273 results on '"Schalij, Martin J"'
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2. An omission in guidelines. Cardiovascular disease prevention should also focus on dietary policies for healthcare facilities.
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de Frel, Daan L., Assendelft, Willem J.J., Hondmann, Sara, Janssen, Veronica R., Molema, Johanna J.W., Trines, Serge A., de Vries, Iris A.C., Schalij, Martin J., and Atsma, Douwe E.
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Suboptimal diet is a major modifiable risk factor in cardiovascular disease. Governments, individuals, educational institutes, healthcare facilities and the industry all share the responsibility to improve dietary habits. Healthcare facilities in particular present a unique opportunity to convey the importance of healthy nutrition to patients, visitors and staff. Guidelines on cardiovascular disease do include policy suggestions for population-based approaches to diet in a broad list of settings. Regrettably, healthcare facilities are not explicitly included in this list. The authors propose to explicitly include healthcare facilities as a setting for policy suggestions in the current and future ESC Guidelines for cardiovascular disease prevention in clinical practice. [ABSTRACT FROM AUTHOR]
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- 2023
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3. Tolerability and beneficial effects of sacubitril/valsartan on systemic right ventricular failure
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Nederend, Marieke, Kiès, Philippine, Regeer, Madelien V, Vliegen, Hubert W, Mertens, Bart JA, Robbers-Visser, Danie¨lle, Bouma, Berto J, Tops, Laurens F, Schalij, Martin J, Jongbloed, Monique R M, and Egorova, Anastasia D
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ObjectivePatients with a systemic right ventricle (sRV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are prone to sRV dysfunction. Pharmacological options for sRV failure remain poorly defined. This study aims to investigate the tolerability and effects of sacubitril/valsartan on sRV failure in adult patients with sRV.MethodsIn this two-centre, prospective cohort study, all consecutive adult patients with symptomatic heart failure and at least moderately reduced sRV systolic function were initiated on sacubitril/valsartan and underwent structured follow-up.ResultsData of 40 patients were included (40% female, 30% ccTGA, median age 48 (44–53) years). Five patients discontinued therapy during titration. Median follow-up was 24 (12–36) months. The maximal dose was tolerated by 49% of patients. No episodes of hyperkalaemia or renal function decline occurred. Six-minute walking distance increased significantly after 6 months of treatment (569±16 to 597±16 m, p=0.016). Serum N-terminal-prohormone brain natriuretic peptide (NT-proBNP) levels decreased significantly after 3 months (567 (374–1134) to 404 (226–633) ng/L, p<0.001). Small, yet consistent echocardiographic improvements in sRV function were observed after 6 months (sRV global longitudinal strain: −11.1±0.5% to −12.6±0.7%, p<0.001, and fractional area change: 20% (16%−24%) to 26% (19%−30%), p<0.001). The linear mixed-effects model illustrated that after first follow-up moment, no time effect was present for the parameters.ConclusionsTreatment with sacubitril/valsartan was associated with a low rate of adverse effects in this adult sRV cohort. Persisting improvement in 6-minute walking test distance, NT-proBNP levels and echocardiographic parameters of sRV function was observed in an on-treatment analysis and showed no differential response based on sex or anatomy.
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- 2023
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4. Managing Hospital Capacity: Achievements and Lessons from the COVID-19 Pandemic
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de Koning, Enrico R., Boogers, Mark J., Beeres, Saskia LMA, Kramer, Iwona D., Dannenberg, Wouter J., and Schalij, Martin J.
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AbstractIntroduction:The coronavirus disease 2019 (COVID-19) pandemic challenged health care systems in an unprecedented way. Due to the enormous amount of hospital ward and intensive care unit (ICU) admissions, regular care came to a standstill, thereby overcrowding ICUs and endangering (regular and COVID-19-related) critical care. Acute care coordination centers were set up to safely manage the influx of COVID-19 patients. Furthermore, treatments requiring ICU surveillance were postponed leading to increased waiting lists.Hypothesis:A coordination center organizing patient transfers and admissions could reduce overcrowding and optimize in-hospital capacity.Methods:The acute lack of hospital capacity urged the region West-Netherlands to form a new regional system for patient triage and transfer: the Regional Capacity and Patient Transfer Service (RCPS). By combining hospital capacity data and a new method of triage and transfer, the RCPS was able to effectively select patients for transfer to other hospitals within the region or, in close collaboration with the National Capacity and Patient Transfer Service (LCPS), transfer patients to hospitals in other regions within the Netherlands.Results:From March 2020 through December 2021 (22 months), the RCPS West-Netherlands was requested to transfer 2,434 COVID-19 patients. After adequate triage, 1,720 patients with a mean age of 62 (SD = 13) years were transferred with the help of the RCPS West-Netherlands. This concerned 1,166 ward patients (68%) and 554 ICU patients (32%). Overcrowded hospitals were relieved by transferring these patients to hospitals with higher capacity.Conclusion:The health care system in the region West-Netherlands benefitted from the RCPS for both ward and ICU occupation. Due to the coordination by the RCPS, regional ICU occupation never exceeded the maximal ICU capacity, and therefore patients in need for acute direct care could always be admitted at the ICU. The presented method can be useful in reducing the waiting lists caused by the delayed care and for coordination and transfer of patients with new variants or other infectious diseases in the future.
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- 2022
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5. Original Research: Long-Term Prognosis After ST-Elevation Myocardial Infarction in Patients with a Prior Cancer Diagnosis.
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Heemelaar, Julius C., Polomski, Elissa A. S., Mertens, Bart J. A., Jukema, J. Wouter, Schalij, Martin J., and Antoni, M. Louisa
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- 2022
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6. Original Research: Long-Term Prognosis After ST-Elevation Myocardial Infarction in Patients with a Prior Cancer Diagnosis
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Heemelaar, Julius C., Polomski, Elissa A. S., Mertens, Bart J. A., Jukema, J. Wouter, Schalij, Martin J., and Antoni, M. Louisa
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Introduction: It is unknown how long-term prognosis after ST-elevation myocardial infarction (STEMI) in patients with a prior cancer diagnosis is impacted by cancer-related factors as diagnosis, stage, and treatment. We aimed to assess long-term survival trends after STEMI in this population to evaluate both cardiovascular and cancer-related drivers of prognosis over a follow-up period of 5 years. Methods: In this retrospective single-center cohort study, patients with a prior cancer diagnosis admitted with STEMI between 2004 and 2014 and treated with primary percutaneous coronary intervention (PCI) were recruited from the STEMI clinical registry of our institution. Results: In the 211 included patients, the cumulative incidence of all-cause death after 5 years of follow-up was 38.1% (N= 60). The cause of death was predominantly malignancy-related (N= 29, 48.3% of deaths) and nine patients (15.0%) died of a cardiovascular cause. After correcting for age and sex, a recent cancer diagnosis (< 1 year relative to > 10 years, HR
adj 2.98 [95% CI: 1.39–6.41], p= 0.005) and distant metastasis at presentation (HRadj 4.02 [1.70–9.53], p= 0.002) were significant predictors of long-term mortality. While maximum levels of cardiac troponin-T and creatinine kinase showed significant association with mortality (resp. HRadj 1.34 [1.08–1.66], p= 0.008; HRadj 1.36 [1.05–1.76], p= 0.019), other known determinants of prognosis after STEMI, e.g., hypertension and renal insufficiency, were not significantly associated with survival. Conclusions: Patients with a prior cancer diagnosis admitted with STEMI have a poor survival rate. However, when the STEMI is optimally treated with primary PCI and medication, cardiac mortality is low, and prognosis is mainly determined by factors related to cancer stage.- Published
- 2022
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7. Utilization of diagnostic resources and costs in patients with suspected cardiac chest pain
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Vester, Marijke P M, Eindhoven, Daniëlle C, Bonten, Tobias N, Wagenaar, Holger, Holthuis, Hendrik J, Schalij, Martin J, de Grooth, Greetje J, and van Dijkman, Paul R M
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- 2021
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8. Vasoplegia After Restrictive Mitral Annuloplasty for Functional Mitral Regurgitation in Patients With Heart Failure.
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van Vessem, Marieke E., Petrus, Annelieke H.J., Palmen, Meindert, Braun, Jerry, Schalij, Martin J., Klautz, Robert J.M., and Beeres, Saskia L.M.A.
