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Breetveld NM, Alers R, Geerts L, van Kuijk SMJ, van Dijk AP, van der Vlugt MJ, Heidema WM, van Neer J, van Empel VPM, Brunner‐La Rocca H, Scholten RR, Ghossein‐Doha C, Spaanderman MEA. Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study. J Am Heart Assoc 2020; 9:e015043. [PMID: 32924785 PMCID: PMC7792392 DOI: 10.1161/jaha.119.015043] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 06/18/2020] [Indexed: 12/31/2022]
Abstract
Background During uncomplicated pregnancy, left ventricular remodeling occurs in an eccentric way. In contrast, during preeclamptic gestation, the left ventricle hypertrophies concentrically, concurrent with loss in circulatory volume and increased blood pressure. Concentric cardiac structure persists in a substantial proportion of women and may be associated with pressure and volume load after preeclampsia. We hypothesize that low volume load, as indicated by plasma volume (PV) after preeclampsia and increased pressure load, is associated with remote concentric remodeling. Methods and Results In this longitudinal cohort study, we included 100 formerly preeclamptic women. Two visits were performed: at 0.8 years postpartum and at 4.8 years postpartum. During visit 1, we measured blood pressure and PV (I125 dilution technique, low PV ≤48 mL/kg lean body mass). During the second visit, we assessed cardiac geometry by cardiac ultrasound. Concentric remodeling was defined as relative wall thickness >0.42 and left ventricular mass index ≤95 g/m2. We adjusted multivariable analysis for primiparity, systolic blood pressure, PV mL/kg lean body mass, and antihypertensive medication at visit 1. Low PV is associated with remote concentric remodeling (odds ratio [OR], 4.37; 95% CI, 1.06-17.40; and adjusted OR, 4.67; 95% CI, 1.02-21.42). Arterial pressure load (systolic, diastolic, and mean arterial pressure) is also associated with development of concentric remodeling (OR, 1.15 [95% CI, 0.99-1.35]; OR, 1.24 [95% CI, 0.98-1.58]; and OR, 1.20 [95% CI, 0.98-1.47], respectively). Conclusions In former preeclamptic women, development toward left ventricular concentric remodeling is associated with low volume load and increased pressure load.
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Affiliation(s)
- Nicolette M. Breetveld
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Robert‐Jan Alers
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Lauren Geerts
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology AssessmentMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Arie P. van Dijk
- Department of CardiologyRadboud University Medical CenterNijmegenthe Netherlands
| | | | - Wieteke M. Heidema
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Jolijn van Neer
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | | | | | - Ralph R. Scholten
- Department of Obstetrics and GynecologyRadboud University Medical CenterNijmegenthe Netherlands
| | - Chahinda Ghossein‐Doha
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
| | - Marc E. A. Spaanderman
- Department of Obstetrics and GynecologyResearch School GROWMaastricht University Medical CenterMaastrichtthe Netherlands
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2
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Swart LE, Gomes A, Scholtens AM, Sinha B, Tanis W, Lam MGEH, van der Vlugt MJ, Streukens SAF, Aarntzen EHJG, Bucerius J, van Assen S, Bleeker-Rovers CP, van Geel PP, Krestin GP, van Melle JP, Roos-Hesselink JW, Slart RHJA, Glaudemans AWJM, Budde RPJ. Improving the Diagnostic Performance of 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography in Prosthetic Heart Valve Endocarditis. Circulation 2019; 138:1412-1427. [PMID: 30018167 DOI: 10.1161/circulationaha.118.035032] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND 18F-Fluorodeoxyglucose (FDG) positron-emission tomography/computed tomography (PET/CT) was recently introduced as a new tool for the diagnosis of prosthetic heart valve endocarditis (PVE). Previous studies reporting a modest diagnostic accuracy may have been hampered by unstandardized image acquisition and assessment, and several confounders, as well. The aim of this study was to improve the diagnostic performance of FDG PET/CT in patients in whom PVE was suspected by identifying and excluding possible confounders, using both visual and standardized quantitative assessments. METHODS In this multicenter study, 160 patients with a prosthetic heart valve (median age, 62 years [43-73]; 68% male; 82 mechanical valves; 62 biological; 9 transcatheter aortic valve replacements; 7 other) who underwent FDG PET/CT for suspicion of PVE, and 77 patients with a PV (median age, 73 years [65-77]; 71% male; 26 mechanical valves; 45 biological; 6 transcatheter aortic valve replacements) who underwent FDG PET/CT for other indications (negative control group), were retrospectively included. Their scans were reassessed by 2 independent observers blinded to all clinical data, both visually and quantitatively on available European Association of Nuclear Medicine Research Ltd-standardized reconstructions. Confounders were identified by use of a logistic regression model and subsequently excluded. RESULTS Visual assessment of FDG PET/CT had a sensitivity/specificity/positive predictive value/negative predictive value for PVE of 74%/91%/89%/78%, respectively. Low inflammatory activity (C-reactive protein <40 mg/L) at the time of imaging and use of surgical adhesives during prosthetic heart valve implantation were significant confounders, whereas recent valve implantation was not. After the exclusion of patients with significant confounders, diagnostic performance values of the visual assessment increased to 91%/95%/95%/91%. As a semiquantitative measure of FDG uptake, a European Association of Nuclear Medicine Research Ltd-standardized uptake value ratio of ≥2.0 was a 100% sensitive and 91% specific predictor of PVE. CONCLUSIONS Both visual and quantitative assessments of FDG PET/CT have a high diagnostic accuracy in patients in whom PVE is suspected. FDG PET/CT should be implemented early in the diagnostic workup to prevent the negative confounding effects of low inflammatory activity (eg, attributable to prolonged antibiotic therapy). Recent valve implantation was not a significant predictor of false-positive interpretations, but surgical adhesives used during implantation were.
