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6. Plasma Proteomic Patterns Show Sex Differences in Early Concentric Left Ventricular Remodeling

Author

van Ommen, Anne-Mar, primary, Diez Benavente, Ernest, additional, Onland-Moret, N. Charlotte, additional, Valstar, Gideon B., additional, Cramer, Maarten J., additional, Rutten, Frans H., additional, Teske, Arco J., additional, Menken, Roxana, additional, Hofstra, Leonard, additional, Tulevski, Igor I., additional, Sweitzer, Nancy, additional, Somsen, G. Aernout, additional, and den Ruijter, Hester M., additional

Published
2023
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8. Plasma Proteomic Patterns Show Sex Differences in Early Concentric Left Ventricular Remodeling.

Author

Ommen, Anne-Mar van, Benavente, Ernest Diez, Onland-Moret, N. Charlotte, Valstar, Gideon B., Cramer, Maarten J., Rutten, Frans H., Teske, Arco J., Menken, Roxana, Hofstra, Leonard, Tulevski, Igor I., Sweitzer, Nancy, Somsen, G. Aernout, and den Ruijter, Hester M.

Abstract

BACKGROUND: Concentric remodeling (cRM) can precede heart failure with preserved ejection fraction (HFpEF), a condition prevalent in women. METHODS: Patients (n=60 593, 54.2% women) visiting outpatient clinics of Cardiology Centers of the Netherlands were analyzed for cRM, HFpEF development, and mortality risk. We studied risk factors for relative wall thickness both sex- stratified and in women and men combined. Biomarker profiling was performed (4534 plasma proteins) in a substudy involving 557 patients (65.4% women) to identify pathways involved in cRM. RESULTS: cRM was present in 23.5% of women and 27.6% of men and associated with developing HFpEF (HR, 2.15 [95% CI, 1.51–2.99]) and mortality risk (HR, 1.09 [95% CI, 1.00–1.19]) in both sexes. Age, heart rate, and hypertension were statistically significantly stronger risk factors for relative wall thickness in women than men. Higher circulating levels of IFNA5 (interferon alpha-5) were associated with higher relative wall thickness in women only. Pathway analysis revealed differential pathway activation by sex and increased expression of inflammatory pathways in women. CONCLUSIONS: cRM is prevalent in approximately 1 in 4 women and men visiting outpatient cardiology clinics and associated with HFpEF development and mortality risk in both sexes. Known risk factors for cRM were more strongly associated in women than men. Proteomic analysis revealed inflammatory pathway activation in women, with a central role for IFNA5. Differential biologic pathway activation by sex in cRM may contribute to the female predominance of HFpEF and holds promise for identification of new therapeutic avenues for prevention and treatment of HFpEF. [ABSTRACT FROM AUTHOR]

Published
2023
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9. Coronary calcification measures predict mortality in symptomatic women and men

Author

Siegersma, Klaske R, primary, Groepenhoff, Floor, additional, Eikendal, Anouk L M, additional, op den Brouw, Willemijn J, additional, Leiner, Tim, additional, Appelman, Yolande, additional, Tulevski, Igor I, additional, Somsen, G Aernout, additional, Onland-Moret, N Charlotte, additional, Hofstra, Leonard, additional, and den Ruijter, Hester M, additional

Published
2022
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11. Sex Differences in the Relationship between New York Heart Association Functional Classification and Survival in Cardiovascular Disease Patients

Author

Siegersma, Klaske R., Stens, Niels A., Groepenhoff, Floor, Appelman, Yolande, Tulevski, Igor I., Hofstra, Leonard, den Ruijter, Hester M., Somsen, G. Aernout, Onland-Moret, N. Charlotte, Cardiology, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, and ACS - Heart failure & arrhythmias

Subjects
All institutes and research themes of the Radboud University Medical Center, Vascular damage Radboud Institute for Health Sciences [Radboudumc 16], General Medicine, Cardiology and Cardiovascular Medicine
Abstract

