34 results on '"Floré, V."'
Search Results
2. Occupational exposure to trichloroethylene and risk of non-Hodgkin lymphoma and its major subtypes: a pooled linterLlymph analysis
- Author
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Cocco, P, Vermeulen, R, Flore, V, Nonne, T, Campagna, M, Purdue, M, Blair, A, Monnereau, A, Orsi, L, Clavel, J, Becker, N, de Sanjosé, S, Foretova, L, Staines, A, Maynadié, M, Nieters, A, Miligi, L, Mannetje, A 't, Kricker, A, Brennan, P, Boffetta, P, Lan, Q, and Rothman, N
- Published
- 2013
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3. T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction
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Floré, V., Claus, P., Vos, M. A., Vandenberk, B., Van Soest, S., Sipido, K. R., Adriaenssens, T., Bogaert, J., Desmet, W., and Willems, R.
- Published
- 2015
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4. Lung Cancer Mortality Among Female Mine Workers Exposed to Silica
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Cocco, P. L., Carta, P., Flore, V., Picchiri, G. F., and Zucca, C.
- Published
- 1994
5. T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction
- Author
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Floré, V, Claus, P, Vos, M A, Vandenberk, B, Van Soest, S, Sipido, K R, Adriaenssens, T, Bogaert, J, Desmet, W, Willems, R, Floré, V, Claus, P, Vos, M A, Vandenberk, B, Van Soest, S, Sipido, K R, Adriaenssens, T, Bogaert, J, Desmet, W, and Willems, R
- Published
- 2015
6. T-Wave Alternans Is Linked to Microvascular Obstruction and to Recurrent Coronary Ischemia After Myocardial Infarction
- Author
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Medische Fysiologie, Circulatory Health, Floré, V, Claus, P, Vos, M A, Vandenberk, B, Van Soest, S, Sipido, K R, Adriaenssens, T, Bogaert, J, Desmet, W, Willems, R, Medische Fysiologie, Circulatory Health, Floré, V, Claus, P, Vos, M A, Vandenberk, B, Van Soest, S, Sipido, K R, Adriaenssens, T, Bogaert, J, Desmet, W, and Willems, R
- Published
- 2015
7. Electrical remodeling reflected by QRS and T vector changes following cardiac resynchronization therapy is related to survival in heart failure patients with left bundle branch block
- Author
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Floré, V., primary, Bartunek, J., additional, Goethals, M., additional, Verstreken, S., additional, Timmermans, W., additional, De Pauw, F., additional, Van Bockstal, K., additional, and Vanderheyden, M., additional
- Published
- 2015
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8. Rationale, objectives, and design of the EUTrigTreat clinical study: a prospective observational study for arrhythmia risk stratification and assessment of interrelationships among repolarization markers and genotype.
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Seegers J, Vos MA, Flevari P, Willems R, Sohns C, Vollmann D, Lüthje L, Kremastinos DT, Floré V, Meine M, Tuinenburg A, Myles RC, Simon D, Brockmöller J, Friede T, Hasenfuß G, Lehnart SE, Zabel M, EUTrigTreat Clinical Study Investigators, and Seegers, Joachim
- Abstract
Aims: The EUTrigTreat clinical study has been designed as a prospective multicentre observational study and aims to (i) risk stratify patients with an implantable cardioverter defibrillator (ICD) for mortality and shock risk using multiple novel and established risk markers, (ii) explore a link between repolarization biomarkers and genetics of ion (Ca(2+), Na(+), K(+)) metabolism, (iii) compare the results of invasive and non-invasive electrophysiological (EP) testing, (iv) assess changes of non-invasive risk stratification tests over time, and (v) associate arrythmogenomic risk through 19 candidate genes.Methods and Results: Patients with clinical ICD indication are eligible for the trial. Upon inclusion, patients will undergo non-invasive risk stratification, including beat-to-beat variability of repolarization (BVR), T-wave alternans, T-wave morphology variables, ambient arrhythmias from Holter, heart rate variability, and heart rate turbulence. Non-invasive or invasive programmed electrical stimulation will assess inducibility of ventricular arrhythmias, with the latter including recordings of monophasic action potentials and assessment of restitution properties. Established candidate genes are screened for variants. The primary endpoint is all-cause mortality, while one of the secondary endpoints is ICD shock risk. A mean follow-up of 3.3 years is anticipated. Non-invasive testing will be repeated annually during follow-up. It has been calculated that 700 patients are required to identify risk predictors of the primary endpoint, with a possible increase to 1000 patients based on interim risk analysis.Conclusion: The EUTrigTreat clinical study aims to overcome current shortcomings in sudden cardiac death risk stratification and to answer several related research questions. The initial patient recruitment is expected to be completed in July 2012, and follow-up is expected to end in September 2014. Clinicaltrials.gov identifier: NCT01209494. [ABSTRACT FROM AUTHOR]- Published
- 2012
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9. T-wave alternans and beat-to-beat variability of repolarization: pathophysiological backgrounds and clinical relevance
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Floré, V. and Willems, R.
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- 2012
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10. Implantable cardioverter/defibrillator interventions in primary prevention: do current implantation criteria really predict ICD interventions?
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Cools, T., Rossenbacker, T., Floré, V., Nuyens, D., Heidbüchel, H., and Willems, R.
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- 2011
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11. A systematic algorithm for large-bore arterial access closure after TAVI: the TAVI-MultiCLOSE study.
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Rosseel L, Montarello NJ, Nuyens P, Tirado-Conte G, Quagliana A, Cornelis K, Floré V, Rosseel M, Bieliauskas G, Sondergaard L, and De Backer O
- Subjects
- Humans, Aortic Valve diagnostic imaging, Aortic Valve surgery, Femoral Artery surgery, Hemorrhage etiology, Hemorrhage prevention & control, Hemostatic Techniques adverse effects, Treatment Outcome, Aortic Valve Stenosis, Transcatheter Aortic Valve Replacement methods, Vascular Closure Devices adverse effects
- Abstract
Background: Despite transcatheter aortic valve implantation (TAVI) having become a routine procedure, access site bleeding and vascular complications are still a concern which contribute to procedure-related morbidity and mortality., Aims: The TAVI-MultiCLOSE study aimed to assess the safety and efficacy of a new vascular closure algorithm for percutaneous large-bore arterial access closure following transfemoral (TF)-TAVI., Methods: All consecutive TF-TAVI cases in which the MultiCLOSE vascular closure algorithm was used were prospectively included in a multicentre, observational study. This stepwise algorithm entails the reinsertion of a 6-8 Fr sheath (primary access) following the initial preclosure with one or two suture-based vascular closure devices (VCDs). This provides the operator with the opportunity to perform a quick and easy angiographic control and tailor the final vascular closure with either an additional suture- or plug-based VCD, or neither of these., Results: Among 630 patients who underwent TF-TAVI utilising the MultiCLOSE algorithm, complete arterial haemostasis was achieved in 616 patients (98%). VCD failure occurred in 14 patients (2%), treated with either balloon inflation (N=1), covered stent (N=12) or surgical repair (N=1). Overall, this vascular closure approach resulted in a minor and major vascular complication rate of 2.2% and 0.6%, respectively. At 30 days, only one new minor vascular complication (0.2%) was noted. In-hospital and 30-day all-cause mortality rates were 0.2% and 1.0%, respectively., Conclusions: Use of the MultiCLOSE vascular closure algorithm was demonstrated to contribute to an easy, safe, efficacious and durable vascular closure after TF-TAVI, resulting in a major vascular complication rate of less than 1%.