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Affiliation(s)
- Laurens E Swart
- Department of Radiology and Nuclear Medicine (L.E.S., G.P.K., R.P.J.B.), Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Cardiology (L.E.S., J.W.R.-H.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anna Gomes
- Department of Medical Microbiology (A.G., B.S.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Asbjørn M Scholtens
- Department of Nuclear Medicine, Meander Medical Center, Amersfoort, The Netherlands (A.M.S.)
| | - Bhanu Sinha
- Department of Medical Microbiology (A.G., B.S.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Wilco Tanis
- Heartcenter, Haga Teaching Hospital, The Hague, The Netherlands (W.T.)
| | - Marnix G E H Lam
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, The Netherlands (M.G.E.H.L.)
| | - Maureen J van der Vlugt
- Department of Cardiology (M.J.v.d.V.), Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Erik H J G Aarntzen
- Department of Radiology and Nuclear Medicine (E.H.J.G.A.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jan Bucerius
- Department of Radiology and Nuclear Medicine (J.B.), Maastricht University Medical Center, The Netherlands.,Cardiovascular Research Institute Maastricht (J.B.), Maastricht University Medical Center, The Netherlands.,Department of Nuclear Medicine, University Hospital Rheinisch-Westfälische Technische Hochschule (RWTH) Aachen, Germany (J.B.)
| | - Sander van Assen
- Department of Internal Medicine, Treant Care Group, Hoogeveen/Emmen/Stadskanaal, The Netherlands (S.v.A.)
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine (C.P.B.-R.), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Paul van Geel
- Department of Cardiology (P.P.v.G., J.P.v.M.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Gabriel P Krestin
- Department of Radiology and Nuclear Medicine (L.E.S., G.P.K., R.P.J.B.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost P van Melle
- Department of Cardiology (P.P.v.G., J.P.v.M.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jolien W Roos-Hesselink
- Department of Cardiology (L.E.S., J.W.R.-H.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Riemer H J A Slart
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center (R.H.J.A.S., A.W.J.M.G.), University of Groningen, University Medical Center Groningen, The Netherlands.,Department of Biomedical Photonic Imaging, University of Twente, Enschede, The Netherlands (R.H.J.A.S.)
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, Medical Imaging Center (R.H.J.A.S., A.W.J.M.G.), University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ricardo P J Budde
- Department of Radiology and Nuclear Medicine (L.E.S., G.P.K., R.P.J.B.), Erasmus Medical Center, Rotterdam, The Netherlands
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3
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Koenraadt WMC, Siebelink HMJ, Bartelings MM, Schalij MJ, van der Vlugt MJ, van den Bosch AE, Budde RPJ, Roos-Hesselink JW, Duijnhouwer AL, van den Hoven AT, DeRuiter MC, Jongbloed MRM. Coronary anatomy in Turner syndrome versus patients with isolated bicuspid aortic valves. Heart 2018; 105:701-707. [PMID: 30368485 DOI: 10.1136/heartjnl-2018-313724] [Citation(s) in RCA: 6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 09/25/2018] [Accepted: 09/26/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Variations in coronary anatomy, like absent left main stem and left dominant coronary system, have been described in patients with Turner syndrome (TS) and in patients with bicuspid aortic valves (BAV). It is unknown whether coronary variations in TS are related to BAV and to specific BAV subtypes. AIM To compare coronary anatomy in patients with TS with/without BAV versus isolated BAV and to study BAV morphology subtypes in these groups. METHODS Coronary anatomy and BAV morphology were studied in 86 patients with TS (20 TS-BAV, 66 TS-tricuspid aortic valve) and 86 patients with isolated BAV (37±13 years vs 42±15 years, respectively) by CT. RESULTS There was no significant difference in coronary dominance between patients with TS with and without BAV (25% vs 21%, p=0.933). BAVs with fusion of right and left coronary leaflets (RL BAV) without raphe showed a high prevalence of left coronary dominance in both TS-BAV and isolated BAV (both 38%). Absent left main stem was more often seen in TS-BAV as compared with isolated BAV (10% vs 0%). All patients with TS-BAV with absent left main stem had RL BAV without raphe. CONCLUSION The equal distribution of left dominance in RL BAV without raphe in TS-BAV and isolated BAV suggests that presence of left dominance is a feature of BAVs without raphe, independent of TS. Both TS and RL BAV without raphe seem independently associated with absent left main stems. Awareness of the higher incidence of particularly absent left main stems is important to avoid complications during hypothermic perfusion.