Background: The New York Heart Association (NYHA) functional class has extensively been used for risk stratification in patients suspected of heart failure, although its prognostic value differs between sexes and disease entities. Functional exercise capacity might explain the association between NYHA functional class and survival, and can serve as an objective proxy for the subjective nature of the NYHA classification. Therefore, we assessed whether sex-differences in exercise capacity explain the association between NYHA functional class and survival in patients suspected of cardiovascular disease. Methods: Electronic health record data from 7259 patients with cardiovascular symptoms, a documented NYHA functional class and cardiac stress electrocardiogram (ECG), was analysed. Followup for all-cause mortality was obtained through linkage with Statistics Netherlands. A sex-stratified mediation analysis was performed to assess to what extent the proportional heart rate and -workload during ECG stress testing explain the association between NYHA functional class and survival. Results: In men, increments in NYHA functional class were related to higher all-cause mortality in a dose-response manner (NYHA II vs III/IV: hazard ratio [HR] 1.59 vs 3.64, referenced to NYHA I), whilst in women those classified as NYHA functional class II and III/IV had a similar higher mortality risk (HR 1.49 vs 1.41). Sex-stratified mediation analysis showed that the association between NYHA and survival was mostly explained by proportional workload during stress ECG (men vs women: 22.9%, 95% CI: 18.9%–27.3% vs 40.3%, 95% CI: 28.5%–68.6%) and less so by proportional heart rate (men vs women: 2.5%, 95% CI: 1.3%–4.3% vs 8.0%, 95% CI: 4.1%–18.1%). Post-hoc analysis showed that NYHA classification explained a minor proportion of the association between proportional workload and all-cause mortality (men vs women: 15.1%, 95% CI: 12.0%–18.3% vs 4.4%, 95% CI: 1.5%–7.4%). Conclusions: This study showed a significant mediation in both sexes on the association between NYHA functional class and all-cause mortality by proportional workload, but the effect explained by NYHA classification on the association between survival and proportional workload is small. This implies that NYHA classification is not a sole representation of a patient’s functional capacity, but might also incude other aspects of the patient’s overall health status.

Published
2022

12. Wanneer is de coronaire calciumscore zinvol?

Author

Slaats, Bridget M. I., Pinto-Sietsma, Sara-Joan, Koetsier, David W., Tulevski, Igor I., Hofstra, Leonard, Somsen, G. Aernout, Epidemiology and Data Science, ACS - Atherosclerosis & ischemic syndromes, APH - Methodology, Cardiology, and ACS - Heart failure & arrhythmias

Abstract

Currently, risk prediction models like SCORE are used for decision making in the primary prevention of cardiovascular disease. The external validity of these models is questionable since they give rise to overtreatment with statins or antihypertensive drugs. Detailed individual risk assessment may reduce this drawback and will increase cost effectiveness. The CT derived coronary calcium score, in asymptomatic patients, was shown to be more accurate than the current prediction models. A coronary calcium score of zero reclassifies a significant number of individuals to a lower risk group and subsequently prevent overtreatment. Using this strategy, it can be anticipated that the Dutch healthcare costs can be reduced by at least 15 million Euro per year.

Published
2022

13. Statins are associated with a large reduction in all-cause mortality in women from a cardiac outpatient population

Author

Bots, Sophie H, Onland-Moret, N Charlotte, Jancev, Milena, Hollander, Monika, Tulevski, Igor I, Hofstra, Leonard, Somsen, G Aernoud, den Ruijter, Hester M, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Cardiology, ACS - Atherosclerosis & ischemic syndromes, and ACS - Heart failure & arrhythmias

Subjects
Male, Risk, Primary prevention, Efficacy, nutritional and metabolic diseases, Individual data, Metaanalysis, Cohort Studies, Ldl cholesterol, Cardiovascular Diseases, Outpatients, Humans, Female, Disease, lipids (amino acids, peptides, and proteins), Therapy, cardiovascular diseases, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Safety, Propensity Score, Cardiology and Cardiovascular Medicine
Abstract

ObjectivesUncertainty about the benefit of (high-intensity) statins for women remains due to under-representation of women in primary prevention trials and scarcity of sex-stratified data. This study evaluates the sex-specific relation between statin treatment and survival and the additional benefit of high-intensity statins.MethodsElectronic health record data from 47 801 patients (17 008 statin users and 30 793 non-users) without prior cardiovascular disease were extracted from thirteen Dutch outpatient cardiology clinics. Patients prescribed statins at baseline were propensity-score matched to those eligible for statin therapy (low-density lipoprotein >2.5 mmol/L) without a statin prescription. Statins were divided into low-intensity and high-intensity according to Dutch guidelines. Mortality data were obtained via linkage to the national mortality registry. Cox regression was used to evaluate the relationship between statin prescription and intensity and all-cause and cardiovascular mortality.ResultsPropensity score matching created a cohort of 8631 statin users and 8631 non-users. 35% of women and 28% of men received a low-intensity statin. The beneficial effect of statins on both all-cause and cardiovascular mortality was stronger in women (HR 0.66, 95% CI 0.58 to 0.74 and HR 0.55, 95% CI 0.39 to 0.71, respectively) than in men (HR 0.89, 95% CI 0.81 to 0.95 and HR 0.93, 95% CI 0.77 to 1.08, respectively). High-intensity statins conferred modest protection against all-cause mortality (HR 0.94, 95% CI 0.88 to 1.00) and cardiovascular mortality (HR 0.86, 95% CI 0.74 to 0.98) in both sexes.ConclusionsThe protective effect of primary prevention statins was stronger in women than men for both all-cause and cardiovascular mortality. High-intensity statins conferred a modest additional benefit in both sexes. Statins seem to be effective regardless of treatment intensity, especially in women.