- Published
- 2024
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12. iFR/FFR/IVUS Discordance and Clinical Implications: Results From the Prospective Left Main Physiology Registry.
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Kayaert P, Coeman M, Ghafari C, Drieghe B, Gheeraert P, Bennett J, McCutcheon K, Ungureanu C, Vandeloo B, Floré V, Hermans K, Dens J, Saad G, Janssens L, Xaplanteris P, Bataille Y, Semeraro O, Kefer J, Gevaert S, De Pauw M, Carlier S, Claeys MJ, and Haine S
- Subjects
- Humans, Prospective Studies, Clinical Decision-Making, Constriction, Pathologic, Registries, Fractional Flow Reserve, Myocardial
- Abstract
Objectives: This study aimed to assess discordance between results of instantaneous wave-free ratio (iFR), fractional flow reserve (FFR), and intravascular ultrasound (IVUS) in intermediate left main coronary (LM) lesions, and its impact on clinical decision making and outcome., Methods: We enrolled 250 patients with a 40%-80% LM stenosis in a prospective, multicenter registry. These patients underwent both iFR and FFR measurements. Of these, 86 underwent IVUS and assessment of the minimal lumen area (MLA), with a 6 mm2 cutoff for significance., Results: Isolated LM disease was recognized in 95 patients (38.0%), while 155 patients (62.0%) had both LM disease and downstream disease. In 53.2% of iFR+ and 56.7% of FFR+ LM lesions, the measurement was positive in only one daughter vessel. iFR/FFR discordance occurred in 25.0% of patients with isolated LM disease and 36.2% of patients with concomitant downstream disease (P=.049). In patients with isolated LM disease, discordance was significantly more common in the left anterior descending artery and younger age was an independent predictor of iFR-/FFR+ discordance. iFR/MLA and FFR/MLA discordance occurred in 37.0% and 29.4%, respectively. Within 1 year of follow-up, major cardiac adverse events (MACE) occurred in 8.5% and 9.7% (P=.763) of patients whose LM lesion was deferred or revascularized, respectively. Discordance was not an independent predictor of MACE., Conclusions: Current methods of estimating LM lesion significance often yield discrepant findings, complicating therapeutic decision-making.
- Published
- 2023
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13. Impact of routine use of a cerebral protection device on the TAVR procedure and its short-term outcomes: a single-centre experience.
- Author
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von Kemp MJ, Floré V, Lau CW, De Sutter J, Provenier F, and Cornelis K
- Subjects
- Humans, Aortic Valve diagnostic imaging, Aortic Valve surgery, Retrospective Studies, Treatment Outcome, Time Factors, Risk Factors, Transcatheter Aortic Valve Replacement adverse effects, Aortic Valve Stenosis diagnosis, Aortic Valve Stenosis surgery, Embolic Protection Devices, Intracranial Embolism diagnosis, Intracranial Embolism etiology, Intracranial Embolism surgery, Stroke epidemiology, Stroke etiology, Stroke prevention & control
- Abstract
Background: Stroke is a major concern in transcatheter aortic valve replacement (TAVR). The introduction of a cerebral protection devices may counteract the evolution towards minimally invasive TAVR. At this time, there is insufficient data to support the routine use of these devices., Methods: We aimed to evaluate the outcome of the routine use of the Sentinel Cerebral protection system
® (CPS) in patients undergoing TAVR, after completing a CT-based screening process for feasibility of Sentinel implantation. We report our initial experience with the routine implementation of the Sentinel CPS in all anatomically suitable patients undergoing TAVR. We retrospectively compared the procedural characteristics and outcomes between all TAVR patients treated with ( n = 78) and without ( n = 79) intended Sentinel., Results: The Sentinel CPS could successfully be deployed in 99% of intended cases after CT feasibility screening. TAVR procedures with Sentinel CPS were not longer than procedures without Sentinel use (89 ± 20 versus 120 ± 50 min, p = 0.007). Sentinel CPS use was not associated with an increased risk of procedural complications. Stroke was observed in none (0%) of the Sentinel CPS patients, and in 6.3% of the non-Sentinel CPS patients ( p = 0.05). The finding of stroke was associated with a high risk of early postprocedural mortality: 60% of stroke patients died within 3 months., Conclusion: Routine use of the Sentinel CPS in CT-screened TAVR patients is feasible with high procedural success, without significant adverse events and without counteracting the evolution towards minimally invasive TAVR. Clinically relevant stroke was observed in none of the Sentinel CPS patients.- Published
- 2022
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14. SPECT-CCTA: guiding treatment in ischaemic heart disease.
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Deschepper C, Berwouts D, Cornelis K, Floré V, Beckers R, and De Sutter J
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- Computed Tomography Angiography methods, Coronary Angiography methods, Humans, Tomography, Emission-Computed, Single-Photon methods, Tomography, X-Ray Computed, Coronary Artery Disease therapy, Myocardial Ischemia diagnostic imaging, Myocardial Ischemia therapy, Myocardial Perfusion Imaging methods
- Abstract
Combining myocardial perfusion single photon emission computed tomography (SPECT-MPI) and coronary computed tomography angiography (CCTA) is an interesting hybrid imaging option in modern cardiovascular medicine. The integrated hybrid technique has a number of advantages compared to visual side-by-side analysis of the separate modalities. CT attenuation map can correct for attenuation artefacts and thus improve the diagnostic accuracy of SPECT-MPI. Moreover, the anatomical information of the CCTA and the perfusion map of SPECT-MPI allow for vessel-based correlation and culprit vessel identification. Combining SPECT-MPI with CCTA is an appealing tool in the work-up of complex ischaemic heart disease and might help determine the optimal treatment strategy. This case series illustrates the role of SPECT-CCTA in decision-making of revascularization strategy in complex ischaemic heart disease.
- Published
- 2022
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15. Coronary imaging of cardiac allograft vasculopathy predicts current and future deterioration of left ventricular function in patients with orthotopic heart transplantation.
