TY  - JOUR
AU  - Camaro, C.
AU  - Aengevaeren, W.R.M.
PY  - 2009
UR  - https://hdl.handle.net/2066/79511
AB  - A 66-year-old female was referred for primary coronary intervention because of acute inferior STelevation myocardial infarction. Electrocardiography also showed atrial fibrillation. Coronary angiography showed a distal occlusion of the right coronary artery. Two different wires did not pass the occlusion, but dislodged the apparent thrombus more distally. No abnormalities were seen in the course of the recanalised part of the vessel. The sequential angiographic images together with the presence of atrial fibrillation are highly suggestive of coronary embolism as the cause of the myocardial infarction. Anticoagulation and rate control strategy was initiated. The patient was discharged in good condition. (Neth Heart J 2009;17:297-9.).
TI  - Acute myocardial infarction due to coronary artery embolism in a patient with atrial fibrillation.
EP  - 299
SN  - 1568-5888
IS  - iss. 7-8
SP  - 297
JF  - Netherlands Heart Journal
VL  - vol. 17
DO  - http://dx.doi.org/10.1007/BF03086271
ER  - 
TY  - JOUR
AU  - Bergh, P.J.P.C. van den
AU  - Kievit, P.C.
AU  - Brouwer, M.A.
AU  - Aengevaeren, W.R.M.
AU  - Veen, G.
AU  - Verheugt, F.W.A.
PY  - 2009
UR  - https://hdl.handle.net/2066/81815
AB  - BACKGROUND: Long-term addition of antithrombotics (clopidogrel, anticoagulants) to aspirin has improved outcome after acute coronary syndromes. Data on the impact after fibrinolysis are scarce. In Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis-2 (APRICOT-2), adjunctive moderate-intensity coumarin (median international normalized ratio 2.6) conferred a marked reduction in 3-month reocclusion and ischemic events. Given the association between reocclusion and long-term outcome, we performed long-term clinical follow-up. METHODS: Patients with thrombolysis in myocardial infarction (TIMI) 3 flow <48 hours after fibrinolysis for ST-elevation myocardial infarction were randomized to aspirin plus coumarin, with prolonged heparinization until the target international normalized ratio (2-3) was reached, or aspirin with standard heparinization. Three-month follow-up angiography (reocclusion rates 15% vs 28%) and long-term clinical follow-up (median 7.3 years, interquartile range 5.9-8.6 years) were performed. RESULTS: Patients randomized to adjunctive anticoagulation (n = 123) received coumarin for a median of 280 days (113-387 days). Survival was 94% versus 88% in patients on aspirin alone (n = 128, P = .12). Infarct-free survival was 86% versus 71% (P = .01). Thrombolysis in myocardial infarction bleeding was 4% in both groups. Patients with reocclusion had impaired survival: 80% versus 94% (P < .01). In a multivariable model without reocclusion, combination therapy independently predicted survival (hazard ratio [HR] 0.36, 95% confidence interval [CI] 0.13-1.00) and infarct-free survival (HR 0.51, 95% CI 0.28-0.95). When adjusted for reocclusion, combination therapy did not predict outcome. Reocclusion independently predicted death (HR 2.56, 95% CI 1.02-6.43) and reinfarction. CONCLUSIONS: Moderate-intensity oral anticoagulation added to aspirin improved 8-year clinical outcome after successful fibrinolysis. The beneficial effect was largely attributed to a reduction in reocclusion, which independently predicted death and reinfarction. This study provides a mechanistic rationale for prolonged adjunctive anticoagulation after fibrinolysis.
TI  - Prolonged anticoagulation therapy adjunctive to aspirin after successful fibrinolysis: from early reduction in reocclusion to improved long-term clinical outcome.
EP  - 540
SN  - 0002-8703
IS  - iss. 3
SP  - 532
JF  - American Heart Journal
VL  - vol. 157
DO  - https://doi.org/10.1016/j.ahj.2008.11.008
ER  - 
TY  - JOUR
AU  - Kievit, P.C.
AU  - Brouwer, M.A.
AU  - Veen, G.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
PY  - 2009
UR  - https://hdl.handle.net/2066/81178
AB  - BACKGROUND: In smokers treated with fibrinolysis for ST-elevation myocardial infarction (STEMI) a paradoxical beneficial short-term outcome has been reported. This was attributed to favorable clinical and angiographic baseline variables and a better response to fibrinolysis. During follow-up infarct artery reocclusion is an important prognosticator. We studied the effects of smoking on reocclusion and long-term cardiac outcome after successful fibrinolysis. METHODS: In the Antithrombotics in the Prevention of Reocclusion In COronary Thrombolysis trials (APRICOT-1 and -2) 499 STEMI patients with an open infarct artery <48 h after fibrinolysis received randomized antithrombotic treatment until 3-month follow-up angiography. Five-year clinical follow-up was complete. RESULTS: Current smokers (317 patients, 64%) had favorable clinical (age 54 vs. 60 years, P < 0.01) and angiographic (single vessel disease 61% vs. 49%, P = 0.02) baseline characteristics. Reocclusion rates were 21% (67/317) in smokers versus 32% (59/182) in non-smokers (P < 0.01). Five-year infarct-free cardiac survival did not differ: 82% vs. 85%. Reocclusion (HR 2.41, 95%CI 1.05-5.56, P = 0.04) independently predicted cardiac mortality. Smoking was independently associated with a reduced risk of reocclusion (OR 0.58, 95%CI 0.37-0.91, P = 0.02), but not with improved 5-year cardiac outcome (HR 1.34, 95%CI 0.79-2.25, P = ns). CONCLUSIONS: After successful fibrinolysis, smoking is independently associated with a more than 40% reduced risk of reocclusion, which is an independent predictor of adverse outcome. However, even with more favorable baseline characteristics smokers did not have improved 5-year cardiac outcome in this low-risk population.
