1
|
Halim J, den Heijer P, van den Branden B, Meuwissen M, Vos J, Schölzel B, IJsselmuiden A. Short-term outcome after transcatheter aortic valve replacement with a novel balloon-expandable valve. Neth Heart J 2023; 31:500-505. [PMID: 36480146 PMCID: PMC10667167 DOI: 10.1007/s12471-022-01738-z] [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] [Accepted: 09/28/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Transcatheter aortic valve replacement (TAVR) has been expanding rapidly with numerous transcatheter heart valve (THV) systems currently available. The Myval balloon-expandable (BE) valve (Meril Life Sciences Pvt. Ltd., India) is a novel THV system indicated for the treatment of patients with severe aortic stenosis. The primary objective of this study is to assess the safety and performance of the Myval BE valve. METHODS In this prospective single-centre study, 120 consecutive patients who underwent TAVR with the Myval BE valve were included. Clinical outcomes were evaluated at 30 days and 6 months using Valve Academic Research Consortium‑2 criteria. All-cause mortality, stroke, acute kidney injury, major vascular complications, moderate or severe paravalvular leakage (PVL) and need for a permanent pacemaker implantation (PPI) were investigated. RESULTS At 6‑month follow-up, all-cause death and cardiac death were seen in 5.8% and 0.8% of the patients respectively. Periprocedural stroke and need for PPI were both seen in 3.3% of the patients. Access-site-related vascular and bleeding complications were absent. Improved valve haemodynamics and no moderate to severe PVL could be seen at 30 days. An intermediate valve size was selected in 51% of the patients. CONCLUSIONS The Myval BE valve demonstrates improved valve haemodynamics, absence of moderate to severe PVL and good safety outcomes at 6‑month follow-up with low cardiac death rate and acceptable rates of permanent pacemaker implantation and periprocedural stroke. Future randomised controlled trials will further establish the clinical utility of the Myval BE valve.
Collapse
Affiliation(s)
- J Halim
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands.
| | - P den Heijer
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B van den Branden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - B Schölzel
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| | - A IJsselmuiden
- Department of Cardiology, Amphia Hospital Breda, Breda, The Netherlands
| |
Collapse
|
2
|
Crooijmans C, Jansen TPJ, Konst RE, Woudstra J, Appelman Y, den Ruijter HM, Onland-Moret NC, Meeder JG, de Vos AMJ, Paradies V, Woudstra P, Sjauw KD, van 't Hof A, Meuwissen M, Winkler P, Boersma E, van de Hoef TP, Maas AHEM, Dimitriu-Leen AC, van Royen N, Elias-Smale SE, Damman P. Design and rationale of the NetherLands registry of invasive Coronary vasomotor Function Testing (NL-CFT). Int J Cardiol 2023; 379:1-8. [PMID: 36863419 DOI: 10.1016/j.ijcard.2023.02.043] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 03/04/2023]
Abstract
BACKGROUND Angina without angiographic evidence of obstructive coronary artery disease (ANOCA) is a highly prevalent condition with insufficient pathophysiological knowledge and lack of evidence-based medical therapies. This affects ANOCA patients prognosis, their healthcare utilization and quality of life. In current guidelines, performing a coronary function test (CFT) is recommended to identify a specific vasomotor dysfunction endotype. The NetherLands registry of invasive Coronary vasomotor Function testing (NL-CFT) has been designed to collect data on ANOCA patients undergoing CFT in the Netherlands. METHODS The NL-CFT is a web-based, prospective, observational registry including all consecutive ANOCA patients undergoing clinically indicated CFT in participating centers throughout the Netherlands. Data on medical history, procedural data and (patient reported) outcomes are gathered. The implementation of a common CFT protocol in all participating hospitals promotes an equal diagnostic strategy and ensures representation of the entire ANOCA population. A CFT is performed after ruling out obstructive coronary artery disease. It comprises of both acetylcholine vasoreactivity testing as well as bolus thermodilution assessment of microvascular function. Optionally, continuous thermodilution or Doppler flow measurements can be performed. Participating centers can perform research using own data, or pooled data will be made available upon specific request via a secure digital research environment, after approval of a steering committee. CONCLUSION NL-CFT will be an important registry by enabling both observational and registry based (randomized) clinical trials in ANOCA patients undergoing CFT.
Collapse
Affiliation(s)
- C Crooijmans
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - T P J Jansen
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - R E Konst
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | - J Woudstra
- Dept. of Cardiology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Y Appelman
- Dept. of Cardiology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - H M den Ruijter
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - N C Onland-Moret
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - J G Meeder
- Dept. of Cardiology, Viecuri Medical Center, Venlo, the Netherlands
| | - A M J de Vos
- Dept. of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - V Paradies
- Dept. of Cardiology, Maasstad Hospital, Rotterdam, the Netherlands
| | - P Woudstra
- Dept. of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - K D Sjauw
- Dept. of Cardiology, Medical Center Leeuwarden, Leeuwarden, the Netherlands
| | - A van 't Hof
- Dept. of Cardiology, MUMC, Maastricht, the Netherlands; Dept. of Cardiology, Zuyderland, Heerlen, the Netherlands; CArdiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - M Meuwissen
- Dept. of Cardiology, Amphia Hospital, Breda, the Netherlands
| | - P Winkler
- Dept. of Cardiology, Zuyderland, Heerlen, the Netherlands
| | - E Boersma
- Dept. of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - T P van de Hoef
- Laboratory of Experimental Cardiology, UMC Utrecht, Utrecht University, Utrecht, the Netherlands
| | - A H E M Maas
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | | | - N van Royen
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands
| | | | - P Damman
- Dept. of Cardiology, Radboudumc, Nijmegen, the Netherlands.
