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Kaya E, Otten M, Theuns DAMJ, Veen K, Yap SC, Schinkel AFL, Constantinescu AA, Michels M, Manintveld OC, Szili-Torok T, Caliskan K. Long-Term Outcome of ICD Therapy in Patients With Noncompaction Cardiomyopathy Compared With DCM and HCM. JACC Clin Electrophysiol 2023; 9:1368-1378. [PMID: 37141904 DOI: 10.1016/j.jacep.2023.01.011] [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] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) are frequently used for primary and secondary prevention in patients with cardiomyopathies due to different etiologies. However, long-term outcome studies in patients with noncompaction cardiomyopathy (NCCM) are scarce. OBJECTIVES This study summarizes the long-term outcome of ICD therapy in patients with NCCM compared with those with dilated cardiomyopathy (DCM) or hypertrophic cardiomyopathy (HCM). METHODS Prospective data from our single-center ICD registry were used to analyze the ICD interventions and survival in patients with NCCM (n = 68) compared with patients with DCM (n = 458) and patients with HCM (n = 158) from January 2005 to January 2018. RESULTS This NCCM population with an ICD for primary prevention comprised 56 (82%) patients with a median age of 43 years and 52% males, compared with 85% in patients with DCM and 79% in patients with HCM (P = 0.20). During a median follow-up of 5 years (IQR: 2.0-6.9 years), appropriate and inappropriate ICD interventions were not significantly different. Nonsustained ventricular tachycardia during Holter monitoring in patients with NCCM was the only significant risk factor for appropriate ICD therapy in patients with NCCM, with a HR of 5.29 (95% CI: 1.12-24.96). The long-term survival was significantly better in the univariable analysis in the NCCM group. However, there was no difference in multivariable Cox regression analyses between the cardiomyopathy groups. CONCLUSIONS At 5 years of follow-up, the rate of appropriate and inappropriate ICD interventions in NCCM was comparable to that in DCM or HCM. In multivariable analysis, no differences in survival were found between the cardiomyopathy groups.
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Affiliation(s)
- Emrah Kaya
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Cardiology, St. Antonius Hospital Nieuwegein, the Netherlands
| | - Martijn Otten
- Department of Cardiology, Amsterdam University Medical Center, the Netherlands
| | - Dominic A M J Theuns
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Kevin Veen
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, University Medical Center Rotterdam, the Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Michelle Michels
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
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Veen KM, Papageorgiou G, Zijderhand CF, Mokhles MM, Brugts JJ, Manintveld OC, Constantinescu AA, Bekkers JA, Takkenberg JJM, Bogers AJJC, Caliskan K. The clinical impact of tricuspid regurgitation in patients with a biatrial orthotopic heart transplant. Front Med 2023; 17:527-533. [PMID: 37000348 DOI: 10.1007/s11684-022-0967-5] [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] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/01/2022] [Indexed: 04/01/2023]
Abstract
In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984-2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02-1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.
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Affiliation(s)
- Kevin M Veen
- Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | | | - Casper F Zijderhand
- Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | - Mostafa M Mokhles
- Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | | | | | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | | | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, 3000 CA, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, 3000 CA, Rotterdam, The Netherlands.
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Aga YS, Abou Kamar S, Chin JF, van den Berg VJ, Strachinaru M, Bowen D, Frowijn R, Akkerhuis MK, Constantinescu AA, Umans V, Geleijnse ML, Boersma E, Brugts JJ, Kardys I, van Dalen BM. Potential role of left atrial strain in estimation of left atrial pressure in patients with chronic heart failure. ESC Heart Fail 2023. [PMID: 37157926 PMCID: PMC10375167 DOI: 10.1002/ehf2.14372] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 03/08/2023] [Accepted: 03/23/2023] [Indexed: 05/10/2023] Open
Abstract
AIMS In a large proportion of heart failure with reduced ejection fraction (HFrEF) patients, echocardiographic estimation of left atrial pressure (LAP) is not possible when the ratio of the peak early left ventricular filling velocity over the late filling velocity (E/A ratio) is not available, which may occur due to several potential causes. Left atrial reservoir strain (LASr) is correlated with LV filling pressures and may serve as an alternative parameter in these patients. The aim of this study was to determine whether LASr can be used to estimate LAP in HFrEF patients in whom E/A ratio is not available. METHODS AND RESULTS Echocardiograms of chronic HFrEF patients were analysed and LASr was assessed with speckle tracking echocardiography. LAP was estimated using the current ASE/EACVI algorithm. Patients were divided into those in whom LAP could be estimated using this algorithm (LAPe) and into those in whom this was not possible because E/A ratio was not available (LAPne). We assessed the prognostic value of LASr on the primary endpoint (PEP), which comprised the composite of hospitalization for the management of acute or worsened HF, left ventricular assist device implantation, cardiac transplantation, and cardiovascular death, whichever occurred first in time. We studied 153 patients with a mean age of 58 years of whom 76% men and 82% who were in NYHA class I-II. A total of 86 were in the LAPe group and 67 in the LAPne group. LASr was significantly lower in the LAPne group as compared with the LAPe group (15.8% vs. 23.8%, P < 0.001). PEP-free survival at a median follow-up of 2.5 years was 78% in LAPe versus 51% in LAPne patients. An increase in LASr was significantly associated with a reduced risk of the PEP in LAPne patients (adjusted hazard ratio: 0.91 per %, 95% confidence interval 0.84-0.98). An abnormal LASr (<18%) was associated with a five-fold increase in reaching the PEP. CONCLUSIONS In HFrEF patients in whom echocardiographic estimation of LAP is not possible due to due to unavailability of E/A ratio, assessing LASr potentially carries added clinical and prognostic value.
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Affiliation(s)
- Yaar S Aga
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Sabrina Abou Kamar
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Jie Fen Chin
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Victor J van den Berg
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mihai Strachinaru
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Daniel Bowen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rene Frowijn
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Martijn K Akkerhuis
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Victor Umans
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel L Geleijnse
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Zijderhand CF, Knol WG, Budde RPJ, van der Heiden CW, Veen KM, Sjatskig J, Manintveld OC, Constantinescu AA, Birim O, Bekkers JA, Bogers AJJC, Caliskan K. Relapsing low-flow alarms due to suboptimal alignment of the left ventricular assist device inflow cannula. Eur J Cardiothorac Surg 2022; 62:ezac415. [PMID: 35993906 PMCID: PMC9789739 DOI: 10.1093/ejcts/ezac415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/26/2022] [Revised: 07/29/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This retrospective study investigated the correlation between the angular position of the left ventricular assist device (LVAD) inflow cannula and relapsing low-flow alarms. METHODS Medical charts were reviewed of all patients with HeartMate 3 LVAD support for relapsing low-flow alarms. A standardized protocol was created to measure the angular position with a contrast-enhanced computed tomography scan. Statistics were done using a gamma frailty model with a constant rate function. RESULTS For this analysis, 48 LVAD-supported patients were included. The majority of the patients were male (79%) with a median age of 57 years and a median follow-up of 30 months (interquartile range: 19-41). Low-flow alarm(s) were experienced in 30 (63%) patients. Angulation towards the septal-lateral plane showed a significant increase in low-flow alarms over time with a constant rate function of 0.031 increase in low-flow alarms per month of follow-up per increasing degree of angulation (P = 0.048). When dividing this group using an optimal cut-off point, a significant increase in low-flow alarms was observed when the septal-lateral angulation was 28° or more (P = 0.001). Anterior-posterior and maximal inflow cannula angulation did not show a significant difference. CONCLUSIONS This study showed an increasing number of low-flow alarms when the degrees of LVAD inflow cannula expand towards the septal-lateral plane. This emphasizes the importance of the LVAD inflow cannula angular position to prevent relapsing low-flow alarms with the risk of diminished quality of life and morbidity.
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Affiliation(s)
- Casper F Zijderhand
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Wiebe G Knol
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Cornelis W van der Heiden
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jelena Sjatskig
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ozcan Birim
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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5
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Roest S, van der Meulen MH, van Osch-Gevers LM, Kraemer US, Constantinescu AA, de Hoog M, Bogers AJJC, Manintveld OC, van de Woestijne PC, Dalinghaus M. The Dutch national paediatric heart transplantation programme: outcomes during a 23-year period. Neth Heart J 2022; 31:68-75. [PMID: 35838916 PMCID: PMC9284482 DOI: 10.1007/s12471-022-01703-w] [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: 04/11/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Since 1998, there has been a national programme for paediatric heart transplantations (HT) in the Netherlands. In this study, we investigated waiting list mortality, survival post-HT, the incidence of common complications, and the patients' functional status during follow-up. METHODS All children listed for HT from 1998 until October 2020 were included. Follow-up lasted until 1 January 2021. Data were collected from the patient charts. Survival, post-operative complications as well as the functional status (Karnofsky/Lansky scale) at the end of follow-up were measured. RESULTS In total, 87 patients were listed for HT, of whom 19 (22%) died while on the waiting list. Four patients were removed from the waiting list and 64 (74%) underwent transplantation. Median recipient age at HT was 12.0 (IQR 7.2-14.4) years old; 55% were female. One-, 5‑, and 10-year survival post-HT was 97%, 95%, and 88%, respectively. Common transplant-related complications were rejections (50%), Epstein-Barr virus infections (31%), cytomegalovirus infections (25%), post-transplant lymphoproliferative disease (13%), and cardiac allograft vasculopathy (13%). The median functional score (Karnofsky/Lansky scale) was 100 (IQR 90-100). CONCLUSION Children who undergo HT have an excellent survival rate up to 10 years post-HT. Even though complications post-HT are common, the functional status of most patients is excellent. Waiting list mortality is high, demonstrating that donor availability for this vulnerable patient group remains a major limitation for further improvement of outcome.
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Affiliation(s)
- Stefan Roest
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marijke H. van der Meulen
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lennie M. van Osch-Gevers
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ulrike S. Kraemer
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Paediatric Intensive Care, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alina A. Constantinescu
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Matthijs de Hoog
- Department of Paediatric Intensive Care, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ad J. J. C. Bogers
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Olivier C. Manintveld
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pieter C. van de Woestijne
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Department of Cardiothoracic Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Michiel Dalinghaus
- Department of Paediatric Cardiology, Erasmus MC—Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, The Netherlands ,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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6
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Veenis JF, Radhoe SP, Roest S, Caliskan K, Constantinescu AA, Manintveld OC, Brugts JJ. Prevalence of Iron Deficiency and Iron Administration in Left Ventricular Assist Device and Heart Transplantation Patients. ASAIO J 2022; 68:899-906. [PMID: 34643575 DOI: 10.1097/mat.0000000000001585] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Iron deficiency (ID) is a common comorbidity in heart failure (HF). In these patients, intravenous iron administration can improve clinical outcomes and quality of life (QoL). However, data on ID are lacking in patients who have transitioned toward left ventricular assist device (LVAD) or heart transplantation (HTx). All patients who underwent LVAD (n = 84) surgery or HTx (n = 67) at our center between 2012 and 2019, aged ≥18 years with a follow-up of ≥3 months, were included. Retrospectively, the prevalence of ID up to 1 year preoperatively, and up to February 2020 postoperatively, as well as all iron administrations were assessed during this period. Iron status was assessed in 61% and 51% of the LVAD and HTx patients preoperatively, and 81% and 84%, respectively, postoperatively. Of these patients, 53% and 71% of the LVAD and HTx patients preoperatively were diagnosed with ID preoperatively, and 71% and 77%, respectively, postoperatively. ID was more frequently diagnosed >3 months postoperatively. Sixty-three percent of the LVAD (mostly intravenous) and 63% of the HTx patients (mostly oral) received iron administration. ID is highly prevalent pre- and post-LVAD and HTx. It is plausible that substitution can have similar QoL gains as in regular HF patients.
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Affiliation(s)
- Jesse F Veenis
- From the Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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7
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Kooij C, Szili-Torok T, Roest S, Constantinescu AA, Brugts JJ, Manintveld O, Caliskan K. Theophylline Use to Prevent Permanent Pacing in the Contemporary Era of Heart Transplantation: The Rotterdam Experience. Front Cardiovasc Med 2022; 9:896141. [PMID: 35811728 PMCID: PMC9263186 DOI: 10.3389/fcvm.2022.896141] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionSinus node dysfunction and atrioventricular conduction disorders occur increasingly after orthotopic heart transplantation (HTX) due to aging donors and may require permanent pacemaker (PM) implantation. Theophylline has been used in the past in selected cases as an alternative to PM implantation.PurposeThe aim of this study was to investigate the rate and success of oral theophylline administration after orthotopic heart transplantation preventing permanent PM implantation.MethodsWe included all patients treated with theophylline post HTX due to bradyarrhythmia's in our center from January 1985 to January 2020. Data was obtained retrospectively through electronic patient files. Re-transplants and patients who died within 1 month post HTX were excluded from the analysis.ResultsOf the total of 751 heart transplant recipients, 73 (9,7%) patients (mean age 46 ± 15.2 years; 73% male) were treated with theophylline for bradyarrhythmia's early post HTX. Of these patients, 14 (19%) patients needed a permanent PM during hospitalization and 10(14%) patients stopped using theophylline because of adequate heart rhythm. In the end, 49 (6.5% of the total) patients were discharged with a theophylline (mean maintenance doses of 354 ± 143 mg). At the outpatient clinics, additional 6 (12%) patients needed a PM within 7 months after discharge, with the rest stable sinus rhythm.ConclusionIn this retrospective data analyses oral theophylline remained a viable alternative to permanent PM implantations in patients post HTX with increased heart rates, facilitating the withdrawal of chronotropic support and avoiding the need of permanent PM implantation.
