656 results on '"Felix Zijlstra"'
Search Results
102. Culprit Lesion Detection in Patients Presenting With Non-ST Elevation Acute Coronary Syndrome and Multivessel Disease
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Maria Tovar, Roberto Diletti, Karen Witberg, Nicolas M. Van Mieghem, Kaneshka Masdjedi, Joost Daemen, Jurgen Ligthart, Jeroen Wilschut, Paul Cummins, Wijnand K den Dekker, Paola Scarparo, Felix Zijlstra, Matthew M Balbi, Cardiology, and Public Health
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Acute coronary syndrome ,medicine.medical_specialty ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Coronary Angiography ,Culprit ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,Medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,Angina, Unstable ,Acute Coronary Syndrome ,medicine.diagnostic_test ,business.industry ,Unstable angina ,ST elevation ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Treatment Outcome ,Angiography ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Background/purpose Identification of the culprit lesion in patients with non-ST elevation acute coronary syndrome (NSTE-ACS) allows appropriate coronary revascularization but may be unclear in patients with multivessel coronary disease (MVD). Therefore, we investigated the rate of culprit lesion identification during coronary angiography in NSTE-ACS and multivessel disease. Methods/materials Consecutive patients presenting with NSTE-ACS and MVD, between January 2012 and December 2016 were evaluated. Coronary angiograms, intravascular imaging , and ECGs were analyzed for culprit lesion identification. Long-term clinical outcomes in terms of major adverse cardiac events (MACE) and mortality were reported in patients with or without culprit identification. Results A total of 1107 patients with NSTE-ACS and MVD were included in the analysis, 310 (28.0%) with unstable angina and 797 (72.0%) with non-ST elevation myocardial infarction. The culprit lesion was angiographically identified in 952 (86.0%) patients, while no clear culprit lesion was found in 155 (14.0%) patients. ECG analysis allowed to predict the location of the culprit vessel with low sensitivity (range 28.4%–36.7%) and high specificity (range 90.6%–96.5%). Higher lesion complexity was associated with inability to identify the culprit. Intravascular imaging was applied in 55 patients and helped to identify the culprit lesion in 53 patients (96.4%). There was no difference in all-cause mortality (21.4% vs. 25.8%, p = 0.24) and MACE (39.2% vs. 47.6%, p = 0.07) between the cohorts with or without culprit lesion identification by angiography. Conclusions The culprit lesion appeared unclear by coronary angiography in >10% of patients with NSTE-ACS and MVD. Complementary invasive imaging substantially enhanced the diagnostic accuracy of culprit lesion detection.
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- 2020
103. Efficacy and safety of direct oral anticoagulants in patients undergoing elective electrical cardioversion: A real-world patient population
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Rohit E Bhagwandien, Jaleesa Gros-Bisdom, Koen C. van der Meer, Mattie J. Lenzen, John de Heide, André de Wit, Amira Assaf, Sing-Chien Yap, Felix Zijlstra, Tamas Szili-Torok, Sip Wijchers, and Cardiology
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Male ,Vitamin K ,medicine.drug_class ,Population ,Electric Countershock ,Administration, Oral ,030204 cardiovascular system & hematology ,law.invention ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,Atrial Fibrillation ,medicine ,Humans ,In patient ,030212 general & internal medicine ,education ,Stroke ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Anticoagulants ,Atrial fibrillation ,Vitamin K antagonist ,Middle Aged ,medicine.disease ,Electrical cardioversion ,Anesthesia ,Female ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - Abstract
Background: Direct oral anticoagulants (DOACs) have emerged as the preferred choice of oral anticoagulation in patients with atrial fibrillation. Randomized trials have demonstrated the efficacy and safety of DOAC in patients undergoing electrical cardioversion (ECV); however, there is limited real-world data. Objective: To evaluate the outcome of patients undergoing an elective ECV for atrial tachyarrhythmia in a tertiary referral center who were treated with DOAC or vitamin K antagonist (VKA) without routine trans esophageal echocardiography (TEE). Methods: This was a retrospective single-center cohort study of consecutive patients undergoing an elective ECV for atrial tachyarrhythmia from January 2013 to February 2020. The primary endpoints were thromboembolism (composite of stroke, transient ischemic attack or systemic embolism) and major bleeding events within 60 days. Results: A total of 1431 ECV procedures were performed in 920 patients. One-third of the procedures were performed under DOAC (N = 488, 34%) and the remainder of the procedures was performed under VKA (N = 943, 66%). There were no differences between groups with regard to demographic variables (mean age 62.4 ± 11.7, 72% men) and mean CHA2DS2-VASc score (2.3 ± 1.6); however, the VKA group had a higher proportion of patients with co-morbidity. Thromboembolism occurred in 0.41% in the DOAC group versus 0.64% in the VKA group (P = 0.72). Major bleeding events occurred in 0.41% in the DOAC group versus 0.11% in the VKA group (P = 0.27). Conclusion: In a real-world population, the rates of thromboembolism and major bleeding events were low after elective ECV in patients using DOAC or VKA, even without routine TEE.
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- 2020
104. Predictors for Clinical Outcome of Untreated Stent Edge Dissections as Detected by Optical Coherence Tomography
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Lisanne Visseren, Jurgen Ligthart, Peter de Jaegere, Isabella Kardys, Laurens J.C. van Zandvoort, Jeroen Wilschut, Miguel E. Lemmert, Kaneshka Masdjedi, Roberto Diletti, Karen Witberg, Nicolas M. Van Mieghem, Mariusz Tomaniak, Felix Zijlstra, Maria Natalia Tovar Forero, Joost Daemen, and Cardiology
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Male ,medicine.medical_specialty ,Databases, Factual ,medicine.medical_treatment ,Coronary Artery Disease ,Coronary artery disease ,Percutaneous Coronary Intervention ,Optical coherence tomography ,Predictive Value of Tests ,Risk Factors ,medicine ,Humans ,Myocardial infarction ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Stent ,medicine.disease ,Coronary Vessels ,Treatment Outcome ,Female ,Stents ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Tomography, Optical Coherence - Published
- 2020
105. Aortic root thrombus after left ventricular assist device implantation and aortic valve replacement
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Felix Zijlstra, Jos A. Bekkers, Alina A. Constantinescu, Jesse F. Veenis, Olivier C. Manintveld, Yunus C. Yalcin, Ad J.J.C. Bogers, Kadir Caliskan, Stefan Roest, Jasper J. Brugts, Cardiology, and Cardiothoracic Surgery
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medicine.medical_specialty ,medicine.medical_treatment ,Aortic root ,Left ventricular assist device ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Aortic valve replacement ,Aortic root thrombosis ,Internal medicine ,medicine ,Diseases of the circulatory (Cardiovascular) system ,Humans ,030212 general & internal medicine ,Thrombus ,Heart Failure ,medicine.diagnostic_test ,business.industry ,Thrombosis ,medicine.disease ,equipment and supplies ,Treatment Outcome ,Ventricular assist device ,Heart failure ,Concomitant ,RC666-701 ,Aortic Valve ,Angiography ,Cardiology ,cardiovascular system ,Heart-Assist Devices ,Cardiology and Cardiovascular Medicine ,business - Abstract
Data on the risk of aortic root thrombosis in patients with aortic valve replacement (AVR) and left ventricular assist device (LVAD) surgery are scarce. Two out of nine patients receiving AVR concomitant with LVAD surgery and two out of two patients receiving AVR on LVAD support, at our centre, developed an aortic root thrombus, all diagnosed with computed tomography (CT) angiography. These results demonstrate that patients with concomitant AVR and LVAD surgery, or AVR on LVAD support, have an increased risk of aortic root thrombosis. Therefore, early anti‐thrombotic therapy and vigilant diagnostic follow‐up, using CT scans, are warranted to prevent thromboembolic events.
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- 2020
106. Endovascular procedures cause transient endothelial injury but do not disrupt mature neointima in Drug Eluting Stents
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Heleen M.M. van Beusekom, Ilona Krabbendam-Peters, Richard W. B. van Duin, Anouchska Autar, Aladdin Taha, Felix Zijlstra, Dirk J. Duncker, Cardiology, Neurology, and Hematology
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Neointima ,Drug ,medicine.medical_specialty ,Endothelium ,Swine ,medicine.medical_treatment ,media_common.quotation_subject ,lcsh:Medicine ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Internal medicine ,medicine ,Animals ,cardiovascular diseases ,lcsh:Science ,Ultrasonography, Interventional ,Evans Blue ,media_common ,Multidisciplinary ,business.industry ,lcsh:R ,Stent ,Coronary arterial wall ,Drug-Eluting Stents ,equipment and supplies ,Coronary Vessels ,Cardiovascular biology ,Endothelial stem cell ,medicine.anatomical_structure ,chemistry ,Cardiology ,lcsh:Q ,business ,Interventional cardiology ,030217 neurology & neurosurgery ,Intravascular imaging ,Tomography, Optical Coherence - Abstract
Extensive application of coronary intravascular procedures has led to the increased need of understanding the injury inflicted to the coronary arterial wall. We aimed to investigate acute and prolonged coronary endothelial injury as a result of guidewire use, repeated intravascular imaging and stenting. These interventions were performed in swine (N = 37) and injury was assessed per coronary segment (n = 81) using an Evans Blue dye-exclusion-test. Scanning electron microscopy and light microscopy were then used to visualize the extent and nature of acute (
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- 2020
107. Impact of Valvulo-Arterial Impedance on Long-Term Quality of Life and Exercise Performance After Transcatheter Aortic Valve Replacement
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Rutger-Jan Nuis, Jeannette A Goudzwaard, Mattie J. Lenzen, Joost Daemen, Marjo J A G de Ronde-Tillmans, Peter de Jaegere, Joris F W Ooms, Nicolas M. Van Mieghem, Maarten van Wiechen, Felix Zijlstra, Marcel L. Geleijnse, Herbert Kroon, Francesco U.S. Mattace-Raso, Cardiology, and Internal Medicine
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Aortic valve ,Male ,medicine.medical_specialty ,Time Factors ,Transcatheter aortic ,medicine.medical_treatment ,Severity of Illness Index ,Ventricular Function, Left ,Arterial impedance ,Transcatheter Aortic Valve Replacement ,Quality of life ,Valve replacement ,Risk Factors ,Internal medicine ,Surveys and Questionnaires ,Exercise performance ,Activities of Daily Living ,medicine ,Humans ,Prospective Studies ,Aged ,Aged, 80 and over ,Exercise Tolerance ,business.industry ,Hemodynamics ,Aortic Valve Stenosis ,Recovery of Function ,medicine.disease ,Stenosis ,medicine.anatomical_structure ,Blood pressure ,Treatment Outcome ,Echocardiography ,Aortic Valve ,Cardiology ,Quality of Life ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: In aortic stenosis, valvulo-arterial impedance (Zva) estimates the overall left ventricular afterload (valve and arterial component). We investigated the association of Zva (≥5 versus −1 m −2 ) on quality of life (QOL) and exercise performance (EP) ≥1 year after transcatheter aortic valve replacement (TAVR). Methods: The study population consists of 250 TAVR patients in whom baseline Zva and follow-up QOL was prospectively assessed using EuroQOL-5-dimensions instruments; EP was assessed in 192 patients who survived ≥1 year after TAVR using questionnaires related to daily activities. In 124 patients, Zva at 1-year was also available and was used to study the change in Zva (baseline to 1 year) on QOL/EP. Results: Elevated baseline Zva was present in 125 patients (50%). At a median of 28 (IQR, 17–40) months, patients with elevated baseline Zva were more limited in mobility (88% versus 71%; P =0.004), self-care (40% versus 25%; P =0.019), and independent daily activities (taking a shower: 53% versus 38%, P =0.030; walking 100 meter: 76% versus 54%, P =0.001; and walking stairs: 74% versus 54%, P =0.011). By multivariable analysis, elevated Zva predicted unfavorable QOL (lower EuroQOL-5-dimensions-Utility Index, odds ratio, 1.98; CI, 1.15–3.41) and unfavorable EP (any limitation in ≥3 daily activities, odds ratio, 2.55; CI, 1.41–4.62). After TAVR, the proportion of patients with elevated Zva fell from 50% to 21% and remained 21% at 1 year and was found to be associated with more limitations in mobility, self-care, and daily activities compared with patients with Zva −1 m −2 . Conclusions: Elevated Zva was seen in half of patients and predicted unfavorable long-term QOL and EP. At 1 year after TAVR, the prevalence of elevated Zva was 21% but remained associated with poor QOL/EP.