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Affiliation(s)
- Wilke M C Koenraadt
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Margot M Bartelings
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Ricardo P J Budde
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique R M Jongbloed
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Anatomy and Embryology, Leiden University Medical Center, Leiden, The Netherlands
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4
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van Alebeek ME, Arntz RM, Ekker MS, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Risk factors and mechanisms of stroke in young adults: The FUTURE study. J Cereb Blood Flow Metab 2018; 38:1631-1641. [PMID: 28534705 PMCID: PMC6120122 DOI: 10.1177/0271678x17707138] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 03/17/2017] [Indexed: 11/16/2022]
Abstract
Incidence of ischemic stroke and transient ischemic attack in young adults is rising. However, etiology remains unknown in 30-40% of these patients when current classification systems designed for the elderly are used. Our aim was to identify risk factors according to a pediatric approach, which might lead to both better identification of risk factors and provide a stepping stone for the understanding of disease mechanism, particularly in patients currently classified as "unknown etiology". Risk factors of 656 young stroke patients (aged 18-50) of the FUTURE study were categorized according to the "International Pediatric Stroke Study" (IPSS), with stratification on gender, age and stroke of "unknown etiology". Categorization of risk factors into ≥1 IPSS category was possible in 94% of young stroke patients. Chronic systemic conditions were more present in patients aged <35 compared to patients ≥35 (32.6% vs. 15.6%, p < 0.05). Among 226 patients classified as "stroke of unknown etiology" using TOAST, we found risk factors in 199 patients (88%) with the IPSS approach. We identified multiple risk factors linked to other mechanisms of stroke in the young than in the elderly . This can be a valuable starting point to develop an etiologic classification system specifically designed for young stroke patients.
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Affiliation(s)
- Mayte E van Alebeek
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Merel S Ekker
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth
Tweesteden Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
| | - Noortje AMM Maaijwee
- Center for Neurology and
Neurorehabilitation, Luzern State Hospital, Luzern, Switzerland
| | - Hennie Schoonderwaldt
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Center for
Neuroscience, Radboudumc, Donders Institute for Brain, Cognition and Behaviour,
Nijmegen, The Netherlands
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5
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Bons LR, Duijnhouwer AL, Boccalini S, van den Hoven AT, van der Vlugt MJ, Chelu RG, McGhie JS, Kardys I, van den Bosch AE, Siebelink HMJ, Nieman K, Hirsch A, Broberg CS, Budde RPJ, Roos-Hesselink JW. Intermodality variation of aortic dimensions: How, where and when to measure the ascending aorta. Int J Cardiol 2018; 276:230-235. [PMID: 30213599 DOI: 10.1016/j.ijcard.2018.08.067] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 05/23/2018] [Revised: 08/14/2018] [Accepted: 08/22/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND No established reference-standard technique is available for ascending aortic diameter measurements. The aim of this study was to determine agreement between modalities and techniques. METHODS In patients with aortic pathology transthoracic echocardiography, computed tomography angiography (CTA) and magnetic resonance angiography (MRA) were performed. Aortic diameters were measured at the sinus of Valsalva (SoV), sinotubular junction (STJ) and tubular ascending aorta (TAA) during mid-systole and end-diastole. In echocardiography both the inner edge-to-inner edge (I-I edge) and leading edge-to‑leading edge (L-L edge) methods were applied, and the length of the aortic annulus to the most cranial visible part of the ascending aorta was measured. In CTA and MRA the I-I method was used. RESULTS Fifty patients with bicuspid aortic valve (36 ± 13 years, 26% female) and 50 Turner patients (35 ± 13 years) were included. Comparison of all aortic measurements showed a mean difference of 5.4 ± 2.7 mm for the SoV, 5.1 ± 2.0 mm for the STJ and 4.8 ± 2.1 mm for the TAA. The maximum difference was 18 mm. The best agreement was found between echocardiography L-L edge and CTA during mid-systole. CTA and MRA showed good agreement. A mean difference of 1.5 ± 1.3 mm and 1.8 ± 1.5 mm was demonstrated at the level of the STJ and TAA comparing mid-systolic with end-diastolic diameters. The visible length of the aorta increased on average 5.3 ± 5.1 mmW during mid-systole. CONCLUSIONS MRA and CTA showed best agreement with L-L edge method by echocardiography. In individual patients large differences in ascending aortic diameter were demonstrated, warranting measurement standardization. The use of CTA or MRA is advised at least once.