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Reddy SA, Khialani BV, Lambert B, Floré V, Brown AJ, Pettit SJ, West NE, Lewis C, Parameshwar J, Bhagra S, Kydd A, and Hoole SP
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- Allografts, Coronary Angiography methods, Humans, Stroke Volume, Ultrasonography, Interventional, Ventricular Function, Left, Coronary Artery Disease diagnostic imaging, Coronary Artery Disease etiology, Heart Diseases, Heart Transplantation adverse effects, Heart Transplantation methods
- Abstract
Background: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) improve sensitivity of cardiac allograft vasculopathy (CAV) detection compared to invasive coronary angiography (ICA), but their ability to predict clinical events is unknown. We determined whether severe CAV detected with ICA, IVUS, or OCT correlates with graft function., Methods: Comparison of specific vessel parameters between IVUS and OCT on 20 patients attending for angiography 12-24 months post-orthotopic heart transplant. Serial left ventricular ejection fraction (EF) was recorded prospectively., Results: Analyzing 55 coronary arteries, OCT and IVUS correlated well for vessel CAV characteristics. A mean intimal thickness (MIT)
OCT > .25 mm had a sensitivity of 86.7% and specificity of 74.3% at detecting Stanford grade 4 CAV. Those with angiographically evident CAV had significant reduction in graft EF over 7.3 years follow-up (median ΔEF -2% vs +1.5%, P = .03). Patients with MITOCT > .25 mm in at least one vessel had a lower median EF at time of surveillance (57% vs 62%, P = .014). Two MACEs were noted., Conclusion: Imaging with OCT correlates well with IVUS for CAV detection. Combined angiography and OCT to screen for CAV within 12-24 months of transplant predicts concurrent and future deterioration in graft function., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)- Published
- 2022
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16. Impact of COVID-19-related public containment measures on the ST elevation myocardial infarction epidemic in Belgium: a nationwide, serial, cross-sectional study.
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Claeys MJ, Argacha JF, Collart P, Carlier M, Van Caenegem O, Sinnaeve PR, Desmet W, Dubois P, Stammen F, Gevaert S, Pourbaix S, Coussement P, Beauloye C, Evrard P, Brasseur O, Fierens F, Marechal P, Schelfaut D, Floré V, and Hanet C
- Subjects
- Belgium epidemiology, Cross-Sectional Studies, Humans, COVID-19 prevention & control, Communicable Disease Control, Epidemics, Percutaneous Coronary Intervention, ST Elevation Myocardial Infarction diagnosis, ST Elevation Myocardial Infarction epidemiology
- Abstract
Aims: The current study assessed the impact of COVID-19-related public containment measures (i.e. lockdown) on the ST elevation myocardial infarction (STEMI) epidemic in Belgium., Methods and Results: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive STEMI patients who were admitted to Belgian hospitals for percutaneous coronary intervention (PCI) were recorded during a three-week period starting at the beginning of the lockdown period on 13 March 2020. Similar data were collected for the same time period for 2017-2019. An evaluation of air quality revealed a 32% decrease in ambient NO
2 concentrations during lockdown (19.5 µg/m³ versus 13.2 µg/m³, p < .001). During the three-week period, there were 188 STEMI patients admitted for PCI during the lockdown versus an average 254 STEMI patients before the lockdown period (incidence rate ratio = 0.74, p = .001). Reperfusion strategy was predominantly primary PCI in both time periods (96% versus 95%). However, there was a significant delay in treatment during the lockdown period, with more late presentations (>12 h after onset of pain) (14% versus 7.6%, p = .04) and with longer door-to-balloon times (median of 45 versus 39 min, p = .02). Although the in-hospital mortality between the two periods was comparable (5.9% versus 6.7%), 5 of the 7 (71%) COVID-19-positive STEMI patients died., Conclusion: The present study revealed a 26% reduction in STEMI admissions and a delay in treatment of STEMI patients. Less exposure to external STEMI triggers (such as ambient air pollution) and/or reluctance to seek medical care are possible explanations of this observation.- Published
- 2021
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17. Repeating noninvasive risk stratification improves prediction of outcome in ICD patients.
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Vandenberk B, Floré V, Röver C, Vos MA, Dunnink A, Leftheriotis D, Friede T, Flevari P, Zabel M, and Willems R
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- Aged, Europe, Female, Follow-Up Studies, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Risk Assessment, Defibrillators, Implantable, Electrocardiography, Ambulatory methods, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular physiopathology
- Abstract
Background: Noninvasive risk stratification aims to detect abnormalities in the pathophysiological mechanisms underlying ventricular arrhythmias. We studied the predictive value of repeating risk stratification in patients with an implantable cardioverter-defibrillator (ICD)., Methods: The EUTrigTreat clinical study was a prospective multicenter trial including ischemic and nonischemic cardiomyopathies and arrhythmogenic heart disease. Left ventricular ejection fraction ≤40% (LVEF), premature ventricular complexes >400/24 hr (PVC), non-negative microvolt T-wave alternans (MTWA), and abnormal heart rate turbulence (HRT) were considered high risk. Tests were repeated within 12 months after inclusion. Adjusted Cox regression analysis was performed for mortality and appropriate ICD shocks., Results: In total, 635 patients had analyzable baseline data with a median follow-up of 4.4 years. Worsening of LVEF was associated with increased mortality (HR 3.59, 95% CI 1.17-11.04), as was consistent abnormal HRT (HR 8.34, 95%CI 1.06-65.54). HRT improvement was associated with improved survival when compared to consistent abnormal HRT (HR 0.10, 95%CI 0.01-0.82). For appropriate ICD shocks, a non-negative MTWA test or high PVC count at any moment was associated with increased arrhythmic risk independent of the evolution of test results (worsening: HR 3.76 (95%CI 1.43-9.88) and HR 2.50 (95%CI 1.15-5.46); improvement: HR 2.80 (95%CI 1.03-7.61) and HR 2.45 (95%CI 1.07-5.62); consistent: HR 2.47 (95%CI 0.95-6.45) and HR 2.40 (95%CI 1.33-4.33), respectively). LVEF improvement was associated with a lower arrhythmic risk (HR 0.34, 95%CI 0.12-0.94)., Conclusions: Repeating LVEF and HRT improved the prediction of mortality, whereas stratification of ventricular arrhythmias may be improved by repeating LVEF measurements, MTWA and ECG Holter monitoring., (© 2020 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC.)
- Published
- 2020
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18. Clinical outcomes of bioresorbable vascular scaffolds implanted with routine versus selective optical coherence tomography guidance: results from a single-centre experience.
