TY - JOUR AU - Bisschops, L.L.A. AU - Pop, G.A.M. AU - Teerenstra, S. AU - Struijk, P.C. AU - Hoeven, J.G. van der AU - Hoedemaekers, C.W.E. PY - 2014 UR - https://hdl.handle.net/2066/136280 AB - OBJECTIVES: To determine blood viscosity in adult comatose patients treated with mild therapeutic hypothermia after cardiac arrest and to assess the relation between blood viscosity, cerebral blood flow, and cerebral oxygen extraction. DESIGN: Observational study. SETTING: Tertiary care university hospital. PATIENTS: Ten comatose patients with return of spontaneous circulation after out-of-hospital cardiac arrest. INTERVENTION: Treatment with mild therapeutic hypothermia for 24 hours followed by passive rewarming to normothermia. MEASUREMENTS AND MAIN RESULTS: Median viscosity at shear rate 50/s was 5.27 mPa . s (4.29-5.91 mPa . s) at admission; it remained relatively stable during the first 12 hours and decreased significantly to 3.00 mPa . s (2.72-3.58 mPa . s) at 72 hours (p < 0.001). Median mean flow velocity in the middle cerebral artery was low (27.0 cm/s [23.8-30.5 cm/s]) at admission and significantly increased to 63.0 cm/s (51.0-80.0 cm/s) at 72 hours. Median jugular bulb saturation at the start of the study was 61.5% (55.5-75.3%) and significantly increased to 73.0% (69.0-81.0%) at 72 hours. Median hematocrit was 0.41 L/L (0.36-0.44 L/L) at admission and subsequently decreased significantly to 0.32 L/L (0.27-0.35 L/L) at 72 hours. Median C-reactive protein concentration was low at admission (2.5 mg/L [2.5-6.5 mg/L]) and increased to 101 mg/L (65-113.3 mg/L) in the following hours. Median fibrinogen concentration was increased at admission 2,795 mg/L (2,503-3,565 mg/L) and subsequently further increased to 6,195 mg/L (5,843-7,368 mg/L) at 72 hours. There was a significant negative association between blood viscosity and the mean flow velocity in the middle cerebral artery (p = 0.0008). CONCLUSIONS: Changes in blood viscosity in vivo are associated with changes in flow velocity in the middle cerebral artery. High viscosity early after cardiac arrest may reduce cerebral blood flow and may contribute to secondary brain injury. Further studies are needed to determine the optimal viscosity during the different stages of the postcardiac arrest syndrome. TI - Effects of viscosity on cerebral blood flow after cardiac arrest EP - 637 SN - 0090-3493 IS - iss. 3 SP - 632 JF - Critical Care Medicine VL - vol. 42 DO - http://dx.doi.org/10.1097/CCM.0000000000000027 ER - TY - JOUR AU - Selten, K. AU - Brakel, T.J. van AU - Swieten, H.A. van AU - Smeets, J.L.R.M. PY - 2014 UR - https://hdl.handle.net/2066/133825 TI - Mapping-guided total excision of the sinoatrial node for inappropriate sinus tachycardia EP - 8 SN - 0022-5223 IS - iss. 4 SP - e56 JF - Journal of Thoracic and Cardiovascular Surgery VL - vol. 147 DO - http://dx.doi.org/10.1016/j.jtcvs.2013.12.055 ER - TY - JOUR AU - Verheugt, F.W.A. PY - 2014 UR - https://hdl.handle.net/2066/134043 AB - This article refers to 'Impact of aspirin and statins on longterm survival in patients with acute myocardial infarction complicated by heart failure: an analysis in 1746 patients' by C. Lewinter et al., published in this issue on page 95-102. TI - Evidence-based co-medication in heart failure: necessary or bystander? EP - 3 SN - 1388-9842 IS - iss. 1 SP - 1 JF - European Journal of Heart Failure VL - vol. 16 DO - http://dx.doi.org/10.1002/ejhf.46 ER - TY - JOUR AU - Ostrowska, M. AU - Adamski, P. AU - Kozinski, M. AU - Navarese, E.P. AU - Fabiszak, T. AU - Grzesk, G. AU - Paciorek, P. AU - Kubica, J. PY - 2014 UR - https://hdl.handle.net/2066/135993 AB - Soon after identification of the platelet membrane glycoprotein (GP) IIb/IIIa, it has become a target of antiplatelet therapy. There are 3 intravenous GP IIb/IIIa receptor inhibitors, namely- eptifibatide, tirofiban and abciximab, used in the contemporary clinical practice, particularly in patients with acute coronary syndrome undergoing percutaneous coronary intervention (PCI). The aim of the current review is to summarize available knowledge concerning off-target effects of GP IIb/IIIa receptor inhibitors. All 3 drugs have similar antithrombotic properties, but differ with respect to pharmacodynamics, pharmacokinetics and off-target effects. Eptifibatide and tirofiban are highly specific GP IIb/IIIa receptor inhibitors, while abciximab is unselectiveand cross-reacts with integrin avb3 - a vitronectin receptor and leukocyte-associatedi ntegrin Mac-1. As a result of these interactions, abciximab seems to reduce the development of clinical restenosis, decrease infarct size, inhibit adhesion of monocytes to medical steel and modulate the inflammatory response. Intracoronary administration of abciximab provides higher drug concentration in the target area, increasing dose-dependent interactions with other integrins. Off-target effects of small molecule GP IIb/IIIa receptor inhibitors (i.e. eptifibatide and tirofiban) are predominantly connected with their suppressive influence on the inflammatory response. All in all, although GP IIb/IIIa receptor inhibitors are not recommended as a routine therapy during PCI, their antiplatelet properties and potential off-target effects may bebeneficial in certain subsets of patients. TI - Off-target effects of glycoprotein IIb/IIIa receptor inhibitors EP - 464 SN - 1897-5593 IS - iss. 5 SP - 458 JF - Cardiology Journal VL - vol. 21 DO - http://dx.doi.org/10.5603/CJ.a2014.0020 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/135993/135993.pdf?sequence=1 ER - TY - THES AU - Mouden, M. PY - 2014 SN - 9789090284187 UR - https://hdl.handle.net/2066/131201 PB - [S.l. : s.n.] TI - SPECT and CT imaging in stable coronary artery disease. N1 - Radboud Universiteit Nijmegen, 12 september 2014 N1 - Promotores : Boer, M.J. de, Jager, P.L. Co-promotores : Ottervanger, J.P., Knollema, S. L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/131201/131201.pdf?sequence=1 ER - TY - JOUR AU - Panhuyzen-Goedkoop, N.M. AU - Smeets, J.L.R.M. PY - 2014 UR - https://hdl.handle.net/2066/133818 AB - Safe sports participation involves protecting athletes from injury and life-threatening situations. Preparticipation cardiovascular screening (PPS) in athletes is intended to prevent exercise-related sudden cardiac death by medical management of athletes at risk, which may include disqualification from sports participation. The screening physician relies on current guidelines and expert recommendations for management and decision-making. There is concern about false-positive screening results and wrongly grounding an athlete. Similarly, there is a concern about false-negative screening results and athletes participating with potentially lethal disorders. Who is legally responsible if an athlete suddenly dies after a proper PPS resulting in low risk? Several consensus documents based on expert opinion describe only a few lines on legal responsibilities in eligibility screening and disqualification decision-making in athletes. This article discusses legal responsibilities and concerns in eligibility decision-making for physicians. TI - Legal responsibilities of physicians when making participation decisions in athletes with cardiac disorders: Do guidelines provide a solid legal footing? EP - 1195 SN - 0306-3674 IS - iss. 15 SP - 1193 JF - British Journal of Sports Medicine VL - vol. 48 DO - http://dx.doi.org/10.1136/bjsports-2013-093023 ER - TY - JOUR AU - Navarese, E.P. AU - Szczesniak, A. AU - Kolodziejczak, M. AU - Gorny, B. AU - Kubica, J. AU - Suryapranata, H. PY - 2014 UR - https://hdl.handle.net/2066/133892 AB - Statins (hydroxymethylglutaryl-coenzyme-A reductase inhibitors) are first-line agents for the management of hyperlipidemia in patients at high risk of cardiovascular (CV) events, and are the most commonly prescribed CV drugs worldwide. Although safe and generally well tolerated, there is growing evidence to suggest that statins are associated with an elevated occurrence of new-onset diabetes mellitus (DM). Recent experimental and clinical data have prompted the US Food and Drug Administration to add information to statin labels regarding the increased risk of development of type 2 DM. The main purpose of this review is to critically discuss the clinical evidence regarding the association of statin use with new-onset DM, the CV benefit/risk ratio with statins, and the rationale for individualized statin therapy. TI - Statins and Risk of New-Onset Diabetes Mellitus: is there a Rationale for Individualized Statin Therapy? EP - 87 SN - 1175-3277 IS - iss. 2 SP - 79 JF - American Journal of Cardiovascular Drugs VL - vol. 14 DO - http://dx.doi.org/10.1007/s40256-013-0053-0 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/133892/133892.pdf?sequence=1 ER - TY - JOUR AU - Verheugt, F.W.A. PY - 2014 UR - https://hdl.handle.net/2066/133903 TI - The elusive disconnection between mortality and early stent thrombosis: observations from the CHAMPION-PHOENIX trial EP - 9 SN - 0340-6245 IS - iss. 1 SP - 8 JF - Thrombosis and Haemostasis VL - vol. 111 DO - http://dx.doi.org/10.1160/TH13-10-0846 ER - TY - JOUR AU - Smid, B.E. AU - Tol, L. van der AU - Cecchi, F. AU - Elliott, P.M. AU - Hughes, D.A. AU - Linthorst, G.E. AU - Timmermans, J. AU - Weidemann, F. AU - West, M.L. AU - Biegstraaten, M. AU - Deprez, R.H. Lekanne AU - Florquin, S. AU - Postema, P.G. AU - Tomberli, B. AU - Wal, A.C. van der AU - Weerman, M.A. van den Bergh AU - Hollak, C.E. PY - 2014 UR - https://hdl.handle.net/2066/136144 AB - BACKGROUND: Screening in subjects with left ventricular hypertrophy (LVH) reveals a high prevalence of Fabry disease (FD). Often, a diagnosis is uncertain because characteristic clinical features are absent and genetic variants of unknown significance (GVUS) in the alpha-galactosidase A (GLA) gene are identified. This carries a risk of misdiagnosis, inappropriate counselling and extremely expensive treatment. We developed a diagnostic algorithm for adults with LVH (maximal wall thickness (MWT) of >12mm), GLA GVUS and an uncertain diagnosis of FD. METHODS: A Delphi method was used to reach a consensus between FD experts. We performed a systematic review selecting criteria on electrocardiogram, MRI and echocardiography to confirm or exclude FD. Criteria for a definite or uncertain diagnosis and a gold standard were defined. Results : A definite diagnosis of FD was defined as follows: a GLA mutation with /=1 characteristic FD symptom or sign (neuropathic pain, cornea verticillata, angiokeratoma) or increased plasma (lyso)Gb3 (classical male range) or family members with definite FD. Subjects with LVH failing these criteria have a GVUS and an uncertain diagnosis. The gold standard was defined as characteristic storage in an endomyocardial biopsy on electron microscopy. Abnormally low voltages on ECG and severe LVH (MWT>15mm) <20years exclude FD. Other criteria were rejected due to insufficient evidence. CONCLUSIONS: In adults with unexplained LVH and a GLA GVUS, severe LVH at young age and low voltages on ECG exclude FD. If absent, an endomyocardial biopsy with electron microscopy should be performed. TI - Uncertain diagnosis of Fabry disease: Consensus recommendation on diagnosis in adults with left ventricular hypertrophy and genetic variants of unknown significance EP - 408 SN - 0167-5273 IS - iss. 2 SP - 400 JF - International Journal of Cardiology VL - vol. 177 DO - http://dx.doi.org/10.1016/j.ijcard.2014.09.001 ER - TY - JOUR AU - Atar, D. AU - Bode, C. AU - Stuerzenbecher, A. AU - Verheugt, F.W.A. PY - 2014 UR - https://hdl.handle.net/2066/133827 AB - The impact of an acute coronary syndrome (ACS) event, such as an acute myocardial infarction (MI), is not limited to the acute management phase; patients face an elevated risk of residual atherothrombotic events that commonly requires chronic management for months or even years. Significant advances have been made in both the acute and chronic management of patients with acute MI over the past decade, resulting in improved prognoses. One of the hallmarks of modern treatment strategies is more aggressive antiplatelet treatment regimens. However, the risks of further ACS events, stroke and premature death remain elevated in these patients, and addressing this residual risk is challenging owing to interpatient variability, differences in management strategies between centres and countries, incomplete understanding of the specific pathophysiology of post-ACS thrombosis and limitations of current therapeutic approaches. The recent approval in Europe of the direct oral anticoagulant rivaroxaban for use in this setting in combination with clopidogrel and acetylsalicylic acid offers another strategy to consider in the management of these patients, and clinical strategies in this area continue to evolve. In this review, we chart the progress made over the past decade in reducing the burden of secondary thromboembolic events after acute MI and discuss the current position of and future perspectives on the inclusion of oral anticoagulants into care pathways in this setting. TI - Anticoagulants for secondary prevention after acute myocardial infarction: lessons from the past decade EP - 363 SN - 0767-3981 IS - iss. 4 SP - 353 JF - Fundamental & Clinical Pharmacology VL - vol. 28 DO - http://dx.doi.org/10.1111/fcp.12063 ER - TY - JOUR AU - Minasian, A.G. AU - Elshout, F.J.J. van den AU - Dekhuijzen, P.N.R. AU - Vos, P.J.E. AU - Willems, F.F. AU - Bergh, P.J.P.C. van den AU - Heijdra, Y.F. PY - 2014 UR - https://hdl.handle.net/2066/133864 AB - OBJECTIVE: To determine the prevalence of pulmonary function abnormalities in patients with chronic heart failure (HF) according to recent American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines using the lower limit of normal (LLN) compared to conventional cutoff values. BACKGROUND: Recent ATS/ERS guidelines recommend the use of the LLN instead of the conventional cutoff values to define pulmonary function impairment to avoid misclassification of patients. However, studies addressing the prevalence of pulmonary function abnormalities according to both definitions in patients with chronic HF are lacking. METHODS: In this prospective cross-sectional study, 164 chronic HF outpatients (age 68 +/- 10 years, 78% men, 88% New York Heart Association class I-II) with left ventricular ejection fraction < 40% underwent spirometry and measurement of diffusing capacity. Body plethysmography was performed in patients with abnormal spirometry results. Results : Diffusion impairment and airway obstruction were found in 44-58% and 26-37% of the