49 results on '"Umans, Victor A. W. M."'
Search Results
2. Myocardial infarction care in low and high socioeconomic environments: claims data analysis
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Hilt, Alexander D., Umans, Victor A. W. M., Vossenberg, Tessel N. E., Schalij, Martin J., and Beeres, Saskia L. M. A.
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- 2023
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3. Distant embolisation in infective endocarditis: characteristics and outcomes
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Duffels, Mariëlle G. J., Germans, Tjeerd, Bos-Schaap, Annet, Drexhage, Olivier, Wagenaar, Jiri F. P., van der Zant, Friso M., Hoogewerf, Martine, Knol, Remco J. J., and Umans, Victor A. W. M.
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- 2023
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4. The influence of timing of coronary angiography on acute kidney injury in out-of-hospital cardiac arrest patients: a retrospective cohort study
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Janssens, Gladys N., Daemen, Joost, Lemkes, Jorrit S., Spoormans, Eva M., Janssen, Dieuwertje, den Uil, Corstiaan A., Jewbali, Lucia S. D., Heestermans, Ton A. C. M., Umans, Victor A. W. M., Halfwerk, Frank R., Beishuizen, Albertus, Nas, Joris, Bonnes, Judith, van de Ven, Peter M., van Rossum, Albert C., Elbers, Paul W. G., and van Royen, Niels
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- 2022
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5. Myocardial infarction care in low and high socioeconomic environments: claims data analysis.
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Hilt, Alexander D., Umans, Victor A. W. M., Vossenberg, Tessel N. E., Schalij, Martin J., and Beeres, Saskia L. M. A.
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MYOCARDIAL infarction ,NON-ST elevated myocardial infarction ,ST elevation myocardial infarction ,CORONARY artery bypass ,PERCUTANEOUS coronary intervention - Abstract
Background: To date, claims data have not been used to study outcome differences between low and high socioeconomic status (SES) patients surviving ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in the Netherlands. Aim: To evaluate STEMI and NSTEMI care among patients with low and high SES in the referral area of three Dutch percutaneous coronary intervention (PCI) centres, using claims data as a source. Methods: STEMI and NSTEMI patients treated in 2015–2017 were included. Patients' SES scores were collected based on their postal code via an open access government database. In patients with low (SES1) and high (SES4) status, revascularisation strategies and secondary prevention medication were compared. Results: A total of 2065 SES1 patients (age 68 ± 13 years, 58% NSTEMI) and 1639 SES4 patients (age 68 ± 13 years, 63% NSTEMI) were included. PCI use was lower in SES1 compared to SES4 in both STEMI (80% vs 84%, p < 0.012) and NSTEMI (42% vs 48%, p < 0.002) patients. Coronary artery bypass grafting was performed more often in SES1 than in SES4 in both STEMI (7% vs 4%, p = NS) and NSTEMI (11% vs 7%, p < 0.001) patients. Optimal medical therapy use in STEMI patients was higher in SES1 compared to SES4 (52% vs 46%, p = 0.01) but comparable among NSTEMI patients (39% vs 40%, p = NS). One-year mortality was comparable in SES1 and SES4 patients following STEMI (14% vs 16%, p = NS) and NSTEMI (10% vs 11%, p = NS). Conclusion: Combined analysis of claims data and area-specific socioeconomic statistics can provide unique insight into how to improve myocardial infarction care for low and high SES patients. [ABSTRACT FROM AUTHOR]
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- 2024
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6. Serially Measured hs-cTnT, NT-proBNP, hs-CRP and GDF-15 for Risk Assessment After Acute Coronary Syndrome: the BIOMArCS Cohort
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Gürgöze, Muhammed T, primary, Akkerhuis, K Martijn, additional, Oemrawsingh, Rohit M, additional, Umans, Victor A W M, additional, Kietselaer, Bas, additional, Schotborgh, Carl E, additional, Ronner, Eelko, additional, Lenderink, Timo, additional, Aksoy, Ismail, additional, van der Harst, Pim, additional, Asselbergs, Folkert W, additional, Maas, Arthur C, additional, Ophuis, Anton J Oude, additional, Krenning, Boudewijn, additional, de Winter, Robbert J, additional, The, Salem H K, additional, Wardeh, Alexander J, additional, Hermans, Walter R M, additional, Cramer, G Etienne, additional, van Gorp, Ina, additional, de Rijke, Yolanda B, additional, van Schaik, Ron H N, additional, and Boersma, Eric, additional
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- 2023
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7. Serially measured high-sensitivity cardiac troponin T, N-terminal-pro-B-type natriuretic peptide, high-sensitivity C-reactive protein, and growth differentiation factor 15 for risk assessment after acute coronary syndrome: the BIOMArCS cohort.
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Gürgöze, Muhammed T, Akkerhuis, K Martijn, Oemrawsingh, Rohit M, Umans, Victor A W M, Kietselaer, Bas, Schotborgh, Carl E, Ronner, Eelko, Lenderink, Timo, Aksoy, Ismail, van der Harst, Pim, Asselbergs, Folkert W, Maas, Arthur C, Oude Ophuis, Anton J, Krenning, Boudewijn, de Winter, Robbert J, The, Salem H K, Wardeh, Alexander J, Hermans, Walter R M, Cramer, G Etienne, and van Gorp, Ina
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- 2023
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8. Additional file 1 of The influence of timing of coronary angiography on acute kidney injury in out-of-hospital cardiac arrest patients: a retrospective cohort study
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Janssens, Gladys N., Daemen, Joost, Lemkes, Jorrit S., Spoormans, Eva M., Janssen, Dieuwertje, den Uil, Corstiaan A., Jewbali, Lucia S. D., Heestermans, Ton A. C. M., Umans, Victor A. W. M., Halfwerk, Frank R., Beishuizen, Albertus, Nas, Joris, Bonnes, Judith, van de Ven, Peter M., van Rossum, Albert C., Elbers, Paul W. G., and van Royen, Niels
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Additional file 1. AKI definition, Additional statistical analysis, Table S1-7, Figure S1.
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- 2022
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9. Care for Vulnerable Elderly in Cardiology: A Program for Daily Practice
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Wit, Mirjam A. M., Bos-Schaap, Annet J. C. M., and Umans, Victor A. W. M.