TI  - The smoker's paradox after successful fibrinolysis: reduced risk of reocclusion but no improved long-term cardiac outcome.
EP  - 393
SN  - 0929-5305
IS  - iss. 4
SP  - 385
JF  - Journal of Thrombosis and Thrombolysis
VL  - vol. 27
DO  - https://doi.org/10.1007/s11239-008-0238-6
ER  - 
TY  - JOUR
AU  - Schiks, I.E.J.M.
AU  - Schoonhoven, L.
AU  - Aengevaeren, W.R.M.
AU  - Nogarede-Hoekstra, C.
AU  - Achterberg, T. van
AU  - Verheugt, F.W.A.
PY  - 2009
UR  - https://hdl.handle.net/2066/79970
AB  - AIM AND OBJECTIVES: To investigate if ambulation four hours after sheath removal can replace ambulation 10 hours or more after sheath removal with regard to puncture site complications after percutaneous coronary interventions and to examine patient comfort in both groups. BACKGROUND: Early ambulation after percutaneous coronary intervention may facilitate earlier hospital discharge. Whether this approach is safe, is unknown. DESIGN: A non-randomised comparative study. METHODS: Percutaneous coronary intervention was performed by femoral approach. Registered nurses of the ward removed the sheath and haemostasis was achieved by manual compression. After bed rest with a compression bandage for four hours, the patients in the early ambulation group were ambulated. The patients in the control group stayed in bed till the next morning. Primary study endpoint was the composition of puncture site complications: haematoma, bleeding, false aneurysm and arteriovenous fistula. Secondary endpoints were occurrence of vasovagal collapse after mobilisation, back pain and problems with voiding. RESULTS: In the early ambulation group (n = 329) the total number of complications was nine (2.7%), vs. six (3.0%) in the control group (n = 202). The complication rate in the early ambulation group is not increased compared to the control group (test for non-inferiority p = 0.002). Hence non-inferiority is accepted and practical equivalence shown. There were no statistically significant differences concerning patient comfort between the groups. CONCLUSIONS: Early ambulation four hours after femoral sheath removal is feasible and safe. The incidence of puncture site complications in the early ambulation group is not increased in comparison with the group with prolonged bed rest. RELEVANCE TO CLINICAL PRACTICE: Patients could possibly be discharged earlier after percutaneous coronary intervention, allowing percutaneous coronary intervention in an ambulant setting. Further research should confirm these findings and extend the research to the effect of various closure devices in early ambulation and on patients' well-being.
TI  - Ambulation after femoral sheath removal in percutaneous coronary intervention: a prospective comparison of early vs. late ambulation.
EP  - 1870
SN  - 0962-1067
IS  - iss. 13
SP  - 1862
JF  - Journal of Clinical Nursing
VL  - vol. 18
DO  - https://doi.org/10.1111/j.1365-2702.2008.02587.x
ER  - 
TY  - JOUR
AU  - Gunal, A.
AU  - Aengevaeren, W.R.M.
AU  - Gehlmann, H.R.
AU  - Luijten, J.E.
AU  - Bos, J.S.
AU  - Verheugt, F.W.A.
PY  - 2008
UR  - https://hdl.handle.net/2066/71532
AB  - BACKGROUND: While percutaneous coronary intervention (PCI) is increasingly being performed in octogenarians, little is known about the quality of life (QOL) one year after PCI. We assessed the one-year outcome and QOL after PCI. METHODS: Outcome and QOL at one year were assessed in patients of 80 years and older who underwent PCI at our institution. We used the RAND-36 Health Survey to assess health-related QOL at follow-up. The EuroSCORE was used for reference risk assessment. RESULTS: Ninety-eight patients (mean age 82.7+/-2.9 years; 60% female) underwent PCI. Acute PCI was performed in 36% of the patients. Canadian Cardiovascular Society (CCS) angina class before the procedure was class III for 28% and class IV for 64%. Of the patients, 98% were in the highest-risk group (additive EuroSCORE 6+). The overall PCI success rate was 94%. Mortality at one year was 19% (38% acute vs. 12% elective PCI). At followup, general health was rated as fairly good and better then before PCI (CCS I and II: 77%). RAND-36 scores for the mental component were better than scores for the physical component. Physical functioning (41+/-28) and role limitations caused by physical health problems (32+/-37) had the worst scores. The mental component vitality had the lowest (55+/-20) and mental health the highest (70+/-21) score. Social functioning was in general good (67+/-26). CONCLUSION: Octogenarians have a high mortality risk following PCI, especially in acute PCI. In survivors QOL is acceptable with a better mental than physical score. In general, PCI in octogenarians has a positive effect on health perception, with less symptoms of angina pectoris. (Neth Heart J 2008;16:117-22.).
TI  - Outcome and quality of life one year after percutaneous coronary interventions in octogenarians.
