9.4%, p = 0.634) did not differ between cohorts. Thirty-day and 150-day mortality were comparable (2.8% vs 2.2%, p = 0.359 and 5.2% vs 5.2%, p = 0.993, respectively). Conclusions During the COVID-19 pandemic, patient characteristics and outcomes after TAVI were not different than before the pandemic. This highlights the fact that TAVI procedures can be safely performed during the COVID-19 pandemic, without an increased risk of complications or mortality. Supplementary Information The online version of this article (10.1007/s12471-022-01704-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J P Rooijakkers
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - W W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N A Stens
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Department of Physiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M M Vis
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - P A L Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - L Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - N M Van Mieghem
- Department of Cardiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - S Kats
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - V Roolvink
- Department of Cardiology, Isala Hospital, Zwolle, The Netherlands
| | - H W van der Werf
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - M G Stoel
- Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands
| | - C E Schotborgh
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - G Amoroso
- Department of Cardiology, OLVG Hospital, Amsterdam, The Netherlands
| | - F Porta
- Department of Cardiothoracic Surgery, Leeuwarden Medical Centre, Leeuwarden, The Netherlands
| | - F van der Kley
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - M H van Wely
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - H Gehlmann
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - L A F M van Garsse
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M W A Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J M Mourisse
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - N M Medendorp
- Netherlands Heart Registration, Utrecht, The Netherlands
| | - N van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands.
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van Ginkel DJ, Brouwer J, van Hemert ND, Kraaijeveld AO, Rensing BJWM, Swaans MJ, Timmers L, Voskuil M, Stella PR, Ten Berg JM. Major threats to early safety after transcatheter aortic valve implantation in a contemporary cohort of real-world patients. Neth Heart J 2021; 29:632-642. [PMID: 34724147 PMCID: PMC8630308 DOI: 10.1007/s12471-021-01638-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/07/2021] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Despite considerable advances in the last decade, major adverse events remain a concern after transcatheter aortic valve implantation (TAVI). The aim of this study was to provide a detailed overview of their underlying causes and contributing factors in order to identify key domains for quality improvement. METHODS This observational, prospective registry included all patients undergoing TAVI between 31 December 2015 and 1 January 2020 at the St. Antonius Hospital in Nieuwegein and the University Medical Centre in Utrecht. Outcomes of interest were all-cause mortality, stroke, major bleeding, life-threatening or disabling bleeding, major vascular complications, myocardial infarction, severe acute kidney injury and conduction disturbances requiring permanent pacemaker implantation within 30 days after TAVI, according to the Valve Academic Research Consortium‑2 criteria. RESULTS Of the 1250 patients who underwent TAVI in the evaluated period, 146 (11.7%) developed a major complication. In 54 (4.3%) patients a thromboembolic event occurred, leading to stroke in 36 (2.9%), myocardial infarction in 13 (1.0%) and lower limb ischaemia in 11 (0.9%). Major bleeding occurred in 65 (5.2%) patients, most frequently consisting of acute cardiac tamponade (n = 25; 2.0%) and major access-site bleeding (n = 21; 1.7%). Most complications occurred within 1 day of the procedure. Within 30 days a total of 54 (4.3%) patients died, the cause being directly TAVI-related in 30 (2.4%). Of the patients who died from causes that were not directly TAVI-related, 14 (1.1%) had multiple hospital-acquired complications. CONCLUSION A variety of underlying mechanisms and causes form a wide spectrum of major threats affecting early safety in 11.7% of patients undergoing TAVI in a contemporary cohort of real-world patients.
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Affiliation(s)
- D J van Ginkel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - J Brouwer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - N D van Hemert
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - B J W M Rensing
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - L Timmers
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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7
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Moeliker LM, Nijenhuis VJ, Ten Berg JM, Swaans MJ, De Kroon TL, Heijmen RH, Agostoni P, Sonker U, Timmers L, Van Kuijk JP. Transcatheter paravalvular leak closure is an effective alternative to surgical repair with respect to 5-year outcomes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2239] [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
Paravalvular leakage (PVL) is a relatively common complication of heart valve replacement, associated with heart failure and increased mortality. Transcatheter PVL closure may be a promising alternative to surgical repair, especially in high-risk patients.