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- 2020
108. Validation of a three-dimensional quantitative coronary angiography-based software to calculate fractional flow reserve: the FAST study
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Jurgen Ligthart, Peter de Jaegere, Matthew M Balbi, Jeroen Wilschut, Roberto Diletti, Frank J. H. Gijsen, Laurens J.C. van Zandvoort, Marcel C. M. Rutten, Miguel E. Lemmert, Nicolas M. Van Mieghem, Felix Zijlstra, Kaneshka Masdjedi, Joost Daemen, and Cardiology
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Coronary angiography ,medicine.medical_specialty ,Aortic root ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Coronary Angiography ,Severity of Illness Index ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Humans ,In patient ,030212 general & internal medicine ,Myocardial infarction ,Retrospective Studies ,business.industry ,Coronary Stenosis ,Retrospective cohort study ,medicine.disease ,Fractional Flow Reserve, Myocardial ,Predictive value of tests ,Cardiology ,Cardiology and Cardiovascular Medicine ,business ,Software ,Cohort study - Abstract
Aims: The aim of this study was to validate novel software to calculate vessel fractional flow reserve (vFFR) based on 3D-QCA and to assess inter-observer variability in patients who underwent routine preprocedural FFR assessment for intermediate coronary artery stenosis. Methods and results: In vitro validation was performed in an experimental model. Clinical validation was performed in an observational, retrospective, single-centre cohort study. A total of 100 patients presenting with stable angina or non-ST-segment elevation myocardial infarction and an indication to perform FFR between January 2016 and October 2016 were included. vFFR was calculated based on the aortic root pressure along with two angiographic projections and validated against pressure wire-derived FFR. Mean FFR and vFFR were 0.82±0.08 and 0.84±0.07, respectively. A good linear correlation was found between FFR and vFFR (r=0.89; p
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- 2020
109. P1825 Myocardial bridging and coronary artery disease in hypertrophic cardiomyopathy: a matched case control study
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Ricardo P.J. Budde, Isabella Kardys, A F L Schinkel, Yuzo Yamasaki, Alexander Hirsch, N. Van Der Velde, Roy Huurman, Tjebbe W. Galema, Michelle Michels, and Felix Zijlstra
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medicine.medical_specialty ,Myocardial bridging ,business.industry ,Case-control study ,Hypertrophic cardiomyopathy ,General Medicine ,medicine.disease ,Coronary artery disease ,Internal medicine ,Cardiology ,Medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Cardiology and Cardiovascular Medicine ,business - Abstract
Funding Acknowledgements None. Introduction The etiology of chest pain in hypertrophic cardiomyopathy (HCM) is diverse and includes coronary artery disease (CAD) as well as HCM-specific causes. Myocardial bridging (MB) has been associated with HCM, chest pain, and accelerated atherosclerosis. To investigate differences in the presence of MB and CAD, we compared HCM patients with age-, gender- and CAD pre-test probability (PTP)-matched outpatients presenting with chest pain. Methods We studied 84 HCM patients who underwent cardiac computed tomography and compared these with 168 matched controls (age 54 ± 11 years, 70% men, PTP 12% [5%–32%]). MB, calcium score, plaque morphology and presence and extent of CAD were assessed for each patient. Linear mixed models were used to assess differences between cases and controls. Results Differences between HCM patients and controls are described in the table. In summary, MB was more often seen in HCM patients (50% vs. 25%, p 1 segment affected (14% vs. 2%, p 0.05 for both). Conclusion MB was twice as prevalent in the HCM group. However, in a matched analysis, the prevalence and extent of CAD was equal among patients with and without HCM. These finding illustrate that despite a higher prevalence of MB, the prevalence of CAD is similar between groups, also demonstrating satisfactory performance of pre-test risk prediction in HCM patients. Assessment of CAD by CT HCM group(n = 84) Control group (n = 168) p-value Agatston score 9 [0-225] 4 [0-82] 0.22 No. of pts with score* 0.07 0-399 31 (89%) 149 (91%) >400 8 (11%) 15 (9%) Obstructive CAD 15 (18%) 32 (19%) 0.82 No. of pts with MB 42 (50%) 42 (25%) 1 segment with MB 12 (14%) 4 (2%)
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- 2020
110. Percutaneous complete revascularization strategies using sirolimus-eluting biodegradable polymer-coated stents in patients presenting with acute coronary syndrome and multivessel disease: Rationale and design of the BIOVASC trial
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Giovanni Esposito, Paul Cummins, Rutger J. van Bommel, Eric Boersma, Matthias Vrolix, BioVasc Trial Investigators, Johan Bennett, Mattie J. Lenzen, Manel Sabaté, Joost Daemen, Roberto Diletti, Nicolas M. Van Mieghem, Felix Zijlstra, Wijnand K den Dekker, Cardiology, den Dekker, W. K., Van Mieghem, N. M., Bennett, J., Sabate, M., Esposito, G., van Bommel, R. J., Daemen, J., Vrolix, M., Cummins, P. A., Lenzen, M. J., Boersma, E., Zijlstra, F., and Diletti, R.
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medicine.medical_specialty ,Acute coronary syndrome ,Percutaneous ,Polymers ,medicine.medical_treatment ,Equivalence Trials as Topic ,030204 cardiovascular system & hematology ,Revascularization ,Prosthesis Design ,BioVasc Trial Investigators ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Absorbable Implant ,Absorbable Implants ,medicine ,Clinical endpoint ,Drug-Eluting Stent ,Humans ,Multicenter Studies as Topic ,Sirolimu ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,Acute Coronary Syndrome ,Prospective cohort study ,Polymer ,Randomized Controlled Trials as Topic ,Sirolimus ,business.industry ,Percutaneous coronary intervention ,Drug-Eluting Stents ,medicine.disease ,Surgery ,Prospective Studie ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Human - Abstract
BACKGROUND: Complete revascularization in patients with an acute coronary syndrome and multivessel disease is superior compared to culprit-only treatment. However, it is unknown whether direct complete or staged complete revascularization should be pursued. METHODS: The BIOVASC study is an investigator-initiated, prospective, multicenter, randomized, 2-arm, international, open-label, noninferiority trial. We will randomize 1,525 patients 1:1 to immediate complete revascularization (experimental arm) or culprit-only plus staged complete revascularization (control arm). Patients will be enrolled in approximately 30 sites in Belgium, Italy, the Netherlands, and Spain. The primary end point is a composite of all-cause mortality, nonfatal myocardial infarction, any unplanned ischemia-driven revascularization (excluding staged procedures in the control arm at the predetermined time), and cerebrovascular events (MACCE) at 1 year post index procedure. CONCLUSIONS: The BIOVASC study aims to further refine the treatment algorithm for acute coronary syndrome patients with multivessel disease in terms of optimal timing for complete revascularization (Clinicaltrials.gov NCT03621501). ispartof: AMERICAN HEART JOURNAL vol:227 pages:111-117 ispartof: location:United States status: published
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- 2020
111. Incidence and predictors of outcomes after a first definite coronary stent thrombosis
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Lorenz Räber, Jonas Dominik Häner, Maria Natalia Tovar Forero, Felix Zijlstra, Laurens J.C. van Zandvoort, Isabella Kardys, Joost Daemen, Stephan Windecker, Nicolas M. Van Mieghem, Kaneshka Masdjedi, Thomas Zanchin, and Cardiology
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Kaplan-Meier Estimate ,030204 cardiovascular system & hematology ,Prosthesis Design ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,Coronary stent ,medicine ,Humans ,030212 general & internal medicine ,Myocardial infarction ,610 Medicine & health ,Aged ,Aged, 80 and over ,First episode ,business.industry ,Incidence ,Cardiogenic shock ,Percutaneous coronary intervention ,Drug-Eluting Stents ,Thrombosis ,Middle Aged ,medicine.disease ,Treatment Outcome ,Cardiology ,Female ,Stents ,Myocardial infarction diagnosis ,Cardiology and Cardiovascular Medicine ,business ,TIMI ,Mace - Abstract
Aims: Stent thrombosis (ST) is a rare but potentially fatal complication of coronary artery stenting. Little is known about the optimal treatment strategy at the time of an ST event. We aimed to identify the incidence and predictors of adverse cardiac events after treatment of a definite ST. Methods and results: A total of 695 patients with definite ST were included between 1996 and 2017 in two academic medical centres. The primary endpoint was MACE, the composite of cardiac death, myocardial infarction (MI) and target vessel revascularisation (TVR). Mean age was 62.8±12.1 years and 76.3% were male. ST occurred at a median of 22 days (IQR 3-551 days); 50.8% were early and 49.2% were late/very late ST. At 60-month follow-up, the MACE rate was 43.7%, cardiac death 19.5%, MI 17.9%, TVR 24.8%, and repeat definite ST was 12.1% (10.5% in target vessel). Independent predictors of MACE were cardiogenic shock (HR 2.54, 95% CI: 1.75-3.70; p
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- 2020
112. Resolute zotarolimus-eluting stent in ST-elevation myocardial infarction (resolute-STEMI): A prespecified prospective register from the DAPT-STEMI trial
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Warner Rintje Postma, Elvin Kedhi, Hans Wedel, Ronak Delewi, Enrico Fabris, Clemens Von Birgelen C, Stéphane Cook, Felix Zijlstra, Martin van der Ent, R. S. Hermanides, Giuseppe De Luca, Paweł Buszman, Cardiology, Postma, W., Fabris, E., Van der Ent, M., Hermanides, R., Buszman, P., Von Birgelen C, C., Cook, S., Wedel, H., De Luca, G., Delewi, R., Zijlstra, F., Kedhi, E., Health Technology & Services Research, ACS - Atherosclerosis & ischemic syndromes, ACS - Microcirculation, and ACS - Pulmonary hypertension & thrombosis
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Male ,Time Factors ,medicine.medical_treatment ,UT-Hybrid-D ,030204 cardiovascular system & hematology ,antiplatelet therapy ,Coronary artery disease ,0302 clinical medicine ,Recurrence ,Risk Factors ,Cause of Death ,030212 general & internal medicine ,Myocardial infarction ,Prospective Studies ,Registries ,Stroke ,Drug-eluting stents (DES) ,stent thrombosis ,Dual Anti-Platelet Therapy ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,surgical procedures, operative ,Treatment Outcome ,Drug-eluting stent ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,TIMI ,coronary artery disease ,medicine.medical_specialty ,acute myocardial infarction ,Revascularization ,Prosthesis Design ,Risk Assessment ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,drug-eluting stent ,Humans ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Aged ,Sirolimus ,business.industry ,Coronary Thrombosis ,Stent ,Percutaneous coronary intervention ,Cardiovascular Agents ,medicine.disease ,n/a OA procedure ,ST Elevation Myocardial Infarction ,business - Abstract
To evaluate the safety and efficacy outcomes after primary percutaneous coronary intervention (pPCI) with second‐generation Resolute™ zotarolimus‐eluting stent (R‐ ZES) in patients enrolled in the DAPT‐STEMI Trial (NCT01459627).Background: R‐ ZES is one of the most used drug eluting stents worldwide. To date, the safety and efficacy data of this stent in setting of STEMI is limited.Methods: The Resolute‐STEMI is a prespecified prospective register that reports the safety and efficacy of R‐ZES in setting of ST‐Elevation Myocardial Infarction (STEMI) at 6 months for the following endpoints: a composite endpoint of all‐cause mortality, any myocardial infarction (MI), any (unscheduled) revascularization, stroke and TIMI major bleeding, as well as target lesion failure and stent thrombosis (ST).Results: From a total of 1,100 STEMI patients enrolled in the trial, 998 received a R‐ZES. At 6 months the PE occurred in 42 (4.2%) patients. All‐cause death, MI, revascularization, stroke and TIMI major bleeding was respectively 8 (0.8%), 9 (0.8%), 34 (3.4%), 2 (0.2%), and 4 (0.4%). The rate of target lesion revascularizations involving the culprit lesion was 1.1%. Target lesion failure was 1.5%. The rate of definite ST was 0.5%. The rate of both definite or probable ST was 0.7%.Conclusions: The present analysis is the largest to date reporting short‐ term and mid‐term clinical outcomes with the R‐ZES stent in setting of STEMI. At 30 days and 6‐months R‐ZES has an outstanding safety and efficacy even in this high‐ risk category of patients.
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- 2020
113. Long-term outcome in patients treated with first- versus second-generation drug-eluting stents for the treatment of unprotected left main coronary artery stenosis
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Laurens J.C. van Zandvoort, Rutger J. van Bommel, Jeroen Wilschut, Felix Zijlstra, Roberto Diletti, Nicolas M. Van Mieghem, Peter de Jaegere, Miguel M. Lemmert, Maria Natalia Tovar Forero, Joost Daemen, Kaneshka Masdjedi, and Cardiology
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Male ,Acute coronary syndrome ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Population ,Left Main Coronary Artery Stenosis ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,Risk Assessment ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Risk Factors ,Internal medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,Acute Coronary Syndrome ,education ,Aged ,Retrospective Studies ,education.field_of_study ,business.industry ,Hazard ratio ,Coronary Stenosis ,Percutaneous coronary intervention ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Stenosis ,Treatment Outcome ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
Objective and background The study aim is to provide long-term clinical outcome after percutaneous coronary intervention (PCI) for unprotected left main coronary arteries (ULMCA) stenosis with the first-generation (1st -gen) drug-eluting stents (DES) in comparison to 2nd -gen DES, since this is largely unknown. Methods Between May 2002, and December 2014, a consecutive series of 656 all-comer patients underwent a PCI for ULMCA stenosis at the Erasmus Medical Center. A total of 235 patients were treated with 1st -gen DES, while a total of 421 patients were treated with 2nd -gen DES. Results Overall, the population consisted of 73% males and 58% presented with an acute coronary syndrome. Median follow-up time was 1,361 days (range from 0 to 5,031). At 5 years, the cumulative incidence of major adverse clinical events (the primary composite endpoint of all-cause death, any myocardial infarction or target lesion revascularization; MACE) did not differ between 1st - and 2nd -gen DES (36.8 vs. 38.6%, respectively, Log Rank p = .79, adjusted hazard ratio [HR] = 1.28 [95% confidence interval (CI) 0.94-1.74]). No difference was found in the individual endpoints of all-cause mortality (29.5 vs. 29% respectively, p = .88, adjusted HR = 1.19 [95% CI, 0.84-1.68]), target vessel myocardial infarction (5.0 vs. 8.4%, p = 0.17, adjusted HR = 1.75 [95% CI, 0.78-3.96]) and target lesion revascularization (8.1 vs. 9.8%, p = .94, adjusted HR = 1.16 [95% CI, 0.59-2.29]) between the 1st - and 2nd -gen DES cohorts, respectively. Conclusions In this large cohort of consecutive patients treated for ULMCA stenosis, no significant differences were found in the safety and efficacy of 1st versus 2nd -gen DES at 5 years follow-up.