EP  - 122
SN  - 1568-5888
IS  - iss. 4
SP  - 117
JF  - Netherlands Heart Journal
VL  - vol. 16
ER  - 
TY  - JOUR
AU  - Gilles, R.
AU  - Veldman, B.A.J.
AU  - Aengevaeren, W.R.M.
AU  - Schultze Kool, L.J.
AU  - Oort, A.M. van
AU  - Lenders, J.W.M.
PY  - 2008
UR  - https://hdl.handle.net/2066/69176
AB  - Two adult patients with presumed primary hypertension are presented. In the first patient the diagnosis of coarctation of the aorta was straightforward while in the second patient there was a substantial delay in reaching the correct diagnosis. A 32-year-old patient was analysed for hypertension in the outpatient clinic. At physical examination a systolic cardiac murmur was present and leg blood pressure was not measurable. Magnetic resonance imaging angiography showed a severe coarctation of the thoracic aorta with extensive distended collateral blood vessels. A second patient was a 31-year-old man referred with longstanding hypertension and an unsatisfactory blood pressure response to treatment. Previously, a diagnosis of primary hypertension was made. Renal computed tomography angiography excluded renal artery stenosis as a cause of hypertension but disclosed many distended collateral blood vessels in the musculus rectus abdominis and in the upper abdominal area. Leg blood pressure was measured and further analysis revealed a coarctation of the aorta. Both patients illustrate and emphasise the importance of leg blood pressure measurement at a first analysis of adult hypertensive patients and should always be performed when hypertension is accompanied by murmurs or weak femoral pulsations.
TI  - Measurement of leg blood pressure: the most straightforward way to the diagnosis.
EP  - 84
SN  - 0300-2977
IS  - iss. 2
SP  - 81
JF  - Netherlands Journal of Medicine
VL  - vol. 66
ER  - 
TY  - JOUR
AU  - Hashimi, H.M. Al
AU  - Wardeh, A.J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
PY  - 2007
UR  - https://hdl.handle.net/2066/53702
TI  - Percutaneous closure of an adult patent ductus arteriosus.
EP  - 197
SN  - 1568-5888
IS  - iss. 5
SP  - 196
JF  - Netherlands Heart Journal
VL  - vol. 15
ER  - 
TY  - JOUR
AU  - Schiks, I.E.J.M.
AU  - Schoonhoven, L.
AU  - Verheugt, F.W.A.
AU  - Aengevaeren, W.R.M.
AU  - Achterberg, T. van
PY  - 2007
UR  - https://hdl.handle.net/2066/51526
AB  - BACKGROUND: Sheath removal after PCI by registered nurses can improve patients' comfort and shorten immobilisation time. As sheath removal is not without risk, it is important to assure the quality of performance. AIMS: The aim was (a) to check if nurses' performance in 1999 and 2005 was in accordance with the protocol for arterial sheath removal and (b) to compare both measurements to explore differences in performance over time. METHODS: We trained registered nurses in sheath removal and observed them during sheath removal in elective uncomplicated PCI-patients. We developed and used a checklist, including 10 elements and 65 items. RESULTS: Both in 1999 (n=43 observations with 13 nurses) and 2005 (n=42 observations with 16 nurses) the norm of more than 90% for the total score was not achieved: we found 82% and 80%, respectively. Four elements scored more than 90%, and three elements scored less than 80% at both points in time. The results on the other three elements differed significantly over time. CONCLUSION: Registered nurses achieved the norm for good performance (80-89%) of removing arterial sheaths according to protocol after a training programme and this is stable in time. Since the norm for excellent performance (> or =90%) was not achieved, current performance could be improved, e.g. by yearly repetition of training and observation of skills. More research is needed, and could focus on the validation of the instrument. Also multi-centre studies with this checklist could test the association between the quality of arterial femoral sheath removal and the occurrence of vascular complications.
TI  - Performance evaluation of arterial femoral sheath removal by registered nurses after PCI.
EP  - 177
SN  - 1474-5151
IS  - iss. 3
SP  - 172
JF  - European Journal of Cardiovascular Nursing
VL  - vol. 6
ER  - 
TY  - JOUR
AU  - Dieker, H.J.
AU  - Horssen, E.V. van
AU  - Hersbach, F.M.
AU  - Brouwer, M.A.
AU  - Boven, A.J. van
AU  - Hof, A.W. van 't
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
AU  - Bar, F.W.
PY  - 2006
UR  - https://hdl.handle.net/2066/49828
AB  - AIMS: As of to date, the only large transportation trial comparing on-site fibrin-specific thrombolysis with transfer for primary angioplasty in patients presenting in a referral centre is the DANAMI-2 trial, with only 3% rescue angioplasty. The Holland Infarction Study (HIS) compared abciximab facilitated primary angioplasty (FP) with on-site fibrin-specific thrombolytic therapy (TT) with a liberal protocol-driven rescue angioplasty (transport to intervention centre in case < 50% ST resolution at 60 min). METHODS AND RESULTS: Patients in a referral centre without shock and < 4.5 h of chest pain presenting with ST-elevation having > or = 12 mm ST-segment shift were randomised to either strategy. Of the originally planned 900 patients only 48 were included due to suspension of financial funding. Death, recurrent MI and stroke at one year was 8% for the FP-group and 22% for the TT-group (p = 0.2). Two hours after randomisation the rates of complete ST-segment resolution (> or =70%) were 52% and 35%, respectively (p = 0.2). CONCLUSION: This prematurely discontinued randomised transportation trial shows favorable trends with respect to long-term clinical outcome and early ST-resolution for abciximab facilitated primary angioplasty. In view of the real world delays associated with interhospital transport for primary angioplasty, treatment strategies focusing on early fibrin-specific lysis with a liberal selective rescue policy are warranted.