patients, respectively, depending on the definition used (LLN versus conventional cutoff values, p < 0.05). However, restriction was infrequent, irrespective of the definition used (7% versus 5%, respectively, p > 0.05). The LLN identified fewer patients with abnormal lung function, whereas the conventional cutoff values classified more patients with diffusion impairment, airway obstruction, or a mixed category. Twenty-seven percent of patients were misclassified by the conventional cutoff values. CONCLUSION: Pulmonary function abnormalities, especially diffusion impairment and airway obstruction, were highly prevalent in patients with chronic HF. Conventional cutoff values classified more patients with diffusion impairment, airway obstruction, or a mixed category compared to the LLN. TI - Pulmonary function impairment in patients with chronic heart failure: Lower limit of normal versus conventional cutoff values EP - 316 SN - 0147-9563 IS - iss. 4 SP - 311 JF - Heart & Lung VL - vol. 43 DO - http://dx.doi.org/10.1016/j.hrtlng.2014.03.011 ER - TY - JOUR AU - Minasian, A.G. AU - Elshout, F.J.J. van den AU - Dekhuijzen, P.N.R. AU - Vos, P.J.E. AU - Willems, F.F. AU - Bergh, P.J.P.C. van den AU - Heijdra, Y.F. PY - 2014 UR - https://hdl.handle.net/2066/136076 AB - BACKGROUND: It is unknown whether serial pulmonary function tests are necessary for the correct diagnosis of chronic obstructive pulmonary disease (COPD) in patients with stable non-congested chronic heart failure (CHF). The aim of this study was to determine the prevalence of COPD in outpatients with stable CHF without pulmonary congestion using initial as well as confirmatory spirometry three months after treatment for COPD. METHODS: Spirometry was performed in 187 outpatients with stable CHF without pulmonary congestion on chest radiograph who had a left ventricular ejection fraction < 40% (mean age 69 +/- 10 years, 78% men). COPD was defined according to the Global Initiative for Chronic Obstructive Lung Disease guidelines. The diagnosis of COPD was confirmed three months after treatment with tiotropium in newly diagnosed COPD patients. Results : Using a three month follow-up spirometry to confirm initial diagnosis of de novo COPD did not change COPD prevalence significantly: 32.6% initially versus 32.1% after three months of follow-up. Only 1 of 25 (4%) patients with newly diagnosed COPD was not reproducibly obstructed at follow-up. COPD was greatly under- (19%) and overdiagnosed (32%). CONCLUSIONS: Spirometry should be used under stable and euvolemic conditions to decrease the burden of undiagnosed or overdiagnosed COPD in patients with CHF. Under these conditions, a confirmatory spirometry is unnecessary, as it does not change a newly established diagnosis of COPD in the vast majority of patients with CHF. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT01429376. TI - Serial pulmonary function tests to diagnose COPD in chronic heart failure SN - 2213-0802 IS - iss. 1 SP - 12 JF - Translational Respiratory Medicine VL - vol. 2 ER - TY - JOUR AU - Luca, G. De AU - Wirianta, J. AU - Lee, J.H. van der AU - Kaiser, C. AU - Lorenzo, E. Di AU - Suryapranata, H. PY - 2014 UR - https://hdl.handle.net/2066/136082 AB - Large interests have been focused on the role of drug-eluting stents in the setting of ST-segment elevation myocardial infarction (STEMI) and concerns have emerged regarding an higher risk of stent thrombosis. Aim of the current study was to perform a meta-analysis using individual patient data to evaluate the long-term safety and effectiveness of sirolimus-eluting stent (SES) as compared to paclitaxel-eluting stent (PES) in patients undergoing primary percutaneous coronary intervention (PCI) for STEMI. The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of SES versus PES for STEMI. No language restriction was applied. Primary study endpoint was the occurrence of major adverse cardiac events (MACE). Secondary endpoints were the occurrence of death, reinfarction, stent thrombosis, target-vessel revascularization (TVR). Individual patient data were obtained from 4 out of 5 trials identified, including a total of 1,000 patients, 504 (50.4 %) randomized to SES and 496 (49.6 %) randomized to PES. At long-term follow-up (1,021 [372-1,351] days), no difference was observed between SES and PES in terms of TVR (10 vs 11.6 %, HR [95 % CI 0.73 [0.45-1.16], p = 0.18, p het = 0.92]) (primary endpoint) or death (9.4 vs 10.4 %, HR [95 % CI 0.95 [0.58-1.54], p = 0.82, p het = 0.89]), reinfarction (8.2 vs 10.4 %, HR [95 % CI 0.91 [0.53-1.57], p = 0.73, p het = 0.83]), stent thrombosis (7.4 vs 4.6 %, HR [95 % CI 1.04 [0.55-2.05], p = 0.92, p het = 0.65]), and MACE (10 vs 13.6 %, HR[95 % CI 0.86 [0.63-1.18], p = 0.36, p het = 0.84]) (secondary endpoints). The present pooled patient-level meta-analysis demonstrates that, among STEMI patients undergoing primary PCI, SES and PES are associated with a similar outcome at long-term follow-up, in terms of death, reinfarction, stent thrombosis, TVR and MACE. TI - Sirolimus-eluting versus paclitaxel-eluting stent in primary angioplasty: a pooled patient-level meta-analysis of randomized trials EP - 363 SN - 0929-5305 IS - iss. 3 SP - 355 JF - Journal of Thrombosis and Thrombolysis VL - vol. 38 DO - http://dx.doi.org/10.1007/s11239-014-1052-y ER - TY - JOUR AU - Lorenzo, E. Di AU - Sauro, R. AU - Varricchio, A. AU - Capasso, M. AU - Lanzillo, T. AU - Manganelli, F. AU - Carbone, G. AU - Lanni, F. AU - Pagliuca, M.R. AU - Stanco, G. AU - Rosato, G. AU - Suryapranata, H. AU - Luca, G. De PY - 2014 UR - https://hdl.handle.net/2066/133866 AB - OBJECTIVES: The aim of the current study was to compare everolimus-eluting stents (EES) with sirolimus-eluting stents (SES) in patients undergoing primary angioplasty. BACKGROUND: Drug-eluting stents may offer benefits in terms of repeat revascularization. However, as shown for first-generation drug-eluting stents, they may be counterbalanced by a potential higher risk of stent thrombosis, especially among patients with ST-segment elevation myocardial infarction (STEMI). No data have been reported so far on the long-term benefits and safety of the new generation of drug-eluting stents in STEMI. METHODS: Consecutive STEMI patients admitted within 12 h of symptom onset and undergoing primary angioplasty and stent implantation at a tertiary center with 24-h primary percutaneous coronary intervention capability were randomly assigned to SES or EES. The primary endpoint was a major adverse cardiac event at 3-year follow-up. The secondary endpoints were death, reinfarction, definite or probable stent thrombosis, and target vessel revascularization at 3-year follow-up. No patient was lost to follow-up. RESULTS: From April 2007 to May 2009, 500 patients with STEMI were randomized to EES (n = 250) or SES (n = 250). No difference was observed in terms of baseline demographic and clinical characteristics between the groups. No difference was observed between the groups in terms of number of implanted stents per patient or total stent length. However, a larger reference diameter was observed with SES (3.35 +/- 0.51 mm vs. 3.25 +/- 0.51 mm, p = 0.001), whereas patients randomized to EES more often received glycoprotein IIb/IIIa inhibitors (54.4% vs. 42.4%, p = 0.006). Follow-up data