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Affiliation(s)
- Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | - Sara Boccalini
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Raluca G Chelu
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Jackie S McGhie
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | | | | | - Koen Nieman
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands; Departments of Cardiovascular medicine and Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Alexander Hirsch
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Craig S Broberg
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, OR, USA
| | - Ricardo P J Budde
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
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6
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Schellekens MMI, van Alebeek ME, Arntz RM, Synhaeve NE, Maaijwee NAMM, Schoonderwaldt HC, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LCA, de Leeuw FE. Prothrombotic factors do not increase the risk of recurrent ischemic events after cryptogenic stroke at young age: the FUTURE study. J Thromb Thrombolysis 2018; 45:504-511. [PMID: 29480382 PMCID: PMC5889776 DOI: 10.1007/s11239-018-1631-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND The role of hypercoagulable states and preceding infections in the etiology of young stroke and their role in developing recurrent ischemic events remains unclear. Our aim is to determine the prevalence of these conditions in patients with cryptogenic stroke at young age and to assess the long-term risk of recurrent ischemic events in patients with and without a hypercoagulable state or a recent pre-stroke infection with Borrelia or Syphilis. PATIENTS AND METHODS We prospectively included patients with a first-ever transient ischemic attack or ischemic stroke, aged 18-50, admitted to our hospital between 1995 and 2010. A retrospective analysis was conducted of prothrombotic factors and preceding infections. Outcome was recurrent ischemic events. RESULTS Prevalence of prothrombotic factors did not significantly differ between patients with a cryptogenic stroke and with an identified cause (24/120 (20.0%) and 32/174 (18.4%) respectively). In patients with a cryptogenic stroke the long-term risk [mean follow-up of 8.9 years (SD 4.6)] of any recurrent ischemic event or recurrent cerebral ischemia did not significantly differ between patients with and without a hypercoagulable state or a recent infection. In patients with a cryptogenic stroke 15-years cumulative risk of any recurrent ischemic event was 24 and 23% in patients with and without any prothrombotic factor respectively. CONCLUSIONS The prevalence of prothrombotic factors and preceding infections did not significantly differ between stroke patients with a cryptogenic versus an identified cause of stroke and neither is significantly associated with an increased risk of recurrent ischemic events after cryptogenic stroke.
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Affiliation(s)
- Mijntje M I Schellekens
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Mayte E van Alebeek
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Renate M Arntz
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, Elisabeth Tweesteden Hospital, PO Box 90151, 5000 LC, Tilburg, The Netherlands
| | - Noortje A M M Maaijwee
- Center for Neurology and Neurorehabilitation, Luzern State Hospital, Spitalstrasse 31, 6000, Luzern 16, Switzerland
| | - Hennie C Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, RadboudUMC, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
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7
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van Alebeek ME, de Vrijer M, Arntz RM, Maaijwee NA, Synhaeve NE, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, de Heus R, Rutten-Jacobs LC, de Leeuw FE. Increased Risk of Pregnancy Complications After Stroke. Stroke 2018; 49:877-883. [DOI: 10.1161/strokeaha.117.019904] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/02/2018] [Accepted: 01/29/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Mayte E. van Alebeek
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Myrthe de Vrijer
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Renate M. Arntz
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Noortje A.M.M. Maaijwee
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Nathalie E. Synhaeve
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Hennie Schoonderwaldt
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Maureen J. van der Vlugt
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Ewoud J. van Dijk
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Roel de Heus
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Loes C.A. Rutten-Jacobs
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
| | - Frank-Erik de Leeuw
- From the Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Center for Neuroscience (M.E.v.A., M.d.V., R.M.A., H.S., E.J.v.D., F.-E.d.L.) and Department of Cardiology (M.J.v.d.V.), Radboud University Nijmegen Medical Center, the Netherlands; Center for Neurology and Neurorehabilitation, State Hospital, Switzerland (N.A.M.M.M.); Department of Neurology, St. Elisabeth Hospital, the Netherlands (N.E.S.); Division of Woman and Baby, Birth Center, University Utrecht Medical
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Arntz RM, van Alebeek ME, Synhaeve NE, van Pamelen J, Maaijwee NA, Schoonderwaldt H, van der Vlugt MJ, van Dijk EJ, Rutten-Jacobs LC, de Leeuw FE. The very long-term risk and predictors of recurrent ischaemic events after a stroke at a young age: The FUTURE study. Eur Stroke J 2016; 1:337-345. [PMID: 31008296 DOI: 10.1177/2396987316673440] [Citation(s) in RCA: 5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 09/16/2016] [Indexed: 11/15/2022] Open
Abstract
Introduction Patients who suffer a stroke at a young age, remain at a substantial risk of developing recurrent vascular events and information on very long-term prognosis and its risk factors is indispensable. Our aim is to investigate this very long-term risk and associated risk factors up to 35 years after stroke. Patients and methods Prospective cohort study among 656 patients with a first-ever ischaemic stroke or transient ischaemic stroke (TIA), aged 18-50, who visited our hospital (1980-2010). Outcomes assessed at follow-up (2014-2015) included TIA or ischaemic stroke and other arterial events, whichever occurred first. Kaplan-Meier analysis quantified cumulative risks. A prediction model was constructed to assess risk factors independently associated with any ischaemic event using Cox proportional hazard analyses followed by bootstrap validation procedure to avoid overestimation. Results Mean follow-up was 12.4 (SD 8.2) years (8105 person-years). Twenty-five years cumulative risk was 45.4% (95%CI: 39.4-51.5) for any ischaemic event, 30.1% (95%CI: 24.8-35.4) for cerebral ischaemia and 27.0% (95%CI: 21.1-33.0) for other arterial events. Risk factors retained in the prediction model were smoking (HR 1.35, 95%CI: 1.04-1.74), poor kidney function (HR 2.10, 95%CI: 1.32-3.35), history of peripheral arterial disease (HR 2.10, 95%CI: 1.08-3.76) and cardiac disease (HR 1.84, 95%CI: 1.06-3.18) (C-statistic 0.59 (95%CI: 0.55-0.64)). Discussion and conclusion Young stroke patients remain at a substantial risk for recurrent events; almost 1 of 2 develops a recurrent ischaemic event and 1 of 3 develops a recurrent stroke or TIA during 25 years of follow-up. Risk factors independently associated with recurrent events were poor kidney function, smoking, history of peripheral arterial disease and cardiac disease.