TI  - Transport for abciximab facilitated primary angioplasty versus on-site thrombolysis with a liberal rescue policy: the randomised Holland Infarction Study (HIS).
EP  - 45
SN  - 0929-5305
IS  - iss. 1
SP  - 39
JF  - Journal of Thrombosis and Thrombolysis
VL  - vol. 22
DO  - http://dx.doi.org/10.1007/s11239-006-7731-6
ER  - 
TY  - JOUR
AU  - Remmen, J.J.
AU  - Jansen, R.W.M.M.
AU  - Aengevaeren, W.R.M.
AU  - Brouwer, M.A.
AU  - Verheugt, F.W.A.
PY  - 2006
UR  - https://hdl.handle.net/2066/49300
TI  - Prognostic implications of the blood pressure response to the Valsalva manoeuvre in elderly cardiac patients.
EP  - 1328
SN  - 1355-6037
IS  - iss. 9
SP  - 1327
JF  - Heart
VL  - vol. 92
DO  - https://doi.org/10.1136/hrt.2005.078386
ER  - 
TY  - JOUR
AU  - Remmen, J.J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
AU  - Jansen, R.W.M.M.
PY  - 2006
UR  - https://hdl.handle.net/2066/49614
AB  - In the present study, we assessed whether elevated (> or =15 mmHg) PCWP (pulmonary capillary wedge pressure) can be detected using the blood pressure response to the Valsalva manoeuvre in a group of elderly patients with various cardiac disorders, including atrial fibrillation and valvular heart disease, and healthy elderly controls. The Valsalva manoeuvre was performed in 93 patients (71+/-4 years) and 28 healthy controls (70+/-4 years) undergoing right-sided cardiac catheterization. Blood pressure was measured non-invasively with Finapres. PPR (pulse pressure ratio), the ratio of minimum pulse pressure during phase 2 and maximum pulse pressure during phase 1 of the Valsalva manoeuvre, was correlated with PCWP (r=0.63, P<0.001). The area under the receiver operator characteristic curve of PPR with elevated PCWP was 0.85 (P<0.001). For PPR=0.62, sensitivity for elevated PCWP was 80%, specificity was 79%, positive predictive value was 76% and negative predictive value was 83%. Correlation of PPR with PCWP and the ability of PPR to detect elevated PCWP was present in atrial fibrillation, heart failure and valvular heart disease. In conclusion, PPR is a sensitive and specific instrument to diagnose elevated PCWP non-invasively in a large group of elderly patients with various cardiac disorders. This makes the Valsalva manoeuvre a useful non-invasive tool for diagnosing heart failure, applicable in elderly patients with common cardiac disorders, such as atrial fibrillation and valvular heart disease.
TI  - Detection of elevated pulmonary capillary wedge pressure in elderly patients with various cardiac disorders by the Valsalva manoeuvre.
EP  - 162
SN  - 0143-5221
IS  - iss. 2
SP  - 153
JF  - Clinical Science
VL  - vol. 111
DO  - https://doi.org/10.1042/CS20050372
ER  - 
TY  - JOUR
AU  - Verheugt, F.W.A.
AU  - Dieker, H.J.
AU  - Aengevaeren, W.R.M.
PY  - 2005
UR  - https://hdl.handle.net/2066/48318
AB  - Antithrombotic therapy is essential during percutaneous coronary interventions for the prevention of peri-procedural death and myocardial infarction. The most commonly used agents are aspirin, clopidogrel and heparin in patients treated by percutaneous angioplasty or receiving an arterial stent. Glycoprotein IIb/IIIa receptor antagonists such as abciximab are indicated during percutaneous interventions in high-risk-patients as well as, in principle, in all patients with an acute coronary syndrome with ST-segment elevation undergoing primary percutaneous angioplasty. In patients with so-called drug-eluting stents, clopidogrel should be continued for several months longer than the usual 30 days.
TI  - [Antithrombotic therapy during percutaneous coronary interventions]
J2  - [Antithrombotic therapy during percutaneous coronary interventions]
EP  - 916
SN  - 0028-2162
IS  - iss. 17
SP  - 912
JF  - Nederlands Tijdschrift voor Geneeskunde
VL  - vol. 149
ER  - 
TY  - JOUR
AU  - Neumann, F.J.
AU  - Desmet, W.
AU  - Grube, E.
AU  - Brachmann, J.
AU  - Presbitero, P.
AU  - Rubartelli, P.
AU  - Mugge, A.
AU  - Pede, F. Di
AU  - Fullgraf, D.
AU  - Aengevaeren, W.R.M.
AU  - Spedicato, L.
AU  - Popma, J.J.
