TY - JOUR AU - Elsman, P. AU - Verheugt, F.W.A. AU - Lamfers, E.J.P. PY - 2004 UR - https://hdl.handle.net/2066/58073 TI - Influence of time to treatment interval on myocardial salvage in patients with acute myocardial infarction treated with coronary artery stenting or thrombolysis. EP - 1088 SN - 0009-7322 IS - iss. 7 SP - e68 JF - Circulation VL - vol. 109 ER - TY - JOUR AU - Houben, R.P. AU - Groot, N.M. de AU - Smeets, J.L.R.M. AU - Becker, A.E. AU - Lindemans, F.W. AU - Allessie, M.A. PY - 2004 UR - https://hdl.handle.net/2066/59318 AB - OBJECTIVES: The purpose of this study was to characterize the morphology of fibrillation electrograms in patients in order to provide insight into the underlying electropathologic substrate of atrial fibrillation (AF). BACKGROUND: Electrograms recorded during AF show a high degree of spatiotemporal variation. METHODS: AF was induced by rapid atrial pacing in 25 patients undergoing cardiac surgery. A unipolar mapping array of 244 electrodes was positioned on the free wall of the right atrium to record multiple epicardial fibrillation electrograms. Local anisotropy in conduction and epicardial wavefront curvature during AF were determined by fitting the best quadratic surface on the activation times of rectangular areas of 3 x 3 electrodes. RESULTS: During AF, unipolar epicardial electrograms revealed a clear predominance of S waves. The average RS difference during type I and II AF was -0.15 +/- 0.08 and -0.22 +/- 0.08. During type III AF, the predominance of S waves was less prominent (-0.07 +/- 0.05; P < .005). In all types of AF, the degree of anisotropy in conduction was remarkably low (anisotropy ratio: 1.24 +/- 0.09), and no clear directional effect on the relative amplitude of R and S waves was found. There was a weak relationship between local curvature of wavefronts and RS difference (r = 0.23; P < .01). Computer simulations showed that the negative RS difference could result from transmural activation in an epicardial to endocardial direction. CONCLUSIONS: The clear predominance of S waves in epicardial fibrillation electrograms is not due to anisotropy and can only be partly explained by a high curvature of fibrillation waves. Predominant epicardial to endocardial activation seems to be important in producing rS electrograms on the epicardium. This finding provides indirect evidence that the thin epicardial layer of atrial myocardium plays an important role in propagation of fibrillation waves. TI - S-wave predominance of epicardial electrograms during atrial fibrillation in humans: indirect evidence for a role of the thin subepicardial layer. EP - 647 SN - 1547-5271 IS - iss. 6 SP - 639 JF - Heart Rhythm VL - vol. 1 DO - http://dx.doi.org/10.1016/j.hrthm.2004.08.015 ER - TY - JOUR AU - Schellekens, S.A. AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/58269 TI - Hotline sessions of the 26th European Congress of Cardiology. EP - 2166 SN - 0195-668X IS - iss. 23 SP - 2164 JF - European Heart Journal VL - vol. 25 ER - TY - JOUR AU - Verheugt, F.W.A. AU - Antman, E.A. PY - 2004 UR - https://hdl.handle.net/2066/58189 TI - Anticoagulation in cardiac disease: New data - New options - Introduction EP - B1 SN - 1520-765X IS - iss. b SP - B1 JF - European Heart Journal. Supplement VL - vol. 6 DO - https://doi.org/10.1016/j.ehjsup.2004.01.011 ER - TY - JOUR AU - Taher, T.E. AU - Fu, Y. AU - Wagner, G. AU - Goodman, S.G. AU - Fresco, C. AU - Granger, C. AU - Wallentin, L. AU - Werf, F. van de AU - Verheugt, F.W.A. AU - Armstrong, P.W. PY - 2004 UR - https://hdl.handle.net/2066/57603 AB - OBJECTIVES: The investigators undertook a systematic, comprehensive analysis of the therapeutic response and clinical outcomes of reperfusion therapy for acute ST-segment elevation myocardial infarction (STEMI) in 5,470 patients from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 trial. BACKGROUND: Prompt effective reperfusion therapy for acute STEMI may attenuate major myocardial necrosis. METHODS: We prospectively collected sequential electrocardiographs and clinical data. Aborted myocardial infarction (MI) was defined as maximal creatine kinase < or =2x upper limit of normal coupled with typical evolutionary electrocardiographic changes. RESULTS: Of the patients, 727 (13.3%) had an aborted MI, with the highest frequency (25%) occurring in patients treated <1 h after symptom onset. As compared with MI patients, patients with aborted MI more often had complete ST-segment resolution at 60 min (56.3% vs. 30.2%, p < 0.001) and 180 min (61.5% vs. 53%, p < 0.001); they also had smaller infarct sizes based on QRS score at discharge (2.37 vs. 4.62, p <0.001). Mortality in aborted MI patients compared with those who had true MI was 3.9% versus 4.6% at 30-day and 7.0% versus 7.4% at 1-year. The baseline-adjusted mortality was significantly lower in patients with aborted MI (odds ratio [OR] 0.76, 95% confidence interval [CI] 0.63 to 0.92, p = 0.005 for 30-day and OR 0.70, 95% CI 0.50 to 0.98, p = 0.035 for one year). A very low-risk subset was identified with > or =70% ST-segment resolution at 60 min whose 30-day and 1-year mortality was 1.0% and 2.7%, respectively, compared with 5.9% and 9.3% in aborted MI patients with <70% ST-segment resolution at 60 min (all p < or = 0.002). CONCLUSIONS: Prompt fibrinolytic treatment improved the likelihood of aborted MI. The