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- 2020
114. ST-segment elevation myocardial infarction: Historical perspective and new horizons
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Menko-Jan de Boer, Harry Suryapranata, Felix Zijlstra, and Cardiology
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History ,medicine.medical_specialty ,New horizons ,Thrombus aspiration ,Review Article ,030204 cardiovascular system & hematology ,03 medical and health sciences ,0302 clinical medicine ,Pharmacotherapy ,St elevation myocardial infarction ,Internal medicine ,medicine ,ST segment ,030212 general & internal medicine ,Myocardial infarction ,Primary angioplasty ,medicine.diagnostic_test ,business.industry ,Cardiogenic shock ,medicine.disease ,ST elevation myocardial infarction ,Future perspectives ,Angiography ,cardiovascular system ,OHCA ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
After a brief history of the emergence of modern therapy for acute ST-elevation myocardial infarction, we discuss the issues that dominate ongoing studies and are the focus of intense debates. The role of angiography, pharmacotherapy, thrombus aspiration, management of multi-vessel disease, mechanical complications and cardiogenic shock and the quest for myocardial salvage are discussed.
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- 2020
115. 434 Feasibility and reproducibility of parameters of cardiac function and dimension by transthoracic echocardiography in obesity patients
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J E Van Velzen, J A Akkerhuis, Sanne M. Snelder, J O Younge, B.M. van Dalen, and Felix Zijlstra
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Cardiac function curve ,Reproducibility ,medicine.medical_specialty ,Dimension (vector space) ,business.industry ,Internal medicine ,medicine ,Cardiology ,Echocardiography transthoracic ,Radiology, Nuclear Medicine and imaging ,General Medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Cardiac disease occurs more frequently in obesity patients. Imaging by transthoracic echocardiography (TTE) can be limited due to poor acoustic windows. An increase of the number of obesity patients who need to undergo TTE is expected. Purpose The aim of this study was to evaluate the feasibility, test-retest variability and inter- and intra-observer variability of parameters of cardiac function and dimension by TTE in obesity patients as compared to non-obese controls. Methods 100 obesity patients (BMI≥35kg/m2) and 50 non-obese controls (BMI Results Image quality was excellent in 11% of the obesity patients as compared to 60% of the non-obese controls. Nevertheless, apart from global longitudinal strain (GLS), all investigated parameters of cardiac function and dimension were available in both groups (Table). GLS was obtainable in 93% of obesity patients versus 98% of non-obese controls (p = 0.20). For the vast majority of parameters inter- and intra-observer variability was comparable between obesity patients and non-obese controls. There were no significant differences between obesity patients and non-obese controls regarding the test-retest variability (Table). Conclusion Although non-obese controls on average had better echocardiographic image quality than obesity patients, feasibility of assessment of a broad variety of parameters of cardiac function and dimension was excellent in obesity patients and there were no important differences regarding variability of measurements. Echocardiographic parameters Available obesity patients (n = 100) Available non-obese controls (n-50) Intra-observer variability obese (n = 50) Intra-observer variability non-obese (n = 25) Inter-observer variability obese (n = 50) Interobeserver variability non-obese (n = 25) Test-retest variability obese (n = 37) Test-rest variability non-obese(n= 17) IVSd 100% 100% 10.6 ± 6.3 6.8 ± 6.3* 10.8 ± 6.9 8.5 ± 4.5 11.1 ± 9.0 10.1 ± 6.4 LVEDD 100% 100% 5.4 ± 4.7 6.7 ± 5.3 5.5 ± 3.7 5.5 ± 3.3 6.7 ± 5.1 6.1 ± 5.2 PWd 100% 100% 12.4 ± 9.0 13.7 ± 9.6 11.5 ± 9.7 9.7 ± 6.7 12.4 ± 9.4 9.8 ± 6.4 E/A ratio 100% 100% 5.9 ± 9.6 2.1 ± 3.0 4.9 ± 5.0 3.8 ± 3.4 8.9 ± 5.7 8.5 ± 5.7 LA-volume index 100% 100% 12.3 ± 7.8 8.7 ± 6.5 11.0 ± 6.9 9.2 ± 4.8 13.6 ± 11.8 10.1 ± 6.3 GLS 93% 98% 6.8 ± 5.2 5.6 ± 4.6 6.4 ± 4.9 5.6 ± 4.6 8.8 ± 7.6 6.9 ± 5.3 Selection of various echocardiographic parameters. *p
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- 2020
116. Invasive left ventricle pressure-volume analysis: overview and practical clinical implications
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Corstiaan A. den Uil, Nicolas M. Van Mieghem, Joost Daemen, Mattie J. Lenzen, Felix Mahfoud, Johannes Jacobus Schreuder, Marcelo B Bastos, Jiri Maly, Daniel Burkhoff, Felix Zijlstra, Koen Ameloot, and Cardiology
- Subjects
Pressure-volume loop ,medicine.medical_specialty ,Cardiac Volume ,Heart Ventricles ,Management of heart failure ,Diastole ,Myocardial energetics ,030204 cardiovascular system & hematology ,Ventricular Function, Left ,Clinical Reviews ,03 medical and health sciences ,0302 clinical medicine ,Basic Science for the clinician ,Internal medicine ,Ventricular Pressure ,medicine ,Humans ,Systole ,Heart Failure ,business.industry ,valvular heart disease ,Heart ,Stroke Volume ,medicine.disease ,Myocardial Contraction ,Cardiac support ,medicine.anatomical_structure ,Ventricle ,Heart failure ,cardiovascular system ,Cardiology ,Pressure volume ,Left ventricular haemodynamics ,Cardiology and Cardiovascular Medicine ,business ,030217 neurology & neurosurgery - Abstract
Ventricular pressure–volume (PV) analysis is the reference method for the study of cardiac mechanics. Advances in calibration algorithms and measuring techniques brought new perspectives for its application in different research and clinical settings. Simultaneous PV measurement in the heart chambers offers unique insights into mechanical cardiac efficiency. Beat to beat invasive PV monitoring can be instrumental in the understanding and management of heart failure, valvular heart disease, and mechanical cardiac support. This review focuses on intra cardiac left ventricular PV analysis principles, interpretation of signals, and potential clinical applications.
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- 2020
117. Serial invasive imaging follow-up of the first clinical experience with the Magmaris magnesium bioresorbable scaffold
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Nicolas M. Van Mieghem, Peter P de Jaegere, Joost Daemen, Laurens J.C. van Zandvoort, Maria Natalia Tovar Forero, Roberto Diletti, K. Masdjedi, Felix Zijlstra, J. Wilschut, and Cardiology
- Subjects
Male ,Target lesion ,Time Factors ,scaffold bioresorption ,medicine.medical_treatment ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Prosthesis Design ,Revascularization ,Original Studies ,scaffold recoil ,Coronary Restenosis ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,Optical coherence tomography ,Restenosis ,Predictive Value of Tests ,Absorbable Implants ,medicine ,Humans ,Magnesium ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,scaffold collapse ,Sirolimus ,bioresorbable scaffolds ,medicine.diagnostic_test ,business.industry ,Cardiovascular Agents ,General Medicine ,Middle Aged ,medicine.disease ,Coronary Vessels ,Treatment Outcome ,medicine.anatomical_structure ,constrictive remodeling ,Angiography ,Female ,Magmaris sirolimus‐eluting bioresorbable scaffold ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Tomography, Optical Coherence ,Intravascular imaging ,Bioresorbable scaffold ,Artery - Abstract
Objectives To assess the performance of the commercially available Magmaris sirolimus‐eluting bioresorbable scaffold (BRS) with invasive imaging at different time points. Background Coronary BRS with a magnesium backbone have been recently studied as an alternative to polymeric scaffolds, providing enhanced vessel support and a faster resorption rate. We aimed to assess the performance of the commercially available Magmaris sirolimus‐eluting BRS at different time points. Methods A prospective, single‐center, nonrandomized study was performed at the Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands. Six patients with stable de novo coronary artery lesions underwent single‐vessel revascularization with the Magmaris sirolimus‐eluting BRS. Invasive follow‐up including intravascular imaging using optical coherence tomography (OCT) was performed at different time points. Results At a median of 8 months (range 4–12 months) target lesion failure occurred in one patient. Angiography revealed a late lumen loss of 0.59 ± 0.39 mm, a percentage diameter stenosis of 39.65 ± 15.81%, and a binary restenosis rate of 33.3%. OCT showed a significant reduction in both minimal lumen area (MLA) and scaffold area at the site of the MLA by 43.44 ± 28.62 and 38.20 ± 25.74%, respectively. A fast and heterogeneous scaffold degradation process was found with a significant reduction of patent struts at 4–5 months. Conclusions Our findings show that the latest iteration of magnesium BRS suffers from premature dismantling, resulting in a higher than expected decrease in MLA.
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- 2020
118. An update on the use of anticoagulant therapy in ST-segment elevation myocardial infarction
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M E Lemmert, Joost Daemen, N. M. D. A. Van Mieghem, M. Van Gameren, Roberto Diletti, Felix Zijlstra, P. de Jaegere, J. Wilschut, and Cardiology
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medicine.medical_specialty ,Hemorrhage ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Percutaneous Coronary Intervention ,0302 clinical medicine ,St elevation myocardial infarction ,Internal medicine ,medicine ,Humans ,ST segment ,Bivalirudin ,Thrombolytic Therapy ,Pharmacology (medical) ,In patient ,cardiovascular diseases ,030212 general & internal medicine ,Myocardial infarction ,Pharmacology ,Heparin ,business.industry ,Elevation ,Anticoagulants ,Thrombosis ,General Medicine ,Hirudins ,medicine.disease ,Peptide Fragments ,Recombinant Proteins ,Treatment Outcome ,Anticoagulant therapy ,Cardiology ,ST Elevation Myocardial Infarction ,business ,medicine.drug - Abstract
Together with antiplatelet therapy, anticoagulants are vital to improve outcomes in patients presenting with ST-segment elevation myocardial infarction. Challenges lie in finding the optimal balance between the risk of bleeding and preventing thrombotic complications such as reinfarction or stent thrombosis. During the last decade, bivalirudin was introduced as a valid alternative to heparin for patients undergoing primary percutaneous coronary intervention. Several trials have been conducted to identify the agent with the best antithrombotic results at the lowest bleeding complication rate. In a rapidly evolving field with changes in vascular access, available P2YThis paper mainly focuses on the evidence above and gives brief discussion to the recent literature on anticoagulation in fibrinolytic therapy and advances in antiplatelet therapy.To date, no robust evidence is available challenging unfractionated heparin as the primary choice for anticoagulation in patients presenting with ST-segment elevation myocardial infarction. Further research should include efforts to refine anticoagulation strategies on an individual patient level. For patients undergoing primary percutaneous coronary intervention, bivalirudin could be used as an alternative to unfractionated heparin, while enoxaparin or fondaparinux is an alternative agent for patients treated with fibrinolytic therapy.
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- 2018
119. Authors' Reply
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Sanne M. Snelder, Felix Zijlstra, and Bas M. van Dalen
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Echocardiography ,Feasibility Studies ,Humans ,Reproducibility of Results ,Radiology, Nuclear Medicine and imaging ,Obesity ,Cardiology and Cardiovascular Medicine - Published
- 2019
120. A case-vignette based assessment of patient's perspective on coronary revascularization strategies, the OPINION study
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Jeroen Wilschut, Elisabeth M. W. J. Utens, Miguel E. Lemmert, Peter de Jaegere, Ron T. van Domburg, Roberto Diletti, Nicolas M. Van Mieghem, Felix Zijlstra, Joost Daemen, Arie-Pieter Kappetein, Kaneshka Masdjedi, Developmental Psychopathology (RICDE, FMG), Cardiology, Child and Adolescent Psychiatry / Psychology, Cardiothoracic Surgery, and Child Psychiatry
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Adult ,Male ,Risk ,medicine.medical_specialty ,medicine.medical_treatment ,Hemorrhage ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Anxiety ,Revascularization ,Coronary artery disease ,03 medical and health sciences ,Type D Personality ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Internal medicine ,Surveys and Questionnaires ,medicine ,Outpatient clinic ,Humans ,030212 general & internal medicine ,cardiovascular diseases ,Coronary Artery Bypass ,Stroke ,Aged ,Aged, 80 and over ,business.industry ,Depression ,Type D personality ,Percutaneous coronary intervention ,Patient Preference ,Middle Aged ,medicine.disease ,Treatment Outcome ,surgical procedures, operative ,Conventional PCI ,Emergency medicine ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background and aims: Significant left main (LM) stem disease is potentially life-threatening and mandates revascularization. This study aimed to assess how patients rate the importance of particular features of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), how this determines their preference for a particular treatment strategy, and whether particular personality characteristics influence this preference. Methods and results: In total, 1145 patients who visited the outpatient clinic of the Erasmus Medical Center for stable coronary artery disease were asked to complete a case vignette-questionnaire on a hypothetical significant LM stenosis amenable to PCI or CABG. To assess the individual's personality disposition and general distress level, each patient had to complete a set of 3 standardized, validated questionnaires with satisfactory psychometric properties. Overall 89% of patients preferred PCI to CABG. PCI was the preferred strategy despite a higher risk for repeat revascularization and need for more medication. Remarkably, the fact that a risk for repeat revascularization is more common in the PCI group is less important for the patients who opt for PCI. Risk for stroke and bleeding were the most important arguments to opt for PCI over CABG. Type D personality, depression, and anxiety were all associated with a relatively higher preference for CABG as revascularization strategy. Conclusion: Overall, when given the choice patients seem to have a clear preference for PCI over CABG and consider stroke and bleeding important procedure-related complications. Patients with Type D personality, depression, or anxiety favor CABG.