were available in all patients (1,095 +/- 159 days). No significant difference was observed between EES and SES in major adverse cardiac events (16% vs. 20.8%, adjusted hazard ratio [HR]: 0.75 [95% confidence interval (CI): 0.5 to 1.13], p = 0.17), cardiac death (4.4% vs. 5.6%, adjusted HR: 0.77 [95% CI: 0.35 to 1.71], p = 0.53), recurrent MI (6.4% vs. 10%, adjusted HR: 0.62 [95% CI: 0.33 to 1.16], p = 0.13), and target vessel revascularization (4.8% vs. 4.8%, adjusted HR: 1.00 [95% CI: 0.45 to 2.32], p = 0.99). However, EES was associated with a significant reduction in stent thrombosis (1.6% vs. 5.2%, adjusted HR: 0.3 [95% CI: 0.1 to 0.92], p = 0.035). CONCLUSIONS: This study shows that among STEMI patients undergoing primary angioplasty, EES has similar efficacy as SES, but is associated with a significant reduction in stent thrombosis. (Randomized Comparison of Everolimus Eluting Stents and Sirolimus Eluting Stent in Patients With ST Elevation Myocardial Infarction [RACES-MI]; NCT01684982). TI - Randomized Comparison of Everolimus-Eluting Stents and Sirolimus-Eluting Stents in Patients With ST Elevation Myocardial Infarction: RACES-MI Trial EP - 856 SN - 1936-8798 IS - iss. 8 SP - 849 JF - Jacc. Cardiovascular Interventions VL - vol. 7 DO - http://dx.doi.org/10.1016/j.jcin.2014.02.016 ER - TY - JOUR AU - Dijk, G.P. van AU - Kooi, E. van der AU - Behin, A. AU - Smeets, J.L. AU - Timmermans, J. AU - Maarel, S. van der AU - Padberg, G.W. AU - Voermans, N.C. AU - Engelen, B.G.M. van PY - 2014 UR - https://hdl.handle.net/2066/135912 AB - The exact prevalence and nature of cardiac involvement in facioscapulohumeral muscular dystrophy (FSHD) is unknown. Nevertheless, the current opinion is that symptomatic cardiac disease is rare. We performed a cardiac screening [electrocardiogram (ECG) and echocardiography in the event of ECG abnormalities] in 75 genetically confirmed, ambulant FSHD patients without cardiac symptoms, with an eight-year follow-up of 57 patients, and compared the findings with results of previously performed cardiac screenings in the normal population. Baseline ECG demonstrated incomplete right bundle branch block (RBBB) in 33%, complete RBBB in 4%, and other minor abnormalities in 16%. Echocardiography showed no abnormalities. No significant changes were found after eight years of follow-up. Comparison with ECG abnor-High prevalence of incomplete right bundle branch block in facioscapulohumeral muscular dystrophy without cardiac symptoms malities in the normal population showed a higher prevalence of incomplete RBBB (9.7 times higher) and of complete RBBB (4.8 times higher) in FSHD patients. This study in cardiac asymptomatic FSHD patients shows i) increased prevalence of incomplete RBBB in the absence of cardiomyopathy; ii) no progression of these abnormalities during eight years of follow-up. We conclude that FSHD patients without cardiac complaints do not need specific cardiac screening or surveillance. Furthermore, the increased prevalence of incomplete RBBB in the absence of cardiomyopathy suggests a selective involvement of the His-Purkinje system in FSHD. TI - High prevalence of incomplete right bundle branch block in facioscapulohumeral muscular dystrophy without cardiac symptoms EP - 165 SN - 0393-5264 IS - iss. 3 SP - 159 JF - Functional Neurology VL - vol. 29 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/135912/135912.pdf?sequence=1 ER - TY - JOUR AU - Adamski, P. AU - Kozinski, M. AU - Ostrowska, M. AU - Fabiszak, T. AU - Navarese, E.P. AU - Paciorek, P. AU - Grzesk, G. AU - Kubica, J. PY - 2014 UR - https://hdl.handle.net/2066/133851 AB - Dual antiplatelet therapy consisting of one of the P2Y12 receptor inhibitors in conjunction with aspirin is the mainstay of treatment for patients with acute coronary syndromes (ACS) and those undergoing percutaneous coronary interventions (PCI). In recent years, multiple extra-platelet features of P2Y12 receptor antagonists have been reported in numerous clinical trials. The aim of this review is to summarise reported pleiotropic effects of clopidogrel, prasugrel, ticagrelor and other P2Y12 receptor blockers. We included observations made both in human and in animal models, together with proposed mechanisms of action for described features. If confirmed in randomised studies and properly applied to everyday practice, the observed extra-platelet actions could enable us to improve efficacy of ACS and post-PCI treatment, as well as to confine mortality and occurrence rate of cardiovascular events. TI - Overview of pleiotropic effects of platelet P2Y12 receptor inhibitors EP - 242 SN - 0340-6245 IS - iss. 2 SP - 224 JF - Thrombosis and Haemostasis VL - vol. 112 DO - https://doi.org/10.1160/TH13-11-0915 ER - TY - JOUR AU - Navarese, E.P. AU - Kowalewski, M. AU - Suryapranata, H. PY - 2014 UR - https://hdl.handle.net/2066/133853 TI - Percutaneous coronary intervention vs medical treatment in stable angina: the never-ending story EP - 1200 SN - 2168-6106 IS - iss. 7 SP - 1199 JF - Jama Internal Medicine VL - vol. 174 DO - https://doi.org/10.1001/jamainternmed.2014.1529 ER - TY - JOUR AU - Halvorsen, S. AU - Andreotti, F. AU - Berg, J.M. van den AU - Cattaneo, M. AU - Coccheri, S. AU - Marchioli, R. AU - Morais, J. AU - Verheugt, F.W.A. AU - Caterina, R. de PY - 2014 UR - https://hdl.handle.net/2066/133860 AB - Although the use of oral anticoagulants (vitamin K antagonists) has been abandoned in primary cardiovascular prevention due to lack of a favorable benefit-to-risk ratio, the indications for aspirin use in this setting continue to be a source of major debate, with major international guidelines providing conflicting recommendations. Here, we review the evidence in favor and against aspirin therapy in primary prevention based on the evidence accumulated so far, including recent data linking aspirin with cancer protection. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to using low-dose aspirin in primary cardiovascular prevention and suggest its use in patients at high cardiovascular risk, defined as >/=2 major cardiovascular events (death, myocardial infarction, or stroke) projected per 100 person-years, who are not at increased risk of bleeding. TI - Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis EP - 327 SN - 0735-1097 IS - iss. 3 SP - 319 JF - Journal of the American College of Cardiology VL - vol. 64 DO - https://doi.org/10.1016/j.jacc.2014.03.049 ER - TY - JOUR AU - Navarese, E.P. AU - Kowalewski, M. AU - Kandzari, D. AU - Lansky, A. AU - Gorny, B. AU - Koltowski, L. AU - Waksman, R. AU - Berti, S. AU - Musumeci, G. AU - Limbruno, U. AU - Schaaf, R.J. van der AU - Kelm, M. AU - Kubica, J. AU - Suryapranata, H. PY - 2014 UR - https://hdl.handle.net/2066/135889 AB - BACKGROUND: First-generation drug-eluting stents (DES) have become the most widely used devices worldwide for management of coronary artery disease. As remote follow-up data were becoming available, concerns emerged in regard to their long-term safety. Second-generation DES were designed to overcome safety issues, but the results of randomised clinical trials remain conflicting. METHODS: We compared the safety and efficacy of first-generation versus second-generation Food and Drug Administration approved DES; the following devices were included: first-generation