Published
2022

14. Functional stress imaging to predict abnormal coronary fractional flow reserve: the PACIFIC 2 study

Author

Driessen, Roel S, primary, van Diemen, Pepijn A, additional, Raijmakers, Pieter G, additional, Knuuti, Juhani, additional, Maaniitty, Teemu, additional, Underwood, S Richard, additional, Nagel, Eike, additional, Robbers, Lourens F H J, additional, Demirkiran, Ahmet, additional, von Bartheld, Martin B, additional, van de Ven, Peter M, additional, Hofstra, Leonard, additional, Somsen, G Aernout, additional, Tulevski, Igor I, additional, Boellaard, Ronald, additional, van Rossum, Albert C, additional, Danad, Ibrahim, additional, and Knaapen, Paul, additional

Published
2022
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15. Development of a Pipeline for Adverse Drug Reaction Identification in Clinical Notes: Word Embedding Models and String Matching

Author

Siegersma, Klaske R, primary, Evers, Maxime, additional, Bots, Sophie H, additional, Groepenhoff, Floor, additional, Appelman, Yolande, additional, Hofstra, Leonard, additional, Tulevski, Igor I, additional, Somsen, G Aernout, additional, den Ruijter, Hester M, additional, Spruit, Marco, additional, and Onland-Moret, N Charlotte, additional

Published
2022
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19. Additional file 1 of Routine clinical care data from thirteen cardiac outpatient clinics: design of the Cardiology Centers of the Netherlands (CCN) database

Author

Bots, Sophie H., Siegersma, Klaske R., Onland-Moret, N. Charlotte, Asselbergs, Folkert W., Somsen, G. Aernout, Tulevski, Igor I., den Ruijter, Hester M., and Hofstra, Leonard

Subjects
ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, ComputingMilieux_COMPUTERSANDEDUCATION, Data_FILES, ComputerApplications_COMPUTERSINOTHERSYSTEMS
Abstract

Additional file 1. Supplementary figure and tables.

Published
2021
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20. Outcomes in patients with a first episode of chest pain undergoing early coronary CT imaging.

Author

Siegersma, Klaske R., Onland-Moret, N. Charlotte, Appelman, Yolande, van der Harst, Pim, Tulevski, Igor I., Somsen, G. Aernout, Narula, Jagat, den Ruijter, Hester M., and Hofstra, Leonard

Subjects
CHEST pain diagnosis, PREDICTIVE tests, ANGINA pectoris, CORONARY angiography, CORONARY artery disease, CHEST pain, COMPUTED tomography, DISEASE complications
Abstract

Objectives: To investigate the impact of a CT-first strategy on all-cause and cardiovascular mortality in patients presenting with chest pain in outpatient cardiology clinics.Methods: Patients with a first presentation of suspected angina pectoris were identified and their data linked to the registrations of Statistics Netherlands for information on mortality. The linked database consisted of 33 068 patients. CT-first patients were defined as patients with a CT calcium score and coronary CT angiography, within 6 weeks after their initial visit. Propensity score matching (1:5) was used to match patients with and without a CT-first strategy. After matching, 12 545 patients were included of which 2308 CT-first patients and 10 237 patients that underwent usual care.Results: Mean age was 57 years, 56.3% were women and median follow-up was 4.9 years. All-cause mortality was significantly lower in CT-first patients (n=43, 1.9%) compared with patients without CT (n=363, 3.5%) (HR: 0.51, 95% CI 0.37 to 0.70). Furthermore, CT-first patients were more likely to receive cardiovascular preventative and antianginal medication (aspirin: 44.9% vs 27.1%, statins: 48.7% vs 30.3%, beta-blockers: 37.8% vs 25.5%, in CT-first and without CT-first patients, respectively) and to undergo downstream diagnostics and interventions (coronary interventions: 8.5% vs 5.7%, coronary angiography: 16.2% vs 10.6% in CT-first and without CT-first patients, respectively).Conclusions: In a real-world regular care database, a CT-first strategy in patients suspected of angina pectoris was associated with a lowering of all-cause mortality. [ABSTRACT FROM AUTHOR]