- Author
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Floré V, Brown AJ, Giblett JP, Liou K, Cranley J, Hoole SP, and West NEJ
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- Absorbable Implants, Coronary Angiography, Humans, Tissue Scaffolds, Tomography, Optical Coherence, Treatment Outcome, Drug-Eluting Stents, Percutaneous Coronary Intervention
- Abstract
Aims: We aimed to investigate the effects of an initial learning period with mandatory optical coherence tomography (OCT) guidance for the implantation of everolimus-eluting bioresorbable vascular scaffolds (BVS)., Methods and Results: We analysed procedural and clinical outcomes of all BVS implantations at a single centre where OCT guidance was mandatory in the initial rollout (OCT-mandatory) phase. We compared these data with the later phase where use of OCT was at operator discretion (OCT-selective or angiography). We implanted 406 BVS in 306 vessels (201 OCT, 105 angiography) in 272 patients. Follow-up duration was 38±10 months. Annualised rates of device-oriented cardiac events (DOCE) and scaffold thrombosis (ScT) were 1.4% and 0.4%, respectively. The risks of DOCE (HR 1.06, 95% CI: 0.33-3.34; p=0.71) and ScT (HR 0.48, 95% CI: 0.07-3.85; p=0.49) were not significantly different when comparing the OCT and angiography groups., Conclusions: Routine use of OCT to guide and optimise BVS implants results in very acceptable outcomes. Further, the benefits of such an early OCT-mandatory "learning" period persist after cessation of routine OCT usage when imaging is not routinely used. A period of mandatory OCT usage for BVS implants may therefore be beneficial in improving patient outcomes with these devices.
- Published
- 2019
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19. From debulking to delivery: sequential use of rotational atherectomy and Guidezilla™ for complex saphenous vein grafts intervention.
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Pellicano M, Floré V, Barbato E, and De Bruyne B
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- Aged, Coronary Angiography, Drug-Eluting Stents, Equipment Design, Graft Occlusion, Vascular diagnostic imaging, Graft Occlusion, Vascular etiology, Graft Occlusion, Vascular physiopathology, Humans, Male, Non-ST Elevated Myocardial Infarction diagnostic imaging, Non-ST Elevated Myocardial Infarction etiology, Non-ST Elevated Myocardial Infarction physiopathology, Saphenous Vein diagnostic imaging, Saphenous Vein physiopathology, Treatment Outcome, Vascular Calcification diagnostic imaging, Vascular Calcification etiology, Vascular Calcification physiopathology, Vascular Patency, Atherectomy, Coronary instrumentation, Cardiac Catheterization instrumentation, Cardiac Catheters, Coronary Artery Bypass adverse effects, Graft Occlusion, Vascular surgery, Non-ST Elevated Myocardial Infarction surgery, Percutaneous Coronary Intervention instrumentation, Saphenous Vein transplantation, Vascular Calcification surgery
- Abstract
Background: Percutaneous coronary interventions (PCI) of old calcified saphenous vein grafts (SVGs) is challenging and is associated with a considerably high risk of adverse ischemic events in the short- and long-term as compared to native coronary arteries. We report a case in which a non-dilatable, calcified SVG lesion is successfully treated with rotational atherectomy followed by PCI and stenting with local stent delivery (LSD) technique using the Guidezilla™ guide extension catheter (5-in-6 Fr) in the "child-in-mother" fashion., Case Presentation: A 70 years-old man with a dilated ischemic cardiomyopathy, triple coronary artery bypass grafting (CABG) in 1990 and chronic renal failure (baseline GFR: 45 ml/min/1.73 m
2 ) underwent a coronary angiography for a Non-ST segment elevation myocardial infarction (NSTEMI). Native coronary circulation was completely occluded at the proximal segments. Grafts angiography showed a tandem calcified lesions of SVG on distal right coronary artery (RCA) and an ostial stenosis of the SVG on first obtuse marginal branch (OM1). Left internal mammary artery on the mid left anterior descending artery was patent. Ad Hoc PCI of SVG on RCA was attempted. The proximal calcified stenosis has been crossed with a 1.5 x 12 mm balloon only with the support of Guidezilla™, however the non-compliant (NC) balloon 2.5 x 15 mm was unable to break the hard and calcified plaque. After several attempts, the procedure was interrupted with a suboptimal result. An elective transradial PCI of SVG on RCA with rotational atherectomy was performed. Two runs with 1.25 mm burr and 2 runs with 1.5 mm burr were carried out. Then, the use of distal anchoring balloon warranted support and tracking, made as centring rail for the advance of the tip of the "mother-and-child" catheter into the SVG. During slow deflation of the balloon, the Guidezilla™ was advanced distal to the stenoses to be stented, thus allowing the placement of two long drug eluting stents according to a LSD technique., Conclusions: Rotational atherectomy is a feasible option for non-dilatable stenoses in old SVGs when there is no evidence of thrombus or vessel dissection and the subsequent use of "mother-and-child" catheter has a key role, especially in case of radial approach, for long stents delivery.- Published
- 2018
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20. QRS fragmentation after acute myocardial infarction.
- Author
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Floré V
- Subjects
- Humans, Electrocardiography, Myocardial Infarction
- Published
- 2018
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21. Intravascular ultrasound of the proximal left anterior descending artery is sufficient to detect early cardiac allograft vasculopathy.
- Author
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Floré V, Brown AJ, Pettit SJ, West NEJ, Lewis C, Parameshwar J, and Hoole SP
- Subjects
- Adolescent, Adult, Aged, Allografts, Coronary Angiography, Coronary Vessels diagnostic imaging, Early Diagnosis, Endovascular Procedures, Female, Follow-Up Studies, Graft Rejection diagnostic imaging, Graft Rejection etiology, Graft Survival, Humans, Male, Middle Aged, Prognosis, Prospective Studies, Risk Factors, Vascular Diseases diagnostic imaging, Vascular Diseases etiology, Young Adult, Coronary Vessels pathology, Graft Rejection diagnosis, Heart Transplantation adverse effects, Postoperative Complications, Ultrasonography methods, Vascular Diseases diagnosis
- Abstract
Objective: Cardiac allograft vasculopathy (CAV) can be detected early with intravascular ultrasound (IVUS), but there is limited information on the most efficient imaging protocol., Methods: Coronary angiography and IVUS of the three coronary arteries were performed. Volumetric IVUS analysis was performed, and a Stanford grade determined for each vessel., Results: Eighteen patients were included 18 (range 12-24) months after transplantation. Angiographic CAV severity ranged from none (CAV0) to mild (CAV1), whereas IVUS CAV severity ranged from none (Stanford grade I) to severe (grade IV). Maximal intimal thickness measured with IVUS was significantly greater in the LAD (0.84 ± 0.48 mm) than in the LCX (0.46 ± 0.32 mm) or the RCA (0.53 ± 0.41 mm, P = .005). Diagnostic accuracy of IVUS in the left anterior descending artery was 100% (18 of 18 Stanford grades matched the patient's highest overall Stanford grade), 66% in the right coronary artery (12 of 18), and 56% in the left circumflex artery (11 of 18). The minimal required length of left anterior descending artery pullbacks to attain 100% accuracy was 36 mm (range 3-36 mm) distal from the guide catheter ostium., Conclusions: These data suggest that focal IVUS imaging of the proximal LAD followed by volumetric analysis may suffice when screening for transplant vasculopathy., (© 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)
- Published
- 2018
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22. Introducing ICD-resistant mortality as an end point to evaluate the clinical efficacy of an implantable cardioverter-defibrillator in ischaemic cardiomyopathy.
