224 results on '"Arend F.L. Schinkel"'
Search Results
52. Usefulness of Contrast-Enhanced Ultrasound for Detection of Carotid Plaque Ulceration in Patients With Symptomatic Carotid Atherosclerosis
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Hence J.M. Verhagen, Burhan Hussain, Aad van der Lugt, Eric J.G. Sijbrands, Arend F.L. Schinkel, Gerrit L. ten Kate, Anouk C. van Dijk, Antonius F.W. van der Steen, Stijn C.H. van den Oord, Internal Medicine, Radiology & Nuclear Medicine, Cardiology, and Surgery
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Carotid atherosclerosis ,Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Contrast Media ,Sensitivity and Specificity ,medicine.artery ,medicine ,Humans ,In patient ,Carotid Stenosis ,Prospective Studies ,Ultrasonography, Doppler, Color ,Prospective cohort study ,Ultrasonography ,medicine.diagnostic_test ,business.industry ,Ultrasound ,Middle Aged ,medicine.disease ,Stenosis ,Angiography ,cardiovascular system ,Female ,Radiology ,Internal carotid artery ,Cardiology and Cardiovascular Medicine ,business ,Contrast-enhanced ultrasound - Abstract
Previous data have indicated that carotid plaque ulceration is a strong predictor of cerebrovascular events. Standard ultrasound and color Doppler ultrasound (CDUS) scans have poor diagnostic accuracy for the detection of carotid plaque ulceration. The aim of the present prospective study was to assess the value of contrast-enhanced ultrasound (CEUS) scans for the detection of carotid plaque ulceration. The Institutional Ethics Committee approved the study protocol, and all patients provided informed consent. The patients had symptomatic stenosis of the internal carotid artery and underwent carotid computed tomographic angiography as part of their clinical evaluation. All patients underwent a CDUS examination in conjunction with CEUS. Carotid plaque ulceration was defined as the presence of >= 1 disruptions in the plaque-lumen border >= 1 x 1 mm. Carotid computed tomographic angiography was used as reference technique. The study population consisted of 20 patients (mean age 64 +/- 9 years, 80% men), and 39 carotid arteries were included in the present analysis. Computed tomographic angiography demonstrated that the plaque surface was smooth in 15 (38%), irregular in 7 (18%) and ulcerated in 17 (44%) carotid arteries. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CDUS for the detection of ulceration was 29%, 73%, 54%, 46%, and 57%, respectively. The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of CEUS for the detection of ulceration was 88%, 59%, 72%, 63%, and 87%, respectively. CEUS had superior sensitivity and diagnostic accuracy for the assessment of carotid plaque ulceration compared with CDUS. CEUS improved the intrareader and inter-reader variability for the assessment of carotid plaque ulceration compared with CDUS. In conclusion, CEUS could be an additional method for the detection of carotid plaque ulceration. The role of CDUS for the assessment of carotid plaque ulceration seems limited. (C) 2013 Elsevier Inc. All rights reserved.
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- 2013
53. Carotid intima-media thickness for cardiovascular risk assessment: Systematic review and meta-analysis
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Gerrit L. ten Kate, Stijn C.H. van den Oord, Antonius F.W. van der Steen, Eric J.G. Sijbrands, David van Klaveren, Ron T. van Domburg, Arend F.L. Schinkel, Cardiology, Internal Medicine, and Public Health
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medicine.medical_specialty ,business.industry ,medicine.disease ,Random effects model ,Risk prediction models ,Carotid Intima-Media Thickness ,Risk Assessment ,Surgery ,Intima-media thickness ,Cardiovascular Diseases ,Risk Factors ,Meta-analysis ,Internal medicine ,medicine ,Cardiology ,cardiovascular system ,Humans ,Myocardial infarction ,Overall performance ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Stroke - Abstract
Objective B-mode ultrasound measurement of the carotid intima-media thickness (CIMT) is a widely used marker for atherosclerosis and is associated with future cardiovascular events. This article provides a review and meta-analysis of the published evidence on the association of CIMT with future cardiovascular events and its additional value to traditional cardiovascular risk prediction models. Methods A systematic review and meta-analysis of the evidence on the association of CIMT with future cardiovascular events and the additional value of CIMT to traditional cardiovascular risk prediction models was conducted. The association of CIMT with future cardiovascular events and the additional value of CIMT were calculated using random effects analysis. Results The literature search yielded 1196 articles of which 15 articles provided sufficient data for the meta-analysis. A 1 SD increase in CIMT was predictive for myocardial infarction (HR 1.26, 95% CI 1.20–1.31) and for stroke (HR 1.31, 95% CI 1.26–1.36). A 0.1 mm increase in CIMT was predictive for myocardial infarction (HR 1.15, 95% CI 1.12–1.18) and for stroke (HR 1.17, 95% CI 1.15–1.21). The overall performance of risk prediction models did not significantly increase after addition of CIMT data. The areas under the curve increased from 0.726 to 0.729 ( p = 0.8). Conclusions CIMT as measured by B-mode ultrasound is associated with future cardiovascular events. However, the addition of CIMT to traditional cardiovascular risk prediction models does not lead to a statistical significantly increase in performance of those models.
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- 2013
54. 12-Year outcome after normal myocardial perfusion SPECT in patients with known coronary artery disease
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Hendrik J. Boiten, Arend F.L. Schinkel, Machiel J. M. Ottenhof, Marisa C. G. Tjong Joe Wai, Roelf Valkema, Ron T. van Domburg, Rebecca S. Korbee, Radiology & Nuclear Medicine, and Cardiology
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Atropine ,Male ,Risk ,medicine.medical_specialty ,Population ,Myocardial Infarction ,Infarction ,Perfusion scanning ,Coronary Artery Disease ,Coronary artery disease ,Myocardial perfusion imaging ,SDG 3 - Good Health and Well-being ,Internal medicine ,Dobutamine ,medicine ,Myocardial Revascularization ,Humans ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,education ,False Negative Reactions ,Aged ,Tomography, Emission-Computed, Single-Photon ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Mortality rate ,Myocardial Perfusion Imaging ,Middle Aged ,medicine.disease ,Prognosis ,Treatment Outcome ,Multivariate Analysis ,Cardiology ,Exercise Test ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Follow-Up Studies - Abstract
Previous studies have reported a favorable outcome of patients with normal single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI). The aim of this study was to assess the very long-term prognosis of patients with known coronary artery disease (CAD) and normal SPECT MPI results. The population consisted of 266 patients with known CAD (defined as a healed myocardial infarction and/or a previous coronary revascularization), who underwent exercise bicycle or dobutamine-atropine stress SPECT MPI and had normal perfusion during stress and at rest. End points during follow-up were all-cause mortality, cardiac mortality, and nonfatal myocardial infarction. Univariate and multivariate analyses were performed to identify predictors of long-term outcome. Follow-up was completed in 261 (98%) patients. During a median follow-up of 12 years, 94 (36%) patients died, of which 26 (10%) died due to cardiac causes, and 15 (6%) had a nonfatal myocardial infarction. The annualized mortality rate was 3.1%, annualized cardiac mortality rate was 0.9%, and the annualized event rate for cardiac death and/or nonfatal infarction was 1.2%. Independent predictors of total mortality were age, diabetes mellitus, and rate-pressure product at peak stress. Independent predictors of cardiac mortality were age, male gender, and rate-pressure product at peak stress. Patients with known CAD and a normal SPECT MPI study have a favorable long-term prognosis. Clinical and stress test variables can be used to identify patients with a higher risk status.
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- 2013
55. Implantable Cardioverter Defibrillators in Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy: Patient Outcomes, Incidence of Appropriate and Inappropriate Interventions, and Complications
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Arend F.L. Schinkel and Cardiology
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Cardiomyopathy ,Ventricular tachycardia ,Amiodarone ,Risk Assessment ,Sudden cardiac death ,Physiology (medical) ,Internal medicine ,medicine ,Humans ,Arrhythmogenic Right Ventricular Dysplasia ,Aged ,business.industry ,Mortality rate ,Middle Aged ,Implantable cardioverter-defibrillator ,medicine.disease ,Prognosis ,Arrhythmogenic right ventricular dysplasia ,Defibrillators, Implantable ,Survival Rate ,Death, Sudden, Cardiac ,Treatment Outcome ,Ventricular fibrillation ,Ventricular Fibrillation ,Cardiology ,Tachycardia, Ventricular ,Female ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Background— Arrhythmogenic right ventricular dysplasia/cardiomyopathy (ARVD/C) is a cardiomyopathy characterized by ventricular arrhythmias and an abnormal right ventricle. Implantable cardioverter defibrillator (ICD) therapy may prevent sudden cardiac death in patients with ARVD/C. Currently, an overview of outcomes, appropriate and inappropriate interventions, and complications of ICD therapy in ARVD/C is lacking. Methods and Results— A literature search was performed to identify studies reporting outcome and complications in patients with ARVD/C who underwent ICD implantation. Of 641 articles screened, 24 studies on 18 cohorts were eligible for inclusion. In case of multiple publications on a cohort, the most recent publication was included in the meta-analysis. There were 610 patients (mean age, 40.4 years; 42% women), who had an ICD for primary or secondary prevention of sudden cardiac death. Risk factors for sudden cardiac death were presyncope (61%), syncope (31%), previous cardiac arrest (14%), ventricular tachycardia (58%), and ventricular fibrillation (6%). Antiarrhythmic medication consisted mostly of β-blockers (38%), amiodarone (14%), or sotalol (30%). During the 3.8-year follow-up, annualized cardiac mortality rate was 0.9%, annualized noncardiac mortality rate was 0.8%, and annualized heart transplant rate was 0.9%. The annualized appropriate and inappropriate ICD intervention rates were 9.5% and 3.7%, respectively. ICD-related complications consisted of difficult lead placement (18.4%), lead malfunction (9.8%), infection (1.4%), lead displacement (3.3%), and any complication (20.3%). Conclusions— Cardiac and noncardiac mortality rates after ICD implantation in patients with ARVD/C are low. Appropriate ICD interventions occur at a rate of 9.5%/y. Inappropriate ICD interventions and complications lead to considerable ICD-related morbidity.
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- 2013
56. Effect of Carotid Plaque Screening Using Contrast-Enhanced Ultrasound on Cardiovascular Risk Stratification
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Stijn C.H. van den Oord, Gerrit L. ten Kate, Eric J.G. Sijbrands, Arend F.L. Schinkel, Antonius F.W. van der Steen, Cardiology, and Internal Medicine
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Carotid Artery Diseases ,Male ,medicine.medical_specialty ,Contrast Media ,Carotid Intima-Media Thickness ,Risk Assessment ,Asymptomatic ,McNemar's test ,Risk Factors ,Internal medicine ,medicine ,Humans ,Prospective Studies ,Netherlands ,Subclinical infection ,Framingham Risk Score ,business.industry ,Incidence ,Ultrasound ,Middle Aged ,Plaque, Atherosclerotic ,Carotid Arteries ,Cardiovascular Diseases ,Cardiology ,Population study ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Risk assessment ,Contrast-enhanced ultrasound - Abstract
Cardiovascular risk stratification of asymptomatic patients is based on the assessment of risk factors. Noninvasive imaging of subclinical atherosclerosis may improve cardiovascular risk stratification, especially in patients with co-morbidities. The aim of this study was to investigate the effect of contrast-enhanced ultrasound (CEUS) of the carotid arteries on cardiovascular risk assessment. The study population consisted of 100 consecutive asymptomatic patients with >= 1 clinical risk factor for atherosclerosis. Cardiovascular risk was estimated by calculating the Prospective Cardiovascular Munster Heart Study (PRO-CAM) risk score. This score was divided into 3 subgroups: low (= 20%). Subclinical carotid atherosclerosis was assessed using standard ultrasound for intima-media thickness and plaque screening and CEUS for additional plaque screening. CEUS was performed using SonoVue contrast agent. Patients with subclinical atherosclerosis were considered to be at high cardiovascular risk. McNemar's test was used to compare PROCAM score to ultrasound findings. The mean PROCAM risk score was 9 +/- 10; the PROCAM risk score was low in 72 patients (72%), intermediate in 17 patients (17%), and high in 11 patients (11%). A total of 21 patients (21%) had abnormal carotid intima-media thickness, 77% had plaques on conventional carotid ultrasound, and 88% had plaques on standard carotid ultrasound combined with CEUS. Detection of atherosclerosis led to the reclassification of 79 patients (79%) to high cardiovascular risk (p
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- 2013
57. Long-Term Outcome of Alcohol Septal Ablation for Obstructive Hypertrophic Cardiomyopathy in the Young and the Elderly
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Arend F.L. Schinkel, Hannah G. van Velzen, Johan Van Cleemput, Michelle Michels, Max Liebregts, Robbert C. Steggerda, Maarten P. van den Berg, Jurriën M. ten Berg, Rik Willems, Pieter A. Vriesendorp, Cardiovascular Centre (CVC), and Cardiology
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Ablation Techniques ,Male ,Pacemaker, Artificial ,Time Factors ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,GUIDELINES ,0302 clinical medicine ,Risk Factors ,Heart Septum ,Medicine ,Ventricular outflow tract ,030212 general & internal medicine ,Atrioventricular Block ,septal reduction therapy ,PREDICTORS ,Netherlands ,Mortality rate ,MYOCARDIAL ABLATION ,Hypertrophic cardiomyopathy ,Age Factors ,Cardiac Pacing, Artificial ,Middle Aged ,Treatment Outcome ,REDUCTION THERAPY ,MYECTOMY ,Cardiology ,SURVIVAL ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Cohort study ,Adult ,Alcohol septal ablation ,medicine.medical_specialty ,alcohol septal ablation ,Ventricular outflow tract obstruction ,Lower risk ,DIAGNOSIS ,03 medical and health sciences ,Internal medicine ,Humans ,Aged ,Ethanol ,business.industry ,MORTALITY ,Cardiomyopathy, Hypertrophic ,medicine.disease ,hypertrophic cardiomyopathy ,business ,FOLLOW-UP ,Atrioventricular block ,TASK-FORCE - Abstract
Objectives The aim of this study was to compare outcomes of alcohol septal ablation (ASA) in young and elderly patients with obstructive hypertrophic cardiomyopathy (HCM). Background The American College of Cardiology Foundation/American Heart Association guidelines reserve ASA for elderly patients and patients with serious comorbidities. Information on long-term age-specific outcomes after ASA is scarce. Methods This cohort study included 217 HCM patients (age 54 ± 12 years) who underwent ASA because of symptomatic left ventricular outflow tract obstruction. Patients were divided into young (age ≤55 years) and elderly (age >55 years) groups and matched by age in a 1:1 fashion to nonobstructive HCM patients. Results Atrioventricular block following ASA was more common in elderly patients (43% vs. 21%; p = 0.001), resulting in pacemaker implantation in 13% and 5%, respectively (p = 0.06). Residual left ventricular outflow tract gradient, post-procedural New York Heart Association functional class, and necessity for additional septal reduction therapy was comparable between age groups. During a follow-up of 7.6 ± 4.6 years, 54 patients died. The 5- and 10-year survival following ASA was 95% and 90% in patients age ≤55 years and 93% and 82% in patients age >55 years, which was comparable to their control groups. The annual adverse arrhythmic event rate following ASA was 0.7%/year in young patients and 1.4%/year in elderly patients, which was comparable to their control groups. Conclusions ASA is similarly effective for reduction of symptoms in young and elderly patients; however, younger patients have a lower risk of procedure-related atrioventricular conduction disturbances. The long-term mortality rate and risk of adverse arrhythmic events following ASA are low, both in young and elderly patients, and are comparable to age-matched nonobstructive HCM patients.