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Affiliation(s)
- Claudette Kooij
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alina A. Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Jasper J. Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Olivier Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
- *Correspondence: Kadir Caliskan
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8
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de Lange I, Petersen TB, de Bakker M, Akkerhuis KM, Brugts JJ, Caliskan K, Manintveld OC, Constantinescu AA, Germans T, van Ramshorst J, Umans VAWM, Boersma E, Rizopoulos D, Kardys I. Heart failure subphenotypes based on repeated biomarker measurements are associated with clinical characteristics and adverse events (Bio-SHiFT study). Int J Cardiol 2022; 364:77-84. [PMID: 35714717 DOI: 10.1016/j.ijcard.2022.06.020] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/27/2022] [Accepted: 06/10/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND This study aimed to identify heart failure (HF) subphenotypes using 92 repeatedly measured circulating proteins in 250 patients with heart failure with reduced ejection fraction, and to investigate their clinical characteristics and prognosis. METHODS Clinical data and blood samples were collected tri-monthly until the primary endpoint (PEP) or censoring occurred, with a maximum of 11 visits. The Olink Cardiovascular III panel was measured in baseline samples and the last two samples before the PEP (in 66 PEP cases), or the last sample before censoring (in 184 PEP-free patients). The PEP comprised cardiovascular death, heart transplantation, Left Ventricular Assist Device implantation, and hospitalization for HF. Cluster analysis was performed on individual biomarker trajectories to identify subphenotypes. Then biomarker profiles and clinical characteristics were investigated, and survival analysis was conducted. RESULTS Clustering revealed three clinically diverse subphenotypes. Cluster 3 was older, with a longer duration of, and more advanced HF, and most comorbidities. Cluster 2 showed increasing levels over time of most biomarkers. In cluster 3, there were elevated baseline levels and increasing levels over time of 16 remaining biomarkers. Median follow-up was 2.2 (1.4-2.5) years. Cluster 3 had a significantly poorer prognosis compared to cluster 1 (adjusted event-free survival time ratio 0.25 (95%CI:0.12-0.50), p < 0.001). Repeated measurements clusters showed incremental prognostic value compared to clusters using single measurements, or clinical characteristics only. CONCLUSIONS Clustering based on repeated biomarker measurements revealed three clinically diverse subphenotypes, of which one has a significantly worse prognosis, therefore contributing to improved (individualized) prognostication.
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Affiliation(s)
- Iris de Lange
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Teun B Petersen
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marie de Bakker
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - Jan van Ramshorst
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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9
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Verkaik NJ, Yalcin YC, Bax HI, Constantinescu AA, Brugts JJ, Manintveld OC, Birim O, Croughs PD, Bogers AJJC, Caliskan K. Single-Center Experience With Protocolized Treatment of Left Ventricular Assist Device Infections. Front Med (Lausanne) 2022; 9:835765. [PMID: 35685416 PMCID: PMC9171101 DOI: 10.3389/fmed.2022.835765] [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] [Received: 12/14/2021] [Accepted: 04/22/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Because of the current lack of evidence-based antimicrobial treatment guidelines, Left Ventricular Assist Device (LVAD) infections are often treated according to local insights. Here, we propose a flowchart for protocolized treatment, in order to improve outcome. Methods The flowchart was composed based on literature, consensus and expert opinion statements. It includes choice, dosage and duration of antibiotics, and indications for suppressive therapy, with particular focus on Staphylococcus aureus (SA) (Figure 1). The preliminary treatment results of 28 patients (2 from start cephalexin suppressive therapy) after implementation in July 2018 are described. Results Cumulative incidence for first episode of infection in a 3-year time period was 27% (26 of 96 patients with an LVAD). Twenty-one of 23 (91%) first episodes of driveline infection (10 superficial and 13 deep; nine of 13 caused by SA) were successfully treated with antibiotics according to flowchart with complete resolution of clinical signs and symptoms. For two patients with deep driveline infections, surgery was needed in addition. There were no relapses of deep driveline infections, and only 2 SA deep driveline re-infections after 6 months. Nine patients received cephalexin of whom four patients (44%) developed a breakthrough infection with cephalexin-resistant gram-negative bacteria. Conclusions The first results of this protocolized treatment approach of LVAD infections are promising. Yet, initiation of cephalexin suppressive therapy should be carefully considered given the occurrence of infections with resistant micro-organisms. The long-term outcome of this approach needs to be established in a larger number of patients, preferably in a multi-center setting.
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Affiliation(s)
- Nelianne J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Rotterdam, Netherlands
| | - Yunus C Yalcin
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands.,Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Hannelore I Bax
- Department of Medical Microbiology and Infectious Diseases, Rotterdam, Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
| | - Ozcan Birim
- Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Peter D Croughs
- Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Rotterdam, Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Unit of Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Rotterdam, Netherlands
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10
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Roest S, Goedendorp-Sluimer MM, Köbben JJ, Constantinescu AA, Taverne YJHJ, Zijlstra F, Zandbergen AAM, Manintveld OC. Oral Glucose Tolerance Test for the Screening of Glucose Intolerance Long Term Post-Heart Transplantation. Transpl Int 2022; 35:10113. [PMID: 35516977 PMCID: PMC9061939 DOI: 10.3389/ti.2022.10113] [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] [Received: 10/14/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022]
Abstract
Post-transplant diabetes mellitus (PTDM) is a frequent complication post-heart transplantation (HT), however long-term prevalence studies are missing. The aim of this study was to determine the prevalence and determinants of PTDM as well as prediabetes long-term post-HT using oral glucose tolerance tests (OGTT). Also, the additional value of OGTT compared to fasting glucose and glycated hemoglobin (HbA1c) was investigated. All patients > 1 year post-HT seen at the outpatient clinic between August 2018 and April 2021 were screened with an OGTT. Patients with known diabetes, an active infection/rejection/malignancy or patients unwilling or unable to undergo OGTT were excluded. In total, 263 patients were screened, 108 were excluded. The included 155 patients had a median age of 54.3 [42.2–64.3] years, and 63 (41%) were female. Median time since HT was 8.5 [4.8–14.5] years. Overall, 51 (33%) had a normal range, 85 (55%) had a prediabetes range and 19 (12%) had a PTDM range test. OGTT identified prediabetes and PTDM in more patients (18% and 50%, respectively), than fasting glucose levels and HbA1c. Age at HT (OR 1.03 (1.00–1.06), p = 0.044) was a significant determinant of an abnormal OGTT. Prediabetes as well as PTDM are frequently seen long-term post-HT. OGTT is the preferred screening method.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Marleen M Goedendorp-Sluimer
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Julia J Köbben
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Yannick J H J Taverne
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Adrienne A M Zandbergen
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
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11
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Roest S, Manintveld OC, Kolff MAE, Akca F, Veenis JF, Constantinescu AA, Brugts JJ, Birim O, van Osch-Gevers LM, Szili-Torok T, Caliskan K. Cardiac allograft vasculopathy and donor age affecting permanent pacemaker implantation after heart transplantation. ESC Heart Fail 2022; 9:1239-1247. [PMID: 35174653 PMCID: PMC8934965 DOI: 10.1002/ehf2.13799] [Citation(s) in RCA: 1] [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] [Received: 08/13/2021] [Revised: 11/27/2021] [Accepted: 12/20/2021] [Indexed: 11/23/2022] Open
Abstract
Aims The need for permanent pacemakers (PMs) after heart transplantation (HT) is increasing. The aim was to determine the influence of cardiac allograft vasculopathy (CAV), donor age, and other risk factors on PM implantations early and late after HT and its effect on survival. Methods and results A retrospective, single‐centre study was performed including HTs from 1984 to July 2018. Early PM was defined as PM implantation ≤90 days and late PM as PM > 90 days. Risk factors for PM and survival after PM were determined with (time‐dependent) multivariable Cox regression. Out of 720 HTs performed, 62 were excluded (55 mortalities ≤30 days and 7 retransplantations). Of the remaining 658 patients, 95 (14%) needed a PM: 38 (6%) early and 57 (9%) late during follow‐up (median 9.3 years). Early PM risk factors were donor age [hazard ratio (HR) 1.06, P < 0.001], ischaemic time (HR 1.01, P < 0.001), and in adults amiodarone use before HT (HR 2.02, P = 0.045). Late PM risk factors were donor age (HR 1.03, P = 0.024) and CAV (HR 3.59, P < 0.001). Late PM compromised survival (HR 2.05, P < 0.001), while early PM did not (HR 0.77, P = 0.41). Conclusions Risk factors for early PM implantation were donor age, ischaemic time, and in adults amiodarone use before HT. Late PM implantation risk factors were donor age and CAV. Late PM diminished survival, which is probably a surrogate marker for underlying progressive cardiac disease.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marit A E Kolff
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ferdi Akca
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jesse F Veenis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ozcan Birim
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Lennie M van Osch-Gevers
- Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Department of Paediatrics, Division of Paediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
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12
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Feyz L, Nannan Panday R, Henneman M, Verzijlbergen F, Constantinescu AA, van Dalen BM, Brugts JJ, Caliskan K, Geleijnse ML, Kardys I, Van Mieghem NM, Manintveld O, Daemen J. Endovascular renal sympathetic denervation to improve heart failure with reduced ejection fraction: the IMPROVE-HF-I study. Neth Heart J 2021; 30:149-159. [PMID: 34609726 PMCID: PMC8881518 DOI: 10.1007/s12471-021-01633-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction The aim of the present study was to assess the safety and efficacy of renal sympathetic denervation (RDN) in patients with heart failure with reduced ejection fraction (HFrEF). Methods We randomly assigned 50 patients with a left ventricular ejection fraction (LVEF) ≤ 35% and NYHA class ≥ II, in a 1:1 ratio, to either RDN and optimal medical therapy (OMT) or OMT alone. The primary safety endpoint was the occurrence of a combined endpoint of cardiovascular death, rehospitalisation for heart failure, and acute kidney injury at 6 months. The primary efficacy endpoint was the change in iodine-123 meta-iodobenzylguanidine (123I‑MIBG) heart-to-mediastinum ratio (HMR) at 6 months. Results Mean age was 60 ± 9 years, 86% was male and mean LVEF was 33 ± 8%. At 6 months, the primary safety endpoint occurred in 8.3% vs 8.0% in the RDN and OMT groups, respectively (p = 0.97). At 6 months, the mean change in late HMR was −0.02 (95% CI: −0.08 to 0.12) in the RDN group, versus −0.02 (95% CI: −0.09 to 0.12) in the OMT group (p = 0.95) whereas the mean change in washout rate was 2.34 (95% CI: −6.35 to 1.67) in the RDN group versus −2.59 (95% CI: −1.61 to 6.79) in the OMT group (p-value 0.09). Conclusion RDN with the Vessix system in patients with HFrEF was safe, but did not result in significant changes in cardiac sympathetic nerve activity at 6 months as measured using 123I‑MIBG. Supplementary Information The online version of this article (10.1007/s12471-021-01633-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Feyz
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - R Nannan Panday
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - M Henneman
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - F Verzijlbergen
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A A Constantinescu
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - B M van Dalen
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
- Department of Cardiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - J J Brugts
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - K Caliskan
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - M L Geleijnse
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - I Kardys
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - N M Van Mieghem
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - O Manintveld
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - J Daemen
- University Medical Center, Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
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13
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Deckers JW, Arshi B, van den Berge JC, Constantinescu AA. Preventive implantable cardioverter defibrillator therapy in contemporary clinical practice: need for more stringent selection criteria. ESC Heart Fail 2021; 8:3656-3662. [PMID: 34337903 PMCID: PMC8497353 DOI: 10.1002/ehf2.13506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 12/03/2022] Open
Abstract
While the efficacy of the intracardiac defibrillators (ICDs) for primary prevention is not disputed, the relevant studies were carried out a long time ago. Most pertinent trials, including MADIT‐II, SCD‐Heft, and DEFINITE, recruited patients more than 20 years ago. Since then, improved therapeutic modalities including, in addition to cardiac resynchronization therapy, mineralocorticoid receptor antagonists, angiotensin receptor‐neprilysin inhibitors, and, most recently, inhibitors of sodium‐glucose cotransporter 2, have lowered present‐day rates of mortality and of sudden cardiac death. Thus, nowadays, ICD therapy may be less effective than previously reported, and not as beneficial as many people currently believe. However, criteria for ICD implantation remain very inclusive. The patient must (only) be symptomatic and have ejection fraction (EF) ≤ 35%. The choice of EF 35% is notable because the average EF in all large trials was much lower, and clinical benefit was mainly limited to EF ≤ 30%. This EF cut‐off value defines a substantial portion of potential ICD recipients. It seems therefore reasonable to limit ICD eligibility criteria in the EF range 30–35% to patients at highest risk only. We discuss and present some rational criteria to assist the clinician in improving risk stratification for preventive ICD implantation.