- Author
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Floré V, Vandenberk B, Belmans A, Garweg C, Ector J, and Willems R
- Subjects
- Aged, Belgium epidemiology, Death, Sudden, Cardiac etiology, Death, Sudden, Cardiac prevention & control, Female, Follow-Up Studies, Humans, Incidence, Male, Middle Aged, Myocardial Ischemia complications, Myocardial Ischemia mortality, Retrospective Studies, Risk Factors, Survival Rate trends, Treatment Outcome, Death, Sudden, Cardiac epidemiology, Defibrillators, Implantable, Electric Countershock mortality, Myocardial Ischemia therapy
- Abstract
Objective: A new end point called ICD-resistant mortality was evaluated to assess the clinical efficacy of ICD implantations., Methods and Results: In 302 ICD patients with ischaemic cardiomyopathy, we investigated which clinical parameters predicted useful ICD implantations using cumulative incidence competing risk analysis. Implantation was deemed clinically useful when the ICD provided appropriate therapy and the patient survived implantation by 1 year and the first shock by 30 days. ICD-resistant mortality (ICDRM) was defined as death within 30 days after the first shock, within 1 year of implantation or without previous appropriate ICD therapy. After 5 years, ICDRM occurred in 23% of implantations, while 36% were clinically useful. After multivariable analysis, ICDRM was associated with LVEF <35% (HR: 2.63; p = .005), beta-blocker dose <50% (HR: 2.0; p = .01) and anterior or diffuse infarct location (HR: 3.61; p = .001 and HR: 2.89; p = .02). Useful ICD implantations were associated with beta-blocker dose <50% (HR: 1.64; p = .02) and non-anterior infarct location (HR: 3.22 vs anterior and 1.59 vs diffuse; combined p<.001)., Conclusions: Five years after implantation, an ICD could be classified as useful in 1 out of 3, while ICDRM occurred in one out of four patients. At 10 years, up to 80% of implantations could be categorized. Lower LVEF was related with significantly higher incidence of ICDRM. Anterior infarcts were associated with more ICDRM and less useful implantations than non-anterior infarcts. Future risk stratification for ICD should focus more on the discrimination between arrhythmic risk, probably preventable by ICDs and ICD-resistant mortality risk.
- Published
- 2018
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23. Edge effect after intracoronary beta radiation brachytherapy and bare metal stent implantation: the pathway for very late stent failure.
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Pellicano M, Floré V, Ferrara A, Adjedj J, Barbato E, and Wijns W
- Subjects
- Aged, 80 and over, Coronary Restenosis diagnostic imaging, Humans, Male, Time Factors, Tomography, Optical Coherence, Beta Particles therapeutic use, Brachytherapy methods, Coronary Restenosis radiotherapy, Stents
- Published
- 2018
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24. The impact of changes in LVEF and renal function on the prognosis of ICD patients after elective device replacement.
- Author
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Vandenberk B, Robyns T, Garweg C, Floré V, Foulon S, Voros G, Ector J, and Willems R
- Subjects
- Aged, Cardiomyopathies mortality, Female, Humans, Male, Prognosis, Retrospective Studies, Cardiomyopathies physiopathology, Cardiomyopathies therapy, Defibrillators, Implantable, Kidney physiopathology, Ventricular Function, Left
- Abstract
Background: A proportion of patients with an implantable cardioverter-defibrillator (ICD) in prevention of sudden cardiac death will only receive their first appropriate ICD therapy (AT) after device replacement. Clinical reassessment at the time of replacement could be helpful to guide the decision to replace or not in the future., Methods: All patients with an ICD for primary or secondary prevention in ischemic (ICM) or nonischemic cardiomyopathy were included in a single-center retrospective registry. The association of changes in left ventricular ejection fraction (LVEF; cut-off at 35%), worsening renal function (decrease in estimated glomerular filtration rate > 15 mL/min), and worsening New York Heart Association class at elective device replacement with mortality and AT was analyzed using adjusted Cox regression analysis., Results: A total of 238 (33%) out of 727 patients received elective device replacement (86.1% male, 74.4% ICM, 42.9% primary prevention). During this replacement 20.2% received a device upgrade. The mean time to replacement was 6.4 ± 2.0 years and mean follow-up after replacement was 3.4 ± 3.0 years. Of patients who did not receive AT before replacement 23.1% received their first AT after replacement. Worsening renal function (hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.50-5.18) and a consistently LVEF ≤35% compared to a consistently LVEF >35% (HR 2.15, 95% CI 1.10-4.19) at the time of replacement were independent predictors of mortality. Independent predictors of first AT after replacement could not be identified., Conclusion: Although reassessment of LVEF and renal function at replacement can be helpful in predicting total mortality, the clinical utility to guide reimplantation seemed limited. Our experience indicates that approximately 25% of patients received their first AT only after replacement., (© 2017 Wiley Periodicals, Inc.)
- Published
- 2017
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25. Visual and Quantitative Assessment of Coronary Stenoses at Angiography Versus Fractional Flow Reserve: The Impact of Risk Factors.