Purpose
Assessment of safety and efficacy of transcatheter PVL closure compared to surgical repair.
Methods
This is a retrospective single-centre study including all consecutive patients who underwent either transcatheter PVL closure between January 2013 and December 2020, or surgical repair between March 2015 and December 2020. Primary endpoints were 5-year all-cause mortality and the composite of 5-year cardiovascular mortality and rehospitalization for the underlying condition. Secondary endpoints were technical success and individual patient success at one year according to the PVL Academic Research Consortium.
Results
Of the 129 patients included, 85 went for transcatheter repair and 44 went for surgical repair. As compared to surgical repair, patients undergoing transcatheter PVL closure were older (71 years vs. 64,5 years; p≤0,01) and more symptomatic (NYHA class III & IV; 76,5% vs. 59,1%; p=0,04). At 5 years, transcatheter PVL closure was comparable to surgery in terms of the primary composite endpoint (HR: 1,20; 95% CI: 0,68–2,13; p=0,54), all-cause mortality (HR: 1,70; 95% CI: 0,82–3,50; p=0,15) and rehospitalization for the underlying condition (HR: 1,12; 95% CI: 0,54–2,89; p=0,780). Rates of technical success (92,9% vs. 95,5%; p=0,58) and individual patient success at one year (70,6% vs. 77,3%; p=0,87) were similar between transcatheter PVL closure and surgery respectively. Transcatheter PVL closure was associated with shorter in-hospital stay (7 days vs. 14 days; p≤0,01).
Conclusion
These findings support the use of transcatheter closure of PVL, especially in high-risk patients. Long term survival remains temperate in these challenging patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L M Moeliker
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | - V J Nijenhuis
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - J M Ten Berg
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - M J Swaans
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - T L De Kroon
- St Antonius Hospital, Cardiothoracic surgery, Nieuwegein, Netherlands (The)
| | - R H Heijmen
- St Antonius Hospital, Cardiothoracic surgery, Nieuwegein, Netherlands (The)
| | - P Agostoni
- Middelheim, Cardiology, Antwerpen, Belgium
| | - U Sonker
- St Antonius Hospital, Cardiothoracic surgery, Nieuwegein, Netherlands (The)
| | - L Timmers
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
| | - J P Van Kuijk
- St Antonius Hospital, Cardiology, Nieuwegein, Netherlands (The)
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Meijerink F, Koch KT, de Winter RJ, Holierook M, Rensing BJWM, Timmers L, Eefting FD, Swaans MJ, Bouma BJ, Baan J. Transcatheter tricuspid valve repair: early experience in the Netherlands. Neth Heart J 2021; 29:595-603. [PMID: 34415550 PMCID: PMC8556435 DOI: 10.1007/s12471-021-01613-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/06/2021] [Indexed: 11/25/2022] Open
Abstract
Background Symptomatic tricuspid regurgitation (TR) is increasingly prevalent and impairs quality of life and survival, despite medical treatment. Transcatheter tricuspid valve repair (TTVR) has recently become available as a treatment option for patients not eligible for tricuspid valve surgery. In this study we describe the early experience with TTVR in the Netherlands. Methods All consecutive patients scheduled for TTVR in two tertiary hospitals were included in the current study. Patients were symptomatic and had severe functional TR. TTVR was performed either with the MitraClip (off-label use) or dedicated TriClip delivery system and device. Procedural success was defined as achievement of clip implantation, TR reduction ≥ 1 grade and no need for re-do surgical or transcatheter intervention. Clinical improvement was evaluated after 4 weeks. Results Twenty-one patients (median age 78 years, 33% male, 95% New York Heart Association class ≥ 3, 100% history of atrial fibrillation) underwent TTVR. Procedural success was achieved in 16 patients, of whom 15 reported symptomatic improvement (New York Heart Association class 1 or 2). There was no in-hospital mortality and no major complications occurred. Baseline glomerular filtration rate and TR coaptation gap size were associated with procedural success. Conclusion The current study showed that TTVR seems a promising treatment option for patients with severe functional TR deemed high risk for surgery. Successful TR reduction is most likely in patients with limited coaptation gap size and strongly determines clinical benefit. Adequate patient selection and timing of treatment seem essential for an optimal patient outcome. Supplementary Information The online version of this article (10.1007/s12471-021-01613-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F Meijerink
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - K T Koch
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - R J de Winter
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - M Holierook
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - B J W M Rensing
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - L Timmers
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - F D Eefting
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - M J Swaans
- Department of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - B J Bouma
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands
| | - J Baan
- Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, The Netherlands.