| |
Collapse
|
3
|
de Veer AJWM, Bennaghmouch N, Bor WL, Herrman JPR, Vrolix M, Meuwissen M, Vandendriessche T, Adriaenssens T, de Bruyne B, Magro M, Dewilde WJM, Ten Berg JM. The WOEST 2 registry : A prospective registry on antithrombotic therapy in atrial fibrillation patients undergoing percutaneous coronary intervention. Neth Heart J 2022; 30:302-311. [PMID: 35230636 PMCID: PMC9123099 DOI: 10.1007/s12471-022-01664-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 11/17/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patients on oral anticoagulants (OACs) undergoing percutaneous coronary intervention (PCI) also require aspirin and a P2Y12 inhibitor (triple therapy). However, triple therapy increases bleeding. The use of non-vitamin K antagonist oral anticoagulants (NOACs) and stronger P2Y12 inhibitors has increased. The aim of our study was to gain insight into antithrombotic management over time. Methods A prospective cohort study of patients on OACs for atrial fibrillation or a mechanical heart valve undergoing PCI was performed. Thrombotic outcomes were myocardial infarction, stroke, target-vessel revascularisation and all-cause mortality. Bleeding outcome was any bleeding. We report the 30-day outcome. Results The mean age of the 758 patients was 73.5 ± 8.2 years. The CHA2DS2-VASc score was ≥ 3 in 82% and the HAS-BLED score ≥ 3 in 44%. At discharge, 47% were on vitamin K antagonists (VKAs), 52% on NOACs, 43% on triple therapy and 54% on dual therapy. Treatment with a NOAC plus clopidogrel increased from 14% in 2014 to 67% in 2019. The rate of thrombotic (4.5% vs 2.0%, p = 0.06) and bleeding (17% vs. 14%, p = 0.42) events was not significantly different in patients on VKAs versus NOACs. Also, the rate of thrombotic (2.9% vs 3.4%, p = 0.83) and bleeding (18% vs 14%, p = 0.26) events did not differ significantly between patients on triple versus dual therapy. Conclusions Patients on combined oral anticoagulation and antiplatelet therapy undergoing PCI are elderly and have both a high bleeding and ischaemic risk. Over time, a NOAC plus clopidogrel became the preferred treatment. The rate of thrombotic and bleeding events was not significantly different between patients on triple or dual therapy or between those on VKAs versus NOACs. Supplementary Information The online version of this article (10.1007/s12471-022-01664-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- A J W M de Veer
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - N Bennaghmouch
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - W L Bor
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - J P R Herrman
- Department of Cardiology, OLVG, Amsterdam, The Netherlands
| | - M Vrolix
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - T Vandendriessche
- Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
| | - T Adriaenssens
- Department of Cardiovascular Medicine, University Hospital Leuven, Leuven, Belgium
| | - B de Bruyne
- Cardiovascular Research Centre Aalst, OLV Clinic, Aalst, Belgium
| | - M Magro
- Department of Cardiology, Elizabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - W J M Dewilde
- Department of Cardiology, Imelda Hospital, Bonheiden, Belgium
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| |
Collapse
|
4
|
Arnouts L, Van Mechelen K, Laroche S, Meuwissen M, Boudewyns A, Martens M, Mahieu L. Non-primary CMV infection not always innocent. A case-report and literature review. Acta Clin Belg 2022; 77:96-100. [PMID: 32491959 DOI: 10.1080/17843286.2020.1773651] [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] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Cytomegalovirus (CMV) is the most common infectious cause of congenital malformations. CMV infections are frequently symptomatic in case of a primary infection during pregnancy. Generally, maternal immunity protects the newborn against a symptomatic course of the CMV infection. METHODS We present clinical information and medical images of a neonate with non-primary congenital CMV infection. RESULTS We report the case of a severe congenital infection in a newborn clinically presenting with diffuse petechia, facial dysmorphisms, respiratory distress, hepatomegaly and hypotonia. The girl was born to a mother with CMV immunity. Blood results demonstrated thrombocytopenia and elevated transaminases. Brain MRI revealed ventricular dilatation and germinolytic cysts, compatible with CMV infection. Auditory brain stem response testing was abnormal. CMV culture of saliva was positive. This led to the diagnosis of a severe congenital CMV infection due to a non-primary maternal infection. Antiviral treatment with valganciclovir was initiated immediately and continued for 6 months. CONCLUSION Our case illustrates that, even when the mother was demonstrated CMV immune, congenital CMV infection is still an important differential diagnostic consideration in neonates presenting with congenital cerebral abnormalities, thrombocytopenia and/or hearing loss. ABBREVIATIONS ABR: auditory brainstem responses; CMV: Cytomegalovirus; CPAP: Continuous Positive Airway Pressure; CRP: C-Reactive Protein; dBnHL: Decibel Above Normal Adult Hearing Level; IV: intravenously; MRI: Magnetic Resonance Imaging; SGA: Small for Gestational Age; SNHL: Sensorineural Hearing Loss.
Collapse
Affiliation(s)
- Lieselot Arnouts
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Belgium
| | - K. Van Mechelen
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Belgium
| | - S. Laroche
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Belgium
| | - M. Meuwissen
- Department of Genetics, Antwerp University Hospital, University of Antwerp, Belgium
| | - A. Boudewyns
- Department of Otorhinolaryngology, Antwerp University Hospital, University of Antwerp, Belgium
| | - M. Martens
- Department of Pediatrics, Hospital AZ Turnhout, Belgium
| | - L. Mahieu
- Department of Neonatology, Antwerp University Hospital, University of Antwerp, Belgium
| |
Collapse
|
5
|
vanGorsel B, Voskuil M, Ijsselmuiden AJJ, Meuwissen M. Case report: Dobutamine stress intracoronary physiology and imaging to examine the functional and dynamic properties of an apparent malignant intra-arterial right coronary artery. Eur Heart J Case Rep 2021; 5:ytab296. [PMID: 34755030 PMCID: PMC8573164 DOI: 10.1093/ehjcr/ytab296] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/03/2021] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
Background We present a case concerning a 64-year-old female with complaints of palpitations, chest pain, and an anomalous right coronary artery (RCA) from the opposite sinus (R-ACAOS) with a suspected malignant trajectory on computed tomography. She was referred to our clinic for a second opinion to re-assess the suggested treatment of coronary surgery. Case summary A coronary angiogram was performed demonstrating a RCA with a tapered ostium typical for an inter-arterial course. Dobutamine and adenosine stress test during simultaneous intracoronary flow, pressure, and ultrasound assessment, was performed to determine the functional significance. After 120 mcg adenosine, intracoronary baseline flow velocity increased from 14 cm/s to a peak flow velocity of 37 cm/s, demonstrating a sufficient coronary flow velocity reserve (CFVR) of 2.6. No intracoronary pressure drop during maximal hyperaemia was found. After maximum dobutamine stress, CFVR was measured 2.5. Fractional flow reserve measured 0.99. Cross-sectional area measurement through intravascular ultrasound demonstrated a diameter reduction from 14.6 mm2 to 8.5 mm2. Therefore, we concluded this aberrant trajectory was not of any functional relevance and should be considered non-malignant. Discussion There are several anatomic coronary anomalies which may contribute to coronary compression during exercise and are therefore correlated with sudden cardiac death. Right coronary artery from the opposite sinus is correlated with a low mortality rate of 0.2% in comparison to left-ACAOS at 6.3% over 20 years in participants of competitive sport. Therefore, strong evidence of ischaemia must be present before opting for surgery. Our pragmatic approach provided in our opinion enough evidence for a conservative treatment strategy.
Collapse
Affiliation(s)
- B vanGorsel
- Department of Cardiology, Amphia Hospital, Room NWO-003, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - M Voskuil
- Department of cardiology, Universitair Medisch Centrum Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A J J Ijsselmuiden
- Department of Cardiology, Amphia Hospital, Room NWO-003, Molengracht 21, 4818 CK, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Room NWO-003, Molengracht 21, 4818 CK, Breda, The Netherlands
| |
Collapse
|
6
|
Spoormans E, Lemkes JS, Janssens GN, Van Der Hoeven NW, Soultana O, Jewbali LSD, Dubois EA, Meuwissen M, Bosker HA, Bleeker GB, Vlachojannis GJ, Van Der Harst P, Voskuil M, Van De Ven P, Van Royen N. Ischemic signs on the post-resuscitation ECG in absence of STEMI is associated with lower survival. A COACT trial's sub-study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1548] [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
The recently published Coronary Angiography after Cardiac arrest (COACT) trial found that urgent coronary angiography did not improve 90-day survival in out-of-hospital cardiac arrest (OHCA) patients without STEMI. The prognostic value of signs of ischemia on the ECG in absence of STEMI, is yet to be determined.
Purpose
To assess whether ischemic ECG patterns such as ST-depression and T-wave inversion are predictors for survival after OHCA in patients without STEMI.
Methods
In the COACT trial, patients with return of spontaneous circulation after OHCA with initial shockable rhythm and absence of ST-segment elevation were included. In this sub-study, the first post-resuscitation ECG recorded at the hospital was analysed for signs of ischemia. Ischemia was defined as ST-depression or T-wave inversion >1mm in ≥2 contiguous leads, or both. Primary endpoint was 90-day survival. Secondary endpoints included angiographic outcomes and left ventricular function assessed by cardiac magnetic resonance imaging or echocardiography.
Results
In total, 552 patients were included in the COACT trial. For this sub-study, 510 OHCA-patients had an ECG available for assessment of whom 340 patients (66.7%) had signs of ischemia on the ECG and 170 patients (33.3%) were without signs of ischemia. Patients with signs of ischemia were significantly older (p=0.003) and more frequently had a history of CAD (p=0.009). Left ventricular ejection fraction was lower in those with signs of ischemia (p=0.007). The number of acute thrombotic occlusions did not differ between groups (p=0.34). Patients with signs of ischemia had a significantly worse 90-day survival compared to patients that showed no signs of ischemia (HR 1.51 (95% CI 1.08–2.12); log-rank p=0.02). Furthermore, larger ST-depression was found to be associated with worse survival (log-rank p=0.01). Neurologic injury was the most common cause of death and its incidence did not differ between the groups (p=0.77).