sirolimus-eluting stent (SES) and paclitaxel-eluting stents (PES); second-generation everolimus-eluting stent (EES), zotarolimus-eluting stent Endeavor and ZES-Resolute (ZES-R). Prespecified safety end points comprised 1 year: overall and cardiac mortality, myocardial infarction (MI), definite/definite or probable ST; efficacy end points were target lesion revascularisation and target vessel revascularisation. Composite end points were analysed as well. RESULTS: 33 randomised controlled trials involving 31 379 patients with stable coronary artery disease or acute coronary syndrome undergoing DES implantation were retrieved. No differences in mortality among devices were found. In the overall class comparison, second-generation DES were associated with a 22% reduction of odds of MI at short-term OR 0.77 (95% CI 0.68 to 0.89) p=0.0002; EES reduced the odds of definite-probable ST compared with PES: OR 0.33 (95% CI 0.15 to 0.73) p=0.006; First-generation SES along with second-generation EES and ZES-R showed similar efficacy in decreasing the odds of repeat revascularisation. CONCLUSIONS: Second-generation EES and ZES-R offer similar levels of efficacy compared with first-generation SES, but are more effective than PES; however, only second-generation EES significantly reduced the incidence of MI and ST, and therefore should be perceived as the safest DES to date. TI - First-generation versus second-generation drug-eluting stents in current clinical practice: updated evidence from a comprehensive meta-analysis of randomised clinical trials comprising 31 379 patients SN - 2053-3624 IS - iss. 1 SP - e000064 JF - Open Heart VL - vol. 1 DO - https://doi.org/10.1136/openhrt-2014-000064 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/135889/135889.pdf?sequence=1 ER - TY - JOUR AU - Luca, G. De AU - Schaffer, A. AU - Verdoia, M. AU - Suryapranata, H. PY - 2014 UR - https://hdl.handle.net/2066/133830 AB - BACKGROUND AND AIM: Clinical trials have reported lower mortality and repeated revascularization rate in diabetic patients treated with coronary artery bypass grafting (CABG) as compared to percutaneous revascularization. However, these studies were conducted in the era of bare-metal stents. Therefore, we performed a meta-analysis to compare CABG to PCI with drug-eluting stents (DES) in diabetic patients with multivessel and/or left main disease. METHODS AND RESULTS: The literature was scanned by formal search of electronic databases (Medline, EMBASE, and Cochrane databases), and major international scientific session abstracts from 2000 to 2013. Primary endpoint was mortality. A total of 14 (4 randomized and 10 non-randomized) trials were finally included, with a total of 7072 patients. Up to 5 years follow-up, CABG was associated with a reduction in mortality (7.3% vs 10.4%, OR[95%CI] = 0.65[0.55-0.77], p < 0.0001; phet = 0.00001), with similar results in both RCTs (OR[95%CI] = 0.64[0.50-0.82], p = 0.0005) and NRCTs (OR[95%CI] = 0.75[0.6-0.94)], p = 0.01) (p int = 0.93). A significant relationship was observed between risk profile and benefits in mortality with CABG (p < 0.001). CABG reduced target vessel revascularization (TVR; 5.2% vs 15.7%, OR[95%CI] = 0.30[0.25-0.36], p < 0.00001, p het = 0.02), with a relationship between risk profile and the benefits from CABG as compared to DES (p < 0.0001). CABG was associated with a lower rate of MACCE (14.9% vs 22.9%, OR[95%CI] = 0.59[0.51-0.67], p < 0.00001, p het<0.00001) but higher risk of CVA (3.6% vs 1.4%, OR[95%CI] = 2.34[1.63-3.35], p < 0.00001, p het = 0.71). CONCLUSIONS: The present meta-analysis demonstrates that among diabetic patients with multivessel disease and/or left main disease, CABG provides benefits in mortality and TVR, especially in high-risk patients but it is counterbalanced by a higher risk of stroke. Future trials are certainly needed in the era of new DES and improved antiplatelet therapies. TI - Meta-analysis of 14 trials comparing bypass grafting vs drug-eluting stents in diabetic patients with multivessel coronary artery disease EP - 354 SN - 0939-4753 IS - iss. 4 SP - 344 JF - Nutrition Metabolism and Cardiovascular Diseases VL - vol. 24 DO - https://doi.org/10.1016/j.numecd.2013.11.002 ER - TY - JOUR AU - Verdoia, M. AU - Secco, G.G. AU - Barbieri, L. AU - Cassetti, E. AU - Schaffer, A. AU - Sinigaglia, F. AU - Marino, P. AU - Suryapranata, H. AU - Luca, G. De PY - 2014 UR - https://hdl.handle.net/2066/133857 AB - Periprocedural myocardial infarction (PMI) represents a relatively common complication of percutaneous coronary intervention (PCI) and large interests have been focused on platelets in order to prevent such a complication. The single nucleotide polymorphism Leu33Pro of platelet glycoprotein IIIa has been related to an increased platelet reactivity, a lower response to antiplatelet agents and higher risk of stent restenosis. Therefore, aim of our study was to evaluate the impact of this polymorphism on PMI in elective patients undergoing PCI. Our population is represented by 422 consecutive patients with cardiac biomarkers within normality undergoing elective PCI. We measured cardiac biomarkers (CK-MB and Troponin I) at baseline, and 8, 24 and 48 hours after the procedure. For all subjects, we performed genetic analysis to assess the presence of Leu33Pro polymorphism. A total of 136 patients (32.2%) were polymorphic. Those patients were younger (p = 0.03) and more often dislypidemic (p = 0.01). Angiographic features did not differ according to genetic status. Pharmacological treatment pre and during angioplasty was similar. PCI-related complications did not differ according to genotype, with the only exception of higher rate of distal embolization in polymorphic patients. However, Leu33Pro polymorphism was not associated with increased risk of periprocedural myonecrosis and PMI even after correction for baseline differences, (respectively OR = 1.22 [0.81-1.84], p = 0.34 for myonecrosis and OR = 1.66 [0.85-3.23]; p = 0.14 for PMI). At subgroup analysis, the Leu33Pro substitution was associated with higher risk of PMI only among diabetics (adjusted OR = 4.46 [1.12-17.76], p = 0.03). Among patients undergoing elective PCI, the polymorphism Leu33Pro of platelet glycoprotein IIIa is associated with increased risk of PMI only in diabetic patients. TI - Platelet HPA-1 a/HPA-1 b polymorphism and the risk of periprocedural myocardial infarction in patients undergoing elective PCI EP - 372 SN - 0953-7104 IS - iss. 5 SP - 367 JF - Platelets VL - vol. 25 DO - https://doi.org/10.3109/09537104.2013.821602 ER - TY - JOUR AU - Verdoia, M. AU - Secco, G.G. AU - Cassetti, E. AU - Schaffer, A. AU - Barbieri, L. AU - Perrone-Filardi, P. AU - Marino, P. AU - Suryapranata, H. AU - Sinigaglia, F. AU - Luca, G. De PY - 2014 UR - https://hdl.handle.net/2066/133858 AB - Acute coronary syndromes (ACSs) represent a high-risk condition, as enhanced platelet reactivity importantly influences myocardial perfusion and procedural results after percutaneous coronary intervention (PCI). In fact, higher rate of periprocedural myocardial infarction (PMI) and reduced event-free survival have been reported in these patients. The single nucleotide polymorphism Leu33Pro of platelet glycoprotein IIIa has been related to an increased platelet reactivity, a lower