PY  - 2005
UR  - https://hdl.handle.net/2066/48353
AB  - BACKGROUND: In-stent restenosis is notoriously difficult to treat by repeat catheter intervention because of its propensity for aggressive recurrent neointimal formation. This study sought to assess the effectiveness and safety of the sirolimus-eluting stent in the treatment of in-stent restenosis. METHODS AND RESULTS: The study was designed as a prospective multicenter registry. We included 162 patients with in-stent restenosis of a native coronary artery who had a clinical indication for repeat intervention. Patients were scheduled for follow-up angiography at 6 months. The primary end point was in-lesion late loss. Follow-up angiography was performed in 155 patients. We obtained an in-lesion late loss of 0.08+/-0.49 mm and a binary restenosis rate of 9.7% (15/155), which prompted reintervention in 7.4% (12/162) at 9 months. The 9-month rate of death was 1.2% (2/162) and that of nonfatal myocardial infarction was 1.2% (2/162). CONCLUSIONS: Sirolimus-eluting stents were highly efficacious and safe in the treatment of in-stent restenosis. Our study provides rationale for the use of sirolimus-eluting stents in the treatment of in-stent restenosis.
TI  - Effectiveness and safety of sirolimus-eluting stents in the treatment of restenosis after coronary stent placement.
EP  - 2111
SN  - 0009-7322
IS  - iss. 16
SP  - 2107
JF  - Circulation
VL  - vol. 111
DO  - https://doi.org/10.1161/01.CIR.0000162467.53001.6B
ER  - 
TY  - JOUR
AU  - Remmen, J.J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
AU  - Jansen, R.W.M.M.
PY  - 2005
UR  - https://hdl.handle.net/2066/48984
AB  - The blood pressure response to the Valsalva manoeuvre is related to pulmonary capillary wedge pressure (PCWP) and can be used to diagnose heart failure. However, this has never been studied specifically in the elderly, in whom the prevalence of heart failure is highest. Furthermore, normal values of the Valsalva manoeuvre are lacking. We aimed to obtain normal values of PCWP and the blood pressure response to the Valsalva manoeuvre in elderly subjects. Therefore, 28 healthy subjects, aged 70 +/- 4 years, performed Valsalva manoeuvres before and after anti-G garment inflation, which was used for temporary increase of PCWP. Before inflation, PCWP was 9.8 +/- 1.9 mmHg in supine and 8.9 +/- 2.1 in semi-recumbent position. From the blood pressure response, measured with Finapres, the systolic blood pressure ratio (SBPR), pulse pressure ratio (PPR), stroke volume ratio (SVR) and heart rate ratio (HRR) were calculated. In supine position, SBPR was 0.76 +/- 0.11, PPR 0.51 +/- 0.16, SVR 0.42 +/- 0.11, and HRR 1.17 +/- 0.12. Semi-recumbently, SBPR was 0.74 +/- 0.10, PPR 0.46 +/- 0.14, SVR 0.41 +/- 0.10, and HRR 1.24 +/- 0.23. After inflation of the anti-G garment, the areas under the Receiver Operator Characteristics curves of SBPR, PPR and SVR for elevated (> or = 15 mmHg) PCWP were >0.85 in supine position. In conclusion, this is the first study to obtain normal values of the blood pressure response to the Valsalva manoeuvre and PCWP in healthy elderly subjects, which is essential for the interpretation of patient data. The Valsalva manoeuvre showed significant discriminatory power in the detection of elevated PCWP, which underscores its potential in the non-invasive diagnosis of heart failure.
TI  - Normal values of pulmonary capillary wedge pressure and the blood pressure response to the Valsalva manoeuvre in healthy elderly subjects.
EP  - 326
SN  - 1475-0961
IS  - iss. 6
SP  - 318
JF  - Clinical Physiology and Functional Imaging
VL  - vol. 25
DO  - https://doi.org/10.1111/j.1475-097X.2005.00630.x
ER  - 
TY  - JOUR
AU  - Remmen, J.J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
AU  - Bos, A.
AU  - Jansen, R.W.M.M.
PY  - 2005
UR  - https://hdl.handle.net/2066/48718
AB  - In a study on non-invasive assessment of pulmonary capillary wedge pressure (PCWP), we sought a method to increase PCWP non-invasively. We hypothesized that inflation of an anti-G garment was suitable to increase PCWP non-invasively in healthy elderly subjects. In 20 subjects, aged 70 +/- 4 years (mean +/- SD), before, immediately after, and 4 min after anti-G garment inflation to 52 mmHg, PCWP and mean pulmonary artery pressure (MPAP) were measured with a Swan-Ganz catheter, and mean arterial blood pressure (MAP) with Finapres, in supine and semi-recumbent position. Supine, PCWP (mmHg, mean +/- SD) increased from 9.9 +/- 2.1 to 15.5 +/- 3.9** immediately after inflation and 13.4 +/- 3.7** at 4 min; semi-recumbent from 8.9 +/- 2.0 to 17.5 +/- 3.3** and 14.7 +/- 2.9** (*P<0.05, **P< 0.001 versus before inflation). MPAP (mmHg) increased after inflation: supine 16.9 +/- 2.3 to 22.3 +/- 4.6** and 20.6 +/- 3.9** and semi-recumbent 15.7 +/- 2.8 to 24.3 +/- 5.1** and 22.5 +/- 3.5**, suggesting that increased preload was the primary effect of anti-G garment inflation. Supine MAP (mmHg) increased from 96.0 +/- 11.3 to 101.4 +/- 13.4** and 100.5 +/- 12.7* and semi-recumbent from 102.0 +/- 8.9 to 108.3 +/- 11.4** and 106.0 +/- 11.3*, suggesting an effect of increased afterload as well. The latter was supported by an increase in total peripheral resistance (d s cm(-5)) from 1346 +/- 299 to 1441 +/- 384 after 4 min (P = 0.057) and from 1461 +/- 341 to 1532 +/- 406 (P = 0.054), supine and semi-recumbent respectively, while cardiac output remained unchanged. Complications did not occur. We conclude that in healthy elderly subjects, anti-G garment inflation is a safe, non-invasive, method to induce a significant increase in PCWP. Our findings justify its application in future studies in which non-invasive temporary increase in PCWP is required.