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9
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Al-Farra H, de Mol BAJM, Ravelli ACJ, Ter Burg WJPP, Houterman S, Henriques JPS, Abu-Hanna A, Vis MM, Vos J, Timmers L, Tonino WAL, Schotborgh CE, Roolvink V, Porta F, Stoel MG, Kats S, Amoroso G, van der Werf HW, Stella PR, de Jaegere P. Update and, internal and temporal-validation of the FRANCE-2 and ACC-TAVI early-mortality prediction models for Transcatheter Aortic Valve Implantation (TAVI) using data from the Netherlands heart registration (NHR). Int J Cardiol Heart Vasc 2021; 32:100716. [PMID: 33537406 PMCID: PMC7843396 DOI: 10.1016/j.ijcha.2021.100716] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 01/08/2023]
Abstract
Background The predictive performance of the models FRANCE-2 and ACC-TAVI for early-mortality after Transcatheter Aortic Valve Implantation (TAVI) can decline over time and can be enhanced by updating them on new populations. We aim to update and internally and temporally validate these models using a recent TAVI-cohort from the Netherlands Heart Registration (NHR). Methods We used data of TAVI-patients treated in 2013-2017. For each original-model, the best update-method (model-intercept, model-recalibration, or model-revision) was selected by a closed-testing procedure. We internally validated both updated models with 1000 bootstrap samples. We also updated the models on the 2013-2016 dataset and temporally validated them on the 2017-dataset. Performance measures were the Area-Under ROC-curve (AU-ROC), Brier-score, and calibration graphs. Results We included 6177 TAVI-patients, with 4.5% observed early-mortality. The selected update-method for FRANCE-2 was model-intercept-update. Internal validation showed an AU-ROC of 0.63 (95%CI 0.62-0.66) and Brier-score of 0.04 (0.04-0.05). Calibration graphs show that it overestimates early-mortality. In temporal-validation, the AU-ROC was 0.61 (0.53-0.67).The selected update-method for ACC-TAVI was model-revision. In internal-validation, the AU-ROC was 0.63 (0.63-0.66) and Brier-score was 0.04 (0.04-0.05). The updated ACC-TAVI calibrates well up to a probability of 20%, and subsequently underestimates early-mortality. In temporal-validation the AU-ROC was 0.65 (0.58-0.72). Conclusion Internal-validation of the updated models FRANCE-2 and ACC-TAVI with data from the NHR demonstrated improved performance, which was better than in external-validation studies and comparable to the original studies. In temporal-validation, ACC-TAVI outperformed FRANCE-2 because it suffered less from changes over time.
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Key Words
- ACC-TAVI (ACC TVT), American College of Cardiology Transcatheter Valve Therapy
- AU-PRC, Area Under the Precision-Recall Curve
- AU-ROC, Area Under the Receiver Operating-Characteristic Curve
- Amsterdam UMC, Amsterdam University Medical Center - location AMC (Academic Medical Center)
- BSS, Brier-skill score
- Closed-testing procedure
- EuroSCORE, European System for Cardiac Operative Risk Evaluation
- External Validation
- FRANCE-2, French Aortic National CoreValve and Edwards [15]
- LVEF, Left Ventricular Ejection Fraction
- MPM, Mortality Prediction Models
- Model recalibration
- Model updating
- NHR, Netherlands Heart Registration (“Nederlandse Hart Registratie in Dutch”)
- NYHA, New York Heart Association
- Prediction models
- SAVR, Surgical Aortic Valve Replacement
- TAVI (TAVR), Transcatheter Aortic Valve Implantation (Replacement)
- Transcatheter Aortic Valve Implantation (TAVI)
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Affiliation(s)
- Hatem Al-Farra
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Bas A J M de Mol
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anita C J Ravelli
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - W J P P Ter Burg
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | | | - José P S Henriques
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - M M Vis
- Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - J Vos
- Amphia Hospital, the Netherlands
| | - L Timmers
- St. Antonius Hospital, the Netherlands
| | | | | | | | - F Porta
- Leeuwarden Medical Center, the Netherlands
| | - M G Stoel
- Medisch Spectrum Twente, the Netherlands
| | - S Kats
- Maastricht University Medical Center, the Netherlands
| | - G Amoroso
- Onze Lieve Vrouwe Gasthuis, the Netherlands
| | | | - P R Stella
- University Medical Center Utrecht, the Netherlands
| | - P de Jaegere
- Erasmus University Medical Center, the Netherlands
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10