response to antiplatelet agents and higher risk of stent restenosis. Therefore, our aim was to evaluate the impact of this polymorphism on PMI in patients undergoing PCI for non-ST-segment elevation MI (NSTEMI). Our population is represented by 478 consecutive patients undergoing coronary angioplasty for NSTEMI. Cardiac biomarkers were monitored at intervals from 8 to 48 h after the procedure. Genetic analysis was performed to assess the presence of Leu33Pro polymorphism. A total of 156 patients (32.6%) were polymorphic. Clinical features did not differ according to genetic status, neither pharmacological treatment pre and during angioplasty. PlA carriers had lower rate of calcifications (P = 0.01) and higher coronary tortuosity (P = 0.03) at angiography and underwent more frequently to thrombectomy (P = 0.05). PCI-related complications did not differ according to genotype. Leu33Pro polymorphism was not associated with increased risk of periprocedural myonecrosis and PMI even after correction for baseline differences, [odds ratio (OR) (95% confidence interval (CI) = 0.70 (0.44-1.13), P = 0.15 for PMI and OR (95% CI) = 0.77 (0.53-1.11), P = 0.17 for myonecrosis, respectively]. Results were confirmed in high-risk subgroups of patients. In conclusion, among patients undergoing PCI for ACS, the polymorphism Leu33Pro of platelet glycoprotein IIIa is not associated with increased risk of PMI. TI - Platelet PIA1/PIA2 polymorphism and the risk of periprocedural myocardial infarction in patients with acute coronary syndromes undergoing coronary angioplasty EP - 113 SN - 0957-5235 IS - iss. 2 SP - 107 JF - Blood Coagulation & Fibrinolysis VL - vol. 25 DO - https://doi.org/10.1097/MBC.0b013e3283650717 ER - TY - JOUR AU - Driessen, M.M. AU - Baggen, V.J. AU - Freling, H.G. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Doevendans, P.A. AU - Snijder, R.J. AU - Post, M.C. AU - Meijboom, F.J. AU - Sieswerda, G.T. AU - Leiner, T. AU - Willems, T.P. PY - 2014 UR - https://hdl.handle.net/2066/133862 AB - Cardiac magnetic resonance (CMR) imaging is the preferred method to measure right ventricular (RV) volumes and ejection fraction (RVEF). This study aimed to determine the impact of excluding trabeculae and papillary muscles on RV volumes and function in patients with RV pressure and/or volume overload and healthy controls and its reproducibility using semi-automatic software. Eighty patients (pulmonary hypertension, transposition of the great arteries after arterial switch operation and after atrial switch procedure and repaired Tetralogy of Fallot) and 20 controls underwent short-axis multislice cine CMR. End diastolic volume (EDV), end systolic volume (ESV), RV mass and RVEF were measured using 2 methods. First, manual contour tracing of RV endo- and epi-cardial borders was performed. Thereafter, trabeculae were excluded from the RV blood volume using semi-automatic pixel-intensity based software. Both methods were compared using a Student T test and 25 datasets were re-analyzed for reproducibility. Exclusion of trabeculae resulted in significantly decreased EDV; ranging from -5.7 +/- 1.7 ml/m(2) in controls to -29.2 +/- 6.6 ml/m(2) in patients after atrial switch procedure. RVEF significantly increased in all groups, ranging from an absolute increase of 3.4 +/- 0.8 % in healthy controls to 10.1 +/- 2.3 % in patients after atrial switch procedure. Interobserver agreement of method 2 was equal to method 1 for RVEDV, RVESV and RVEF and superior for RV mass. In patients with overloaded RVs exclusion of trabeculae from the blood volume results in a significant change in RV volumes, RVEF and RV mass. Exclusion of trabeculae is highly reproducible when semi-automatic pixel-intensity based software is used. TI - Pressure overloaded right ventricles: a multicenter study on the importance of trabeculae in RV function measured by CMR EP - 608 SN - 1569-5794 IS - iss. 3 SP - 599 JF - International Journal of Cardiovascular Imaging VL - vol. 30 DO - https://doi.org/10.1007/s10554-014-0367-2 ER - TY - JOUR AU - Aalberts, J.J.J. AU - Tintelen, J.P. van AU - Meijboom, L.J. AU - Polko, A. AU - Jongbloed, J.D. AU - Wal, H. van der AU - Pals, G. AU - Osinga, J. AU - Timmermans, J. AU - Backer, J. de AU - Bakker, M.K. AU - Veldhuisen, D.J. van AU - Hofstra, R.M. AU - Mulder, B.J. AU - Berg, M.P van den PY - 2014 UR - https://hdl.handle.net/2066/133873 AB - Cardiovascular manifestations in patients with Marfan syndrome (MFS) are related to aortic and valvular abnormalities. However, dilatation of the left ventricle (LV) can occur, even in the absence of aortic surgery or valvular abnormalities. We evaluated genetic characteristics of patients with MFS with LV dilatation. One hundred eighty-two patients fulfilling the MFS criteria, without valvular abnormalities or previous aortic surgery, with a complete FBN1 analysis, were studied. FBN1 mutations were identified in over 81% of patients. Twenty-nine patients (16%) demonstrated LV dilatation (LV end diastolic diameter corrected for age and body surface area >112%). FBN1-positive patients carrying a non-missense mutation more often had LV dilatation than missense mutation carriers (14/74 versus 5/75; p<0.05). Finally, FBN1-negative MFS patients significantly more often demonstrated LV dilatation than FBN1-positive patients (10/33 versus 19/149; p<0.05). It is concluded that LV dilatation in MFS patients is more often seen in patients with a non-missense mutation and in those patients without an FBN1 mutation. Therefore physicians should be aware of the possibility of LV dilatation in these patients even in the absence of valvular pathology. TI - Relation between genotype and left-ventricular dilatation in patients with Marfan syndrome EP - 43 SN - 0378-1119 IS - iss. 1 SP - 40 JF - Gene VL - vol. 534 DO - https://doi.org/10.1016/j.gene.2013.10.033 ER - TY - JOUR AU - Schaffer, A. AU - Verdoia, M. AU - Cassetti, E. AU - Marino, P. AU - Suryapranata, H. AU - Luca, G. De PY - 2014 UR - https://hdl.handle.net/2066/133875 AB - BACKGROUND: Coronary artery disease (CAD) still represents the major cause of mortality in developed countries. Large research programs have been focused on the identification of new risk factors to prevent CAD, with special attention to homocysteine (Hcy), due to the known associated increased thrombogenicity, oxidative stress status and endothelial dysfunction. However, controversy still exists on the association between Hcy and CAD. Therefore, aim of the current study was to investigate the association of Hcy with the prevalence and extent of CAD in a large consecutive cohort of patients undergoing coronary angiography. METHODS: Our population is represented by a total of 3056 consecutive patients undergoing coronary angiography between at the Azienda Ospedaliera "Maggiore della Carita", Novara, Italy. Fasting samples were collected for homocysteine levels assessment. Coronary disease was defined for at least 1 vessel stenosis>50% as evaluated by QCA. RESULTS: Study population was divided according to Hcy tertiles (<13,3, 13,3-18.2, >18.2nmol/ml). High plasmatic level of homocysteine was related with age (p<0.001), male gender (p<0.001), hypertension (p<0.001) renal failure (p<0.001), family history of CAD (p<0.001), previous cerebrovascular accident (p<0.001), previous