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- 2017
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10. Evaluation of the clinical use of directional coronary atherectomy using quantitative coronary angiography
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Umans, Victor A. W. M., Foley, David P., Robert, Annie, Quaedvlieg, Pascal, Van Swijndregt, Eline Montauban, Wijns, William, Serruys, Patrick W., Serruys, Patrick W., editor, Foley, David P., editor, and De Feyter, Pim J., editor
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- 1994
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11. Experiences of a quantitative coronary angiographic core laboratory in restenosis prevention trials
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Umans, Victor A. W. M., Hermans, Walter R. M., Herrman, Jean-Paul R., Pameyer, Jaap, Serruys, Patrick W., Serruys, Patrick W., editor, Foley, David P., editor, and De Feyter, Pim J., editor
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- 1994
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12. Benefit and Risks of Aspirin in Addition to Ticagrelor in Acute Coronary Syndromes: A Post Hoc Analysis of the Randomized GLOBAL LEADERS Trial
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Tomaniak, Mariusz, Chichareon, Ply, Onuma, Yoshinobu, Deliargyris, Efthymios N., Takahashi, Kuniaki, Kogame, Norihiro, Modolo, Rodrigo, Chang, Chun Ching, Rademaker-Havinga, Tessa, Storey, Robert F., Dangas, George D., Bhatt, Deepak L., Angiolillo, Dominick J., Hamm, Christian, Valgimigli, Marco, Windecker, Stephan, Steg, Philippe Gabriel, Vranckx, Pascal, Serruys, Patrick W., Bertrand, Olivier F., Plante, Sylvain, Van Geuns, Robert-Jan, Hofma, Sjoerd H., Royaards, Kees-Jan, Slagboom, Ton, Suryapranata, Harry, Umans, Victor A. W. M., Rensing, Benno, van der Harst, Pim, Magro, Michael, Barbato, Emanuel, Aminian, Adel, Benit, Edouard, Janssens, Luc, Vrolix, Mathias, Buysschaert, Ian, Carrie, Didier, Barraud, Pascal, Teiger, Emmanuel, Koning, Ren, Farzin, Beygui, Morelle, Jean-francois, Isaaz, Karl, Maillard, Luc, Abdellaoui, Mohamed, Brunel, Philippe, Angioi, Michael, Lantelme, Pierre, Sabate, Manel, Albarran Gonzalez-Trevilla, Agustin, Cardiology, Graduate School, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, ACS - Heart failure & arrhythmias, and Cardiovascular Centre (CVC)
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Male ,Ticagrelor ,Internationality ,Time Factors ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Severity of Illness Index ,Tertiary Care Centers ,Coronary artery disease ,0302 clinical medicine ,Cause of Death ,030212 general & internal medicine ,610 Medicine & health ,Original Investigation ,Aspirin ,DUAL ANTIPLATELET THERAPY ,Continuity of Patient Care ,Clopidogrel ,Treatment Outcome ,CLOPIDOGREL ,Platelet aggregation inhibitor ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,INTERVENTION ,medicine.drug ,Acute coronary syndrome ,medicine.medical_specialty ,Hemorrhage ,Risk Assessment ,Drug Administration Schedule ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,Acute Coronary Syndrome ,Dose-Response Relationship, Drug ,RECEPTOR ,business.industry ,Percutaneous coronary intervention ,IN-VITRO ,medicine.disease ,Survival Analysis ,PLATO ,Conventional PCI ,business ,Platelet Aggregation Inhibitors ,Follow-Up Studies - Abstract
Key PointsQuestionWhat are the benefits and risks of continuing aspirin in addition to P2Y12 receptor inhibition with ticagrelor among patients with acute coronary syndrome between 1 month and 12 months after percutaneous coronary intervention? FindingsIn this nonprespecified, post hoc analysis of the GLOBAL LEADERS randomized clinical trial, beyond 1 month after percutaneous coronary intervention in acute coronary syndrome, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. MeaningThe findings of this hypothesis-generating analysis pave the way for further trials evaluating aspirin-free antiplatelet strategies after percutaneous coronary intervention.ImportanceThe role of aspirin as part of antiplatelet regimens in acute coronary syndromes (ACS) needs to be clarified in the context of newer potent P2Y12 antagonists. ObjectiveTo evaluate the benefit and risks of aspirin in addition to ticagrelor among patients with ACS beyond 1 month after percutaneous coronary intervention (PCI). Design, Setting, and ParticipantsThis is a nonprespecified, post hoc analysis of GLOBAL LEADERS, a randomized, open-label superiority trial comparing 2 antiplatelet treatment strategies after PCI. The trial included 130 secondary/tertiary care hospitals in different countries, with 15991 unselected patients with stable coronary artery disease or ACS undergoing PCI. Patients had outpatient visits at 1, 3, 6, 12, 18, and 24 months after index procedure. InterventionsThe experimental group received aspirin plus ticagrelor for 1 month followed by 23-month ticagrelor monotherapy; the reference group received aspirin plus either clopidogrel (stable coronary artery disease) or ticagrelor (ACS) for 12 months, followed by 12-month aspirin monotherapy. In this analysis, we examined the clinical outcomes occurring between 31 days and 365 days after randomization, specifically in patients with ACS who, within this time frame, were assigned to receive either ticagrelor alone or ticagrelor and aspirin. Main Outcomes and MeasuresThe primary outcome was the composite of all-cause death or new Q-wave myocardial infarction. ResultsOf 15968 participants, there were 7487 patients with ACS enrolled; 3750 patients were assigned to the experimental group and 3737 patients to the reference group. Between 31 and 365 days after randomization, the primary outcome occurred in 55 patients (1.5%) in the experimental group and in 75 patients (2.0%) in the reference group (hazard ratio [HR], 0.73; 95% CI, 0.51-1.03; P=.07); investigator-reported Bleeding Academic Research Consortium-defined bleeding type 3 or 5 occurred in 28 patients (0.8%) in the experimental group and in 54 patients (1.5%) in the reference arm (HR, 0.52; 95% CI, 0.33-0.81; P=.004). Conclusions and RelevanceBetween 1 month and 12 months after PCI in ACS, aspirin was associated with increased bleeding risk and appeared not to add to the benefit of ticagrelor on ischemic events. These findings should be interpreted as exploratory and hypothesis generating; however, they pave the way for further trials evaluating aspirin-free antiplatelet strategies after PCI. Trial RegistrationClinicalTrials.gov identifier: NCT01813435.This secondary analysis of the GLOBAL LEADERS randomized clinical trial evaluates the benefit and risks of aspirin in addition to ticagrelor among patients with acute coronary syndrome beyond 1 month after percutaneous coronary intervention.
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- 2019
13. Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study
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Knaapen, Paul, de Mulder, Maarten, van der Zant, Friso M., Peels, Hans O., Twisk, Jos W. R., van Rossum, Albert C., Cornel, Jan H., and Umans, Victor A. W. M.
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- 2009
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14. Temporal Evolution of Serum Concentrations of High‐Sensitivity Cardiac Troponin During 1 Year After Acute Coronary Syndrome Admission
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van den Berg, Victor J., primary, Oemrawsingh, Rohit M., additional, Umans, Victor A. W. M., additional, Kardys, Isabella, additional, Asselbergs, Folkert W., additional, van der Harst, Pim, additional, Hoefer, Imo E., additional, Kietselaer, Bas, additional, Lenderink, Timo, additional, Oude Ophuis, Anton J., additional, van Schaik, Ron H., additional, de Winter, Robbert J., additional, Akkerhuis, K. Martijn, additional, Boersma, Eric, additional, Mulder, Maarten, additional, Schotborgh, Carl, additional, Ronner, Eelko, additional, Liem, Anho, additional, Haitsma, David, additional, Maas, Arthur, additional, Ilmer,, Ben, additional, Dijkgraaf, Rene, additional, Kie, S. Hong, additional, Wardeh, Alexander J, additional, Hermans, Walther, additional, Cramer, Etienne, additional, Doevendans, Pieter A, additional, and Simoons, Maarten L, additional
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- 2021
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15. Variability in lipid measurements can have major impact on treatment during secondary prevention
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van den Berg, Victor J, primary, Vroegindewey, Maxime M, additional, Roeters van Lennep, Jeanine E, additional, Umans, Victor A W M, additional, Deckers, Jaap W, additional, Akkerhuis, K Martijn, additional, Kardys, Isabella, additional, and Boersma, Eric, additional
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- 2020
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16. Circulating Biomarkers of Cell Adhesion Predict Clinical Outcome in Patients with Chronic Heart Failure
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Bouwens, Elke, primary, van den Berg, Victor J., additional, Akkerhuis, K. Martijn, additional, Baart, Sara J., additional, Caliskan, Kadir, additional, Brugts, Jasper J., additional, Mouthaan, Henk, additional, van Ramshorst, Jan, additional, Germans, Tjeerd, additional, Umans, Victor A. W. M., additional, Boersma, Eric, additional, and Kardys, Isabella, additional
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- 2020
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17. Longitudinally Measured Fibrinolysis Factors are Strong Predictors of Clinical Outcome in Patients with Chronic Heart Failure: The Bio-SHiFT Study
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van den Berg, Victor J., additional, Bouwens, Elke, additional, Umans, Victor A. W. M., additional, de Maat, Moniek, additional, Manintveld, Olivier C., additional, Caliskan, Kadir, additional, Constantinescu, Alina A., additional, Mouthaan, Henk, additional, Cornel, Jan-Hein, additional, Baart, Sara, additional, Akkerhuis, K. Martijn, additional, Boersma, Eric, additional, and Kardys, Isabella, additional
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- 2019
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18. Inter- and intra-observer variability in the qualitative categorization of coronary angiograms
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Herrman, Jean-Paul R., Azar, Aida, Umans, Victor A. W. M., Boersma, Eric, v. Es, Gerrit-Anne, and Serruys, Patrick W.
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- 1996
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19. Evaluation of the clinical use of directional coronary atherectomy using quantitative coronary angiography
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Umans, Victor A. W. M., primary, Foley, David P., additional, Robert, Annie, additional, Quaedvlieg, Pascal, additional, Van Swijndregt, Eline Montauban, additional, Wijns, William, additional, and Serruys, Patrick W., additional
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- 1994
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20. Experiences of a quantitative coronary angiographic core laboratory in restenosis prevention trials
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Umans, Victor A. W. M., primary, Hermans, Walter R. M., additional, Herrman, Jean-Paul R., additional, Pameyer, Jaap, additional, and Serruys, Patrick W., additional
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- 1994
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21. Antithrombotic strategy after bioprosthetic aortic valve replacement in patients in sinus rhythm: evaluation of guideline implementation.