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Silvis MJM, Dekker M, Zivelonghi C, Agostoni P, Stella PR, Doevendans PA, de Kleijn DPV, van Kuijk JP, Leenders GE, Timmers L. The Coronary Sinus Reducer; 5-year Dutch experience. Neth Heart J 2020; 29:215-223. [PMID: 33284421 PMCID: PMC7991026 DOI: 10.1007/s12471-020-01525-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 11/10/2020] [Indexed: 11/29/2022] Open
Abstract
Background Refractory angina is a growing and major health-care problem affecting millions of patients with coronary artery disease worldwide. The Coronary Sinus Reducer (CSR) is a device that may be considered for the relief of symptoms of refractory angina. It causes increased venous pressure leading to a dilatation of arterioles and reduced arterial vascular resistance in the sub-endocardium. This study describes the 5‑year Dutch experience regarding safety and efficacy of the CSR. Methods One hundred and thirty-two patients with refractory angina were treated with the CSR. The primary efficacy endpoint of the study was Canadian Cardiovascular Society (CCS) class improvement between baseline and 6‑month follow-up. The primary safety endpoint was successful CSR implantation in the absence of any device-related events. Results Eighty-five patients (67%) showed improvement of at least 1 CCS class and 43 patients (34%) of at least 2 classes. Mean CCS class improved from 3.17 ± 0.61 to 2.12 ± 1.07 after implantation (P < 0.001). The CSR was successfully implanted in 99% of the patients and only minor complications during implantation were reported. Conclusion The CSR is a simple, safe, and effective option for most patients with refractory angina. However, approximately thirty percent of the patients showed no benefit after implantation. Future studies should focus on the exact underlying mechanisms of action and reasons for non-response to better identify patients that could benefit most from this therapy. Electronic supplementary material The online version of this article (10.1007/s12471-020-01525-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Silvis
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Dekker
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - C Zivelonghi
- Hart Centrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerpen, Belgium
| | - P Agostoni
- Hart Centrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim, Antwerpen, Belgium
| | - P R Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - P A Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, University Medical Center Utrecht, Utrecht, The Netherlands
| | - D P V de Kleijn
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - J P van Kuijk
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands
| | - G E Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L Timmers
- Department of Cardiology, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
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11
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Rozemeijer R, van Bezouwen WP, van Hemert ND, Damen JA, Koudstaal S, Stein M, Leenders GE, Timmers L, Kraaijeveld AO, Roes K, Agostoni P, Doevendans PA, Stella PR, Voskuil M. Direct comparison of predictive performance of PRECISE-DAPT versus PARIS versus CREDO-Kyoto: a subanalysis of the ReCre8 trial. Neth Heart J 2020; 29:201-214. [PMID: 32955703 PMCID: PMC7991032 DOI: 10.1007/s12471-020-01486-y] [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: 12/13/2022] Open
Abstract
Background Multiple scores have been proposed to guide risk stratification after percutaneous coronary intervention. This study assessed the performance of the PRECISE-DAPT, PARIS and CREDO-Kyoto risk scores to predict post-discharge ischaemic or bleeding events. Methods A total of 1491 patients treated with latest-generation drug-eluting stent implantation were evaluated. Risk scores for post-discharge ischaemic or bleeding events were calculated and directly compared. Prognostic performance of both risk scores was assessed with calibration, Harrell’s c‑statistics net reclassification index and decision curve analyses. Results Post-discharge ischaemic events occurred in 56 patients (3.8%) and post-discharge bleeding events in 34 patients (2.3%) within the first year after the invasive procedure. C‑statistics for the PARIS ischaemic risk score was marginal (0.59, 95% confidence interval (CI) 0.51–0.68), whereas the CREDO-Kyoto ischaemic risk score was moderate (0.68, 95% CI 0.60–0.75). With regard to post-discharge bleeding events, CREDO-Kyoto displayed moderate discrimination (c-statistic 0.67, 95% CI 0.56–0.77), whereas PRECISE-DAPT (0.59, 95% CI 0.48–0.69) and PARIS (0.55, 95% CI 0.44–0.65) had a marginal discriminative capacity. Net reclassification index and decision curve