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Patients undergoing heart failure surgery are at risk for developing postoperative vasoplegia. The aim of this study was to determine the incidence, survival, and predictors of vasoplegia in heart failure patients undergoing mitral valve repair for functional mitral regurgitation and to evaluate the effect of ischemic versus non-ischemic etiology. Retrospective. University medical center, single institutional. Heart failure patients with functional mitral regurgitation who underwent restrictive mitral annuloplasty (2006-2015). One hundred twenty-two patients were included (48% ischemic etiology). The incidence of vasoplegia was 19% and was not influenced by mitral regurgitation etiology. Ninety-day survival rate was decreased in vasoplegic compared with non-vasoplegic patients (65% v 93%, p < 0.001). After adjusting for age, gender, and heart failure etiology, prior hypertension (odds ratio [OR] 0.28; 95% confidence interval [CI] 0.08-0.91; p = 0.034), higher creatinine clearance (OR 0.97; 95% CI 0.95-0.99; p = 0.009), and beta-blocker use (OR 0.25; 95% CI 0.09-0.73; p = 0.011) decreased the risk of vasoplegia. Anemia (OR 3.00; 95% CI 1.10-8.20; p = 0.032) and longer cross clamp (OR 1.03; 95% CI 1.01-1.04; p = 0.001), cardiopulmonary bypass (OR 1.01; 95% CI 1.00-1.02; p = 0.003), and procedure times (OR 1.01; 95% CI 1.00-1.02, p = 0.002) increased the risk of vasoplegia. Vasoplegia occurs in 19% of heart failure patients undergoing mitral valve repair for functional mitral regurgitation. It is associated with a poor early outcome. Prior hypertension, a higher creatinine clearance, and beta-blocker use were associated with a decreased risk of vasoplegia, whereas anemia and longer procedure times were associated with an increased risk of vasoplegia, independent of heart failure etiology. [ABSTRACT FROM AUTHOR]
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- 2019
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9. Sacubitril/valsartan in the treatment of systemic right ventricular failure
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Zandstra, Tjitske E, Nederend, Marieke, Jongbloed, Monique R M, Kiès, Philippine, Vliegen, Hubert W, Bouma, Berto J, Tops, Laurens F, Schalij, Martin J, and Egorova, Anastasia D
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ObjectivePharmacological options for patients with a failing systemic right ventricle (RV) in the context of transposition of the great arteries (TGA) after atrial switch or congenitally corrected TGA (ccTGA) are not well defined. This study aims to investigate the feasibility and effects of sacubitril/valsartan treatment in a single-centre cohort of patients.MethodsData on all consecutive adult patients (n=20, mean age 46 years, 50% women) with a failing systemic RV in a biventricular circulation treated with sacubitril/valsartan in our centre are reported. Patients with a systemic RV ejection fraction of ≤35% who were symptomatic despite treatment with β-blocker and ACE-inhibitor/angiotensin II receptor-blockers were started on sacubitril/valsartan. This cohort underwent structural follow-up including echocardiography, exercise testing, laboratory investigations and quality of life (QOL) assessment.ResultsSix-month follow-up data were available in 18 out of 20 patients, including 12 (67%) patients with TGA after atrial switch and 6 (33%) patients with ccTGA. N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) decreased significantly (950–358 ng/L, p<0.001). Echocardiographic systemic RV fractional area change and global longitudinal strain showed small improvements (19%–22%, p<0.001 and −11% to −13%, p=0.014, respectively). The 6 min walking distance improved significantly from an average of 564 to 600 m (p=0.011). The QOL domains of cognitive function, sleep and vitality improved (p=0.015, p=0.007 and p=0.037, respectively).ConclusionsWe describe the first patient cohort with systemic RV failure treated with sacubitril/valsartan. Treatment appears feasible with improvements in NT-pro-BNP and echocardiographic function. Our positive results show the potential of sacubitril/valsartan for this patient population.
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- 2021
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10. Prevalence and Prognostic Impact of Pathogenic Variants in Patients With Dilated Cardiomyopathy Referred for Ventricular Tachycardia Ablation
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Ebert, Micaela, Wijnmaalen, Adrianus P., de Riva, Marta, Trines, Serge A., Androulakis, Alexander F.A., Glashan, Claire A., Schalij, Martin J., Peter van Tintelen, J., Jongbloed, Jan D.H., and Zeppenfeld, Katja
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This study aimed to assess the frequency of (likely) pathogenic variants (LP/Pv) among dilated cardiomyopathy (DCM) ventricular tachycardia (VT) patients referred for CA and their impact on procedural outcome and long-term prognosis.
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- 2020
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11. Correlates and Long-Term Implications of Left Ventricular Mechanical Dispersion by Two-Dimensional Speckle-Tracking Echocardiography in Patients with ST-Segment Elevation Myocardial Infarction
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Abou, Rachid, Goedemans, Laurien, van der Bijl, Pieter, Fortuni, Federico, Prihadi, Edgard A., Mertens, Bart, Schalij, Martin J., Ajmone Marsan, Nina, Bax, Jeroen J., and Delgado, Victoria
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Left ventricular (LV) mechanical dispersion (LVMD), measured with speckle-tracking echocardiography (STE) after ST-segment elevation myocardial infarction (STEMI), has been proposed as a measurement of regional heterogeneity of myocardial contraction and may reflect changes in the myocardial structure (e.g., fibrosis or edema). Further insight into this parameter may aid in the risk stratification of STEMI patients.
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- 2020
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12. Familial occurrence of mitral regurgitation in patients with mitral valve prolapse undergoing mitral valve surgery
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Hiemstra, Yasmine L, Wijngaarden, Aniek L van, Bos, Mathilde W, Schalij, Martin J, Klautz, Robert JM, Bax, Jeroen J, Delgado, Victoria, Barge-Schaapveld, Daniela QCM, and Marsan, Nina Ajmone
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- 2020
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13. Familial occurrence of mitral regurgitation in patients with mitral valve prolapse undergoing mitral valve surgery
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Hiemstra, Yasmine L, Wijngaarden, Aniek L van, Bos, Mathilde W, Schalij, Martin J, Klautz, Robert JM, Bax, Jeroen J, Delgado, Victoria, Barge-Schaapveld, Daniela QCM, and Marsan, Nina Ajmone
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Background Initial studies have suggested the familial clustering of mitral valve prolapse, but most of them were either community based among unselected individuals or applied non-specific diagnostic criteria. Therefore little is known about the familial distribution of mitral regurgitation in a referral-type population with a more severe mitral valve prolapse phenotype. The objective of this study was to evaluate the presence of familial mitral regurgitation in patients undergoing surgery for mitral valve prolapse, differentiating patients with Barlow's disease, Barlow forme fruste and fibro-elastic deficiency.Methods A total of 385 patients (62 ± 12 years, 63% men) who underwent surgery for mitral valve prolapse were contacted to assess cardiac family history systematically. Only the documented presence of mitral regurgitation was considered to define ‘familial mitral regurgitation’. In the probands, the aetiology of mitral valve prolapse was defined by surgical observations.Results A total of 107 (28%) probands were classified as having Barlow's disease, 85 (22%) as Barlow forme fruste and 193 (50%) patients as fibro-elastic deficiency. In total, 51 patients (13%) reported a clear family history for mitral regurgitation; these patients were significantly younger, more often diagnosed with Barlow's disease and also reported more sudden death in their family as compared with ‘sporadic mitral regurgitation’. In particular, ‘familial mitral regurgitation’ was reported in 28 patients with Barlow's disease (26%), 15 patients (8%) with fibro-elastic deficiency and eight (9%) with Barlow forme fruste (P< 0.001).Conclusions In a large cohort of patients operated for mitral valve prolapse, the self-reported prevalence of familial mitral regurgitation was 26% in patients with Barlow's disease and still 8% in patients with fibro-elastic deficiency, highlighting the importance of familial anamnesis and echocardiographic screening in all mitral valve prolapse patients.
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- 2020
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14. Identification of known and unknown genes associated with mitral valve prolapse using an exome slice methodology
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van Wijngaarden, Aniek L, Hiemstra, Yasmine L, Koopmann, Tamara T, Ruivenkamp, Claudia A L, Aten, Emmelien, Schalij, Martin J, Bax, Jeroen J, Delgado, Victoria, Barge-Schaapveld, Daniela Q C M, and Ajmone Marsan, Nina
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PurposeAlthough a familial distribution has been documented, the genetic aetiology of mitral valve prolapse (MVP) is largely unknown, with only four genes identified so far: FLNA, DCHS1, DZIP1and PLD1. The aim of this study was to evaluate the genetic yield in known causative genes and to identify possible novel genes associated with MVP using a heart gene panel based on exome sequencing.MethodsPatients with MVP were referred for genetic counselling when a positive family history for MVP was reported and/or Barlow’s disease was diagnosed. In total, 101 probands were included to identify potentially pathogenic variants in a set of 522 genes associated with cardiac development and/or diseases.Results97 (96%) probands were classified as Barlow’s disease and 4 (4%) as fibroelastic deficiency. Only one patient (1%) had a likely pathogenic variant in the known causative genes (DCHS1). However, an interesting finding was that 10 probands (11%) had a variant that was classified as likely pathogenic in six different, mostly cardiomyopathy genes: DSP(1×), HCN4(1×), MYH6(1×), TMEM67(1×), TRPS1(1×) and TTN(5×).ConclusionExome slice sequencing analysis performed in MVP probands reveals a low genetic yield in known causative genes but may expand the cardiac phenotype of other genes. This study suggests for the first time that also genes related to cardiomyopathy may be associated with MVP. This highlights the importance to screen these patients and their family for the presence of arrhythmias and of ‘disproportionate’ LV remodelling as compared with the severity of mitral regurgitation, unravelling a possible coexistent cardiomyopathy.
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- 2020
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15. Growth Differentiation Factor-15 Levels at Admission Provide Incremental Prognostic Information on All-Cause Long-term Mortality in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention.
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Bodde, Mathijs C., Hermans, Maaike P. J., van der Laarse, Arnoud, Mertens, Bart, Romijn, Fred P. H. T. M., Schalij, Martin J., Cobbaert, Christa M., and Jukema, J. Wouter
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- 2019
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16. Plasma LDL-Cholesterol Level at Admission is Independently Associated with Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention.
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Bodde, Mathijs C., Hermans, Maaike P. J., Wolterbeek, Ron, Cobbaert, Christa M., van der Laarse, Arnoud, Schalij, Martin J., and Jukema, J. Wouter
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- 2019
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17. Progression of Left Ventricular Myocardial Dysfunction in Systemic Sclerosis: A Speckle-tracking Strain Echocardiography Study.