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Affiliation(s)
- Renate M Arntz
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Mayte E van Alebeek
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | - Nathalie E Synhaeve
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands.,Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Jeske van Pamelen
- Department of Neurology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - Noortje Amm Maaijwee
- Centre for Neurology and Neurorehabilitation, State Hospital, Luzern, Switzerland
| | - Hennie Schoonderwaldt
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | | | - Ewoud J van Dijk
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
| | | | - Frank-Erik de Leeuw
- Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Nijmegen, The Netherlands
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Synhaeve NE, van Alebeek ME, Arntz RM, Maaijwee NA, Rutten-Jacobs LC, Schoonderwaldt HC, de Kort PL, van der Vlugt MJ, Van Dijk EJ, Wetzels JF, de Leeuw FE. Kidney Dysfunction Increases Mortality and Incident Events after Young Stroke: The FUTURE Study. Cerebrovasc Dis 2016; 42:224-31. [DOI: 10.1159/000444683] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 01/28/2016] [Indexed: 11/19/2022] Open
Abstract
Background: In about 30% of young stroke patients, no cause can be identified. In elderly patients, kidney dysfunction has been suggested as a contributing risk factor for mortality as well as stroke. There are hypotheses that novel non-traditional risk factors, like chronic inflammation and oxidative stress, are involved in chronic kidney disease, affecting the cerebral microvasculature that would in turn lead to stroke. Our objective is to investigate the influence of kidney dysfunction on long-term mortality and incident vascular events after stroke in young adults aged 18 through 50 and if this relationship would be independent of other cardiovascular risk factors. Methods: We prospectively included 460 young stroke patients with an ischemic stroke or transient ischemic attack admitted to our department between January 1, 1980 and November 1, 2010. Follow-up was done between 2014 and 2015. Estimated glomerular filtration rate (eGFR) was calculated from baseline creatinine levels and was divided in 3 subgroups: eGFR <60, 60-120 and >120 ml/min/1.73 m2. Cox proportional hazard models were used to determine the effect of kidney dysfunction on mortality and incident vascular events, adjusting for cardiovascular risk factors. Results: An eGFR <60 (HR 4.6; 95% CI 2.6-8.2) was associated with an increased risk of death and an increased risk of incident stroke (HR 4.1; 95% CI 1.9-9.0) independent of cardiovascular risk factors, but it was not associated with other vascular events. The point estimate for the 15-year cumulative mortality was 70% (95% CI 46-94) for patients with a low eGFR, 24% (95% CI 18-30) for patients with a normal eGFR and 30% (95% CI 12-48) for patients with a high eGFR. The point estimate for the 15-year cumulative risk of incident stroke was 45% (95% CI 16-74) for patients with a low eGFR, 13% (95% CI 9-17) for patients with a normal eGFR and 8% (95% CI 0-18) for patients with a high eGFR. Conclusions: Kidney dysfunction is related to long-term mortality and stroke recurrence, but not to incident cardiovascular disease, on average 11 years after young stroke. This warrants a more intensive follow-up of young stroke patients with signs of kidney dysfunction in the early phase. In addition, the clear association between kidney dysfunction and incident stroke seen in our young stroke population might be a first step in the recognition of kidney dysfunction as a new risk factor for the development of stroke at young age. Also, it can lead to new insights in the etiological differences between cardiovascular and cerebrovascular disease.
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Willemsen AECAB, Bredie SJHB, Lobo CM, van der Vlugt MJ, Kramers C. [Choosing wisely when prescribing statins]. Ned Tijdschr Geneeskd 2015; 159:A8695. [PMID: 25990330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The Dutch campaign 'Verstandig kiezen', based on the American programme 'Choosing wisely', aims to improve quality in healthcare, with attention to cost control. The 'Choosing wisely'-based programme can be applied in the choice of a statin. Atorvastatin and rosuvastatin are regarded as equal choices in various guidelines regarding cardiovascular risk management. Generic atorvastatin is available, and is approximately 25 times cheaper than rosuvastatin in almost equipotent doses. Rosuvastatin provides a greater LDL reduction than atorvastatin. Patient LDL targets can usually be achieved with atorvastatin, and rosuvastatin is not needed. At group level, there are no relevant differences in adverse-events profile between both statins. Atorvastatin and rosuvastatin do have different pharmacokinetic interactions. When changing medication, good provision of information is a prerequisite for patient satisfaction and compliance. We advise use of atorvastatin instead of rosuvastatin as drug of choice when the LDL target is not reached using simvastatin. However, under specific conditions, rosuvastatin should be the treatment of choice. Efficacy and adverse effects should then be evaluated at individual patient level.