Conclusion
Signs of ischemia in absence of STEMI on the post-resuscitation ECG is a predictor for worse survival. Furthermore, a correlation was found between the sum of ST-depression and lower survival rate.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Research grants of Netherlands Heart institue, Biotronic, AstraZeneca Survival plot signs of ischemia on ECGSurvival plot sum of ST-depression
Collapse
Affiliation(s)
- E Spoormans
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - J S Lemkes
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - G N Janssens
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | | | - O Soultana
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - L S D Jewbali
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - E A Dubois
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - M Meuwissen
- Amphia Hospital, Cardiology, Breda, Netherlands (The)
| | - H A Bosker
- Rijnstate Hospital, Cardiology, Arnhem, Netherlands (The)
| | - G B Bleeker
- Haga Hospital, Cardiology, Den Haag, Netherlands (The)
| | | | - P Van Der Harst
- University Medical Center Groningen, Cardiology, Groningen, Netherlands (The)
| | - M Voskuil
- University Medical Center Utrecht, Cardiology, Utrecht, Netherlands (The)
| | - P Van De Ven
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - N Van Royen
- Radboud University Medical Center, Cardiology, Nijmegen, Netherlands (The)
| | | |
Collapse
|
7
|
Lemkes J, Spoormans EM, Demirkiran A, Leutscher MSG, Janssens GN, Van Der Hoeven NW, Jewbali LSD, Dubios E, Meuwissen M, Bosker H, Bleeker G, Vlachojannis G, Van De Ven P, Van Loon R, Van Royen N. The effect of immediate coronary angiography after cardiac arrest without ST-segment elevation on left ventricular function. A sub-study of the COACT randomised trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1187] [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
The effect of immediate coronary angiography and percutaneous coronary intervention (PCI) in patients who are successfully resuscitated after cardiac arrest in the absence of ST-segment elevation myocardial infarction (STEMI) on left ventricular function is currently unknown.
Purpose
To evaluate whether immediate coronary angiography and PCI improves left ventricular function in patients who are successfully resuscitated from cardiac arrest without STEMI.
Methods
This prespecified sub-study of the multicentre COACT trial evaluated 552 patients, successfully resuscitated from out-of-hospital cardiac arrest without signs of STEMI. Patients were randomized to either undergo immediate coronary angiography or delayed coronary angiography, after neurologic recovery. All patients underwent PCI if indicated. The main outcomes of this analysis were left ventricular ejection fraction and end-diastolic and systolic volumes assessed by cardiac magnetic resonance imaging or echocardiography.
Results
Data on left ventricular function was available for 397 patients. The mean (± standard deviation) left ventricular ejection fraction was 45.2% (±12.8) in the immediate angiography group and 48.4% (±13.2) in the delayed angiography group (mean difference: −3.19; 95% confidence interval [CI], −6.75 to 0.37). Median left ventricular end-diastolic volume was 177 ml in the immediate angiography group compared to 169 ml in the delayed angiography group (ratio of geometric means: 1.06; 95% CI, 0.95 to 1.19). In addition, mean left ventricular end-systolic volume was 90 ml in the immediate angiography group compared to 78 ml in the delayed angiography group (ratio of geometric means: 1.13; 95% CI 0.97 to 1.32).
Conclusion
In patients successfully resuscitated after out-of-hospital cardiac arrest and without signs of STEMI, immediate coronary angiography was not found to improve left ventricular dimensions or function compared with a delayed angiography strategy.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Netherlands Heart InstituteBiotronikAstraZeneca
Collapse
Affiliation(s)
- J Lemkes
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - E M Spoormans
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - A Demirkiran
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - M S G Leutscher
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - G N Janssens
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | | | - L S D Jewbali
- Erasmus University Rotterdam, Cardiology, Rotterdam, Netherlands (The)
| | - E Dubios
- Erasmus University Rotterdam, Cardiology, Rotterdam, Netherlands (The)
| | | | - H Bosker
- Rijnstate Hospital, Arnhem, Netherlands (The)
| | - G Bleeker
- Haga Hospital, Den Haag, Netherlands (The)
| | | | - P Van De Ven
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - R Van Loon
- Amsterdam University Medical Center, Amsterdam, Netherlands (The)
| | - N Van Royen
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | | |
Collapse
|
8
|
Camaro C, Bonnes JL, Adang EM, Spoormans EM, Janssens GN, Meuwissen M, Van Der Horst ICC, Voskuil M, Stoel M, Vlaar APJ, Elbers PWG, Van De Ven PM, Lemkes JS, Van Royen N. Costs analysis from a randomized comparison of immediate versus delayed angiography in patients successfully resuscitated after out-of-hospital cardiac arrest. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.3154] [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
In out-of-hospital cardiac arrest (OHCA) patients without ST-segment elevation, immediate coronary angiography did not improve clinical outcomes when compared to delayed angiography in the Coronary Angiography after Cardiac Arrest (COACT) trial (1,2). Whether one of the two strategies has benefits in terms of healthcare resource use and costs is currently unknown. We assess the healthcare resource use and costs in patients with OHCA.
Methods
521 patients were eligible for a cost consequence analysis. Detailed healthcare resource use and cost-prices were collected from the initial hospital episode and compared between both groups. A generalized model (GLM) with a log link function and a gamma distribution was performed. Generic quality of life was measured with the RAND36 and collected at 12 months follow-up.
Results
Overall total mean costs were similar between both groups (EUR 33575±19612 vs EUR 33880±21044, P=0.86). GLM: (β 0.991 (95% CI 0.894–1.099), P=0.86. Mean procedural costs (CAG and/or PCI, coronary artery bypass graft) were higher in the immediate angiography group (EUR 4384±3447 vs EUR 3028±4220, P<0.001). Costs concerning Intensive Care Unit and ward stay did not show any significant difference. The median for the RAND-36 questionnaire physical component score was 49.2 in the immediate angiography group and 50.4 in the delayed group, P=0.57.
Conclusions
The mean total costs between OHCA patients randomized to an immediate angiography or a delayed invasive strategy were similar. With respect to the higher invasive procedure costs in the immediate group, a strategy awaiting neurological recovery followed by coronary angiography and planned revascularization may be considered.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Supported by unrestricted research grants from the Netherlands Heart Institute, Biotronik, and AstraZeneca.