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- 2018
121. Minimally interrupted novel oral anticoagulant versus uninterrupted vitamin K antagonist during atrial fibrillation ablation
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Mattie J. Lenzen, Tamas Szili-Torok, Sing-Chien Yap, Christiaan J. Vroegh, John de Heide, Felix Zijlstra, Sip Wijchers, Rohit E Bhagwandien, and Cardiology
- Subjects
Vitamin-K antagonist ,Male ,medicine.medical_specialty ,Vitamin K ,medicine.drug_class ,medicine.medical_treatment ,Novel oral anticoagulation ,Catheter ablation ,Hemorrhage ,030204 cardiovascular system & hematology ,Article ,Dabigatran ,Cohort Studies ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Postoperative Complications ,Edoxaban ,Physiology (medical) ,Thromboembolism ,medicine ,Humans ,030212 general & internal medicine ,Aged ,Netherlands ,Retrospective Studies ,Rivaroxaban ,business.industry ,Bleeding ,Anticoagulants ,Atrial fibrillation ,Vitamin K antagonist ,Middle Aged ,medicine.disease ,Thrombosis ,Surgery ,Stroke ,Outcome and Process Assessment, Health Care ,chemistry ,Catheter Ablation ,Apixaban ,Female ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug ,Factor Xa Inhibitors - Abstract
Purpose: The safety and efficacy of a minimally interrupted novel oral anticoagulant (NOAC) strategy at the time of atrial fibrillation (AF) ablation is uncertain. The purpose of this study was to compare rates of bleeding and thromboembolic events between minimally interrupted NOAC and uninterrupted vitamin K antagonist (VKA) in patients undergoing AF ablation. Methods: This was a retrospective single-center cohort study of consecutive patients who underwent AF catheter ablation between January 2013 and April 2017. Endpoints included major bleeding, clinically relevant non-major bleeding and systemic thromboembolic event from the time of ablation through 30 days. Bleeding events were defined by the Bleeding Academic Research Consortium (BARC) and International Society on Thrombosis and Haemostasis (ISTH). Results: A total of 637 patients were included in the analysis, 520 patients used uninterrupted VKA and 117 patients minimally interrupted NOAC (dabigatran: n = 68; apixaban: n = 30; rivaroxaban, n = 14; edoxaban, n = 5). The rate of clinically relevant non-major bleeding was lower in the NOAC group in comparison to the VKA group (BARC type 2: 2.6% versus 8.3%, P = 0.03; ISTH: 0% versus 3.8%, P = 0.03). Rates of major bleeding were similar between groups (BARC type 3 to 5: 3.4% versus 4.2%, P = NS; ISTH: 6.0% versus 8.7%, P = NS; for NOAC and VKA groups, respectively). Rates of systemic embolism were 0% with minimally interrupted NOAC, and 0.6% with uninterrupted VKA (P = NS). Conclusions: In patients undergoing AF ablation, anticoagulation with minimally interrupted NOAC was associated with fewer clinically relevant non-major bleeding events in comparison with uninterrupted VKA without compromising thromboembolic safety.
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- 2018
122. Right ventricular systolic function in patients undergoing transcatheter aortic valve implantation: A systematic review and meta-analysis
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Ernest Spitzer, Jan G.P. Tijssen, Marcel L. Geleijnse, Nicolas M. Van Mieghem, Peter P de Jaegere, Felix Zijlstra, Ben Ren, Cardiology, ACS - Amsterdam Cardiovascular Sciences, and ACS - Heart failure & arrhythmias
- Subjects
medicine.medical_specialty ,Transcatheter aortic ,Ventricular Dysfunction, Right ,Systolic function ,030204 cardiovascular system & hematology ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Primary outcome ,Aortic valve replacement ,Internal medicine ,Humans ,Medicine ,In patient ,030212 general & internal medicine ,business.industry ,Aortic Valve Stenosis ,medicine.disease ,Confidence interval ,Survival Rate ,Relative risk ,Meta-analysis ,Ventricular Function, Right ,Cardiology ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background Right ventricular (RV) systolic dysfunction is associated with worse survival in patients undergoing surgical aortic valve replacement (SAVR), yet it is not included in traditional risk scores of transcatheter aortic valve implantation (TAVI) candidates. We aimed to evaluate the prognostic value of RV systolic function on clinical outcomes in patients undergoing TAVI at one year follow-up; and, echocardiographic changes of RV systolic function up to 12 months after TAVI and compared with SAVR when possible. Methods and results This systematic review and meta-analysis is registered in PROSPERO (CRD42017065761). Studies investigating RV systolic function with echocardiography in TAVI cohorts were identified from Medline, Embase and Cochrane databases. We used random-effects models to assess differences in primary outcomes. Twenty-one studies were identified, where RV systolic function and clinical outcomes were assessed in eight (4016 patients) and RV systolic function changes were evaluated in 14 (1709 patients). For the primary outcome of all-cause death at one year, RV systolic dysfunction was associated with a significant 78% relative risk increase (risk ratio[95% confidence interval (CI)]) = 1.78[1.37, 2.31], P 2 = 64%, P Conclusions RV systolic dysfunction was associated with a significant increase in all-cause mortality at one year after TAVI. RV systolic function was unchanged after TAVI up to 12 months, whereas deteriorated significantly after SAVR.
- Published
- 2018
123. Timing of coronary angiography in survivors of out-of-hospital cardiac arrest without obvious extracardiac causes
- Author
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Nicolas M. Van Mieghem, Felix Zijlstra, Laurens J.C. van Zandvoort, Eric Boersma, Joost Daemen, Lucia S.D. Jewbali, Corstiaan A. den Uil, Isabelle Irene Staudacher, Cardiology, and Intensive Care
- Subjects
Male ,Coronary angiography ,medicine.medical_specialty ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Emergency Nursing ,Coronary Angiography ,Time-to-Treatment ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Clinical endpoint ,Humans ,Myocardial infarction ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Cardiac catheterization ,business.industry ,Cardiogenic shock ,Hazard ratio ,Percutaneous coronary intervention ,030208 emergency & critical care medicine ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Cardiopulmonary Resuscitation ,Case-Control Studies ,Emergency Medicine ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Out-of-Hospital Cardiac Arrest - Abstract
Indications and timing of coronary angiography in patients surviving out-of-hospital cardiac arrest (OHCA) remain controversial. The aim of the present study was to assess the impact of an early invasive strategy in patients presenting with an OHCA and no obvious extracardiac cause.Between January 1st 2009 and December 31st 2014 a total 612 survivors of OHCA were admitted to our institution. Patients with no obvious extracardiac cause (n=507) were stratified into two groups: patients that underwent cardiac catheterization ≤3h (early invasive; n=291) and patients not undergoing cardiac catheterization within 3h (non-early invasive; n=216). Primary endpoint was all-cause mortality at 30days.All-cause 30-day mortality was 28.9% in the early invasive group vs. 36.6% in the non-early invasive group (log-rank p=0.071). After propensity analyses, an early invasive strategy, as compared to a non-early strategy, was not associated with 30-day mortality (adjusted Hazard ratio [HR] 0.69; 95% CI 0.35-1.37; p=0.029). Cox multivariable regression analyses demonstrated age (HR 1.04/year; 95% CI 1.02-1.07) and presentation with cardiogenic shock (HR 5.1; 95% CI 1.8-14.0) to be the sole independent predictors of 30-day mortality.In this retrospective study, early coronary angiography (3h), as compared to a non-early invasive strategy, was not associated with reduced 30-day mortality in patients hospitalized after OHCA, irrespective of the presence of ST segment elevation or cardiogenic shock at presentation.
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- 2018
124. Development and validation of a risk model for long-term mortality after percutaneous coronary intervention: The IDEA-BIO Study
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Isabella Kardys, Joost Daemen, Mattie J. Lenzen, Robert-Jan van Geuns, Marco Valgimigli, K. Martijn Akkerhuis, Nick van Boven, Eric Boersma, Victor A. Umans, Ron T. van Domburg, Felix Zijlstra, and Cardiology
- Subjects
Male ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Health Status ,Clinical Decision-Making ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Comorbidity ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Tertiary referral hospital ,Coronary Angiography ,Prosthesis Design ,Risk Assessment ,Decision Support Techniques ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Interquartile range ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Absorbable Implants ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Myocardial infarction ,610 Medicine & health ,Aged ,Aged, 80 and over ,Proportional hazards model ,business.industry ,Age Factors ,Percutaneous coronary intervention ,Reproducibility of Results ,Drug-Eluting Stents ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Clinical trial ,Treatment Outcome ,Conventional PCI ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Item does not contain fulltext OBJECTIVES: We aimed to develop a model to predict long-term mortality after percutaneous coronary intervention (PCI), to aid in selecting patients with sufficient life expectancy to benefit from bioabsorbable scaffolds. BACKGROUND: Clinical trials are currently designed to demonstrate superiority of bioabsorbable scaffolds over metal devices up to 5 years after implantation. METHODS: From 2000 to 2011, 19.532 consecutive patients underwent PCI in a tertiary referral hospital. Patients were randomly (2:1) divided into a training (N = 13,090) and validation (N = 6,442) set. Cox regression was used to identify determinants of long-term mortality in the training set and used to develop a risk model. Model performance was studied in the training and validation dataset. RESULTS: Median age was 63 years (IQR 54-72) and 72% were men. Median follow-up was 3.6 years (interquartile range [IQR] 2.4-6.8). The ratio elective vs. non-elective PCIs was 42/58. During 88,620 patient-years of follow-up, 3,156 deaths occurred, implying an incidence rate of 35.6 per 1,000. Estimated 5-year mortality was 12.9%.Regression analysis revealed age, body mass index, diabetes mellitus, renal insufficiency, prior myocardial infarction, PCI indication, lesion location, number of diseased vessels and cardiogenic shock at presentation as determinants of mortality. The long-term risk model showed good discrimination in the training and validation sets (c-indices 0.76 and 0.74), whereas calibration was appropriate. CONCLUSIONS: A simple risk model, containing 9 baseline clinical and angiographic variables effectively predicts long-term mortality after PCI and may possibly be used to select suitable patients for bioabsorbable scaffolds.
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- 2018
125. Prevalence and consequences of noncardiac incidental findings on preprocedural imaging in the workup for transcatheter aortic valve implantation, renal sympathetic denervation, or MitraClip implantation
- Author
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Miguel E. Lemmert, Eric Boersma, Lida Feyz, Ricardo P.J. Budde, Joost Daemen, Nicolas M. Van Mieghem, Karan R.R. Ramdat Misier, Nahid El Faquir, Laurens J.C. van Zandvoort, Peter de Jaegere, Felix Zijlstra, Cardiology, and Radiology & Nuclear Medicine
- Subjects
Male ,medicine.medical_specialty ,Transcatheter aortic ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Text mining ,Cardiovascular procedures ,Internal medicine ,medicine ,Prevalence ,Humans ,Clinical significance ,In patient ,Cardiac Surgical Procedures ,Sympathectomy ,Aged ,Aged, 80 and over ,Incidental Findings ,medicine.diagnostic_test ,business.industry ,MitraClip ,Mitral Valve Insufficiency ,Magnetic resonance imaging ,Surgical Instruments ,Magnetic Resonance Imaging ,Renal sympathetic denervation ,Asymptomatic Diseases ,Cardiology ,Female ,Cardiology and Cardiovascular Medicine ,business ,Tomography, X-Ray Computed - Abstract
Background: Dedicated data on the prevalence of incidental findings (IF) stratified according to overall clinical relevance and their subsequent correlation to outcome are lacking. The aim of the present study was to describe the prevalence and consequences of noncardiac IF on computed tomography or magnetic resonance imaging in the workup for interventional cardiovascular procedures. Methods: A total of 916 patients underwent preprocedural computed tomography or magnetic resonance imaging in the workup for transcatheter aortic valve implantation (TAVI), renal sympathetic denervation (RDN), or MitraClip implantation. Results: IF were found in 395 of 916 patients (43.1%), with an average of 1.8 IF per patient. Classifying the IF resulted in 155 patients with minor, 171 patients with moderate, and 69 patients with major IF. The intended procedure was delayed or canceled in only 15 of 916 (1.6%) of the patients because of the presence of potential malignant IF. In patients that did undergo the intended procedure (n = 774), the presence of a moderate or major IF (23.8%) did not impact 1-year mortality compared to no or minor IF (adjusted HR 0.90, 95% CI 0.56-1.44, P value =.65). These findings were consistent among patients referred for TAVI, RDN, or MitraClip. Conclusions: IF are frequent in patients referred for cardiovascular procedures. IF did not result in a delay or cancellation of the intended procedure in the vast majority of cases, irrespective of their clinical relevance. The presence of a major or moderate IF did not significantly impact 1-year mortality.