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11
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Stevens DU, Al-Nasiry S, Fajta MM, Bulten J, van Dijk AP, van der Vlugt MJ, Oyen WJ, van Vugt JM, Spaanderman ME. Cardiovascular and thrombogenic risk of decidual vasculopathy in preeclampsia. Am J Obstet Gynecol 2014; 210:545.e1-6. [PMID: 24370690 DOI: 10.1016/j.ajog.2013.12.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 10/22/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Women with a history of preeclampsia (PE) have an increased prevalence of cardiometabolic, cardiovascular, and prothrombotic risk factors. Remotely, these women are at increased risk of developing cardiovascular and thrombotic disease. Decidual vasculopathy (DV) describes vascular lesions in the maternal spiral arteries of the uterus, which are found in approximately 40-60% of women with PE. DV is thought to be related to atherosclerosis because of their morphological similarity. The aim of this study was to investigate the association of cardiovascular and thrombogenic risk factors with DV in women with a history of PE. STUDY DESIGN We retrospectively analyzed the cardiovascular and thrombogenic risk of women with a history of PE, comparing cases with DV (n = 95) with cases without the lesions (n = 81) 7 months after the index pregnancy. Data from a cohort of patients with a history of PE were matched with records from our pathology database. RESULTS The DV group showed higher diastolic blood pressure (73 vs 70 mm Hg, P = .031), lower left ventricular stroke volume (71 vs 76 mL, P = .032), higher total peripheral vascular resistance (1546 vs 1385, P = .009), and a higher percentage of low plasma volume (34% vs 19%, P = .030). DV did not relate to other cardiovascular parameters, urinary protein, body mass index, lipid or glucose metabolism parameters, or thrombophilia. CONCLUSION In this study, in women with a history of PE, cases with DV had increased cardiovascular risk, exhibiting circulatory alterations, suggesting reduced venous reserves and elevated arterial tone, without metabolic or thrombophilic disturbances.
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Arntz RM, van Alebeek ME, Synhaeve NE, Brouwers PJ, van Dijk GW, Gons RA, den Heijer T, de Kort PLM, de Laat KF, van Norden AG, Vermeer SE, van der Vlugt MJ, Kessels RPC, van Dijk EJ, de Leeuw FE. Observational Dutch Young Symptomatic StrokE studY (ODYSSEY): study rationale and protocol of a multicentre prospective cohort study. BMC Neurol 2014; 14:55. [PMID: 24655479 PMCID: PMC3998025 DOI: 10.1186/1471-2377-14-55] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 03/05/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The proportion of strokes occurring in younger adults has been rising over the past decade. Due to the far longer life expectancy in the young, stroke in this group has an even larger socio-economic impact. However, information on etiology and prognosis remains scarce. METHODS/DESIGN ODYSSEY is a multicentre prospective cohort study on the prognosis and risk factors of patients with a first-ever TIA, ischemic stroke or intracerebral hemorrhage aged 18 to 49 years. Our aim is to include 1500 patients. Primary outcome will be all cause mortality and risk of recurrent vascular events. Secondary outcome will be the risk of post-stroke epilepsy and cognitive impairment. Patients will complete structured questionnaires on outcome measures and risk factors. Both well-documented and less well-documented risk factors and potentially acute trigger factors will be investigated. Patients will be followed every 6 months for at least 3 years. In addition, an extensive neuropsychological assessment will be administered both at baseline and 1 year after the stroke/TIA. Furthermore we will include 250 stroke-free controls, who will complete baseline assessment and one neuropsychological assessment. DISCUSSION ODYSSEY is designed to prospectively determine prognosis after a young stroke and get more insight into etiology of patients with a TIA, ischemic stroke and intracerebral hemorrhage in patients aged 18 to 49 years old in a large sample size.