MI (p=0.002), previous CABG (p=0.003), ejection fraction (p<0.001), higher baseline creatinine (p<0.001), in treatment with nitrates (p<0.001), calcium antagonists (p<0.001), diuretics (p<0.001), Ace inhibitors (ACE-I) (p=0.006), Clopidogrel (p=0.05), haemoglobin (p=0.001), white blood cells (WBC) count (p=0.008), total cholesterol (p=0.04), Low-Density Lipoproteins (LDL) (p=0.01). A significant relationship was found between Hcy levels and the extent of coronary artery disease (71.8% vs 77.8% vs 77.4%, OR[95%CI]=1.18[1.11-1.252.], p<0.001 and severe CAD (23.6% vs 29.5% vs 32.1%, OR [95%CI]=1.275 [1.209-1.344], p<0.001). Elevated Hcy was significantly associated with increased risk of CAD (adjusted OR[95%CI]=1.087[1.009-1.171], p=0.02 and severe CAD (adjusted OR [95%CI]=1.07 [1.01-1.16, P=0.04]). The results were confirmed in the majority of high risk subsets of patients. CONCLUSIONS: This study showed that high levels of plasmatic Hcy are independently associated with CAD. Further large studies are certainly needed to explore the adjunctive benefits from vitamin administration in patients with elevated Hcy to prevent the occurrence and progression of CAD. TI - Relationship between homocysteine and coronary artery disease. Results from a large prospective cohort study EP - 293 SN - 0049-3848 IS - iss. 2 SP - 288 JF - Thrombosis Research VL - vol. 134 DO - https://doi.org/10.1016/j.thromres.2014.05.025 ER - TY - JOUR AU - Luijendijk, P. AU - Bouma, B.J. AU - Vriend, J.W. AU - Groenink, M. AU - Vliegen, H.W. AU - Groot, E. de AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Konings, T.C. AU - Stroes, E.S. AU - Zwinderman, A.H. AU - Mulder, B.J. PY - 2014 UR - https://hdl.handle.net/2066/133882 AB - BACKGROUND: Carotid intima-media thickness (CIMT) is a marker for atherosclerosis. Adult post-coarctectomy patients (CoA) demonstrate an increased cardiovascular risk and increased CIMT compared to controls. This study evaluates the effect of high dose statins on the change in CIMT and cardiovascular risk. METHODS: We designed a multicenter, prospective, randomized, open label trial with blinded endpoint (PROBE design) to evaluate the effect of three year treatment with atorvastatin 80mg on CIMT and cardiovascular risk. Primary endpoint was CIMT measured by B mode ultrasonography. Secondary endpoints were mortality and morbidity due to cardiovascular disease and serum lipids. RESULTS: 155 patients (36.3+/-11.8years, 96 (62%) male) were randomized (atorvastatin=80, no treatment=75). There was no significant effect of atorvastatin on the change in CIMT (treatment effect -0.005, 95% CI, -0.039-0.029; P=0.76). A significant effect on serum cholesterol and LDL levels was found (- 0.71, 95% CI, - 1.16 to - 0.26; P = 0.002 vs - 0.66, 95% CI - 1.06 to - 0.26; P = 0.001). There was no difference in secondary outcome measures. Baseline CIMT was higher in hypertensive compared to normotensive CoA. (0.69+/-0.16mm vs 0.61+/-0.98mm; P=0.002). Hypertension (ss=0.043, P=0.031) was the strongest determinant CIMT. CONCLUSION: Three year treatment with atorvastatin does not lead to a reduction of CIMT and secondary outcome measures, despite a decrease in total cholesterol and LDL levels. Hypertensive CoA demonstrate the highest CIMT and the largest CIMT progression. Blood pressure control should be the main focus in CoA to decrease cardiovascular risk. TI - Beneficial effect of high dose statins on the vascular wall in patients with repaired aortic coarctation? EP - 47 SN - 0167-5273 IS - iss. 1 SP - 40 JF - International Journal of Cardiology VL - vol. 176 DO - https://doi.org/10.1016/j.ijcard.2014.06.016 ER - TY - JOUR AU - Hamon, M. AU - Bonello, L. AU - Marso, S. AU - Rao, S.V. AU - Valgimigli, M. AU - Verheugt, F.W.A. AU - Gershlick, A. AU - Wang, Y. AU - Prats, J. AU - Steg, G.P. AU - Deliargyris, E. PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127585 AB - BACKGROUND: Several percutaneous coronary intervention (PCI) trials have established that the use of bivalirudin (BIV) is associated with improved patient outcomes and substantial hospital cost savings, relative to heparin (HEP)-based regimens+/-glycoprotein IIb/IIIa inhibitors (GPIs). Whether these benefits persist with the use of prasugrel, a new third-generation oral thienopyridine, has not been previously evaluated. METHODS: Using the Premier hospital database, 6986 patients treated with prasugrel who underwent elective, urgent, or primary PCI between quarter 3, 2009 and quarter 4, 2010 from 166 US hospitals were identified. These patients received either BIV (n=3377) or HEP+/-GPI (n=3609) as procedural anticoagulation. Outcomes of interest included bleeding, transfusions, death, and hospital length of stay (LOS). To control for patient and hospital-level characteristics, propensity score-matching (PSM) analyses were performed. RESULTS: Mortality, clinically apparent bleeding, clinically apparent bleeding requiring transfusion, any transfusions, and LOS were all lower in patients treated with BIV as compared with patients treated with HEP+/-GPI. After PSM, the rate of transfusion was significantly lower with BIV (odds ratio: 0.57, 95% confidence interval: 0.34-0.96), and the hospital LOS was significantly shorter in patients treated with BIV compared with those treated with HEP+/-GPI (0.9+/-2.0 vs 1.2+/-2.3 days, P<0.0001). CONCLUSIONS: In patients undergoing PCI and treated with prasugrel, the use of BIV rather than HEP+/-GPI is associated with significantly lower transfusion rate and LOS. These results suggest that the previously documented safety and cost-effectiveness benefits of BIV remain applicable when prasugrel is used. TI - Comparison of bivalirudin versus heparin(s) during percutaneous coronary interventions in patients receiving prasugrel: a propensity-matched study EP - 20 SN - 0160-9289 IS - iss. 1 SP - 14 JF - Clinical Cardiology VL - vol. 37 DO - https://doi.org/10.1002/clc.22208 ER - TY - JOUR AU - Franken, R. AU - Hartog, A.W. den AU - Radonic, T. AU - Waard, V. de AU - Timmermans, J. AU - Scholte, A. AU - Berg, M.P van den AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Groenink, M. PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127600 AB - OBJECTIVE: To determine the effect of losartan on aortic dilatation rate in adults with Marfan syndrome. DESIGN: Randomised, controlled multicentre clinical trial. METHOD: Adult Marfan patients from the 4 Marfan centres in the Netherlands with a maximum of 1 aortic prosthesis were randomised to 100 mg losartan once daily or no additional losartan treatment. All patients continued their standard treatment, which consisted mainly of beta-blockers. The primary outcome measure was a reduction in aortic dilatation rate. The secondary outcome measures were an increase in aortic volume and the incidence of the combined outcome measure: cardiovascular mortality, aortic dissection and aorta surgery. This trial was registered with the Dutch Trial Register (NTR1423). RESULTS: 233 patients were included. Absolute aortic diameters were measured at the beginning and at the end of the study. The aortic root dilatation rate after 3 years was significantly lower in patients in the losartan group than in those in the control group (0.77 mm/3 years (SD: 1.36) vs. 1.35 mm/3 years (SD: 1.55); p = 