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- 2016
58. Contributors
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Amr E. Abbas, Sahar S. Abdelmoneim, Theodore Abraham, Harry Acquatella, David B. Adams, Karima Addetia, Jonathan Afilalo, Vikram Agarwal, Yoram Agmon, Mohamed Ahmed, Carlos Alviar, Bonita Anderson, Edgar Argulian, Federico M. Asch, Gerard P. Aurigemma, Kelly Axsom, Luigi P. Badano, Revathi Balakrishnan, Sourin Banerji, Sripal Bangalore, Manish Bansal, Thomas Bartel, Rebecca Lynn Baumann, Helmut Baumgartner, Roy Beigel, J. Todd Belcik, Marek Belohlavek, Ricardo Benenstein, Eric Berkowitz, Nicole M. Bhave, Angelo Biviano, Nimrod Blank, Robert O. Bonow, Darryl J. Burstow, Benjamin Byrd, Scipione Carerj, John D. Carroll, Scott Chadderdon, Hari P. Chaliki, Kwan-Leung Chan, Farooq A. Chaudhry, Geoff Chidsey, Sofia Churzidse, Blai Coll, Vivian W. Cui, Maurizio Cusma-Picconne, Abdellaziz Dahou, Jacob P. Dal-Bianco, Daniel A. Daneshvar, Melissa A. Daubert, Ravin Davidoff, Jeanne M. DeCara, Antonia Delgado-Montero, Lisa Dellefave-Castillo, Ankit A. Desai, Kavit A. DeSouza, Bryan Doherty, Robert Donnino, Pamela S. Douglas, David M. Dudzinski, Raluca Dulgheru, Jean G. Dumesnil, Uri Elkayam, Raimund Erbel, Francine Erenberg, Arturo A. Evangelista, Steven B. Feinstein, Beatriz Ferreira, Elyse Foster, Benjamin H. Freed, Julius M. Gardin, Edward A. Gill, Linda Gillam, Steven Giovannone, Mark Goldberger, Steven A. Goldstein, John Gorcsan, Riccardo Gorla, Julia Grapsa, Erin S. Grawe, Christiane Gruner, Pooja Gupta, Swaminatha Gurudevan, Rebecca T. Hahn, Yuchi Han, Jennifer L. Hellawell, Samuel D. Hillier, Brian D. Hoit, Richard Humes, Vikrant Jagadeesan, Sonia Jain, Alexander Janosi, Peter A. Kahn, Sanjiv Kaul, Bijoy K. Khandheria, Gene H. Kim, Michael S. Kim, Bruce J. Kimura, Mary Etta King, Dmitry Kireyev, James N. Kirkpatrick, Allan L. Klein, Payal Kohli, Claudia E. Korcarz, Smadar Kort, Wojciech Kosmala, Konstantinos Koulogiannis, Ilias Koutsogeorgis, Frederick W. Kremkau, Eric V. Krieger, Itzhak Kronzon, Richard T. Kutnick, Wyman Lai, Stephane Lambert, Patrizio Lancellotti, Roberto M. Lang, Alex Pui-Wai Lee, Ming Sum Lee, Stamatios Lerakis, Jonathan Lessick, Steven J. Lester, Steve W. Leung, Florent LeVen, Robert A. Levine, Qin Li, Fabio Lima, Jonathan R. Lindner, Leo Lopez, Julien Magne, Haifa Mahjoub, Judy R. Mangion, Sunil V. Mankad, Dimitrios Maragiannis, Leo Marcoff, Randolph P. Martin, Thomas H. Marwick, Pierre Massabuau, Moses Mathur, Robert McCully, Edwin C. McGee, Elizabeth McNally, Sudhir Ken Mehta, Todd Mendelson, Issam A. Mikati, Karen Modesto, Mark Monaghan, Farouk Mookadam, Marie Moonen, Monica Mukherjee, Silvana Müller, Sharon L. Mulvagh, Denisa Muraru, Gillian Murtagh, Sherif F. Nagueh, Tasneem Z. Naqvi, Sandeep Nathan, Kazuaki Negishi, Petros Nihoyannopoulos, Vuyisile T. Nkomo, Erwin Oechslin, Joan Olson, John Palios, Gaurav Parikh, Amit R. Patel, Amit V. Patel, Aneet Patel, Anupa Patel, Timothy E. Paterick, Laila A. Payvandi, Gianni Pedrizzetti, Patricia A. Pellikka, Gila Perk, Ferande Peters, Dermot Phelan, Philippe Pibarot, Michael H. Picard, Juan Carlos Plana, Zoran B. Popovic, Thomas Porter, Shawn C. Pun, Atif N. Qasim, Nishath Quader, Miguel A. Quinones, Peter S. Rahko, Harry Rakowski, Rajeev V. Rao, Joseph Reiken, Shimon A. Reisner, Elizabeth M. Retzer, Vera H. Rigolin, David A. Roberson, Keith Rodgers, Damian Roper, Raphael Rosenhek, Eleanor Ross, R. Raina Roy, Frederick L. Ruberg, Lawrence G. Rudski, Carlos Ruiz, Ernesto E. Salcedo, Danita M. Yoerger Sanborn, Vrinda Sardana, Muhamed Saric, Nelson B. Schiller, Arend F.L. Schinkel, Shmuel S. Schwartzenberg, Partho P. Sengupta, Pravin M. Shah, Jack S. Shanewise, Stanton K. Shernan, Jeffrey A. Shih, Robert J. Siegel, Maithri Siriwardena, Samuel Siu, Scott D. Solomon, Vincent L. Sorrell, Kirk T. Spencer, Denise Spiegel, Martin St. John Sutton, James H. Stein, Kathleen Stergiopoulos, Azhar A. Supariwala, Paul E. Szmitko, Tanya H. Tajouri, Masaaki Takeuchi, Timothy C. Tan, James D. Thomas, Dennis A. Tighe, Maria C. Todaro, Albree Tower-Rader, Michael Y.C. Tsang, Teresa S.M. Tsang, Wendy Tsang, Paul A. Tunick, Philippe Vignon, Meagan M. Wafsy, Rachel Wald, R. Parker Ward, Nozomi Watanabe, Kevin Wei, Neil J. Weissman, Mariko Welsch, Susan Wiegers, Lynne Williams, Anna Woo, Chanwit Wuttichaipradit, Feng Xie, Teerapat Yingchoncharoen, Cheuk-Man Yu, Zoe Yu, Qiong Zhao, Concetta Zito, and William A. Zoghbi
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- 2016
59. Long-term prognostic value of exercise technetium-99m tetrofosmin myocardial perfusion single-photon emission computed tomography
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Arend F.L. Schinkel, Ron T. van Domburg, Marcel L. Geleijnse, Pauline R. Ruitinga, Eric J.G. Sijbrands, Roelf Valkema, Johannes N. van der Sijde, Hendrik J. Boiten, Pathology, Radiology & Nuclear Medicine, Cardiology, and Internal Medicine
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Adult ,Male ,medicine.medical_specialty ,99mTc-tetrofosmin ,Organotechnetium Compounds ,Kaplan-Meier Estimate ,Coronary Artery Disease ,Single-photon emission computed tomography ,Coronary artery disease ,Myocardial perfusion imaging ,Organophosphorus Compounds ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,long-term prognosis ,Aged ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Middle Aged ,Prognosis ,medicine.disease ,Radiology Nuclear Medicine and imaging ,SPECT ,Exercise Test ,Original Article ,Female ,99mTc-Tetrofosmin ,Radiology ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Perfusion ,Technetium-99m-tetrofosmin ,Emission computed tomography - Abstract
Background Exercise 99mTc-tetrofosmin single-photon emission computed tomography (SPECT) is a useful tool for short- and medium-term risk stratifications. Currently, the long-term prognostic application of this technique has not been evaluated. Methods and Results Exercise 99mTc-tetrofosmin was performed in 655 consecutive patients. Ten patients who underwent revascularization
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- 2012
60. Assessment of subclinical atherosclerosis using contrast-enhanced ultrasound
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Gerrit L. ten Kate, Guillaume Renaud, Folkert J. ten Cate, Aad van der Lugt, Antonius F.W. van der Steen, Nico de Jong, Stijn C.H. van den Oord, Eric J.G. Sijbrands, Arend F.L. Schinkel, Johan G. Bosch, Zeynettin Akkus, Cardiology, Internal Medicine, and Radiology & Nuclear Medicine
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Male ,medicine.medical_specialty ,Contrast Media ,Carotid Intima-Media Thickness ,Risk Assessment ,Sensitivity and Specificity ,Asymptomatic ,Predictive Value of Tests ,Risk Factors ,Outpatients ,medicine ,Humans ,Carotid Stenosis ,Radiology, Nuclear Medicine and imaging ,Prospective Studies ,cardiovascular diseases ,Prospective cohort study ,Aged ,Subclinical infection ,business.industry ,Ultrasound ,General Medicine ,Middle Aged ,Atherosclerosis ,Plaque, Atherosclerotic ,Echocardiography, Doppler, Color ,Carotid Arteries ,Intima-media thickness ,Predictive value of tests ,Subclinical atherosclerosis ,cardiovascular system ,Female ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Contrast-enhanced ultrasound - Abstract
Aims The sensitivity of standard carotid ultrasound and colour Doppler for the detection of subclinical atherosclerotic plaques is suboptimal. The aim of this study is to assess whether contrast-enhanced ultrasound (CEUS) added to standard carotid ultrasound improves the detection of subclinical atherosclerosis. Methods and results Carotid intima–media thickness (CIMT) measurement, standard carotid ultrasound including colour Doppler imaging, and CEUS were performed in 100 asymptomatic patients with one or more risk factors for atherosclerosis. CEUS was performed using intravenous administration of SonoVue™ contrast agent (Bracco S.p.A., Milan, Italy). CIMT, standard ultrasound, colour Doppler, and CEUS were reviewed by two independent observers. Standard ultrasound, colour Doppler, and CEUS were scored for the presence of atherosclerotic plaques. Subclinical atherosclerosis was diagnosed if patients had a CIMT above their age-corrected threshold value or if atherosclerotic plaques were present on standard carotid ultrasound clips or CEUS clips. McNemar's test was performed to compare between groups. Twenty-one patients (21%) had a thickened CIMT value and were considered to have subclinical atherosclerosis. Standard carotid ultrasound including colour Doppler demonstrated atherosclerotic plaques in 77 patients (77%). The addition of CEUS to the standard ultrasound protocol demonstrated atherosclerotic plaques in 88 patients (88%). The incorporation of CEUS into the standard carotid ultrasound protocol resulted in a significantly improved detection of patients with subclinical atherosclerosis ( P < 0.01). Conclusion CEUS has an incremental value for the detection of subclinical atherosclerosis in the carotid arteries. Atherosclerotic plaques which were only detected with CEUS and not with standard carotid ultrasound and colour Doppler imaging were predominantly hypoechoic.
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- 2012
61. Long-Term Prognostic Value of Dobutamine Stress Echocardiography in Diabetic Patients With Limited Exercise Capability
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Ron T. van Domburg, Henk J. Boiten, Abdou Elhendy, Fabiola B. Sozzi, Jors van der Sijde, and Arend F.L. Schinkel
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Advanced and Specialized Nursing ,Research design ,medicine.medical_specialty ,Multivariate analysis ,business.industry ,Dobutamine stress echocardiography ,Endocrinology, Diabetes and Metabolism ,Ischemia ,medicine.disease ,Surgery ,Predictive value of tests ,Diabetes mellitus ,Internal medicine ,Internal Medicine ,medicine ,Cardiology ,Myocardial infarction ,business ,Survival analysis - Abstract
OBJECTIVE To determine the incremental prognostic value of dobutamine stress echocardiography (DSE) at 13-year follow-up (SD 3.2 years) for predicting mortality and cardiac events in diabetic patients. RESEARCH DESIGN AND METHODS A total of 396 diabetic patients (mean age 61 ± 11 years; 252 men [64%]) with limited exercise capacity who underwent DSE for evaluation of ischemia were studied. End points were all causes of mortality, cardiac death, and hard cardiac events (cardiac death and nonfatal myocardial infarction). RESULTS During a mean follow-up of 13 years, 230 patients (58%) died (121 cardiac deaths), and 30 patients had nonfatal myocardial infarction. Cumulative survival in patients with an abnormal DSE at 5, 10, and 15 years was 68, 49, and 41%, respectively. In patients with a normal DSE, these respective numbers were 74, 57, and 44%. Multivariate analyses showed that DSE provided incremental value over clinical characteristics and stress test parameters for prediction of mortality and cardiac events. Survival analysis showed that DSE provided optimal risk stratification up to 7 years after initial testing; after that period, the risk of adverse outcome increased comparably in both normal and abnormal DSE patients. CONCLUSIONS DSE provided restricted predictive value of adverse outcome in patients with diabetes who were unable to perform an adequate exercise stress test. DSE provided optimal risk stratification up to 7 years after initial testing. Repeated DSE at that time might add to its prognostic value.
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- 2012
62. 15-Year outcome after normal exercise Tc-99m-sestamibi myocardial perfusion imaging: What is the duration of low risk after a normal scan?