Collapse
Affiliation(s)
- C Camaro
- Radboud University Medical Centre, Nijmegen, Netherlands (The)
| | - J L Bonnes
- Radboud University Medical Centre, Nijmegen, Netherlands (The)
| | - E M Adang
- Radboud University Medical Center, Department of Health Evidence, Nijmegen, Netherlands (The)
| | - E M Spoormans
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - G N Janssens
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | | | | | - M Voskuil
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - M Stoel
- Thorax Centre in Medisch Spectrum Twente (MST), Enschede, Netherlands (The)
| | - A P J Vlaar
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - P W G Elbers
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - P M Van De Ven
- University of Amsterdam, Department of Epidemiology and Data Science, Amsterdam, Netherlands (The)
| | - J S Lemkes
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - N Van Royen
- Radboud University Medical Centre, Nijmegen, Netherlands (The)
| | | |
Collapse
|
9
|
van der Graaf M, Jewbali LSD, Lemkes JS, Spoormans EM, van der Ent M, Meuwissen M, Blans MJ, van der Harst P, Henriques JP, Beishuizen A, Camaro C, Bleeker GB, van Royen N, Yap SC. Infarct-related chronic total coronary occlusion and the risk of ventricular tachyarrhythmic events in out-of-hospital cardiac arrest survivors. Neth Heart J 2021; 29:500-505. [PMID: 34046780 PMCID: PMC8455757 DOI: 10.1007/s12471-021-01578-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Chronic total coronary occlusion (CTO) has been identified as a risk factor for ventricular arrhythmias, especially a CTO in an infarct-related artery (IRA). This study aimed to evaluate the effect of an IRA-CTO on the occurrence of ventricular tachyarrhythmic events (VTEs) in out-of-hospital cardiac arrest survivors without ST-segment elevation. Methods We conducted a post hoc analysis of the COACT trial, a multicentre randomised controlled trial. Patients were included when they survived index hospitalisation after cardiac arrest and demonstrated coronary artery disease on coronary angiography. The primary endpoint was the occurrence of a VTE, defined as appropriate implantable cardioverter-defibrillator (ICD) therapy, sustained ventricular tachyarrhythmia or sudden cardiac death. Results A total of 163 patients from ten centres were included. Unrevascularised IRA-CTO in a main vessel was present in 43 patients (26%). Overall, 61% of the study population received an ICD for secondary prevention. During a follow-up of 1 year, 12 patients (7.4%) experienced at least one VTE. The cumulative incidence rate of VTEs was higher in patients with an IRA-CTO compared to patients without an IRA-CTO (17.4% vs 5.6%, log-rank p = 0.03). However, multivariable analysis only identified left ventricular ejection fraction < 35% as an independent factor associated with VTEs (adjusted hazard ratio 8.7, 95% confidence interval 2.2–35.4). A subanalysis focusing on CTO, with or without an infarct in the CTO territory, did not change the results. Conclusion In out-of-hospital cardiac arrest survivors with coronary artery disease without ST-segment elevation, an IRA-CTO was not an independent factor associated with VTEs in the 1st year after the index event. Supplementary Information The online version of this article (10.1007/s12471-021-01578-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M van der Graaf
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - L S D Jewbali
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J S Lemkes
- Department of Cardiology, Amsterdam University Medical Centre VUMC, Amsterdam, The Netherlands
| | - E M Spoormans
- Department of Cardiology, Amsterdam University Medical Centre VUMC, Amsterdam, The Netherlands
| | - M van der Ent
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
| | - M J Blans
- Department of Intensive Care Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - P van der Harst
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - J P Henriques
- Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - A Beishuizen
- Department of Intensive Care, Medisch Spectrum Twente, Enschede, The Netherlands
| | - C Camaro
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - G B Bleeker
- Department of Cardiology, Haga Hospital, The Hague, The Netherlands
| | - N van Royen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - S C Yap
- Department of Cardiology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| |
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
Eriksson M, Meuwissen M, Peijs T, Goossens H. The Influence of Melt-Mixing Conditions and State of Dispersion on Crystallisation, Rheology and Mechanical Properties of PCL/Sepiolite Nanocomposites. INT POLYM PROC 2020. [DOI: 10.3139/217.3890] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Abstract
It is generally accepted that the benefit of anisotropic nanofiller addition is strongly dependent on the state of the dispersion of these fillers in a polymer matrix. In this paper the influence of melt-compounding conditions on the dispersion of a needle-like clay, i. e. sepiolite, in poly(∊-caprolactone) (PCL) is investigated. The crystallisation behavior as well as the rheological and mechanical properties of PCL/sepiolite nanocomposites with filler contents up to 5 wt.% are studied. By changing the screw speed during melt-mixing in a micro-compounder, the state of dispersion was varied, with the higher speed leading to better dispersion and breakdown of the sepiolite agglomerates or bundles. Rheometry showed that better dispersed nanocomposites displayed an increase in viscosity due to network formation at slightly higher filler loadings. Likewise, better dispersed composites showed a modest increase in crystallisation temperature at low filler content, accompanied by a decrease in both nucleation efficiency and degree of crystallisation at higher loadings. Better dispersed nanocomposite systems also showed superior mechanical properties, particularly at higher filler loadings. However, overall the reinforcing efficiency of sepiolite in all nanocomposites was relatively low. This was mainly a consequence of the relatively low filler aspect ratio and the simultaneous breakup of sepiolite needles together with a breakdown of bundles during compounding.
Collapse
Affiliation(s)
- M. Eriksson
- Laboratory of Polymer Materials , Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven , The Netherlands
- Tetra Pak Packaging Solutions AB , Lund , Sweden
| | - M. Meuwissen
- Laboratory of Polymer Materials , Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven , The Netherlands
| | - T. Peijs
- WMG , Materials Engineering Centre, The University of Warwick, Coventry , UK
| | - H. Goossens
- Laboratory of Polymer Materials , Department of Chemical Engineering and Chemistry, Eindhoven University of Technology, Eindhoven , The Netherlands
- Sabic , Bergen op Zoom , The Netherlands
| |
Collapse
|
12
|
Simsek C, Schölzel BE, den Heijer P, Vos J, Meuwissen M, van den Branden B, IJsselmuiden AJJ. The rationale of using cerebral embolic protection devices during transcatheter aortic valve implantation. Neth Heart J 2020; 28:249-252. [PMID: 32152782 PMCID: PMC7190763 DOI: 10.1007/s12471-020-01380-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/28/2022] Open
Abstract
Aortic valve stenosis is one of the most common valvular abnormalities, which can manifest as angina, syncope, dyspnoea and sudden cardiac death. Transcatheter aortic valve implantation (TAVI) has been introduced as an alternative to surgical valve replacement in patients with severe aortic valve stenosis, resulting in less morbidity, shorter time to recovery and similar mortality rates. Progress in this field has reduced complication rates. However, the incidence of peri-procedural stroke remains relatively high (around 4%). To fully utilise the potential of TAVI, cerebral embolic protection devices (CEPD) have been developed and introduced. In this position paper, we aim to summarise the available data on several CEPD.
Collapse
Affiliation(s)
- C Simsek
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - B E Schölzel
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - P den Heijer
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - J Vos
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | - M Meuwissen
- Department of Cardiology, Amphia Ziekenhuis, Breda, The Netherlands
| | | | | |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Meuwissen M, Remmers MJM, Pertiwi KR, Scholzel BE, Versteylen RJ, De Boer O, Sturm MFAM, Van Den Hoef TP, Ijsselmuiden AJJ, Van Norden AGW, De Jong TEAM, Haans HAW, Aarts RAHM, Vos LD, Van Der Wal AC. P3717More fresh thrombi in cardio embolic than vascular related acute vessel syndromes. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0571] [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
Acute thrombotic occlusion may lead to major life threatening syndromes such as ST elevation myocardial infarction (STEMI) or stroke. In the majority, the underlying pathophysiology may be related to local vascular factors or thrombotic emboli. Thrombus composition might be indicative of underlying etiology and affect therapeutic considerations. Comparison of thrombi of patients suffering from both these acute syndromes has not been made yet. In this study, we compared the “age” of thrombi of patients with STEMI and acute large vessel occlusion related stroke (LVOS).
Methods and results
A total of 126 consecutive patients underwent thrombectomy for either STEMI (n=51) or LVO (n=75). All STEMI patients had vascular related occlusions. Causes of LVOS were classified according to the TOAST criteria; i.e. large artery atherosclerosis (LAA), cardio embolic (CE), other determined and embolic stroke of unknown source. Aspirated material was histopathological ordered as fresh (<1 day old), lytic (1–5 days old) or organized (>5 days old). In general, thrombi of patients with LVOS were fresher compared to thrombi of STEMI patients (p=0,04). This difference is can be attributed mainly to CE patients, which had significantly younger thrombi (p=0.001). Thrombi of LAA had comparable age with thrombi of STEMI (Figure).