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van Wijngaarden, Suzanne E., Said-Bouyeri, Samira Ben, Ninaber, Maarten K., Huizinga, Tom W. J., Schalij, Martin J., Bax, Jeroen J., Delgado, Victoria, de Vries-Bouwstra, Jeska K., Marsan, Nina Ajmone, and Ben Said-Bouyeri, Samira
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- 2019
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18. Coding of coronary arterial origin and branching in congenital heart disease: The modified Leiden Convention.
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Gittenberger-de Groot, Adriana C., Koenraadt, Wilke M.C., Bartelings, Margot M., Bökenkamp, Regina, DeRuiter, Marco C., Hazekamp, Mark G., Bogers, Ad J.J. C., Quaegebeur, Jan M., Schalij, Martin J., Vliegen, Hubert W., Poelmann, Robert E., and Jongbloed, Monique R.M.
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Abstract Objectives Variations in coronary anatomy are common and may relate to the position of the coronary ostium relative to the aortic sinus, the angle of coronary take-off, or the course of the coronary arterial branches. Several classification systems have been proposed. However, they all lack a simple rationale that is applicable irrespective of the relative position of the great arteries, as well as in bicuspid aortic valves. We present a modification of a relatively simple system introduced in the early 1980s, designated the "Leiden Convention." Methods The first step of the Leiden Convention is that the clinician takes position in the nonfacing sinus of the aorta looking toward the pulmonary orifice. The right-hand facing sinus is sinus 1 , and the left-hand facing sinus is sinus 2. The coronary branches arising from sinus 1 are annotated proceeding in a counterclockwise fashion toward sinus 2. "Usual" (normal) coronary anatomy would be 1R-2LCx. Given their clinical relevance, single sinus coronary arteries are discussed separately. Results This system was originally designed and highly applicable in hearts with an altered great artery relationship, such as in the variable and complicated patterns seen in transposition of the great arteries and double outlet right ventricle. The modified system also can be used in cases with normally related great arteries, cases with single sinus coronary arteries, and cases with bicuspid aortic valves. Conclusions The modified Leiden Convention is not a strict classification but a simple coronary coding system that is broadly applicable. [ABSTRACT FROM AUTHOR]
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- 2018
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19. Mortality differences in acute myocardial infarction patients in the Netherlands: The weekend-effect.
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Eindhoven, Daniëlle C., Wu, Hoi W., Kremer, Stijn W.F., van Erkelens, Judith A., Cannegieter, Suzanne C., Schalij, Martin J., and Borleffs, C. Jan Willem
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Copyright of American Heart Journal is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2018
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20. Vasoplegia After Surgical Left Ventricular Restoration: 2-Year Follow-Up.
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van Vessem, Marieke E., Palmen, Meindert, Couperus, Lotte E., Stijnen, Theo, Berendsen, Remco R., Aarts, Leon P.H.J., de Jonge, Evert, Klautz, Robert J.M., Schalij, Martin J., and Beeres, Saskia L.M.A.
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Background Vasoplegia is a severe complication that can develop after surgical procedures for heart failure. The current study evaluated the effect of vasoplegia on survival, cardiac function, and renal function 2 years after surgical left ventricular restoration (SVR). Methods Heart failure patients with a left ventricular ejection fraction (LVEF) of 0.35 or less who underwent SVR in 2006 to 2014 were included. Vasoplegia was defined as the continuous need of vasopressors (norepinephrine ≥0.2 μg · kg
–1 · min–1 or terlipressin [any dose], or both) combined with a cardiac index of 2.2 L · min–1 · m–2 or higher for at least 12 consecutive hours, starting within the first 3 days postoperatively. The effect of vasoplegia on mortality, New York Heart Association Functional Classification, LVEF, and creatinine clearance was assessed up to 2 years of follow-up. Results SVR was performed in 113 patients (80% men), aged 62 ± 10 years, and with an LVEF of 0.25 ± 0.06. Postoperative vasoplegia developed in 23%. Survival was lower in patients with vasoplegia compared with patients without vasoplegia at 6 months (62% vs 90%, p = 0.001) and at 2 years (50% versus 84%, p < 0.001). At the 2-year follow-up, New York Heart Association class and LVEF had improved and were similar in both groups (respectively, p = 0.319 and p = 0.444). Creatinine clearance was lower in patients with vasoplegia compared with patients without vasoplegia 2 years postoperatively (p < 0.001), even after correcting for baseline creatinine clearance (p = 0.009). Conclusions Vasoplegia after SVR is associated with decreased survival. Despite an improved and similar cardiac function, renal function was compromised in vasoplegic patients at the 2-year follow-up. [ABSTRACT FROM AUTHOR]- Published
- 2018
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21. Fast nonclinical ventricular tachycardia inducible after ablation in patients with structural heart disease: Definition and clinical implications.
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Watanabe, Masaya, de Riva, Marta, Piers, Sebastiaan R.D., Dekkers, Olaf M., Ebert, Micaela, Venlet, Jeroen, Trines, Serge A., Schalij, Martin J., Pijnappels, Daniël A., and Zeppenfeld, Katja
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Background: Noninducibility of ventricular tachycardia (VT) with an equal or longer cycle length (CL) than that of the clinical VT is considered the minimum ablation endpoint in patients with structural heart disease. Because their clinical relevance remains unclear, fast nonclinical VTs are often not targeted. However, an accepted definition for fast VT is lacking. The shortest possible CL of a monomorphic reentrant VT is determined by the ventricular refractory period (VRP).Objective: The purpose of this study was to propose a patient-specific definition for fast VT based on the individual VRP (fVTVRP) and assess the prognostic significance of persistent inducibility after ablation of fVTVRP for VT recurrence.Methods: Of 191 patients with previous myocardial infarction or with nonischemic cardiomyopathy undergoing VT ablation, 70 (age 63 ± 13 years; 64% ischemic) remained inducible for a nonclinical VT and composed the study population. FVTVRP was defined as any VT with CL ≤VRP400 + 30 ms. Patients were followed for VT recurrence.Results: After ablation, 30 patients (43%) remained inducible exclusively for fVTVRP and 40 (57%) for any slower VT. Patients with only fVTVRP had 3-year VT-free survival of 64% (95% confidence interval [CI] 46%-82%) compared to 27% (95% CI 14%-48%) for patients with any slower remaining VT (P = .013). Inducibility of only fVTVRP was independently associated with lower VT recurrence (hazard ratio 0.38; 95% CI 0.19-0.86; P = .019). Among 36 patients inducible for any fVTVRP, only 1 had recurrence with fVTVRP.Conclusion: In patients with structural heart disease, inducibility of exclusively fVTVRP after ablation is associated with low VT recurrence. [ABSTRACT FROM AUTHOR]- Published
- 2018
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22. Effects of Transcatheter Mitral Valve Repair With MitraClip on Left Ventricular and Atrial Hemodynamic Load and Myocardial Wall Stress.
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van Wijngaarden, Suzanne Elize, Kamperidis, Vasileios, Al-Amri, Ibtihal, van der Kley, Frank, Schalij, Martin J., Ajmone Marsan, Nina, Bax, Jeroen J., and Delgado, Victoria
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Aims: To evaluate the effects of MitraClip on left ventricular (LV) and left atrial (LA) myocardial wall stress as assessed with the use of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and strain imaging.Methods and Results: Sixty-five patients with symptomatic moderate and severe mitral regurgitation (MR; age 75 ± 9 y, 57% male, 89% functional MR) treated with the use of MitraClip were evaluated. Patients were divided according to 6-month NT-proBNP tertiles. Changes in echocardiographic parameters over 6 months were assessed. Reductions in LV end-diastolic volumes (178 ± 77 mL to 170 ± 79 mL; P = .045) and LV end-systolic volumes (120 ± 70 mL to 111 ± 69 mL; P = .040) were observed in the overall population. Interestingly, low-NT-proBNP-tertile patients showed slight improvements in LV and LA longitudinal strain, whereas high-NT-proBNP-tertile patients showed impairment.Conclusions: Although MitraClip induces hemodynamic unloading in patients with predominantly functional MR, myocardial wall stress is not consistently improved. In patients with reduced NT-proBNP, improvements in LA volume index and LV and LA strains were observed. Patients who showed an increase in NT-proBNP exhibited impairment in LV and LA strain, suggesting an increase of myocardial wall stress. [ABSTRACT FROM AUTHOR]- Published
- 2018
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23. Low levels of apolipoprotein-CII in normotriglyceridemic patients with very premature coronary artery disease: Observations from the MISSION! Intervention study.
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Hermans, Maaike P.J., Bodde, Mathijs C., Jukema, J. Wouter, Schalij, Martin J., van der Laarse, Arnoud, and Cobbaert, Christa M.