subgroup with complete 60-min ST-segment resolution had the best clinical outcomes. TI - Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electrocardiographic Substudy. EP - 43 SN - 0735-1097 IS - iss. 1 SP - 38 JF - Journal of the American College of Cardiology VL - vol. 44 DO - https://doi.org/10.1016/j.jacc.2004.03.041 ER - TY - JOUR AU - Farkouh, M.E. AU - Kirshner, H. AU - Harrington, R.A. AU - Ruland, S. AU - Verheugt, F.W.A. AU - Schnitzer, T.J. AU - Burmester, G.R. AU - Mysler, E. AU - Hochberg, M.C. AU - Doherty, M. AU - Ehrsam, E. AU - Gitton, X. AU - Krammer, G. AU - Mellein, B. AU - Gimona, A. AU - Matchaba, P. AU - Hawkey, C.J. AU - Chesebro, J.H. PY - 2004 UR - https://hdl.handle.net/2066/57937 AB - BACKGROUND: The potential for cyclo-oxygenase 2 (COX2)-selective inhibitors to increase the risk for myocardial infarction is controversial. The Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET) aimed to assess gastrointestinal and cardiovascular safety of the COX2 inhibitor lumiracoxib compared with two non-steroidal anti-inflammatory drugs, naproxen and ibuprofen. METHODS: 18325 patients age 50 years or older with osteoarthritis were randomised to lumiracoxib 400 mg once daily (n=9156), naproxen 500 mg twice daily (4754), or ibuprofen 800 mg three times daily (4415) in two substudies of identical design. Randomisation was stratified for low-dose aspirin use and age. The primary cardiovascular endpoint was the Antiplatelet Trialists' Collaboration endpoint of non-fatal and silent myocardial infarction, stroke, or cardiovascular death. Analysis was by intention to treat. FINDINGS: 81 (0.44%) patients did not start treatment and 7120 (39%) did not complete the study. At 1-year follow-up, incidence of the primary endpoint was low, both with lumiracoxib (59 events [0.65%]) and the non-steroidal anti-inflammatory drugs (50 events [0.55%]; hazard ratio 1.14 [95% CI 0.78-1.66], p=0.5074). Incidence of myocardial infarction (clinical and silent) in the overall population in the individual substudies was 0.38% with lumiracoxib (18 events) versus 0.21% with naproxen (ten) and 0.11% with lumiracoxib (five) versus 0.16% with ibuprofen (seven). In the naproxen substudy, rates of myocardial infarction (clinical and silent) did not differ significantly compared with lumiracoxib in the population not taking low-dose aspirin (hazard ratio 2.37 [95% CI 0.74-7.55], p=0.1454), overall (1.77 [0.82-3.84], p=0.1471), and in patients taking aspirin (1.36 [0.47-3.93], p=0.5658). In the ibuprofen substudy, these rates did not differ between lumiracoxib and ibuprofen in the population not taking low-dose aspirin (0.75 [0.20-2.79], p=0.6669), overall (0.66 [0.21-2.09], p=0.4833), and in patients taking aspirin (0.47 [0.04-5.14], p=0.5328). INTERPRETATION: The primary endpoint, including incidence of myocardial infarction, did not differ between lumiracoxib and either ibuprofen or naproxen, irrespective of aspirin use. This finding suggests that lumiracoxib is an appropriate treatment for patients with osteoarthritis, who are often at high cardiovascular risk and taking low-dose aspirin. TI - Comparison of lumiracoxib with naproxen and ibuprofen in the Therapeutic Arthritis Research and Gastrointestinal Event Trial (TARGET), cardiovascular outcomes: randomised controlled trial. EP - 684 SN - 0140-6736 IS - iss. 9435 SP - 675 JF - The Lancet (London) VL - vol. 364 DO - https://doi.org/10.1016/S0140-6736(04)16894-3 ER - TY - JOUR AU - Bos, H.S. AU - Pop, G.A.M. AU - Stel, E.A. AU - Gelder, B.M. van PY - 2004 UR - https://hdl.handle.net/2066/57835 AB - For safety reasons, two leads for left ventricular pacing were implanted in the coronary sinus of a pacemaker dependent patient with an artificial tricuspid valve prosthesis. TI - Dual site coronary sinus pacing in a patient with an artificial tricuspid valve prosthesis. EP - 1452 SN - 0147-8389 IS - iss. 10 SP - 1451 JF - Pace-Pacing and Clinical Electrophysiology VL - vol. 27 DO - https://doi.org/10.1111/j.1540-8159.2004.00655.x ER - TY - JOUR AU - Patrono, C. AU - Bachmann, F. AU - Baigent, C. AU - Bode, C. AU - Caterina, R. de AU - Charbonnier, B. AU - Fitzgerald, D. AU - Hirsh, J. AU - Husted, S. AU - Kvasnicka, J. AU - Montalescot, G. AU - Garcia Rodriguez, L.A. AU - Verheugt, F.W.A. AU - Vermylen, J. AU - Wallentin, L. PY - 2004 UR - https://hdl.handle.net/2066/59008 TI - [Expert consensus document on the use of antiplatelet agents] EP - 980 SN - 0300-8932 IS - iss. 10 SP - 963 JF - Revista Espanõla de Cardiología VL - vol. 57 DO - https://doi.org/10.1157/13066457 ER - TY - JOUR AU - Pop, G.A.M. AU - Chang, Z.Y. AU - Slager, C.J. AU - Kooij, B.J. AU - Deel, E.D. van AU - Moraru, L. AU - Quak, J. AU - Meijer, G.C. AU - Duncker, D.J. PY - 2004 UR - https://hdl.handle.net/2066/58752 AB - Hematocrit is the most important determinant of whole blood viscosity and it affects thrombosis. As hematocrit can be measured accurately in vitro by using an electrical impedance technique, aim of the present study is to investigate the diagnostic potential of using this technique in vivo to continuously monitor hematocrit. Characteristics of a special catheter for in vivo measurement of electrical resistivity in blood in the right atrium are described. In five anesthetized swine hematocrit is monitored continuously with this catheter while different levels of