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Affiliation(s)
- Renate M Arntz
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Mayte E van Alebeek
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Nathalie E Synhaeve
- Department of Neurology, St. Elisabeth Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
- Department of Neurology, TweeSteden Hospital, PO Box 90107, 5000, LA Tilburg, the Netherlands
| | - Paul J Brouwers
- Department of Neurology, Medisch Spectrum Twente, PO Box 50000, 7500, KA Enschede, the Netherlands
| | - Gert W van Dijk
- Department of Neurology, Canisius-Wilhelmina Hospital, PO Box 9015, 6500, GS Nijmegen, the Netherlands
| | - Rob A Gons
- Department of Neurology, Catharina Hospital, PO Box 1350, 5602, ZA Eindhoven, the Netherlands
| | - Tom den Heijer
- Department of Neurology, Sint Franciscus Gasthuis, PO Box 109000, 3004, BA Rotterdam, the Netherlands
| | - Paul LM de Kort
- Department of Neurology, St. Elisabeth Hospital, PO Box 90151, 5000, LC Tilburg, the Netherlands
- Department of Neurology, TweeSteden Hospital, PO Box 90107, 5000, LA Tilburg, the Netherlands
| | - Karlijn F de Laat
- Department of Neurology, Haga Hospital, PO Box 40551, 2504, LN Den Haag, Netherlands
| | - Anouk G van Norden
- Department of Neurology, Amphia Hospital, PO Box 90157, 4800, RL Breda, the Netherlands
| | - Sarah E Vermeer
- Department of Neurology, Rijnstate Hospital, PO Box 9555, 6800, TA Arnhem, the Netherlands
| | - Maureen J van der Vlugt
- Radboud University Medical Centre, department of Cardiology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Roy PC Kessels
- Department of Medical Psychology, Radboud University Medical Centre, PO Box 9101, 6500, HB Nijmegen, the Netherlands
- Donders Institute for Brain, Radboud University Nijmegen, Cognition and Behaviour, Nijmegen, the Netherlands
| | - Ewoud J van Dijk
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
| | - Frank-Erik de Leeuw
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Center for Neuroscience, department of Neurology, PO Box 9101, 6500, HB Nijmegen, the Netherlands
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Rutten-Jacobs LCA, Maaijwee NAM, Arntz RM, Schoonderwaldt HC, Dorresteijn LD, van der Vlugt MJ, van Dijk EJ, de Leeuw FE. Long-term risk of recurrent vascular events after young stroke: The FUTURE study. Ann Neurol 2013; 74:592-601. [DOI: 10.1002/ana.23953] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 05/07/2013] [Accepted: 05/18/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Loes C. A. Rutten-Jacobs
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Noortje A. M. Maaijwee
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Renate M. Arntz
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Henny C. Schoonderwaldt
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | | | | | - Ewoud J. van Dijk
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
| | - Frank-Erik de Leeuw
- Department of Neurology, Donders Institute for Brain, Cognition, and Behavior; Radboud University Nijmegen Medical Center; Nijmegen
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Rutten-Jacobs LCA, Maaijwee NAM, Arntz RM, Van Alebeek ME, Schaapsmeerders P, Schoonderwaldt HC, Dorresteijn LDA, Overeem S, Drost G, Janssen MC, van Heerde WL, Kessels RPC, Zwiers MP, Norris DG, van der Vlugt MJ, van Dijk EJ, de Leeuw FE. Risk factors and prognosis of young stroke. The FUTURE study: a prospective cohort study. Study rationale and protocol. BMC Neurol 2011; 11:109. [PMID: 21933424 PMCID: PMC3185265 DOI: 10.1186/1471-2377-11-109] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 09/20/2011] [Indexed: 11/13/2022] Open
Abstract
Background Young stroke can have devastating consequences with respect to quality of life, the ability to work, plan or run a family, and participate in social life. Better insight into risk factors and the long-term prognosis is extremely important, especially in young stroke patients with a life expectancy of decades. To date, detailed information on risk factors and the long-term prognosis in young stroke patients, and more specific risk of mortality or recurrent vascular events, remains scarce. Methods/Design The FUTURE study is a prospective cohort study on risk factors and prognosis of young ischemic and hemorrhagic stroke among 1006 patients, aged 18-50 years, included in our study database between 1-1-1980 and 1-11-2010. Follow-up visits at our research centre take place from the end of 2009 until the end of 2011. Control subjects will be recruited among the patients' spouses, relatives or social environment. Information on mortality and incident vascular events will be retrieved via structured questionnaires. In addition, participants are invited to the research centre to undergo an extensive sub study including MRI. Discussion The FUTURE study has the potential to make an important contribution to increase the knowledge on risk factors and long-term prognosis in young stroke patients. Our study differs from previous studies by having a maximal follow-up of more than 30 years, including not only TIA and ischemic stroke but also hemorrhagic stroke, the addition of healthy controls and prospectively collect data during an extensive follow-up visit. Completion of the FUTURE study may provide better information for treating physicians and patients with respect to the prognosis of young stroke.