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APOLIPOPROTEINS ,CONFIDENCE intervals ,CORONARY disease ,ELECTROCARDIOGRAPHY ,EXPERIMENTAL design ,LIQUID chromatography ,LOW density lipoproteins ,MASS spectrometry ,MYOCARDIAL infarction ,TRIGLYCERIDES ,REVASCULARIZATION (Surgery) - Abstract
Background While the overall acute myocardial infarction rates declined in women and men, premature acute myocardial infarction rates remained stable in men and increased in women. Objective The purpose of this study was to assess whether baseline apolipoprotein (apo) levels, clinical characteristics, and follow-up of patients with very premature coronary artery disease (CAD) could provide novel clues for the identification of high-risk individuals. Methods Apos were measured with a validated quantification liquid chromatography–mass spectrometry method in a well-defined cohort of 38 patients aged ≤45 years admitted with acute ST-segment elevation myocardial infarction. Results Mean age was 39.8 ± 4.6 years and 24% was female. Four of these patients (11%) had apoCII levels ≤5.0 mg/L. Compared with the very premature CAD group with apoCII > 5 mg/L, the patients with apoCII levels ≤5.0 mg/L were all females, tended to be younger (35.8 ± 8.4 years vs 40.3 ± 3.9 years, P = .063), had more often a family history of cardiovascular disease ≤65 years ( P = .034) and a significantly lower Framingham risk score ( P = .001). They presented with normal triglyceride levels, and had lower low-density lipoprotein cholesterol, apoB 100 , and apoE levels. Corrected for differences in risk profile, apoCII ≤ 5 mg/L was associated with increased risk of 10-years reinfarction or revascularization (hazard ratio 7.9 [95% confidence interval 1.5–41.6], P = .015). Conclusions In 38 patients with very premature CAD, 11% were found to have low apoCII levels (≤5.0 mg/L) with normal triglyceride levels. Despite their low a priori risk for CAD, these patients presented with ST-segment elevation myocardial infarction and had a high relative risk of 10-year reinfarction or revascularization. This particular phenotype of relatively young female patients with CAD is not recognized earlier and deserves further study. [ABSTRACT FROM AUTHOR]
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- 2017
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24. Localized Optogenetic Targeting of Rotors in Atrial Cardiomyocyte Monolayers.
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Feola, Iolanda, Volkers, Linda, Majumder, Rupamanjari, Teplenin, Alexander, Schalij, Martin J., Panfilov, Alexander V., de Vries, Antoine A. F., and Pijnappels, Daniël A.
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CALCIUM metabolism ,CELL metabolism ,ACTION potentials ,ANIMAL experimentation ,ANIMAL populations ,ATRIAL fibrillation ,BIOLOGICAL models ,CALCIUM ,CATHETER ablation ,CELL culture ,CELL receptors ,GENETIC techniques ,HEART atrium ,HEART beat ,RATS ,TIME ,SURGERY - Abstract
Background: Recently, a new ablation strategy for atrial fibrillation has emerged, which involves the identification of rotors (ie, local drivers) followed by the localized targeting of their core region by ablation. However, this concept has been subject to debate because the mode of arrhythmia termination remains poorly understood, as dedicated models and research tools are lacking. We took a unique optogenetic approach to induce and locally target a rotor in atrial monolayers.Methods and Results: Neonatal rat atrial cardiomyocyte monolayers expressing a depolarizing light-gated ion channel (Ca2+-translocating channelrhodopsin) were subjected to patterned illumination to induce single, stable, and centralized rotors by optical S1-S2 cross-field stimulation. Next, the core region of these rotors was specifically and precisely targeted by light to induce local conduction blocks of circular or linear shapes. Conduction blocks crossing the core region, but not reaching any unexcitable boundary, did not lead to termination. Instead, electric waves started to propagate along the circumference of block, thereby maintaining reentrant activity, although of lower frequency. If, however, core-spanning lines of block reached at least 1 unexcitable boundary, reentrant activity was consistently terminated by wave collision. Lines of block away from the core region resulted merely in rotor destabilization (ie, drifting).Conclusions: Localized optogenetic targeting of rotors in atrial monolayers could lead to both stabilization and destabilization of reentrant activity. For termination, however, a line of block is required reaching from the core region to at least 1 unexcitable boundary. These findings may improve our understanding of the mechanisms involved in rotor-guided ablation. [ABSTRACT FROM AUTHOR]- Published
- 2017
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25. ST-Segment Elevation Myocardial Infarction in Patients With Chronic Obstructive Pulmonary Disease: Prognostic Implications of Right Ventricular Systolic Dysfunction as Assessed with Two-Dimensional Speckle-Tracking Echocardiography
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Goedemans, Laurien, Hoogslag, Georgette E., Abou, Rachid, Schalij, Martin J., Marsan, Nina Ajmone, Bax, Jeroen J., and Delgado, Victoria
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Right ventricular (RV) systolic function in patients admitted with ST-segment elevation myocardial infarction (STEMI) with chronic obstructive pulmonary disease (COPD) and its impact on prognosis have not been characterized. The present study aims to compare the prevalence of RV systolic dysfunction in COPD versus non-COPD patients with STEMI and evaluate the prognostic implications.
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- 2019
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26. Prophylactic Use of Implantable Cardioverter-Defibrillators in the Prevention of Sudden Cardiac Death in Dialysis Patients
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Jukema, J. Wouter, Timal, Rohit J., Rotmans, Joris I., Hensen, Liselotte C. R., Buiten, Maurits S., de Bie, Mihaly K., Putter, Hein, Zwinderman, Aeilko H., van Erven, Lieselot, Krol-van Straaten, M. Jacqueline, Hommes, Nienke, Gabreëls, Bas, van Dorp, Wim, van Dam, Bastiaan, Herzog, Charles A., Schalij, Martin J., and Rabelink, Ton J.
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Supplemental Digital Content is available in the text.
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- 2019
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27. Plasma LDL-Cholesterol Level at Admission is Independently Associated with Infarct Size in Patients with ST-Segment Elevation Myocardial Infarction Treated with Primary Percutaneous Coronary Intervention
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Bodde, Mathijs C., Hermans, Maaike P. J., Wolterbeek, Ron, Cobbaert, Christa M., van der Laarse, Arnoud, Schalij, Martin J., and Jukema, J. Wouter
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Introduction: Hypercholesterolemia is a well-known risk factor for developing atherosclerosis and subsequently for the risk of a myocardial infarction (MI). Moreover, it might also be related to the extent of damaged myocardium in the event of a MI. The aim of this study was to evaluate the association of baseline low density lipoprotein-cholesterol (LDL-c) level with infarct size in patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneously coronary intervention (pPCI). Methods: Baseline blood samples were obtained from all patients admitted between 2004 and 2014 with STEMI who underwent pPCI. Patients were excluded in case of out of hospital cardiac arrest, treatment delay of at least 10 h or no complete reperfusion after pPCI in the culprit vessel. Peak creatine kinase (CK) level was used for infarct size estimation, defined as the maximal value during admission. Results: A total of 2248 patients were included in this study (mean age 61.8 ± 12.2 years; 25.0% female). Mean LDL-c level was 3.6 ± 1.1 mmol/L and median peak CK level was 1275 U/L (IQR 564–2590 U/L). Baseline LDL-c level [β= 0.041; (95% CI 0.019–0.062); p< 0.001] was independently associated with peak CK level. Furthermore, left anterior descending artery as culprit vessel, initial TIMI 0–1 flow in the culprit vessel, male gender, and treatment delay were also correlated with high peak CK level (p< 0.05). Prior aspirin therapy was associated with lower peak CK level [β= − 0.073 (95% CI − 0.146 to 0.000), p= 0.050]. Conclusion: This study demonstrates that besides the more established predictors of infarct size, elevated LDL-c is associated with augmented infarct size in patients with STEMI treated with pPCI.
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- 2019
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28. Growth Differentiation Factor-15 Levels at Admission Provide Incremental Prognostic Information on All-Cause Long-term Mortality in ST-Segment Elevation Myocardial Infarction Patients Treated with Primary Percutaneous Coronary Intervention
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Bodde, Mathijs C., Hermans, Maaike P. J., van der Laarse, Arnoud, Mertens, Bart, Romijn, Fred P. H. T. M., Schalij, Martin J., Cobbaert, Christa M., and Jukema, J. Wouter
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Introduction: To investigate the additive prognostic value of growth differentiation factor (GDF-15) levels in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneously coronary intervention (pPCI) with 10-year mortality on top of clinical characteristics and known cardiac biomarkers. Methods: Baseline serum GDF-15 levels were measured in 290 STEMI patients treated with pPCI in the MISSION! intervention trial conducted from February 1, 2004 through October 31, 2006. The incremental prognostic value of GDF-15 and NTproBNP levels was evaluated on top of clinical characteristics using Cox proportional hazards analysis, Chi-square models and C-index. Outcome was 10-year all-cause mortality. Results: Mean age was 59.0 ± 11.5 years and 65 (22.4) patients were female. A total of 37 patients died during a follow-up of 9.4 (IQR 8.8–10.0) years. Multivariable Cox regression revealed GDF-15 and NTproBNP levels above median to be independently associated with 10-year all-cause mortality [HR GDF-15, 2.453 (95% CI 1.064–5.658), P= 0.04; HR NTproBNP, 2.413 (95% CI 1.043–5.564), P= 0.04] after correction for other clinical variables. Stratified by median GDF-15 (37.78 pmol/L) and NTproBNP (11.74 pmol/L) levels, Kaplan–Meier curves showed significant better survival for patients with GDF-15 and NTproBNP levels below the median versus above the median. The likelihood ratio test showed a significant incremental value of GDF-15 (P= 0.03) as compared with a model with clinically important variables and NTproBNP. The C-statistics for this model improved from 0.82 to 0.84 when adding GDF-15. Conclusion: GDF-15 levels at admission in STEMI patients are independently associated with 10-year all-cause mortality rates and could improve risk stratification on top of clinical variables and other cardiac biomarkers.
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- 2019
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29. Percutaneous Decannulation of Femoral Venoarterial ECMO Cannulas Using MANTA Vascular Closure Device
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Montero-Cabezas, José M., van der Meer, R.W., van der Kley, Frank, Elzo Kraemer, Carlos V., López Matta, Jorge E., Schalij, Martin J., and de Weger, A.
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Extracorporeal membrane oxygenation (ECMO) has been increasingly used in the treatment of refractory cardiac arrest and postarrest cardiogenic shock. We propose a technique for percutaneous decannulation of femoral venoarterial ECMO cannulas by using the MANTA vascular closure device, designed to close large-bore arteriotomies. This technique significantly simplifies the decannulation and might diminish the potential complications caused by the standard surgical removal.