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Affiliation(s)
- Jaap W Deckers
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.,Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Banafsheh Arshi
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan C van den Berge
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
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14
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Nous FMA, Roest S, van Dijkman ED, Attrach M, Caliskan K, Brugts JJ, Nieman K, Hirsch A, Constantinescu AA, Manintveld OC, Budde RPJ. Clinical implementation of coronary computed tomography angiography for routine detection of cardiac allograft vasculopathy in heart transplant patients. Transpl Int 2021; 34:1886-1894. [PMID: 34268796 PMCID: PMC8519137 DOI: 10.1111/tri.13973] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 03/29/2021] [Revised: 07/04/2021] [Accepted: 07/08/2021] [Indexed: 12/01/2022]
Abstract
Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects long‐term outcomes in heart transplant (HTx) patients. We prospectively evaluated the feasibility of coronary computed tomography angiography (CCTA) for the detection of CAV during clinical implementation at our center. All consecutive HTx patients >4 years post‐transplant were actively converted from myocardial perfusion imaging to CCTA for the annual assessment of CAV. Between February 2018 and May 2019, 129/172 (75%) HTx patients underwent a CCTA. Renal impairment (n = 21/43) was the most frequent reason for patients could not undergo CCTA. CCTA image quality was good–excellent in 118/129 (92%) patients, and the radiation dose was 2.1 (1.6–2.8) mSv. CCTA showed obstructive CAV in 19/129 (15%) patients. Thirteen (10%) patients underwent additional tests, of which 8 patients underwent coronary revascularization within 90 days of CCTA. After 1 year, 3 additional coronary angiograms were performed, resulting in one revascularization in a patient with known severe CAV who developed ventricular tachycardia. One myocardial infarction after coronary stenting and 2 non‐cardiac deaths were observed. CCTA can be successfully implemented for routine detection of CAV with good image quality and low radiation dose. CCTA allows CAV evaluation with the limited need for additional invasive testing.
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Affiliation(s)
- Fay M A Nous
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Eva D van Dijkman
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Mohamed Attrach
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Koen Nieman
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Stanford University School of Medicine, Cardiovascular Institute, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Alexander Hirsch
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Erasmus MC Transplant Institute, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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15
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Yalcin YC, Kooij C, Theuns DAMJ, Constantinescu AA, Brugts JJ, Manintveld OC, Yap SC, Szili-Torok T, Bogers AJJC, Caliskan K. Emerging electromagnetic interferences between implantable cardioverter-defibrillators and left ventricular assist devices. Europace 2021; 22:584-587. [PMID: 32003803 PMCID: PMC7132535 DOI: 10.1093/europace/euaa006] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 09/26/2019] [Accepted: 01/13/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS To investigate the prevalence of electromagnetic interference (EMI) between left ventricular assist devices (LVADs) and implantable cardioverter-defibrillators (ICDs)/pacemakers (PMs). METHODS AND RESULTS A retrospective single-centre study was conducted, including all patients undergoing HeartMate II (HMII) and HeartMate 3 (HM3) LVAD implantation (n = 106). Electromagnetic interference was determined by the inability to interrogate the ICD/PM. Overall, 85 (mean age 59 ± 8, 79% male) patients had an ICD/PM at the time of LVAD implantation; 46 patients with HMII and 40 patients with HM3. Among the 85 LVAD patients with an ICD's/PM's, 11 patients (13%) experienced EMI; 6 patients (15%) with an HMII and 5 patients (11%) with an HM3 (P = 0.59). Electromagnetic interference from the HMII LVADs was only present in patients with a St Jude/Abbott device; 6 of the 23 St Jude/Abbott devices. However, in the HM3 patients, EMI was mainly present in patients with Biotronik devices: 4 of the 18 with only one (1/25) patient with a Medtronic device. While initial interrogation of these devices was not successful, none of the 11 cases experienced pacing inhibition or inappropriate shocks. CONCLUSION In summary, the prevalence of EMI between ICDs in the older and newer type of LVAD's remains rather high. While HMII patients experienced EMI with a St Jude/Abbott device (which was already known), HM3 LVAD patients experience EMI mainly with Biotronik devices. Prospective follow-up, preferably in large registries, is warranted to investigate the overall prevalence and impact of EMI in LVAD patients.
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Affiliation(s)
- Yunus C Yalcin
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands.,Department of Cardio-thoracic Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Claudette Kooij
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Dominic A M J Theuns
- Department of Cardio-thoracic Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Tamas Szili-Torok
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
| | - Ad J J C Bogers
- Department of Cardio-thoracic Surgery, Erasmus Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center, Room RG 431, Dr Molewaterplein 40, Rotterdam, The Netherlands
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16
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Yalcin YC, Muslem R, Veen KM, Soliman OI, Manintveld OC, Darwish Murad S, Kilic A, Constantinescu AA, Brugts JJ, Alkhunaizi F, Birim O, Tedford RJ, Bogers AJJC, Hsu S, Caliskan K. Impact of preoperative liver dysfunction on outcomes in patients with left ventricular assist devices. Eur J Cardiothorac Surg 2021; 57:920-928. [PMID: 31828334 DOI: 10.1093/ejcts/ezz337] [Citation(s) in RCA: 9] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/29/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES We evaluated the impact of preoperative liver function on early and 1-year postoperative outcomes in patients supported with a left ventricular assist device (LVAD) and subsequent evolution of liver function markers. METHODS A retrospective multicentre cohort study was conducted, including all patients undergoing continuous-flow LVAD implantation. The Model for End-stage Liver Disease (MELD) score was used to define liver dysfunction. RESULTS Overall, 290 patients with an LVAD [78% HeartMate II, 15% HVAD and 7% HeartMate 3, mean age 55 (18), 76% men] were included. Over 40 000 measurements of liver function markers were collected over a 1-year period. A receiver operating characteristic curve analysis for the 1-year mortality rate identified the optimal cut-off value of 12.6 for the MELD score. Therefore, the cohort was dichotomized into patients with an MELD score of less than or greater than 12.6. The early (90-day) survival rates in patients with and without liver dysfunction were 76% and 91% (P = 0.002) and 65% and 90% at 1 year, respectively (P < 0.001). Furthermore, patients with preoperative liver dysfunction had more embolic events and more re-explorations. At the 1-year follow-up, liver function markers showed an overall improvement in the majority of patients, with or without pre-LVAD liver dysfunction. CONCLUSIONS Preoperative liver dysfunction is associated with higher early 90-day and 1-year mortality rates after LVAD implantation. Furthermore, liver function improved in both patient groups. It has become imperative to optimize the selection criteria for possible LVAD candidates, since those who survive the first year show excellent recovery of their liver markers.
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Affiliation(s)
- Yunus C Yalcin
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Rahatullah Muslem
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kevin M Veen
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Osama I Soliman
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sarwa Darwish Murad
- Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ahmet Kilic
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Alina A Constantinescu
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Fatimah Alkhunaizi
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Ozcan Birim
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Ryan J Tedford
- Department of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Ad J J C Bogers
- Department of Cardio-thoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Steven Hsu
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, MD, USA
| | - Kadir Caliskan
- Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus MC University Medical Center, Rotterdam, Netherlands
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17
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Kimman JR, Van Mieghem NM, Endeman H, Brugts JJ, Constantinescu AA, Manintveld OC, Dubois EA, den Uil CA. Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation? Curr Heart Fail Rep 2021; 17:247-260. [PMID: 32870448 PMCID: PMC7496039 DOI: 10.1007/s11897-020-00480-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Purpose of Review We aim to summarize recent insights and provide an up-to-date overview on the role of intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS). Recent Findings In the largest randomized controlled trial (RCT) of patients with CS after acute myocardial infarction (AMICS), IABP did not lower mortality. However, recent data suggest a role for IABP in patients who have persistent ischemia after revascularization. Moreover, in the growing population of CS not caused by acute coronary syndrome (ACS), multiple retrospective studies and one small RCT report on significant hemodynamic improvement following (early) initiation of IABP support, which allowed bridging of most patients to recovery or definitive therapies like heart transplant or a left ventricular assist device (LVAD). Summary Routine use of IABP in patients with AMICS is not recommended, but many patients with CS either from ischemic or non-ischemic cause may benefit from IABP at least for hemodynamic improvement in the short term. There is a need for a larger RCT regarding the role of IABP in selected patients with ACS, as well as in patients with non-ACS CS.
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Affiliation(s)
- Jesse R Kimman
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Henrik Endeman
- Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Eric A Dubois
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Corstiaan A den Uil
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Intensive Care Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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18
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van den Berge JC, Vroegindewey MM, Veenis JF, Brugts JJ, Caliskan K, Manintveld OC, Akkerhuis KM, Boersma E, Deckers JW, Constantinescu AA. Left ventricular remodelling and prognosis after discharge in new-onset acute heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:2679-2689. [PMID: 33934556 PMCID: PMC8318456 DOI: 10.1002/ehf2.13299] [Citation(s) in RCA: 3] [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] [Received: 07/23/2020] [Revised: 02/23/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022] Open
Abstract
Aims This study aimed to investigate the left ventricular (LV) remodelling and long‐term prognosis of patients with new‐onset acute heart failure (HF) with reduced ejection fraction who were pharmacologically managed and survived until hospital discharge. We compared patients with ischaemic and non‐ischaemic aetiology. Methods and results This cohort study consisted of 111 patients admitted with new‐onset acute HF in the period 2008–2016 [62% non‐ischaemic aetiology, 48% supported by inotropes, vasopressors, or short‐term mechanical circulatory devices, and left ventricular ejection fraction (LVEF) at discharge 28% (interquartile range 22–34)]. LV dimensions, LVEF, and mitral valve regurgitation were used as markers for LV remodelling during up to 3 years of follow‐up. Both patients with non‐ischaemic and ischaemic HF had significant improvement in LVEF (P < 0.001 and P = 0.004, respectively) with significant higher improvement in those with non‐ischaemic HF (17% vs. 6%, P < 0.001). Patients with non‐ischaemic HF had reduction in LV end‐diastolic and end‐systolic diameters (6 and 10 mm, both P < 0.001), but this was not found in those with ischaemic HF [+3 mm (P = 0.09) and +2 mm (P = 0.07), respectively]. During a median follow‐up of 4.6 years, 98 patients (88%) did not reach the composite endpoint of LV assist device implantation, heart transplantation, or all‐cause mortality, with no difference between with ischaemic and non‐ischaemic HF [hazard ratio 0.69 (95% confidence interval 0.19–2.45)]. Conclusions Patients with new‐onset acute HF with reduced ejection fraction discharged on optimal medical treatment have a good prognosis. We observed a considerable LV remodelling with improvement in LV function and dimensions, starting already at 6 months in patients with non‐ischaemic HF but not in their ischaemic counterparts.