- Published
- 2018
126. Repeatability Assessment of Intravascular Polarimetry in Patients
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Gijs van Soest, Antonios Karanasos, Norman Lippok, Jian Ren, Evelyn Regar, Jouke Dijkstra, Robert-Jan van Geuns, Pallavi Doradla, Milen Shishkov, Seemantini K. Nadkarni, Martin Villiger, Kenichiro Otsuka, Roberto Diletti, Brett E. Bouma, Joost Daemen, Felix Zijlstra, University of Zurich, Villiger, Martin, and Cardiology
- Subjects
vessels ,Materials science ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Polarimetry ,610 Medicine & health ,heart ,030204 cardiovascular system & hematology ,Electronic mail ,Article ,03 medical and health sciences ,optical imaging ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Optical coherence tomography ,medicine ,Medical imaging ,1706 Computer Science Applications ,Humans ,030212 general & internal medicine ,Electrical and Electronic Engineering ,3614 Radiological and Ultrasound Technology ,polarimetry ,validation ,Reproducibility ,Birefringence ,optical coherence tomography ,Radiological and Ultrasound Technology ,medicine.diagnostic_test ,2208 Electrical and Electronic Engineering ,Endovascular Procedures ,Reproducibility of Results ,Depolarization ,Endoscopy ,Middle Aged ,Coronary Vessels ,Plaque, Atherosclerotic ,Computer Science Applications ,10020 Clinic for Cardiac Surgery ,evaluation and performance ,Coronary arteries ,1712 Software ,medicine.anatomical_structure ,Female ,Software ,Biomedical engineering - Abstract
Item does not contain fulltext Intravascular polarimetry with polarization sensitive optical frequency domain imaging (PS-OFDI) measures polarization properties of the vessel wall and offers characterization of coronary atherosclerotic lesions beyond the cross-sectional image of arterial microstructure available to conventional OFDI. A previous study of intravascular polarimetry in cadaveric human coronary arteries found that tissue birefringence and depolarization provide valuable insight into key features of atherosclerotic plaques. In addition to various tissue components, catheter and sample motion can also influence the polarization of near infrared light as used by PS-OFDI. This paper aimed to evaluate the robustness and repeatability of imaging tissue birefringence and depolarization in a clinical setting. 30 patients scheduled for percutaneous coronary intervention at the Erasmus Medical Center underwent repeated PS-OFDI pullback imaging, using commercial imaging catheters in combination with a custom-built PS-OFDI console. We identified 274 matching cross sections among the repeat pullbacks to evaluate the reproducibility of the conventional backscatter intensity, the birefringence, and the depolarization signals at each spatial location across the vessel wall. Bland-Altman analysis revealed best agreement for the birefringence measurements, followed by backscatter intensity, and depolarization, when limiting the analysis to areas of meaningful birefringence. Pearson correlation analysis confirmed highest correlation for birefringence (0.86), preceding backscatter intensity (0.83), and depolarization (0.78). Our results demonstrate that intravascular polarimetry generates robust maps of tissue birefringence and depolarization in a clinical setting. This outcome motivates the use of intravascular polarimetry for future clinical studies that investigate polarization properties of arterial atherosclerosis.
- Published
- 2018
127. TCT-173 FFR-Guided PCI Optimization Directed by High-Definition Intravascular Ultrasound: Baseline Findings From the FFR REACT Trial
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Tara Neleman, Jurgen Ligthart, Maria Natalia Tovar Forero, Laurens J.C. van Zandvoort, Joost Daemen, Peter de Jaegere, Roberto Diletti, Felix Zijlstra, Karen Witberg, Nicolas M. Van Mieghem, Mattie J. Lenzen, Kaneshka Masdjedi, Jeroen Wilschut, Wijnand K den Dekker, and Eric Boersma
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Internal medicine ,Conventional PCI ,Intravascular ultrasound ,medicine ,Cardiology ,High definition ,Cardiology and Cardiovascular Medicine ,Baseline (configuration management) ,business - Published
- 2021
128. TCT-301 Diagnostic Accuracy of Angiography-Based Vessel Fractional Flow Reserve (vFFR) Virtual Stenting
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Isabella Kardys, Laurens J.C. van Zandvoort, Kaneshka Masdjedi, Ibrahim Kucuk, Tara Neleman, Jeroen Wilschut, Janusz Kochman, Mariusz Tomaniak, Joost Daemen, Felix Zijlstra, Wijnand K den Dekker, Roberto Diletti, and Nicolas M. Van Mieghem
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medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Angiography ,medicine ,Diagnostic accuracy ,Fractional flow reserve ,Radiology ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
129. TCT-24 Long-Term Efficacy of Pre-Hospital Crushed Versus Integral Prasugrel in Patients Presenting With ST-Segment Elevation Myocardial Infarction: One-Year Results From the Randomized COMPARE CRUSH Trial
- Author
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Nancy W.P.L. van der Waarden, Ronak Delewi, Roberto Diletti, Nicolas M. Van Mieghem, Pieter C. Smits, Miguel E. Lemmert, Georgios J. Vlachojannis, Ria van Vliet, Jeroen Wilschut, Dimitrios Alexopoulos, Felix Zijlstra, Gilles Montalescot, Rutger Jan Nuis, Rosanne F. Vogel, Valeria Paradies, and Dominick J. Angiolillo
- Subjects
medicine.medical_specialty ,Prasugrel ,business.industry ,Elevation ,medicine.disease ,Term (time) ,Internal medicine ,Cardiology ,Medicine ,ST segment ,In patient ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2021
130. TCT-272 Influence of Activated Clotting Time on Early Myocardial Reperfusion in Patients With ST-Segment Elevation Myocardial Infarction: Results From the COMPARE CRUSH Trial
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Miguel E. Lemmert, Valeria Paradies, Dominick J. Angiolillo, Dimitrios Alexopoulos, Georgios J. Vlachojannis, Ria van Vliet, Nancy W.P.L. van der Waarden, Felix Zijlstra, Ronak Delewi, Roberto Diletti, Nicolas M. Van Mieghem, Jeroen Wilschut, Rutger Jan Nuis, Gilles Montalescot, Rosanne F. Vogel, and Pieter C. Smits
- Subjects
medicine.medical_specialty ,Myocardial reperfusion ,medicine.diagnostic_test ,business.industry ,Activated clotting time ,medicine.disease ,Internal medicine ,medicine ,Cardiology ,ST segment ,In patient ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
131. Pharmacodynamic Effect of Prehospital Crushed Prasugrel Tablets in Patients With ST-Segment Elevation Myocardial Infarction Planned for Primary Percutaneous Coronary Intervention: A Prespecified Subanalysis of The COMPARE CRUSH Trial
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Ronak Delewi, Dimitri Alexopoulos, Valeria Paradies, Rutger-Jan Nuis, Rosanne F. Vogel, Nancy W.P.L. van der Waarden, Dominick J. Angiolillo, Gilles Montalescot, Mitchell W. Krucoff, Miguel E. Lemmert, Jeroen Wilschut, Georgios J. Vlachojannis, Roberto Diletti, Nicolas M. Van Mieghem, Felix Zijlstra, and Pieter C. Smits
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medicine.medical_specialty ,Prasugrel ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Internal medicine ,Pharmacodynamics ,medicine ,Cardiology ,ST segment ,In patient ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business ,medicine.drug - Published
- 2021
132. FRACTIONAL FLOW RESERVE GUIDED PERCUTANEOUS CORONARY INTERVENTION OPTIMIZATION DIRECTED BY HIGH-DEFINITION INTRAVASCULAR ULTRASOUND VERSUS STANDARD OF CARE: THE FFR REACT TRIAL
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Jurgen Ligthart, Tara Neleman, Mattie J. Lenzen, Jeroen Wilschut, Felix Zijlstra, Peter P.T. de Jaegere, Wijnand K den Dekker, Maria Natalia Tovar Forero, Roberto Diletti, Karen Witberg, Joost Daemen, Nicolas M. Van Mieghem, Laurens J.C. van Zandvoort, Eric Boersma, and Kaneshka Masdjedi
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medicine.medical_specialty ,Standard of care ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Fractional flow reserve ,Internal medicine ,Intravascular ultrasound ,medicine ,Cardiology ,High definition ,Cardiology and Cardiovascular Medicine ,business - Published
- 2021
133. A prospective, randomized, open-label trial of 6-month versus 12-month dual antiplatelet therapy after drug-eluting stent implantation in ST-elevation myocardial infarction: Rationale and design of the 'DAPT-STEMI trial'
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Felix Zijlstra, Martin van der Ent, Mark W. Kennedy, Enrico Fabris, Hans Wedel, Stéphane Cook, Elvin Kedhi, Clemens von Birgelen, Paweł Buszman, Health Technology & Services Research, Cardiology, Kedhi, E., Fabris, E., van der Ent, M., Kennedy, M. W., Buszman, P., von Birgelen, C., Cook, S., Wedel, H., and Zijlstra, F.
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Hirudin ,Ticagrelor ,Adenosine ,Time Factors ,Antithrombin ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,law.invention ,0302 clinical medicine ,Peptide Fragment ,Randomized controlled trial ,law ,Cause of Death ,Drug-Eluting Stent ,Clinical endpoint ,Postoperative Period ,Prospective Studies ,030212 general & internal medicine ,Myocardial infarction ,Stroke ,Aspirin ,Drug-Eluting Stents ,Recombinant Protein ,Hirudins ,Recombinant Proteins ,Europe ,Survival Rate ,Treatment Outcome ,Drug-eluting stent ,Combination ,Cardiology ,Drug Therapy, Combination ,Drug ,Cardiology and Cardiovascular Medicine ,medicine.drug ,medicine.medical_specialty ,animal structures ,Time Factor ,Antithrombins ,Disease-Free Survival ,Follow-Up Studie ,Dose-Response Relationship ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Drug Therapy ,Internal medicine ,Dose-Response Relationship, Drug ,Follow-Up Studies ,Peptide Fragments ,Platelet Aggregation Inhibitors ,Prasugrel Hydrochloride ,Purinergic P2Y Receptor Antagonists ,ST Elevation Myocardial Infarction ,medicine ,cardiovascular diseases ,business.industry ,Platelet Aggregation Inhibitor ,Percutaneous coronary intervention ,Purinergic P2Y Receptor Antagonist ,medicine.disease ,n/a OA procedure ,Discontinuation ,Surgery ,Prospective Studie ,business - Abstract
Background The optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention with second-generation drug eluting stents (DESs) is unclear. Because prolonged DAPT is associated with higher bleeding risk and health care costs, establishing optimal DAPT duration is of paramount importance. No other randomized controlled trials have evaluated the safety of shorter DAPT duration in ST-elevation myocardial infarction (STEMI) patients treated with second-generation DESs and latest P2Y12 platelet receptor inhibitors. Hypothesis Six months of DAPT after Resolute Integrity stent implantation in STEMI patients is not inferior to 12 months of DAPT in clinical outcomes. Study design The Dual Antiplatelet Therapy After Drug-Eluting Stent Implantation In ST-elevation Myocardial Infarction (DAPT-STEMI) trial is a randomized, multicenter, international, open-label trial designed to examine the safety (noninferiority) of 6-month DAPT after Resolute Integrity stent implantation in STEMI patients compared with 12-month DAPT. Event-free patients on DAPT at 6month will be randomized (1:1 fashion) between single (aspirin only) versus DAPT for an additional 6 months and followed until 2 years after primary percutaneous coronary intervention. The primary end point is a patient-oriented composite endpoint of all-cause mortality, any myocardial infarction, any revascularization, stroke, and major bleeding (net adverse clinical events [NACE]) at 18 months after randomization. To achieve a power of 85% for a noninferiority limit of 1.66, a total of 1100 enrolled patients are required. Summary The DAPT-STEMI trial aims to assess in STEMI patients treated with second-generation DESs whether discontinuation of DAPT after 6 months of event-free survival is noninferior to routine 12-month DAPT.