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Adjedj J, Xaplanteris P, Toth G, Ferrara A, Pellicano M, Ciccarelli G, Floré V, Barbato E, and De Bruyne B
- Subjects
- Aged, Belgium, Coronary Stenosis physiopathology, Coronary Stenosis therapy, Coronary Vessels physiopathology, Databases, Factual, Diabetic Angiopathies diagnostic imaging, Diabetic Angiopathies physiopathology, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Prognosis, Reproducibility of Results, Retrospective Studies, Risk Factors, Severity of Illness Index, Cardiac Catheterization, Coronary Angiography, Coronary Stenosis diagnostic imaging, Coronary Vessels diagnostic imaging, Fractional Flow Reserve, Myocardial
- Abstract
Background: The correlation between angiographic assessment of coronary stenoses and fractional flow reserve (FFR) is weak. Whether and how risk factors impact the diagnostic accuracy of angiography is unknown. We sought to evaluate the diagnostic accuracy of angiography by visual estimate and by quantitative coronary angiography when compared with FFR and evaluate the influence of risk factors (RF) on this accuracy., Methods and Results: In 1382 coronary stenoses (1104 patients), percent diameter stenosis by visual estimation (DS
VE ) and by quantitative coronary angiography (DSQCA ) was compared with FFR. Patients were divided into 4 subgroups, according to the presence of RFs, and the relationship between DSVE , DSQCA , and FFR was analyzed. Overall, DSVE was significantly higher than DSQCA ( P <0.0001); nonetheless, when examined by strata of DS, DSVE was significantly smaller than DSQCA in mild stenoses, although the reverse held true for severe stenoses. Compared with FFR, a large scatter was observed for both DSVE and DSQCA . When using a dichotomous FFR value of 0.80, C statistic was significantly higher for DSVE than for DSQCA (0.712 versus 0.640, respectively; P <0.001). C statistics for DSVE decreased progressively as RFs accumulated (0.776 for ≤1 RF, 0.750 for 2 RFs, 0.713 for 3 RFs and 0.627 for ≥4 RFs; P =0.0053). In addition, in diabetics, the relationship between FFR and angiographic indices was particularly weak (C statistics: 0.524 for DSVE and 0.511 for DSQCA )., Conclusions: Overall, DSVE has a better diagnostic accuracy than DSQCA to predict the functional significance of coronary stenosis. The predictive accuracy of angiography is moderate in patients with ≤1 RFs, but weakens as RFs accumulate, especially in diabetics., (© 2017 American Heart Association, Inc.)- Published
- 2017
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26. Saline-Induced Coronary Hyperemia: Mechanisms and Effects on Left Ventricular Function.
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De Bruyne B, Adjedj J, Xaplanteris P, Ferrara A, Mo Y, Penicka M, Floré V, Pellicano M, Toth G, Barbato E, Duncker DJ, and Pijls NH
- Subjects
- Blood Flow Velocity drug effects, Coronary Artery Disease diagnosis, Coronary Circulation drug effects, Coronary Vessels diagnostic imaging, Echocardiography, Doppler, Female, Humans, Hyperemia physiopathology, Injections, Intra-Arterial, Male, Middle Aged, Thermodilution methods, Blood Flow Velocity physiology, Coronary Artery Disease physiopathology, Coronary Circulation physiology, Coronary Vessels physiopathology, Microcirculation drug effects, Sodium Chloride administration & dosage, Ventricular Function, Left physiology
- Abstract
Background: During thermodilution-based assessment of volumetric coronary blood flow, we observed that intracoronary infusion of saline increased coronary flow. This study aims to quantify the extent and unravel the mechanisms of saline-induced hyperemia., Methods and Results: Thirty-three patients were studied; in 24 patients, intracoronary Doppler flow velocity measurements were performed at rest, after intracoronary adenosine, and during increasing infusion rates of saline at room temperature through a dedicated catheter with 4 lateral side holes. In 9 patients, global longitudinal strain and flow propagation velocity were assessed by transthoracic echocardiography during a prolonged intracoronary saline infusion. Taking adenosine-induced maximal hyperemia as reference, intracoronary infusion of saline at rates of 5, 10, 15, and 20 mL/min induced 6%, 46%, 111%, and 112% of maximal hyperemia, respectively. There was a close agreement of maximal saline- and adenosine-induced coronary flow reserve (intraclass correlation coefficient, 0.922; P <0.001). The same infusion rates given through 1 end hole (n=6) or in the contralateral artery (n=6) did not induce a significant increase in flow velocity. Intracoronary saline given on top of an intravenous infusion of adenosine did not further increase flow. Intracoronary saline infusion did not affect blood pressure, systolic, or diastolic left ventricular function. Heart rate decreased by 15% during saline infusion ( P =0.021)., Conclusions: Intracoronary infusion of saline at room temperature through a dedicated catheter for coronary thermodilution induces steady-state maximal hyperemia at a flow rate ≥15 mL/min. These findings open new possibilities to measure maximal absolute coronary blood flow and minimal microcirculatory resistance., (© 2017 American Heart Association, Inc.)
- Published
- 2017
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27. Plaque protrusion compromising bioresorbable coronary scaffold patency.
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Floré V, Pellicano M, Adjedj J, Ferrara A, Van Der Steen K, and Bartunek J
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- Absorbable Implants, Blood Vessel Prosthesis, Coronary Angiography, Coronary Vessels pathology, Humans, Male, Middle Aged, Plaque, Atherosclerotic complications, Plaque, Atherosclerotic pathology, Postoperative Complications etiology, Postoperative Complications pathology, Tissue Scaffolds, Tomography, Optical Coherence, Coronary Vessels diagnostic imaging, Percutaneous Coronary Intervention adverse effects, Plaque, Atherosclerotic diagnostic imaging, Postoperative Complications diagnostic imaging
- Published
- 2016
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28. Changes in Implantation Patterns and Therapy Rates of Implantable Cardioverter Defibrillators over Time in Ischemic and Dilated Cardiomyopathy Patients.
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Vandenberk B, Garweg C, Voros G, Floré V, Marynissen T, Sticherling C, Zabel M, Ector J, and Willems R
- Subjects
- Age Distribution, Aged, Belgium epidemiology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Practice Patterns, Physicians' statistics & numerical data, Practice Patterns, Physicians' trends, Prevalence, Prosthesis Implantation statistics & numerical data, Prosthesis Implantation trends, Retrospective Studies, Risk Factors, Survival Rate, Time Factors, Cardiomyopathy, Dilated mortality, Cardiomyopathy, Dilated prevention & control, Defibrillators, Implantable statistics & numerical data, Myocardial Ischemia mortality, Myocardial Ischemia prevention & control, Prosthesis Implantation mortality
- Abstract
Background: Clinical guidelines on implantable cardioverter defibrillator (ICD) therapy changed significantly in the last decades with potential inherent effects on therapy efficacy. We aimed to study therapy rates in time and the association between therapies and mortality., Methods: All patients receiving an ICD, primary and secondary prevention, were included in a single-center retrospective registry. Information on first appropriate and inappropriate therapies was documented. Dates of implant were divided in P1: 1996-2001, P2: 2002-2008, and P3: 2009-2014., Results: A total of 727 patients, 84.9% male-66.4% ischemic cardiomyopathy (ICM)-56% primary prevention-mean follow-up 5.2 ± 4.1 years, were included. There was a shift from secondary to primary prevention indications, from ischemic to non-ICM, and from single chamber to cardiac resynchronization therapy defibrillator devices. The annual 1- and 3-year appropriate shock (AS) rate declined from 29.4% and 15.1% in P1, over 13.3% and 9.2% in P2 to 7.8% and 5.7% in P3 (log-rank P < 0.001), while inappropriate shock (IAS) rates remained unchanged (log-rank P = 0.635). After multivariate regression analysis a higher age at implant, lower left ventricular ejection fraction, history of stroke, diabetes mellitus, intake of loop diuretics or digitalis, higher creatinine, and longer QTc were independent predictors of mortality., Conclusion: These changes in clinical practice with a shift to primary prevention and rise in non-ICM implants caused a significant decrease in AS incidence, while IAS remained stable. Receiving AS or IAS was not an independent predictor of mortality in our real-life cohort., (© 2016 Wiley Periodicals, Inc.)