analysis favoured CREDO-Kyoto-derived bleeding risk assessment. Conclusion In this contemporary all-comer population, PARIS and PRECISE-DAPT risk scores were not resilient to independent testing for post-discharge bleeding events. CREDO-Kyoto-derived risk stratification was associated with a moderate predictive capability for post-discharge ischaemic or bleeding events. Future studies are warranted to improve risk stratification with more focus on robustness and rigorous testing. Electronic supplementary material The online version of this article (10.1007/s12471-020-01486-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Rozemeijer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - W P van Bezouwen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N D van Hemert
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J A Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S Koudstaal
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Farr Institute of Health Informatics, University College London, London, UK
| | - M Stein
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - G E Leenders
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Timmers
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,St. Antonius Hospital, Nieuwegein, The Netherlands
| | - A O Kraaijeveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - K Roes
- Department of Biostatistics and Research Support, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P Agostoni
- Department of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium
| | - P A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands.,Central Military Hospital, Utrecht, The Netherlands
| | - P R Stella
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Van Doorn-Khosrovani SBVW, Pisters-van Roy A, Timmers L, van Saase L, Tran T, Zeverijn L, Evers P, Gelderblom H, Verheul H, Smit E, Blijlevens N, Eskens F, Bloemendal H, Voest E. 1594P Harmonising patient-access programmes. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Jordaens L, Timmers L, Goethals P. Funny waves in repolarisation and tachycardia in a patient suspected for Brugada syndrome. Neth Heart J 2019; 27:454-455. [PMID: 31115759 PMCID: PMC6712107 DOI: 10.1007/s12471-019-1292-8] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- L Jordaens
- Kliniek Sint Jan, Brussels, Belgium.
- Universitair Ziekenhuis Gent, Ghent, Belgium.
| | - L Timmers
- Universitair Ziekenhuis Gent, Ghent, Belgium
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14
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van Waalwijk van Doorn-Khosrovani SB, Pisters-van Roy A, van Saase L, van der Graaff M, Gijzen J, Sleijfer S, Hoes LR, van Berge Henegouwen JM, van der Wijngaart H, van der Velden DL, van Werkhoven E, Retel VP, van Harten WH, Huitema ADR, Timmers L, Gelderblom H, Verheul HMW, Voest EE. Personalised reimbursement: a risk-sharing model for biomarker-driven treatment of rare subgroups of cancer patients. Ann Oncol 2019; 30:663-665. [PMID: 31038154 DOI: 10.1093/annonc/mdz119] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | - L van Saase
- National Health Care Institute (Zorginstituut Nederland), Diemen
| | - M van der Graaff
- National Health Care Institute (Zorginstituut Nederland), Diemen
| | | | - S Sleijfer
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam; Center for Personalised Cancer Treatment (CPCT)
| | - L R Hoes
- Division of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam
| | | | - H van der Wijngaart
- Division of Medical Oncology, Amsterdam University Medical Center, Cancer Center Amsterdam, Amsterdam
| | - D L van der Velden
- Division of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam
| | - E van Werkhoven
- Department of Biometrics, Netherlands Cancer Institute, Amsterdam
| | - V P Retel
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam; Department of Health Technology and Services Research, University of Twente, Enschede
| | - W H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam; Department of Health Technology and Services Research, University of Twente, Enschede; Rijnstate Hospital, Arnhem
| | - A D R Huitema
- Department of Pharmacy & Pharmacology, Netherlands Cancer Institute, Amsterdam; Department of Clinical Pharmacy, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L Timmers
- National Health Care Institute (Zorginstituut Nederland), Diemen
| | - H Gelderblom
- Division of Medical Oncology, Leiden University Medical Center, Leiden
| | - H M W Verheul
- Division of Medical Oncology, Leiden University Medical Center, Leiden
| | - E E Voest
- Center for Personalised Cancer Treatment (CPCT); Division of Molecular Oncology, The Netherlands Cancer Institute, Amsterdam.