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- 2017
134. Prognostic Value of N-Terminal Pro-B-Type Natriuretic Peptide, Troponin-T, and Growth-Differentiation Factor 15 in Adult Congenital Heart Disease
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Felix Zijlstra, Jolien W. Roos-Hesselink, Maarten Witsenburg, Monique de Waart, Judith A.A.E. Cuypers, Jannet A. Eindhoven, Ron H.N. van Schaik, Vivan J.M. Baggen, Anne-Rose W. Schut, Eric Boersma, Annemien E. van den Bosch, Cardiology, Surgery, Pediatrics, and Clinical Chemistry
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Adult ,Heart Defects, Congenital ,Male ,medicine.medical_specialty ,Growth Differentiation Factor 15 ,Heart disease ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Troponin T ,Physiology (medical) ,Internal medicine ,Natriuretic Peptide, Brain ,Humans ,Medicine ,Prospective Studies ,030212 general & internal medicine ,biology ,business.industry ,Prognosis ,medicine.disease ,Troponin ,Peptide Fragments ,Patient management ,Echocardiography ,biology.protein ,Cardiology ,Biomarker (medicine) ,Female ,N terminal pro b type natriuretic peptide ,GDF15 ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: The number of patients with adult congenital heart disease (ACHD) is rapidly increasing. To optimize patient management, there is a great need to accurately identify high-risk patients. Still, no biomarker has been firmly established as a clinically useful prognostic tool in this group. We studied the association of N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitive troponin-T, and growth-differentiation factor 15 with cardiovascular events in ACHD. Methods: Clinically stable patients with ACHD who routinely visited the outpatient clinic between April 2011 and April 2013 underwent clinical assessment, electrocardiography, echocardiography, and biomarker measurement (NT-proBNP, high-sensitive troponin-T, and growth-differentiation factor 15) at the time of study inclusion. Patients were prospectively followed for the occurrence of cardiovascular events (death, heart failure, hospitalization, arrhythmia, thromboembolic events, and reintervention). Survival curves were derived by the Kaplan-Meier method, and Cox regression was performed to investigate the relation between biomarkers and events with adjustment for multiple clinical and echocardiographic variables. Results: In total, 595 patients were included (median age, 33 years; interquartile range, 25–41 years; 58% male; 90% New York Heart Association class I). Patients were followed during a median of 42 (interquartile range, 37–46) months. Of the 3 evaluated biomarkers, NT-proBNP in the upper quartile (>33.3 pmol/L) was most strongly associated with cardiovascular events (n=165, adjusted hazard ratio, 9.05 [3.24–25.3], P P 14 pmol/L), elevated high-sensitive troponin-T (>14 ng/L), and elevated growth-differentiation factor 15 (>1109 ng/L) identified those patients at highest risk of cardiovascular events (log-rank P Conclusions: NT-proBNP provides prognostic information beyond a conventional risk marker model in patients with ACHD and can reliably exclude the risk of death and heart failure. Elevated levels of NT-proBNP, high-sensitive troponin-T, and growth-differentiation factor 15 identify patients at highest risk of cardiovascular events. These biomarkers therefore may play an important role in the monitoring and management of patients with ACHD.
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- 2017
135. High sensitive TROponin levels In Patients with Chest pain and kidney disease: A multicenter registry - The TROPIC study
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Andrea Mariani, Roberto Diletti, Fiorenzo Gaita, Alberto Palazzuoli, Artur Dziewierz, Marco Di Cuia, Claudio Moretti, Serena Bergerone, Giuseppe Biondi Zoccai, Fabrizio D'Ascenzo, Matthew J. Reed, Marco Pavani, Sebastiano Marra, Nicolas M Mieghem, Carlo Budano, Ron T Van Domburgh, Dariusz Dudek, Tullio Palmerini, Pierluigi Omedè, Alfredo R. Galassi, Flavia Ballocca, David A. Ferenbach, Diego Della Riva, Nicholas L. Mills, Felix Zijlstra, Robert-Jan van Geuns, and Cardiology
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Male ,medicine.medical_specialty ,Chest Pain ,macromolecular substances ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Chest pain ,Chronic kidney disease ,Coronary artery disease ,High sensitive troponin ,Aged ,Biomarkers ,Female ,Follow-Up Studies ,Humans ,Prognosis ,ROC Curve ,Renal Insufficiency, Chronic ,Reproducibility of Results ,Retrospective Studies ,Troponin I ,Troponin T ,Registries ,Cardiology and Cardiovascular Medicine ,Article ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Journal Article ,medicine ,030212 general & internal medicine ,Renal Insufficiency ,Thrombus ,Chronic ,biology ,business.industry ,Area under the curve ,General Medicine ,medicine.disease ,musculoskeletal system ,Troponin ,biology.protein ,Cardiology ,medicine.symptom ,business ,Kidney disease - Abstract
Background: Accuracy of high sensitive troponin (hs-cTn) to detect coronary artery disease (CAD) in patients with renal insufficiency is not established. The aim of this study was to evaluate the prognostic role of hs-cTn T and I in patients with chronic kidney disease (CKD). Methods: All consecutive patients with chest pain, renal insufficiency (eGFR < 60 mL/min/1.73 m2) and high sensitive troponin level were included. The predictive value of baseline and interval troponin (hs-cTnT and hs-cTnI) for the presence of CAD was assessed. Results: One hundred and thirteen patients with troponin I and 534 with troponin T were included, with 95 (84%) and 463 (87%) diagnosis of CAD respectively. There were no differences in clinical, procedural and outcomes between the two assays. For both, baseline hs-cTn values did not differ between patients with/without CAD showing low area under the curve (AUC). For interval levels, hs-cTnI was significantly higher for patients with CAD (0.2 ± 0.8 vs. 8.9 ± 4.6 ng/mL; p = 0.04) and AUC was more accurate for troponin I than hs-cTnT (AUC 0.85 vs. 0.69). Peak level was greater for hs-cTnI in patients with CAD or thrombus (0.4 ± 0.6 vs. 15 ± 20 ng/mL; p = 0.02; AUC 0.87: 0.79–0.93); no differences were found for troponin T assays (0.8 ± 1.5 vs. 2.2 ± 3.6 ng/mL; p = 1.7), with lower AUC (0.73: 0.69–0.77). Peak troponin levels (both T and I) independently predicted all cause death at 30 days. Conclusions: Patients with CKD presenting with altered troponin are at high risk of coronary disease. Peak level of both troponin assays predicts events at 30 days, with troponin I being more accurate than troponin T. (Cardiol J 2017; 24, 2: 139–150)
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- 2017
136. Potentially increased incidence of scaffold thrombosis in patients treated with Absorb BVS who terminated DAPT before 18 months
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Georgios J. Vlachojannis, Cordula Felix, Alexander Ijsselmuiden, Eric Boersma, Wouter Lansink, Roberto Diletti, Yoshinobu Onuma, Jiang M Fam, Peter Smits, Robert J. van Geuns, Felix Zijlstra, Evelyn Regar, University of Zurich, van Geuns, Robert J M, and Cardiology
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Male ,Time Factors ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,030204 cardiovascular system & hematology ,Gastroenterology ,0302 clinical medicine ,Coated Materials, Biocompatible ,Risk Factors ,Absorbable Implants ,030212 general & internal medicine ,Stent thrombosis ,Registries ,Netherlands ,Incidence (epidemiology) ,Incidence ,Middle Aged ,Thrombosis ,Clopidogrel ,Treatment Outcome ,Cohort ,Drug Therapy, Combination ,Female ,Cardiology and Cardiovascular Medicine ,medicine.medical_specialty ,animal structures ,Ticlopidine ,610 Medicine & health ,Prosthesis Design ,2705 Cardiology and Cardiovascular Medicine ,Drug Administration Schedule ,03 medical and health sciences ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,In patient ,Bioresorbable vascular scaffold ,Aged ,Retrospective Studies ,Aspirin ,business.industry ,Coronary Thrombosis ,Cardiovascular Agents ,medicine.disease ,Confidence interval ,Surgery ,10020 Clinic for Cardiac Surgery ,Clinical research ,business ,Platelet Aggregation Inhibitors - Abstract
Item does not contain fulltext AIMS: The aim of this study was to investigate the impact of dual antiplatelet therapy (DAPT) termination on late and very late scaffold thrombosis (ScT) in patients treated with the Absorb bioresorbable vascular scaffold (BVS). METHODS AND RESULTS: Data from the registries of three centres were pooled (808 patients). To investigate the effect of DAPT termination on ScT after a minimum of six months, we selected a subgroup ("DAPT study cohort" with 685 patients) with known DAPT status >6 months and excluded the use of oral anticoagulants and early ScT. In this cohort, definite/probable ScT incidence for the period on DAPT was compared to ScT incidence after DAPT termination. ScT incidence was 0.83 ScT/100 py with 95% confidence interval (CI): 0.34-1.98. After DAPT termination, the incidence was higher (1.77/100 py; 95% CI: 0.66-4.72), compared to the incidence on DAPT (0.26/100 py, 95% CI: 0.04-1.86; p=0.12) and increased within the month after DAPT termination (6.57/100 py, 95% CI: 2.12-20.38; p=0.01). No very late ScT occurred in patients who continued on DAPT for a minimum of 18 months. CONCLUSIONS: The incidence of late and very late definite/probable ScT was acceptable. The incidence was low while on DAPT but potentially higher when DAPT was terminated before 18 months.
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- 2017
137. Safety of optical coherence tomography in daily practice: a comparison with intravascular ultrasound
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Antonios Karanasos, Saskia Wemelsfelder, Evelyn Regar, Peter de Jaegere, Gijs van Soest, Robert-Jan van Geuns, Takayuki Okamura, Nienke S. van Ditzhuijzen, Jiang Ming Fam, Felix Zijlstra, Roberto Diletti, Bu-Chun Zhang, Karen Witberg, Nicolas M. Van Mieghem, Ron T. van Domburg, Marco Valgimigli, Johannes N. van der Sijde, Jurgen Ligthart, University of Zurich, Regar, Evelyn, and Cardiology
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Male ,Cardiac Catheterization ,medicine.medical_treatment ,Vascular damage Radboud Institute for Health Sciences [Radboudumc 16] ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Cohort Studies ,Coronary artery disease ,0302 clinical medicine ,Catheterization procedure ,Intravascular ultrasound ,Prospective Studies ,Registries ,030212 general & internal medicine ,Cardiac catheterization ,medicine.diagnostic_test ,General Medicine ,Middle Aged ,Coronary Vessels ,Female ,Patient Safety ,Radiology ,Safety ,Cardiology and Cardiovascular Medicine ,Tomography, Optical Coherence ,Safety Management ,medicine.medical_specialty ,610 Medicine & health ,Risk Assessment ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,Patient safety ,Percutaneous Coronary Intervention ,Optical coherence tomography ,Predictive Value of Tests ,Preoperative Care ,Medical imaging ,medicine ,Humans ,2741 Radiology, Nuclear Medicine and Imaging ,Radiology, Nuclear Medicine and imaging ,Ultrasonography, Interventional ,Aged ,Analysis of Variance ,business.industry ,Patient Selection ,Percutaneous coronary intervention ,medicine.disease ,10020 Clinic for Cardiac Surgery ,Adverse Events ,business - Abstract
Item does not contain fulltext Aims: Previous studies have reported the safety and feasibility of both time-domain optical coherence tomography (TD-OCT) and Fourier-domain OCT (FD-OCT) in highly selected patients and clinical settings. However, the generalizability of these data is limited, and data in unselected patient populations reflecting a routine cathlab practice are lacking. We compared safety of intracoronary FD-OCT imaging to intravascular ultrasound (IVUS) imaging in a large real-world series of consecutive patients who underwent invasive imaging during coronary catheterization in our centre. Methods and results: This is a prospective, single-centre registry of patients scheduled for coronary angiography or intervention undergoing intracoronary imaging with FD-OCT or IVUS between April 2008 and December 2013. Intra-procedural and major in-hospital adverse events that could be possibly related to invasive imaging were registered routinely by the operator as part of our clinical report and prospectively recorded in our database. These events were retrospectively individually adjudicated by an independent safety committee. Between April 2008 and December 2013, 13 418 diagnostic or interventional coronary catheterization procedures were performed. Of these, 1142 procedures used OCT and 2476 procedures used IVUS. Invasive imaging-related complications were rare, did not differ between the two imaging methods (OCT: n = 7, 0.6%; IVUS: n = 12, 0.5%; P = 0.6), and were self-limiting after retrieval of the imaging catheter or easily treatable in the catheterization laboratory. No major adverse events, prolongation of hospital stay, or permanent patient harm was observed. Conclusion: FD-OCT is safe in an unselected and heterogeneous group of patients with varying clinical settings.
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- 2017
138. Accuracy of an automated transthoracic echocardiographic tool for 3D assessment of left heart chamber volumes
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Ernest Spitzer, Marcel L. Geleijnse, Felix Zijlstra, Nicolas M. Van Mieghem, Osama Ibrahim Ibrahim Soliman, Ben Ren, and Cardiology
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Male ,medicine.medical_specialty ,Heart Ventricles ,Heart chamber ,Echocardiography, Three-Dimensional ,030204 cardiovascular system & hematology ,030218 nuclear medicine & medical imaging ,Ventricular Dysfunction, Left ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Human interaction ,Internal medicine ,Image Processing, Computer-Assisted ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Observer Variation ,Contouring ,Ejection fraction ,Adaptive algorithm ,business.industry ,Philips healthcare ,Reproducibility of Results ,Middle Aged ,medicine.anatomical_structure ,Ventricle ,Cardiology ,Feasibility Studies ,Female ,Cardiology and Cardiovascular Medicine ,business ,Algorithms - Abstract
Aims The feasibility and accuracy of an automated adaptive algorithm (Heart Model) for the quantification of left heart chamber volumes and left ventricular ejection fraction has been reported earlier. An improved version of the algorithm is available, and we aimed to test its accuracy compared with manual 3D echocardiography. Methods and Results Apical 3D transthoracic datasets were obtained in 67 patients. Acquisitions covering ventricles and atria were performed for analysis using the automated software (Heart Model, Philips Healthcare). In addition, acquisitions focused on the left ventricle were acquired for left ventricle manual 3D measurements (QLAB 10 3DQA, Philips Healthcare). Automated results using endocardial contouring settings at 50% showed a strong correlation with manual 3D measurements (r=.84-.97). Left ventricular end-diastolic volumes were underestimated (bias −5.9 mL, LOA ±38.5 mL), with no significant differences in other parameters. Intra-observer variability using the automated algorithm was zero for all parameters given the lack of human interaction. Manual corrections of the automatic algorithm introduced small but significant differences in volumes but not in ejection fraction when compared with automatic results. Manually corrected results of the automatic algorithm were not significantly different from those obtained with manual 3D echocardiography, except for a small underestimation of left atrial volumes (bias −2.1 mL, LOA ±15.2 mL). Conclusions The current improved version of the automated adaptive algorithm is accurate for the assessment of left heart chamber volumes, albeit a small underestimation of left ventricular end-diastolic volume is seen, when compared with manual 3D echocardiography.