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van der Wall, Sake Johannes, Umans, Victor A. W. M., Schotten, Jeroen, Keijzers, Mitran, Wolterbeek, Ron, Jansen, Evert K., Huisman, Menno V., and Vonk, Alexander B. A.
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AORTIC valve , *THROMBOEMBOLISM , *VITAMIN K , *ASPIRIN , *MEDICAL care - Abstract
OBJECTIVES: After elective aortic valve replacement, patients are at risk of developing valve thrombosis and systemic arterial thromboembolism. Current guidelines recommend antithrombotic therapy with aspirin or vitamin K antagonists (VKAs) during the first 3 months after the procedure, but have level 2 or 3 evidence. As a consequence, the most appropriate antithrombotic therapy is still a matter of debate. This retrospective study analysed all thromboembolic and bleeding complications in patients with either antiplatelet or anticoagulation therapy 1 year after bioprosthetic aortic valve replacement. METHODS: A total of 402 patients undergoing bioprosthetic aortic valve implantation at the VU University Medical Centre and subsequently treated at three regional hospitals were included. The individual duration of either VKAs (acenocoumarol) or aspirin was determined and related to thrombotic and bleeding events. Patients were followed and censored at 1 year postoperatively for survival, cerebral ischaemia, myocardial infarction, peripheral arterial embolism, and minor and major haemorrhages. RESULTS: A total of 24 thromboembolic complications and 31 bleeding episodes occurred. Multivariable analyses revealed that acenocoumarol caused more bleeding episodes (risk ratio [RR]: 8.41, 95% CI: 3.58-19.79) and a similar amount of thromboembolic events (RR: 1.2, 95% CI: 0.47-3.02) compared with aspirin. Prior use of acenocoumarol was found to be a risk factor for thromboembolic events (RR: 3.1, 95% CI: 1.31-7.19). Gender, dyslipidaemia, prior percutaneous coronary intervention, prior use of acenocoumarol and concomitant coronary artery bypass grafting were found to be predictors for bleeding events. CONCLUSIONS: In patients 1 year following bioprosthetic aortic valve replacement, acenocoumarol therapy was associated with a significant increased risk of bleeding events and no reduction in thromboembolic events compared with antiplatelet therapy. These findings support the recommendations of aspirin over VKAs as postoperative thromboprophylaxis. [ABSTRACT FROM AUTHOR]
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- 2016
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22. Variability in lipid measurements can have major impact on treatment during secondary prevention.
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Berg, Victor J van den, Vroegindewey, Maxime M, Lennep, Jeanine E Roeters van, Umans, Victor A W M, Deckers, Jaap W, Akkerhuis, K Martijn, Kardys, Isabella, Boersma, Eric, and investigators, the BIOMArCS
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- 2021
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23. Assessment of Microvascular Obstruction and Prediction of Short-term Remodeling after Acute Myocardial Infarction: Cardiac MR Imaging Study
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Nijveldt, Robin, primary, Hofman, Mark B. M., additional, Hirsch, Alexander, additional, Beek, Aernout M., additional, Umans, Victor A. W. M., additional, Algra, Paul R., additional, Piek, Jan J., additional, and van Rossum, Albert C., additional
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- 2009
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24. Infarct size in primary angioplasty without on-site cardiac surgical backup versus transferal to a tertiary center: a single photon emission computed tomography study
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Knaapen, Paul, primary, de Mulder, Maarten, additional, van der Zant, Friso M., additional, Peels, Hans O., additional, Twisk, Jos W. R., additional, van Rossum, Albert C., additional, Cornel, Jan H., additional, and Umans, Victor A. W. M., additional
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- 2008
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25. Variability in lipid measurements can have major impact on treatment during secondary prevention
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van den Berg, Victor J, Vroegindewey, Maxime M, Roeters van Lennep, Jeanine E, Umans, Victor A W M, Deckers, Jaap W, Akkerhuis, K Martijn, Kardys, Isabella, and Boersma, Eric
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- 2021
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26. Long-Term Follow-Up of the Randomized (BIOMArCS-2) Glucose Trial: Intensive Glucose Regulation in Hyperglycemic Acute Coronary Syndrome.
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van den Berg, Victor J., Umans, Victor A. W. M., Stam, Frank, de Mulder, Maarten, Akkerhuis, K. Martijn, Cornel, Jan H., Kardys, Isabella, and Boersma, Eric
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RANDOMIZED controlled trials , *MYOCARDIAL infarction , *BLOOD sugar monitoring , *MORTALITY , *MEDICAL research - Abstract
The article focuses on a randomized trial BIOMArCS-2 Glucose which was conducted to evaluate the effect of using intensive glucose control (IGC) in myocardial infarction (MI). Topics discussed include no association between use of IGC in hyperglycemic MI patients and improved outcomes, lowering blood glucose in hyperglycemic causes excess mortality and risk of higher mortality during long term follow-up.
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- 2016
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27. Late Gadolinium-Enhanced Cardiovascular Magnetic Resonance Evaluation of Infarct Size and Microvascular Obstruction in Optimally Treated Patients after Acute Myocardial Infarction.
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Nijveldt, Robin, Beek, Aernout M., Hofman, Mark B. M., Umans, Victor A. W. M., Algra, Paul R., Spreeuwenberg, Marieke D., Visser, Cees A., and van Rossum, Albert C.
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MYOCARDIAL infarction ,CORONARY disease ,BLOOD circulation disorders ,MYOCARDIAL reperfusion ,CLINICAL trials ,CARDIOVASCULAR system ,MAGNETIC resonance ,MAGNETIC resonance imaging - Abstract
Purpose: Cardiovascular magnetic resonance (CMR) is considered the standard imaging modality in clinical trials to monitor patients after acute myocardial infarction (AMI). However, limited data is available with respect to infarct size, presence, and extent of microvascular injury (MVO), and changes over time, in relation to cardiac function in these optimally treated patients. In this study, we prospectively investigate the change of infarct size over time, and the incidence and significance of MVO in a uniform, optimally treated patient group after AMI. Methods: Forty patients underwent cine and late gadolinium-enhanced CMR within 9 days and at 4 months after primary stenting. Left ventricular ejection fraction (LVEF), infarct size (IS) and MVO size were calculated. Results: IS decreased with 19.0% at follow-up (p < 0.01). The 23 (57.5%) patients with MVO had larger infarct size, higher left ventricular volumes and lower LVEF and more involution of IS at follow-up. Overall, LVEF improved from 42.3 ± 9.8% to 44.0 ± 9.8% (p = 0.06), irrespective of presence or size of MVO. Conclusion: Infarct size reduces over time by 19.0% in optimally treated patients after AMI. Despite optimal reperfusion, MVO was found in the majority of patients. Although patients with MVO had larger infarcts and worse indices of left ventricular remodelling, functional change at follow-up was comparable to patients without MVO. [ABSTRACT FROM AUTHOR]
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- 2007
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28. Functional Recovery After Acute Myocardial Infarction Comparison Between Angiography, Electrocardiography, and Cardiovascular Magnetic Resonance Measures of Microvascular Injury
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Nijveldt, Robin, Beek, Aernout M., Hirsch, Alexander, Stoel, Martin G., Hofman, Mark B. M., Umans, Victor A. W. M., Algra, Paul R., Twisk, Jos W. R., van Rossum, Albert C., and Cardiology
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microvascular injury ,myocardial infarction ,electrocardiography ,magnetic resonance imaging ,angiography ,cardiovascular diseases ,human activities - Abstract
OBJECTIVES: We examined the relation between angiographic, electrocardiographic, and gadolinium-enhanced cardiovascular magnetic resonance (CMR) characteristics of microvascular obstruction (MVO), and their predictive value on functional recovery after acute myocardial infarction (AMI). BACKGROUND: Microvascular obstruction on CMR has been shown to predict left ventricular (LV) remodeling, but it is not well known how it compares with commonly used criteria of microvascular injury, and earlier reports have produced conflicting results on the significance and extent of MVO. METHODS: Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment resolution were assessed in 60 patients with AMI treated with primary stenting. Cardiovascular magnetic resonance was performed between 2 and 9 days after revascularization to determine early MVO on first-pass perfusion imaging, late MVO on late gadolinium-enhanced imaging, and infarct size and transmural extent. Cine imaging was used to determine LV volumes and global and regional function at baseline and 4-month follow-up. RESULTS: Early and late MVO were both related to incomplete ST-segment resolution (p = 0.002 and p = 0.01, respectively), but not to TIMI flow grade and MBG. Of all angiographic, electrocardiographic, and CMR variables, late MVO was the strongest parameter to predict changes in end-diastolic volume (beta = 0.53; p = 0.001), end-systolic volume (beta = 8.67; p = 0.001), and ejection fraction (beta = 3.94; p = 0.006) at follow-up. Regional analysis showed that late MVO had incremental diagnostic value to transmural extent of infarction (odds ratio: 0.18; p
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29. Outcome After ST Elevation Myocardial Infarction in Patients With Cancer Treated With Primary Percutaneous Coronary Intervention.