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Affiliation(s)
- Jan C van den Berge
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Maxime M Vroegindewey
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Jesse F Veenis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Room Rg4, PO Box 2040, Rotterdam, 3015 GD, The Netherlands
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19
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Schreuder MM, Schuurman A, Akkerhuis KM, Constantinescu AA, Caliskan K, van Ramshorst J, Germans T, Umans VA, Boersma E, Roeters van Lennep JE, Kardys I. Sex-specific temporal evolution of circulating biomarkers in patients with chronic heart failure with reduced ejection fraction. Int J Cardiol 2021; 334:126-134. [PMID: 33940096 DOI: 10.1016/j.ijcard.2021.04.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 02/08/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND We aimed to assess differences in clinical characteristics, prognosis, and the temporal evolution of circulating biomarkers in male and female patients with HFrEF. METHODS We included 250 patients (66 women) with chronic heart failure (CHF) between 2011 and 2013 and performed trimonthly blood sampling during a median follow-up of 2.2 years [median (IQR) of 8 (5-10) urine and 9 (5-10) plasma samples per patient]. After completion of follow-up we measured 8 biomarkers. The primary endpoint (PE) was the composite of cardiac death, cardiac transplantation, left ventricular assist device implantation, and hospitalization due to acute or worsened CHF. Joint models were used to determine whether there were differences in the temporal patterns of the biomarkers between men and women as the PE approached. RESULTS A total of 66 patients reached the PE of which 52 (78.8%) were male and 14 (21.2%) were female. The temporal patterns of all studied biomarkers were associated with the PE, and overall showed disadvantageous changes as the PE approached. For NT-proBNP, HsTnT, and CRP, women showed higher levels over the entire follow-up duration and concomitant numerically higher hazard ratios [NT-proBNP: women: HR(95%CI) 7.57 (3.17-21.93), men: HR(95%CI) 3.14 (2.09-4.79), p for interaction = 0.104, HsTnT: women: HR(95%CI) 6.38 (2.18-22.46), men: HR(95%CI) 4.91 (2.58-9.39), p for interaction = 0.704, CRP: women: HR(95%CI) 7.48 (3.43-19.53), men: HR(95%CI) 3.29 [2.27-5.44], p for interaction = 0.106). In contrast, temporal patterns of glomerular and tubular renal markers showed similar associations with the PE in men and women. CONCLUSION Although interaction terms are not statistically significant, the associations of temporal patterns of NT-proBNP, HsTnT, and CRP appear more outspoken in women than in men with HFrEF, whereas associations seem similar for temporal patterns of creatinine, eGFR, Cystatin C, KIM-1 and NAG. Larger studies are needed to confirm these potential sex differences.
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Affiliation(s)
- M M Schreuder
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A Schuurman
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - K M Akkerhuis
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - A A Constantinescu
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - K Caliskan
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - J van Ramshorst
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - T Germans
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - V A Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - E Boersma
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | - I Kardys
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, the Netherlands.
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20
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Roest S, Brugts JJ, van Kampen JJA, von der Thüsen JH, Constantinescu AA, Caliskan K, Hirsch A, Manintveld OC. COVID-19-related myocarditis post-heart transplantation. Int J Infect Dis 2021; 107:34-36. [PMID: 33862215 PMCID: PMC8056480 DOI: 10.1016/j.ijid.2021.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 01/23/2023] Open
Abstract
This report describes the first heart transplantation recipient with acute biventricular heart failure symptoms caused by a post-myocarditis state, late after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. No other viral pathogens could be detected. Computed tomography angiography did not show cardiac allograft vasculopathy, and myocardial biopsy demonstrated no clinically relevant rejection. Subsequent cardiovascular magnetic resonance imaging revealed extensive epicardial delayed enhancement without myocardial edema. Heart failure medication was initiated and an implantable cardioverter defibrillator was implanted (due to non-sustained ventricular tachycardias), leading to a partial recovery of the ejection fraction. Further studies are needed to investigate the number of heart transplant recipients with myocardial damage after a SARS-CoV-2 infection.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen J A van Kampen
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Viroscience, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan H von der Thüsen
- Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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21
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Houkes KM, Mudde SE, Constantinescu AA, Verkaik NJ, Yusuf E. Concomitant endocarditis and spondylodiscitis due to coagulase-negative Staphylococci and a review of the literature. IDCases 2021; 24:e01100. [PMID: 33889493 PMCID: PMC8050024 DOI: 10.1016/j.idcr.2021.e01100] [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: 02/27/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Coagulase-negative staphylococci (CoNS) are part of the normal skin flora. Although CoNS are generally considered as low pathogenic microorganisms, they can cause serious infections, particularly in the context of foreign body material. CASE REPORT Here we present two cases of concomitant infectious endocarditis and spondylodiscitis; one caused by S. epidermidis, the other by S. haemolyticus. Additionally, we reviewed the literature for previously reported cases of concomitant endocarditis and spondylodiscitis due to CoNS. CONCLUSION In patients with back pain and a cardiac device in situ, CoNS should be considered as causative pathogens for possible endocarditis and/or spondylodiscitis, and should not be regarded as contamination.
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Affiliation(s)
- Karlijn M.G. Houkes
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Saskia E. Mudde
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alina A. Constantinescu
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Erlangga Yusuf
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
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22
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Roest S, Struijk C, Constantinescu AA, Caliskan K, Plasmeijer EI, Boersma E, Brugts JJ, Manintveld OC. Influence of renal insufficiency pre-heart transplantation on malignancy risk post-heart transplantation. ESC Heart Fail 2021; 8:2172-2182. [PMID: 33779076 PMCID: PMC8120392 DOI: 10.1002/ehf2.13309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/29/2021] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
Aims Recent reports demonstrated that patients with heart failure (HF) might have an increased risk to develop malignancies. This is also seen in patients with chronic kidney disease (CKD). Immunosuppression in heart transplantation (HT) recipients additionally increases the risk of malignancies. The aim of this study was to determine the relation between HF duration and CKD pre‐HT and the risk of malignancy development post‐HT. Methods and results We included all adult HT recipients transplanted between January 2000 and November 2017 in our centre. Patients were excluded if they died or were retransplanted within 3 months post‐HT. Clinical characteristics were retrospectively collected. Sixty out of 250 patients (24%) developed a malignancy after a median of 66 months [interquartile range 33–108] post‐HT. In multivariable Cox regression analysis, HF duration was not a risk factor for all malignancies or solid organ malignancies post‐HT [hazard ratio (HR) 1.033 (0.974–1.096), P = 0.281 and HR 1.036 (0.958–1.120), P = 0.376, respectively]. Age [HR 1.051 (1.016–1.086), P = 0.004] and CKD pre‐HT [HR 2.173 (1.236–3.822), P = 0.007] were independent risk factors for all malignancies. CKD pre‐HT [HR 2.542 (1.142–5.661), P = 0.022] increased the risk for solid organ malignancies. Exclusion of patients with durable mechanical circulatory support in the analysis did not alter the significance of these risk factors. Conclusions Duration of HF pre‐HT was not associated with malignancy risk post‐HT. CKD was an independent risk factor for malignancies post‐HT. More studies are needed to investigate this association.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Christianne Struijk
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elsemieke I Plasmeijer
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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23
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Schinkel AFL, Akin S, Strachinaru M, Muslem R, Bowen D, Yalcin YC, Brugts JJ, Constantinescu AA, Manintveld OC, Caliskan K. Evaluation of patients with a HeartMate 3 left ventricular assist device using echocardiographic particle image velocimetry. J Ultrasound 2020; 24:499-503. [PMID: 33241488 PMCID: PMC8572275 DOI: 10.1007/s40477-020-00533-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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 10/08/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Poor left ventricular (LV) function may affect the physiological intraventricular blood flow and physiological vortex formation. The aim of this study was to investigate the pattern of intraventricular blood flow dynamics in patients with LV assist devices (LVADs) using echocardiographic particle image velocimetry. Materials and methods This prospective study included 17 patients (mean age 57 ± 11 years, 82% male) who had received an LVAD (HeartMate 3, Abbott Laboratories, Chicago, Illinois, USA) because of end-stage heart failure and poor LV function. Eleven (64%) patients had ischemic cardiomyopathy, and six patients (36%) had nonischemic cardiomyopathy. All patients underwent echocardiography, including intravenous administration of an ultrasound-enhancing agent (SonoVue, Bracco, Milan, Italy). Echocardiographic particle image velocimetry was used to quantify LV blood flow dynamics, including vortex formation (Hyperflow software, Tomtec imaging systems Gmbh, Unterschleissheim, Germany). Results Contrast-enhanced ultrasound was well tolerated in all patients and was performed without adverse reactions or side effects. The LVAD function parameters did not change during or after the ultrasound examination. The LVAD flow was on average 4.3 ± 0.3 L/min, and the speed was 5247 ± 109 rotations/min. The quantification of LV intraventricular flow demonstrated substantial impairment of vortex parameters. The energy dissipation, vorticity, and kinetic energy fluctuation indices were severely impaired. Conclusions Echo particle velocimetry is safe and feasible for the quantitative assessment of intraventricular flow in patients with an LVAD. The intraventricular LV flow and vortex parameters are severely impaired in these patients.
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Affiliation(s)
- Arend F L Schinkel
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Sakir Akin
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.,Department of Intensive Care, Haga Teaching Hospital, The Hague, The Netherlands
| | - Mihai Strachinaru
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Rahatullah Muslem
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Dan Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Yunus C Yalcin
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter, Erasmus MC, Room Rg427, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
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24
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Veenis JF, Yalcin YC, Brugts JJ, Constantinescu AA, Manintveld OC, Bekkers JA, Bogers AJJC, Caliskan K. Survival following a concomitant aortic valve procedure during left ventricular assist device surgery: an ISHLT Mechanically Assisted Circulatory Support (IMACS) Registry analysis. Eur J Heart Fail 2020; 22:1878-1887. [PMID: 32809227 PMCID: PMC7702162 DOI: 10.1002/ejhf.1989] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/05/2020] [Accepted: 08/08/2020] [Indexed: 11/11/2022] Open
Abstract
Aims The aim of this study was to compare early‐ and late‐term survival and causes of death between patients with and without a concomitant aortic valve (AoV) procedure during continuous‐flow left ventricular assist device (LVAD) surgery. Methods and results All adult primary continuous‐flow LVAD patients on the International Society of Heart and Lung Transplantation (ISHLT) Mechanically Assisted Circulatory Support (IMACS) Registry (n = 15 267) were included in this analysis and stratified into patients submitted to a concomitant AoV procedure (AoV replacement or AoV repair) and patients without an AoV procedure. The primary outcome was early (≤90 days) survival post‐LVAD surgery. Secondary outcomes were late survival (survival during the entire follow‐up period) and conditional survival (in patients who survived the first 90 days post‐LVAD surgery), and determinants. Patients who underwent concomitant AoV replacement (n = 457) had significantly reduced late survival compared with patients with AoV repair (n = 328) or without an AoV procedure (n = 14 482) (56% vs. 61% and 62%, respectively; P = 0.001). After adjustment for other significant predictors, concomitant AoV replacement remained an independent predictor for early [hazard ratio (HR) 1.226, 95% confidence interval (CI) 1.037–1.449] and late (HR 1.477, 95% CI 1.154–1.890) mortality. However, patients undergoing AoV replacement or repair, in whom the presence of moderate‐to‐severe AoV regurgitation was diagnosed prior to LVAD implantation, had survival similar to patients not undergoing AoV interventions. Conclusions Concomitant AoV surgery in patients undergoing LVAD implantation is an independent predictor of mortality. Additional research is needed to determine the best AoV surgical strategy at the time of LVAD surgery.
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Affiliation(s)
- Jesse F Veenis
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Yunus C Yalcin
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Jos A Bekkers
- Department of Cardio-Thoracic Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardio-Thoracic Surgery, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands
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25
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Constantinescu AA, Galli G, Daemen J, Brugts JJ, van de Woestijne P, Manintveld OC, Van Mieghem NM, Caliskan K. Transcatheter closure and prognosis of coronary artery fistulae in heart transplant recipients. EUROINTERVENTION 2020; 16:600-602. [PMID: 31763983 DOI: 10.4244/eij-d-19-00191] [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: 11/23/2022]
Affiliation(s)
- Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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26
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Veenis JF, Brugts JJ, Yalcin YC, Roest S, Bekkers JA, Manintveld OC, Constantinescu AA, Bogers AJJC, Zijlstra F, Caliskan K. Aortic root thrombus after left ventricular assist device implantation and aortic valve replacement. ESC Heart Fail 2020; 7:3208-3212. [PMID: 32729665 PMCID: PMC7524097 DOI: 10.1002/ehf2.12921] [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] [Received: 02/19/2020] [Revised: 05/11/2020] [Accepted: 07/13/2020] [Indexed: 11/11/2022] Open
Abstract
Data on the risk of aortic root thrombosis in patients with aortic valve replacement (AVR) and left ventricular assist device (LVAD) surgery are scarce. Two out of nine patients receiving AVR concomitant with LVAD surgery and two out of two patients receiving AVR on LVAD support, at our centre, developed an aortic root thrombus, all diagnosed with computed tomography (CT) angiography. These results demonstrate that patients with concomitant AVR and LVAD surgery, or AVR on LVAD support, have an increased risk of aortic root thrombosis. Therefore, early anti-thrombotic therapy and vigilant diagnostic follow-up, using CT scans, are warranted to prevent thromboembolic events.