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- 2019
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30. Incidence and Clinical Significance of Cerebral Embolism During Atrial Fibrillation Ablation With Duty-Cycled Phased-Radiofrequency Versus Cooled-Radiofrequency
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Keçe, Fehmi, Bruggemans, Eline F., de Riva, Marta, Alizadeh Dehnavi, Reza, Wijnmaalen, Adrianus P., Meulman, Tamara J., Brugman, Julia A., Rooijmans, Anouk M., van Buchem, Mark A., Middelkoop, Huub A., Eikenboom, Jeroen, Schalij, Martin J., Zeppenfeld, Katja, and Trines, Serge A.
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The purpose of this study was to randomly compare the incidence of asymptomatic cerebral embolism (ACE) between the second-generation pulmonary vein ablation catheter (PVAC Gold) and the irrigated Thermocool catheter.
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- 2019
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31. Long-term outcome after atrial correction for transposition of the great arteries
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Couperus, Lotte E, Vliegen, Hubert W, Zandstra, Tjitske E, Kiès, Philippine, Jongbloed, Monique R M, Holman, Eduard R, Zeppenfeld, Katja, Hazekamp, Mark G, Schalij, Martin J, and Scherptong, Roderick W C
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ObjectiveThis study assessed adult survival and morbidity patterns in patients who underwent atrial correction according to Mustard or Senning for transposition of the great arteries (TGA).MethodsIn 76 adult patients with TGA (59% male) after atrial correction, long-term survival and morbidity were investigated in three periods: early (<15 years postoperatively), midterm (15–30 years postoperatively) and late (>30 years postoperatively).ResultsThe Mustard technique was performed in 41 (54%) patients, and the Senning technique was performed in 35 (46%) patients aged 3.1 (IQR: 2.1–3.8) and 1.0 (IQR: 0.6–3.1; p<0.01) years, respectively. Adult survival was 82% at 39.7 (IQR: 35.9–42.4) years postoperatively and exceeded 50 years in four patients. Supraventricular tachycardia (SVT) occurred in 51% of patients. The incidences of ventricular arrhythmia (0%, 8% and 13%; p<0.01), heart failure (0%, 5% and 19%; p<0.01) and surgical reinterventions (0%, 5% and 11%; p=0.01) increased from early to late follow-up. At last follow-up, RV function was depressed in 31 (46%) patients, and New York Heart Association functional class was ≥2 in 34 (48%) patients. Bradyarrhythmia, SVT and ventricular arrhythmia were associated with depressed RV function (OR: 4.47, 95% CI 1.50 to 13.28, p<0.01; OR: 3.74, 95% CI 1.26 to 11.14, p=0.02; OR: 14.40, 95% CI 2.80 to 74.07, p<0.01, respectively) and worse functional capacity (OR: 2.10, 95% CI 0.75 to 5.82, p=0.16; OR: 2.87, 95% CI 1.06 to 7.81, p=0.04; OR: 8.47, 95% CI 1.70 to 42.10, p<0.01, respectively).ConclusionsIn adult patients with TGA, survival was 82% at 39.7 (IQR: 35.9–42.4) years after atrial correction. Morbidity was high and included SVT as most frequent adverse event. Ventricular arrhythmias, heart failure and surgical reinterventions were common during late follow-up. Adverse events were associated with depressed right ventricle function and reduced functional class.
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- 2019
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32. Coronary anatomy in Turner syndrome versus patients with isolated bicuspid aortic valves
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Koenraadt, Wilke M C, Siebelink, Hans-Marc J, Bartelings, Margot M, Schalij, Martin J, van der Vlugt, Maureen J, van den Bosch, Annemien E, Budde, Ricardo P J, Roos-Hesselink, Jolien W, Duijnhouwer, Anthonie L, van den Hoven, Allard T, DeRuiter, Marco C, and Jongbloed, Monique R M
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ObjectiveVariations 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.AimTo compare coronary anatomy in patients with TS with/without BAV versus isolated BAV and to study BAV morphology subtypes in these groups.MethodsCoronary 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.ResultsThere 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.ConclusionThe 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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- 2019
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33. Progression of Left Ventricular Myocardial Dysfunction in Systemic Sclerosis: A Speckle-tracking Strain Echocardiography Study
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van Wijngaarden, Suzanne E., Ben Said-Bouyeri, Samira, Ninaber, Maarten K., Huizinga, Tom W.J., Schalij, Martin J., Bax, Jeroen J., Delgado, Victoria, de Vries-Bouwstra, Jeska K., and Marsan, Nina Ajmone
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Objective.Cardiac involvement is a main cause of mortality in systemic sclerosis (SSc). Its detection remains challenging using conventional echocardiography and little is known about its potential progression. This study assessed changes in cardiac performance over time in a prospective cohort of patients with SSc, including echocardiographic speckle-tracking strain analysis.Methods.The study included 234 patients with SSc [196 women, age 52 ± 14 yrs, 165 limited SSc, time since diagnosis 5.2 yrs, interquartile range (IQR) 2.9–11.3]. Clinical variables, laboratory tests, pulmonary function tests, and echocardiographic measures were recorded at baseline and followup (median 2.3 yrs, IQR 1.3–3.9). Additionally, left ventricular (LV) systolic function was assessed with global longitudinal strain (GLS) by echocardiographic speckle-tracking analysis.Results.At followup, GLS had significantly worsened (−21% ± 2 vs −19% ± 2, p < 0.001) while LV ejection fraction had not changed (62% ± 7 vs 61% ± 8, p = 0.124). In particular, 39 patients showed a significant deterioration of GLS as defined by a ≥ 15% decrease, which was accompanied by a concomitant worsening of proximal muscle weakness, lung fibrosis, renal function, LV diastolic function, and right ventricular systolic function. Baseline variables associated with ≥ 15% deterioration in GLS were proximal muscle weakness (OR 3.437, 95% CI 1.13–10.43, p = 0.020), decreased DLCO (OR 3.621, 95% CI 1.25–10.51, p = 0.049), and LV diastolic dysfunction (OR 2.378, 95% CI 1.07–5.27, p = 0.033).Conclusion.In patients with SSc, progression of LV systolic dysfunction was demonstrated by GLS but not by LV ejection fraction. Proximal muscle weakness, DLCO, and LV diastolic dysfunction may identify patients at risk for progressive LV systolic dysfunction and in need of closer cardiac monitoring.
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- 2019
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34. Global Longitudinal Strain and Left Atrial Volume Index Provide Incremental Prognostic Value in Patients With Hypertrophic Cardiomyopathy.
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Hiemstra, Yasmine L., Debonnaire, Philippe, Bootsma, Marianne, van Zwet, Erik W., Delgado, Victoria, Schalij, Martin J., Atsma, Douwe E., Bax, Jeroen J., and Marsan, Nina Ajmone
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Background—Current methods for predicting adverse events in patients with hypertrophic cardiomyopathy are still limited. Left ventricular global longitudinal strain (GLS) and left atrial volume index (LAVI) have been recently proposed as novel prognostic factors in several cardiovascular diseases. The objective of this study was to evaluate the prognostic value of GLS and LAVI in patients with hypertrophic cardiomyopathy. Methods and Results—Two-dimensional echocardiography was performed in 427 patients with hypertrophic cardiomyopathy (66% men, age 52±15 years), and LAVI and GLS were assessed. During follow-up, the primary end point of all-cause mortality, heart transplantation, sudden cardiac death, and appropriate implantable cardioverter defibrillator therapy was noted. A total of 103 patients reached the primary end point during a follow-up of 6.7 (interquartile range, 3.3–10.0) years. Multivariable Cox regression analysis revealed GLS and LAVI to be independently associated with the primary end point (hazard ratio GLS, 1.10 [1.03–1.19], P=0.007; hazard ratio LAVI, 4.27 [2.35–7.74], P<0.001) after correcting for other clinical variables. When applying the pre-specified cut-off values of 34 mL/m
2 for LAVI and −15% for GLS, Kaplan–Meier survival curves showed significant better survival for patients with LAVI <34 mL/m2 (P<0.001) and GLS <−15% (P<0.001) as compared with their counterparts. The likelihood ratio test showed a significant incremental prognostic value of LAVI and GLS (P<0.001) as compared with a model with clinical and standard echocardiographic risk factors. The C-statistic for this model increased from 0.68 to 0.73 when adding GLS and LAVI. Conclusions—GLS and LAVI are independently associated with adverse outcome in patients with hypertrophic cardiomyopathy and may help to optimize risk stratification in these patients. [ABSTRACT FROM AUTHOR]- Published
- 2017
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35. Right ventricular dysfunction affects survival after surgical left ventricular restoration.
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Couperus, Lotte E., Delgado, Victoria, Palmen, Meindert, van Vessem, Marieke E., Braun, Jerry, Fiocco, Marta, Tops, Laurens F., Verwey, Harriëtte F., Klautz, Robert J.M., Schalij, Martin J., and Beeres, Saskia L.M.A.