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Arend F.L. Schinkel, Eric J.G. Sijbrands, Pauline R. Ruitinga, Jors van der Sijde, Henk J. Boiten, Ron T. van Domburg, Roelf Valkema, Cardiology, Pathology, Internal Medicine, and Radiology & Nuclear Medicine
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medicine.medical_specialty ,medicine.diagnostic_test ,Proportional hazards model ,business.industry ,Infarction ,medicine.disease ,Coronary artery disease ,Myocardial perfusion imaging ,Rate pressure product ,Blood pressure ,SDG 3 - Good Health and Well-being ,Radiology Nuclear Medicine and imaging ,Internal medicine ,Heart rate ,medicine ,Cardiology ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Radiology ,business ,Cardiology and Cardiovascular Medicine - Abstract
The goal of this study was to evaluate the very long-term outcome after normal exercise 99mTc-sestamibi myocardial perfusion single-photon emission computed tomography (SPECT). Exercise 99mTc-sestamibi SPECT is widely used for risk stratification, but data on very long-term outcome after a normal test are scarce. A consecutive group of 233 patients (122 men, mean age 54 ± 12 years) with known or suspected coronary artery disease (CAD) underwent exercise 99mTc-sestamibi SPECT and had normal myocardial perfusion at exercise and at rest. Follow-up endpoints were all-cause mortality, cardiac mortality, nonfatal myocardial infarction, and coronary revascularization. Predictors of outcome were identified by Cox proportional hazard regression models using clinical and exercise testing variables. During a mean follow-up of 15.5 ± 4.9 years, 41 (18%) patients died, of which 13 were cardiac deaths. A total of 18 (8%) patients had a nonfatal myocardial infarction, and 47 (20%) had coronary revascularization. The annualized event rates for all-cause mortality, cardiac mortality, cardiac mortality/nonfatal infarction, and major adverse cardiac events were, respectively, 1.1%, 0.3%, 0.7%, and 1.8%. Multivariate analysis demonstrated that the variables age, male gender, diabetes, diastolic blood pressure at rest, rate pressure product at rest, peak exercise heart rate, and ST segment changes were independent predictors of major adverse cardiac events. Patients with suspected or known CAD and normal exercise 99mTc-sestamibi myocardial perfusion SPECT have a favorable 15-year prognosis. Follow-up should be closer in patients with known CAD, and/or having clinical and exercise parameters indicating higher risk status.
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- 2012
63. Estimating 3D lumen centerlines of carotid arteries in free-hand acquisition ultrasound
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Stefan Klein, Zeynettin Akkus, Johan G. Bosch, Wiro J. Niessen, Aad van der Lugt, Arend F.L. Schinkel, Gerrit L. ten Kate, Diego D. B. Carvalho, Radiology & Nuclear Medicine, Cardiothoracic Surgery, Internal Medicine, and Cardiology
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Carotid Artery Diseases ,Male ,Computer science ,Carotid arteries ,Biomedical Engineering ,Health Informatics ,Ellipse ,Sensitivity and Specificity ,Sampling Studies ,Imaging, Three-Dimensional ,carotid lumen centerline ,Image Interpretation, Computer-Assisted ,Humans ,Radiology, Nuclear Medicine and imaging ,Computer vision ,Ultrasonography, Interventional ,Phantoms, Imaging ,business.industry ,Ultrasound ,Reproducibility of Results ,Lumen segmentation ,Speckle noise ,General Medicine ,Computer Graphics and Computer-Aided Design ,Computer Science Applications ,Euclidean distance ,Carotid Arteries ,free-hand ultrasound ,Beam direction ,Female ,Surgery ,Computer Vision and Pattern Recognition ,Artificial intelligence ,atherosclerosis ,business ,Algorithms ,Software ,Lumen (unit) - Abstract
Purpose The purpose of this paper is to present a methodology to estimate the carotid artery lumen centerlines in ultrasound (US) images obtained in a free-hand examination. Challenging aspects here are speckle noise in US images, artifacts, and the lack of contrast in the direction orthogonal to the US beam direction. Method An algorithm based on a rough lumen segmentation obtained by robust ellipse fitting was developed to deal with these conditions and estimate the lumen center in 2D B-mode scans. In a free-hand sweep examination, continuous image acquisitions are performed through time when the radiologist moves the probe on the patient’s neck. The result is a series of images that show 2D cross-sections of the carotid’s morphology. A tracking sensor (Flock of Birds) was attached to the probe and both were connected to a PC executing the Stradwin software, which relates spatial information to the acquisition data of the US probe. The spatial information was combined with the 2D lumen center estimates to provide a centerline in 3D. For validation, 19 carotid scans from 15 different patients were scanned, their centerlines calculated by the algorithm and compared with results acquired by manual annotations. Results The average Euclidean distance between both among all the examinations was 0.82 mm. For each examination, the percentage of these Euclidean distances below 2 mm was calculated; the average over all examinations was 92%. Conclusion Automated 3D estimation of carotid artery lumen centerlines in free-hand real-time ultrasound is feasible and can be performed with high accuracy. The algorithm is robust enough to keep the centerlines inside the vessel, even in the absence of contrast in parts of the vessel wall.
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- 2011
64. Incidence, Pathophysiology, and Treatment of Complications During Dobutamine-Atropine Stress Echocardiography
- Author
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Folkert J. ten Cate, Osama Ibrahim Ibrahim Soliman, Arend F.L. Schinkel, Boudewijn J. Krenning, Bas M. van Dalen, Marcel L. Geleijnse, Maarten L. Simoons, Eric Boersma, Attila Nemes, and Cardiology
- Subjects
Atropine ,medicine.medical_specialty ,Cardiotonic Agents ,Coronary Artery Disease ,Coronary artery disease ,Dobutamine ,Physiology (medical) ,medicine ,Stress Echocardiography ,Humans ,cardiovascular diseases ,Unstable angina ,business.industry ,Incidence ,valvular heart disease ,Parasympatholytics ,Vascular surgery ,medicine.disease ,Echocardiography ,Anesthesia ,Ventricular fibrillation ,Exercise Test ,Cardiology and Cardiovascular Medicine ,Complication ,business ,medicine.drug - Abstract
modality rapidly expanded from diagnosing coronary artery disease (CAD) to risk stratification of patients undergoing vascular surgery; risk stratification of patients with chronic CAD, unstable angina, acute or chronic myocardial infarction (MI), or valvular heart disease; and the assessment of myocardial viability in patients with severe left ventricular (LV) dysfunction. Thus, dobutamine stress has been applied to progressively more complex, older, and higher-risk patients. Additionally, stress protocols became more aggressive, with higher dobutamine doses and the addition of atropine. 3 Although generally regarded as a safe stress modality, serious complications do occur. In this review, we will describe the incidence, pathophysiology, and treatment of complications during dobutamine-atropine stress echocardiography (DASE). Data on incidence of complications were obtained from 26 studies including 400 patients that reported at least the major complications of mortality, acute MI, ventricular fibrillation, and sustained ventricular tachycardia, 4–29 for a total of 55 071 patients (Table 1). In addition, references are given to case reports and studies dealing specifically with a particular complication.
- Published
- 2010
65. Contrast-enhanced ultrasound for imaging vasa vasorum: comparison with histopathology in a swine model of atherosclerosis
- Author
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Juan F. Granada, Chris G. Krueger, Blai Coll, Steven B. Feinstein, Daniel Staub, Jess D. Reed, Greg L. Kaluza, William Zang, Arend F.L. Schinkel, Cindy Owens, Anne L. Hall, Folkert J. ten Cate, Armando Tellez, and Cardiology
- Subjects
medicine.medical_specialty ,Pathology ,Time Factors ,Arteriosclerosis ,Swine ,Contrast Media ,Femoral artery ,medicine.disease_cause ,Hyperlipoproteinemia Type II ,medicine.artery ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Radionuclide Imaging ,Ultrasonography ,business.industry ,Vasa Vasorum ,Ultrasound ,General Medicine ,medicine.disease ,Vulnerable plaque ,Disease Models, Animal ,medicine.anatomical_structure ,Atheroma ,Intima-media thickness ,Vasa vasorum ,cardiovascular system ,Disease Progression ,Histopathology ,Tunica Intima ,Tunica Media ,Cardiology and Cardiovascular Medicine ,business ,Contrast-enhanced ultrasound - Abstract
Aim To evaluate the agreement between contrast-enhanced ultrasound imaging and histopathology in an animal model of atherosclerosis. Methods and results Atherosclerosis was studied in both femoral arteries of four Rapacz familial hypercholesterolaemia (RFH) swine. Contrast-enhanced ultrasound imaging of the eight femoral arteries was performed at baseline and at 5, 12, 26, and 43 weeks follow-up after percutaneous transluminal stimulation of atherosclerosis to assess the progression of intima-media thickness (IMT) and the density and extent of the vasa vasorum network. Contrast-enhanced ultrasound imaging allowed an early detection of atherosclerosis and showed a significant gradual progression of atherosclerosis over time. IMT increased from 0.22 ± 0.05 mm at baseline to 0.45 ± 0.06 mm ( P < 0.001) at follow-up. The density of the vasa vasorum network increased during follow-up and was significantly higher in advanced than in early atherosclerosis. The findings with contrast-enhanced ultrasound were confirmed by histopathological specimens of the arterial wall. Conclusion Contrast-enhanced ultrasound is effective for in vivo detection of vasa vasorum in atherosclerotic plaques in the RFH swine model. After stimulation of atherosclerosis, contrast-enhanced ultrasound demonstrated a significantly increased IMT and significantly increased density of the vasa vasorum network in the developing atherosclerotic plaque, which was validated by histology.
- Published
- 2010
66. Clinical and genetic factors influencing cardiovascular risk in patients with familial hypercholesterolemia
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Arend F.L. Schinkel, Monique T. Mulder, Daniëlla M. Oosterveer, Janneke G. Langendonk, Jorie Versmissen, and Eric J.G. Sijbrands
- Subjects
medicine.medical_specialty ,business.industry ,Endocrinology, Diabetes and Metabolism ,Disease ,Familial hypercholesterolemia ,Statin treatment ,medicine.disease ,SDG 3 - Good Health and Well-being ,Internal medicine ,LDL receptor ,Cardiology ,Medicine ,In patient ,cardiovascular diseases ,Risk factor ,Age of onset ,Genetic risk ,Cardiology and Cardiovascular Medicine ,business - Abstract
Patients with familial hypercholesterolemia (FH) have high levels of LDL-C, owing to defective uptake of these particles by LDL receptors in the liver. Consequently, FH patients have a high risk of cardiovascular disease (CVD). However, among these patients, there is marked variance in age of onset of CVD and a proportion of untreated patients do not develop CVD at all. Statin treatment can greatly reduce risk, and since it is not yet possible to precisely predict which FH patients will develop CVD, all patients initiate treatment once the diagnosis has been made. The purpose of this article is to provide an update of clinical and genetic risk factors influencing CVD risk in FH patients, and to discuss future lines of research that could uncover improved methods of treatment for heterozygous FH patients.
- Published
- 2010
67. Evaluation of a clinical decision support system for glucose control: impact of protocol modifications on compliance and achievement of glycemic targets
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Rogier Barendse, Jonathan Lipton, Arend F.L. Schinkel, Maarten L. Simoons, K. Martijn Akkerhuis, Cardiology, and Cardiothoracic Surgery
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Blood Glucose ,Male ,medicine.medical_specialty ,Cardiac Care Facilities ,Critical Illness ,medicine.medical_treatment ,Myocardial Infarction ,Hypoglycemia ,Risk Assessment ,Cohort Studies ,Internal medicine ,Diabetes mellitus ,medicine ,Humans ,Insulin ,Acute Coronary Syndrome ,Intensive care medicine ,Aged ,Glycemic ,Protocol (science) ,Analysis of Variance ,business.industry ,Incidence (epidemiology) ,Glucose Measurement ,Middle Aged ,Decision Support Systems, Clinical ,medicine.disease ,Compliance (physiology) ,Intensive Care Units ,Treatment Outcome ,Diabetes Mellitus, Type 2 ,Hyperglycemia ,Practice Guidelines as Topic ,Female ,Guideline Adherence ,Cardiology and Cardiovascular Medicine ,business - Abstract
Treating hyperglycemia may improve patient outcome, but is a clinical challenge. Three variations of a computerized insulin protocol were compared with regard to protocol compliance and achievement of glucose target levels. In group 1, the existing protocol was applied, in group 2 the protocol was modified to account for decreasing glucose values; group 3 had a higher threshold for initiating insulin, wider glucose target ranges, and included instructions to regulate glucose around mealtimes. From July 28, 2008 until February 1, 2010, data from 1255 patients admitted to our Intensive Cardiac Care Unit with at least 2 glucose measurements were analyzed. Mean age was 64 +/- 15 years, 66% were male, 21% had diabetes. Groups 1 to 3 included 269, 814, and 142 patients, respectively. Protocol compliance in group 2 was lower with 44% of the glucose measurements performed on time versus 51% in group 1 (P < 0.001), and insulin was dosed correctly in 57% versus 67% (P < 0.001). In group 3, compliance increased, 52% of the measurements were done on time, and insulin was dosed correctly in 71%. Average glucose levels increased in group 3 due to a higher threshold for starting insulin and a wider target range: 70% (group 1), 66% (group 2), and 61% (group 3) had an average glucose of
- Published
- 2010
68. Abnormal spatial QRS-T angle predicts mortality in patients undergoing dobutamine stress echocardiography for suspected coronary artery disease
- Author
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Jan A. Kors, Stefan P. Nelwan, Abdou Elhendy, Ron T. van Domburg, Jonathan Lipton, Arend F.L. Schinkel, Don Poldermans, Cardiology, Cardiothoracic Surgery, Medical Informatics, and Anesthesiology
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,Coronary Artery Disease ,Risk Assessment ,Coronary artery disease ,Electrocardiography ,SDG 3 - Good Health and Well-being ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Stress Echocardiography ,Humans ,Risk factor ,Aged ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,Hemodynamics ,Spatial QRS-T angle ,General Medicine ,Middle Aged ,medicine.disease ,Prognosis ,Logistic Models ,Heart failure ,cardiovascular system ,Cardiology ,Dobutamine ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Echocardiography, Stress - Abstract
Objective To investigate the association between (cardiac) mortality and spatial QRS-T angle in patients undergoing dobutamine - atropine stress echocardiography (DSE) for evaluation of known or suspected coronary disease. Methods Between 1990 and 2003, 2347 patients underwent DSE for evaluation of coronary disease at the Erasmus Medical Center. Echocardiographic images were analyzed offline using a 16-segment, 5-point scoring model for regional function. Twelve-lead resting ECGs were analyzed and patients were grouped in three categories according to their spatial QRS-T angle: normal (0-105 degrees), borderline (105-135 degrees), and abnormal (135-180 degrees). Results Mean age was 61 +/- 13 years, 66% were male, 32% had hypertension, 26% had hypercholesterolemia, 28% were smokers, and 12% were diabetic. During a mean follow-up of 7 +/- 3.4 years, 26.5% (623) of the patients died; 15.3% (359) died due to a cardiac cause. Abnormal QRS-T angle (135-180 degrees) was present in 21% of the patients. Abnormal QRS-T angle was a predictor of cardiac death [ hazard ratio: 3.2 (2.6-4.1)] and all-cause mortality [hazard ratio: 2.2 (1.8-2.6)]. After multivariate analysis abnormal and borderline QRS-T angle, peak wall motion score, age, male sex, history of diabetes, history of heart failure, smoking, and hypertension were independent predictors of (cardiac) death. Conclusion Abnormal QRS-T angle is an independent predictor of (cardiac) death in patients undergoing DSE. Abnormal QRS-T angle should be considered as a risk factor in stable patients evaluated for coronary disease. Coron Artery Dis 21:26-32 (C) 2010 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.
- Published
- 2010
69. Molecular imaging of inflammation and intraplaque vasa vasorum: A step forward to identification of vulnerable plaques?