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Affiliation(s)
- Jesse F Veenis
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Jasper J Brugts
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Yunus C Yalcin
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Stefan Roest
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Jos A Bekkers
- Thorax Center, Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Olivier C Manintveld
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Alina A Constantinescu
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Ad J J C Bogers
- Thorax Center, Department of Cardio-Thoracic Surgery, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Felix Zijlstra
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
| | - Kadir Caliskan
- Thorax Center, Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015GD, The Netherlands
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27
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Schuurman AS, Tomer A, Akkerhuis KM, Brugts JJ, Constantinescu AA, Ramshorst JV, Umans VA, Boersma E, Rizopoulos D, Kardys I. Personalized screening intervals for measurement of N-terminal pro-B-type natriuretic peptide improve efficiency of prognostication in patients with chronic heart failure. Eur J Prev Cardiol 2020; 28:e11-e14. [PMID: 33611526 DOI: 10.1177/2047487320922639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/16/2022]
Affiliation(s)
- Anne-Sophie Schuurman
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Anirudh Tomer
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | | | | | - Victor A Umans
- Department of Cardiology, Northwest Clinics, Alkmaar, Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
- Cardiovascular Research School COEUR, Erasmus MC University Medical Center, Rotterdam, Netherlands
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28
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De Bakker CC, Veenis JF, Manintveld OC, Constantinescu AA, Caliskan K, den Uil CA, Brugts JJ. Monitoring pulmonary pressures during long-term continuous-flow left ventricular assist device and fixed pulmonary hypertension: redefining alleged pathophysiological mechanisms? ESC Heart Fail 2020; 7:702-704. [PMID: 32022460 PMCID: PMC7160469 DOI: 10.1002/ehf2.12594] [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] [Received: 07/26/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/05/2022] Open
Abstract
Pulmonary hypertension (PH) type II (classified by the World Health Organization) is a common complication in chronic left-sided heart failure. In advanced heart failure therapy, fixed PH is an absolute contraindication for heart transplantation after which a left ventricular assist device (LVAD) is the only remaining option. With remote monitoring, we can now continuously evaluate the pulmonary artery pressures during long-term LV unloading by the LVAD. In this case, we demonstrate that fixed PH can be reversed with LVAD implantation, whereby previous thoughts of this concept should be redefined in the era of assist devices.
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Affiliation(s)
- Chantal C De Bakker
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Jesse F Veenis
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - K Caliskan
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Corstiaan A den Uil
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015GD, Rotterdam, The Netherlands
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29
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Roest S, Hesselink DA, Klimczak-Tomaniak D, Kardys I, Caliskan K, Brugts JJ, Maat APWM, Ciszek M, Constantinescu AA, Manintveld OC. Incidence of end-stage renal disease after heart transplantation and effect of its treatment on survival. ESC Heart Fail 2020; 7:533-541. [PMID: 32022443 PMCID: PMC7160492 DOI: 10.1002/ehf2.12585] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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] [Received: 08/26/2019] [Revised: 10/30/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023] Open
Abstract
Aims Many heart transplant recipients will develop end‐stage renal disease in the post‐operative course. The aim of this study was to identify the long‐term incidence of end‐stage renal disease, determine its risk factors, and investigate what subsequent therapy was associated with the best survival. Methods and results A retrospective, single‐centre study was performed in all adult heart transplant patients from 1984 to 2016. Risk factors for end‐stage renal disease were analysed by means of multivariable regression analysis and survival by means of Kaplan–Meier. Of 685 heart transplant recipients, 71 were excluded: 64 were under 18 years of age and seven were re‐transplantations. During a median follow‐up of 8.6 years, 121 (19.7%) patients developed end‐stage renal disease: 22 received conservative therapy, 80 were treated with dialysis (46 haemodialysis and 34 peritoneal dialysis), and 19 received a kidney transplant. Development of end‐stage renal disease (examined as a time‐dependent variable) inferred a hazard ratio of 6.45 (95% confidence interval 4.87–8.54, P < 0.001) for mortality. Tacrolimus‐based therapy decreased, and acute kidney injury requiring renal replacement therapy increased the risk for end‐stage renal disease development (hazard ratio 0.40, 95% confidence interval 0.26–0.62, P < 0.001, and hazard ratio 4.18, 95% confidence interval 2.30–7.59, P < 0.001, respectively). Kidney transplantation was associated with the best median survival compared with dialysis or conservative therapy: 6.4 vs. 2.2 vs. 0.3 years (P < 0.0001), respectively, after end‐stage renal disease development. Conclusions End‐stage renal disease is a frequent complication after heart transplant and is associated with poor survival. Kidney transplantation resulted in the longest survival of patients with end‐stage renal disease.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dominika Klimczak-Tomaniak
- Department of Cardiology, Hypertension and Internal Medicine, Medical University of Warsaw, Warsaw, Poland.,Division of Immunology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michał Ciszek
- Division of Immunology, Transplantation and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Rotterdam Transplant Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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30
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Yalcin YC, Muslem R, Veen KM, Soliman OI, Hesselink DA, Constantinescu AA, Brugts JJ, Manintveld OC, Fudim M, Russell SD, Tomashitis B, Houston BA, Hsu S, Tedford RJ, Bogers AJJC, Caliskan K. Impact of Continuous Flow Left Ventricular Assist Device Therapy on Chronic Kidney Disease: A Longitudinal Multicenter Study. J Card Fail 2020; 26:333-341. [PMID: 31981698 DOI: 10.1016/j.cardfail.2020.01.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [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: 09/10/2019] [Revised: 12/04/2019] [Accepted: 01/17/2020] [Indexed: 01/21/2023]
Abstract
BACKGROUND Many patients undergoing durable left ventricular assist device (LVAD) implantation suffer from chronic kidney disease (CKD). Therefore, we investigated the effect of LVAD support on CKD. METHODS A retrospective multicenter cohort study, including all patients undergoing LVAD (HeartMate II (n = 330), HeartMate 3 (n = 22) and HeartWare (n = 48) implantation. In total, 227 (56.8%) patients were implanted as bridge-to-transplantation; 154 (38.5%) as destination therapy; and 19 (4.7%) as bridge-to-decision. Serum creatinine measurements were collected over a 2-year follow-up period. Patients were stratified based on CKD stage. RESULTS Overall, 400 patients (mean age 53 ± 14 years, 75% male) were included: 186 (46.5%) patients had CKD stage 1 or 2; 93 (23.3%) had CKD stage 3a; 82 (20.5%) had CKD stage 3b; and 39 (9.8%) had CKD stage 4 or 5 prior to LVAD implantation. During a median follow-up of 179 days (IQR 28-627), 32,629 creatinine measurements were available. Improvement of kidney function was noticed in every preoperative CKD-stage group. Following this improvement, estimated glomerular filtration rates regressed to baseline values for all CKD stages. Patients showing early renal function improvement were younger and in worse preoperative condition. Moreover, survival rates were higher in patients showing early improvement (69% vs 56%, log-rank P = 0 .013). CONCLUSIONS Renal function following LVAD implantation is characterized by improvement, steady state and subsequent deterioration. Patients who showed early renal function improvement were in worse preoperative condition, however, and had higher survival rates at 2 years of follow-up.
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Affiliation(s)
- Yunus C Yalcin
- Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Rahatullah Muslem
- Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kevin M Veen
- Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Osama I Soliman
- Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dennis A Hesselink
- Division of Nephrology and Renal Transplantation, Department of Internal Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jasper J Brugts
- Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Olivier C Manintveld
- Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Marat Fudim
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Stuart D Russell
- Duke Clinical Research Institute, Division of Cardiology, Duke University, Durham, North Carolina, USA
| | - Brett Tomashitis
- Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Brian A Houston
- Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Steven Hsu
- Department of Cardiology, Johns Hopkins Heart and Vascular Institute, Baltimore, Maryland, USA
| | - Ryan J Tedford
- Department of Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Kadir Caliskan
- Thoraxcenter, Unit Heart Failure, Transplantation and Mechanical Circulatory Support, Department of Cardiology, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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31
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Roest S, Bax HI, Verkaik NJ, Brugts JJ, Constantinescu AA, de Bakker CC, Birim O, Caliskan K, Manintveld OC. Mycobacterium chelonae, an 'atypical' cause of an LVAD driveline infection. Int J Infect Dis 2020; 92:127-129. [PMID: 31926352 DOI: 10.1016/j.ijid.2020.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 12/11/2019] [Revised: 12/27/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022] Open
Abstract
We describe the first patient with a left ventricular assist device (LVAD) driveline infection caused by Mycobacterium chelonae presenting with persistent infection despite conventional antibiotics. Treatment was successful with surgical debridement, driveline exit relocation, and a 4-month period of antibiotics. In the case of a culture-negative LVAD driveline infection, non-tuberculous mycobacteria should be considered. This case illustrates that multidisciplinary collaboration is essential in providing optimal care for LVAD patients.
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Affiliation(s)
- Stefan Roest
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Hannelore I Bax
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Internal Medicine, Division of Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Nelianne J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Chantal C de Bakker
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Ozcan Birim
- Department of Cardio-Thoracic Surgery, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thorax Centre, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
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32
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van den Berg VJ, Bouwens E, Umans VAWM, de Maat M, Manintveld OC, Caliskan K, Constantinescu AA, Mouthaan H, Cornel JH, Baart S, Akkerhuis KM, Boersma E, Kardys I. Longitudinally Measured Fibrinolysis Factors are Strong Predictors of Clinical Outcome in Patients with Chronic Heart Failure: The Bio-SHiFT Study. Thromb Haemost 2019; 119:1947-1955. [PMID: 31659734 DOI: 10.1055/s-0039-1696973] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This article investigates whether longitudinally measured fibrinolysis factors are associated with cardiac events in patients with chronic heart failure (CHF). METHODS A median of 9 (interquartile range [IQR] 5-10) serial, tri-monthly blood samples per patient were prospectively collected in 263 CHF patients during a median follow-up of 2.2 (IQR 1.4-2.5) years. Seventy patients (cases) reached the composite endpoint of cardiac death, heart failure hospitalization, left ventricular assist device, or heart transplantation. From all longitudinal samples, we selected baseline samples in all patients and the last two samples before the event in cases or the last sample available in event-free patients. Herein, we measured plasminogen activator inhibitor 1 (PAI-1), tissue-type plasminogen activator (tPA), urokinase-type plasminogen activator (uPA), and soluble urokinase plasminogen activator surface receptor (suPAR). Associations between temporal biomarker patterns during follow-up and the cardiac event were investigated using a joint model. RESULTS Cases were on average older and showed higher New York Heart Association class than those who remained event-free. They also had lower blood pressures, and were more likely to have diabetes, renal failure, and atrial fibrillation. Longitudinally measured PAI-1, uPA, and suPAR were independently associated with adverse cardiac events after correction for clinical characteristics (hazard ratio [95% confidence interval]) per standard deviation increase of 2.09 (1.28-3.45) for PAI-1, 1.91 (1.18-3.24) for uPA, and 3.96 (2.48-6.63) for suPAR. Serial measurements of tPA were not significantly associated with the event after correction for multiple testing. CONCLUSION Longitudinally measured PAI-1, uPA, and suPAR are strongly associated with adverse cardiac events during the course of CHF. If future research confirms our results, these fibrinolytic factors may carry potential for improved, and personalized, heart failure surveillance and treatment monitoring.
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Affiliation(s)
- Victor J van den Berg
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands.,The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Elke Bouwens
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Moniek de Maat
- Department of Hematology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Jan-Hein Cornel
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Sara Baart
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,The Netherlands Heart Institute, Utrecht, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Budde RPJ, Nous FMA, Constantinescu AA, Nieman K, Koweek LM, Leipsic J, Manintveld OC. P6319CT derived fractional flow reserve (FFRct) for functional coronary artery evaluation in the follow-up of patients after heart transplantation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0916] [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
Cardiac allograft vasculopathy (CAV) remains a leading cause of morbidity and mortality after heart transplantation. Annual screening is recommended to improve risk stratification and early treatment of CAV and is often performed with invasive coronary angiography (ICA). Coronary computed tomography angiography (CCTA) with CCTA-derived fractional flow reserve (FFRct) might be a non-invasive alternative to ICA for the surveillance of CAV providing both anatomical and functional information.
Purpose
To describe our initial results with CCTA and FFRct for detection of CAV in a cohort of heart transplant patients.
Methods
Heart transplant patients who underwent CCTA with FFRct as part of routine annual assessment for CAV were enrolled in a prospective registry from February 2018 to February 2019 in a single center. The most recently known CAV score (0–3) based on invasive angio and single photon emission computed tomography (SPECT) before CCTA was recorded. CCTA image quality was scored as non-diagnostic, moderate, good or excellent. FFRct analysis was performed off-site by a commercial company. For each coronary stenosis >30%, an FFRCTvalue distal to the stenosis was measured. For the RCA, LAD and CX without a stenosis, the FFRct value in the most distal location in the vessel was recorded. CAV classification was rescored based on CCTA. Demographics, additional diagnostic tests, and treatment plans were evaluated including major adverse events (MACE) during 90-day follow-up.