TI  - Lower body positive pressure by anti-G garment inflation: a suitable method to increase pulmonary capillary wedge pressure in healthy elderly subjects.
EP  - 33
SN  - 1475-0961
IS  - iss. 1
SP  - 27
JF  - Clinical Physiology and Functional Imaging
VL  - vol. 25
DO  - https://doi.org/10.1111/j.1475-097X.2004.00582.x
ER  - 
TY  - JOUR
AU  - Barbato, E.
AU  - Aarnoudse, W.
AU  - Aengevaeren, W.R.M.
AU  - Werner, G.
AU  - Klauss, V.
AU  - Bojara, W.
AU  - Herzfeld, I.
AU  - Oldroyd, K.G.
AU  - Pijls, N.H.
AU  - Bruyne, B. de
PY  - 2004
UR  - https://hdl.handle.net/2066/59099
AB  - BACKGROUND: Coronary flow reserve (CFR) and fractional flow reserve (FFR) provide complementary information on the coronary circulation. Using a pressure wire, it is possible to calculate CFR by thermodilution (CFR(thermo)), so that FFR and CFR can be measured with a single guide wire. The present multicentric study was performed to compare the feasibility of CFR(thermo)obtained with an improved algorithm and a standardized injection technique and its agreement with Doppler-derived CFR (CFR(Doppler)). METHODS AND RESULTS: In 86 patients with coronary artery disease recruited during 1 week in eight centres FFR, CFR(thermo)and CFR(Doppler)were measured. FFR could be obtained in all patients (100%). An optimal CFR(Doppler)could be obtained in 69% of the patients. CFR(thermo)could be obtained in 97% of the patients. A significant correlation was found between CFR(Doppler)and CFR(thermo)(r=0.79, P<0.0001) but CFR(thermo)tended to be higher than CFR(Doppler). CONCLUSIONS: In a setting close to 'real world' practice, this multicentric study confirms the feasibility and reliability of thermodilution-derived CFR. In addition, the safety and the swiftness of assessing FFR and CFR with one single guide wire makes the latter a unique clinical tool for the evaluation of the coronary circulation.
TI  - Validation of coronary flow reserve measurements by thermodilution in clinical practice.
EP  - 223
SN  - 0195-668X
IS  - iss. 3
SP  - 219
JF  - European Heart Journal
VL  - vol. 25
ER  - 
TY  - JOUR
AU  - Sick, P.B.
AU  - Gelbrich, G.
AU  - Kalnins, U.
AU  - Erglis, A.
AU  - Bonan, R.
AU  - Aengevaeren, W.R.M.
AU  - Elsner, D.
AU  - Lauer, B.
AU  - Woinke, M.
AU  - Brosteanu, O.
AU  - Schuler, G.
PY  - 2004
UR  - https://hdl.handle.net/2066/57936
AB  - The long-term success of coronary interventions with stents is largely determined by the development of restenosis. The aim of this study was to compare a Carbofilm-coated and a pure stainless steel stent with regard to early and late adverse events. In this prospective, randomized trial, the Carbofilm-coated Carbostent and Sirius stent (same stent design, newly developed delivery system) were compared with the stainless steel stents S660, S670, and S7 (newly developed delivery system, same principal stent design with a few changes). The primary end point was relative late luminal loss, and secondary end points were diameter stenosis at 6 months, rate of restenosis, and major adverse cardiac events (MACEs) (myocardial infarction, reintervention, and death). From March 2000 to June 2002 at 18 centers in Canada and Europe, 420 patients were randomized. Relative late luminal loss (Carbofilm 28.9 +/- 23.0% vs stainless steel 26.7 +/- 20.2%, p = 0.95) as the primary end point, absolute late luminal loss (1.00 +/- 0.72 vs 0.93 +/- 0.62 mm, p = 0.95), net gain (1.32 +/- 0.82 vs 1.40 +/- 0.74 mm, p = 0.75), and the degree of stenosis (40.7 +/- 22.9% vs 38.0 +/- 20.1%, p = 0.92), as well as restenosis rates (23.5% vs 15.9%, p = 0.09) and MACEs (20.1% vs 13.7%, p = 0.11) were not significantly different. Thus, the Carbofilm coating of stents does not lead to an improvement in angiographic results or a reduction of restenosis rate and MACEs. These results agree with other trials using inactive coatings on stents, which also could not demonstrate any advantage over pure stainless steel stents.
TI  - Comparison of early and late results of a Carbofilm-coated stent versus a pure high-grade stainless steel stent (the Carbostent-Trial).
EP  - 6, A5
SN  - 0002-9149
IS  - iss. 11
SP  - 1351
JF  - American Journal of Cardiology
VL  - vol. 93
DO  - https://doi.org/10.1016/j.amjcard.2004.02.029
ER  - 
TY  - JOUR
AU  - Schiks, I.E.J.M.