Conclusion
Thrombi of cardio embolic stroke are fresher compared to that of thrombi of atherosclerotic related stroke. The latter have thrombi with comparable age of that with thrombi of ST elevation myocardial infarction. These findings may have therapeutic implications in anti-thrombotic therapies.
Collapse
Affiliation(s)
| | | | - K R Pertiwi
- Academic Medical Center, Amsterdam, Netherlands (The)
| | | | | | - O De Boer
- Academic Medical Center, Amsterdam, Netherlands (The)
| | | | | | | | | | | | | | | | - L D Vos
- Amphia Hospital, Breda, Netherlands (The)
| | | |
Collapse
|
15
|
Janssens GN, Van Der Hoeven NW, Lemkes JS, Everaars H, Van De Ven P, Marques KMJ, Nap A, Van Leeuwen MAH, Appelman YEA, Brinckman SL, Timmer JR, Meuwissen M, Van Der Weerdt A, Nijveldt R, Van Royen N. P3126Immediate versus delayed revascularization in patients with transient ST-elevation myocardial infarction: 1-year follow-up of the randomized clinical TRANSIENT trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0201] [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
Up to 24% of acute coronary syndrome patients present with ST-elevation but show complete resolution of ST-elevation and symptoms before revascularization. The current guidelines do not clearly state whether these transient ST-elevation myocardial infarction (TSTEMI) patients should be treated with a ST-elevation myocardial infarction (STEMI)-like or a non-STEMI-like invasive approach.
Purpose
The aim of the present study is to determine the effect of an immediate versus a delayed invasive strategy on infarct size measured by 4-month cardiac magnetic resonance imaging (CMR) and clinical outcome up to one year.
Methods
In this multicenter trial, 142 TSTEMI patients were randomized 1:1 to either an immediate or a delayed intervention. CMR was performed at four days and at 4-month follow-up to assess infarct size and myocardial function. Clinical follow-up was performed at four months and one year.
Results
Both in the immediate (0.4 h) and the delayed invasive group (22.7 h) CMR-derived infarct size at four months was very small and left ventricular function was good. In addition, major adverse cardiac events and all-cause mortality at one year were low and not different between both groups (table 1).
CMR and clinical outcomes up to one year Outcome Immediate invasive group (n=70) Delayed invasive group (n=72) p-value Myocardial infarct size (% of LV), median (IQR) 0.4 (0.0–3.5) 0.4 (0.0–2.5) 0.79 LVEF (%), mean ± SD 59.9±5.4 59.3±6.5 0.63 LVEF recovery (%), mean ± SD 2.2±5.4 1.7±5.3 0.66 MVO present, No. (%) 0 (0.0) 1 (1.9) 0.50 MACE (death, reinfarction, target lesion revascularization), No. (%) 3 (4.4) 4 (5.7) 1.00 Death from any cause, No. (%) 0 (0.0) 3 (4.3) 0.24 Reinfarction, No. (%) 2 (3.0) 1 (1.4) 0.62 Target lesion revascularization, No. (%) 2 (3.0) 1 (1.4) 0.62 Definite stent thrombosis, No. (%) 1 (1.5) 1 (1.4) 1.00 Abbreviations: IQR, interquartile range; LV, left ventricle; LVEF, left ventricle ejection fraction; MACE, major adverse cardiac events; MVO, microvascular obstruction; NA, not applicable; SD, standard deviation.
Conclusions
We demonstrated that patients with TSTEMI have limited infarct size and preserved left ventricular function and that an immediate or delayed approach has no effect on clinical outcome up to one year. Therefore, patients with TSTEMI can be treated with both an immediate or a delayed invasive strategy with similar outcome. These findings extend our current knowledge about the optimal timing of coronary intervention in patients with TSTEMI and complement the guidelines.
Acknowledgement/Funding
AstraZeneca, Biotronik
Collapse
Affiliation(s)
- G N Janssens
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - N W Van Der Hoeven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - J S Lemkes
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - H Everaars
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - P Van De Ven
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - K M J Marques
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - A Nap
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | | | - Y E A Appelman
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands (The)
| | - S L Brinckman
- Tergooi Hospital, Cardiology, Blaricum, Netherlands (The)
| | - J R Timmer
- Isala Clinics, Cardiology, Zwolle, Netherlands (The)
| | - M Meuwissen
- Amphia Hospital, Cardiology, Breda, Netherlands (The)
| | - A Van Der Weerdt
- Medical Center Leeuwarden, Cardiology, Leeuwarden, Netherlands (The)
| | - R Nijveldt
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| | - N Van Royen
- Radboud University Medical Centre, Cardiology, Nijmegen, Netherlands (The)
| |
Collapse
|
16
|
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.
Collapse
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)
| |
Collapse
|
17
|
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
| |
Collapse
|
18
|
Sanders MF, Blankestijn PJ, Voskuil M, Spiering W, Vonken EJ, Rotmans JI, van der Hoeven BL, Daemen J, van den Meiracker AH, Kroon AA, de Haan MW, Das M, Bax M, van der Meer IM, van Overhagen H, van den Born BJH, van Brussel PM, van der Valk PHM, Smak Gregoor PJH, Meuwissen M, Gomes MER, Oude Ophuis T, Troe E, Tonino WAL, Konings CJAM, de Vries PAM, van Balen A, Heeg JE, Smit JJJ, Elvan A, Steggerda R, Niamut SML, Peels JOJ, de Swart JBRM, Wardeh AJ, Groeneveld JHM, van der Linden E, Hemmelder MH, Folkeringa R, Stoel MG, Kant GD, Herrman JPR, van Wissen S, Deinum J, Westra SW, Aengevaeren WRM, Parlevliet KJ, Schramm A, Jessurun GAJ, Rensing BJWM, Winkens MHM, Wierema TKA, Santegoets E, Lipsic E, Houwerzijl E, Kater M, Allaart CP, Nap A, Bots ML. Safety and long-term effects of renal denervation: Rationale and design of the Dutch registry. Neth J Med 2016; 74:5-15. [PMID: 26819356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Percutaneous renal denervation (RDN) has recently been introduced as a treatment for therapy-resistant hypertension. Also, it has been suggested that RDN may be beneficial for other conditions characterised by increased sympathetic nerve activity. There are still many uncertainties with regard to efficacy, safety, predictors for success and long-term effects. To answer these important questions, we initiated a Dutch RDN registry aiming to collect data from all RDN procedures performed in the Netherlands. METHODS The Dutch RDN registry is an ongoing investigator-initiated, prospective, multicentre cohort study. Twenty-six Dutch hospitals agreed to participate in this registry. All patients who undergo RDN, regardless of the clinical indication or device that is used, will be included. Data are currently being collected on eligibility and screening, treatment and follow-up. RESULTS Procedures have been performed since August 2010. At present, data from 306 patients have been entered into the database. The main indication for RDN was hypertension (n = 302, 99%). Patients had a mean office blood pressure of 177/100 (±29/16) mmHg with a median use of three (range 0-8) blood pressure lowering drugs. Mean 24-hour blood pressure before RDN was 157/93 (±18/13) mmHg. RDN was performed with different devices, with the Simplicity™ catheter currently used most frequently. CONCLUSION Here we report on the rationale and design of the Dutch RDN registry. Enrolment in this investigator-initiated study is ongoing. We present baseline characteristics of the first 306 participants.