Results
65 patients (56 (39–65) years (median/ 25th–75thpercentile), 40% women) that were 11 (7–16) years after transplantation were included. The most recent CAV score was 0 in 52 patients (80%) and 1 or 2 in 13 patients. CCTA image quality was good or excellent in 59 (91%) patients. CCTA reclassified CAV scores in 32 (49%) patients to 33 patients with CAV 0, 18 patients with CAV 1, 9 patients with CAV 2 and 5 patients with CAV 3. In 17 patients (26%) at least one stenosis with FFRct ≤0.80 was detected including 11 patients with single vessel disease, 5 with two-vessel disease and one with three-vessel disease. In the 48 patients without a focal stenosis, mean distal FFRct values were 0.88 (0.86–0.91), 0.87 (0.85–0.90) and 0.90 (0.86–0.91) at less than 10, 10–15 or more than 15 years after transplantation, respectively (p=0.457). Additional tests were performed in 10 (15%) patients (1 SPECT and 10 invasive coronary angiographies), which resulted in revascularization by PCI in 6 (9%) patients. No MACE occurred during 90-day follow-up.
Conclusion
CCTA with FFRct can be successfully performed in heart transplant patients, detects patients with significant coronary stenosis and CCTA leads to substantial reclassification of CAV grades.
Acknowledgement/Funding
FFRct analysis was performed as part of the ADVANCE registry which is supported by Heartflow Inc.
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Affiliation(s)
- R P J Budde
- Erasmus Medical Center, Radiology and nuclear medicine, Rotterdam, Netherlands (The)
| | - F M A Nous
- Erasmus Medical Center, Radiology and nuclear medicine, Rotterdam, Netherlands (The)
| | | | - K Nieman
- Stanford University, Cardiology and radiology, Palo Alto, United States of America
| | - L M Koweek
- Duke University Medical Center, Radiology, Durham, United States of America
| | - J Leipsic
- Providence Health Care Research Institute (PHCRI), Radiology, Vancouver, Canada
| | - O C Manintveld
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
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Yalcin YC, Muslem R, Papageorgiou G, Tedford RJ, Constantinescu AA, Birim OC, Brugts JJ, Manintveld OC, Hsu S, Leebeek FWG, Bogers AJJC, Caliskan K. P1675Evolution of lactate dehydrogenase levels in patients with HeartMate II, HeartWare and HeartMate 3 left ventricular assist devices during first-year follow-up. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0431] [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
Lactate dehydrogenase (LDH) is considered as a biomarker of thrombotic events in patients receiving a left ventricular assist device (LVAD).
Purpose
This study aimed to investigate the evolution of LDH levels over time between patients supported with a HeartMate II (HMII), HeartMate 3 (HM3) or HeartWare (HVAD) LVAD during their first-year post implantation.
Methods
We analyzed in this multi-center retrospective study, all patients with HMII, HM3 and HVAD LVAD implanted between December 2006 and April 2017. Patients were classified into three groups based on their device type. Loess splines over time were used to depict the repeated measurements of LDH.
Results
In total, 134 patients received an LVAD (77% male, mean age 55 [46–61]), of whom 64 (48%) were HMII, 22 (16%) HM3 and 48 (36%) were HVAD. Loess splines over time indicate that there could be a considerable difference between evolution of LDH (Figure). During the first-year follow-up, 3 (5%) patients had a confirmed and 10 (16%) patients had a suspected pump thrombosis in the HMII group. For the HVAD, there were 6 (13%) patients with confirmed thrombosis and 1 (2%) case of suspected thrombosis, whereas none of the patients in the HM3 group experienced a suspected or confirmed pump thrombosis (p=0.01). The 1-year overall survival rate for HM II, HM3 and HVAD was 84%, 86% and 72% respectively (p=0.311). The overall stroke-free rate at one year was: 89%, 77% and 91% for HMII, HVAD and HM3 respectively (p=0.15).
Means of observed LDH values over time
Conclusion
During the first-year post LVAD implantation, there appear to be different evolutions of LDH levels over time in HMII device patients compared to HVAD or HM3 device patients. Given differences in baseline hemolysis levels between devices, currently used LDH thresholds for detection of impending pump thrombosis may be less sensitive and thus thresholds may be device specific.
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Affiliation(s)
- Y C Yalcin
- Erasmus Medical Center, Cardiothoracic Surgery + Cardiology, Rotterdam, Netherlands (The)
| | - R Muslem
- Erasmus Medical Center, Cardiothoracic Surgery + Cardiology, Rotterdam, Netherlands (The)
| | - G Papageorgiou
- Erasmus Medical Center, Biostatistics, Rotterdam, Netherlands (The)
| | - R J Tedford
- Medical University of South Carolina, Medicine, Charleston, United States of America
| | | | - O C Birim
- Erasmus Medical Center, Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - J J Brugts
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - O C Manintveld
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - S Hsu
- Johns Hopkins University of Baltimore, Medicine, Baltimore, United States of America
| | - F W G Leebeek
- Erasmus Medical Center, Hematology, Rotterdam, Netherlands (The)
| | - A J J C Bogers
- Erasmus Medical Center, Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - K Caliskan
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
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den Uil CA, Van Mieghem NM, B Bastos M, Jewbali LS, Lenzen MJ, Engstrom AE, Bunge JJH, Brugts JJ, Manintveld OC, Daemen J, Wilschut JM, Zijlstra F, Constantinescu AA. Primary intra-aortic balloon support versus inotropes for decompensated heart failure and low output: a randomised trial. EUROINTERVENTION 2019; 15:586-593. [PMID: 31147306 DOI: 10.4244/eij-d-19-00254] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [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: 11/23/2022]
Abstract
AIMS The haemodynamic effects of primary implantation of an intra-aortic balloon pump (IABP) versus inotropes in decompensated heart failure and low output (DHF-LO), but without an acute coronary syndrome, have not been investigated. We therefore aimed to investigate the effect of primary IABP implantation as compared to inotropes on haemodynamics in DHF-LO with no acute ischaemia. METHODS AND RESULTS Patients (n=32) with DHF-LO despite IV diuretics were randomised to primary 50 mL IABP or inotropes (INO: enoximone or dobutamine). The primary endpoint was the improvement of organ perfusion assessed by ∆ mixed-venous oxygen saturation (SvO2) at 3 hours; secondary endpoints included ∆ cardiac power output (CPO), NT-proBNP proportional change, cumulative fluid balance and ∆ dyspnoea severity score, all at 48 hours. Data are presented as median (IQR). Patients were 60 (48-69) years old and 72% were male. Baseline SvO2 was 44 (39-53)%. ∆SvO2 was higher in the IABP group (+17 [+9; +24] vs. +5 [+2; +9]%, p<0.05). IABP patients had a higher ∆CPO, a greater relative reduction in NT-proBNP, a more negative cumulative fluid balance, and a greater reduction in dyspnoea severity score. There were no IABP-related serious adverse events (SAEs). Thirty-day mortality was 23% (IABP) vs. 44% (INO). CONCLUSIONS Primary circulatory support by IABP showed a significant increase in improved organ perfusion assessed by SvO2.
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Affiliation(s)
- Corstiaan A den Uil
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Kooij C, Yalcin YC, Theuns DAMJ, Constantinescu AA, Brugts JJ, Manintveld OC, Yap SC, Szili-Torok T, Bogers AJJC, Caliskan K. P5421Prevalence of electromagnetic interference from left ventricular assist devices in patients with implantable cardioverter defibrillator/pacemakers. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0378] [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
Many patients eligible for left ventricular assist device (LVAD) therapy already have an implantable cardioverter defibrillator (ICD) and/or pacemaker (PM). However, electromagnetic interference (EMI) between the LVAD and ICD/PM devices could be cumbersome.
Purpose
The aim of this study was to investigate the prevalence of EMI between different types of ICD/PM in patients implanted with an LVAD.
Methods
Data was obtained through a retrospective electronic patient database analysis of all LVAD patients (including HeartMate II (HMII) and HeartMate 3 (HM3)), from our tertiary referral center, from December 2006 to February 2019. Device switches have also been taken into account due to elective replacement. Electromagnetic interference was defined as ICD/PM telemetry interference (i.e. the inability to interrogate ICD/PM)
Results
In total, 109 patients received an LVAD (mean age 52±12, 83% male), Of these, 86 (79%) patients had an ICD/PM at LVAD implantation. One patient with ICD/PM was excluded from further analysis because of missing follow-up data. Among the 85 patients (45 HM II and 40 HM3), 11 (13%) experienced EMI; 5 (11%) with a HM II and 6 (15%) with a HM3 (p=0.59). The implanted ICD/PM devices were from Medtronic (n=25), Abbott (n=23), Biotronik (n=18), Boston Scientific (n=18), and Microport (n=1). EMI with the HM II was present in St Jude/Abbott devices (type 1 Atlas, 1 Unify, 1 Fortify, and 2 Promote). In HM 3 LVAD patients, EMI was observed in Biotronik devices (1 Lumax, 1 Ilivia, 1 Ilesto, and 2 Iperia) and Medtronic (Claria).
Conclusion
In our cohort of HM II and HM 3 LVAD patients, at least one in seven patients experienced EMI from either the HM II or HM3 LVAD with the ICD/PM. Electromagnetic interference from HM II LVADs was mainly present in patients with St Jude/Abbott ICD/PM devices However, in the HM3 patients, EMI was mainly present in patients with Biotronik devices, which is not yet widely known!
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Affiliation(s)
- C Kooij
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - Y C Yalcin
- Erasmus Medical Center, Cardiothoracic Surgery + Cardiology, Rotterdam, Netherlands (The)
| | - D A M J Theuns
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | | | - J J Brugts
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - O C Manintveld
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - S C Yap
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - T Szili-Torok
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - A J J C Bogers
- Erasmus Medical Center, Cardiothoracic Surgery, Rotterdam, Netherlands (The)
| | - K Caliskan
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
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Schuurman AS, Tomer A, Akkerhuis KM, Brugts JJ, Constantinescu AA, Van Ramshorst J, Umans VA, Boersma H, Rizopoulos D, Kardys I. P1644Personalized screening intervals for measurement of n-terminal pro-b-type natriuretic peptide improve efficiency of prognostication in patients with chronic heart failure. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0403] [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
Predefined screening intervals and target levels do not account for variations in temporal patterns of biomarkers between individuals, which may hamper their potential use for therapy guidance. Conversely, a personalized screening approach with screening intervals and target levels based on the evolution of biomarkers in individual patients may further improve risk assessment and therapy guidance.
Purpose
We hypothesize that personalized screening intervals for N-terminal pro-B-type natriuretic peptide (NT-proBNP) measurements in patients with chronic heart failure (CHF) maximize information gain on the individual patient's disease progression, while minimizing the number of necessary measurements. We aim to compare such personalized scheduling of NT-proBNP measurements to a predefined fixed scheduling approach.
Methods
In 263 CHF patients from the Bio-SHiFT study, NT-proBNP was measured trimonthly according to a prespecified, fixed schedule [median: 9 (IQR: 5–10) measurements per patient].The primary composite endpoint (PE) comprised cardiac death, cardiac transplantation, left ventricular assist device implantation or heart failure hospitalization, and occurred in 70 patients (26.6%). Using joint models for time-to-event and longitudinal data, we modelled the association between repeated NT-proBNP measurements and the PE. Using the fitted joint model, for each patient at each follow-up visit, we determined the optimal time point of the next NT-proBNP measurement based on the patient's individual risk profile and the maximum information gain on the patient's prognosis as assessed by the Kullback-Leibler divergence. Personalized scheduling was compared to fixed (trimonthly) scheduling by means of a realistic simulation study, based on a replica of the study population included in the Bio-SHiFT study. In this simulation study, we stopped monitoring NT-proBNP to potentially enable appropriate timely intervention if the cumulative risk of PE exceeded an arbitrary risk threshold of 7.5% within 3-months. We compared personalized scheduling with fixed scheduling in terms of capability of identification of high-risk intervals (whether timely intervention was enabled before occurrence of PE), number of measurements needed, and costs.
Results
Compared to fixed scheduling, personalized scheduling saved on average 2 measurements [personalized; median: 7 (IQR: 7–8) vs. fixed; 9 (IQR: 8–10) measurements], while the start of the time-window identified for therapeutic intervention to avoid the occurrence of PE was similar in both approaches [personalized; median: 6.6 (IQR: 4.5–11.3) vs. fixed; 6.3 (IQR: 4.2–10.3) months before occurrence of PE]. Costs saved were €165 per patient per year.
Figure 1
Conclusion
Personalized scheduling of NT-proBNP measurements in CHF patients shows similar prognostic performance as fixed scheduling, but requires fewer NT-proBNP measurements. This may improve efficiency of natriuretic guided therapy, if the latter were to be installed.