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- 2017
139. TCT CONNECT-303 Patient Perspectives on Left Main Stem Revascularization Strategies: The OPINION-2 Study
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Bas M. van Dalen, Karolijn Dulfer, Wijnand K den Dekker, Kaneshka Masdjedi, Adeel Jadoon, Roberto Diletti, Nicolas M. Van Mieghem, Felix Zijlstra, Pieter C. Smits, Joost Daemen, Rutger Jan Nuis, Jeroen Wilschut, and Mattie J. Lenzen
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,medicine ,Cardiology and Cardiovascular Medicine ,Intensive care medicine ,business ,Revascularization ,Main stem - Published
- 2020
140. TCT CONNECT-210 Three-Dimensional QCA-Based Vessel Fractional Flow Reserve (vFFR) in Heart Team Decision-Making: A Multicenter, Reclassification Study
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Loe Kie Soei, Bas M. van Dalen, Roberto Diletti, Kaneshka Masdjedi, Nicolas M. Van Mieghem, Ibrahim Kucuk, Wijnand K den Dekker, Tara Neleman, Isabella Kardys, Felix Zijlstra, Laurens J.C. van Zandvoort, Mariusz Tomaniak, Joost Daemen, and Alise Vermaire
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business.industry ,Heart team ,Medicine ,Operations management ,Fractional flow reserve ,Cardiology and Cardiovascular Medicine ,business - Published
- 2020
141. Current approaches for treatment of coronary chronic occlusions
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Joost Daemen, Roberto Diletti, Nicolas M. Van Mieghem, Jeroen Wilschut, Peter de Jaegere, Felix Zijlstra, Giulia Iannaccone, Paola Scarparo, Wijnand K den Dekker, and Cardiology
- Subjects
Computer science ,Biomedical Engineering ,General Medicine ,030204 cardiovascular system & hematology ,Hybrid approach ,03 medical and health sciences ,0302 clinical medicine ,Percutaneous Coronary Intervention ,Postoperative Complications ,Treatment Outcome ,Coronary Occlusion ,Chronic Disease ,Treatment strategy ,Humans ,Surgery ,Operations management ,030217 neurology & neurosurgery ,Algorithms - Abstract
Introduction: Coronary chronic total occlusions (CTO) represent a challenging subset in interventional cardiology.Areas covered: During the last decade, improvements in materials, techniques, and meticulous pre-procedural lesion assessment have increased the success rate in CTO lesions. Several scores have been developed to address overall lesion evaluation and help select the most appropriate treatment strategy. In addition, specific algorithms such as the hybrid algorithm have been introduced to provide a framework for CTO operators and a rapid management of the various challenging aspects of the procedure. The hybrid approach requires operator's ability to switch from one treatment strategy to another when the first one appears to be unsuccessful. Adequate training and operators' experience remain crucial to improve the likelihood of success.Expert opinion: The aim of this review is to provide insights and guidance for operators on current approaches for treatment of CTO and complication management.
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- 2019
142. A novel mortality risk score predicting intensive care mortality in cardiogenic shock patients treated with veno-arterial extracorporeal membrane oxygenation
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Ard Struijs, Sakir Akin, Dinis dos Reis Miranda, Diederik Gommers, Robert J. van Thiel, Goksel Guven, Jan Bakker, Kadir Caliskan, Rahatullah Muslem, Felix Zijlstra, Osama Ibrahim Ibrahim Soliman, Cardiology, Intensive Care, and Cardiothoracic Surgery
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Male ,medicine.medical_specialty ,Organ Dysfunction Scores ,health care facilities, manpower, and services ,medicine.medical_treatment ,Ventricular Dysfunction, Right ,Shock, Cardiogenic ,Critical Care and Intensive Care Medicine ,03 medical and health sciences ,0302 clinical medicine ,Extracorporeal Membrane Oxygenation ,Predictive Value of Tests ,Intensive care ,Internal medicine ,medicine ,Extracorporeal membrane oxygenation ,Humans ,Hospital Mortality ,Retrospective Studies ,Framingham Risk Score ,Icu mortality ,business.industry ,Cardiogenic shock ,030208 emergency & critical care medicine ,Middle Aged ,medicine.disease ,Intensive Care Units ,surgical procedures, operative ,030228 respiratory system ,Heart failure ,Rv function ,Cardiology ,SOFA score ,Female ,business - Abstract
Purpose Mortality after veno-arterial extracorporeal membrane oxygenation (VA-ECMO) implantation remains a major problem in patients with cardiogenic shock. Our objective was to assess the utility of the SOFA score in combination with markers of right ventricular (RV) dysfunction in predicting mortality in the ICU. Materials and methods Data were retrospectively obtained from all adult patients (n=103) who were treated with VA-ECMO between November 2004 and January 2016. The primary outcome of this study was ICU mortality after VA-ECMO implantation. Using the clinical, demographic and echocardiographic data, we developed a novel mortality risk score, the SOFA-RV score, which combine RV-function to the SOFA score at the time of VA-ECMO implantation. Results Out of 103 patients, 37 (36%) died in the ICU. The median duration of VA-ECMO support was 7 days [IQR 4-11], mean age 49 ± 16 years, and 54% were male. SOFA-RV score has an AUC of 0.70, and was significantly better than SOFA alone (AUC of 0.57) in predicting ICU mortality. In addition, SAVE and MELD scores were not able to predict ICU mortality. Conclusion Adding RV-function to the existing SOFA score improves significantly the prediction of ICU mortality in patients on VA-ECMO. Dedicated evaluation of RV function in patients with VA-ECMO is therefore recommended.
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- 2019
143. Routine Fractional Flow Reserve Measurement After Percutaneous Coronary Intervention
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Rutger J, van Bommel, Kaneshka, Masdjedi, Roberto, Diletti, Miguel E, Lemmert, Laurens, van Zandvoort, Jeroen, Wilschut, Felix, Zijlstra, Peter, de Jaegere, Joost, Daemen, and Nicolas M, van Mieghem
- Subjects
Male ,Cardiac Catheterization ,Adenosine ,Time Factors ,Vasodilator Agents ,Hyperemia ,Coronary Artery Disease ,Middle Aged ,Coronary Angiography ,Fractional Flow Reserve, Myocardial ,Percutaneous Coronary Intervention ,Treatment Outcome ,Predictive Value of Tests ,Recurrence ,Risk Factors ,Humans ,Female ,Stents ,Angina, Stable ,Prospective Studies ,Registries ,Acute Coronary Syndrome ,Aged - Abstract
Fractional flow reserve (FFR) is the current gold standard to determine hemodynamic severity of angiographically intermediate coronary lesions. Much less is known about the prognostic effects of FFR measured directly after percutaneous coronary intervention (PCI). The aims of this study were to evaluate post-PCI FFR values, identify predictors for a low post-PCI FFR, and to investigate whether a relationship between postprocedural FFR and outcome during 30-day follow-up exists.The FFR-SEARCH (Fractional Flow Reserve-Stent Evaluated at Rotterdam Cardiology Hospital) is a prospective registry in which FFR measurements were performed after PCI in 1000 consecutive patients. All FFR measurements were performed under maximum hyperemia with intravenous adenosine with the Navvus RXi system (ACIST Medical Systems, Eden Prairie, MN). The clinical end point was defined as a composite of death, target vessel revascularization, or nonfatal myocardial infarction at 30-day follow-up. Measurement of post-PCI FFR was successful in 959 patients (96%), and a total of 1165 lesions were assessed. There were no complications related to the microcatheter. A total of 322 ST-segment-elevation myocardial infarction patients with 371 measured lesions were excluded leaving 637 patients with 794 measured lesions for the final analysis. Overall post-PCI FFR was 0.90±0.07. In 396 lesions (50%), post-PCI FFR was0.90. A total of 357 patients (56%) had ≥1 lesion(s) with a post-PCI FFR ≤0.90, and 73 patients (11%) had ≥1 lesion(s) with a post-PCI FFR ≤0.80 with post-PCI FFR ≤0.80 in 78 lesions (9.8%). Complex lesion characteristics, use of multiple stents and smaller reference vessel diameter was associated with post-PCI FFR ≤0.90. During follow-up, 11 patients (1.8%) reached the clinical end point. There was no significant relationship between post-PCI FFR and the clinical end point at 30-day follow-up ( P=0.636).Routine measurement of post-PCI FFR using a monorail microcatheter is safe and feasible. Several lesion and patient characteristics were associated with a low post-PCI FFR. Post-PCI FFR did not correlate with clinical events at 30 days.
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- 2019
144. Explanation of Postprocedural Fractional Flow Reserve Below 0.85
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Jeroen Wilschut, Maria Natalia Tovar Forero, Joost Daemen, Jurgen Ligthart, Miguel E. Lemmert, Kaneshka Masdjedi, Roberto Diletti, Karen Witberg, Nicolas M. Van Mieghem, Peter de Jaegere, Eric Boersma, Laurens J.C. van Zandvoort, Felix Zijlstra, and Cardiology
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,medicine.medical_treatment ,Percutaneous coronary intervention ,Fractional flow reserve ,medicine.disease ,Internal medicine ,Intravascular ultrasound ,medicine ,Cardiology ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Fractional flow reserve (FFR) after percutaneous coronary intervention is a predictor of adverse cardiovascular events during follow-up. However, the rationale for low post procedural FFR values remains often elusive based on angiographic findings alone. Methods and Results: FFR SEARCH (Stent Evaluated at Rotterdam Cardiology Hospital) is a prospective single-center registry in which post-percutaneous coronary intervention FFR was assessed in 1000 consecutive all-comer patients. FFR measurements were performed with a microcatheter ±20 mm distal to the most distal stent edge. In 100 vessels with a post procedural FFR ≤0.85, and 20 vessels >0.85 high definition intravascular ultrasound analysis was performed. In 100 vessels with a post-percutaneous coronary intervention FFR ≤0.85, mean post procedural FFR was 0.79±0.05. Minimal lumen area was 2.19 (1.81–3.19) mm 2 , mean lumen area was 5.95 (5.01–7.03) mm 2 , and minimal stent area was 4.01 (3.09–5.21) mm 2 . Significant residual focal proximal lesions were found in 29% of the assessed vessels whereas, focal distal lesions were found in 30% of the vessels. Stent underexpansion and malapposition were found in 74% and 22% of vessels, respectively. Clear focal signs of luminal narrowing were found in 54% of the vessels analyzed. Although incidences of focal lesions, underexpansion, and malapposition were similar between both cohorts, minimal stent area was significantly smaller in vessels with a post-percutaneous coronary intervention FFR ≤0.85 as compared with those with an FFR >0.85. Conclusions: In patients with a post procedural FFR ≤0.85, intravascular ultrasound revealed focal signs of luminal narrowing in a significant number of cases.