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Eric J.G. Sijbrands, Gerrit L. ten Kate, Steven B. Feinstein, Roelf Valkema, Mat J.A.P. Daemen, Arend F.L. Schinkel, Antonius F.W. van der Steen, Folkert J. ten Cate, Internal Medicine, Radiology & Nuclear Medicine, Cardiology, Pathologie, and RS: CARIM School for Cardiovascular Diseases
- Subjects
vulnerable atherosclerotic plaque ,medicine.medical_specialty ,Pathology ,Angiogenesis ,Neovascularization, Physiologic ,Review Article ,Review ,Single-photon emission computed tomography ,Neovascularization ,angiogenesis ,Drug Delivery Systems ,medicine ,Journal Article ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,Physiologic ,Tomography ,Plaque ,Atherosclerotic ,Tomography, Emission-Computed, Single-Photon ,Inflammation ,Microbubbles ,medicine.diagnostic_test ,business.industry ,Vasa Vasorum ,Magnetic resonance imaging ,Atherosclerosis ,Intercellular Adhesion Molecule-1 ,Magnetic Resonance Imaging ,Plaque, Atherosclerotic ,Molecular Imaging ,X-Ray Computed ,medicine.anatomical_structure ,Positron emission tomography ,Radiology Nuclear Medicine and imaging ,Vasa vasorum ,Positron-Emission Tomography ,Selectins ,Radiology ,Emission-Computed ,Molecular imaging ,medicine.symptom ,business ,Cardiology and Cardiovascular Medicine ,Tomography, X-Ray Computed ,Single-Photon - Abstract
Current developments in cardiovascular biology and imaging enable the noninvasive molecular evaluation of atherosclerotic vascular disease. Intraplaque neovascularization sprouting from the adventitial vasa vasorum has been identified as an independent predictor of intraplaque hemorrhage and plaque rupture. These intraplaque vasa vasorum result from angiogenesis, most likely under influence of hypoxic and inflammatory stimuli. Several molecular imaging techniques are currently available. Most experience has been obtained with molecular imaging using positron emission tomography and single photon emission computed tomography. Recently, the development of targeted contrast agents has allowed molecular imaging with magnetic resonance imaging, ultrasound and computed tomography. The present review discusses the use of these molecular imaging techniques to identify inflammation and intraplaque vasa vasorum to identify vulnerable atherosclerotic plaques at risk of rupture and thrombosis. The available literature on molecular imaging techniques and molecular targets associated with inflammation and angiogenesis is discussed, and the clinical applications of molecular cardiovascular imaging and the use of molecular techniques for local drug delivery are addressed.
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- 2010
70. Clinical Relevance of Hibernating Myocardium in Ischemic Left Ventricular Dysfunction
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Jeroen J. Bax, Shahbudin H. Rahimtoola, Victoria Delgado, Don Poldermans, Arend F.L. Schinkel, Cardiology, and Anesthesiology
- Subjects
medicine.medical_specialty ,Heart disease ,medicine.medical_treatment ,Ischemia ,Myocardial Ischemia ,Single-photon emission computed tomography ,Revascularization ,Coronary artery disease ,Ventricular Dysfunction, Left ,Internal medicine ,medicine ,Myocardial Revascularization ,Humans ,cardiovascular diseases ,Coronary artery disease Hibernating myocardium Left ventricular dysfunction Myocardial hibernation Myocardial viability positron-emission-tomography coronary-artery-disease viable myocardium functional recovery ejection fraction heart-failure surgical revascularization time-course cardiomyopathy viability ,Hibernating myocardium ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,General Medicine ,medicine.disease ,Prognosis ,Magnetic Resonance Imaging ,Positron emission tomography ,Echocardiography ,Positron-Emission Tomography ,Cardiology ,cardiovascular system ,Radiology ,medicine.symptom ,business ,Cardiomyopathies - Abstract
Patients with chronic ischemic left ventricular dysfunction may have a substantial amount of viable, hibernating myocardium, which is a state of chronic contractile dysfunction with reduced blood flow at rest. Coronary revascularization in these patients may result in improvement of left ventricular function; in the absence of viability, left ventricular function will not improve postrevascularization. Various noninvasive imaging techniques are available for detection of viable myocardium, including magnetic resonance imaging, dobutamine stress echocardiography, and nuclear imaging with single photon emission computed tomography or positron emission tomography. Because these techniques probe different characteristics of viable myocardium, the sensitivities and specificities of the techniques are not precisely identical; in general, dobutamine stress echocardiography has the highest specificity, whereas the nuclear techniques have the highest sensitivity. The presence of myocardial viability also is related to prognosis: patients with viable myocardium who undergo revascularization have a good prognosis, whereas patients with viable myocardium who are treated medically have poor outcome. Accordingly, assessment of viability is important in the therapeutic decision-making process of patients with chronic ischemic left ventricular dysfunction. (C) 2010 Elsevier Inc. All rights reserved. circle The American Journal of Medicine (2010) 123, 978-986
- Published
- 2010
71. Prognostic Significance of QRS Duration in Patients With Suspected Coronary Artery Disease Referred for Noninvasive Evaluation of Myocardial Ischemia
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Marcel L. Geleijnse, Don Poldermans, Vittoria Rizzello, Abdou Elhendy, Ron T. van Domburg, Folkert J. ten Cate, Elena Biagini, Jeroen J. Bax, K. Martijn Akkerhuis, Arend F.L. Schinkel, Caroline E. Veltman, Maarten L. Simoons, Eric J.G. Sijbrands, Gerrit L. ten Kate, Cardiology, Cardiothoracic Surgery, Epidemiology, Internal Medicine, and Anesthesiology
- Subjects
Male ,medicine.medical_specialty ,Myocardial ischemia ,Heart disease ,Myocardial Infarction ,Myocardial Ischemia ,Infarction ,Coronary Disease ,Risk Assessment ,Coronary artery disease ,QRS complex ,Electrocardiography ,Heart Conduction System ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Dobutamine ,medicine ,Humans ,Myocardial infarction ,cardiovascular diseases ,Aged ,business.industry ,Mortality rate ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,Heart failure ,Cardiology ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,Follow-Up Studies - Abstract
The purpose of this study was to evaluate the prognostic significance of QRS duration in patients with suspected coronary artery disease (CAD) referred for noninvasive evaluation of myocardial ischemia by dobutamine stress echocardiography. QRS duration is a prognostic marker in patients with previous myocardial infarction and/or heart failure. The relation between QRS duration and outcome of patients without known heart disease has not been evaluated. A total of 1,227 patients (707 men, mean age 61 +/- 14 years) with suspected CAD underwent dobutamine stress echocardiography for evaluation of myocardial ischemia. Patients were followed to determine predictors of cardiac events and to assess the incremental significance of QRS duration compared to clinical and dobutamine stress echocardiographic data. During a mean follow-up of 4.2 +/- 2.4 years, 280 patients (23%) died (129 cardiac deaths), and 60 (5%) had a nonfatal infarction. Annualized cardiac death rates were 2.0% in patients with QRS duration = 120 ms, respectively (p = 120 ms (p = 0.0001). Multivariate models identified age, male gender, smoking, QRS duration >= 120 ms, and an abnormal dobutamine stress echocardiogram as independent predictors of cardiac death and the combined end point cardiac death/nonfatal infarction. In conclusion, QRS duration is an independent predictor of cardiac death and cardiac death/nonfatal infarction in patients with suspected CAD. This risk is persistent after adjustment for clinical variables, left ventricular function, and myocardial ischemia. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;104:1490-1493)
- Published
- 2009
72. Prognosis of patients with ischaemic cardiomyopathy after coronary revascularisation: relation to viability and improvement in left ventricular ejection fraction
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Vittoria Rizzello, Alessandro Boccanelli, Thomas H. Marwick, Elena Biagini, Eric Boersma, Arend F.L. Schinkel, Jeroen J. Bax, Don Poldermans, Jos R.T.C. Roelandt, Cardiology, and Anesthesiology
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Ischemia ,Cardiomyopathy ,Myocardial Infarction ,Myocardial Ischemia ,Hemodynamics ,Radionuclide ventriculography ,Kaplan-Meier Estimate ,Revascularization ,Ventricular Function, Left ,Angina Pectoris ,Internal medicine ,medicine ,Myocardial Revascularization ,Humans ,cardiovascular diseases ,Heart Failure ,Analysis of Variance ,Ejection fraction ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,Treatment Outcome ,Echocardiography ,Heart failure ,Circulatory system ,Cardiology ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: In patients with ischaemic cardiomyopathy and viable myocardium, left ventricular ejection fraction (LVEF) does not always improve after revascularisation. Whether this may affect prognosis is unclear. Objective: To evaluate the prognosis of viable patients with and without improvement of LVEF after coronary revascularisation. Methods: Before revascularisation, radionuclide ventriculography (RNV) and dobutamine stress echocardiography were performed to assess LVEF and myocardial viability, respectively. Nine to 12 months after revascularisation, LVEF improvement was assessed by RNV. Patients were divided into three groups: group 1, viable patients with LVEF improvement (n = 27); group 2, viable patients without LVEF improvement (n = 15), group 3, non-viable patients (n = 48). Cardiac events were evaluated during a 4-year follow-up. Results: After revascularisation, the mean (SD) LVEF improved from 32 (9)% to 42 (10)% in group 1, but did not change significantly in group 2 and in group 3, p
- Published
- 2009
73. Comparison of Outcome After Myocardial Infarction in Patients With and Without Abnormalities on Previous Stress Tc-99m Tetrofosmin Myocardial Perfusion Imaging
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Olaf Schouten, Arend F.L. Schinkel, Martin Dunkelgrun, Harm H.H. Feringa, Don Poldermans, Abdou Elhendy, Peter G. Noordzij, Stefanos E. Karagiannis, Jeroen J. Bax, Ron T. van Domburg, Cardiology, and Anesthesiology
- Subjects
Male ,medicine.medical_specialty ,Myocardial Infarction ,Perfusion scanning ,Coronary artery disease ,Myocardial perfusion imaging ,Organophosphorus Compounds ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Aged ,Proportional Hazards Models ,medicine.diagnostic_test ,business.industry ,Myocardial Perfusion Imaging ,Electrocardiography in myocardial infarction ,Organotechnetium Compounds ,General Medicine ,medicine.disease ,Survival Analysis ,Treatment Outcome ,Heart failure ,Relative risk ,Exercise Test ,Cardiology ,Female ,business ,Perfusion - Abstract
Background: Acute myocardial infarction (MI) can occur in patients with previously normal stress myocardial perfusion imaging (MPI). It is not known whether the prognosis of these patients differ from those with MI who had an abnormal MPI on an earlier testing. The aim of this study was to compare the outcome of patients who sustained a MI during follow-up after stress MPI based on the presence or absence of perfusion abnormalities on the earlier test. Methods: We studied 109 patients (age 62 +/- 11 years, 73 men) who developed MI 2.1 +/- 2.7 years after exercise or dobutamine stress Tc-99m tetrofosmin MPI. Subsequently, a follow-up was done for the occurrence of death during or after the acute event. Results: Myocardial perfusion was normal in 31 patients and was abnormal in 78 (45 had reversible defects). During a mean follow-up of 3.1 +/- 2.4 years after MI, death occurred in 35 (32%) patients. The death rate was 19% in patients with previously normal versus 33% in patients with abnormal perfusion (P < 0.01). In a Cox model, independent predictors of death were age (risk ratio (RR) 1.06, 95% Cl: 1.02-1.10), heart failure (RR 2.7, Cl: 1.3-5.5), and abnormal MPI (RR 2.5, Cl: 1.3-4.5). Conclusion: Patients with a previously normal stress MPI are less likely to die after acute MI than patients who had an abnormal MPI.
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- 2008
74. Hibernating Myocardium: Diagnosis and Patient Outcomes
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Roberto Ferrari, Jeroen J. Bax, Shahbudin H. Rahimtoola, Abdou Elhendy, Arend F.L. Schinkel, Don Poldermans, and Cardiology
- Subjects
medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Scintigraphy ,Revascularization ,Coronary artery disease ,Internal medicine ,Myocardial Revascularization ,Prevalence ,Humans ,Medicine ,cardiovascular diseases ,Retrospective Studies ,Myocardial Stunning ,Tomography, Emission-Computed, Single-Photon ,Hibernating myocardium ,medicine.diagnostic_test ,business.industry ,Magnetic resonance imaging ,Retrospective cohort study ,General Medicine ,medicine.disease ,Magnetic Resonance Imaging ,Survival Rate ,Treatment Outcome ,Pooled analysis ,Positron emission tomography ,cardiovascular system ,Cardiology ,Radiology ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,Follow-Up Studies - Abstract
Approximately 50% of the patients with chronic obstructive coronary artery disease resulting in chronic contractile dysfunction have hibernating myocardium and may benefit from revascularization. This pooled analysis describes the relative merits of dobutamine echocardiography, thallium-201 and technetium-99m scintigraphy, positron emission tomography, and magnetic resonance imaging, for the diagnosis of hibernating myocardium and prediction of patient outcomes.
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- 2007
75. Prognostic significance of akinesis becoming dyskinesis during dobutamine stress echocardiography
- Author
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Jeroen J. Bax, Vittoria Rizzello, Abdou Elhendy, Arend F.L. Schinkel, Elena Biagini, Fabiola B. Sozzi, Ron T. van Domburg, Don Poldermans, Gian Battista Danzi, Eleni C. Vourvouri, Cardiology, and Radiology & Nuclear Medicine
- Subjects
Male ,medicine.medical_specialty ,Myocardial Ischemia ,Ischemia ,Comorbidity ,Coronary Artery Disease ,Risk Assessment ,Sensitivity and Specificity ,Cohort Studies ,Ventricular Dysfunction, Left ,Risk Factors ,Dobutamine ,Internal medicine ,Prevalence ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Myocardial infarction ,Survival rate ,Survival analysis ,business.industry ,Incidence ,Reproducibility of Results ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Survival Rate ,Italy ,Heart failure ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,medicine.drug ,Cohort study - Abstract
Akinesis becoming dyskinesis (AKBD) at high-dose dobutamine stress echocardiography (DSE) has been disregarded as a marker of myocardial ischemia. However, its prognostic significance is unknown.We sought to assess the long-term outcome of patients with AKBD during DSE.A total of 731 patients (age 62 +/- 15 years, 628 men) with two or more akinetic left ventricular segments at rest underwent DSE and were followed up for a mean period of 5 +/- 2.7 years. The end points considered during follow-up were hard cardiac events (cardiac death and nonfatal myocardial infarction) and heart failure.Dyskinesis in two or more segments at peak stress developed in 60 patients (8%). Resting wall-motion score index was 2.6 +/- 0.56 in patients with AKBD versus 2.3 +/- 0.55 in patients without AKBD (P = .0002). Ischemia occurred in 197 patients (27%). During follow-up, 254 patients (35%) developed hard cardiac events and 204 patients (28%) developed heart failure. In all, 226 patients (31%) died of various causes (cardiac death in 172 patients). The annualized hard cardiac event rate was 11% in patients with AKBD and 6% in patients without (P = .03). The incidence of heart failure was significantly higher in patients with AKBD than without (47% vs 26%, P.001). Independent predictors of hard cardiac events were age (hazard ratio [HR] 1.03 [confidence interval {CI} = 1.01-1.04]), previous myocardial infarction (HR 1.4 [CI = 1.1-1.9]), diabetes mellitus (HR 1.8 [CI = 1.3-2.5]), resting wall-motion score index (HR 1.11 [CI = 1.01-1.04]), and AKBD (HR 1.6 [CI = 1.1-2.4]).AKBD at peak DSE is associated with increased risk of cardiac events in patients with akinetic segments at baseline echocardiogram.