Acknowledgement/Funding
Funding for this study was provided by the Jaap Schouten Foundation and Erasmus MC Efficiency Research grant
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Affiliation(s)
- A.-S Schuurman
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - A Tomer
- Erasmus Medical Center, Biostatistics, Rotterdam, Netherlands (The)
| | - K M Akkerhuis
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - J J Brugts
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | | | | | - V A Umans
- Northwest Clinics, Cardiology, Alkmaar, Netherlands (The)
| | - H Boersma
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
| | - D Rizopoulos
- Erasmus Medical Center, Biostatistics, Rotterdam, Netherlands (The)
| | - I Kardys
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands (The)
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Veenis JF, Boiten HJ, van den Berge JC, Caliskan K, Maat APWM, Valkema R, Constantinescu AA, Manintveld OC, Zijlstra F, van Domburg RT, Schinkel AFL. Prediction of long-term (> 10 year) cardiovascular outcomes in heart transplant recipients: Value of stress technetium-99m tetrofosmin myocardial perfusion imaging. J Nucl Cardiol 2019; 26:845-852. [PMID: 29116562 DOI: 10.1007/s12350-017-1089-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Myocardial perfusion imaging (MPI) using single-photon emission computed tomography (SPECT) is useful in the evaluation of cardiac allograft vasculopathy (CAV) in heart transplant (HTx) recipients. The current study evaluated the long-term prognostic value of stress SPECT MPI for predicting all-cause mortality and cardiac events in HTx recipients. METHODS The study population consisted of 166 HTx recipients (mean age 54 ± 10 years, 84% male) who underwent exercise or dobutamine stress 99mTc-tetrofosmin SPECT MPI for the assessment of CAV. An abnormal SPECT MPI was defined as the presence of a fixed or a reversible perfusion defect. Endpoints were all-cause mortality, cardiac mortality, and non-fatal myocardial infarction (MI). RESULTS MPI abnormalities were detected in 55 patients (33%), including fixed defects in 28 patients (17%), partially reversible in 17 patients (10%), and completely reversible defects in 10 patients (6%). During a median follow-up of 12.8 years (range 0-15, mean follow-up 9.5 years), 109 (66%) patients died (all-cause mortality), of which 67 (40%) were due to cardiac causes. A total of 5 (3%) patients experienced a non-fatal MI. HTx recipients with a normal stress 99mTc-tetrofosmin SPECT MPI had a significantly better prognosis as compared with those with an abnormal study, up to 5 years after the initial test. The presence of a reversible perfusion defect was a significant predictor of all-cause mortality, cardiac mortality, and major cardiac events, during the entire follow-up period. CONCLUSIONS Stress 99mTc-tetrofosmin SPECT MPI provides valuable prognostic information for the prediction of long-term outcome in HTx recipients. Patients with a normal stress 99mTc-tetrofosmin SPECT MPI have a significantly better prognosis as compared with those with an abnormal study, up to 5 years after initial testing.
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Affiliation(s)
- Jesse F Veenis
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hendrik J Boiten
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
- Department of Cardiology, Thoraxcenter, Erasmus MC, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Jan C van den Berge
- Department of Cardiology, Thoraxcenter, Erasmus MC, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Alex P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Roelf Valkema
- Department of Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Felix Zijlstra
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
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den Uil CA, Friesema ECH, Constantinescu AA. Vasodilation through levodopa for Parkinson's disease may require high left ventricular assist device flow. J Card Surg 2019; 34:226-228. [PMID: 30847947 PMCID: PMC6594037 DOI: 10.1111/jocs.14012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/26/2019] [Accepted: 02/19/2019] [Indexed: 11/29/2022]
Abstract
We report implantation of a left ventricular assist device (LVAD) in a patient with Parkinson's disease. Postoperative fluid overload together with insufficient LVAD output in the setting of vasodilation through levodopa likely caused renal hypoperfusion and acute kidney injury. A patient like ours, therefore, requires the highest possible increase of HM3 RPM and LVAD flow early after surgery.
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Affiliation(s)
- Corstiaan A den Uil
- Department of Cardiology, Mechanical Circulatory Support and Cardiac Transplantation, University Medical Center, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Intensive Care Medicine, University Medical Center, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Edith C H Friesema
- Department of Internal Medicine, University Medical Center, Section of Pharmacology, Vascular and Metabolic Diseases, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Mechanical Circulatory Support and Cardiac Transplantation, University Medical Center, Thoraxcenter, Erasmus University Medical Center, Rotterdam, the Netherlands
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40
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Schinkel AFL, Akin S, Strachinaru M, Muslem R, Soliman OII, Brugts JJ, Constantinescu AA, Manintveld OC, Caliskan K. Safety and feasibility of contrast echocardiography for the evaluation of patients with HeartMate 3 left ventricular assist devices. Eur Heart J Cardiovasc Imaging 2019; 19:690-693. [PMID: 28950368 DOI: 10.1093/ehjci/jex177] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Received: 04/18/2017] [Accepted: 06/16/2017] [Indexed: 11/13/2022] Open
Abstract
Aims Patients with a left ventricular assist device (LVAD) are challenging to evaluate using conventional imaging techniques, such as standard echocardiography (SE). The aim of this pilot study was to evaluate the potential of contrast echocardiography (CE) for the evaluation of the left ventricle (LV). Methods and results This prospective study included 14 ambulatory patients (mean age 58 ± 9 years, 79% male) with a LVAD (all HeartMate 3, Abbott Laboratories, Chicago, IL, USA). Nine (64%) patients had an ischaemic cardiomyopathy, and 5 (36%) had a non-ischaemic cardiomyopathy. All patients underwent SE and CE using intravenous administration of Sonovue contrast agent (Bracco, Milan, Italy). The echocardiograms were assessed by three observers, using a standard 17-segment model of the LV. Left ventricular end-diastolic volume (LVEDV) was assessed using the biplane Simpson method. The contrast agent was well tolerated by all patients, without any side effects. Overall, SE allowed visualization of 57% of LV segments (135/238) and CE allowed visualization of 79% of LV segments (187/238), P < 0.001. Per patient, SE resulted in visualization of 9.6 ± 5.2 segments and CE was able to visualize 13.4 ± 5.8 segments (P < 0.001). Administration of contrast agent significantly improved the assessment of LVEDV (feasibility SE: 36% vs. CE: 79%, P < 0.05). Conclusion Routine use of a contrast agent appears safe when used in patients having a new third generation LVAD and may enhance the diagnostic accuracy of transthoracic echocardiography in these patients. LV size determination can be obtained more often due to improved LV visualization using contrast agent.
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Affiliation(s)
- Arend F L Schinkel
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Sakir Akin
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus MC,' s-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Mihai Strachinaru
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Rahatullah Muslem
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Osama I I Soliman
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands.,Cardialysis Clinical Trials Management and Core Laboratories, PO Box 2125, 3000 CC Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Thoraxcenter Room Ba304, Erasmus MC, 's-Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands
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41
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Veenis JF, Manintveld OC, Constantinescu AA, Caliskan K, Birim O, Bekkers JA, van Mieghem NM, den Uil CA, Boersma E, Lenzen MJ, Zijlstra F, Abraham WT, Adamson PB, Brugts JJ. Design and rationale of haemodynamic guidance with CardioMEMS in patients with a left ventricular assist device: the HEMO-VAD pilot study. ESC Heart Fail 2019; 6:194-201. [PMID: 30614639 PMCID: PMC6351888 DOI: 10.1002/ehf2.12392] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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] [Received: 08/08/2018] [Revised: 10/16/2018] [Accepted: 11/05/2018] [Indexed: 12/28/2022] Open
Abstract
AIMS We aim to study the feasibility and clinical value of pulmonary artery pressure monitoring with the CardioMEMS™ device in order to optimize and guide treatment in patients with a HeartMate 3 left ventricular assist device (LVAD). METHODS AND RESULTS In this single-centre, prospective pilot study, we will include 10 consecutive patients with New York Heart Association Class IIIb or IV with Interagency Registry for Mechanically Assisted Circulatory Support Classes 2-5 scheduled for implantation of a HeartMate 3 LVAD. Prior to LVAD implantation, patients will receive a CardioMEMS sensor, for daily pulmonary pressure readings. The haemodynamic information provided by the CardioMEMS will be used to improve haemodynamic status prior to LVAD surgery and optimize the timing of LVAD implantation. Post-LVAD implantation, the haemodynamic changes will be assessed for additive value in detecting potential complications in an earlier stage (bleeding and tamponade). During the outpatient clinic phase, we will assess whether the haemodynamic feedback can optimize pump settings, detect potential complications, and further tailor the clinical management of these patients. CONCLUSIONS The HEMO-VAD study is the first prospective pilot study to explore the safety and feasibility of using CardioMEMS for optimization of LVAD therapy with additional (remote) haemodynamic information.
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Affiliation(s)
- Jesse F Veenis
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | | | | | - Kadir Caliskan
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Ozcan Birim
- Department of Cardiothoracic Surgery, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | | | - Corstiaan A den Uil
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands.,Department of Intensive Care Medicine, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Mattie J Lenzen
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - Felix Zijlstra
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
| | - William T Abraham
- Division of Cardiovascular Medicine, The Ohio State University, Colombus, OH, USA
| | - Philip B Adamson
- Division of Cardiology, Oklahoma Foundation for Cardiovascular Research, Oklahoma City, OK, USA
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC Thoraxcenter, Rotterdam, The Netherlands
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42
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van den Berge JC, Constantinescu AA, van Domburg RT, Brankovic M, Deckers JW, Akkerhuis KM. Renal function and anemia in relation to short- and long-term prognosis of patients with acute heart failure in the period 1985-2008: A clinical cohort study. PLoS One 2018; 13:e0201714. [PMID: 30086179 PMCID: PMC6080795 DOI: 10.1371/journal.pone.0201714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/21/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Renal dysfunction and anaemia are common in patients with acute heart failure (HF). It is not known whether their combined presence has additive prognostic value. We investigated their prognostic value separately and in combination, on prognosis in acute HF patients. Furthermore, we examined whether the improvement in prognosis was comparable between patients with and without renal dysfunction. METHODS AND RESULTS This prospective registry includes 1783 patients admitted to the (Intensive) Coronary Care Unit for acute HF in the period of 1985-2008. The outcome measure was the composite of all-cause mortality, heart transplantation and left ventricular assist device implantation. In patients without renal dysfunction, anemia was associated with worse 30-day outcome (HR 2.91; [95% CI 1.69-5.00]), but not with 10-year outcome (HR 1.13 [95% CI 0.93-1.37]). On the contrary, anemia was found to influence prognosis in patients with renal dysfunction, both at 30 days (HR 1.93 [95% CI 1.33-2.80]) and at 10 years (HR 1.27 [95% CI 1.10-1.47]). Over time, the 10-year survival rate improved in patients with preserved renal function (HR 0.73 [95% CI 0.55-0.97]), but not in patients with renal dysfunction. CONCLUSION The long-term prognosis of acute HF patients with a preserved renal function was found to have improved significantly. However, the prognosis of patients with renal dysfunction did not change. Anemia was a strong prognosticator for short-term outcome in all patients. In patients with renal dysfunction, anemia was also associated with impaired long-term prognosis.