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Objective Several clinical and left ventricular parameters have been associated with prognosis after surgical left ventricular restoration in patients with ischemic heart failure. The aim of this study was to determine the prognostic value of right ventricular function. Methods A total of 139 patients with ischemic heart failure (62 ± 10 years; 79% were male; left ventricular ejection fraction 27% ± 7%) underwent surgical left ventricular restoration. Biventricular function was assessed with echocardiography before surgery. The independent association between all-cause mortality and right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain was assessed. The additive effect of multiple impaired right ventricular parameters on mortality also was assessed. Results Baseline right ventricular fractional area change was 42% ± 9%, tricuspid annular plane systolic excursion was 18 ± 3 mm, and right ventricular longitudinal peak systolic strain was −24% ± 7%. Within 30 days after surgery, 15 patients died. Right ventricular fractional area change (hazard ratio, 0.93; 95% confidence interval, 0.88-0.98; P < .01), tricuspid annular plane systolic excursion (hazard ratio, 0.80; 95% confidence interval, 0.66-0.96; P = .02), and right ventricular longitudinal peak systolic strain (hazard ratio, 1.15; 95% confidence interval, 1.05-1.26; P < .01) were independently associated with 30-day mortality, after adjusting for left ventricular ejection fraction and aortic crossclamping time. Right ventricular function was impaired in 21%, 20%, and 27% of patients on the basis of right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular longitudinal peak systolic strain, respectively. Any echocardiographic parameter of right ventricular dysfunction was present in 39% of patients. The coexistence of several impaired right ventricular parameters per patient was independently associated with increased 30-day mortality (hazard ratio, 2.83; 95% confidence interval, 1.64-4.87, P < .01 per additional impaired parameter). Conclusions Baseline right ventricular systolic dysfunction is independently associated with increased mortality in patients with ischemic heart failure undergoing surgical left ventricular restoration. [ABSTRACT FROM AUTHOR]
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- 2017
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36. Left Atrial Size and Function in Hypertrophic Cardiomyopathy Patients and Risk of New-Onset Atrial Fibrillation.
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Debonnaire, Philippe, Joyce, Emer, Hiemstra, Yasmine, Mertens, Bart J., Atsma, Douwe E., Schalij, Martin J., Bax, Jeroen J., Delgado, Victoria, and Marsan, Nina Ajmone
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Background: The value of left atrial (LA) diameter, volume, and strain to risk stratify hypertrophic cardiomyopathy patients for new-onset atrial fibrillation (AF) was explored.Methods and Results: A total of 242 hypertrophic cardiomyopathy patients without AF history were evaluated by (speckle-tracking) echocardiography. During mean follow-up of 4.8±3.7 years, 41 patients (17%) developed new-onset AF. Multivariable analysis showed LA volume (≥37 mL/m2; hazard ratio, 2.68; 95% confidence interval, 1.30-5.54; P=0.008) and LA strain (≤23.4%; hazard ratio, 3.22; 95% confidence interval, 1.50-6.88; P=0.003), but not LA diameter (≥45 mm; hazard ratio, 1.67; 95% confidence interval, 0.84-3.32; P=0.145), as independent AF correlates. Importantly, 59% (n=24) of AF events occurred despite a baseline LA diameter <45 mm, observed in 185 patients. In this patient subset, LA strain (area under the curve 0.73) and LA volume (area under the curve 0.83) showed good predictive value for new-onset AF. Furthermore, patients with LA volume <37 versus ≥37 mL/m2 and LA strain >23.4% versus ≤23.4% had superior 5-year AF-free survival of 93% versus 80% (P=0.003) and 98% versus 74% (P=0.002), respectively. Importantly, LA volume <37 mL/m2 and strain >23.4% yielded high negative predictive value (93% and 98%, respectively) for new-onset AF. Likelihood ratio test indicated incremental value of LA volume assessment (P=0.011) on top of LA diameter to predict new-onset AF in hypertrophic cardiomyopathy patients with LA diameter <45 mm, which tended to increase further by addition of LA strain (P=0.126).Conclusions: LA diameter, volume, and strain all relate to new-onset AF in hypertrophic cardiomyopathy patients. In patients with normal LA size, however, both LA volume and strain further refine risk stratification for new-onset AF. [ABSTRACT FROM AUTHOR]- Published
- 2017
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37. Prognostic implications of descending thoracic aorta dilation after surgery for aortic dissection.
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Regeer, Madelien V., Martina, Bryan, Versteegh, Michel I.M., de Weger, Arend, Klautz, Robert J.M., Schalij, Martin J., Bax, Jeroen J., Marsan, Nina Ajmone, and Delgado, Victoria
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Background The present study assessed whether descending thoracic aorta growth can be measured reliably by volumetric analysis using multi-detector row computed tomography (MDCT) and whether growth influences the need for future aortic interventions in survivors of acute type A aortic dissection. Methods A total of 51 patients (58 ± 11 years, 61% male) who underwent surgery for type A aortic dissection with ≥2 postoperative MDCT scans ≥5 months apart were included. Volumetric analysis of the descending thoracic aorta was performed with acceptable intraobserver variability. Growth of the complete, false and true lumen was estimated in ml/year and defined as slow growth (≤average growth) or fast growth (>average growth). Results The complete lumen volume increased from 133 ± 8 ml to 163 ± 9 ml after 3.5 years follow-up (p < 0.001), with an average growth rate of 6.1 ml/year. The false lumen volume increased from 81 ± 7 ml to 106 ± 12 ml (p = 0.018) with an average growth rate of 2.8 ml/year. The true lumen changed only slightly from 59 ± 4 ml to 65 ± 8 ml (p = 0.205). Five-year freedom from descending thoracic aorta intervention was significantly lower in patients with above-average growth of the complete lumen (80 ± 9%) compared to slow growth (100%; p = 0.003). Similar observations were made for the false lumen (fast: 74 ± 12% vs. slow: 100%; p = 0.042). Conclusions Increased growth of the false lumen of the descending thoracic aorta after type A aortic dissection was associated with a higher risk of secondary interventions. [ABSTRACT FROM AUTHOR]
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- 2017
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38. Position of ST-deviation measurements relative to the J-point: Impact for ischemia detection.
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Man, Sumche, ter Haar, C. Cato, de Jongh, Marjolein C., Maan, Arie C., Schalij, Martin J., and Swenne, Cees A.
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Background: There is no consensus about the time instant relative to the J point where ST deviation has to be measured for detection of acute ischemia in the ECG.Methods: We analyzed 53 ECGs, recorded preceding emergency catheterization of acute coronary syndrome patients with a completely occluded culprit artery (cases), and 88 control ECGs recorded in the cardiology outpatient clinic. ECG-amplitude measurements were made every 10 ms, between 20 ms before till 80 ms after the J point. STEMI-detection algorithms varied from the traditional STEMI criterion (elevations in at least two adjacent ECG leads), via the STEMI equivalent criterion (depressions in V2 and V3), to the most liberal STEMI-detection algorithm in which elevations as well as depressions in two adjacent leads were considered as signs of ischemia.Results: Diagnostic accuracy was highest (93.6%) for the most liberal STEMI-detection algorithm at 10 ms after the J point; sensitivity was 94.3% and specificity was 93.2%.Conclusion: The results of our study suggest that STEMI detection close to the J point is optimal. [ABSTRACT FROM AUTHOR]- Published
- 2017
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39. Detection of elevated pulmonary pressures by the ECG-derived ventricular gradient: A comparison of conversion matrices in patients with suspected pulmonary hypertension.
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Haeck, Marlieke L.A., Kapel, Gijsbert F.L., Scherptong, Roderick W.C., Swenne, Cees A., Maan, Arie C., Bax, Jeroen J., Schalij, Martin J., and Vliegen, Hubert W.
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Background: The aim was to assess the diagnostic value of the Inverse Dower (INVD)-derived vectorcardiogram (VCG) and the Kors-derived VCG to detect elevated systolic pulmonary artery pressure (SPAP) in suspected pulmonary hypertension (PH).Methods: In 132 patients, morphologic variables were evaluated by comparing the VCG parameters synthesized by INVD and Kors matrix. Comparison of the diagnostic accuracy of detecting SPAP ≥50mmHg between the matrices was performed by ROC curve analysis and logistic regression analysis.Results: Most VCG parameters differed significantly between INVD and Kors. ROC analysis for detection of SPAP ≥50mmHg by VG projected on the X-axis demonstrated no difference (p=0.99) between INVD (AUC=0.80) and Kors (AUC=0.80). Both the INVD- and Kors-derived VCG provided significant diagnostic information on the presence of SPAP ≥50mmHg (INVD, OR 1.05, 95%CI 1.03-1.07; P<0.001; Kors, OR 1.05, 95%CI 1.03-1.08; P<0.001).Conclusion: Although there were significant differences in measures of vector morphology, both INVD- and Kors-derived VCG demonstrated equal clinical performance in case of elevated SPAP. [ABSTRACT FROM AUTHOR]- Published
- 2017
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40. Effect of Aortic Valve Replacement on Aortic Root Dilatation Rate in Patients With Bicuspid and Tricuspid Aortic Valves.