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Velders, Matthijs A., Boden, Helèn, Hofma, Sjoerd H., Osanto, Susanne, van der Hoeven, Bas L., Heestermans, Anton A. C. M., Cannegieter, Suzanne C., Jukema, J. Wouter, Umans, Victor A. W. M., Schalij, Martin J., and van Boven, Adrianus J.
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MYOCARDIAL infarction , *ANGIOPLASTY , *CANCER treatment , *CORONARY disease , *HEALTH outcome assessment , *PATIENTS ,WESTERN countries - Abstract
The simultaneous occurrence of cancer and coronary heart disease is increasing in the Western world. Nevertheless, the influence of cancer on ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) has not been investigated extensively. This multicenter registry included patients with STEMI treated with primary PCI from 2006 to 2009. Patients were stratified according to history of cancer, and primary focus lay on all-cause and cardiac mortalities during 1-year follow-up. Adjusted effect sizes were calculated using Cox proportional hazard models. In total, 208 patients had a history of cancer (diagnosed ≼6 months ago in 20.7%, 6 months to 3 years ago in 21.7%, and >3 years ago in 57.6%) and 3,215 patients had no history of cancer. Chemotherapy had been administered previously to 23% of patients with cancer. Patients with cancer were older, more frequently women, and more commonly known with previous myocardial infarction or anemia. Reperfusion rates were similar after PCI. Patients with cancer showed greater all-cause (17.4% vs 6.5% in other patients) and cardiac mortalities at 1 year (10.7% vs 5.4% in other patients) because of high early cardiac death (23.8%) in recently diagnosed patients with cancer. After adjustment, a recent cancer diagnosis predicted cardiac mortality at 7 days (hazard ratio 3.34, 95% confidence interval 1.57 to 7.08). The adverse prognosis was partly explained by anemia and occurrence of cardiogenic shock, whereas outcome was independent of cancer treatment. In conclusion, patients with cancer showed greater mortality after STEMI. A cancer diagnosis in the 6 months before primary PCI was strongly associated with early cardiac mortality. [ABSTRACT FROM AUTHOR]
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- 2013
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30. Influence of Gender on Ischemic Times and Outcomes After ST-Elevation Myocardial Infarction.
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Velders, Matthijs A., Boden, Helèn, van Boven, Adrianus J., van der Hoeven, Bas L., Heestermans, Anton A. C. M., Cannegieter, Suzanne C., Umans, Victor A. W. M., Jukema, J. Wouter, Hofma, Sjoerd H., and Schalij, Martin J.
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MYOCARDIAL infarction , *SEX factors in disease , *PROPORTIONAL hazards models , *MEDICAL records , *PERIPHERAL vascular diseases , *CORONARY angiography , *ANGIOPLASTY , *REGRESSION analysis , *HEALTH outcome assessment - Abstract
Previous studies investigating the influence of gender on ST-segment elevation myocardial infarction have reported conflicting results. The aim of this study was to assess the influence of gender on ischemic times and outcomes after ST-segment elevation myocardial infarction in patients treated with primary percutaneous coronary intervention in modern practice. The present multicenter registry included consecutive patients with ST-segment elevation myocardial infarctions treated with primary percutaneous coronary intervention at 3 hospitals. Adjusted mortality rates were calculated using Cox proportional-hazards analyses. In total, 3,483 patients were included, of whom 868 were women (25%). Women were older, had a higher risk factor burden, and more frequently had histories of malignancy. Men more often had cardiac histories and peripheral vascular disease. Ischemic times were longer in women (median 192 minutes [interquartile range 141 to 286] vs 175 minutes [interquartile range 128 to 279] in men, p=0.002). However, multivariate linear regression showed that this was due to age and co-morbidity. All-cause mortality was higher at 7 days (6.0% in women vs 3.0% in men, p <0.001) and at 1 year (9.9% in women vs 6.6% in men, p = 0.001). After adjustment, female gender predicted 7 day all-cause mortality (hazard ratio 1.61, 95% confidence interval 1.06 to 2.46) and cardiac mortality (hazard ratio 1.58, 95% confidence interval 1.03 to 2.42) but not 1-year mortality. Moreover, gender was an independent effect modifier for cardiogenic shock, leading to substantially worse outcomes in women. In conclusion, ischemic times remain longer in women because of age and comorbidity. Female gender independently predicted early all-cause and cardiac mortality after primary percutaneous coronary intervention, and a strong interaction between gender and cardiogenic shock was observed. [ABSTRACT FROM AUTHOR]
- Published
- 2013
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31. Prognostic value of predischarge dobutamine stress echocardiography in chest pain patients with a negative cardiac troponin T.
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Bholasingh R, Cornel JH, Kamp O, van Straalen JP, Sanders GT, Tijssen JGP, Umans VAW, Visser CA, de Winter RJ, Bholasingh, Radha, Cornel, Jan Hein, Kamp, Otto, van Straalen, Jan P, Sanders, Gerard T, Tijssen, Jan G P, Umans, Victor A W M, Visser, Cees A, and de Winter, Robbert J
- Abstract
Objectives: We prospectively studied the prognostic value of predischarge dobutamine stress echocardiography (DSE) in low-risk chest pain patients with a normal or nondiagnostic electrocardiogram (ECG) and a negative serial troponin T.Background: Noninvasive stress testing is recommended before discharge or within 72 h in patients with low-risk chest pain. The prognostic value of immediate DSE has not been studied in a blinded, prospective fashion.Methods: Patients presenting at the emergency room within 6 h of symptom onset and a normal or nondiagnostic ECG were eligible. Dobutamine stress echocardiography was performed after unstable coronary artery disease was ruled out by a standard rule-out protocol and a negative serial troponin T; the occurrence of any new wall motion abnormality was considered positive. Results were kept blinded. End points were cardiac death, myocardial infarction, rehospitalization for unstable angina or revascularization.Results: In total, 377 patients were included. There were 2 deaths, 2 myocardial infarctions, 8 rehospitalization for unstable angina, and 10 revascularizations at six-month follow-up. The end points occurred in 8/26 (30.8%) patients with a positive versus 14/351 (4.0%) patients with a negative DSE (odds ratio, 10.7; 95% confidence interval, 4.0 to 28.8; p < 0.0001). By multivariate analysis, DSE remained a predictor of end points (p < 0.0001).Conclusions: A predischarge DSE had important, independent prognostic value in low-risk, troponin negative, chest pain patients. [ABSTRACT FROM AUTHOR]- Published
- 2003
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32. [Outpatient parenteral antimicrobial therapy for infective endocarditis].
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Umans VAWM, Douiyeb S, Duffels MGJ, Wagenaar JFP, Hoogewerf M, and Germans T
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- Humans, Outpatients, Anti-Bacterial Agents therapeutic use, Endocarditis, Bacterial drug therapy, Endocarditis drug therapy, Endocarditis complications, Anti-Infective Agents therapeutic use
- Abstract
Bacterial endocarditis is associated with high morbidity and mortality and requires a long hospitalization due to long-term intravenous antimicrobial therapy. It is possible to partially treat selected and stable patients at home. We present 3 patients partially treated at home with intravenous antibiotics for proven complicated endocarditis. Patient A presented with a septic shock and mitral valve endocarditis. Patient B presented with an ICD lead endocarditis and patient C presented with an mitral valve endocarditis. All 3 patients had a complicated endocarditis and presented with extensive embolic dissemination. Following the initial complicated clinical course, the patients were discharged for antibiotic home treatment after clinical improvement. Subsequent treatment was successful and reduced their hospital stay with more than 14 days. Thanks to transmural cooperation with the home-care colleagues, we can safely provide antibiotic care at home so that stabilized endocarditis patients can be treated in their own habitat.