- Published
- 2007
76. PATIENTS WITH GENOTYPE-POSITIVE HYPERTROPHIC CARDIOMYOPATHY ARE AT INCREASED RISK OF HEART FAILURE RELATED DEATH
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M. van Slegtenhorst, Michelle Michels, H.G. van Velzen, Arend F.L. Schinkel, Pieter A. Vriesendorp, and Rogier A. Oldenburg
- Subjects
medicine.medical_specialty ,business.industry ,Hypertrophic cardiomyopathy ,macromolecular substances ,medicine.disease ,Phenotype ,Sarcomere ,Increased risk ,Heart failure ,Internal medicine ,Genotype ,cardiovascular system ,Cardiology ,Medicine ,cardiovascular diseases ,business ,Cardiology and Cardiovascular Medicine - Abstract
Pathogenic sarcomere mutations are found in about 50% of hypertrophic cardiomyopathy (HCM) patients. Currently, clear genotype-phenotype relations are lacking. This study compares phenotype and outcome in genotype positive (G+) and genotype negative (G-) HCM. Between January 2004 and 2012, 431 HCM
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- 2015
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77. Left ventricular outflow tract gradient is associated with reduced capillary density in hypertrophic cardiomyopathy irrespective of genotype
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Seyma Eren, Marjon van Slegtenhorst, Michelle Michels, Patrick Klein, Hans W.M. Niessen, Jolanda van der Velden, H. Ibrahim Korkmaz, Tjeerd Germans, Albert C. van Rossum, Arend F.L. Schinkel, Chris Happé, Ahmet Güçlü, Erasmus MC other, Cardiology, ICaR - Heartfailure and pulmonary arterial hypertension, Pulmonary medicine, Pathology, ICaR - Ischemia and repair, Cardio-thoracic surgery, and Physiology
- Subjects
Adult ,Male ,medicine.medical_specialty ,Genotype ,Clinical Biochemistry ,Autopsy ,Ventricular Outflow Obstruction ,030204 cardiovascular system & hematology ,Biochemistry ,Muscle hypertrophy ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Internal medicine ,Medicine ,Ventricular outflow tract ,Humans ,Myocytes, Cardiac ,030212 general & internal medicine ,cardiovascular diseases ,Aged ,Aged, 80 and over ,business.industry ,Myocardium ,Hypertrophic cardiomyopathy ,General Medicine ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Septal myectomy ,Capillaries ,Capillary density ,Microscopy, Fluorescence ,Case-Control Studies ,Cardiology ,cardiovascular system ,Female ,business - Abstract
BACKGROUND: Coronary microvascular dysfunction (CMD) is an important feature of hypertrophic cardiomyopathy (HCM), which contributes negatively to symptoms and long-term outcome. Previous in vivo imaging studies in HCM suggest that left ventricular outflow tract (LVOT) gradient and genetic status are important contributors to CMD. CMD may be caused by reduced capillary density. Here, we investigated whether a reduction in capillary density is related to genetic status or LVOT gradient severity in an in vitro study of HCM cardiac samples.METHODS: Using immunofluorescence microscopy, we analysed capillaries (Cap) and cardiomyocytes (CM) in myectomy specimens from 18 HCM patients with maximum left ventricular (LV) wall thickness ≥15 mm. All subjects exhibited significant LVOT obstruction, necessitating septal myectomy. In addition, control myocardium from the LV septal wall was collected at autopsy of 6 individuals that suffered a noncardiac death.RESULTS: CM area was higher in patients with HCM compared to controls. Capillary density was significantly lower in patients with HCM compared with controls (1425 ± 262 vs. 2543 ± 509 Cap/mm(2) , P < 0·001), as was the number of Cap per CM corrected for CM area (2·2 ± 0·5 vs. 4·2 ± 0·9 Cap/CM area, P < 0·001). Capillary density did not differ between genotype-negative and genotype-positive HCM patients at similar resting LVOT gradients. A significant correlation was present between resting LVOT gradient and CM area (r = 0·73, P < 0·001), capillary density (r = -0·74, P < 0·001) and the number of Cap per CM corrected for CM area (r = -0·82, P < 0·001).CONCLUSIONS: Our data indicate that LVOT gradient, rather than genetic status, is associated with reduced capillary density in HCM.
- Published
- 2015
78. Long-term benefit of myectomy and anterior mitral leaflet extension in obstructive hypertrophic cardiomyopathy
- Author
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Arend F.L. Schinkel, Folkert J. ten Cate, Michelle Michels, Lex A. van Herwerden, Marcel J.M. Kofflard, Peter L. de Jong, Osama Ibrahim Ibrahim Soliman, Pieter A. Vriesendorp, Cardiology, and Cardiothoracic Surgery
- Subjects
Adult ,Male ,medicine.medical_specialty ,Time Factors ,Cardiomyopathy ,Population ,Observational Study ,Cohort Studies ,Internal medicine ,Mitral valve ,medicine ,Journal Article ,Ventricular outflow tract ,Humans ,education ,Survival rate ,Aged ,Mitral regurgitation ,education.field_of_study ,business.industry ,Mitral Valve Insufficiency ,Cardiomyopathy, Hypertrophic ,Middle Aged ,medicine.disease ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Treatment Outcome ,Hypertrophic ,Cardiology ,Mitral Valve ,Female ,Obstructive hypertrophic cardiomyopathy ,Cardiology and Cardiovascular Medicine ,Mitral valve regurgitation ,business ,Cohort study - Abstract
Severely symptomatic patients with obstructive hypertrophic cardiomyopathy (HC) may benefit from surgical myectomy. In patients with enlarged mitral leaflets and mitral regurgitation, myectomy can be combined with anterior mitral leaflet extension (AMLE) to stiffen the midsegment of the leaflet. The aim of this study was to evaluate the long-term results of myectomy combined with AMLE in patients with obstructive HC. This prospective, observational, single-center cohort study included 98 patients (49 +/- 14 years, 37% female) who underwent myectomy combined with AMLE from 1991 to 2012. End points included all-cause mortality and change in clinical and echocardiographic characteristics. Mortality was compared with age- and gender-matched patients with nonobstructive HC and subjects from the general population. Long-term follow-up was 8.3 +/- 6.1 years. There was no operative mortality, and New York Heart Association class was reduced from 2.8 +/- 0.5 to 1.3 +/- 0.5 (p
- Published
- 2015
79. Carotid Intraplaque Neovascularization Quantification Software (CINQS)
- Author
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Johan G. Bosch, Stijn C.H. van den Oord, Antonius F.W. van der Steen, Gerard van Burken, Nico de Jong, Arend F.L. Schinkel, Zeynettin Akkus, Cardiology, and Cardiothoracic Surgery
- Subjects
medicine.medical_specialty ,Quantitative imaging ,Computer science ,Software Validation ,Contrast Media ,Sensitivity and Specificity ,Pattern Recognition, Automated ,Neovascularization ,Software ,Health Information Management ,Artificial Intelligence ,Image Interpretation, Computer-Assisted ,Early prediction ,Medical imaging ,medicine ,Humans ,Carotid Stenosis ,Electrical and Electronic Engineering ,Ultrasonography ,Neovascularization, Pathologic ,Receiver operating characteristic ,business.industry ,Reproducibility of Results ,Computer Science Applications ,Radiology ,Analysis tools ,medicine.symptom ,business ,Algorithms ,Biotechnology ,Biomedical engineering ,Contrast-enhanced ultrasound - Abstract
Intraplaque neovascularization (IPN) is an important biomarker of atherosclerotic plaque vulnerability. As IPN can be detected by contrast enhanced ultrasound (CEUS), imaging-biomarkers derived from CEUS may allow early prediction of plaque vulnerability. To select the best quantitative imaging-biomarkers for prediction of plaque vulnerability, a systematic analysis of IPN with existing and new analysis algorithms is necessary. Currently available commercial contrast quantification tools are not applicable for quantitative analysis of carotid IPN due to substantial motion of the carotid artery, artifacts, and intermittent perfusion of plaques. We therefore developed a specialized software package called Carotid intraplaque neovascularization quantification software (CINQS). It was designed for effective and systematic comparison of sets of quantitative imaging biomarkers. CINQS includes several analysis algorithms for carotid IPN quantification and overcomes the limitations of current contrast quantification tools and existing carotid IPN quantification approaches. CINQS has a modular design which allows integrating new analysis tools. Wizard-like analysis tools and its graphical-user-interface facilitate its usage. In this paper, we describe the concept, analysis tools, and performance of CINQS and present analysis results of 45 plaques of 23 patients. The results in 45 plaques showed excellent agreement with visual IPN scores for two quantitative imaging-biomarkers (The area under the receiver operating characteristic curve was 0.92 and 0.93).
- Published
- 2015
80. Fully automated carotid plaque segmentation in combined contrast-enhanced and B-mode ultrasound
- Author
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Johan G. Bosch, Arend F.L. Schinkel, Wiro J. Niessen, Antonius F.W. van der Steen, Nico de Jong, Stefan Klein, Stijn C.H. van den Oord, Zeynettin Akkus, Diego D. B. Carvalho, Cardiology, Medical Informatics, and Radiology & Nuclear Medicine
- Subjects
Carotid Artery Diseases ,medicine.medical_specialty ,Acoustics and Ultrasonics ,Biophysics ,Contrast Media ,Carotid Intima-Media Thickness ,Motion estimation ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Plaque morphology ,Segmentation ,Observer Variation ,Ground truth ,Radiological and Ultrasound Technology ,B mode ultrasound ,business.industry ,Ultrasound ,Reproducibility of Results ,Image Enhancement ,Plaque, Atherosclerotic ,Carotid Arteries ,Fully automated ,cardiovascular system ,Radiology ,business ,Algorithms ,Biomedical engineering ,Contrast-enhanced ultrasound - Abstract
Carotid plaque segmentation in B-mode ultrasound (BMUS) and contrast-enhanced ultrasound (CEUS) is crucial to the assessment of plaque morphology and composition, which are linked to plaque vulnerability. Segmentation in BMUS is challenging because of noise, artifacts and echo-lucent plaques. CEUS allows better delineation of the lumen but contains artifacts and lacks tissue information. We describe a method that exploits the combined information from simultaneously acquired BMUS and CEUS images. Our method consists of non-rigid motion estimation, vessel detection, lumen-intima segmentation and media-adventitia segmentation. The evaluation was performed in training (n = 20 carotids) and test (n = 28) data sets by comparison with manually obtained ground truth. The average root-mean-square errors in the training and test data sets were comparable for media-adventitia (411 +/- 224 and 393 +/- 239 mm) and for lumen-intima (362 +/- 192 and 388 +/- 200 mm), and were comparable to inter-observer variability. To the best of our knowledge, this is the first method to perform fully automatic carotid plaque segmentation using combined BMUS and CEUS. (E-mail: j.bosch@erasmusmc.nl) (C) 2015 World Federation for Ultrasound in Medicine & Biology.
- Published
- 2015
81. Baseline plasma N-terminal pro-B-type natriuretic peptide is associated with the extent of stress-induced myocardial ischemia during dobutamine stress echocardiography
- Author
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Olaf Schouten, Don Poldermans, Robert de Jonge, Abdou Elhendy, Stefanos E. Karagiannis, Jeroen J. Bax, Harm H.H. Feringa, Eric Boersma, Arend F.L. Schinkel, Jan Lindemans, Anesthesiology, Cardiology, and Clinical Chemistry
- Subjects
Adult ,Male ,medicine.medical_specialty ,Myocardial ischemia ,Dobutamine stress echocardiography ,medicine.drug_class ,Myocardial Ischemia ,Coronary Artery Disease ,Sensitivity and Specificity ,Heart Rate ,Interquartile range ,Internal medicine ,Natriuretic Peptide, Brain ,medicine ,Natriuretic peptide ,Humans ,Prospective Studies ,cardiovascular diseases ,Aged ,Analysis of Variance ,business.industry ,Stress induced ,General Medicine ,Odds ratio ,Peptide Fragments ,Confidence interval ,Cardiology ,Female ,N terminal pro b type natriuretic peptide ,Cardiology and Cardiovascular Medicine ,business ,Biomarkers ,hormones, hormone substitutes, and hormone antagonists ,Echocardiography, Stress - Abstract
To determine the relationship between baseline plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and the presence and extent of myocardial ischemia during dobutamine stress echocardiography (DSE).NT-proBNP was measured in 170 consecutive patients prior to DSE. Rest wall motion abnormalities (RWMAs) and new wall motion abnormalities (NWMAs) were scored using a 5-point, 17-segment model. Kruskal-Wallis tests were applied to study differences in NT-proBNP levels between patients with normal DSE, RWMAs but no NWMAs, and NWMAs, and (in patients with NWMAs) between those with 1-2, 3-4 and4 ischemic segments. Univariate and multivariate regression analyses were used to determine the value of NT-proBNP in predicting NWMAs.The median NT-proBNP level was 110 ng/l (interquartile range: 42-389 ng/l). Median NT-proBNP was 59, 321 and 440 ng/l in patients with normal DSE, with RWMAs but no NWMAs, and with NWMAs, respectively (P0001). Among patients with NWMAs, median NT-proBNP was associated with the number of ischemic segments: 364, 710 and 2376 ng/l in patients with 1-2, 3-4 and4 ischemic segments, respectively (P0.001). Elevated NT-proBNP levels were significantly associated with NWMAs (odds ratio per 100 ng/l increase: 1.14, 95% confidence interval: 1.1-1.2) in a multivariate analysis of clinical baseline variables and RWMAs.Elevated baseline levels of NT-proBNP are associated with the presence and extent of myocardial ischemia during DSE, independent of the presence of RWMAs.