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15
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Rozemeijer R, Wing Wong C, Leenders G, Timmers L, Koudstaal S, Rittersma SZ, Kraaijeveld A, Bots M, Doevendans P, Stella P, Voskuil M. Incidence, angiographic and clinical predictors, and impact of stent thrombosis: a 6-year survey of 6,545 consecutive patients. Neth Heart J 2019; 27:321-329. [PMID: 30895527 PMCID: PMC6533324 DOI: 10.1007/s12471-019-1253-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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
Objective We sought to determine the incidence, angiographic predictors, and impact of stent thrombosis (ST). Background Given the high mortality after ST, this study emphasises the importance of ongoing efforts to identify angiographic predictors of ST. Methods All consecutive patients with angiographically confirmed ST between 2010 and 2016 were 1:4 matched for (1) percutaneous coronary intervention (PCI) indication and (2) index date ±6 weeks to randomly selected controls. Index PCI angiograms were reassessed by two independent cardiologists. A multivariable conditional logistic regression model was built to identify independent predictors of ST. Results Of 6,545 consecutive patients undergoing PCI, 55 patients [0.84%, 95% confidence interval (CI) 0.63–1.10%] presented with definite ST. Multivariable logistic regression identified dual antiplatelet therapy (DAPT) non-use as the strongest predictor of ST (odds ratio (OR) 10.9, 95% CI 2.47–48.5, p < 0.001), followed by: stent underexpansion (OR 5.70, 95% CI 2.39–13.6, p < 0.001), lesion complexity B2/C (OR 4.32, 95% CI 1.43–13.1, p = 0.010), uncovered edge dissection (OR 4.16, 95% CI 1.47–11.8, p = 0.007), diabetes mellitus (OR 3.23, 95% CI 1.25–8.36, p = 0.016), and residual coronary artery disease at the stent edge (OR 3.02, 95% CI 1.02–8.92, p = 0.045). ST was associated with increased rates of mortality as analysed by Kaplan-Meier estimates (27.3 vs 11.3%, plog-rank < 0.001) and adjusted Cox proportional-hazard regression (hazard ratio 2.29, 95% CI 1.03–5.10, p = 0.042). Conclusions ST remains a serious complication following PCI with a high rate of mortality. DAPT non-use was associated with the highest risk of ST, followed by various angiographic parameters and high lesion complexity. Electronic supplementary material The online version of this article (10.1007/s12471-019-1253-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R Rozemeijer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C Wing Wong
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - G Leenders
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - L Timmers
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - S Koudstaal
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Department of Epidemiology, Julius Centrum, Utrecht, The Netherlands
| | - S Z Rittersma
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - A Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Bots
- Department of Epidemiology, Julius Centrum, Utrecht, The Netherlands
| | - P Doevendans
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.,Netherlands Heart Institute, Utrecht, The Netherlands
| | - P Stella
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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16
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Baldetti L, Gallone G, Ponticelli F, Banai S, Konigstein M, Verheye S, Rosseel L, Timmers L, Leenders G, Agostoni P, Zivelonghi C, Colombo A, Giannini F. P6363Real world experience with Reducer implantation for refractory angina treatment. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6363] [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: 11/12/2022] Open
Affiliation(s)
- L Baldetti
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - G Gallone
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - F Ponticelli
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - S Banai
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - M Konigstein
- Tel Aviv University, Department of Cardiology, Tel Aviv, Israel
| | - S Verheye
- ZNA Middelheim Hospital, Cardiovascular Center, Antwerp, Belgium
| | - L Rosseel
- ZNA Middelheim Hospital, Cardiovascular Center, Antwerp, Belgium
| | - L Timmers
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands
| | - G Leenders
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands
| | - P Agostoni
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - C Zivelonghi
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - A Colombo
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
| | - F Giannini
- San Raffaele Hospital of Milan (IRCCS), Unit of Cardiovascular Interventions, Milan, Italy
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17