- Published
- 2019
145. Pulmonary Arterial Elastance and INTERMACS-Defined Right Heart Failure Following Left Ventricular Assist Device
- Author
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Michael L. Craig, Chin S. Ong, Felix Zijlstra, Nisha A. Gilotra, Steven Hsu, Brett Tomashitis, Bhavadharini Ramu, Rebecca Cogswell, Ad J.J.C. Bogers, Brian A. Houston, Ryan J. Tedford, Kadir Caliskan, Jessica Schultz, Adrian B. Van Bakel, Kavita Sharma, Lucian Lozonschi, Peter J. Leary, Glenn J.R. Whitman, Rahatullah Muslem, Cardiology, and Cardiothoracic Surgery
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Male ,medicine.medical_specialty ,Cardiac Catheterization ,medicine.medical_treatment ,Heart Ventricles ,Hemodynamics ,macromolecular substances ,030204 cardiovascular system & hematology ,Pulmonary Artery ,03 medical and health sciences ,0302 clinical medicine ,Right heart failure ,Postoperative Complications ,Internal medicine ,medicine ,Humans ,Registries ,Heart-Assist Devices ,Aged ,Retrospective Studies ,Heart Failure ,business.industry ,Acute right heart failure ,Stroke Volume ,Middle Aged ,medicine.disease ,Pulmonary hypertension ,Elasticity ,United States ,Survival Rate ,030228 respiratory system ,Echocardiography ,Ventricular assist device ,Heart failure ,Acute Disease ,Cardiology ,Arterial elastance ,Ventricular Function, Right ,Female ,Vascular Resistance ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Acute right heart failure (RHF) after left ventricular assist device implantation remains a major source of morbidity and mortality, yet the definition of RHF and the preimplant variables that predict RHF remain controversial. This study evaluated the ability of (1) INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) RHF classification to predict post-left ventricular assist device survival and (2) preoperative characteristics and hemodynamic parameters to predict severe and severe acute RHF. Methods and Results: An international, multicenter study at 4 large academic centers was conducted between 2008 and 2016. All subjects with hemodynamics measured by right heart catheterization within 30 days before left ventricular assist device implantation were included. RHF was defined using the INTERMACS definition for RHF. In total, 375 subjects were included (mean age, 57.4±13.2 years, 54% bridge-to-transplant). Mild RHF was most common (34%), followed by moderate RHF (16%), severe RHF (13%), and severe acute RHF (9%). Estimated on-device survival rates at 2 years were 72%, 71%, and 55% in the patients with none, mild-to-moderate, and severe-to-severe acute RHF, respectively ( P =0.004). In addition, the independent hazard ratio for mortality was only increased in the patients with severe-to-severe acute RHF (hazard ratio, 3.95; 95% CI, 2.16–7.23; P Conclusions: The INTERMACS RHF classification correctly identifies patients at risk for mortality, though this risk is only increased in patients with severe-to-severe acute RHF. Several predictors for RHF were identified, of which ratio of systolic pulmonary artery pressure to stroke volume was the strongest hemodynamic predictor. Coupling ratio of systolic pulmonary artery pressure to stroke volume with right atrial pressure may be most helpful in identifying patients at risk for severe-to-severe acute RHF.
- Published
- 2019
146. Routine Fractional Flow Reserve Measurement After Percutaneous Coronary Intervention The FFR-SEARCH Study
- Author
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Jeroen Wilschut, Laurens J.C. van Zandvoort, Felix Zijlstra, Rutger J. van Bommel, Joost Daemen, Peter de Jaegere, Roberto Diletti, Nicolas M. Van Mieghem, Kaneshka Masdjedi, Miguel E. Lemmert, and Cardiology
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gold standard ,Percutaneous coronary intervention ,Hemodynamics ,Fractional flow reserve ,medicine.disease ,surgical procedures, operative ,Internal medicine ,medicine ,Cardiology ,cardiovascular diseases ,Myocardial infarction ,Cardiology and Cardiovascular Medicine ,business - Abstract
Background: Fractional flow reserve (FFR) is the current gold standard to determine hemodynamic severity of angiographically intermediate coronary lesions. Much less is known about the prognostic effects of FFR measured directly after percutaneous coronary intervention (PCI). The aims of this study were to evaluate post-PCI FFR values, identify predictors for a low post-PCI FFR, and to investigate whether a relationship between postprocedural FFR and outcome during 30-day follow-up exists. Methods and Results: The FFR-SEARCH (Fractional Flow Reserve—Stent Evaluated at Rotterdam Cardiology Hospital) is a prospective registry in which FFR measurements were performed after PCI in 1000 consecutive patients. All FFR measurements were performed under maximum hyperemia with intravenous adenosine with the Navvus RXi system (ACIST Medical Systems, Eden Prairie, MN). The clinical end point was defined as a composite of death, target vessel revascularization, or nonfatal myocardial infarction at 30-day follow-up. Measurement of post-PCI FFR was successful in 959 patients (96%), and a total of 1165 lesions were assessed. There were no complications related to the microcatheter. A total of 322 ST-segment–elevation myocardial infarction patients with 371 measured lesions were excluded leaving 637 patients with 794 measured lesions for the final analysis. Overall post-PCI FFR was 0.90±0.07. In 396 lesions (50%), post-PCI FFR was >0.90. A total of 357 patients (56%) had ≥1 lesion(s) with a post-PCI FFR ≤0.90, and 73 patients (11%) had ≥1 lesion(s) with a post-PCI FFR ≤0.80 with post-PCI FFR ≤0.80 in 78 lesions (9.8%). Complex lesion characteristics, use of multiple stents and smaller reference vessel diameter was associated with post-PCI FFR ≤0.90. During follow-up, 11 patients (1.8%) reached the clinical end point. There was no significant relationship between post-PCI FFR and the clinical end point at 30-day follow-up ( P =0.636). Conclusions: Routine measurement of post-PCI FFR using a monorail microcatheter is safe and feasible. Several lesion and patient characteristics were associated with a low post-PCI FFR. Post-PCI FFR did not correlate with clinical events at 30 days.
- Published
- 2019
147. Feasibility and Reproducibility of Transthoracic Echocardiography in Obese Patients
- Author
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Jurgen M. Akkerhuis, Sanne M. Snelder, Joella E. van Velzen, Lotte E. de Groot-de Laat, Felix Zijlstra, John O. Younge, Bas M. van Dalen, Adem Dereci, Cardiology, and Cardiothoracic Surgery
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Reproducibility ,business.industry ,Medicine ,Radiology, Nuclear Medicine and imaging ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business - Published
- 2019
148. References for left main stem dimensions: A cross sectional intravascular ultrasound analysis
- Author
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Peter de Jaegere, Miguel E. Lemmert, Kaneshka Masdjedi, Roberto Diletti, Jeroen Wilschut, Laurens J.C. van Zandvoort, Maria Natalia Tovar Forero, Nicolas M. Van Mieghem, Joost Daemen, Felix Zijlstra, and Cardiology
- Subjects
Male ,Percutaneous ,Lumen (anatomy) ,030204 cardiovascular system & hematology ,Single Center ,03 medical and health sciences ,Sex Factors ,0302 clinical medicine ,Predictive Value of Tests ,Reference Values ,Intravascular ultrasound ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,030212 general & internal medicine ,Ultrasonography, Interventional ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Body Weight ,General Medicine ,Middle Aged ,Coronary Vessels ,Body Height ,Lumen Diameter ,medicine.anatomical_structure ,Conventional PCI ,Female ,Cardiology and Cardiovascular Medicine ,Nuclear medicine ,business ,Artery - Abstract
Background: Angiographic assessment of left main coronary artery (LMCA) lesions remains challenging and limited data is available on reference diameters and length of nonobstructive LMCA dimensions. Our aim was to provide insights in the dimensions of nonobstructive LMCA and to find a possible correlation with gender and patient habitus. Methods: This retrospective single center study was performed in a consecutive cohort of patients who underwent Intravascular Ultrasound (IVUS) guided percutaneous coronary interventions of the left coronary system including complete pullbacks of a non-obstructive LMCA (n = 254). Results: Mean LMCA length as measured with IVUS was 7.37 ± 4.2 mm and mean lumen area (LA) was 15.63 ± 4.76 mm2 corresponding to a mean lumen diameter (LD) of 4.41 ± 0.67 mm. An IVUS derived mean LD of >4 mm was present in 71.7%, >4.5 mm in 43% and > 5 mm in 19% of patients. LMCA mean LA was significantly smaller in women as compared to men (14.1 ± 4.1 mm2 and 16.2 ± 4.8 mm2, P < 0.01). Multivariable analysis identified weight of the patient as the sole significant predictor for LMCA length while height of the patient and LMCA length were predictors of LMCA mean LA. Correlation coefficients of determination for all independent predictors were low (R2 < 0.1 for all). Conclusion: This study demonstrated that the mean LD of a non-obstructive LMCA is 4 mm or greater in the majority of patients, with a mean LMCA length of 7.4 mm. Women have smaller luminal dimension than men. No clinically relevant predictors were found for both LMCA length and mean LA.
- Published
- 2019
149. Validation of Resting Diastolic Pressure Ratio Calculated by a Novel Algorithm and Its Correlation With Distal Coronary Artery Pressure to Aortic Pressure, Instantaneous Wave–Free Ratio, and Fractional Flow Reserve
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Jurgen Ligthart, Isabella Kardys, Jeroen Wilschut, Joost Daemen, Roberto Diletti, Karen Witberg, Kaneshka Masdjedi, Nicolas M. Van Mieghem, Laurens J.C. van Zandvoort, Peter de Jaegere, Felix Zijlstra, Miguel E. Lemmert, Frits Mastik, and Cardiology
- Subjects
Male ,Cardiac Catheterization ,Time Factors ,Software Validation ,Proprietary software ,Coronary Artery Disease ,Fractional flow reserve ,030204 cardiovascular system & hematology ,Coronary Angiography ,Cardiac Catheters ,Correlation ,03 medical and health sciences ,0302 clinical medicine ,Software ,Diastole ,Predictive Value of Tests ,Transducers, Pressure ,medicine ,Humans ,Arterial Pressure ,030212 general & internal medicine ,Instantaneous wave-free ratio ,Aorta ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Reproducibility of Results ,Middle Aged ,Coronary Vessels ,Fractional Flow Reserve, Myocardial ,medicine.anatomical_structure ,Blood pressure ,Aortic pressure ,Feasibility Studies ,Female ,Cardiology and Cardiovascular Medicine ,business ,Algorithm ,Algorithms ,Artery - Abstract
Background: Instantaneous wave–free ratio (iFR) offers a reliable non–hyperemic assessment of coronary physiology but requires dedicated proprietary software with a fully automated algorithm. We hypothesized that dPR (diastolic pressure ratio), calculated with novel universal software, has a strong correlation with iFR, similar diagnostic accuracy relative to resting distal coronary artery pressure/aortic pressure and fractional flow reserve (FFR). Methods and Results: The dPR study is an observational, retrospective, single-center cohort study including patients who underwent iFR or FFR. Dedicated software was used to calculate the dPR from Digital Imaging and Communications in Medicine (DICOM) pressure waveforms. The flat period on the pressure difference between sample (dP) to the time difference between the same sample points (dt) signal was used to detect automatically the period, where the resistance is low and constant, and to calculate the dPR, which is an average over 5 consecutive heartbeats. The software was validated by correlating iFR results with dPR. Software validation was done by comparing 78 iFR measurements in 44 patients who underwent iFR. Mean iFR and dPR were 0.91±0.10 and 0.92±0.10, respectively, with a significant linear correlation ( R =0.997; P R =0.77; P Conclusions: dPR, calculated by a novel validated software tool, showed a strong linear correlation with iFR. dPR correlated well with FFR with a good diagnostic accuracy to identify positive FFR.
- Published
- 2018
150. Biomechanical Stress Profiling of Coronary Atherosclerosis: Identifying a Multifactorial Metric to Evaluate Plaque Rupture Risk
- Author
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Pallavi, Doradla, Kenichiro, Otsuka, Abhijay, Nadkarni, Martin, Villiger, Antonios, Karanasos, Laurens J C van, Zandvoort, Jouke, Dijkstra, Felix, Zijlstra, Gijs van, Soest, Joost, Daemen, Evelyn, Regar, Brett E, Bouma, and Seemantini K, Nadkarni
- Subjects
Rupture, Spontaneous ,Models, Cardiovascular ,Coronary Artery Disease ,Fibrosis ,Risk Assessment ,Plaque, Atherosclerotic ,Biomechanical Phenomena ,Necrosis ,Percutaneous Coronary Intervention ,Predictive Value of Tests ,Risk Factors ,Tensile Strength ,Humans ,Stress, Mechanical ,Acute Coronary Syndrome ,Tomography, Optical Coherence ,Ultrasonography, Interventional ,Retrospective Studies - Abstract
The purpose of this study was to derive a biomechanical stress metric that was based on the multifactorial assessment of coronary plaque morphology, likely related to the propensity of plaque rupture in patients.Plaque rupture, the most frequent cause of coronary thrombosis, occurs at locations of elevated tensile stress in necrotic core fibroatheromas (NCFAs). Finite element modeling (FEM), typically used to calculate tensile stress, is computationally intensive and impractical as a clinical tool for locating rupture-prone plaques. This study derived a multifactorial stress equation (MSE) that accurately computes peak stress in NCFAs by combining the influence of several morphological parameters.Intravascular ultrasound and optical frequency domain imaging were conducted in 30 patients, and plaque morphological parameters were defined in 61 NCFAs. Multivariate regression analysis was applied to derive the MSE and compute a peak stress metric (PSM) that was based on the analysis of plaque morphological parameters. The accuracy of the MSE was determined by comparing PSM with FEM-derived peak stress values. The ability of the PSM in locating plaque rupture sites was tested in 3 additional patients.The following parameters were found to be independently associated with peak stress: fibrous cap thickness (p 0.0001), necrotic core angle (p = 0.024), necrotic core thickness (p 0.0001), lumen area (p 0.0001), necrotic core including calcium areas (p = 0.017), and plaque area (p = 0.003). The PSM showed excellent correlation (R = 0.85; p 0.0001) with FEM-derived peak stress, thus confirming the accuracy of the MSE. In only 56% (n = 34) of plaques, the thinnest fibrous cap thickness was a determining parameter in identifying the cross section with highest PSM. In coronary segments with plaque ruptures, the MSE precisely located the rupture site.The MSE shows potential to calculate the PSM in coronary lesions rapidly. However, further studies are warranted to investigate the use of biomechanical stress profiling for the prognostic evaluation of patients with atherosclerosis.
- Published
- 2018
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