- Published
- 2006
82. Benefits of coronary revascularisation in diabetic and non-diabetic patients with ischaemic cardiomyopathy: Role of myocardial viability
- Author
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Eric Boersma, Elena Biagini, Jeroen J. Bax, Don Poldermans, Alexander P.W.M. Maat, Abdou Elhendy, Arend F.L. Schinkel, Jos R.T.C. Roelandt, Fabiola B. Sozzi, Vittoria Rizzello, Cardiology, and Cardiothoracic Surgery
- Subjects
Male ,medicine.medical_specialty ,Myocardial Ischemia ,Ischaemic cardiomyopathy ,Ventricular Function, Left ,Diabetes Complications ,Coronary artery disease ,SDG 3 - Good Health and Well-being ,Dobutamine ,Internal medicine ,Diabetes mellitus ,Myocardial Revascularization ,medicine ,Humans ,In patient ,Coronary revascularisation ,Aged ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Stroke Volume ,Middle Aged ,medicine.disease ,Heart failure ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,Non diabetic - Abstract
Background: Diabetes mellitus in patients with coronary artery disease is associated with poor outcome. In this study, the relation between myocardial viability, diabetes, coronary revascularisation and outcome was evaluated. Methods: 129 patients (31 diabetic, 98 non-diabetic) with ischaemic cardiomyopathy underwent dobutamine stress echocardiography to assess myocardial viability. Patients with ≥4 viable segments were defined as viable and patients with <
- Published
- 2006
83. Prognostic value of stress Tc-99m-tetrofosmin myocardial perfusion imaging in predicting all-cause mortality: a 6-year follow-up study
- Author
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Arend F.L. Schinkel, Roelf Valkema, Ron T. van Domburg, Abdou Elhendy, Elena Biagini, Jeroen J. Bax, Don Poldermans, Cardiology, and Radiology & Nuclear Medicine
- Subjects
Male ,medicine.medical_specialty ,Vasodilator Agents ,Population ,Coronary Artery Disease ,Risk Assessment ,Sensitivity and Specificity ,Coronary artery disease ,Myocardial perfusion imaging ,Organophosphorus Compounds ,Risk Factors ,Internal medicine ,Diabetes mellitus ,medicine ,Prevalence ,Humans ,Radiology, Nuclear Medicine and imaging ,education ,Radionuclide Imaging ,Netherlands ,Proportional Hazards Models ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Mortality rate ,Reproducibility of Results ,General Medicine ,Organotechnetium Compounds ,Middle Aged ,medicine.disease ,Prognosis ,Survival Analysis ,Perfusion ,Survival Rate ,Relative risk ,Heart failure ,Cardiology ,Exercise Test ,Female ,Radiopharmaceuticals ,business - Abstract
The aim of this study was to ascertain whether stress myocardial perfusion imaging can independently predict long-term mortality.We studied 1,386 patients with known or suspected coronary artery disease by means of stress 99mTc-tetrofosmin myocardial perfusion tomography. The end point during follow-up was death from any cause. Mortality rates were compared with that in a reference population using calculated age- and gender-specific data in the general population.Mean age was 60+/-11 years. There were 608 (44%) women. Perfusion abnormalities were fixed in 416 (30%) patients and reversible in 445 (32%) patients. During a mean follow-up of 6+/-1.9 years, 290 (21%) patients died. The annual mortality was 1.7% in patients with normal perfusion and 5.2% in patients with abnormal perfusion. Patients with multivessel distribution of perfusion abnormalities had the highest annual mortality (6.2%). The annual mortality in the reference population was 3.2%. In a multivariate analysis model, predictors of death were age [risk ratio (RR)=1.06, 95% CI 1.04-1.07], male gender (RR=2, CI 1.6-2.6), history of heart failure (RR=2.3, CI 1.8-3.1), diabetes mellitus (RR=2.1, CI 1.6-2.7), smoking (RR=1.8, CI 1.4-2.3), reversible perfusion defects (RR=1.8, CI 1.4-2.5) and fixed perfusion defects (RR=1.7, CI 1.3-2.1).Myocardial perfusion abnormalities on stress 99mTc-tetrofosmin tomography are independently associated with long-term risk of death. The extent of perfusion abnormalities is a major determinant of mortality. The presence of normal perfusion is associated with a lower mortality compared with the general population.
- Published
- 2006
84. Long term prognostic value of myocardial viability and ischaemia during dobutamine stress echocardiography in patients with ischaemic cardiomyopathy undergoing coronary revascularisation
- Author
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Eric Boersma, Jeroen J. Bax, Abdou Elhendy, Alexander P.W.M. Maat, Arend F.L. Schinkel, Jos R. Roelandt, Elena Biagini, Filippo Crea, Vittoria Rizzello, Fabiola B. Sozzi, Don Poldermans, Cardiology, and Cardiothoracic Surgery
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Ischemia ,Ischemia ,Cardiomyopathy ,Revascularization ,Predictive Value of Tests ,Internal medicine ,Myocardial Revascularization ,medicine ,Humans ,cardiovascular diseases ,Interventional Cardiology and Surgery ,Ejection fraction ,Vascular disease ,business.industry ,Myocardium ,Hazard ratio ,Middle Aged ,Prognosis ,medicine.disease ,Myocardial Contraction ,Predictive value of tests ,Cardiology ,Female ,Dobutamine ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,medicine.drug - Abstract
To evaluate the relative merits of viability and ischaemia for prognosis after revascularisation.Low-high dose dobutamine stress echocardiography (DSE) was performed before revascularisation in 128 consecutive patients with ischaemic cardiomyopathy (mean (SD) left ventricular ejection fraction (LVEF) 31 (8)%). Viability (defined as contractile reserve (CR)) and ischaemia were assessed during low and high dose dobutamine infusion, respectively. Cardiac death was evaluated during a five year follow up. Clinical, angiographic, and echocardiographic data were analysed to identify predictors of events.Univariable predictors of cardiac death were the presence of multivessel disease (hazard ratio (HR) 0.21, p0.001), baseline LVEF (HR 0.90, p0.0001), wall motion score index (WMSI) at rest (HR 4.02, p = 0.0006), low dose DSE (HR 7.01, p0.0001), peak dose DSE (HR 4.62, p0.0001), the extent of scar (HR 1.39, p0.0001), and the presence of CR inor = 25% of dysfunctional segments (HR 0.34, p = 0.02). The best multivariable model to predict cardiac death included the presence of multivessel disease, WMSI at low dose DSE, and the presence of CR inor = 25% of the severely dysfunctional segments (HR 9.62, p0.0001). Inclusion of ischaemia in the model did not provide additional predictive value.The findings of the present study illustrate that in patients with ischaemic cardiomyopathy, the extent of viability (CR) is a strong predictor of long term prognosis after revascularisation. Ischaemia did not add significantly in predicting outcome.
- Published
- 2006
85. Prognostic implications of a normal stress technetium-99m-tetrofosmin myocardial perfusion study in patients with a healed myocardial infarct and/or previous coronary revascularization
- Author
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Vittoria Rizzello, Elena Biagini, Abdou Elhendy, Eric P. Krenning, Don Poldermans, Aukje Huurman, Harm H.H. Feringa, Jeroen J. Bax, Ron T. van Domburg, Arend F.L. Schinkel, Maarten L. Simoons, Roelf Valkema, Cardiology, Radiology & Nuclear Medicine, and Anesthesiology
- Subjects
Male ,medicine.medical_specialty ,Myocardial Infarction ,Blood Pressure ,Coronary Artery Disease ,Coronary artery disease ,Coronary circulation ,Myocardial perfusion imaging ,Organophosphorus Compounds ,Sex Factors ,Heart Rate ,Internal medicine ,Coronary Circulation ,Heart rate ,medicine ,Myocardial Revascularization ,Humans ,Myocardial infarction ,Aged ,Tomography, Emission-Computed, Single-Photon ,medicine.diagnostic_test ,business.industry ,Organotechnetium Compounds ,Middle Aged ,medicine.disease ,Prognosis ,Blood pressure ,medicine.anatomical_structure ,Multivariate Analysis ,Cardiology ,Exercise Test ,Female ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,business ,Perfusion ,Emission computed tomography ,Echocardiography, Stress ,Follow-Up Studies - Abstract
Previous studies have shown a good outcome for patients who present with normal findings on stress myocardial perfusion imaging. Currently, the prognostic implications of a normal study in patients who have a history of coronary artery disease (CAD) are not clear. This study investigated the long-term prognosis after a normal finding on stress technetium-99m (Tc-99m)-tetrofosmin single-photon emission computed tomography in patients with a history of CAD. The study included 147 consecutive patients with a history of CAD (previous myocardial infarction and/or myocardial revascularization), who underwent exercise bicycle or high-dose dobutamine-atropine stress Tc-99m-tetrofosmin single-photon emission computed tomography, and had normal perfusion results during stress and at rest. Follow-up was completed in all patients. During a follow-up of 6.5 +/- 1.9 years, 20 patients (14%) died, 10 (7%) of whom died due to cardiac causes, and 12 (8%) had a nonfatal myocardial infarction. Annual cardiac death rates were 0.5% during the first 3 years of follow-up and 1.3% in the subsequent 3 years. Independent predictors of cardiac death were male gender, rate-pressure product at rest, and rate-pressure product at peak stress. In conclusion, patients who have a history of CAD have a very low cardiac death rate during the 3 years after a normal finding on stress Tc-99m-tetrofosmin single-photon emission computed tomography. Repeated testing should be reconsidered 3 years after the initial evaluation and when a change in symptoms or clinical condition occurs.
- Published
- 2006
86. Stress and tissue Doppler echocardiographic evidence of effectiveness of myoblast transplantation in patients with ischaemic heart failure
- Author
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Don Poldermans, Emile Onderwater, Manolis Bountioukos, Arend F.L. Schinkel, Patrick W. Serruys, Marco Valgimigli, Elena Biagini, Vittoria Rizzello, Pieter C. Smits, and Cardiology
- Subjects
Male ,medicine.medical_specialty ,Myoblasts, Skeletal ,Myocardial Infarction ,Doppler imaging ,Severity of Illness Index ,Ventricular Function, Left ,Cicatrix ,Internal medicine ,Stress Echocardiography ,Medicine ,Humans ,Myocardial infarction ,Prospective Studies ,Ejection fraction ,business.industry ,Stroke Volume ,Stroke volume ,Middle Aged ,medicine.disease ,Echocardiography, Doppler ,Transplantation ,Treatment Outcome ,Heart failure ,Cardiology ,Dobutamine ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Echocardiography, Stress - Abstract
Background There is experimental evidence that transplanting skeletal myoblasts (SM) into the post-infarction myocardial scar improves regional and global left ventricular (LV) function. Aims To evaluate short- and long-term regional and global LV functional effects of percutaneously transplanted SM in patients with ischaemic heart failure. Methods and results Ten patients (mean age 60 ± 10 years, 8 males) with dilated ischaemic cardiomyopathy underwent percutaneous injection of autologous myoblasts. Regional and global LV function was evaluated by 2-dimensional echocardiography and tissue Doppler imaging (TDI) at rest and during low-dose dobutamine infusion to assess contractile reserve. After a baseline examination, sequential follow-ups were performed at 1, 3, and 6 months and 1 year. NYHA functional class decreased from 2.7 ± 0.5 to 1.9 ± 0.5 (p < 0.01) at one year. LV function and volumes at rest remained unchanged while contractile reserve significantly improved during follow-up. At low-dose dobutamine infusion, the peak systolic velocity in the regions of myoblasts injection significantly increased at TDI examination (from 7.7 ± 2.1 to 8.6 ± 1.8 cm/s, p = 0.02); LV ejection fraction improved (from 40 ± 9% to 46 ± 8%, p < 0.0001) and end-systolic volumes decreased (from 56 ± 28 to 50 ± 25 ml/m2, p = 0.001) at 1 year. Conclusion In patients with ischaemic heart failure, percutaneous injection of autologous myoblasts may improve regional and global LV systolic function during dobutamine infusion, at 1-year follow-up.
- Published
- 2006
87. Eleven-year prognostic value of dobutamine stress (99m)Tc-sestamibi myocardial perfusion imaging in patients with limited exercise capacity
- Author
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Roelf Valkema, Hendrik J. Boiten, Arend F.L. Schinkel, Ron T. van Domburg, Cardiology, and Radiology & Nuclear Medicine
- Subjects
Male ,Technetium Tc 99m Sestamibi ,medicine.medical_specialty ,Cardiotonic Agents ,medicine.medical_treatment ,Infarction ,Coronary Artery Disease ,Revascularization ,Coronary artery disease ,Angina ,Myocardial perfusion imaging ,SDG 3 - Good Health and Well-being ,Internal medicine ,Dobutamine ,medicine ,Humans ,Myocardial infarction ,Tomography, Emission-Computed, Single-Photon ,Exercise Tolerance ,medicine.diagnostic_test ,Dose-Response Relationship, Drug ,business.industry ,Myocardial Perfusion Imaging ,Middle Aged ,medicine.disease ,Prognosis ,Heart failure ,Cardiology ,Exercise Test ,Female ,Radiopharmaceuticals ,Cardiology and Cardiovascular Medicine ,business ,Emission computed tomography ,Forecasting - Abstract
Myocardial perfusion single-photon emission computed tomography is a routine technique for the evaluation of coronary artery disease. However, information on the very long term prognostic value of dobutamine stress single-photon emission computed tomographic myocardial perfusion imaging (MPI) in patients with limited exercise capacity is scarce. The aim of this study was to assess the long-term prognostic value of dobutamine stress technetium-99m (Tc-99m) sestamibi MPI in these patients. The study population consisted of a high-risk cohort of 531 consecutive patients with limited exercise capacity who underwent dobutamine stress Tc-99m-sestamibi MPI for the assessment of known or suspected coronary artery disease. Follow-up was successful in 528 patients. Because of early revascularization, 55 patients were excluded. The present data are based on 473 patients. The end points were all-cause mortality, cardiac death, nonfatal myocardial infarction, and late (>60 days) coronary revascularization. Kaplan-Meier survival curves were performed and univariate and multivariate analyses were performed to identify predictors of very long term outcome. The mean age of the patients was 61 +/- 12 years, and 58% were men. Abnormal results (defined as the presence of reversible or fixed defects) were observed in 312 patients (66%). During a mean follow-up period of 11.3 +/- 6.7 years, 287 patients (61%) died (all-cause mortality), of whom 125 (26%) died due to cardiac causes. Nonfatal myocardial infarction occurred in 59 patients (12%). Late coronary revascularization was performed in 61 patients (13%). Univariate predictors of major cardiac events included age, male gender, previous infarction, diabetes mellitus, history of angina, heart failure, ST-segment changes, abnormal results on Tc-99m-sestamibi scan, reversible defect, fixed defect, summed rest score, and summed stress score. Multivariate analysis identified abnormal results on MPI as a strong independent predictor of major adverse cardiac events. In conclusion, in patients with limited exercise capacity, dobutamine stress Tc-99m-sestamibi single-photon emission computed tomography provides incremental prognostic information in addition to clinical and stress test parameters for the prediction of very long term outcomes. (C) 2015 Elsevier Inc. All rights reserved.