- Published
- 2023
33. Heart failure subphenotypes based on repeated biomarker measurements are associated with clinical characteristics and adverse events (Bio-SHiFT study).
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de Lange I, Petersen TB, de Bakker M, Akkerhuis KM, Brugts JJ, Caliskan K, Manintveld OC, Constantinescu AA, Germans T, van Ramshorst J, Umans VAWM, Boersma E, Rizopoulos D, and Kardys I
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- Biomarkers, Humans, Prognosis, Stroke Volume, Ventricular Function, Left, Heart Failure, Heart Transplantation, Ventricular Dysfunction, Left
- Abstract
Background: This study aimed to identify heart failure (HF) subphenotypes using 92 repeatedly measured circulating proteins in 250 patients with heart failure with reduced ejection fraction, and to investigate their clinical characteristics and prognosis., Methods: Clinical data and blood samples were collected tri-monthly until the primary endpoint (PEP) or censoring occurred, with a maximum of 11 visits. The Olink Cardiovascular III panel was measured in baseline samples and the last two samples before the PEP (in 66 PEP cases), or the last sample before censoring (in 184 PEP-free patients). The PEP comprised cardiovascular death, heart transplantation, Left Ventricular Assist Device implantation, and hospitalization for HF. Cluster analysis was performed on individual biomarker trajectories to identify subphenotypes. Then biomarker profiles and clinical characteristics were investigated, and survival analysis was conducted., Results: Clustering revealed three clinically diverse subphenotypes. Cluster 3 was older, with a longer duration of, and more advanced HF, and most comorbidities. Cluster 2 showed increasing levels over time of most biomarkers. In cluster 3, there were elevated baseline levels and increasing levels over time of 16 remaining biomarkers. Median follow-up was 2.2 (1.4-2.5) years. Cluster 3 had a significantly poorer prognosis compared to cluster 1 (adjusted event-free survival time ratio 0.25 (95%CI:0.12-0.50), p < 0.001). Repeated measurements clusters showed incremental prognostic value compared to clusters using single measurements, or clinical characteristics only., Conclusions: Clustering based on repeated biomarker measurements revealed three clinically diverse subphenotypes, of which one has a significantly worse prognosis, therefore contributing to improved (individualized) prognostication., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)
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- 2022
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34. Variability in lipid measurements can have major impact on treatment during secondary prevention.
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van den Berg VJ, Vroegindewey MM, Roeters van Lennep JE, Umans VAWM, Deckers JW, Akkerhuis KM, Kardys I, and Boersma E
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- Cholesterol, LDL, Humans, Secondary Prevention, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use
- Published
- 2022
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35. Stabilization patterns and variability of hs-CRP, NT-proBNP and ST2 during 1 year after acute coronary syndrome admission: results of the BIOMArCS study.
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van den Berg VJ, Umans VAWM, Brankovic M, Oemrawsingh RM, Asselbergs FW, van der Harst P, Hoefer IE, Kietselaer B, Crijns HJGM, Lenderink T, Oude Ophuis AJ, van Schaik RH, Kardys I, Boersma E, and Akkerhuis KM
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- Acute Coronary Syndrome blood, Adult, Aged, Biomarkers blood, C-Reactive Protein analysis, Coronary Artery Disease blood, Female, Humans, Interleukin-1 Receptor-Like 1 Protein analysis, Interleukin-1 Receptor-Like 1 Protein blood, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction blood, Natriuretic Peptide, Brain analysis, Natriuretic Peptide, Brain blood, Peptide Fragments analysis, Peptide Fragments blood, Prospective Studies, Risk Assessment, Risk Factors, Acute Coronary Syndrome metabolism
- Abstract
Objectives Details of the biological variability of high-sensitivity C-reactive protein (hs-CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP) and ST2 are currently lacking in patients with acute coronary syndrome (ACS) but are crucial knowledge when aiming to use these biomarkers for personalized risk prediction. In the current study, we report post-ACS kinetics and the variability of the hs-CRP, NT-proBNP and ST2. Methods BIOMArCS is a prospective, observational study with high frequency blood sampling during 1 year post-ACS. Using 1507 blood samples from 191 patients that remained free from adverse cardiac events, we investigated post-ACS kinetics of hs-CRP, NT-proBNP and ST2. Biological variability was studied using the samples collected between 6 and 12 months after the index ACS, when patients were considered to have stable coronary artery disease. Results On average, hs-CRP rose peaked at day 2 and rose well above the reference value. ST2 peaked immediately after the ACS but never rose above the reference value. NT-proBNP level rose on average during the first 2 days post-ACS and slowly declined afterwards. The within-subject variation and relative change value (RCV) of ST2 were relatively small (13.8%, RCV 39.7%), while hs-CRP (41.9%, lognormal RCV 206.1/-67.3%) and NT-proBNP (39.0%, lognormal RCV 185.2/-64.9%) showed a considerable variation. Conclusions Variability of hs-CRP and NT-proBNP within asymptomatic and clinically stable post-ACS patients is considerable. In contrast, within-patient variability of ST2 is low. Given the low within-subject variation, ST2 might be the most useful biomarker for personalizing risk prediction in stable post-ACS patients.
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- 2020
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36. Serially Measured Cytokines and Cytokine Receptors in Relation to Clinical Outcome in Patients With Stable Heart Failure.
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Bouwens E, Schuurman AS, Akkerhuis KM, Baart SJ, Caliskan K, Brugts JJ, van Ramshorst J, Germans T, Umans VAWM, Boersma E, and Kardys I
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- Biomarkers blood, Cohort Studies, Cytokines blood, Female, Heart Transplantation methods, Heart Transplantation statistics & numerical data, Heart-Assist Devices, Humans, Male, Middle Aged, Netherlands epidemiology, Prospective Studies, Receptors, Cytokine blood, Risk Assessment methods, Assisted Circulation instrumentation, Assisted Circulation methods, Assisted Circulation statistics & numerical data, B-Cell Activating Factor blood, Heart Failure blood, Heart Failure mortality, Heart Failure therapy, Interleukin-1 blood, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care statistics & numerical data, Receptors, Interleukin-1 blood
- Abstract
In this prospective cohort study of 250 stable heart failure patients with trimonthly blood sampling, we investigated associations of 17 repeatedly measured cytokines and cytokine receptors with clinical outcome during a median follow-up of 2.2 (25th-75th percentile, 1.4-2.5) years. Sixty-six patients reached the primary end point (composite of cardiovascular mortality, heart failure hospitalization, heart transplantation, left ventricular assist device implantation). Repeatedly measured levels of 8 biomarkers correlated with clinical outcomes independent of clinical characteristics. Rates of change over time (slopes of biomarker evolutions) remained independently associated with outcome for 15 biomarkers. Thus, temporal patterns of cytokines and cytokine receptors, in particular tumour necrosis factor ligand superfamily member 13B and interleukin-1 receptor type 1, might contribute to personalized risk assessment., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
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37. Relation between pharmacological stress ECG, 13NH3-PET/CT outcome and the occurrence of cardiac events during follow-up in women with chest pain.