AU  - Nogarede-Hoekstra, J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
AU  - Achterberg, T. van
PY  - 2004
UR  - https://hdl.handle.net/2066/58745
TI  - Controlled comparison of early versus late ambulation after femoral sheath removal in coronary angioplasty.
EP  - 24
SN  - 0195-668X
IS  - iss. (suppl)
SP  - 24
JF  - European Heart Journal
VL  - vol. 25
ER  - 
TY  - JOUR
AU  - Willems, F.F.
AU  - Boers, G.H.J.
AU  - Blom, H.J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
PY  - 2004
UR  - https://hdl.handle.net/2066/57125
AB  - 1. Methylenetetrahydrofolate reductase (MTHFR) is a regulating enzyme in folate-dependant homocysteine remethylation, because it catalyses the reduction of 5,10 methylenetetrahydrofolate to 5-methyltetrahydrofolate (5-MTHF). 2. Subjects homozygous for the 677C --> T mutation in the MTHFR enzyme suffer from an increased cardiovascular risk. It can be speculated that the direct administration of 5-MTHF instead of folic acid can facilitate the remethylation of homocysteine in methionine. 3. The aim of this study was to determine the pharmacokinetic properties of orally administered 6[R,S] 5-MTHF versus folic acid in cardiovascular patients with homozygosity for 677C --> T MTHFR. 4. This is an open-controlled, two-way, two-period randomised crossover study. Patients received a single oral dose of either 5 mg folic acid or 5 mg 5-MTHF in each period. The concentrations of the 6[S] 5-MTHF and 6[R] 5-MTHF diastereoisomers were determined in venous blood samples. 5. All pharmacokinetic parameters demonstrate that the bioavailability of 5-MTHF is higher compared to folic acid. The peak concentration of both isomers following the administration of 6[R,S] 5-MTHF is almost seven times higher compared to folic acid, irrespective of the patient's genotype. However, at 1 week after the administration of a single dosage 6[R,S] 5-MTHF, we detected 6[R] 5-MTHF following the administration of folic acid, indicating storage of this isomer in the body. 6. Our results demonstrate that oral 5-MTHF has a different pharmacokinetic profile with a higher bioavailability compared to folic acid, irrespective of the patient's genotype. Detrimental effects of the storage of high levels of the non-natural isomer 6[R] 5-MTHF cannot be excluded.
TI  - Pharmacokinetic study on the utilisation of 5-methyltetrahydrofolate and folic acid in patients with coronary artery disease.
EP  - 830
SN  - 0007-1188
IS  - iss. 5
SP  - 825
JF  - British Journal of Pharmacology
VL  - vol. 141
DO  - https://doi.org/10.1038/sj.bjp.0705446
ER  - 
TY  - JOUR
AU  - Verheugt, F.W.A.
AU  - Lamfers, E.J.P.
AU  - Aengevaeren, W.R.M.
PY  - 2003
UR  - https://hdl.handle.net/2066/165072
AB  - Although fibrinolytic therapy for acute myocardial infarction is widely used and can be administered prior to hospitalisation, it is only successful in restoring full early coronary patency in about 60% of patients and has a 0.5% to 1% risk of severe side effects. Primary percutaneous coronary angioplasty carried out as an alternative to fibrinolysis avoids the risk of fibrinolytic therapy and restores patency in nearly 90% of cases. Data from randomised trials of primary angioplasty versus fibrinolytic therapy in acute myocardial infarction reveal that angioplasty results in a significant reduction in mortality. Furthermore, primary angioplasty can be improved by means of a new pre-angioplasty drug therapy (so-called facilitated primary angioplasty). Transport to a cardiac centre for primary angioplasty (of which there are 14 in the Netherlands) is feasible and safe. Although the time to treatment is delayed by a further 90 minutes, it tends to save lives and prevent strokes and it also significantly reduces the incidence of reinfarction. Interestingly, the time gained to treatment with prehospital fibrinolytic therapy compared to in-hospital therapy gave an outcome similar to that found upon comparing transport and primary angioplasty. Rescue procedures (angioplasty) within 24 hours are necessary in about 30% of patients who are initially treated with lytic therapy. These results support prehospital triage for fibrinolysis or transport to a cardiac centre, where early angioplasty can be performed if clinically indicated. A trial to determine the policy of choice is at present being conducted in the Netherlands.
TI  - [Reperfusion therapy for patients with an acute myocardial infarct with ST-segment elevation: fibrinolysis versus transport to a cardiac center for primary angioplasty]
EP  - 2004
SN  - 0028-2162
IS  - iss. 41
SP  - 2001
JF  - Nederlands Tijdschrift voor Geneeskunde
VL  - vol. 147
ER  - 
TY  - JOUR
AU  - Remmen, J.J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
AU  - Werf, T. van der
AU  - Luijten, J.E.
AU  - Bos, A.
AU  - Jansen, R.W.M.M.
PY  - 2003
UR  - https://hdl.handle.net/2066/186445
TI  - Tracking of cardiac output from arterial pulse wave : authors' reply.
SN  - 0143-5221
SP  - 240
JF  - Clinical Science
VL  - vol. 104
ER  - 
TY  - JOUR
AU  - Brouwer, M.A.