- Published
- 2014
88. Prognostic Significance of Left Anterior Hemiblock in Patients With Suspected Coronary Artery Disease
- Author
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Stefan P. Nelwan, Jeroen J. Bax, Elena Biagini, Maarten L. Simoons, Ron T. van Domburg, Abdou Elhendy, Guido Rocchi, Don Poldermans, Arend F.L. Schinkel, Vittoria Rizzello, Claudio Rapezzi, Biagini E, Elhendy A, Schinkel AF, Nelwan S, Rizzello V, van Domburg RT, Rapezzi C, Rocchi G, Simoons ML, Bax JJ, Poldermans D., and Cardiology
- Subjects
Male ,medicine.medical_specialty ,Bundle-Branch Block ,Stress testing ,Ischemia ,Coronary Artery Disease ,Risk Assessment ,Coronary artery disease ,Ventricular Dysfunction, Left ,Risk Factors ,Internal medicine ,medicine ,Humans ,In patient ,Prospective Studies ,cardiovascular diseases ,Myocardial infarction ,Prospective cohort study ,Aged ,business.industry ,Mortality rate ,Middle Aged ,Prognosis ,medicine.disease ,Cardiology ,Left anterior hemiblock ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress - Abstract
This study was designed to assess the functional and prognostic significance of left anterior hemiblock (LAHB) in patients with no history of myocardial infarction referred for dobutamine stress echocardiography (DSE). BACKGROUND: The significance of isolated LAHB in patients with suspected coronary artery disease (CAD) is unclear. METHODS: We studied 1,187 patients with suspected CAD and no history of myocardial infarction who underwent DSE and were followed for occurrence of cardiac death. RESULTS: Left anterior hemiblock was detected on baseline electrocardiogram in 159 patients (13%). Ischemia occurred more frequently in patients with LAHB (43% vs. 33%, p = 0.02). During a mean follow-up of 5.0 +/- 2.5 years, 125 patients (11%) died of cardiac causes. The annual cardiac death rate was 4.9% in patients with LAHB and 1.9% for patients without (p < 0.0001). Patients with both LAHB and an abnormal DSE had the highest annual cardiac death rate (6.3%). In a Cox multivariable analysis, independent predictors of cardiac death were age, smoking, history of heart failure, diabetes, and ischemia. Left anterior hemiblock was independently associated with increased risk of cardiac death among patients with normal DSE (hazard ratio 1.8, 95% confidence interval 1.1 to 3.8) and in patients with abnormal DSE (hazard ratio 1.7, 95% confidence interval 1.1 to 2.7). CONCLUSIONS: In patients with suspected CAD referred for stress testing, LAHB is associated with increased risk of cardiac death. This risk is persistent after adjustment for major clinical data and abnormalities on the stress echocardiogram. Therefore, isolated LAHB should not be considered a benign electrocardiographic abnormality in these patients.
- Published
- 2005
89. Comparison of All-Cause Mortality in Women With Known or Suspected Coronary Artery Disease Referred for Dobutamine Stress Echocardiography With Normal Versus Abnormal Test Results
- Author
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Vittoria Rizzello, Jeroen J. Bax, Maarten L. Simoons, Olaf Schouten, Ron T. van Domburg, Guido Rocchi, Fabiola B. Sozzi, Boudewijn J. Krenning, Angelo Branzi, Arend F.L. Schinkel, Elena Biagini, Abdou Elhendy, Don Poldermans, Biagini E, Elhendy A, Schinkel AF, Rizzello V, van Domburg RT, Krenning BJ, Schouten O, Sozzi FB, Branzi A, Rocchi G, Simoons ML, Bax JJ, Poldermans D., Cardiology, and Public Health
- Subjects
medicine.medical_specialty ,Time Factors ,Myocardial ischemia ,Dobutamine stress echocardiography ,Myocardial Ischemia ,Coronary Artery Disease ,Risk Assessment ,Coronary artery disease ,Risk Factors ,Cause of Death ,Internal medicine ,Epidemiology ,medicine ,Humans ,In patient ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Increased risk ,Cardiology ,Female ,Dobutamine ,Cardiology and Cardiovascular Medicine ,business ,All cause mortality ,Echocardiography, Stress ,medicine.drug - Abstract
The presence of myocardial ischemia during dobutamine stress echocardiography is independently associated with an increased risk of all-cause mortality in women after adjustment for clinical data. This association is observed in patients who have proved coronary artery disease and in patients who have no history of coronary artery disease.
- Published
- 2005
90. Seven-year follow-up after dobutamine stress echocardiography
- Author
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Vittoria Rizzello, Arend F.L. Schinkel, Ron T. van Domburg, Maarten L. Simoons, Angelo Branzi, Claudio Rapezzi, Jeroen J. Bax, Boudewijn J. Krenning, Don Poldermans, Manolis Bountioukos, Elena Biagini, Abdou Elhendy, and Miklos D. Kertai
- Subjects
medicine.medical_specialty ,Disease free survival ,Dobutamine stress echocardiography ,Proportional hazards model ,business.industry ,Follow up studies ,medicine.disease ,Coronary artery disease ,Sex factors ,Internal medicine ,Cardiology ,medicine ,In patient ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objectives The aim of this study was to investigate the effects of gender on long-term prognosis of patients undergoing dobutamine stress echocardiography (DSE). Background Gender differences in the predictors of outcome among patients with known or suspected coronary artery disease undergoing DSE have not been adequately studied. Methods We studied 2,276 men and 1,105 women with known or suspected coronary artery disease who underwent DSE. Follow-up events were cardiac death and nonfatal myocardial infarction (MI). Results Dobutamine stress echocardiography was normal in 687 men (30%) and 483 women (44%) (p Conclusions Dobutamine stress echocardiography provides independent prognostic information in both men and women. In patients with normal DSE, gender is independently associated with cardiac events. The outcome of patients with abnormal DSE is not related to gender, after adjusting for stress echocardiographic abnormalities.
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- 2005
91. Clinical and prognostic implications of angina pectoris developing during Dobutamine stress echocardiography in the absence of inducible wall motion abnormalities
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Arend F.L. Schinkel, Ron T. van Domburg, Jos R.T.C. Roelandt, Elena Biagini, Abdou Elhendy, Jeroen J. Bax, Don Poldermans, Vittoria Rizzello, and Cardiology
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Male ,medicine.medical_specialty ,Cardiotonic Agents ,Myocardial revascularization ,Dobutamine stress echocardiography ,Angina Pectoris ,Angina ,Dobutamine ,Internal medicine ,medicine ,Humans ,In patient ,Myocardial infarction ,Wall motion ,Aged ,Netherlands ,Exertional angina ,business.industry ,Incidence ,Incidence (epidemiology) ,Middle Aged ,Prognosis ,medicine.disease ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,Follow-Up Studies - Abstract
This study assessed the incidence, clinical correlates, and prognostic significance of angina during dobutamine stress echocardiography (DSE) in patients who did not have inducible wall motion abnormalities. We studied 2,117 patients (61 +/- 13 years of age; 1,149 men) who underwent large-dose DSE and had no new or worsening wall motion abnormalities during DSE. Follow-up events were hard cardiac events (cardiac death or nonfatal myocardial infarction) and myocardial revascularization. Angina was induced in 217 patients (10%) during stress. DSE was normal in 1,198 patients (57%), whereas 919 patients (43%) had fixed wall motion abnormalities. During a mean follow-up of 5.5 +/- 3.7 years, 143 patients (7%) died of cardiac causes and 78 (4%) had nonfatal myocardial infarction. Patients who developed angina during DSE were more likely to have a history of exertional angina (64% vs 16%, p0.001) and had a higher wall motion score index at rest (1.29 +/- 0.5 vs 1.17 +/- 0.4, p = 0.01) compared with patients who did not have angina. Annual hard cardiac event rates were 2.2% in patients who had dobutamine-induced angina (DIA) and 2.1% in patients who did not (p = NS). Myocardial revascularization was performed more frequently in patients who had DIA than in those who did not (39% vs 14%, p0.0001). In Cox's regression model, independent predictors of hard events were age (RR 1.03, 95% confidence interval [CI] 1.02 to 1.04), male gender (RR 1.6, 95% CI 1.1 to 2.2), smoking (RR 1.5, 95% CI 1.1 to 2.9), and wall motion score index at rest (RR 2.6, 95% CI 1.8 to 3.8). In conclusion, in patients who do not have ischemia by echocardiographic criteria during DSE, inducible angina pectoris is associated with a high incidence of revascularization during follow-up. However, the hard cardiac event rate does not differ in patients who develop DIA from those who do not.
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- 2005
92. The use of stress echocardiography for prognostication in coronary artery disease: an overview
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Jeroen J. Bax, Don Poldermans, Elena Biagini, Abdou Elhendy, Arend F.L. Schinkel, and Cardiology
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medicine.medical_specialty ,Ventricular function ,business.industry ,Ischemia ,MEDLINE ,Reproducibility of Results ,Heart ,Coronary Artery Disease ,Prognosis ,medicine.disease ,Cardiovascular physiology ,Coronary artery disease ,Text mining ,Internal medicine ,medicine ,Cardiology ,Stress Echocardiography ,Humans ,Wall motion ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress - Abstract
Stress echocardiography has a high accuracy for the detection of coronary artery disease. Additionally, it provides clinically useful prognostic information, such as resting left ventricular function, myocardial viability, stress-induced ischemia, vascular extent of wall motion abnormalities, and changes in end-systolic volume and ejection fraction with stress.The timing, extent, and severity of the stress-induced wall motion abnormalities are important determinants of long-term prognosis. Previous studies have shown the efficacy of stress echocardiography in predicting long-term cardiac events in mixed patient groups and the value of this test in selected patient subsets.This review attempts to define the role of stress echocardiography for prognostication in coronary artery disease, pointing out the ability of this technique to identify low-risk and high-risk subsets among patients with known or suspected coronary artery disease and thus guide patient management decisions.
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- 2005
93. Effect of myocardial ischemia during Dobutamine stress echocardiography on cardiac mortality in patients with heart failure secondary to ischemic cardiomyopathy
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Ron T. van Domburg, Jeroen J. Bax, Arend F.L. Schinkel, Abdou Elhendy, Fabiola B. Sozzi, Jos R.T.C. Roelandt, Don Poldermans, and Cardiology
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Male ,medicine.medical_specialty ,Cardiotonic Agents ,medicine.medical_treatment ,Myocardial Ischemia ,Ischemia ,Cardiomyopathy ,Blood Pressure ,Revascularization ,Electrocardiography ,Heart Rate ,Predictive Value of Tests ,Risk Factors ,Dobutamine ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Netherlands ,Retrospective Studies ,Heart Failure ,Ischemic cardiomyopathy ,Ejection fraction ,medicine.diagnostic_test ,business.industry ,Middle Aged ,Prognosis ,medicine.disease ,Myocardial Contraction ,Survival Rate ,Death, Sudden, Cardiac ,Heart failure ,Injections, Intravenous ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,Follow-Up Studies - Abstract
This study assessed the effect of ischemia during dobutamine stress echocardiography (DSE) on cardiac mortality in patients with heart failure. We studied 528 patients (62 +/- 11 years of age, 402 men) who had heart failure and previous myocardial infarction or known coronary artery disease and underwent DSE. Ischemia was defined as new or worsening wall motion abnormalities or a biphasic response. End point during follow-up was cardiac death. Mean ejection fraction was 35 +/- 12%. Ischemia was detected in 407 patients (77%). During a mean follow-up of 3.2 +/- 2.4 years, cardiac death occurred in 150 patients (28%). Myocardial revascularization was performed within 4 months after DSE in 117 patients (29%) who had ischemia. Annual rates of cardiac death were 4.8% in patients who did not have ischemia, 5.5% in those who had ischemia and underwent revascularization within 4 months, and 11.8% in those who had ischemia and were not revascularized (p0.001 vs other groups). In a multivariate analysis model, independent predictors of cardiac death were diabetes (RR 2, 95% confidence interval 1.4 to 2.9), male gender (RR 1.7, 95% confidence interval 1.2 to 3.1), low-dose wall motion score index (RR 1.4, 95% confidence interval 1.2 to 2.6), and ischemia (RR 1.9, 95% confidence interval 1.3 to 3.2). Angina was not predictive of death. In patients who had ischemia, revascularization within 4 months after DSE was associated with decreased risk of cardiac death (RR 0.43, 95% confidence interval 0.3 to 0.8). In conclusion, myocardial ischemia that is detected by DSE is associated with increased risk of cardiac death among patients who have heart failure, after adjustment for left ventricular function. Patients who had ischemia and received revascularization within 4 months had a better survival than did patients who had ischemia and did not receive revascularization. Angina had no effect on prognosis. Therefore, patients who do not have angina should not be considered a lower-risk population if they have inducible ischemia.
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- 2005
94. Perioperative cardiovascular mortality in noncardiac surgery: Validation of the Lee cardiac risk index
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Jeroen J. Bax, Marian van Santen, Don Poldermans, Maarten L. Simoons, Arend F.L. Schinkel, Hero van Urk, Miklos D. Kertai, Peter G. Noordzij, Ian R. Thomson, Olaf Schouten, Jan Klein, Ewout W. Steyerberg, Eric Boersma, Cardiology, Public Health, Anesthesiology, and Surgery
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Adult ,Male ,medicine.medical_specialty ,Infections ,Risk Assessment ,Perioperative Care ,Postoperative Complications ,Epidemiology ,Humans ,Medicine ,Sex Distribution ,Aged ,Netherlands ,Retrospective Studies ,business.industry ,Retrospective cohort study ,General Medicine ,Odds ratio ,Perioperative ,Middle Aged ,medicine.disease ,humanities ,Confidence interval ,Cardiac surgery ,Surgery ,Databases as Topic ,Cardiovascular Diseases ,Surgical Procedures, Operative ,Heart failure ,Emergency medicine ,Female ,Emergencies ,business ,Risk assessment - Abstract
PURPOSE: The Lee risk index was developed to predict major cardiac complications in noncardiac surgery. We retrospectively evaluated its ability to predict cardiovascular death in the large cohort of patients who recently underwent noncardiac surgery in our institution. METHODS: The administrative database of the Erasmus MC, Rotterdam, The Netherlands, contains information on 108 593 noncardiac surgical procedures performed from 1991 to 2000. The Lee index assigns 1 point to each of the following characteristics: high-risk surgery, ischemic heart disease, heart failure, cerebrovascular disease, renal insufficiency, and diabetes mellitus. We retrospectively used available information in our database to adapt the Lee index calculated the adapted index for each procedure, and analyzed its relation to cardiovascular death. RESULTS: A total of 1877 patients (1.7%) died perioperatively, including 543 (0.5%) classified as cardiovascular death. The cardiovascular death rates were 0.3% (255/75 352) for Lee Class 1, 0.7% (196/28 892) for Class 2, 1.7% (57/3380) for Class 3, and 3.6% (35/969) for Class 4. The corresponding odds ratios were 1 (reference), 2.0, 5.1, and 11.0, with no overlap for the 95% confidence interval of each class. The C statistic for the prediction of cardiovascular mortality using the Lee index was 0.63. If age and more detailed information regarding the type of surgery was retrospectively added, the C statistic in this exploratory analysis improved to 0.85. CONCLUSION: The adapted Lee index was predictive of cardiovascular mortality in our administrative database, but its simple classification of surgical procedures as high-risk versus not high-risk seems suboptimal. Nevertheless, if the goal is to compare outcomes across hospitals or regions using administrative data, the use of the adapted Lee index, as augmented by age and more detailed classification of type of surgery, is a promising option worthy of prospective testing.