Published
2022
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21. Development of a Pipeline for Adverse Drug Reaction Identification in Clinical Notes: Word Embedding Models and String Matching (Preprint)

Author

Siegersma, Klaske R, primary, Evers, Maxime, additional, Bots, Sophie H, additional, Groepenhoff, Floor, additional, Appelman, Yolande, additional, Hofstra, Leonard, additional, Tulevski, Igor I, additional, Somsen, G Aernout, additional, den Ruijter, Hester M, additional, Spruit, Marco, additional, and Onland-Moret, N Charlotte, additional

Published
2021
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31. Protecting patient privacy in digital health technology: the Dutch m-Health infrastructure of Hartwacht as a learning case

Author

Wierda, Eric, primary, Blok, Sebastiaan, additional, Somsen, G Aernout, additional, van der Velde, Enno T, additional, Tulevski, Igor I, additional, Stavrov, Borut, additional, de Wildt, Maud C C, additional, van den Born, Bert J H, additional, Breukel, Laura, additional, de Mol, Bas A J M, additional, Ploem, M Corrette, additional, and Winter, Michiel M, additional

Published
2020
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37. Protecting patient privacy in digital health technology: the Dutch m-Health infrastructure of Hartwacht as a learning case.

Author

Wierda, Eric, Blok, Sebastiaan, Somsen, G. Aernout, van der Velde, Enno T., Tulevski, Igor I., Stavrov, Borut, de Wildt, Maud C. C., van den Born, Bert J. H., Breukel, Laura, de Mol, Bas A. J. M., Ploem, M. Corrette, and Winter, Michiel M.

Subjects
DIFFUSION of innovations, MEDICAL ethics, MEDICAL technology, PRIVACY, TELEMEDICINE, WEARABLE technology, MOBILE apps, ETHICS
Abstract

Innovative ways of healthcare delivery like m-Health, the practice of medicine by mobile devices and wearable devices are the promising new technique that may lead to improvement in quality of care at lower costs. While fully acknowledging the importance of m-Health development, there are challenges on privacy legislation. We address the legal framework, especially the General Data Protection Regulation, applied to m-Health and its implications for m-Health developments in Europe. We discuss how these rules are applied using a representative example of an m-Health programme with remote monitoring in the Netherlands. We consider informing patients about the data processing and obtaining their explicit consent as main responsibilities of healthcare providers introducing m-Health in their practice. [ABSTRACT FROM AUTHOR]

Published
2020
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38. eHealth in patients with congenital heart disease: a review

Author

Kauw, Dirkjan, primary, Koole, M.A.C., additional, van Dorth, Jolien R., additional, Tulevski, Igor I., additional, Somsen, G. Aernout, additional, Schijven, Marlies P., additional, Dohmen, Daan A.J., additional, Bouma, Berto J., additional, Mulder, Barbara J.M., additional, Schuuring, Mark J., additional, and Winter, Michiel M., additional

Published
2018
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39. Comparison of Coronary CT Angiography, SPECT, PET, and Hybrid Imaging for Diagnosis of Ischemic Heart Disease Determined by Fractional Flow Reserve

Author

Danad, Ibrahim, primary, Raijmakers, Pieter G., additional, Driessen, Roel S., additional, Leipsic, Jonathon, additional, Raju, Rekha, additional, Naoum, Chris, additional, Knuuti, Juhani, additional, Mäki, Maija, additional, Underwood, Richard S., additional, Min, James K., additional, Elmore, Kimberly, additional, Stuijfzand, Wynand J., additional, van Royen, Niels, additional, Tulevski, Igor I., additional, Somsen, Aernout G., additional, Huisman, Marc C., additional, van Lingen, Arthur A., additional, Heymans, Martijn W., additional, van de Ven, Peter M., additional, van Kuijk, Cornelis, additional, Lammertsma, Adriaan A., additional, van Rossum, Albert C., additional, and Knaapen, Paul, additional

Published
2017
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41. Hybrid Imaging Using Quantitative H215O PET and CT-Based Coronary Angiography for the Detection of Coronary Artery Disease

Author

Danad, Ibrahim, primary, Raijmakers, Pieter G., additional, Appelman, Yolande E., additional, Harms, Hendrik J., additional, de Haan, Stefan, additional, van den Oever, Mijntje L.P., additional, Heymans, Martijn W., additional, Tulevski, Igor I., additional, van Kuijk, Cornelis, additional, Hoekstra, Otto S., additional, Lammertsma, Adriaan A., additional, Lubberink, Mark, additional, van Rossum, Albert C., additional, and Knaapen, Paul, additional

Published
2012
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