Collapse
Affiliation(s)
- M F Sanders
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Wijntjens G, Echavarria-Pinto M, van de Hoef TP, van Lavieren MA, Meuwissen M, Koch KT, Voskuil M, de Winter RJ, Tijssen JG, Piek J. TCT-38 Long-term Clinical Outcome Of Resting Pd/Pa Versus FFR-guided Deferral Of Revascularization. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.085] [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: 11/26/2022]
|
20
|
Verloop WL, Agema WRP, Allaart CP, Blankestijn PJ, Khan M, Meuwissen M, Muijs van de Moer WM, Rensing BJWM, Spiering W, Voskuil M, Doevendans PA. Renal denervation for the treatment of hypertension: the Dutch consensus. Neth J Med 2014; 72:449-454. [PMID: 25431389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Since 2010, renal denervation (RDN) is being performed in the Netherlands. To make sure RDN is implemented with care and caution in the Netherlands, a multidisciplinary Working Group has been set up by the Dutch Society of Cardiology (NVVC). The main aim of this Working Group was to establish a consensus document that can be used as a guide for implementation of RDN in the Netherlands. This consensus document was prepared in consultation with the Dutch Association of Internal Medicine (NIV) and the Dutch Society of Radiology (NVVR).
Collapse
Affiliation(s)
- W L Verloop
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
van de Hoef TP, Nijveldt R, van der Ent M, Meuwissen M, Khattab A, Kuijt WJ, Wykrzykowska JJ, Tijssen JG, van Rossum AC, Stone GW, Piek J. TCT-20 Pressure-controlled Intermittent Coronary Sinus Occlusion (PICSO) in Acute ST-segment Elevation Myocardial Infarction: Final Results of the Prepare RAMSES Study. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
22
|
van de Hoef TP, Echavarria-Pinto M, van Lavieren MA, Meuwissen M, Serruys PW, Escaned J, Piek J. TCT-315 Invasively Derived Coronary Flow Capacity: Prognostic Implications of a Cross-modality Physiological Concept. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.361] [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: 10/24/2022]
|
23
|
Petraco R, van de Hoef TP, Nijjer SS, Sen S, Meuwissen M, Foale RA, Malik IS, Broyd C, Foin N, Mikhail G, van Lavieren MA, Francis DP, Echavarria-Pinto M, Escaned J, Hughes AD, Mayet J, Piek J, Davies JE. TCT-627 Identification of stenoses with high underlying coronary flow reserve from pressure-only measurements using baseline instant wave-free ratio (iFR) and hyperaemic fractional flow reserve (FFR). J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1375] [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: 11/17/2022]
|
24
|
Nijjer SS, van de Hoef TP, Petraco R, Sen S, Meuwissen M, Foale RA, van Lavieren MA, Broyd C, Foin N, Echavarria-Pinto M, Mikhail G, Malik IS, Hughes AD, Francis DP, Mayet J, Escaned J, Piek J, Davies JE. TCT-620 Mean Hyperemic Flow is Not Increased Following Adenosine Administration in Physiologically Significant Lesions. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1368] [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: 01/09/2023]
|
25
|
van de Hoef TP, Petraco R, van Lavieren MA, Nijjer SS, Sen S, Henriques JP, de Winter RJ, Tijssen JG, Spaan JA, Meuwissen M, Siebes M, Escaned J, Davies JE, Piek J. TCT-634 Diagnostic accuracy of basal stenosis resistance index (BSR) is higher than that of instantaneous wave-free ratio (iFR): validation of basal stenosis resistance index in an independent cohort of simultaneous pressure and flow measurements. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
26
|
Petraco R, Janssens L, van Belle E, Hellig F, Mates M, Haine S, Sakoda K, Indolfi C, Sharp A, Al-Lamee R, Tanaka N, Bojara W, Ribichini FL, Vrints C, van de Hoef TP, Di Mario C, Escaned J, Gotberg M, Echavarria-Pinto M, Matsuo H, Meuwissen M, Piek J, Yokoi H, Davies JE. TCT-624 Real-time utilisation of instant wave-free ratio (iFR) is feasible when performed by clinicians: results of the ADVISE in-practice, an international, multi-centre evaluation of iFR in clinical practice. J Am Coll Cardiol 2013. [DOI: 10.1016/j.jacc.2013.08.1372] [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: 11/17/2022]
|
27
|
Van De Hoef TP, Meuwissen M, Damman P, Piek M, Chamuleau SAJ, Voskuil M, Henriques JP, De Winter RJ, Tijssen JGP, Piek JJ. Long-term outcome of discordance between fractional flow reserve and coronary flow velocity reserve after deferral of percutaneous coronary intervention using the clinically adopted 0.80 FFR cut-off. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3979] [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: 11/13/2022] Open
|
28
|
Van De Hoef TP, Nolte F, Meuwissen M, Chamuleau SAJ, Voskuil M, Henriques JP, De Winter RJ, Spaan JAE, Tijssen JGP, Piek JJ. Minimal microvascular resistance is associated with the extent of epicardial stenosis severity and is significantly associated with the presence of reversible myocardial ischemia. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.2866] [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: 11/13/2022] Open
|
29
|
Polad J, Graf K, Koishybaevich SA, Chan SH, Gilard M, Grunert S, Iñiguez A, James S, Meuwissen M, Mattos LAP. TCT-632 Contemporary PCI Practices Across Three Continents: A Glimpse Into the Preliminary Results of e-NObori Study. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.669] [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: 10/27/2022]
|
30
|
Hoef TVD, Piek M, Meuwissen M, Delewi R, Damman P, Hassell M, Chamuleau S, Voskuil M, Tijssen J, Piek J. TCT-18 Long-term Outcome Of Discordance Between Fractional Flow Reserve And Coronary Flow Velocity Reserve After Deferral Of Percutaneous Coronary Intervention. J Am Coll Cardiol 2012. [DOI: 10.1016/j.jacc.2012.08.024] [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: 12/01/2022]
|
31
|
Claessen BEPM, Hoebers LP, van der Schaaf RJ, Kikkert WJ, Engstrom AE, Vis MM, Baan J, Koch KT, Meuwissen M, van Royen N, de Winter RJ, Tijssen JGP, Piek JJ, Henriques JPS. Prevalence and impact of a chronic total occlusion in a non-infarct-related artery on long-term mortality in diabetic patients with ST elevation myocardial infarction. Heart 2010; 96:1968-72. [DOI: 10.1136/hrt.2010.197673] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
32
|
Nijmeijer R, Meuwissen M, Krijnen PAJ, van der Wal A, Piek JJ, Visser CA, Hack CE, Niessen HWM. Secretory type II phospholipase A2 in culprit coronary lesions is associated with myocardial infarction. Eur J Clin Invest 2008; 38:205-10. [PMID: 18339001 DOI: 10.1111/j.1365-2362.2008.01933.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secretory type-II phospholipase A(2) (sPLA(2)-II) is a cardiovascular risk marker since higher levels of this acute phase protein imply an increased risk for coronary artery disease. Moreover, it is hypothesized that local activity of sPLA(2)-II in the atherosclerotic plaque facilitates an inflammatory response to induce plaque instability or rupture. We have studied the presence of sPLA(2)-II in culprit lesions in the coronary arteries of patients with acute myocardial infarction (AMI) or angina pectoris. MATERIALS AND METHODS We performed a histological examination of culprit lesions in 41 patients with stable (SAP) or unstable angina pectoris (UAP), or AMI using directed coronary atherectomy (DCA). Frozen slides were analysed immuno-histochemically for the presence of sPLA(2)-II, macrophages and smooth muscle cells. Immunopositive areas were calculated as a percentage of the total tissue area using image analysis software. RESULTS Intracellular sPLA(2)-II was found in atherosclerotic lesions in the macrophages of the intima as well as in vascular smooth muscle cells. Next to this, extracellular sPLA(2)-II depositions were also found. These depositions were significantly more extensive in patients with AMI, i.e. 26%(median)[6%(25th(percentile))-44%(75th(percentile))] of the intima area, than in patients with SAP 0%(median) (0%(25th)-10%(75th); P = 0.013) or UAP 0%(median) (0%(25th)-0%(75th); P = 0.04). CONCLUSIONS Extracellular sPLA(2)-II is more abundantly present in atherosclerotic culprit lesions that have led to myocardial infarction. This suggests a role for extracellular sPLA(2)-II in the development of complications of atherosclerotic lesions in coronary arteries.