AU  - Bergh, P.J.P.C. van den
AU  - Vromans, R.P.J.W.
AU  - Aengevaeren, W.R.M.
AU  - Veen, G.
AU  - Hertzberger, D.P.
AU  - Boven, A.J. van
AU  - Uijen, G.J.H.
AU  - Verheugt, F.W.A.
AU  - Luijten, J.E.
PY  - 2002
UR  - https://hdl.handle.net/2066/185256
AB  - BACKGROUND: Despite the use of aspirin, reocclusion of the infarct-related artery occurs in approximately 30% of patients within the first year after successful fibrinolysis, with impaired clinical outcome. This study sought to assess the impact of a prolonged anticoagulation regimen as adjunctive to aspirin in the prevention of reocclusion and recurrent ischemic events after fibrinolysis for ST-elevation myocardial infarction. METHODS AND RESULTS: At coronary angiography <48 hours after fibrinolytic therapy, 308 patients receiving aspirin and intravenous heparin had a patent infarct-related artery (Thrombolysis In Myocardial Infarction [TIMI] grade 3 flow). They were randomly assigned to standard heparinization and continuation of aspirin alone or to a 3-month combination of aspirin with moderate-intensity coumarin, including continued heparinization until a target international normalized ratio (INR) of 2.0 to 3.0. Angiographic and clinical follow-up were assessed at 3 months. Median INR was 2.6 (25 to 75th percentiles 2.1 to 3.1). Reocclusion (< or =TIMI grade 2 flow) was observed in 15% of patients receiving aspirin and coumarin compared with 28% in those receiving aspirin alone (relative risk [RR], 0.55; 95% CI 0.33 to 0.90; P<0.02). TIMI grade 0 to 1 flow rates were 9% and 20%, respectively (RR, 0.46; 95% CI, 0.24 to 0.89; P<0.02). Survival rates free from reinfarction and revascularization were 86% and 66%, respectively (P<0.01). Bleeding (TIMI major and minor) was infrequent: 5% versus 3% (P=NS). CONCLUSIONS: As adjunctive to aspirin, a 3-month-regimen of moderate-intensity coumarin, including heparinization until the target INR is reached, markedly reduces reocclusion and recurrent events after successful fibrinolysis. This conceptual study provides a mechanistic rationale to further investigate the role of prolonged anticoagulation after fibrinolytic therapy.
TI  - Aspirin plus coumarin versus aspirin alone in the prevention of reocclusion after fibrinolysis for acute myocardial infarction: results of the Antithrombotics in the Prevention of Reocclusion In Coronary Thrombolysis (APRICOT)-2 Trial.
EP  - 665
SN  - 0009-7322
IS  - iss. 6
SP  - 659
JF  - Circulation
VL  - vol. 106
ER  - 
TY  - JOUR
AU  - Remmen, J.J.
AU  - Aengevaeren, W.R.M.
AU  - Verheugt, F.W.A.
AU  - Werf, T. van der
AU  - Luijten, H.E.
AU  - Bos, A.
AU  - Jansen, R.W.M.M.
PY  - 2002
UR  - https://hdl.handle.net/2066/186572
AB  - Non-invasive continuous monitoring of cardiac output could be very useful in clinical care and in research settings, particularly in elderly subjects. We studied whether Finapres arterial pulse wave analysis with Modelflow is a reliable non-invasive method for the assessment of cardiac output in healthy elderly subjects. We compared Modelflow cardiac output (MFCO) with thermodilution cardiac output (TDCO) in 28 healthy subjects, aged 70+/-4 years (mean+/-S.D.). TDCO was measured during right-sided heart catheterization, while MFCO was calculated with Modelflow(R) software from non-invasive arterial Finapres blood pressure, which was measured simultaneously. The two methods were compared using a paired t-test, by Pearson correlation, and by Bland-Altman analysis. TDCO was 6.4+/-1.1 litres/min (mean+/-S.D.) and MFCO was 4.7+/-1.3 litres/min (P<0.001). There was no significant correlation between MFCO and TDCO (r=0.28, P=0.13). Mean difference (bias) was -1.7 litres/min (S.E.M. 0.27 litres/min), with an S.D. (precision) of 1.5 litres/min. The 95% limits of agreement were -4.6 to +1.1 litres/min. In conclusion, non-invasive MFCO values differed significantly from and showed no significant correlation with invasively determined TDCO values in the normal range. Although simple, non-invasive and patient-friendly, the Modelflow method is inaccurate for assessment of cardiac output without invasive calibration.
TI  - Finapres arterial pulse wave analysis with Modelflow is not a reliable non-invasive method for assessment of cardiac output.
EP  - 149
SN  - 0143-5221
IS  - iss. 2
SP  - 143
JF  - Clinical Science
VL  - vol. 103
DO  - https://doi.org/10.1042/CS20010357
ER  - 
TY  - JOUR
AU  - Visser, W.A.
AU  - Santman, F.W.
AU  - Gehlmann, H.R.
AU  - Aengevaeren, W.R.M.
PY  - 2000
UR  - https://hdl.handle.net/2066/187985
TI  - Transesophageal echocardiography in the management of anaphylactic shock [letter]
EP  - 478
SN  - 0832-610X
IS  - iss. 5
SP  - 478
JF  - Canadian Journal of Anaesthesia
VL  - vol. 47
ER  -