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Wang JW, Chong SY, Wang X, Yatim SM, Fairhurst AM, Vernooij F, Chan MY, Timmers L, De Kleijn DPV. P2282Deficiency of Toll-like receptor 7 prevents cardiac rupture and reduces adverse ventricular remodelling after myocardial infarction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2282] [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)
- J W Wang
- National University of Singapore, Department of Surgery, Cardiovascular Research Institute (CVRI), Singapore, Singapore
| | - S Y Chong
- National University of Singapore, Department of Surgery, Cardiovascular Research Institute (CVRI), Singapore, Singapore
| | - X Wang
- National University of Singapore, Department of Surgery, Cardiovascular Research Institute (CVRI), Singapore, Singapore
| | - S M Yatim
- National University of Singapore, Department of Surgery, Cardiovascular Research Institute (CVRI), Singapore, Singapore
| | - A M Fairhurst
- A*STAR, Singapore Immunology Network, Singapore, Singapore
| | - F Vernooij
- National University of Singapore, Department of Surgery, Cardiovascular Research Institute (CVRI), Singapore, Singapore
| | - M Y Chan
- National University Heart Centre, Department of Medicine, Cardiovascular Research Institute (CVRI), Singapore, Singapore
| | - L Timmers
- University Medical Center Utrecht, Department of Cardiology, Utrecht, Netherlands
| | - D P V De Kleijn
- University Medical Center Utrecht, Vascular Surgery, Utrecht, Netherlands
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18
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Boersma L, Merkely B, Neuzil P, Crozier I, Akula D, Timmers L, Kalarus Z, Sherfesee L, Thompson A, Lexcen D, Knight B. 3406The acute extravascular defibrillation, pacing and electrogram (ASD2) study results. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3406] [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)
- L Boersma
- St Antonius Hospital, Department of Cardiology, Nieuwegein, Netherlands
| | - B Merkely
- Semmelweis University Heart Center, Budapest, Hungary
| | - P Neuzil
- Na Homolce Hospital, Prague, Czech Republic
| | - I Crozier
- Christchurch Hospital, Christchurch, New Zealand
| | - D Akula
- Lourdes Cardiology Center, Voorhees, United States of America
| | - L Timmers
- Ghent University Hospital (UZ), Ghent, Belgium
| | - Z Kalarus
- Slaski Heart Disease Center, Zabrze, Poland
| | - L Sherfesee
- Medtronic, Minneapolis, United States of America
| | - A Thompson
- Medtronic, Minneapolis, United States of America
| | - D Lexcen
- Medtronic, Minneapolis, United States of America
| | - B Knight
- Northwestern Memorial Hospital, Chicago, United States of America
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19
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Tavernier R, Strisciuglio T, Van Heuverswyn F, Timmers L, De Pooter J, Knecht S, Duytschaever M, Vandekerckhove Y, Kucher A, Stroobandt R. P1229Different scenarios leading to inappropriate therapy inhibition in single chamber ICD detection programming. Europace 2018. [DOI: 10.1093/europace/euy015.710] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Tavernier
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - T Strisciuglio
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | | | - L Timmers
- Ghent University Hospital (UZ), Ghent, Belgium
| | - J De Pooter
- Ghent University Hospital (UZ), Ghent, Belgium
| | - S Knecht
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
| | - M Duytschaever
- St-Jan Hospital, Department of Cardiology, Bruges, Belgium
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20
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De Pooter J, Elhaddad M, Phlips T, Timmers L, Van Heuverswyn F, Knecht S, Tavernier R, Duytschaever M. P301Comparison of local activation time annotation algorithms in high density mapping of regular atrial tachycardias. Europace 2017. [DOI: 10.1093/ehjci/eux141.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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21
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van Hout GPJ, de Jong R, Vrijenhoek JEP, Timmers L, Duckers HJ, Hoefer IE. Admittance-based pressure-volume loop measurements in a porcine model of chronic myocardial infarction. Exp Physiol 2013; 98:1565-75. [DOI: 10.1113/expphysiol.2013.074179] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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De Hoog VC, Timmers L, Smeets MB, Van Middelaar BJ, Hack CE, Pasterkamp G, De Kleijn DPV. Absence of complement factor c5a receptor on circulating cells reduces myocardial reperfusion injury and improves cardiac function. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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23
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Timmers L, Pasterkamp G, de Hoog VC, Arslan F, Appelman Y, de Kleijn DPV. The innate immune response in reperfused myocardium. Cardiovasc Res 2012; 94:276-83. [DOI: 10.1093/cvr/cvs018] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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24