Collapse
Affiliation(s)
- R Nijmeijer
- Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | | | | | | | | | | | | | | |
Collapse
|
33
|
Meuwissen M, van der Wal AC, Niessen HWM, Koch KT, de Winter RJ, van der Loos CM, Rittersma SZH, Chamuleau SAJ, Tijssen JGP, Becker AE, Piek JJ. Colocalisation of intraplaque C reactive protein, complement, oxidised low density lipoprotein, and macrophages in stable and unstable angina and acute myocardial infarction. J Clin Pathol 2006; 59:196-201. [PMID: 16443738 PMCID: PMC1860312 DOI: 10.1136/jcp.2005.027235] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND C reactive protein (CRP), an important serum marker of atherosclerotic vascular disease, has recently been reported to be active inside human atherosclerotic plaques. AIMS To investigate the simultaneous presence of macrophages, CRP, membrane attack complex C5b-9 (MAC), and oxidised low density lipoprotein (oxLDL) in atherectomy specimens from patients with different coronary syndromes. METHODS In total, 54 patients with stable angina (SA; n = 21), unstable angina (UA; n = 15), and myocardial infarction (MI; n = 18) underwent directional coronary atherectomy for coronary lesions. Cryostat sections of atherosclerotic plaques were immunohistochemically stained with monoclonal antibodies: anti-CD68 (macrophages), anti-5G4 (CRP), aE11 (MAC), and 12E7 (oxLDL). Immunopositive areas were evaluated in relation to fibrous and neointima tissues, atheroma, and media. Quantitative analysis was performed using image cytometry with systematic random sampling (percentage immunopositive/total tissue area). RESULTS Macrophages, CRP, MAC, and oxLDL were simultaneously present in a higher proportion of fibrous tissue and atheroma of atherectomy specimens from patients with UA and MI compared with SA (p<0.05). Quantitative analysis showed significantly higher mean percentages of macrophages in plaques from patients with MI (44%) than UA (30%; p<0.01) and SA (20%; p<0.001). Significantly higher mean percentages of CRP were also seen in MI (25%) and UA (25%) compared with SA (12%; p<0.05). CONCLUSIONS The presence of CRP, complement, and oxLDL in a high proportion of plaque tissue from patients with unstable coronary artery disease implies that these surrogate markers have important proinflammatory effects inside atherosclerotic plaques. This may increase vulnerability to plaque rupture and thrombosis, with subsequent clinical sequelae.
Collapse
Affiliation(s)
- M Meuwissen
- Department of Cardiology, Academic Medical Centre, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Meuwissen M, van der Wal AC, Siebes M, Koch KT, Chamuleau SAJ, van der Loos CM, Teeling P, de Winter RJ, Niessen HWM, Tijssen JGP, Becker AE, Piek JJ. Role of plaque inflammation in acute and recurrent coronary syndromes. Neth Heart J 2004; 12:106-109. [PMID: 25696307 PMCID: PMC2497049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
Inflammation plays an important role in the initiation, development, progression and complications of atherosclerotic vascular disease. Our present knowledge of the elementary role of inflammation for the onset of plaque rupture in atherosclerotic coronary lesions primarily stems from autopsy studies. However, the introduction of directional coronary atherectomy catheters has provided a unique opportunity to directly investigate the role of inflammation in coronary syndromes. In this report we describe the role of coronary plaque inflammation, as determined by immunohistochemistry, on the presentation of coronary syndromes and on the clinical outcome following percutaneous interventions.
Collapse
|
35
|
Chamuleau SA, Meuwissen M, van Eck-Smit BL, Koch KT, de Jong A, de Winter RJ, Schotborgh CE, Bax M, Verberne HJ, Tijssen JG, Piek JJ. Fractional flow reserve, absolute and relative coronary blood flow velocity reserve in relation to the results of technetium-99m sestamibi single-photon emission computed tomography in patients with two-vessel coronary artery disease. J Am Coll Cardiol 2001; 37:1316-22. [PMID: 11300441 DOI: 10.1016/s0735-1097(01)01173-1] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES We sought to perform a direct comparison between perfusion scintigraphic results and intracoronary-derived hemodynamic variables (fractional flow reserve [FFR]; absolute and relative coronary flow velocity reserve [CFVR and rCFVR, respectively]) in patients with two-vessel disease. BACKGROUND There is limited information on the diagnostic accuracy of intracoronary-derived variables (CFVR, FFR and rCFVR) in patients with multivessel disease. METHODS Dipyridamole technetium-99m sestamibi (MIBI) single-photon emission computed tomography (SPECT) was performed in 127 patients. The presence of reversible perfusion defects in the region of interest was determined. Within one week, angiography was performed; CFVR, rCFVR and FFR were determined in 161 coronary lesions after intracoronary administration of adenosine. The predictive value for the presence of reversible perfusion defects on MIBI SPECT of CFVR, rCFVR and FFR was evaluated by the area under the curve (AUC) of the receiver operating characteristics curves. RESULTS The mean percentage diameter stenosis was 57% (range 35% to 85%), as measured by quantitative coronary angiography. Using per-patient analysis, the AUCs for CFVR (0.70 +/- 0.052), rCFVR (0.72 +/- 0.051) and FFR (0.76 +/- 0.050) were not significantly different (p = NS). The percentages of agreement with the results of MIBI SPECT were 76%, 78% and 77% for CFVR, rCFVR and FFR, respectively. Per-lesion analysis, using all 161 measured lesions, yielded similar results. CONCLUSIONS The diagnostic accuracy of three intracoronary-derived hemodynamic variables, as compared with the results of perfusion scintigraphy, is similar in patients with two-vessel coronary artery disease. Cut-offvalues of 2.0 for CFVR, 0.65 for rCFVR and 0.75 for FFR can be used for clinical decision-making in this patient cohort. Discordant results were obtained in 23% of the cases that require prospective evaluation for appropriate patient management.
Collapse
Affiliation(s)
- S A Chamuleau
- Department of Cardiology, Academic Medical Center of Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Meuwissen M, Piek JJ, van der Wal AC, Chamuleau SA, Koch KT, Teeling P, van der Loos CM, Tijssen JG, Becker AE. Recurrent unstable angina after directional coronary atherectomy is related to the extent of initial coronary plaque inflammation. J Am Coll Cardiol 2001; 37:1271-6. [PMID: 11300434 DOI: 10.1016/s0735-1097(01)01133-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study was performed to evaluate the relationship between plaque inflammation of the initial culprit lesion and the incidence of recurrent angina for one year after directional coronary atherectomy (DCA). BACKGROUND A positive correlation between coronary plaque inflammation and angiographic restenosis has been reported. METHODS A total of 110 patients underwent DCA. Cryostat sections were immunohistochemically stained with monoclonal antibodies CD68 (macrophages), CD-3 (T lymphocytes) and alpha-actin (smooth muscle cells [SMCs]). The SMC and macrophage contents were planimetrically quantified as a percentage of the total tissue area. T lymphocytes were counted as the number of cells/mm2. The patients were followed for one year to document recurrent unstable angina pectoris (UAP) or stable angina pectoris (SAP). RESULTS Recurrent UAP developed in 16 patients, whereas recurrent SAP developed in 17 patients. The percent macrophage areas were larger in patients with recurrent UAP (27 +/- 12%) than in patients with recurrent SAP (8 +/- 4%; p = 0.0001) and those without recurrent angina (18 +/- 14%; p = 0.03). The number of T lymphocytes was also greater in patients with recurrent UAP (25 +/- 14 cells/mm2) than in patients with recurrent SAP (14 +/- 8 cells/mm2; p = 0.02) and those without recurrent angina (14 +/- 12 cells/mm2; p = 0.002). Multiple stepwise logistic regression analysis identified macrophage areas and T lymphocytes as independent predictors for recurrent UAP. CONCLUSIONS There is a positive association between the extent of initial coronary plaque inflammation and the recurrence of unstable angina during long-term follow-up after DCA. These results underline the role of ongoing smoldering plaque inflammation in the recurrence of unstable angina after coronary interventions.