hemoconcentration are induced. In addition, blood viscosity is increased by inducing 'acute phase' reaction the day before surgery, resulting in variable degree of elevated fibrinogen levels in the five swine. Good reproducibility of the resistivity measurements (S.D < 0.01) and excellent correlation between resistivity data in vivo and hematocrit levels in each swine are found (r2 = 0.95-0.99). Furthermore, stepwise regression analysis of data from all swine shows a highly significant contribution also of other important parameters of blood viscosity, such as fibrinogen, total protein and temperature (cumulative r2 = 0.97). Determining hematocrit continuously in vivo by electrical resistivity measurements with a catheter in the right atrium is feasible and these measurements correlate significantly also with other important parameters of blood viscosity. TI - Catheter-based impedance measurements in the right atrium for continuously monitoring hematocrit and estimating blood viscosity changes; an in vivo feasibility study in swine. EP - 1693 SN - 0956-5663 IS - iss. 12 SP - 1685 JF - Biosensors and Bioelectronics VL - vol. 19 DO - https://doi.org/10.1016/j.bios.2004.01.002 ER - TY - JOUR AU - Pop, G.A.M. AU - Backer, T.L. de AU - Jong, M. de AU - Struijk, P.C. AU - Moraru, L. AU - Chang, Z.Y. AU - Goovaerts, H.G. AU - Slager, C.J. AU - Bogers, A.J. PY - 2004 UR - https://hdl.handle.net/2066/58856 AB - BACKGROUND: The viscosity of blood (eta) as well as its electrical impedance at 20 kHz at high shear rate depends on hematocrit, temperature, concentration of macromolecules and red cell deformability. The aim of our study was to investigate the relation between viscosity and electrical impedance in a heart-lung machine-like set-up, because during on-pump heart surgery considerable viscosity changes occur. METHODS: Blood of 10 healthy volunteers was examined under temperature variation between 18.5 and 37 degrees C at four different levels of hemodilution. Blood viscosity was examined with a golden-standard technique, i.e. a Contraves LS 30 Couette viscometer, and the results were compared with measurements of the electrical resistivity (R) at 20 kHz by a specially designed device in series with the tubing system of a heart-lung machine. All measurements were performed at a shear rate of 87 s(-1). RESULTS: Using stepwise multiparameter regression analysis (SPSS) a highly significant correlation was found (r(2) = 0.882) between viscosity (eta) and resistivity (R). Adding the variables sodium ([Na(+)]) and fibrinogen ([Fibr]) concentration the coefficient of correlation further improved to r(2) = 0.928 and the relation became: eta = -0.6844 + 0.038 R + 0.038 [Na(+)] + 0.514 [Fibr]. All coefficients showed a statistical significance of p < 0. 001. CONCLUSIONS: Electrical impedance measurement is feasible in a heart-lung machine-like set-up and allows accurate continuous on-line estimation of blood viscosity; it may offer an adequate way to record and control viscosity changes during on-pump heart surgery. TI - On-line electrical impedance measurement for monitoring blood viscosity during on-pump heart surgery. EP - 265 SN - 0014-312X IS - iss. 5 SP - 259 JF - European Surgical Research VL - vol. 36 DO - https://doi.org/10.1159/000079910 ER - TY - JOUR AU - Curtis, J.P. AU - Alexander, J.H. AU - Huang, Y.H. AU - Wallentin, L. AU - Verheugt, F.W.A. AU - Armstrong, P.W. AU - Krumholz, H.M. AU - Werf, F. van de AU - Danays, T. AU - Cheeks, M. AU - Granger, C. PY - 2004 UR - https://hdl.handle.net/2066/58585 AB - We investigated the effect of smaller dose, weight-adjusted heparin with earlier monitoring of activated partial thromboplastin time on the incidence of ischemic and hemorrhagic complications in patients with ST-elevation myocardial infarction treated with full-dose tenecteplase. We compared the outcomes of patients enrolled in the Second Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT-2; n = 8,461) who received heparin stratified by weight (patients weighing >67 kg received a 5,000-U bolus plus infusion at 1,000 U/hour; those weighing < or =67 kg received a 4,000-U bolus plus infusion at 800 U/hour) with patients in ASSENT-3 who received weight-adjusted heparin (60-U/kg bolus, maximum 4,000 U/hour, followed by a 12-U/kg/hour infusion, maximum 1,000 U/hour). Compared with patients in ASSENT-2, those in ASSENT-3 had similar rates of 30-day mortality, recurrent infarction, and intracranial hemorrhage, less major bleeding (2.2% vs 4.7%, p <0.001), and less refractory ischemia (6.5% vs 8.6%, p <0.001). After adjustment for baseline characteristics, patients in ASSENT-3 had similar rates of 30-day mortality (odds ratio [OR] 0.96, 95% confidence interval [CI] 0.77 to 1.19) and intracranial hemorrhage (OR 1.02, 95% CI 0.61 to 1.69) but less major bleeding (OR 0.49, 95% CI 0.35 to 0.67) than did patients in ASSENT-2. These findings support the use of smaller dose, weight-adjusted heparin in patients with ST-elevation myocardial infarction treated with tenecteplase. TI - Efficacy and safety of two unfractionated heparin dosing strategies with tenecteplase in acute myocardial infarction (results from Assessment of the Safety and Efficacy of a New Thrombolytic Regimens 2 and 3). EP - 283 SN - 0002-9149 IS - iss. 3 SP - 279 JF - American Journal of Cardiology VL - vol. 94 DO - https://doi.org/10.1016/j.amjcard.2004.04.019 ER - TY - JOUR AU - Kievit, P.C. AU - Brouwer, M.A. AU - Veen, G. AU - Karreman, A.J. AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/58311 AB - BACKGROUND: After successful thrombolysis, a high-grade stenosis at 24-hour angiography is strongly predictive of reocclusion and is often believed to result in high reinfarction rates. However, routine angioplasty did not reduce death or reinfarction in past trials. Systematic angiographic follow-up shows that reocclusion often occurs without clinical reinfarction. This study investigates whether the increased risk for reocclusion associated with a high-grade lesion translates into impaired clinical outcome. METHODS: In the ischemia-guided Antithrombotics in the Prevention of Reocclusion in COronary Thrombolysis (APRICOT-1) trial, 240 patients with ST-elevation MI who had an open infarct artery 24 hours after thrombolysis had 3-month repeat angiography to assess reocclusion, with clinical follow-up at 3 months and 3 years. RESULTS: On the basis of the optimal discriminative stenosis severity, the reocclusion rate was 40% (47/118) in patients with a high-grade residual stenosis and 16% (20/122) in patients with a low-medium-grade lesion (risk ratio [RR], 2.43; 95% CI, 1.54-3.84; P <.01). Three-month death and reinfarction rates did not differ: 6% (7/118) versus 9% (11/122; RR, 0.66; 95% CI, 0.26-1.64; P = not significant). Systematic angiographic follow-up revealed that reocclusion of a high-grade lesion occurred in the absence of clinical reinfarction in 85% (40/47) of patients, as compared with 45% (9/20) in patients with a low-medium-grade stenosis (RR, 1.89; 95% CI, 1.15-3.12; P <.01). Despite an independent association with reocclusion, a high-grade stenosis was not predictive of either short- or long-term death and reinfarction. CONCLUSIONS: After successful thrombolysis and adopting an ischemia-guided revascularization strategy, patients with a high-grade stenosis experience death/reinfarction rates similar to that of patients with a low-medium-grade lesion. This is true despite a 2- to 3-fold higher risk for reocclusion. The finding that reocclusion of a high-grade lesion often occurs without clinical reinfarction explains the absence of a relationship between a severe stenosis and death/reinfarction. Appreciation of these observations may contribute to an optimal design of a future randomized trial to re-evaluate the impact of a routine invasive strategy. TI - High-grade infarct-related stenosis after successful thrombolysis: strong predictor of reocclusion, but not of clinical reinfarction. EP - 833 SN - 0002-8703 IS - iss. 5 SP - 826 JF - American Heart Journal VL - vol. 148 DO - https://doi.org/10.1016/j.ahj.2004.05.043 ER - TY - JOUR AU - Patrono, C. AU - Bachmann, F. AU - Baigent, C. AU - Bode, C. AU - Caterina, R. de AU - Charbonnier, B. AU - Fitzgerald, D. AU - Hirsh, J. AU - Husted, S. AU - Kvasnicka, J. AU - Montalescot, G. AU - Garcia Rodriguez, L.A. AU - Verheugt, F.W.A. AU - Vermylen, J. AU - Wallentin, L. AU - Priori, S.G. AU - Alonso Garcia, M.A. AU - Blanc, J.J. AU - Budaj, A. AU - Cowie, M. AU - Dean, V. AU - Deckers, J.A. AU - Fernandez Bugos, E. AU - Lekakis, J. AU - Lindahl, B. AU - Mazzotta, G. AU - Steg, P.G. AU - Teixeira, F. AU - Wilcox, R. PY - 2004 UR - https://hdl.handle.net/2066/58492 TI - Expert consensus document on the use of antiplatelet agents. The task force on the use of antiplatelet agents in patients with atherosclerotic cardiovascular disease of the European society of cardiology. EP - 181 SN - 0195-668X IS - iss. 2 SP - 166 JF - European Heart Journal VL - vol. 25 DO - http://dx.doi.org/10.1016/j.ehj.2003.10.013 ER - TY - JOUR AU - Blazing, M.A. AU - Lemos, J.A. de AU - White, H.D. AU - Fox, K. AU - Verheugt, F.W.A. AU - Ardissino, D. AU - DiBattiste, P.M. AU - Palmisano, J. AU - Bilheimer, D.W. AU - Snapinn, S.M. AU - Ramsey, K.E. AU - Gardner, L.H. AU - Hasselblad, V. AU - Pfeffer, M.A. AU - Lewis, E.F. AU - Braunwald, E. AU - Califf, R.M. PY - 2004 UR - https://hdl.handle.net/2066/59322 AB - CONTEXT: Enoxaparin or the combination of glycoprotein IIb/IIIa inhibitor tirofiban with unfractionated heparin independently have shown superior efficacy over unfractionated heparin alone in patients with non-ST-elevation acute coronary syndromes (ACS). It is not clear if combining enoxaparin with glycoprotein IIb/IIIa inhibitors is as safe or as effective as the current standard combination of unfractionated heparin with glycoprotein IIb/IIIa inhibitors. OBJECTIVE: To assess efficacy and safety of the combination of enoxaparin and tirofiban compared with unfractionated heparin and tirofiban in patients with non-ST-elevation ACS. DESIGN, SETTING, AND PARTICIPANTS: A prospective, international, open-label, randomized, noninferiority trial of 1 mg/kg of enoxaparin every 12 hours (n = 2026) compared with weight-adjusted intravenous unfractionated heparin (n = 1961) in patients with non-ST-elevation ACS receiving tirofiban and aspirin. Phase A of the A to Z trial was conducted between December 1999 and May 2002. MAIN OUTCOME MEASURES: Death, recurrent myocardial infarction, or refractory ischemia at 7 days in the intent-to-treat population with boundaries set for superiority and noninferiority. Safety based on measures of bleeding using the Thrombolysis in Myocardial Infarction (TIMI) classification system. RESULTS: A total of 169 (8.4%) of 2018 patients randomized to enoxaparin experienced death, myocardial infarction, or refractory ischemia at 7 days compared with 184 (9.4%) of 1952 patients randomized to unfractionated heparin (hazard ratio [HR], 0.88; 95% confidence interval [CI], 0.71-1.08). This met the prespecified criterion for noninferiority. All components of the composite primary and secondary end points favored enoxaparin except death, which occurred in only 1% of patients (23 for enoxaparin and 17 for unfractionated heparin). Rates for any TIMI grade bleeding were low (3.0% for enoxaparin and 2.2% for unfractionated heparin; P =.13). Using a worst-case approach that combined 2 independent bleeding evaluations, use of enoxaparin was associated with 1 additional TIMI major bleeding episode for each 200 patients treated. CONCLUSIONS: In patients receiving tirofiban and aspirin, enoxaparin is a suitable alternative to unfractionated heparin for treatment of non-ST-elevation ACS. The 12% relative and 1% absolute reductions in the primary end point in favor of enoxaparin met criterion for noninferiority and are consistent with prior trials performed without the use of glycoprotein IIb/IIIa inhibitors. TI - Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: a randomized controlled trial. EP - 64 SN - 0098-7484 IS - iss. 1 SP - 55 JF - Jama : Journal of the American Medical Association VL - vol. 292 DO - https://doi.org/10.1001/jama.292.1.55 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 - Rossum, L.G.M. van AU - Laheij, R.J.F. AU - Vlemmix, F. AU - Jansen, J.B.M.J. AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/58341 AB - BACKGROUND: Upper gastrointestinal discomfort decreases the already impaired health status of patients with cardiovascular disease. AIM: To evaluate whether acid suppressive therapy improves health-related quality of life in patients who developed upper gastrointestinal symptoms after starting low-dose acetylsalicylic acid. METHODS: In a double-blind, placebo-controlled randomized trail, cardiac patients using low-dose (80 mg) acetylsalicylic acid with (n = 142) and without (n = 90) upper gastrointestinal symptoms were included. Patients with symptoms were treated with rabeprazole or placebo for 4 weeks. At baseline and 4 weeks information about gastrointestinal symptoms and health-related quality of life was assessed. RESULTS: The 73 patients assigned to rabeprazole when compared with 69 patients given placebo reported the same quality of life scores 4 weeks after randomization. The differences in quality of life scores between patients with and without symptoms at baseline remained after 4 weeks. Patients in whom treatment led to complete symptom relief or those who remained symptom-free reported significantly higher scores for Physical Component Summary (P < 0.01) and Mental Component Summary (P < 0.01), when compared to those with persistent symptoms or new onset symptoms. CONCLUSION: Proton-pump inhibitor therapy did not improve quality of life. Upper gastrointestinal symptom relief in itself considerably increased quality of life. TI - Health-related quality of life in patients with cardiovascular disease--the effect of upper gastrointestinal symptom treatment. EP - 1104 SN - 0269-2813 IS - iss. 10 SP - 1099 JF - Alimentary Pharmacology & Therapeutics VL - vol. 19 DO - https://doi.org/10.1111/j.1365-2036.2004.01937.x ER - TY - JOUR AU - Lamfers, E.J.P. AU - Schut, A. AU - Hertzberger, D.P. AU - Hooghoudt, T.E.H. AU - Stolwijk, P.W.J. AU - Boersma, E. AU - Simoons, M.L. AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/57160 AB - BACKGROUND: This study investigated the incidence of abortion of myocardial infarction and of unjustified fibrinolysis by using automated versus cardiologist-assisted diagnosis of acute ST-elevation myocardial infarction. The results of prehospital diagnosis and treatment (2 cities in the Netherlands) were compared with those of inhospital treatment. Unjustified fibrinolysis must be differentiated from justified thrombolysis resulting in aborted myocardial infarction. Both have the absence of a significant rise in cardiac enzymes in common. In aborted myocardial infarction, this is a result of timely reperfusion; in unjustified thrombolysis, this is the result of an incorrect diagnosis. METHODS: In the city of Rotterdam, 118 patients were treated before hospitalization for myocardial infarction, diagnosed through the use of a mobile computer electrocardiogram; in the city of Nijmegen, 132 patients were treated before hospitalization with the use of transtelephonic transmission of the electrocardiogram to the coronary care unit and judged by a cardiologist. Their data were compared with those of 269 patients treated inhospital in the city of Arnhem, using the same electrocardiographic criteria. Abortion of myocardial infarction was diagnosed as the absence of a significant rise in cardiac enzymes and the presence of resolution of chest pain and 50% of ST-segment deviation within 2 hours after onset of therapy. Lacking these, the diagnosis of unjustified fibrinolytic therapy was made. RESULTS: Unjustified treatment occurred in 8 (3.2%) prehospital-treated patients (4 in Rotterdam and 4 in Nijmegen). Of the inhospital-treated patients in Arnhem, 5 (1.9%) were treated unjustifiably (P =.49). Aborted myocardial infarction occurred in 15.3% and 18.2% in Rotterdam and Nijmegen, respectively, against 4.5% in inhospital treatment in Arnhem (P <.001). CONCLUSIONS: Abortion of myocardial infarction is associated with prehospital thrombolysis. Unjustified fibrinolysis for acute myocardial infarction occurs in prehospital fibrinolysis as frequently as in the inhospital setting. The use of different electrocardiographic methods for diagnosing acute myocardial infarction does not appear to make any difference. TI - Prehospital versus hospital fibrinolytic therapy using automated versus cardiologist electrocardiographic diagnosis of myocardial infarction: abortion of myocardial infarction and unjustified fibrinolytic therapy. EP - 515 SN - 0002-8703 IS - iss. 3 SP - 509 JF - American Heart Journal VL - vol. 147 DO - https://doi.org/10.1016/j.ahj.2003.10.007 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 - Patrono, C. AU - Bachmann, F. AU - Baigent, C. AU - Bode, C. AU - Caterina, R. de AU - Charbonnier, B. AU - Fitzgerald, D. AU - Hirsh, J. AU - Husted, S. AU - Kvasnicka, J. AU - Montalescot, G. AU - Garcia Rodriguez, L.A. AU - Verheugt, F.W.A. AU - Vermylen, J. AU - Wallentin, L. PY - 2004 UR - https://hdl.handle.net/2066/184563 TI - [Expert consensus document on the use of antiplatelet agents]. EP - 980 SN - 0300-8932 IS - iss. 10 SP - 963 JF - Revista Espanõla de Cardiología VL - vol. 57 N1 - 1 oktober 2004 DO - https://doi.org/10.1157/13066457 ER - TY - JOUR AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/57420 TI - Lyse now, stent later: the grace of GRACIA. EP - 1015 SN - 0140-6736 IS - iss. 9439 SP - 1014 JF - The Lancet (London) VL - vol. 364 DO - https://doi.org/10.1016/S0140-6736(04)17072-4 ER - TY - JOUR AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/57994 TI - The Warfarin/Aspirin Study in Heart Failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. EP - 3 SN - 1743-4297 IS - iss. 10 SP - 2 JF - Nature Clinical Practice Cardiovascular Medicine VL - vol. 1 DO - https://doi.org/10.1038/ncpcardio001 ER - TY - JOUR AU - Brouwer, M.A. AU - Clappers, N. AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/57847 TI - Adjunctive treatment in patients treated with thrombolytic therapy. EP - 588 SN - 1355-6037 IS - iss. 5 SP - 581 JF - Heart VL - vol. 90 DO - https://doi.org/10.1136/hrt.2003.019877 ER - TY - JOUR AU - Bos, M.M. AU - Timmermans, J. AU - Kremer, H.P.H. PY - 2004 UR - https://hdl.handle.net/2066/58231 TI - Idebenonebehandeling bij Friedreich-ataxie. EP - 187 SN - 1571-5930 IS - iss. 4 SP - 183 JF - Tijdschrift voor Neurologie & Neurochirurgie VL - vol. 105 ER - TY - JOUR AU - Smeets, J.L.R.M. PY - 2004 UR - https://hdl.handle.net/2066/58901 AB - The implantable cardioverter-defibrillator (ICD) is used in patients who are at risk for ventricular fibrillation after having suffered from a myocardial infarction. Initially, patient selection was limited to survivors of impending sudden death with coronary artery disease. Later, ICD implantation in high-risk coronary artery disease patients was found to lower cardiovascular mortality. More recently, patients with dilated cardiomyopathy and no coronary artery disease are also potential candidates for implantation of an ICD. In the Netherlands, it is expected that there will be 1-2 ICD-users per 10,000 inhabitants. This means that ambulance personnel, general practitioners and doctors in emergency wards will also be confronted with patients who have had one or more shock treatments. Such medical personnel should have knowledge about the function of the ICD, what to do if several shocks have been given and whom to contact in case problems persist. TI - [The implantable cardioverter-defibrillator: sometimes necessary] EP - 2115 SN - 0028-2162 IS - iss. 43 SP - 2113 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 148 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 - Oijen, M.G.H. van AU - Laheij, R.J.F. AU - Peters, W.H.M. AU - Jansen, J.B.M.J. AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/58513 AB - We examined the prevalence of vitamin B(12) deficiency and its association with medication use and characteristics, including infection with Helicobacter pylori (H. pylori), in 255 patients hospitalized for cardiovascular disease. In almost half of the study population, vitamin B(12) deficiency was found; patients using acetylsalicylic acid were more frequently vitamin B(12) deficient in comparison to nonusers (p = 0.02). Fifty-one percent of the patients were infected with H. pylori, and fewer infected patients were vitamin B(12) deficient. TI - Association of aspirin use with vitamin B12 deficiency (results of the BACH study). EP - 977 SN - 0002-9149 IS - iss. 7 SP - 975 JF - American Journal of Cardiology VL - vol. 94 DO - https://doi.org/10.1016/j.amjcard.2004.06.047 ER - TY - JOUR AU - Janssen, D.P.B. AU - Noyez, L. AU - Wouters, S. AU - Brouwer, M.H.J. PY - 2004 UR - https://hdl.handle.net/2066/57164 AB - OBJECTIVES: To construct a predictive model for a prolonged stay in the intensive care unit (ICU) for coronary artery bypass graft surgery (CABG). METHODS: Eight hundred and eighty-eight patients undergoing CABG were studied by univariate and multivariate analysis. Prolonged stay in the ICU was defined as >/=3 days stay. Stepwise selective procedure (P/=0.40 was used as