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Affiliation(s)
- Jan C. van den Berge
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
- * E-mail:
| | | | - Ron T. van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
| | - Milos Brankovic
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
| | - Jaap W. Deckers
- Department of Cardiology, Thoraxcenter, Erasmus MC Rotterdam, the Netherlands
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43
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Akin S, Ince C, Den Uil CA, Struijs A, Muslem R, Ocak I, Guven G, Constantinescu AA, Soliman OI, Zijlstra F, Bogers AJJC, Caliskan K. P5122A novel method for early identification of cardiac tamponade in patients with continuous flow left ventricular assist devices by use of sublingual microcirculatory imaging. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Akin
- Erasmus Medical Center, Thoraxcenter, Department of Cardiology and Intensive Care, Rotterdam, Netherlands
| | - C Ince
- Erasmus Medical Center, Thoraxcenter, Department of Cardiology and Intensive Care, Rotterdam, Netherlands
| | - C A Den Uil
- Erasmus Medical Center, Thoraxcenter, Department of Cardiology and Intensive Care, Rotterdam, Netherlands
| | - A Struijs
- Erasmus Medical Center, Intensive Care, Rotterdam, Netherlands
| | - R Muslem
- Erasmus Medical Center, Thoraxcenter, Department of Cardiology, Rotterdam, Netherlands
| | - I Ocak
- Erasmus Medical Center, Intensive Care, Rotterdam, Netherlands
| | - G Guven
- Erasmus Medical Center, Intensive Care, Rotterdam, Netherlands
| | - A A Constantinescu
- Erasmus Medical Center, Thoraxcenter, Department of Cardiology, Rotterdam, Netherlands
| | - O I Soliman
- Erasmus Medical Center, Thoraxcenter, Department of Cardiology, Rotterdam, Netherlands
| | - F Zijlstra
- Erasmus Medical Center, Thoraxcenter, Department of Cardiology, Rotterdam, Netherlands
| | - A J J C Bogers
- Erasmus Medical Center, Thoraxcenter, Department of Cardiothoracic Surgery, Rotterdam, Netherlands
| | - K Caliskan
- Erasmus Medical Center, Thoraxcenter, Department of Cardiothoracic Surgery, Rotterdam, Netherlands
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44
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Van Den Berg VJ, Bouwens E, Umans VAWM, Manintveld OC, Caliskan K, Constantinescu AA, Cornel JH, Akkerhuis KM, Boersma E, Kardys I. P5665Coagulation biomarkers and clinical outcomes in patients with chronic heart failure - The bio-shift study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5665] [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 J Van Den Berg
- Erasmus Medical Center, Clinical epidemiology of Cardiology, Rotterdam, Netherlands
| | - E Bouwens
- Erasmus Medical Center, Clinical epidemiology of Cardiology, Rotterdam, Netherlands
| | | | - O C Manintveld
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands
| | - K Caliskan
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands
| | | | - J H Cornel
- Northwest clinics, Cardiology, Alkmaar, Netherlands
| | - K M Akkerhuis
- Erasmus Medical Center, Cardiology, Rotterdam, Netherlands
| | - E Boersma
- Erasmus Medical Center, Clinical epidemiology of Cardiology, Rotterdam, Netherlands
| | - I Kardys
- Erasmus Medical Center, Clinical epidemiology of Cardiology, Rotterdam, Netherlands
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45
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Guven G, Brankovic M, Constantinescu AA, Brugts JJ, Hesselink DA, Akin S, Struijs A, Birim O, Ince C, Manintveld OC, Caliskan K. Preoperative right heart hemodynamics predict postoperative acute kidney injury after heart transplantation. Intensive Care Med 2018; 44:588-597. [PMID: 29671040 PMCID: PMC6006229 DOI: 10.1007/s00134-018-5159-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 12/07/2017] [Accepted: 03/30/2018] [Indexed: 12/23/2022]
Abstract
Purpose Acute kidney injury (AKI) frequently occurs after heart transplantation (HTx), but its relation to preoperative right heart hemodynamic (RHH) parameters remains unknown. Therefore, we aimed to determine their predictive properties for postoperative AKI severity within 30 days after HTx. Methods From 1984 to 2016, all consecutive HTx recipients (n = 595) in our tertiary referral center were included and analyzed for the occurrence of postoperative AKI staged by the kidney disease improving global outcome criteria. The effects of preoperative RHH parameters on postoperative AKI were calculated using logistic regression, and predictive accuracy was assessed using integrated discrimination improvement (IDI), net reclassification improvement (NRI), and area under the receiver operating characteristic curves (AUC). Results Postoperative AKI occurred in 430 (72%) patients including 278 (47%) stage 1, 66 (11%) stage 2, and 86 (14%) stage 3 cases. Renal replacement therapy (RRT) was administered in 41 (7%) patients. Patients with higher AKI stages had also higher baseline right atrial pressure (RAP; median 7, 7, 8, and in RRT 11 mmHg, p trend = 0.021), RAP-to-pulmonary capillary wedge pressure ratio (median 0.37, 0.36, 0.40, 0.47, p trend = 0.009), and lower pulmonary artery pulsatility index (PAPi) values (median 2.83, 3.17, 2.54, 2.31, p trend = 0.012). Higher RAP and lower PAPi values independently predicted AKI severity [adjusted odds ratio (OR) per doubling of RAP 1.16 (1.02–1.32), p = 0.029; of PAPi 0.85 (0.75–0.96), p = 0.008]. Based on IDI, NRI, and delta AUC, inclusion of these parameters improved the models’ predictive accuracy. Conclusions Preoperative PAPi and RAP strongly predict the development of AKI early after HTx and can be used as early AKI predictors. Electronic supplementary material The online version of this article (10.1007/s00134-018-5159-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Goksel Guven
- Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Intensive Care, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Milos Brankovic
- Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands.,School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Alina A Constantinescu
- Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Division of Nephrology and Renal Transplantation, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sakir Akin
- Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands.,Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ard Struijs
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ozcan Birim
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Can Ince
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Thoraxcenter, Department of Cardiology, Unit Heart Failure, Heart Transplantation and Mechanical Circulatory Support, Erasmus University Medical Center, Room Ba 577, 's-Gravendijkswal 230, 3015 CE, Rotterdam, The Netherlands.
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46
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Muslem R, Caliskan K, van Thiel R, Kashif U, Akin S, Birim O, Constantinescu AA, Brugts JJ, Bunge JJH, Bekkers JA, Leebeek FWG, Bogers AJJC. Incidence, predictors and clinical outcome of early bleeding events in patients undergoing a left ventricular assist device implant. Eur J Cardiothorac Surg 2018; 54:176-182. [DOI: 10.1093/ejcts/ezy044] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 12/20/2017] [Indexed: 01/16/2023] Open
Affiliation(s)
- Rahatullah Muslem
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Robert van Thiel
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Usman Kashif
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Sakir Akin
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
- Department of Intensive Care, HagaZiekenhuis, The Hague, Netherlands
| | - Ozcan Birim
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | | | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Jeroen J H Bunge
- Department of Intensive Care, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Jos A Bekkers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Frank W G Leebeek
- Department of Haematology, Erasmus MC, University Medical Center, Rotterdam, Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus MC, University Medical Center, Rotterdam, Netherlands
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47
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van Boven N, Battes LC, Akkerhuis KM, Rizopoulos D, Caliskan K, Anroedh SS, Yassi W, Manintveld OC, Cornel JH, Constantinescu AA, Boersma E, Umans VA, Kardys I. Toward personalized risk assessment in patients with chronic heart failure: Detailed temporal patterns of NT-proBNP, troponin T, and CRP in the Bio-SHiFT study. Am Heart J 2018; 196:36-48. [PMID: 29421013 DOI: 10.1016/j.ahj.2017.10.008] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/16/2017] [Indexed: 12/26/2022]
Affiliation(s)
- Nick van Boven
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands; Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Linda C Battes
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Kadir Caliskan
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Wisam Yassi
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | | | - Jan-Hein Cornel
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | | | - Eric Boersma
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Victor A Umans
- Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands
| | - Isabella Kardys
- Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands.
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48
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Hoorntje ET, Bollen IA, Barge-Schaapveld DQ, van Tienen FH, Te Meerman GJ, Jansweijer JA, van Essen AJ, Volders PG, Constantinescu AA, van den Akker PC, van Spaendonck-Zwarts KY, Oldenburg RA, Marcelis CL, van der Smagt JJ, Hennekam EA, Vink A, Bootsma M, Aten E, Wilde AA, van den Wijngaard A, Broers JL, Jongbloed JD, van der Velden J, van den Berg MP, van Tintelen JP. Lamin A/C-Related Cardiac Disease: Late Onset With a Variable and Mild Phenotype in a Large Cohort of Patients With the Lamin A/C p.(Arg331Gln) Founder Mutation. ACTA ACUST UNITED AC 2018; 10:CIRCGENETICS.116.001631. [PMID: 28790152 DOI: 10.1161/circgenetics.116.001631] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [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: 02/20/2016] [Accepted: 05/08/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interpretation of missense variants can be especially difficult when the variant is also found in control populations. This is what we encountered for the LMNA c.992G>A (p.(Arg331Gln)) variant. Therefore, to evaluate the effect of this variant, we combined an evaluation of clinical data with functional experiments and morphological studies. METHODS AND RESULTS Clinical data of 23 probands and 35 family members carrying this variant were retrospectively collected. A time-to-event analysis was performed to compare the course of the disease with carriers of other LMNA mutations. Myocardial biopsies were studied with electron microscopy and by measuring force development of the sarcomeres. Morphology of the nuclear envelope was assessed with immunofluorescence on cultured fibroblasts. The phenotype in probands and family members was characterized by atrioventricular conduction disturbances (61% and 44%, respectively), supraventricular arrhythmias (69% and 52%, respectively), and dilated cardiomyopathy (74% and 14%, respectively). LMNA p.(Arg331Gln) carriers had a significantly better outcome regarding the composite end point (malignant ventricular arrhythmias, end-stage heart failure, or death) compared with carriers of other pathogenic LMNA mutations. A shared haplotype of 1 Mb around LMNA suggested a common founder. The combined logarithm of the odds score was 3.46. Force development in membrane-permeabilized cardiomyocytes was reduced because of decreased myofibril density. Structural nuclear LMNA-associated envelope abnormalities, that is, blebs, were confirmed by electron microscopy and immunofluorescence microscopy. CONCLUSIONS Clinical, morphological, functional, haplotype, and segregation data all indicate that LMNA p.(Arg331Gln) is a pathogenic founder mutation with a phenotype reminiscent of other LMNA mutations but with a more benign course.
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Affiliation(s)
| | - Ilse A Bollen
- For the author affiliations, please see the Appendix
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Aryan Vink
- For the author affiliations, please see the Appendix
| | | | - Emmelien Aten
- For the author affiliations, please see the Appendix
| | | | | | - Jos L Broers
- For the author affiliations, please see the Appendix
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49
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van den Berge JC, Constantinescu AA, Boiten HJ, van Domburg RT, Deckers JW, Akkerhuis KM. Short- and Long-term Prognosis of Patients With Acute Heart Failure With and Without Diabetes: Changes Over the Last Three Decades. Diabetes Care 2018; 41:143-149. [PMID: 28982652 DOI: 10.2337/dc17-0544] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [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] [Received: 03/16/2017] [Accepted: 09/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We studied differences in long-term (i.e., 10 year) prognosis among patients with acute heart failure (HF) with and without diabetes over the last three decades. In addition, we investigated whether the degree of prognostic improvement in that period was comparable between patients with and without diabetes. RESEARCH DESIGN AND METHODS This prospective registry included all consecutive patients aged 18 years and older admitted to the Intensive Coronary Care Unit with acute HF in the period of 1985-2008. A total of 1,810 patients were included; 384 patients (21%) had diabetes. The outcome measure was the composite of all-cause mortality, heart transplantation, and left ventricular assist device implantation after 10-year follow-up. RESULTS The 10-year outcome in patients with diabetes was significantly worse than in those without diabetes (87% vs. 76%; adjusted hazard ratio [HR] 1.17 [95% CI 1.02-1.33]). Patients admitted in the last decade had a significantly lower 10-year event rate than patients admitted in the first two decades, both among patients without diabetes (adjusted HR 0.86 [95% CI 0.75-0.99]) and patients with diabetes (adjusted HR 0.80 [95% CI 0.63-1.00]). CONCLUSIONS The long-term outcome of patients with diabetes is worse than that of patients without diabetes. However, the long-term prognosis improved over time in both groups. Importantly, this improvement in long-term prognosis was comparable in patients with and without diabetes. Despite these promising results, more awareness for diabetes in patients with acute HF is necessary and there is still need for optimal treatment of diabetes in acute HF.
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Affiliation(s)
- Jan C van den Berge
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Alina A Constantinescu
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Hendrik J Boiten
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
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50
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Shuker N, Bouamar R, Hesselink DA, van Gelder T, Caliskan K, Manintveld OC, Balk AH, Constantinescu AA. Intrapatient Variability in Tacrolimus Exposure Does Not Predict The Development of Cardiac Allograft Vasculopathy After Heart Transplant. EXP CLIN TRANSPLANT 2017; 16:326-332. [PMID: 28969528 DOI: 10.6002/ect.2016.0366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE A high intrapatient variability in tacrolimus exposure is associated with poor long-term outcomes after kidney transplant. We hypothesized that a high intrapatient variability of tacrolimus exposure after heart transplant may be associated with cardiac allograft vasculopathy as a determinant of long-term survival of heart transplant recipients. MATERIALS AND METHODS Eighty-six heart transplant recipients were included. Patients underwent coronary angiography at years 1 and 4 after transplant and were divided according to low and high intrapatient variability of tacrolimus exposure, with the median variability as cut-off. The primary outcome was the association between tacrolimus intrapatient variability and the progression of cardiac allograft vasculopathy score between years 1 and 4. Secondary outcome was this association with acute cellular rejection. RESULTS There was no significant difference in the proportion of patients with high tacrolimus intrapatient variability in the group that progressed to higher grades of cardiac allograft vasculopathy (n = 15) versus the group without progression (n = 71) at 4-year follow-up (60.0% vs 47.9%; P = .57). There was no significant difference in the proportion of patients with high tacrolimus intrapatient variability between the 58 patients with 1 or more acute cellular rejection episodes and the 28 patients without rejection (51.7% vs 46.4%; P = .82). CONCLUSIONS A high intrapatient variability in tacrolimus exposure does not appear to influence heart transplant outcomes, unlike its influence on kidney transplant function. A higher immunosuppression exposure after heart transplant, including the use of prednisone often in a combination of 3 immunosuppressive drugs, may protect against the effects of high intrapatient tacrolimus variability.
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Affiliation(s)
- Nauras Shuker
- Department of Hospital Pharmacy, Clinical Pharmacology Unit, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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