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van der Zant FM, Maurits W, Lazarenko SV, Broos WAM, Umans VAWM, Cornel JH, and Knol RJJ
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- Aged, Chest Pain physiopathology, Female, Follow-Up Studies, Humans, Nitrogen Radioisotopes, Risk Assessment, Ammonia, Cardiovascular Diseases complications, Chest Pain complications, Chest Pain diagnostic imaging, Electrocardiography, Positron Emission Tomography Computed Tomography, Stress, Physiological
- Abstract
Aim: Evaluation of major adverse cardiovascular events (MACE) in women referred for NH3-PET/CT in relation to scan outcome and pharmacological stress ECG (PxECG) results., Patients and Methods: Six hundred twenty-four women, referred for NH3-PET/CT between 2012 and 2016, were included. Demographic data and MACE during follow-up (407 ± 207 days) were retrieved from electronic patient charts. NH3-PET/CT was scored as either normal or abnormal. PxECG was scored as negative, non-diagnostic or positive. PxECG was compared with NH3-PET/CT and related to MACE., Results: The NH3-PET/CT was normal in 482/624 (77%) and abnormal in 142/624 (23%). PxECG was negative in 234/624 (38%), non-diagnostic in 365/624 (58%) and positive in 25/624 (4%). NH3-PET/CT was normal in 87, 71 and 72% with normal, nondiagnostic and positive PxECG, respectively. 41/624(7%) experienced a MACE, 38 with abnormal NH3-PET/CT versus three with normal NH3-PET/CT (P < 0.001). MACE occurred in 5/234 (0.9%), 31/365 (8%) and 5/25 (20%) with normal, non-diagnostic and positive PxECG, respectively (P < 0.001). No MACEs were seen in 204 with both normal PxECG and NH3-PET/CT versus 5/30(17%) with normal PxECG but abnormal NH3-PET/. No MACE occurred in 3/260(1%) with non-diagnostic PxECG and normal NH3-PET/CT versus 28/105(27%) with non-diagnostic PxECG and abnormal NH3-PET/CT. 0/18 with positive PxECG and normal NH3-PET/CT showed MACE versus 5/7(71%) with a positive PxECG and abnormal NH3-PET/CT., Conclusion: Normal NH3-PET/CT is most prevalent in women with normal PxECG. The occurrence of MACE during follow-up is more frequently related to an abnormal NH3-PET/CT than to PxECG. Furthermore, in women with positive PxECG but normal NH3-PET/CT no MACE are to be expected.
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- 2020
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38. Details on high frequency blood collection, data analysis, available material and patient characteristics in BIOMArCS.
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Boersma E, Vroegindewey MM, van den Berg VJ, Asselbergs FW, van der Harst P, Kietselaer B, Lenderink T, Oude Ophuis AJ, Umans VAWM, de Winter RJ, Oemrawsingh RM, and Akkerhuis KM
- Abstract
The Biomarker Study to Identify the Acute Risk of a Coronary Syndrome (BIOMArCS) is a prospective, observational study that has been designed to study the evolution of blood biomarkers in post-acute coronary syndrome (ACS) patients. In our recently published study "Temporal evolution of Myeloperoxidase and Galectin 3 during 1 year after acute coronary syndrome admission" [1] in the American Heart Journal , we demonstrated that repeatedly measuring MPO and Galectin-3 does not aid to differentiate between patients with and without adverse cardiac events during 1-year follow-up. In this Data-In-Brief article, we present further details on data collections and data analysis. In addition, a detailed description of baseline characteristics and the distribution of blood sampling moments is provided. The BIOMArCS dataset contains clinical information and follow-up data on all enrolled 844 patients. These patients underwent a median of 17 (25th -75th percentile 12-20) repeated blood samples in the first year after the index ACS. Blood samples were stored at -80 °C within a median of 82 (25th-75th percentile 58-117) minutes after withdrawal. We collected whole blood, citrate plasma, EDTA plasma, serum and DNA. The dataset used for the analysis in the accompanying research paper has been made available online. We welcome collaborations for further use of our data, whether or not in combination with other biobanks., (© 2019 The Author(s).)
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- 2019
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39. Temporal evolution of myeloperoxidase and galectin 3 during 1 year after acute coronary syndrome admission.
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Vroegindewey MM, van den Berg VJ, Bouwens E, Akkerhuis KM, Oemrawsingh RM, Asselbergs FW, Lenderink T, van der Harst P, Ronner E, Umans VAWM, Kardys I, and Boersma E
- Subjects
- Aged, Biomarkers blood, Blood Proteins, Cohort Studies, Female, Follow-Up Studies, Galectins, Hospitalization, Humans, Male, Middle Aged, Netherlands, Time Factors, Acute Coronary Syndrome blood, Galectin 3 blood, Peroxidase blood
- Abstract
Prior studies reported that Myeloperoxidase and Galectin-3, which are biomarkers of coronary plaque vulnerability, are elevated in acute coronary syndrome (ACS) patients. We studied the temporal evolution of these biomarkers early after ACS admission and prior to a recurrent ACS event during 1 year follow-up., (Copyright © 2019 Elsevier Inc. All rights reserved.)
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- 2019
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40. Repeated Echocardiograms Do Not Provide Incremental Prognostic Value to Single Echocardiographic Assessment in Minimally Symptomatic Patients with Chronic Heart Failure: Results of the Bio-SHiFT Study.
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van den Berg VJ, Strachinaru M, Akkerhuis KM, Baart S, Brankovic M, Constantinescu AA, Cornel JH, Manintveld OC, Umans VAWM, Rizopoulos D, Geleijnse ML, Boersma E, van Dalen BM, and Kardys I
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- Biomarkers analysis, Chronic Disease, Female, Heart Failure physiopathology, Humans, Male, Middle Aged, Netherlands, Prognosis, Prospective Studies, Retreatment, Echocardiography, Heart Failure diagnostic imaging
- Abstract
Background: We aimed to compare the prognostic value of a single "baseline" echocardiogram with repeated echocardiography in stable chronic heart failure (CHF) patients. We hypothesized that repeated echocardiograms would contain incremental prognostic information., Methods: In the prospective Bio-SHiFT study, we performed 332 echocardiograms in 106 patients during a median follow-up of 2.3 years. The endpoint comprised HF hospitalization, left ventricular (LV) assist device implantation, heart transplantation, and cardiovascular death. We compared hazard ratios (HRs; adjusted for N-terminal pro-brain natriuretic peptide) from Cox models for the first available measurement with HRs from joint models, which model individual trajectories based on the repeated measurements and link these to the time-to-event data., Results: The mean age of the patients was 58.1 years; 78.3% were male, 12.6% had New York Heart Association class >II, all had reduced ejection fraction, and the most common HF etiologies were cardiomyopathies (51%) and ischemia (40%). The endpoint occurred in 25 patients. Both the single measurements and the temporal trajectories were significantly associated with the endpoint (adjusted HR Cox model [95% CI] vs adjusted HR joint model [95% CI]): LV ejection fraction, 1.47 (0.93-2.31) vs 1.77 (1.13-2.93); diastolic LV diameter, 1.64 (1.09-2.47) vs 1.68 (1.12-2.57); systolic LV diameter, 1.72 (1.10-2.69) vs 1.68 (1.13-2.63); systolic left atrial diameter, 1.88 (1.18-3.00) vs 2.60 (1.48-4.97); E/A ratio, 2.73 (1.42-5.26) vs 3.87 (1.75-10.13); and E/e' ratio, 2.30 (1.38-3.84) vs 2.99 (1.68-6.19). None of the trajectories from the investigated parameters showed worsening prior to events., Conclusions: Although single baseline or repeatedly measured echocardiographic parameters were associated with the endpoint, all parameters remained on average stable during the 2.3 years of follow-up in this largely minimally symptomatic CHF cohort. Thus, regular echocardiographic monitoring of systolic or diastolic LV function within this time frame does not carry incremental prognostic information over a single baseline measurement., (Copyright © 2019 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.)
- Published
- 2019
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41. Dataset on blood biomarkers and GRACE score measured at admission for myocardial infarction in a large secondary hospital.
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van den Berg VJ, van Toorenburg M, Drexhage O, Boersma E, Kardys I, and Umans VAWM
- Abstract
The GRACE score is currently the most widely used model to assess patient prognosis after myocardial infarction (MI). We have demonstrated that the prognostic performance of the GRACE score can be improved by adding blood biomarkers measured routinely at hospital admission in our study recently published in the International Journal of Cardiology: "Addition of routinely measured blood biomarkers significantly improves GRACE risk stratification in patients with myocardial infarction". In this Data-in-Brief article we present additional original data from our dataset. This dataset consists of clinical and biomarker information and follow-up data of 2055 confirmed MI patients. In 143 of these patients the endpoint (all-cause mortality or reMI) occurred during six months follow-up. We describe the differences in baseline characteristics between ST-elevation MI (STEMI) patients and non-STEMI patients, differences in biomarker levels at admission between patients in whom the endpoint occurred and patients who remained endpoint-free, and associations of the biomarkers with the endpoint. Moreover, we show additional statistical results of analyses that compare the original GRACE-only model with our extended GRACE/biomarker model.
- Published
- 2018
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42. IgM anti-malondialdehyde low density lipoprotein antibody levels indicate coronary heart disease and necrotic core characteristics in the Nordic Diltiazem (NORDIL) study and the Integrated Imaging and Biomarker Study 3 (IBIS-3).