cut-off point for the prognostic test. The specificity of this test for prolonged stay in the ICU was 99%; sensitivity 9%; positive predictive value 60%; and negative predictive value 89%. CONCLUSIONS: The results show that individual patients presented for CABG, can be stratified according to their risk for prolonged stay >/=3 days in the ICU. TI - Preoperative prediction of prolonged stay in the intensive care unit for coronary bypass surgery. EP - 207 SN - 1010-7940 IS - iss. 2 SP - 203 JF - European Journal of Cardio-Thoracic Surgery VL - vol. 25 DO - https://doi.org/10.1016/j.ejcts.2003.11.005 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 - Peeters, A.C.T. AU - Kucharekova, M. AU - Timmermans, J. AU - Berkmortel, F.W.P.J. van den AU - Boers, G.H.J. AU - Nováková, I.R.O. AU - Egging, D.F. AU - Heijer, M. den AU - Schalkwijk, J. PY - 2004 UR - https://hdl.handle.net/2066/57333 AB - BACKGROUND: We recently described a new autosomal recessive type of Ehlers-Danlos syndrome (EDS) based on a deficiency of the extracellular matrix protein tenascin-X (TNX). TNX-deficient patients have hypermobile joints, hyperextensible skin and show easy bruising. Because of the reported cardiovascular abnormalities in other EDS types and the excessive haematoma formation after mild trauma in TNX-deficient individuals, we investigated whether cardiovascular or coagulation abnormalities occur in these patients. METHODS: We examined seven TNX-deficient patients. One of them had a mitral valve prolapse and died postoperatively after valve replacement, before the study was completed. RESULTS: Bleeding time and coagulation factors (INR, APTT, PT and fibrinogen) were all within the normal range. Ultrasonographic examination of the carotid and femoral arteries showed normal vessel wall compliance and distensibility. Echocardiography showed a slight billowing of the mitral valve in two patients from one family. All patients had normal diameters of aortic root and ascending aorta. CONCLUSION: Although the patient group is small, there are no indications of generalised cardiovascular abnormalities in this type of EDS. We would recommend echocardiography for all these patients at the first evaluation and when a cardiac murmur appears. TI - A clinical and cardiovascular survey of Ehlers-Danlos syndrome patients with complete deficiency of tenascin-X. EP - 162 SN - 0300-2977 IS - iss. 5 SP - 160 JF - Netherlands Journal of Medicine VL - vol. 62 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/57333/57333.pdf?sequence=1 ER - TY - THES AU - Brouwer, M.A. PY - 2004 UR - https://hdl.handle.net/2066/59272 PB - [S.l. : s.n.] TI - Antithrombotic strategies and the impact of coronary reocclusion in ST-elevation myocardial infarction. N1 - KUN Katholieke Universiteit Nijmegen, 24 september 2004 N1 - Promotor : Verheugt, F.W.A. Co-promotores : Aengevaeren, W.R.M., Veen, G. PS - 263 p. L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/59272/59272.pdf?sequence=1 ER - TY - JOUR AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/58930 AB - Over the past 10 years it has become clear that passive smoking is correlated with an increased risk of coronary heart disease. The relative risk of 25-30% is comparable to that of lung cancer due to passive smoking. Since coronary heart disease is the most common cause of death, it is likely that passive smoking causes many more deaths from coronary heart disease than from lung cancer. For the Netherlands, yearly figures of 2,500 to 4,000 deaths from coronary heart disease due to passive smoking are estimated. In other words, of every 10 deaths from coronary heart disease due to cigarette smoke, one is caused by passive smoking. A rigorous ban on smoking is advocated, both in public places and at home. TI - [Passive smoking and the risk of coronary heart disease] EP - 647 SN - 0028-2162 IS - iss. 14 SP - 645 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 148 ER - TY - JOUR AU - Verheugt, F.W.A. PY - 2004 UR - https://hdl.handle.net/2066/59058 TI - Ximelagatran or warfarin in atrial fibrillation? Reply EP - 734 SN - 0140-6736 IS - iss. 9410 SP - 734 JF - The Lancet (London) VL - vol. 363 ER - TY - JOUR AU - Camaro, C. AU - Veldman, B.A.J. PY - 2004 UR - https://hdl.handle.net/2066/59001 AB - A 75-year-old woman presented with angina pectoris and dyspnoea due to critical stenosis of the left main coronary artery with diffuse subendocardial ischaemia. TI - [Diagnostic image (191). A woman with angina pectoris and dyspnoea. Critical stenosis of the left main coronary artery with diffuse subendocardial ischemia] EP - 1093 SN - 0028-2162 IS - iss. 22 SP - 1092 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 148 ER - TY - JOUR AU - Driel, V.J.H.M. van AU - Gehlmann, H.R. PY - 2004 UR - https://hdl.handle.net/2066/58998 AB - A 51-year-old man with palpitations had fast, broad and irregular QRS complexes on his ECG, due to atrial fibrillation and Wolff-Parkinson-White syndrome. TI - [Diagnostic image (175). A man with fast and irregular palpitations. Atrial fibrillation and Wolff-Parkinson-White syndrome] J2 - [Diagnostic image (175). A man with fast and irregular palpitations. Atrial fibrillation and Wolff-Parkinson-White syndrome] EP - 276 SN - 0028-2162 IS - iss. 6 SP - 276 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 148 ER - TY - JOUR AU - Welsh, R.C. AU - Goldstein, P. AU - Adgey, J. AU - Verheugt, F.W.A. AU - Bestilny, S.A. AU - Wallentin, L. AU - Werf, F. van de AU - Armstrong, P.W. PY - 2004 UR - https://hdl.handle.net/2066/59107 AB - The Assessment of the Safety and Efficacy of a New Thrombolytic 3 (ASSENT 3 PLUS) Plus trial (n=1639) was an international trial of pre-hospital fibrinolysis with tenecteplase randomly assigned to enoxaparin or unfractionated heparin, involving 106 sites in 12 countries. Given the potential impact of process of care delivery in various healthcare systems, we undertook a comprehensive validated survey of population demographics, geographical factors, emergency medical services, methods of electrocardiogram interpretation and pre-hospital fibrinolysis administration. The potential study population was 42.4 x 10(6) with 70% urban. The land areas of individual emergency medical services sites varied from 6 to 20000/km(2). Three emergency medical services personnel (range 2-5) attended each ambulance with the highest level of training, consisting of a physician (65%), registered nurse (20%) or paramedic. Before the initiation of the study, 72% of sites administered pre-hospital fibrinolysis (range 1-20 years). Electrocardiograms were interpreted on the scene in 60% and transmitted for physician's interpretation in the remainder; 41% of patients (679/1639) were enrolled at sites without a physician at the scene. The ASSENT 3 Plus trial incorporated a wide variation in population density, emergency medical services resources, and physician's interpretation of ECG and administering pre-hospital fibrinolysis. Understanding this diversity will help in evaluating the general applicability and feasibility of pre-hospital fibrinolysis in various health systems, as well as the pre-hospital care of ST elevation myocardial infarction patients regardless of reperfusion strategies. TI - Variations in pre-hospital fibrinolysis process of care: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic 3 Plus international acute myocardial infarction pre-hospital care survey. EP - 140 SN - 0969-9546 IS - iss. 3 SP - 134 JF - European Journal of Emergency Medicine VL - vol. 11 DO - https://doi.org/10.1097/01.mej.0000127653.61705.54 ER - TY - JOUR AU - Hoogendoorn, L. AU - Heijer, M. den AU - Dijk, A.P.J. van AU - Hermus, A.R.M.M. PY - 2004 UR - https://hdl.handle.net/2066/59336 AB - Subclinical hyperthyroidism may be defined as the presence of free thyroxine and tri-iodothyronine levels within the reference range and a reduced serum thyroid stimulating hormone (TSH) level. In this review the prevalence of low TSH in the population and health consequences of subclinical hyperthyroidism, for example, effects on heart and bone mass, are discussed. Guidelines for treatment are given, based on expert opinion. TI - Subclinical hyperthyroidism: to treat or not to treat? EP - 398 SN - 0032-5473 IS - iss. 945 SP - 394 JF - Postgraduate Medical Journal VL - vol. 80 DO - https://doi.org/10.1136/pgmj.2003.017095 ER - TY - JOUR AU - Boito, S.M. AU - Struijk, P.C. AU - Pop, G.A.M. AU - Visser, W. de AU - Steegers, E.A.P. AU - Wladimiroff, J.W. PY - 2004 UR - https://hdl.handle.net/2066/59353 AB - OBJECTIVES: To establish the effects of plasma volume expansion (PVE) followed by intravenous dihydralazine (DH) administration on maternal whole blood viscosity (WBV) and hematocrit, uteroplacental and fetoplacental downstream impedance and umbilical venous (UV) volume flow in pre-eclampsia. METHODS: In 13 pre-eclamptic women maternal and fetal hemodynamics were established by means of combined measurement of maternal arterial blood pressure (BP), WBV, hematocrit and uterine artery (UtA) resistance index (RI) in addition to umbilical artery (UA) pulsatility index (PI) and UV volume flow obtained from UV vessel area and UV time-averaged flow velocity. In each woman all parameters were measured four times at baseline, after PVE, after DH and 24 h after the start of treatment. RESULTS: Maternal diastolic BP, hematocrit and WBV display a significant reduction after PVE. In the fetus UA PI decreases significantly whereas a significant increase in UV cross-sectional area was detected. After maternal DH administration, arterial systolic and diastolic BP and UA PI show a significant decrease compared with the measurements following PVE. At 24 h, only maternal systolic and diastolic BP display a significant further decrease. No significant changes were established for the UtA RI, UV time-averaged velocity and UV volume flow during the entire study period. CONCLUSIONS: During pre-eclampsia, maternal PVE followed by DH administration results in a significant reduction in maternal diastolic BP, maternal hematocrit and WBV. Maternal PVE is associated with a significant increase in UV cross-sectional area and a non-significant rise of 11% in UV volume flow. Maternal DH administration does not result in any change in UV cross-sectional area. However, UA PI decreases significantly after both PVE and DH treatment. TI - The impact of maternal plasma volume expansion and antihypertensive treatment with intravenous dihydralazine on fetal and maternal hemodynamics during pre-eclampsia: a clinical, echo-Doppler and viscometric study. EP - 332 SN - 0960-7692 IS - iss. 4 SP - 327 JF - Ultrasound in Obstetrics & Gynecology VL - vol. 23 DO - https://doi.org/10.1002/uog.1012 ER -