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Regeer, Madelien V., Versteegh, Michel I.M., Klautz, Robert J.M., Schalij, Martin J., Bax, Jeroen J., Marsan, Nina Ajmone, and Delgado, Victoria
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Background It remains unclear whether aortic valve replacement (AVR) has an effect on the aortic root dilatation rate in patients with bicuspid aortic valve (BAV) and tricuspid aortic valve (TAV). The present study evaluated the pre- and postoperative annual aortic root dilatation rates in BAV and TAV. Methods A total of 93 patients (67 ± 11 years; 71% men) who underwent AVR between 2003 and 2013 and had at least 2 pre- and postoperative echocardiographic studies 1 year or more apart were included in this retrospective observational study. The sinus of Valsalva (SOV), sinotubular junction (STJ) and ascending aorta (AAo) were measured in the parasternal long-axis view. Results Patients with BAV (n = 22) were significantly younger and had less coronary artery disease than patients with TAV (n = 71). At all points in time, the aortic root diameters were larger in BAV compared with TAV. Preoperatively, the STJ and AAo grew significantly faster in BAV compared with TAV (STJ, 0.27 versus 0.04 mm/y; p = 0.021; AAo, 0.42 versus 0.15 mm/y; p = 0.019). After operation, there were no significant differences in aortic root dilatation rates between BAV and TAV (SOV, –0.01 versus 0.15 mm/y; p = 0.096; STJ, 0.08 versus 0.05 mm/y; p = 0.676; AAo, 0.28 versus 0.35 mm/y; p = 0.745). Conclusions The annual aortic root dilatation rates were significantly higher in BAV compared with TAV before AVR. However, after AVR, aortic root dilatation rates were similar in BAV and TAV, suggesting an important role of hemodynamics on aortic root dilatation in BAV. [ABSTRACT FROM AUTHOR]
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- 2016
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41. Noninvasive Identification of Ventricular Tachycardia–Related Anatomical Isthmuses in Repaired Tetralogy of Fallot
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Brouwer, Charlotte, Kapel, Gijsbert F.L., Jongbloed, Monique R.M., Schalij, Martin J., de Riva Silva, Marta, and Zeppenfeld, Katja
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This study sought to evaluate the relation between 12-lead ventricular tachycardia (VT) electrocardiography (ECG) and VT-related anatomical isthmuses (AIs) in repaired tetralogy of Fallot (rTOF).
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- 2018
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42. Slow Conducting Electroanatomic Isthmuses
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Kapel, Gijsbert F.L., Brouwer, Charlotte, Jalal, Zakaria, Sacher, Frédéric, Venlet, Jeroen, Schalij, Martin J., Thambo, Jean-Benoît, Jongbloed, Monique R.M., Blom, Nico A., de Riva, Marta, and Zeppenfeld, Katja
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This study sought to evaluate the influence of slow conducting anatomic isthmuses (SCAI) as dominant ventricular tachycardia (VT) substrate on QRS duration.
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- 2018
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43. Targeting the Hidden Substrate Unmasked by Right Ventricular Extrastimulation Improves Ventricular Tachycardia Ablation Outcome After Myocardial Infarction
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de Riva, Marta, Naruse, Yoshihisa, Ebert, Micaela, Androulakis, Alexander F.A., Tao, Qian, Watanabe, Masaya, Wijnmaalen, Adrianus P., Venlet, Jeroen, Brouwer, Charlotte, Trines, Serge A., Schalij, Martin J., and Zeppenfeld, Katja
- Abstract
This study sought to determine whether ablation of hidden substrate unmasked by right ventricular extrastimulation (RVE) improves ablation outcome of post-myocardial infarction (MI) ventricular tachycardia (VT).
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- 2018
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44. Coronary anatomy in children with bicuspid aortic valves and associated congenital heart disease
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Koenraadt, Wilke M C, Bartelings, Margot M, Bokenkamp, Regina, Gittenberger-de Groot, Adriana C, DeRuiter, Marco C, Schalij, Martin J, and Jongbloed, Monique RM
- Abstract
ObjectiveIn patients with bicuspid aortic valve (BAV), coronary anatomy is variable. High take-off coronary arteries have been described, but data are scarce, especially when associated with complex congenital heart disease (CHD). The purpose of this study was to describe coronary patterns in these patients.MethodsIn 84 postmortem heart specimens with BAV and associated CHD, position and height of the coronary ostia were studied and related to BAV morphology.ResultsHigh take-off right (RCA) and left coronary arteries (LCA) were observed in 23% and 37% of hearts, respectively, most frequently in hearts with hypoplastic left ventricle (HLV) and outflow tract anomalies. In HLV, high take-off was observed in 18/40 (45%) more frequently of LCA (n=14) than RCA (n=6). In hearts with aortic hypoplasia, 8/13 (62%) had high take-off LCA and 6/13 (46%) high take-off RCA. High take-off was seen 19 times in 22 specimens with perimembranous ventricular septal defect (RCA 8, LCA 11). High take-off was associated with type 1A BAV (raphe between right and left coronary leaflets), more outspoken for the RCA. Separate ostia of left anterior descending coronary artery and left circumflex coronary artery were seen in four hearts (5%), not related to specific BAV morphology.ConclusionHigh take-off coronary arteries, especially the LCA, occur more frequently in BAV with associated CHD than reported in normal hearts and isolated BAV. Outflow tract defects and HLV are associated with type 1A BAV and high take-off coronary arteries. Although it is unclear whether these findings in infants with detrimental outcome can be related to surviving adults, clinical awareness of variations in coronary anatomy is warranted.
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- 2018
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45. Age and gender differences in medical adherence after myocardial infarction: Women do not receive optimal treatment – The Netherlands claims database
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Eindhoven, Daniëlle C, Hilt, Alexander D, Zwaan, Thomas C, Schalij, Martin J, and Borleffs, C Jan Willem
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Background Following myocardial infarction, medication is, besides lifestyle interventions, the cornerstone treatment to improve survival and minimize the occurrence of new cardiovascular events. Still, data on nationwide medication adherence are scarce. This study assesses medical adherence during one year following myocardial infarction, stratifying per type of infarct, age and gender.Design Retrospective cohort study.Methods In The Netherlands, all inhabitants are by law obliged to have health insurance and all claims data are centrally registered. In 2012 and 2013, all national diagnosis-codings of ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) were acquired. Furthermore, information on retrieved medication was extracted from the Dutch Pharmacy Information System. Twelve months after discharge, the retrieved medication at the pharmacy of each pharmacological therapy (aspirin-species, P2Y12-inhibitor, statin, beta-blocker, angiotensin-converting enzyme-/angiotensin 2-inhibitor, vitamin-K antagonists or novel oral anticoagulant) were analysed.Results In total, 59,534 patients (67 ± 13 years, 39,545 (66%) male, 57% NSTEMI) were included, of whom 52,672 (88%) patients were analysed for one-year medical adherence. STEMI patients more often achieved optimal medical adherence than NSTEMI patients (60% vs. 40%, p≤ 0.001). In both STEMI and NSTEMI, use of all five indicated drugs was higher in male patients compared with female (STEMI male 61% vs. female 57%, p≤ 0.001; NSTEMI male 43% vs. female 37%, p≤ 0.001. With increasing age, a gradual decrease was observed in the use of aspirin, P2Y12-inhibitors and statins.Conclusion Age and gender differences existed in medical adherence after myocardial infarction. Medical adherence was lower in women, young patients and elderly patients, specifically in NSTEMI patients.
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- 2018
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46. Impact of surgery on presence and dimensions of anatomical isthmuses in tetralogy of Fallot
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Kapel, Gijsbert F L, Laranjo, Sergio, Blom, Nico A, Hazekamp, Mark G, Schalij, Martin J, Bartelings, Margot M, Jongbloed, Monique R M, and Zeppenfeld, Katja
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ObjectiveIn tetralogy of Fallot (TOF), the dominant ventricular tachycardia substrates are slow-conducting anatomical isthmuses. Surgical correction has evolved, which might have influenced isthmus presence and dimensions.MethodsOne hundred and forty-two postmortem TOF specimens (84/58 corrected/uncorrected) were studied for isthmus presence. Isthmus 1 is located between the tricuspid annulus and right ventricular (RV) outflow tract (RVOT) patch/RV incision, isthmus 2 between RVOT patch/RV incision and pulmonary valve, isthmus 3 between pulmonary valve and ventricular septal defect (patch), isthmus 4 between ventricular septal defect (patch) and tricuspid annulus. Isthmus width and thickness were measured.ResultsOf 84 corrected postmortem TOF specimens (death: 6.6 years (4.0–11.5)), 83 demonstrated isthmus 1 (99%, width=25±10 mm, thickness=5±2 mm), 35 isthmus 2 (42%, width=10±9 mm, thickness=3±2 mm), 83 isthmus 3 (99%, width=10±6 mm, thickness=5±2 mm), and 5 isthmus 4 (6%, width=4±2 mm, thickness=2±1 mm). Transatrial-transpulmonary correction (n=49) as compared with transventricular correction (n=35) prevented isthmus 2 (0% vs 100%, P<0.001). Transatrial-transpulmonary correction at age <1 year (n=7) as compared with ≥1 year (n=42) required a smaller transannular RVOT patch (28±15 vs 45±14 mm, P<0.001). Mode and timing of correction did not influence presence and dimensions of isthmus 3. In corrected and uncorrected TOF specimens (death 1.8 years (0.5–6.6)), the range of isthmus 3 dimensions was broad (width: min=2 mm, max=32 mm; thickness: min=1, max 13 mm) across all ages. Isthmus 3 width and thickness were strongly correlated (r=0.65, P<0.001).ConclusionsIn TOF, the current routine use of transatrial-transpulmonary correction prevents isthmus 2. Correction <1 year reduces transannular patch size, which may influence isthmus 1 width later in life. Mode and timing of correction did not change prevalence and dimensions of isthmus 3, in which dimensions varied widely in uncorrected and corrected TOF.
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- 2018
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47. Subtraction electrocardiography: Detection of ischemia-induced ST displacement without the need to identify the J point.
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ter Haar, C. Cato, Man, Sum-Che, Maan, Arie C., Schalij, Martin J., and Swenne, Cees A.