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van den Berg VJ, Haskard DO, Fedorowski A, Hartley A, Kardys I, Caga-Anan M, Akkerhuis KM, Oemrawsingh RM, van Geuns RJ, de Jaegere P, van Mieghem N, Regar E, Ligthart JMR, Umans VAWM, Serruys PW, Melander O, Boersma E, and Khamis RY
- Subjects
- Aged, Atherosclerosis blood, Biomarkers blood, Female, Humans, Male, Malondialdehyde immunology, Middle Aged, Prospective Studies, Coronary Artery Disease blood, Immunoglobulin M blood, Lipoproteins, LDL immunology, Malondialdehyde analogs & derivatives, Necrosis blood
- Abstract
Background: Certain immunoglobulins (Ig) are proposed to have protective functions in atherosclerosis., Objectives: We tested whether serum levels of IgG and IgM autoantibodies against malondialdehyde low density lipoprotein (MDA-LDL) are associated with clinical coronary heart disease (CHD) and unfavorable plaque characteristics., Methods: NORDIL was a prospective study investigating adverse cardiovascular outcomes in hypertensive patients. IBIS-3 analyzed lesions in a non-culprit coronary artery with <50% stenosis using radiofrequency intravascular ultrasound (RF-IVUS) and near-infrared spectroscopy (NIRS). Imaging was repeated after a median of 386?days on rosuvastatin. Associations of antibodies with incident CHD and imaging parameters were assessed in the two sub-studies respectively., Findings: From 10,881 NORDIL patients, 87 had serum sampled at baseline and developed CHD over 4.5 years, matched to 227 controls. Higher titers of IgM anti-MDA-LDL had a protective effect on adverse outcomes, with odds ratio 0.29 (0.11, 0.76; p=0.012; p=0.016 for trend). Therefore, the effect was explored at the lesional level in IBIS-3. 143 patients had blood samples and RF-IVUS measurements available, and NIRS was performed in 90 of these. At baseline, IgM anti-MDA-LDL levels had a strong independent inverse relationship with lesional necrotic core volume (p=0.027) and percentage of plaque occupied by necrotic core (p=0.011), as well as lipid core burden index (p=0.024) in the worst 4 mm segment., Interpretation: Our study supports the hypothesis that lower circulating levels of IgM anti-MDA-LDL are associated with clinical CHD development, and for the first time relates these findings to atherosclerotic plaque characteristics that are linked to vulnerability., (© 2018 The Authors. Published by Elsevier B.V.)
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- 2018
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43. Exercise Electrocardiogram Neither Predicts Nor Excludes Coronary Artery Disease in Women with Low to Intermediate Risk.
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Knol RJJ, Kan H, Wondergem M, Cornel JH, Umans VAWM, van der Ploeg T, and van der Zant FM
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- Aged, Chest Pain etiology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Factors, Sensitivity and Specificity, Coronary Artery Disease diagnosis, Echocardiography methods, Electrocardiography methods, Exercise Test methods
- Abstract
Aim: The value of exercise electrocardiogram (ExECG) in symptomatic female patients with low to intermediate risk for significant coronary artery disease (CAD) has been under debate for many years, and nondiagnostic or even erroneous test results are frequently encountered. Cardiac-CT may be more appropriate to exclude CAD in women. This study compares the results of ExECGs with those of cardiac-CTs, performed within a time frame of 1 month in an all-comers female chest pain population., Patients and Methods: Five hundred fifty-one consecutive female patients from a patient registry were included. ExECGs were negative in 324 (59%), positive in 14 (3%), and nondiagnostic in 213 (39%) patients. CAD was revealed by cardiac-CT in 57% of the women with negative ExECG. No signs of CAD were present on cardiac-CT in 64% of the women with a positive ExECG. Cardiac-CT showed presence of CAD in 268/551 (49%) patients, of whom 56/268 (21%) was diagnosed with ≥50% stenosis. The ExECG of the latter group was negative in 26 (46%), inconclusive in 29 (52%), and positive in 1 (2%). Considering ≥50% stenosis at cardiac-CT as the reference, sensitivity, specificity, PPV, and NPV of ExECG for the present population were 3.7%, 95.7%, 7.1%, and 91.7%, respectively. Similar diagnostic performance was calculated when considering ≥70% stenosis at cardiac-CT as the reference., Conclusion: ExECG failed to detect CAD in more than half of this cohort and in almost half of women with >50% stenosis at cardiac-CT. Importantly, no CAD was detected by cardiac-CT in 64% of women with a positive ExECG. ExECG is therefore questionable as a diagnostic strategy in women with low-to-intermediate risk of CAD, although prospective studies are warranted to determine whether replacing ExECG by cardiac-CT provides better prognoses.
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- 2018
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44. Call-to-balloon time dashboard in patients with ST-segment elevation myocardial infarction results in significant improvement in the logistic chain.
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Hermans MPJ, Velders MA, Smeekes M, Drexhage OS, Hautvast RWM, Ytsma T, Schalij MJ, and Umans VAWM
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- Adult, Aged, Angioplasty, Balloon, Coronary methods, Emergency Medical Services methods, Female, Humans, Male, Middle Aged, Risk Factors, Time Factors, Treatment Outcome, Percutaneous Coronary Intervention methods, ST Elevation Myocardial Infarction surgery
- Abstract
Aims: Timely reperfusion with primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients is associated with superior clinical outcomes. Aiming to reduce ischaemic time, an innovative system for home-to-hospital (H2H) time monitoring was implemented, which enabled real-time evaluation of ischaemic time intervals, regular feedback and improvements in the logistic chain. The objective of this study was to assess the results after implementation of the H2H dashboard for monitoring and evaluation of ischaemic time in STEMI patients., Methods and Results: Ischaemic time in STEMI patients transported by emergency medical services (EMS) and treated with pPCI in the Noordwest Ziekenhuis, Alkmaar before (2008-2009; n=495) and after the implementation of the H2H dashboard (2011-2014; n=441) was compared. Median time intervals were significantly shorter in the H2H group (door-to-balloon time 32 [IQR 25-43] vs. 40 [IQR 28-55] minutes, p-value <0.001, FMC-to-balloon time 62 [IQR 52-75] vs. 80 [IQR 67-103] minutes, p-value <0.001, and treatment delay 142 [IQR 103-221] vs. 159 [IQR 123-253] minutes, p-value <0.001). The H2H time dashboard was independently associated with shorter time delays., Conclusions: Real-time monitoring and feedback on time delay with the H2H dashboard improves the logistic chain in STEMI patients, resulting in shorter ischaemic time intervals.
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- 2017
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45. How to implement a clinical pathway for intensive glucose regulation in acute coronary syndromes.
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de Mulder M, Zwaan E, Wielinga Y, Stam F, and Umans VA
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- Acute Coronary Syndrome drug therapy, Aged, Aged, 80 and over, Critical Pathways, Humans, Hyperglycemia blood, Acute Coronary Syndrome blood, Blood Glucose drug effects, Hyperglycemia drug therapy, Hypoglycemic Agents administration & dosage, Insulin administration & dosage
- Abstract
Hyperglycemia upon admission of myocardial infarction patients predicts inferior clinical outcomes. Current strategies investigating hyperglycemia correction mostly use glucose-driven protocols. Implementation of these often labor-intensive protocols might be facilitated with the approach of a clinical pathway. Therefore, we evaluated the implementation of our glucose-driven protocol.We adapted a protocol for use in our coronary care unit (CCU), which was implemented according to the steps of a clinical pathway. To compensate for carbohydrates in meals we additionally developed a regimen of subcutaneous insulin.Protocol adherence was facilitated with a Web-based insulin calculator. All hyperglycemic patients admitted to the CCU were eligible for treatment according to this protocol.In a 4-month period, 643 glucose measurements were obtained in hyperglycemic patients admitted to our CCU. Patients were treated intensively with IV insulin for 35 hours and had 23 glucose measurements in this time span on average. This regimen achieved a median glucose of 6.2 mmol/L. Severe hypoglycemia occurred in only 1.1% of measurements and was without severe clinical side effects.Introduction of new intensive insulin protocol according to the steps of a clinical pathway is safe and feasible. The presence of a clinical pathway coordinator and sound communication are important conditions for successful introduction, which can be further aided with a computerized calculator.
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- 2009
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46. Current management of hyperglycemia in acute coronary syndromes: a national Dutch survey.