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- 2005
95. Improvement of stress LVEF rather than rest LVEF after coronary revascularisation in patients with ischaemic cardiomyopathy and viable myocardium
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Elena Biagini, Arend F.L. Schinkel, R.T. van Domburg, Vittoria Rizzello, J. R. T. C. Roelandt, Abdou Elhendy, M. Bountioukos, Eleni C. Vourvouri, Boudewijn J. Krenning, Jeroen J. Bax, Antonella Lombardo, Don Poldermans, and Cardiology
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Male ,medicine.medical_specialty ,Cardiotonic Agents ,medicine.medical_treatment ,Ischemia ,Cardiomyopathy ,Myocardial Ischemia ,Radionuclide ventriculography ,Blood Pressure ,Cardiovascular Medicine ,Revascularization ,Ventricular Dysfunction, Left ,Heart Rate ,Internal medicine ,Dobutamine ,medicine ,Myocardial Revascularization ,Humans ,cardiovascular diseases ,Prospective Studies ,Prospective cohort study ,Infusions, Intravenous ,Ejection fraction ,business.industry ,Heart ,Stroke Volume ,Canadian Cardiovascular Society ,Middle Aged ,medicine.disease ,humanities ,Cardiology ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business ,therapeutics ,medicine.drug ,circulatory and respiratory physiology ,Echocardiography, Stress - Abstract
OBJECTIVE: To evaluate prospectively the response of left ventricular ejection fraction (LVEF) to high dose dobutamine infusion in patients showing substantial viability, with and without improved resting LVEF after revascularisation. METHODS: Before and 9-12 months after revascularisation, 50 patients with ischaemic cardiomyopathy (LVEF 32 (8)%) and substantial myocardial viability (> or = 4 viable segments) underwent radionuclide ventriculography and dobutamine stress echocardiography. Patients were divided into group 1, patients with, and group 2, patients without significant improvement in resting LVEF (> or = 5% by radionuclide ventriculography) after revascularisation. The response of LVEF during dobutamine stress echocardiography was compared in these two groups. RESULTS: Groups 1 and 2 were comparable in baseline characteristics, resting LVEF, and number of viable segments (mean (SD) 7 (4) v 6 (2), not significant). After revascularisation, the LVEF response during dobutamine stress echocardiography improved significantly in both groups (group 1, 34 (10)% to 56 (8)%; group 2, 32 (10)% to 46 (11)%; both p < 0.001). Interestingly, although resting LVEF did not improve in group 2, peak stress LVEF after revascularisation did (p < 0.001). Group 1 patients had, however, a greater increase in peak stress LVEF (group 1, 22 (10)%; group 2, 13 (9)%; p < 0.01). New York Heart Association and Canadian Cardiovascular Society classes decreased in both groups. CONCLUSIONS: Although patients with viable myocardium did not always have improved rest LVEF after revascularisation, peak stress LVEF improved. Assessment of improvement of resting function may not be the ideal end point to evaluate successful revascularisation.
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- 2005
96. Long-term prognostic value of ejection fraction changes during dobutamine-atropine stress echocardiography
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Don Poldermans, Elena Biagini, Jeroen J. Bax, Boudewijn J. Krenning, Chiara Pedone, Vittoria Rizzello, Eleni C. Vourvouri, Ron T. van Domburg, Arend F.L. Schinkel, and Cardiology
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Atropine ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Ischemia ,Coronary Artery Disease ,Revascularization ,Predictive Value of Tests ,Internal medicine ,medicine ,Stress Echocardiography ,Humans ,Myocardial infarction ,Aged ,Proportional Hazards Models ,Ejection fraction ,Proportional hazards model ,business.industry ,Hazard ratio ,Reproducibility of Results ,Stroke Volume ,General Medicine ,Middle Aged ,Prognosis ,medicine.disease ,Death, Sudden, Cardiac ,Multivariate Analysis ,cardiovascular system ,Cardiology ,Female ,Dobutamine ,Cardiology and Cardiovascular Medicine ,business ,Anti-Arrhythmia Agents ,Echocardiography, Stress ,Follow-Up Studies ,medicine.drug - Abstract
Objective: Dobutamine stress echocardiography (DSE), using subjective wall motion scoring, provides incremental prognostic information over clinical data. The aim of the study was to test the additional prognostic value of left ventriclar ejection fraction (LVEF) changes during DSE at different stages. Methods: The study population comprised 106 consecutive patients (mean age 60 ± 11 years, 73% men) with suspected or known coronary artery disease referred for DSE. Stress-induced ischemia was defined as new or worsening wall motion abnormalities. LVEF was measured at rest, peak stress and recovery. Follow-up was successful in 104 (98%) patients. Four patients who underwent revascularization within 60 days were excluded from the analysis. End-points during follow-up were cardiac death, non-fatal myocardial infarction and late revascularization. Results: During a mean follow-up of 5.3 ± 2.1 years, 26% of patients died: 13% due to cardiac death, 6% patients experienced non-fatal myocardial infarction and 38% underwent late revascularization. Rest-to-peak LVEF increase was lower in patients who experienced cardiac death or non-fatal myocardial infarction (4.9 ± 8.6 compared with 9.2 ± 7.5, P = 0.04) and any cardiac events (6.0 ± 8.5 compared with 10.5 ± 6.7, P = 0.004). An inverse correlation was found between left ventricular ejection increase and the number of ischemic segments (P < 0.0001). A multivariable Cox proportional hazard model demonstrated that, in addition to clinical data and new wall motion abnormalities, lower LVEF increase had an incremental prognostic value in predicting hard cardiac events (hazard ratio 1.1, 95% confidence interval 1.0-1.2). Conclusion: Failure of LVEF to significantly increase during DSE, denoting more extensive ischemia, identifies a higher-risk subgroup for late cardiac events.
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- 2005
97. Pulsed-wave tissue Doppler quantification of systolic and diastolic function of viable and nonviable myocardium in patients with ischemic cardiomyopathy
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Manolis Bountioukos, Elena Biagini, Don Poldermans, Jeroen J. Bax, Vittoria Rizzello, Eleni C. Vourvouri, Jos R.T.C. Roelandt, Arend F.L. Schinkel, Boudewijn J. Krenning, and Cardiology
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Adult ,Male ,Aging ,medicine.medical_specialty ,Heart disease ,Ischemia ,Cardiomyopathy ,Diastole ,Coronary Disease ,Doppler imaging ,Ventricular Dysfunction, Left ,Internal medicine ,medicine ,Humans ,In patient ,Aged ,Echocardiography, Doppler, Pulsed ,Ischemic cardiomyopathy ,business.industry ,Myocardium ,Stroke Volume ,Middle Aged ,medicine.disease ,Myocardial Contraction ,Cardiology ,Female ,Dobutamine ,Cardiology and Cardiovascular Medicine ,business ,Echocardiography, Stress ,medicine.drug - Abstract
Background Detection of myocardial viability is crucial for clinical treatment of patients with ischemic cardiomyopathy. Currently, quantitative information for the evaluation of systolic and diastolic function of viable tissue is limited. Our aim was to compare quantitatively systolic and diastolic function in viable and nonviable dysfunctional myocardium in patients with ischemic cardiomyopathy. Methods A total of 93 patients (mean age, 62 ± 10 years) underwent dobutamine stress echocardiography to assess myocardial viability. Pulsed-wave tissue Doppler imaging (TDI) was used to assess systolic ejection velocity (V S ) and early (V E ) and late (V A ) diastolic velocities at rest and at low-dose dobutamine infusion (10 μg/kg per minute) in viable and nonviable dysfunctional regions. Analysis was repeated after dividing study population in patients ≥65 years old (n = 40) and Results Pulsed-wave TDI demonstrated that V S was comparable in dysfunctional viable and nonviable regions at rest (V S , 6.3 ± 1.9 cm/s vs 6.3 ± 2.0 cm/s, respectively, P = .93). However, at low-dose dobutamine challenge, V S was significantly higher in viable regions (8.5 ± 2.7 cm/s vs 7.8 ± 2.4 cm/s, P = .002). Viable regions had higher V E at rest compared with nonviable regions (8.4 ± 2.5 cm/s vs 7.5 ± 2.8 cm/s, P = .003). Myocardial velocities were significantly higher in patients ≥65 years old, both in viable and nonviable regions. Conclusions Quantification of myocardial motion by pulsed-wave TDI demonstrates that at low-dose dobutamine stress, systolic velocity is markedly improved in viable myocardium, indicating the presence of contractile reserve in viable regions. A superior early diastolic filling at rest can also differentiate viable from nonviable myocardium.
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- 2004
98. Echocardiographic classification of chronic ischemic mitral regurgitation caused by restricted motion according to tethering pattern
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Alberto Margonato, Michele De Bonis, Ottavio Alfieri, Arend F.L. Schinkel, Michele Oppizzi, Giulio Melisurgo, Lucia Torracca, Eustachio Agricola, Francesco Maisano, Cardiology, Agricola, E, Oppizzi, M, Maisano, F, DE BONIS, Michele, Schinkel, Af, Torracca, L, Margonato, Alberto, Melisurgo, G, and Alfieri, Ottavio
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Male ,medicine.medical_specialty ,Wall motion score index ,Ischemia ,Myocardial Ischemia ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Ventricular remodeling ,Papillary muscle ,Aged ,Chi-Square Distribution ,Ischemic mitral regurgitation ,Ventricular Remodeling ,business.industry ,Tethering ,Mitral Valve Insufficiency ,Reproducibility of Results ,General Medicine ,Anatomy ,Commissure ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Homogeneous ,Echocardiography ,Cardiology ,Mitral Valve ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Although the mechanism of ischemic mitral regurgitation (MR) is understood, the echocardiographic picture of ischemic MR is not homogeneous. Ninety-two consecutive patients with chronic ischemic MR due to restricted motion were divided into two groups according to tethering pattern: the asymmetric group with predominant posterior tethering of both leaflets (54 patients) and the symmetric one with predominant apical tethering of both leaflets (38 patients). The mitral deformation indexes, LV global (volume, function and sphericity) and local (papillary muscle displacements and regional wall motion score index) remodeling were evaluated. All indexes of global LV remodeling were significantly higher in the symmetric than asymmetric group (all p
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- 2004
99. Myocardial wall thickness predicts recovery of contractile function after primary coronary intervention for acute myocardial infarction
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Tjebbe W. Galema, Willem B. Vletter, Folkert J. ten Cate, Arend F.L. Schinkel, Elena Biagini, Jos R.T.C. Roelandt, and Cardiology
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Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Contrast Media ,Revascularization ,Ventricular Function, Left ,Internal medicine ,Angioplasty ,medicine ,Humans ,Prospective Studies ,cardiovascular diseases ,Myocardial infarction ,Angioplasty, Balloon, Coronary ,Aged ,Ejection fraction ,business.industry ,Myocardium ,Percutaneous coronary intervention ,Recovery of Function ,Middle Aged ,medicine.disease ,Myocardial Contraction ,Treatment Outcome ,Echocardiography ,Circulatory system ,Conventional PCI ,Cardiology ,Female ,business ,Cardiology and Cardiovascular Medicine ,Perfusion - Abstract
ObjectivesWe sought to determine whether end-diastolic wall thickness (EDWT) can predict recovery of regional left ventricular contractile function after percutaneous coronary intervention (PCI).BackgroundRegional contractile function does not recover in all patients after PCI for acute myocardial infarction (AMI). Prediction of functional recovery after AMI may help in clinical decision making.MethodsForty consecutive patients with AMI were studied with left ventricular contrast echocardiography for accurate wall thickness and function measurement and myocardial perfusion immediately after and two months following PCI.ResultsOut of 640 segments, 175 (27%) dysfunctional segments in the infarct territory were analyzed for EDWT, wall function, and perfusion. One hundred and three (59%) dysfunctional segments presented with an EDWT
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- 2004
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100. Extensive left ventricular remodeling does not allow viable myocardium to improve in left ventricular ejection fraction after revascularization and is associated with worse long-term prognosis
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Jeroen J. Bax, Eric Boersma, Ernst E. van der Wall, Abdou Elhendy, Vittoria Rizzello, Arend F.L. Schinkel, Alexander P.W.M. Maat, Jos R.T.C. Roelandt, Don Poldermans, Cardiology, Cardiothoracic Surgery, and Surgery
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Male ,medicine.medical_specialty ,Cell Survival ,medicine.medical_treatment ,Myocardial Ischemia ,Comorbidity ,Revascularization ,Ventricular Dysfunction, Left ,Physiology (medical) ,Internal medicine ,Myocardial Revascularization ,Humans ,Medicine ,cardiovascular diseases ,Ventricular remodeling ,Aged ,Ultrasonography ,Tomography, Emission-Computed, Single-Photon ,Hibernating myocardium ,Ischemic cardiomyopathy ,Ejection fraction ,Ventricular Remodeling ,business.industry ,Myocardium ,Mitral Valve Insufficiency ,Heart ,Stroke Volume ,Stroke volume ,Middle Aged ,Prognosis ,medicine.disease ,Treatment Outcome ,medicine.anatomical_structure ,Cardiovascular Diseases ,Ventricle ,Heart failure ,cardiovascular system ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background— Extensive left ventricular (LV) remodeling may not allow functional recovery after revascularization, despite the presence of viable myocardium. Methods and Results— Seventy-nine consecutive patients with ischemic cardiomyopathy (left ventricle ejection fraction [LVEF] 29±7%) underwent surgical revascularization. Before revascularization, viability was assessed by metabolic imaging with F18-fluorodeoxyglucose and SPECT. LV volumes and LVEF were assessed by resting echocardiography. LVEF was re-assessed by echocardiography 8 to 12 months after revascularization. Three-year clinical follow-up (events: cardiac death, infarction, and hospitalization for heart failure) was also obtained. Forty-nine patients had substantial viability; 5 died before re-assessment of LVEF. Of the remaining 44 patients, 24 improved ≥5% in LVEF after revascularization, whereas 20 did not improve in LVEF. LV end-systolic volume was the only parameter that was significantly different between the groups (109±46 mL for the improvers versus 141±31 mL for the nonimprovers; P Conclusion— Extensive LV remodeling prohibits improvement in LVEF after revascularization and affects long-term prognosis negatively, despite the presence of viability.
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- 2004
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