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Affiliation(s)
- Loes C A Rutten-Jacobs
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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van Norden AG, de Laat KF, Gons RA, van Uden IW, van Dijk EJ, van Oudheusden LJ, Esselink RA, Bloem BR, van Engelen BG, Zwarts MJ, Tendolkar I, Olde-Rikkert MG, van der Vlugt MJ, Zwiers MP, Norris DG, de Leeuw FE. Causes and consequences of cerebral small vessel disease. The RUN DMC study: a prospective cohort study. Study rationale and protocol. BMC Neurol 2011; 11:29. [PMID: 21356112 PMCID: PMC3053228 DOI: 10.1186/1471-2377-11-29] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 02/28/2011] [Indexed: 12/17/2022] Open
Abstract
Background Cerebral small vessel disease (SVD) is a frequent finding on CT and MRI scans of elderly people and is related to vascular risk factors and cognitive and motor impairment, ultimately leading to dementia or parkinsonism in some. In general, the relations are weak, and not all subjects with SVD become demented or get parkinsonism. This might be explained by the diversity of underlying pathology of both white matter lesions (WML) and the normal appearing white matter (NAWM). Both cannot be properly appreciated with conventional MRI. Diffusion tensor imaging (DTI) provides alternative information on microstructural white matter integrity. The association between SVD, its microstructural integrity, and incident dementia and parkinsonism has never been investigated. Methods/Design The RUN DMC study is a prospective cohort study on the risk factors and cognitive and motor consequences of brain changes among 503 non-demented elderly, aged between 50-85 years, with cerebral SVD. First follow up is being prepared for July 2011. Participants alive will be included and invited to the research centre to undergo a structured questionnaire on demographics and vascular risk factors, and a cognitive, and motor, assessment, followed by a MRI protocol including conventional MRI, DTI and resting state fMRI. Discussion The follow up of the RUN DMC study has the potential to further unravel the causes and possibly better predict the consequences of changes in white matter integrity in elderly with SVD by using relatively new imaging techniques. When proven, these changes might function as a surrogate endpoint for cognitive and motor function in future therapeutic trials. Our data could furthermore provide a better understanding of the pathophysiology of cognitive and motor disturbances in elderly with SVD. The execution and completion of the follow up of our study might ultimately unravel the role of SVD on the microstructural integrity of the white matter in the transition from "normal" aging to cognitive and motor decline and impairment and eventually to incident dementia and parkinsonism.
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Affiliation(s)
- Anouk Gw van Norden
- Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Neurology, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Aalten J, Peeters SA, van der Vlugt MJ, Hoitsma AJ. Is standardized cardiac assessment of asymptomatic high-risk renal transplant candidates beneficial? Nephrol Dial Transplant 2011; 26:3006-12. [PMID: 21321004 DOI: 10.1093/ndt/gfq822] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Perioperative cardiovascular events in renal transplantation are common and non-invasive cardiac stress tests are recommended in high-risk renal transplant candidates. In 2004, we introduced a standardized preoperative cardiac risk assessment programme with the aim of reducing perioperative cardiac events. METHODS Since 2004, all asymptomatic high-risk renal transplant candidates had to undergo non-invasive cardiac stress testing. Patients with a positive stress test went for a coronary angiography and if indicated for revascularization. The incidence of perioperative cardiac events (≤30 days of transplantation) was analysed in all high-risk patients who received a transplantation (screening group) and compared with high-risk renal transplant recipients evaluated in the 4 years before the introduction of the cardiac assessment programme (historical control group). RESULTS Since 2004, 227 of 349 asymptomatic high-risk renal transplant candidates underwent non-invasive cardiac stress testing. In 15 patients (6.6%), significant ischaemia was found. Ten of these 15 patients underwent coronary angiography (eight patients had significant coronary artery disease and in five patients, percutaneous coronary intervention was performed). One hundred and sixty of 349 renal transplant candidates have received renal transplantation so far (screening group). In the screening group, 6 perioperative cardiac events (3.8%) occurred compared to 13 perioperative events (7.6%) in the historical control group (n = 172) (P = 0.136). CONCLUSIONS The incidence of significant cardiac ischaemia in high-risk renal transplant patients was low and was followed by revascularization in a small percentage of patients. No significant decrease in perioperative cardiac events was observed after the introduction of the standardized cardiac assessment programme.
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Affiliation(s)
- Jeroen Aalten
- Department of Nephrology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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van der Vlugt MJ, van Domburg RT, Pedersen SS, Veerhoek RJ, Leenders IM, Pop GAM, ter Keurs D, Deckers JW, Simoons ML, Erdman RAM. Feelings of being disabled as a risk factor for mortality up to 8 years after acute myocardial infarction. J Psychosom Res 2005; 59:247-53. [PMID: 16223628 DOI: 10.1016/j.jpsychores.2005.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Revised: 12/07/2004] [Accepted: 03/15/2005] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We examined the independent prognostic value of the four subscales of the Heart Patients Psychological Questionnaire (HPPQ) on mortality in acute myocardial infarction (AMI) survivors up to 8 years after the event. METHODS The HPPQ, which measures well-being, feelings of being disabled, despondency and social inhibition, was administered to 567 AMI patients during hospitalisation and at 3 months follow-up. The patients were followed for 8 years. RESULTS During follow-up, 157 patients (28%) died. Forty-one percent of the patients had a score indicating at least mild to moderate feelings of being disabled. Patients with feelings of being disabled were at increased risk of mortality compared with those having a low score, adjusted for other cardiac risk factors [hazard ratio (HR)=1.8, 95% confidence interval (CI)=1.3-2.5]. There was no interaction between feelings of being disabled and gender. None of the other HPPQ subscales were related to mortality or recurrent myocardial infarction (MI). When the study population was stratified by low and high clinical risk (43% vs. 57%, respectively), feelings of being disabled was the most prominent predictor of mortality in the low-risk group (HR=3.5, 95% CI=1.4-8.8). CONCLUSION Feelings of being disabled measured at baseline and at 3 months was the most prominent predictor of mortality in low-risk patients 8 years post-MI. This finding adds to the existing knowledge that psychosocial variables influence morbidity and mortality in cardiac patients.
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