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Background: When triaging a patient with acute chest pain at first medical contact, an electrocardiogram (ECG) is routinely made and inspected for signs of myocardial ischemia. The guidelines recommend comparison of the acute and an earlier-made ECG, when available. No concrete recommendations for this comparison exist, neither is known how to handle J-point identification difficulties. Here we present a J-point independent method for such a comparison.Methods: After conversion to vectorcardiograms, baseline and acute ischemic ECGs after 3minutes of balloon occlusion during elective PCI were compared in 81 patients of the STAFF III ECG database. Baseline vectorcardiograms were subtracted from ischemic vectorcardiograms using either the QRS onsets or the J points as synchronization instants, yielding vector magnitude difference signals, ΔH. Output variables for the J-point synchronized differences were ΔH at the actual J point and at 20, 40, 60 and 80ms thereafter. Output variables for the onset-QRS synchronized differences were the ΔH at 80, 100, 120, 140 and 160ms after onset QRS. Finally, linear regressions of all combinations of ΔHJ+… versus ΔHQRS+… were made, and the best combination was identified.Results: The highest correlation, 0.93 (p<0.01), was found between ΔH 40ms after the J point and 160ms after the onset of the QRS complex. With a ΔH ischemia threshold of 0.05mV, 66/81 (J-point synchronized differences) and 68/81 (onset-QRS synchronized differences) subjects were above the ischemia threshold, corresponding to sensitivities of 81% and 84%, respectively.Conclusion: Our current study opens an alternative way to detect cardiac ischemia without the need for human expertise for determination of the J point by measuring the difference vector magnitude at 160ms after the onset of the QRS complex. [ABSTRACT FROM AUTHOR]- Published
- 2016
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48. QRS prolongation after premature stimulation is associated with polymorphic ventricular tachycardia in nonischemic cardiomyopathy: Results from the Leiden Nonischemic Cardiomyopathy Study.
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Piers, Sebastiaan R.D., Askar, Saïd F.A., Venlet, Jeroen, Androulakis, Alexander F.A.A., Kapel, Gijsbert F.L., de Riva Silva, Marta, Jongbloed, Jan J.D.H., van Tintelen, J. Peter, Schalij, Martin J., Pijnappels, Daniël A., and Zeppenfeld, Katja
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Background: Progressive activation delay after premature stimulation has been associated with ventricular fibrillation in nonischemic cardiomyopathy (NICM).Objectives: The objectives of this study were (1) to investigate prolongation of the paced QRS duration (QRSd) after premature stimulation as a marker of activation delay in NICM, (2) to assess its relation to induced ventricular arrhythmias, and (3) to analyze its underlying substrate by late gadolinium enhancement cardiac magnetic resonance imaging (LGE-CMR) and endomyocardial biopsy.Methods: Patients with NICM were prospectively enrolled in the Leiden Nonischemic Cardiomyopathy Study and underwent a comprehensive evaluation including LGE-CMR, electrophysiology study, and endomyocardial biopsy. Patients without structural heart disease served as controls for electrophysiology study.Results: Forty patients with NICM were included (mean age 57 ± 14 years; 33 men [83%]; left ventricular ejection fraction 30% ± 13%). After the 400-ms drive train and progressively premature stimulation, the maximum increase in QRSd was larger in patients with NICM than in controls (35 ± 18 ms vs. 23 ± 12 ms; P = .005) and the coupling interval window with QRSd prolongation was wider (47 ± 23 ms vs. 31 ± 14 ms; P = .005). The maximum paced QRSd exceeded the ventricular effective refractory period, allowing for pacing before the offset of the QRS complex in 20 of 39 patients with NICM vs. 1 of 20 controls (P < .001). In patients with NICM, QRSd prolongation was associated with the inducibility of polymorphic ventricular tachycardia (16 of 39 patients) and was related to long, thick strands of fibrosis in biopsies, but not to focal enhancement on LGE-CMR.Conclusion: QRSd is a simple parameter used to quantify activation delay after premature stimulation, and its prolongation is associated with the inducibility of polymorphic ventricular tachycardia and with the pattern of myocardial fibrosis in biopsies. [ABSTRACT FROM AUTHOR]- Published
- 2016
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49. Allosteric Modulation of Kv11.1 (hERG) Channels Protects Against Drug-Induced Ventricular Arrhythmias.
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Zhiyi Yu, Jia Liu, van Veldhoven, Jacobus P. D., IJzerman, Adriaan P., Schalij, Martin J., Pijnappels, Daniël A., Heitman, Laura H., de Vries, Antoine A. F., Yu, Zhiyi, and Liu, Jia
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CELL metabolism ,ANIMAL experimentation ,ANIMAL populations ,BIOCHEMISTRY ,BIOLOGICAL models ,CARRIER proteins ,CELL culture ,CELLS ,GENES ,IMMUNOHISTOCHEMISTRY ,PHENOMENOLOGY ,MYOCARDIAL depressants ,POLYMERASE chain reaction ,RATS ,RNA ,VENTRICULAR tachycardia ,REVERSE transcriptase polymerase chain reaction - Abstract
Background: Ventricular arrhythmias as a result of unintentional blockade of the Kv11.1 (hERG [human ether-à-go-go-related gene]) channel are a major safety concern in drug development. In past years, several highly prescribed drugs have been withdrawn for their ability to cause such proarrhythmia. Here, we investigated whether the proarrhythmic risk of existing drugs could be reduced by Kv11.1 allosteric modulators.Methods and Results: Using [(3)H]dofetilide-binding assays with membranes of human Kv11.1-expressing human embryonic kidney 293 cells, 2 existing compounds (VU0405601 and ML-T531) and a newly synthesized compound (LUF7244) were found to be negative allosteric modulators of dofetilide binding to the Kv11.1 channel, with LUF7244 showing the strongest effect at 10 μmol/L. The Kv11.1 affinities of typical blockers (ie, dofetilide, astemizole, sertindole, and cisapride) were significantly decreased by LUF7244. Treatment of confluent neonatal rat ventricular myocyte (NRVM) monolayers with astemizole or sertindole caused heterogeneous prolongation of action potential duration and a high incidence of early afterdepolarizations on 1-Hz electric point stimulation, occasionally leading to unstable, self-terminating tachyarrhythmias. Pretreatment of NRVMs with LUF7244 prevented these proarrhythmic effects. NRVM monolayers treated with LUF7244 alone displayed electrophysiological properties indistinguishable from those of untreated NRVM cultures. Prolonged exposure of NRVMs to LUF7244 or LUF7244 plus astemizole did not affect their viability, excitability, and contractility as assessed by molecular, immunological, and electrophysiological assays.Conclusions: Allosteric modulation of the Kv11.1 channel efficiently suppresses drug-induced ventricular arrhythmias in vitro by preventing potentially arrhythmogenic changes in action potential characteristics, raising the possibility to resume the clinical use of unintended Kv11.1 blockers via pharmacological combination therapy. [ABSTRACT FROM AUTHOR]- Published
- 2016
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50. Fatigue as Presenting Symptom and a High Burden of Premature Ventricular Contractions Are Independently Associated With Increased Ventricular Wall Stress in Patients With Normal Left Ventricular Function.
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van Huls van Taxis, Carine F. B., Piers, Sebastiaan R. D., de Riva Silva, Marta, Dekkers, Olaf M., Pijnappels, Daniël A., Schalij, Martin J., Wijnmaalen, Adrianus P., and Zeppenfeld, Katja
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ARRHYTHMIA diagnosis ,AMBULATORY electrocardiography ,ARRHYTHMIA ,CATHETER ablation ,DOPPLER echocardiography ,FATIGUE (Physiology) ,HEART physiology ,LEFT heart ventricle ,PEPTIDE hormones ,PEPTIDES ,TIME ,PHYSIOLOGIC strain ,TREATMENT effectiveness ,STROKE volume (Cardiac output) ,DISEASE complications ,DIAGNOSIS - Abstract
Background: High idiopathic premature ventricular contractions (PVC) burden has been associated with PVC-induced cardiomyopathy. Patients may be symptomatic before left ventricular (LV) dysfunction develops. N-terminal pro-B-type natriuretic peptide (NT-proBNP) and circumferential end-systolic wall stress (cESS) on echocardiography are markers for increased ventricular wall stress. This study aimed to evaluate the relation between presenting symptoms, PVC burden, and increased ventricular wall stress in patients with frequent PVCs and preserved LV function.Methods and Results: Eighty-three patients (41 men; 49±15 years) with idiopathic PVCs and normal LV function referred for PVC ablation were included. Type of symptoms (palpitations, fatigue, and [near-]syncope), PVC burden on 24-hour Holter, NT-proBNP levels, and cESS on echocardiography were assessed before and 3 months after ablation. Sustained successful ablation was defined as ≥80% PVC burden reduction during follow-up. Patients were symptomatic for 24 months (Q1-Q3, 16-60); 73% reported palpitations, 47% fatigue, and 30% (near-)syncope. Baseline PVC burden was 23±13%, median NT-proBNP 92 pg/mL (Q1-Q3 50-156), and cESS 143±35 kdyne/cm(2). Fatigue was associated with higher baseline NT-proBNP and cESS (P<0.001, P=0.011, respectively). After sustained successful ablation, achieved in 81%, NT-proBNP and cESS decreased significantly (P<0.001 and P=0.036, respectively). Fatigue was independently associated with a significantly larger reduction in NT-proBNP. In patients with nonsuccessful ablation, NT-proBNP and cESS remained unchanged.Conclusions: In patients with frequent PVCs and preserved LV function, fatigue was associated with higher baseline NT-proBNP and cESS, and with a significantly larger reduction in NT-proBNP after sustained successful ablation. These findings support a link between fatigue and PVC-induced increased ventricular wall stress, despite preserved LV function. [ABSTRACT FROM AUTHOR]- Published
- 2015
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