- Published
- 2016
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29. Significance of Intermediate Values of Fractional Flow Reserve in Patients With Coronary Artery Disease.
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Adjedj J, De Bruyne B, Floré V, Di Gioia G, Ferrara A, Pellicano M, Toth GG, Bartunek J, Vanderheyden M, Heyndrickx GR, Wijns W, and Barbato E
- Subjects
- Aged, Coronary Artery Disease physiopathology, Female, Follow-Up Studies, Humans, Male, Middle Aged, Retrospective Studies, Coronary Artery Disease diagnosis, Coronary Artery Disease therapy, Fractional Flow Reserve, Myocardial physiology, Myocardial Revascularization methods
- Abstract
Background: The fractional flow reserve (FFR) value of 0.75 has been validated against ischemic testing, whereas the FFR value of 0.80 has been widely accepted to guide clinical decision making. However, revascularization when FFR is 0.76 to 0.80, within the so-called gray zone, is still debatable., Methods and Results: From February 1997 to June 2013, all patients with single-segment disease and an FFR value within the gray zone or within the 2 neighboring FFR strata (0.70-0.75 and 0.81-0.85) were included. Study end points consisted of major adverse cardiovascular events (death, myocardial infarction, and any revascularization) up to 5 years. Of 17 380 FFR measurements, 1459 patients were included. Of them, 449 patients were treated with revascularization and 1010 patients were treated with medical therapy. In the gray zone, the major adverse cardiovascular events rate was similar (37 [13.9%] versus 21 [11.2%], respectively; P=0.3) between medical therapy and revascularization, whereas a strong trend toward a higher rate of death or myocardial infarction (25 [9.4] versus 9 [4.8], P=0.06) and overall death (20 [7.5] versus 6 [3.2], P=0.059) was observed in the medical therapy group. Among medical therapy patients, a significant step-up increase in major adverse cardiovascular events rate was observed across the 3 FFR strata, especially with proximal lesion location. In revascularization patients, the major adverse cardiovascular events rate was not different across the 3 FFR strata., Conclusions: FFR in and around the gray zone bears a major prognostic value, especially in proximal lesions. These data confirm that FFR≤0.80 is valid to guide clinical decision making., (© 2016 American Heart Association, Inc.)
- Published
- 2016
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30. Intracoronary Adenosine: Dose-Response Relationship With Hyperemia.
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Adjedj J, Toth GG, Johnson NP, Pellicano M, Ferrara A, Floré V, Di Gioia G, Barbato E, Muller O, and De Bruyne B
- Subjects
- Adenosine adverse effects, Aged, Blood Flow Velocity, Contrast Media administration & dosage, Coronary Artery Disease physiopathology, Coronary Vessels physiopathology, Dose-Response Relationship, Drug, Echocardiography, Doppler, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Regional Blood Flow, Time Factors, Vasodilator Agents adverse effects, Adenosine administration & dosage, Coronary Artery Disease diagnosis, Coronary Circulation drug effects, Coronary Vessels drug effects, Hyperemia physiopathology, Vasodilation drug effects, Vasodilator Agents administration & dosage
- Abstract
Objectives: The present study sought to establish the dosage of intracoronary (IC) adenosine associated with minimal side effects and above which no further increase in flow can be expected., Background: Despite the widespread adoption of IC adenosine in clinical practice, no wide-ranging, dose-response study has been conducted. A recurring debate still exists regarding its optimal dose., Methods: In 30 patients, Doppler-derived flow velocity measurements were obtained in 10 right coronary arteries (RCAs) and 20 left coronary arteries (LCAs) free of stenoses >20% in diameter. Flow velocity was measured at baseline and after 8 ml bolus administrations of arterial blood, saline, contrast medium, and 9 escalating doses of adenosine (4 to 500 μg). The hyperemic value was expressed in percent of the maximum flow velocity reached in a given artery (Q/Qmax, %)., Results: Q/Qmax did not increase significantly beyond dosages of 60 μg for the RCA and 160 μg for LCA. Heart rate did not change, whereas mean arterial blood pressure decreased by a maximum of 7% (p < 0.05) after bolus injections of IC adenosine. The incidence of transient A-V blocks was 40% after injection of 100 μg in the RCA and was 15% after injection of 200 μg in the LCA. The duration of the plateau reached 12 ± 13 s after injection of 100 μg in the RCA and 21 ± 6 s after the injection of 200 μg in the LCA. A progressive prolongation of the time needed to return to baseline was observed. Hyperemic response after injection of 8 ml of contrast medium reached 65 ± 36% of that achieved after injection of 200 μg of adenosine., Conclusions: This wide-ranging, dose-response study indicates that an IC adenosine bolus injection of 100 μg in the RCA and 200 μg in the LCA induces maximum hyperemia while being associated with minimal side effects., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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31. Heart rate turbulence predicts ICD-resistant mortality in ischaemic heart disease.