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Timmers L, Hamming JF, Oostvogel HJM. [Non-incarcerated inguinal hernia in children: operation within 7 days not necessary]. Ned Tijdschr Geneeskd 2005; 149:247-50. [PMID: 15719836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
OBJECTIVE To assess the necessity to operate on non-incarcerated inguinal hernia in children within 7 days of diagnosis. DESIGN Retrospective. METHOD Data on 360 children, 0-10 years old (104 girls and 256 boys) who were operated on for inguinal hernia between 1 January 1993-31 December 2001 at the St. Elisabeth Hospital in Tilburg, the Netherlands, were collected from the medical records. These data included sex, age, interval between diagnosis and repair, recurrence, incarceration, length of hospitalisation and complications. RESULTS In the group of 113 children 0-1 years old, 137 inguinal hernias were repaired, ofwhich 16 were incarcerated on presentation. The interval between diagnosis and repair was known in 93 of 121 cases: 37 hernias were repaired within 7 days and 56 at a later stage. In the latter group, there was one case of secondary incarceration (1.8%; 95% CI: 0-5.4). The number needed to treat was 56. In the group of 247 children 1-10 years old, 269 inguinal hernias were repaired, of which 8 were primarily incarcerated. The interval between diagnosis and repair was known in 208 of 261 cases: 34 hernias were repaired within 7 days and 174 at a later stage. In the latter group, 3 hernias incarcerated secondarily (1.7%; 95% CI: 0-3.7). The number needed to treat was 58. In the group of non-incarcerated hernias 1 complication occurred, in the group of incarcerated hernias none. The mean length of hospitalisation of children with non-incarcerated hernia was 0.85 days, and of children with incarcerated hernia 2.4 days. CONCLUSION In children with a non-incarcerated inguinal hernia who are waiting for an operation, the risk of secondary incarceration and complications is 2% which we do not think is enough reason to carry out an elective hernia-repair procedure within 7 days.
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Affiliation(s)
- L Timmers
- Universitair Medisch Centrum Utrecht, afd. Experimentele Cardiologie, Utrecht.
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25
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Cuisinier MC, Janssen H, Timmers L, Hoogduin CA. [Grief work an support experienced during abortion and stillbirth]. Ned Tijdschr Geneeskd 1990; 134:2395-9. [PMID: 2263266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
We investigated by means of a semi-structured, oral interview how women cope with a miscarriage or stillbirth. The need for psychosocial support and the support which was experienced were also studied. The results stress that the mourning process after a miscarriage or stillbirth proceeds in one sense like the 'conventional' mourning process, but differs in some aspects. Women with one or more children show less intense emotions than childless women. The experiences with the professional help and the environmental support differ depending on the moment: before, during or after the bereavement. Negative experiences usually refer to a too businesslike attitude of doctors and nurses in charge, lack of information, shortcomings in the aftercare, clumsy reactions of the environment and unfulfilled needs for contact with other women who had a miscarriage or stillbirth.
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Affiliation(s)
- M C Cuisinier
- Katholieke Universiteit, vakgroep Klinische Psychologie en Persoonlijkheidsleer, Nijmegen
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Abstract
Recently, Widaman, Geary, Cormier, and Little (in press) offered a general componential model for simple and complex addition. In the present study, the generalizability of this model to very complex addition problems and to production task performance was tested. We investigated addition-production performance using a new research paradigm, the decision-production task. The paradigm was used to assess the reaction times of 16 adults to 100 single-digit addition problems (Experiment 1) and to very complex three-digit addition problems (Experiment 2). Generally, the results give evidence for the basic assumptions of the Widaman et al. model. Some of the results, however, demonstrate that short-term memory load factors and strategy choices also have important effects on complex addition-production performance. Furthermore, the results of both experiments indicate that, in production tasks, the nature of the elementary search/compute process can be characterized as a memory-retrieval process and that the decision-production paradigm is a valuable alternative to the classical verbal production paradigm.
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Affiliation(s)
- L Timmers
- Department of Psychology, University of Leuven, Belgium
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