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de Mulder M, Oemrawsingh RM, Stam F, Boersma E, and Umans VA
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- Acute Coronary Syndrome complications, Humans, Hyperglycemia complications, Netherlands, Surveys and Questionnaires, Treatment Outcome, Acute Coronary Syndrome blood, Hyperglycemia blood, Hyperglycemia drug therapy, Hypoglycemic Agents therapeutic use
- Abstract
Hyperglycemia is common among patients admitted with acute coronary syndromes (ACS) and is associated with less favorable clinical outcomes. Guidelines for the treatment of hyperglycemia in myocardial infarction are confusing, partly because of lack of sufficient evidence. Neither do we know what the everyday practice on hyperglycemia in ACS is. Therefore the aim of our study is to describe current glucose management in ACS patients in The Netherlands. We designed a multiple-choice questionnaire that was emailed to all 94 independent cardiology departments of each of the 114 hospitals within The Netherlands. We interviewed cardiologists about their specific hospital setting, the presence, content, and actual use of a dedicated hyperglycemia protocol in the setting of ACS. Ninety-four questionnaires were returned (response rate 100%). Only 32% of the respondents reported to have a routinely applied, dedicated hyperglycemia protocol in the setting of ACS. An admission glucose of 13.0 mmol/L is considered a stress value by 60% of respondents. Treatment of hyperglycemia is postponed until after the acute phase (ie, after >6 hours) in 41% of the cardiology departments and in 76% HbA1c is not routinely measured before discharge. Only a minority of Dutch cardiology departments have a routinely applied, dedicated hyperglycemia protocol for patients admitted with ACS. Different views exist on the interpretation of admission hyperglycemia in patients without previously diagnosed diabetes. Dedicated protocols with well-established treatment goals allow early treatment and are mandatory to improve timely metabolic regulation.
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- 2009
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47. Response to 'Insulin therapy in acute coronary syndromes'.
- Author
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de Mulder M and Umans VA
- Subjects
- Acute Coronary Syndrome blood, Acute Coronary Syndrome complications, Acute Coronary Syndrome diagnostic imaging, Acute Coronary Syndrome physiopathology, Biomarkers blood, Evidence-Based Medicine, Humans, Hyperglycemia blood, Hyperglycemia complications, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Randomized Controlled Trials as Topic, Stroke Volume drug effects, Time Factors, Tomography, Emission-Computed, Single-Photon, Treatment Outcome, Troponin T blood, Ventricular Function, Left drug effects, Acute Coronary Syndrome drug therapy, Hyperglycemia drug therapy, Hypoglycemic Agents therapeutic use, Insulin therapeutic use
- Published
- 2009
- Full Text
- View/download PDF
48. Functional recovery after acute myocardial infarction: comparison between angiography, electrocardiography, and cardiovascular magnetic resonance measures of microvascular injury.
- Author
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Nijveldt R, Beek AM, Hirsch A, Stoel MG, Hofman MB, Umans VA, Algra PR, Twisk JW, and van Rossum AC
- Subjects
- Female, Gadolinium, Heart Conduction System diagnostic imaging, Heart Conduction System physiopathology, Humans, Hypertrophy, Left Ventricular etiology, Magnetic Resonance Imaging, Cine, Male, Middle Aged, Myocardial Infarction complications, Myocardial Infarction diagnosis, Predictive Value of Tests, Prospective Studies, Risk Factors, Stroke Volume, Coronary Angiography, Electrocardiography, Magnetic Resonance Imaging instrumentation, Magnetic Resonance Imaging methods, Myocardial Infarction diagnostic imaging, Myocardial Infarction physiopathology
- Abstract
Objectives: We examined the relation between angiographic, electrocardiographic, and gadolinium-enhanced cardiovascular magnetic resonance (CMR) characteristics of microvascular obstruction (MVO), and their predictive value on functional recovery after acute myocardial infarction (AMI)., Background: Microvascular obstruction on CMR has been shown to predict left ventricular (LV) remodeling, but it is not well known how it compares with commonly used criteria of microvascular injury, and earlier reports have produced conflicting results on the significance and extent of MVO., Methods: Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment resolution were assessed in 60 patients with AMI treated with primary stenting. Cardiovascular magnetic resonance was performed between 2 and 9 days after revascularization to determine early MVO on first-pass perfusion imaging, late MVO on late gadolinium-enhanced imaging, and infarct size and transmural extent. Cine imaging was used to determine LV volumes and global and regional function at baseline and 4-month follow-up., Results: Early and late MVO were both related to incomplete ST-segment resolution (p = 0.002 and p = 0.01, respectively), but not to TIMI flow grade and MBG. Of all angiographic, electrocardiographic, and CMR variables, late MVO was the strongest parameter to predict changes in end-diastolic volume (beta = 0.53; p = 0.001), end-systolic volume (beta = 8.67; p = 0.001), and ejection fraction (beta = 3.94; p = 0.006) at follow-up. Regional analysis showed that late MVO had incremental diagnostic value to transmural extent of infarction (odds ratio: 0.18; p < 0.0001)., Conclusions: In patients after revascularized AMI, late MVO proved a more powerful predictor of global and regional functional recovery than all of the other characteristics, including transmural extent of infarction.
- Published
- 2008
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49. A dose-finding study of fondaparinux in patients with non-ST-segment elevation acute coronary syndromes: the Pentasaccharide in Unstable Angina (PENTUA) Study.
- Author
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Simoons ML, Bobbink IW, Boland J, Gardien M, Klootwijk P, Lensing AW, Ruzyllo W, Umans VA, Vahanian A, Van De Werf F, and Zeymer U
- Subjects
- Acute Disease, Adrenergic beta-Antagonists therapeutic use, Adult, Angioplasty, Balloon, Coronary, Angiotensin-Converting Enzyme Inhibitors therapeutic use, Biomarkers blood, Coronary Artery Bypass, Coronary Disease diagnosis, Coronary Disease mortality, Creatine Kinase blood, Creatine Kinase, MB Form, Dose-Response Relationship, Drug, Double-Blind Method, Enoxaparin administration & dosage, Enoxaparin adverse effects, Female, Fibrinolytic Agents administration & dosage, Fibrinolytic Agents adverse effects, Follow-Up Studies, Fondaparinux, Hemorrhage chemically induced, Humans, Hypolipidemic Agents therapeutic use, Isoenzymes blood, Male, Middle Aged, Polysaccharides adverse effects, Survival Analysis, Syndrome, Treatment Outcome, Troponin T blood, Coronary Disease therapy, Electrocardiography, Polysaccharides administration & dosage
- Abstract
Objectives: In this dose-finding study, we sought to compare fondaparinux with enoxaparin in patients with acute coronary syndromes (ACS)., Background: Fondaparinux is a synthetic pentasaccharide that selectively inhibits activated clotting factor X. It has been demonstrated as effective in preventing thromboembolic complications in orthopedic surgery., Methods: Four doses fondaparinux (2.5, 4, 8, or 12 mg once daily) and enoxaparin (1 mg/kg twice daily) were compared, both given for three to seven days, in patients with ACS without persistent ST-segment elevation., Results: The rates of the combined primary end point of death, myocardial infarction, or recurrent ischemia after nine days were 27.9%, 35.9%, 34.7%, 30.3%, and 35.7% in patients allocated to fondaparinux doses of 2.5, 4, 8, and 12 mg and enoxaparin, respectively (p = NS). In the per-protocol analysis (929 patients who received adequate study drug and had adequate ST-segment monitoring), these figures were 30.0%, 43.5%, 41.0%, 34.8%, and 40.2%. Again, no dose response was observed. The lowest event rates were observed in the 2.5-mg fondaparinux group, which had significantly lower rates than the enoxaparin group as well as for 4 and 8 mg fondaparinux in the per-protocol analysis (p < 0.05). Bleeding rates were low and not different among the patient groups. No differences were observed in fondaparinux concentrations in patients with or without death, myocardial infarction, recurrent ischemia, or bleeding events., Conclusions: This dose-finding study revealed no dose response for different fondaparinux doses ranging from 2.5 to 12 mg subcutaneously and suggests that the efficacy and safety of fondaparinux may be similar to that of enoxaparin. Further studies with fondaparinux in ACS might include the lowest dose (2.5 mg) investigated in this study.
- Published
- 2004
- Full Text
- View/download PDF
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