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Marynissen T, Floré V, Heidbuchel H, Nuyens D, Ector J, and Willems R
- Subjects
- Aged, Body Mass Index, Electric Countershock adverse effects, Electric Countershock mortality, Electrocardiography, Ambulatory, Female, Humans, Kaplan-Meier Estimate, Male, Middle Aged, Multivariate Analysis, Myocardial Ischemia diagnosis, Myocardial Ischemia mortality, Myocardial Ischemia physiopathology, Patient Selection, Predictive Value of Tests, Proportional Hazards Models, Retrospective Studies, Risk Assessment, Risk Factors, Stroke Volume, Tachycardia, Ventricular diagnosis, Tachycardia, Ventricular etiology, Tachycardia, Ventricular mortality, Time Factors, Treatment Failure, Ventricular Function, Left, Defibrillators, Implantable, Electric Countershock instrumentation, Heart Rate, Myocardial Ischemia complications, Tachycardia, Ventricular therapy
- Abstract
Aims: In high-risk patients, implantable cardioverter-defibrillators (ICDs) can convert the mode of death from arrhythmic to pump failure death. Therefore, we introduced the concept of 'ICD-resistant mortality' (IRM), defined as death (a) without previous appropriate ICD intervention (AI), (b) within 1 month after the first AI, or (c) within 1 year after the initial ICD implantation. Implantable cardioverter-defibrillator implantation in patients with a high risk of IRM should be avoided., Methods and Results: Implantable cardioverter-defibrillator patients with ischaemic heart disease were included if a digitized 24 h Holter was available pre-implantation. Demographic, electrocardiographic, echocardiographic, and 24 h Holter risk factors were collected at device implantation. The primary endpoint was IRM. Cox regression analyses were used to test the association between predictors and outcome. We included 130 patients, with a mean left ventricular ejection fraction (LVEF) of 33.6 ± 10.3%. During a follow-up of 52 ± 31 months, 33 patients died. There were 21 cases of IRM. Heart rate turbulence (HRT) was the only Holter parameter associated with IRM and total mortality. A higher New York Heart Association (NYHA) class and a lower body mass index were the strongest predictors of IRM. Left ventricular ejection fraction predicted IRM on univariate analysis, and was the strongest predictor of total mortality. The only parameter that predicted AI was non-sustained ventricular tachycardia., Conclusion: Implantable cardioverter-defibrillator implantation based on NYHA class and LVEF leads to selection of patients with a higher risk of IRM and death. Heart rate turbulence may have added value for the identification of poor candidates for ICD therapy. Available Holter parameters seem limited in their ability to predict AI., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2013. For permissions please email: journals.permissions@oup.com.)
- Published
- 2014
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32. Can body surface microvolt T-wave alternans distinguish concordant and discordant intracardiac alternans?
- Author
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Floré V, Claus P, Symons R, Smith GL, Sipido KR, and Willems R
- Subjects
- Animals, Diagnosis, Differential, Reproducibility of Results, Sensitivity and Specificity, Swine, Algorithms, Arrhythmias, Cardiac diagnosis, Arrhythmias, Cardiac physiopathology, Body Surface Potential Mapping methods, Diagnosis, Computer-Assisted methods
- Abstract
Introduction: There is convincing experimental evidence that cellular action potential duration (APD) alternans is arrhythmogenic but its relationship with body surface microvolt T-wave alternans (MTWA) remains unclear. We investigated the relationship between MTWA and APD alternans induced by alternating cycle length (CL) pacing in a pig model., Methods: In 10 pigs, catheters in the right atrium (RA) and right (RV) and left ventricle (LV) allowed pacing and recording of monophasic action potentials (MAP). During RA pacing at stable 500-ms CL, LV was paced at alternating CL (505 ms and 495 ms). Changing the alternating LV (A-LV) pacing delay changes the size of the region with alternating ventricular activation. Spectral analysis of intracardiac MAP was correlated with body surface MTWA. In a similar setup (during alternating pacing in RV and LV), we investigated concordant versus discordant APD alternans., Results: Pacing the LV with subtle alternating cycle lengths at short A-LV delay leads to broad QRS (97 ± 10 ms), body surface MTWA (mean Valt 4.2 ± 1.8 µV), and positive RR-interval alternans. At longer A-LV delay, not resulting in QRS widening (68 ± 5 ms), body surface RR alternans was absent but MTWA remained detectable and was even more pronounced (8.7 ± 5.1 µV, P < 0.01). During both concordant and discordant pacing MTWA was present. The precordial leads were better for detecting discordant APD alternans (8.0 ± 2.9 µV and 12.8 ± 4.52 µV, P = 0.02)., Conclusion: MTWA is a potent technique to detect subtle and isolated intracardiac APD alternans that is artificially induced by alternating pacing. In the same model, discordant activation alternans can only be discriminated from concordant when using a quantifying approach of MTWA analysis., (©2013, The Authors. Journal compilation ©2013 Wiley Periodicals, Inc.)
- Published
- 2013
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33. A marker of mayhem: macrovolt T-wave alternans preceding polymorphic ventricular tachycardia.
- Author
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Floré V, Van Wijngaerden E, and Willems R
- Subjects
- Aged, Humans, Long QT Syndrome chemically induced, Male, Risk Factors, Tachycardia, Ventricular diagnosis, Unconsciousness etiology, Electrocardiography, Long QT Syndrome diagnosis, Tachycardia, Ventricular etiology
- Published
- 2011
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34. Microvolt T-wave alternans and beat-to-beat variability of repolarization during early postischemic remodeling in a pig heart.
- Author
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Floré V, Claus P, Antoons G, Oosterhoff P, Holemans P, Vos MA, Sipido KR, and Willems R
- Subjects
- Animals, Death, Sudden, Cardiac pathology, Death, Sudden, Cardiac prevention & control, Disease Models, Animal, Electrocardiography, Follow-Up Studies, Magnetic Resonance Imaging, Cine, Myocardial Ischemia physiopathology, Swine, Tachycardia, Ventricular complications, Tachycardia, Ventricular diagnosis, Time Factors, Cardiac Resynchronization Therapy methods, Death, Sudden, Cardiac etiology, Heart Conduction System physiopathology, Heart Rate physiology, Myocardial Ischemia complications, Tachycardia, Ventricular physiopathology, Ventricular Remodeling
- Abstract
Background: Repolarization variability is considered to predict sudden cardiac death. T-wave alternans (TWA) has been the subject of exhaustive research, whereas beat-to-beat variability of repolarization (BVR) is a new parameter that possibly predicts proarrhythmia. How these parameters interact has not been tested., Objective: The purpose of this study was to compare TWA and BVR as predictors of proarrhythmic substrate early after myocardial infarction (MI)., Methods: In nine pigs, MI was induced by 1-hour occlusion of the left anterior descending coronary artery. Cardiac magnetic resonance imaging was performed at day 21. Six sham pigs served as control. Spectral TWA was tested during right atrial pacing before induction of MI and after 21 days. BVR was calculated from 60 consecutive QT intervals., Results: Magnetic resonance imaging showed transmural MI. TWA was negative in all pigs at clinical threshold rate and equally present in MI versus sham pigs at higher rates (170 bpm: 55% vs 50% positive TWA). In MI pigs, BVR of QT intervals increased significantly during acute ischemia (2.44 ± 0.43 ms vs 3.55 ± 0.41 ms, P <.01) and even more on day 21 (5.80 ± 1.12 ms), but it differed significantly from sham (2.14 ± 0.54 ms, P <.01). A clinical ventricular tachycardia induction protocol was positive in 2 of 8 MI pigs and in none of 6 shams., Conclusion: In early remodeling after MI, BVR at intrinsic heart rate was a consistent phenomenon, whereas TWA during atrial pacing or baseline QT-interval changes were not. TWA and BVR could reflect different post-MI remodeling processes. BVR may be a new technique for predicting a potentially proarrhythmic substrate in the early postinfarction period., (Copyright © 2011 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.)
- Published
- 2011
- Full Text
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