Collapse
Affiliation(s)
- M Meuwissen
- Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Meuwissen M, Chamuleau SA, Siebes M, Schotborgh CE, Koch KT, de Winter RJ, Bax M, de Jong A, Spaan JA, Piek JJ. Role of variability in microvascular resistance on fractional flow reserve and coronary blood flow velocity reserve in intermediate coronary lesions. Circulation 2001; 103:184-7. [PMID: 11208673 DOI: 10.1161/01.cir.103.2.184] [Citation(s) in RCA: 195] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fractional flow reserve (FFR) and coronary blood flow velocity reserve (CFR) represent physiological quantities used to evaluate coronary lesion severity and to make clinical decisions. A comparison between the outcomes of both diagnostic techniques has not been performed in a large cohort of patients with intermediate coronary lesions. METHODS AND RESULTS FFR and CFR were assessed in 126 consecutive patients with 150 intermediate coronary lesions (between 40% and 70% diameter stenosis by visual assessment). Agreement between outcomes of FFR and CFR, categorized at cut-off values of 0.75 and 2.0, respectively, was observed in 109 coronary lesions (73%), whereas discordant outcomes were present in 41 lesions (27%). In 26 of these 41 lesions, FFR was <0.75 and CFR>or=2.0 (group A); in the remaining 15 lesions, FFR was >or=0.75 and CFR<2.0 (group B). Minimum microvascular resistance, defined as the ratio of mean distal pressure to average peak blood flow velocity during maximum hyperemia, showed a large variability (overall range, 0.65 to 4.64 mm Hg x cm(-1) x s(-1)) and was significantly higher in group B than in group A (2.42+/-0.77 versus 1.91+/-0.70 mm Hg x cm(-1) x s(-1); P:=0.034). CONCLUSIONS Our findings demonstrate the prominent role of microvascular resistance in modulating the relationship between FFR and CFR and emphasize the importance of combined pressure and flow velocity measurements to evaluate coronary lesion severity and microvascular involvement.
Collapse
Affiliation(s)
- M Meuwissen
- Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Piek JJ, van der Wal AC, Meuwissen M, Koch KT, Chamuleau SA, Teeling P, van der Loos CM, Becker AE. Plaque inflammation in restenotic coronary lesions of patients with stable or unstable angina. J Am Coll Cardiol 2000; 35:963-7. [PMID: 10732895 DOI: 10.1016/s0735-1097(99)00647-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To evaluate immunohistochemically various parameters of inflammation in coronary atherectomy specimens obtained from restenotic culprit lesions of patients presenting with either stable or unstable angina (UA). BACKGROUND There is no information regarding the relationship between atherosclerotic plaque inflammation and the severity of the coronary syndromes in patients with restenotic coronary lesions. METHODS A total of 37 patients with either stable angina or UA underwent directional coronary atherectomy for restenotic coronary lesions. Cryostat sections of atherectomy specimen were immunohistochemically stained with monoclonal antibodies CD68 (macrophages [MACs]), CD3 (T-lymphocytes) and alpha-actin (smooth muscle cells [SMCs]). Smooth muscle cell contents and MAC contents were planimetrically quantified as the percentage immunopositive tissue area of the total tissue area. T-lymphocytes were counted at 100-X magnification throughout the entire section and expressed as number of cells per mm2. RESULTS Restenotic coronary lesions of patients with UA or stable angina showed no significant difference in SMC areas (31.9%+/-16.3% vs. 38.5%+/-18.8%, respectively; p = NS). However, restenotic coronary lesions of patients presenting with unstable angina contained significantly more MACs (24.4%+/-15.1% vs. 10.5%+/-5.8%, p = 0.001) and T-lymphocytes (18.8 cells/mm2+/-15.1 cells/mm2 vs. 8.6 cells/mm2+/-9.8 cells/mm2; p = 0.034) than patients with stable angina. CONCLUSIONS These results suggested that inflammation appears to affect plaque instability in restenotic coronary lesions resulting in unstable coronary syndromes.
Collapse
Affiliation(s)
- J J Piek
- Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Abstract
Toxocara canis isolates from dog and from red fox were compared in transmission trials and with molecular analysis using RAPD-PCR technique and comparison of the ITS2 sequence. After oral infection of bitches with 20,000 embryonated T. canis eggs of vulpine and canine origin, the vertical transmission to pup's was examined. All animals of both groups developed typical clinical symptoms of toxocarosis. The haematological, serological, parasitological and post mortem results showed no differences between both isolates except for the infectivity of T. canis stages in mice where the fox isolate showed a significant higher infectivity than the dog isolate. The RAPD-PCR showed a similarity coefficient of 0.95, similar to the range of intraspecific variation in Toxocara cati and Toxascaris leonina specimens as outgroups. The ITS2 comparison showed a 100% identity between both isolates with no intraspecific variations. Therefore, the study shows that the fox and the dog isolate of T. canis were identical in infectivity, transmission and molecular structure; a host adaptation could not be found and the fox has to be seen as a reservoir for T. canis infections in dogs. Considering the increasing number of foxes in urban areas the importance of helminth control in dogs is stressed.
Collapse
Affiliation(s)
- C Epe
- Institute of Parasitology, Hannover School of Veterinary Medicine, Germany.
| | | | | | | |
Collapse
|
40
|
Abstract
We report a 30-year old, previously healthy, Ghanese woman admitted with sudden onset of dyspnoe, hemoptoe and right-sided chest pain due to endomyocardial fibrosis with secondary pulmonary emboli Coronary angiography revealed a myocardial "blush". This finding may focus attention to the presence of mural thrombus that may have diagnostic and therapeutic consequences.
Collapse
Affiliation(s)
- M Meuwissen
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | | | | |
Collapse
|
41
|
van de Wiel JA, Meuwissen M, Kooy H, Fijneman PH, Noordhoek J, Bos RP. Influence of long-term ethanol treatment on in vitro biotransformation of benzo(a)pyrene in microsomes of the liver, lung and small intestine from male and female rats. Biochem Pharmacol 1992; 44:1977-84. [PMID: 1449516 DOI: 10.1016/0006-2952(92)90100-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The influence of long-term ethanol exposure of rats on the microsomal biotransformation of benzo(a)pyrene [B(a)P] was studied. Male and female Wistar rats received an increasing amount of ethanol in their drinking water: percentages rose to 15% (w/v) in 3 weeks. The ethanol content was kept at a concentration of 15% for another 3 weeks. Livers, lungs and intestinal epithelial cells of the rats were then isolated and microsomal fractions prepared. In all organs, the metabolite most formed was 3-hydroxy-B(a)P. In the liver, males showed significantly higher B(a)P hydroxylase activity than females. On the basis of experiments using monoclonal antibodies, a significant part of the B(a)P biotransformation in male rat liver microsomes can be attributed to the male specific P4502C11. In the lung and intestine, there were no significant differences between the sexes. In the liver, ethanol treatment significantly decreased the microsomal formation of phenolic metabolites. In microsomes of intestinal epithelial cells, ethanol treatment enhanced the formation of phenols and diols. In conclusion, ethanol consumption by rats in moderate amounts leads to an alteration in the microsomal biotransformation of B(a)P. Effects are most prominent in the liver, where the formation of phenols is significantly decreased.
Collapse
Affiliation(s)
- J A van de Wiel
- Department of Toxicology, Faculty of Medicine, University of Nijmegen, The Netherlands
| | | | | | | | | | | |
Collapse
|