0.014). The dilatation rate in the trajectory beyond the aortic root was comparable in the two groups. There were no differences in the secondary outcome measures between the two groups. A subanalysis of patients with aortic root replacement surgery prior to inclusion in the study demonstrated that in this group losartan treatment led to a significant decrease in aortic arch dilatation rate versus standard treatment (0.50 mm/3 years (SD: 1.26) vs. 1.01 mm/3 years (1.31); p = 0.033). CONCLUSION: In adult Marfan patients, losartan treatment reduces the aortic root dilatation rate. After aortic root surgery, losartan treatment reduces dilatation rate of the aortic arch. TI - [Effect of losartan treatment on aortic dilatation in adults with Marfan syndrome] SN - 0028-2162 IS - iss. 2 SP - A6845 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 158 ER - TY - JOUR AU - Gouya, G. AU - Arrich, J. AU - Wolzt, M. AU - Huber, K. AU - Verheugt, F.W.A. AU - Gurbel, P.A. AU - Pirker-Kees, A. AU - Siller-Matula, J.M. PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127658 AB - BACKGROUND AND PURPOSE: The efficacy and safety of different antiplatelet regimes for prevention of stroke in patients at high risk were investigated in a systematic review and meta-analysis. METHODS: We searched the Cochrane Central Register of Controlled Trials, MEDLINE, and Web of Science. Twenty-two studies comprising 173 371 patients were included. RESULTS: In the overall population, dual antiplatelet therapy (DAPT) with aspirin and clopidogrel in comparison to aspirin monotherapy reduced the relative risk of total stroke by 20% (risk ratio [RR], 0.80; 95% confidence interval [CI], 0.73-0.88; P<0.0001; I(2)=28%) and of ischemic stroke or transient ischemic attack by 23% (RR, 0.77; 95% CI, 0.69-0.85; P<0.0001; I(2)=18%) without increasing the risk of intracranial hemorrhage. In the secondary prevention cohort, DAPT with aspirin and clopidogrel also reduced the relative risk of total stroke by 24% as compared with aspirin alone (RR, 0.76; 95% CI, 0.68-0.86; P<0.0001; I(2)=0%). DAPT with prasugrel or ticagrelor and aspirin versus DAPT with clopidogrel and aspirin was not associated with a risk reduction of stroke. CONCLUSIONS: DAPT with clopidogrel and aspirin compared with aspirin effectively reduces the risk of total and ischemic stroke in the overall cohort consisting of patients with cardiovascular disease without increase in intracranial hemorrhage, as well as decreases the risk of a recurrent total stroke in patients with a previous stroke/transient ischemic attack. Our meta-analysis suggests that DAPT including low-dose aspirin (75-100 mg) and clopidogrel (75 mg) should be further investigated as a strategy to reduce recurrent strokes. CLINICAL TRIAL REGISTRATION URL: http://www.crd.york.ac.uk/prospero. Unique identifier: CRD42011001596. TI - Antiplatelet treatment for prevention of cerebrovascular events in patients with vascular diseases: a systematic review and meta-analysis EP - 503 SN - 0039-2499 IS - iss. 2 SP - 492 JF - Stroke VL - vol. 45 DO - https://doi.org/10.1161/STROKEAHA.113.002590 ER - TY - JOUR AU - Alexander, J.H. AU - Lopes, R.D. AU - Thomas, L. AU - Alings, M. AU - Atar, D. AU - Aylward, P. AU - Goto, S. AU - Hanna, M. AU - Huber, K. AU - Husted, S. AU - Lewis, B.S. AU - McMurray, J.J. AU - Pais, P. AU - Pouleur, H. AU - Steg, P.G. AU - Verheugt, F.W.A. AU - Wojdyla, D.M. AU - Granger, C.B. AU - Wallentin, L. PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127659 AB - AIMS: We assessed the effect of concomitant aspirin use on the efficacy and safety of apixaban compared with warfarin in patients with atrial fibrillation (AF). METHODS AND RESULTS: In ARISTOTLE, 18 201 patients were randomized to apixaban 5 mg twice daily or warfarin. Concomitant aspirin use was left to the discretion of the treating physician. In this predefined analysis, simple and marginal structured models were used to adjust for baseline and time-dependent confounders associated with aspirin use. Outcome measures included stroke or systemic embolism, ischaemic stroke, myocardial infarction, mortality, major bleeding, haemorrhagic stroke, major or clinically relevant non-major bleeding, and any bleeding. On Day 1, 4434 (24%) patients were taking aspirin. Irrespective of concomitant aspirin use, apixaban reduced stroke or systemic embolism [with aspirin: apixaban 1.12% vs. warfarin 1.91%, hazard ratio (HR) 0.58, 95% confidence interval (CI) 0.39-0.85 vs. without aspirin: apixaban 1.11% vs. warfarin 1.32%, HR 0.84, 95% CI 0.66-1.07; P interaction = 0.10] and caused less major bleeding than warfarin (with aspirin: apixaban 3.10% vs. warfarin 3.92%, HR 0.77, 95% CI 0.60-0.99 vs. without aspirin: apixaban 1.82% vs. warfarin 2.78%, HR without aspirin 0.65, 95% CI 0.55-0.78; P interaction = 0.29). Similar results were seen in the subgroups of patients with and without arterial vascular disease. CONCLUSION: Apixaban had similar beneficial effects on stroke or systemic embolism and major bleeding compared with warfarin, irrespective of concomitant aspirin use. TI - Apixaban vs. warfarin with concomitant aspirin in patients with atrial fibrillation: insights from the ARISTOTLE trial EP - 232 SN - 0195-668X IS - iss. 4 SP - 224 JF - European Heart Journal VL - vol. 35 DO - https://doi.org/10.1093/eurheartj/eht445 ER - TY - JOUR AU - Dewilde, W.J. AU - Janssen, P.W. AU - Verheugt, F.W.A. AU - Storey, R.F. AU - Adriaenssens, T. AU - Hansen, M.L. AU - Lamberts, M. AU - Berg, J.M. van den PY - 2014 UR - https://hdl.handle.net/2066/133911 AB - Chronic oral anticoagulant therapy is recommended (class I) in patients with mechanical heart valves and in patients with atrial fibrillation with a CHA2DS2-VASc (Congestive heart failure, Hypertension, Age >/=75 years, Diabetes mellitus, prior Stroke or transient ischemic attack or thromboembolism, Vascular disease, Age 65 to 74 years, Sex category) score >/=1. When these patients undergo percutaneous coronary intervention with stenting, treatment with aspirin and a P2Y12 receptor inhibitor also becomes indicated. Before 2014, guidelines recommended the use of triple therapy (vitamin K antagonists, aspirin, and clopidogrel) for these patients. However, major bleeding is increasingly recognized as the Achilles' heel of the triple therapy regimen. Lately, various studies have investigated this topic, including a prospective randomized trial, and the evidence for adding aspirin to the regimen of vitamin K antagonists and clopidogrel seems to be weakened. In this group of patients, the challenge is finding the optimal equilibrium to prevent thromboembolic events, such as stent thrombosis and thromboembolic stroke, without increasing bleeding risk. TI - Triple Therapy for Atrial Fibrillation and Percutaneous Coronary Intervention: A Contemporary Review EP - 1280 SN - 0735-1097 IS - iss. 12 SP - 1270 JF - Journal of the American College of Cardiology VL - vol. 64 DO - https://doi.org/10.1016/j.jacc.2014.06.1193 ER - TY - JOUR AU - Riel, A.C. van AU - Schuuring, M.J. AU - Hessen, I.D. van AU - Zwinderman, A.H. AU - Cozijnsen, L. AU - Reichert, C.L. AU - Hoorntje, J.C.A. AU - Wagenaar, L.J. AU - Post, M.C. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2014 UR - https://hdl.handle.net/2066/134023 AB - BACKGROUND: The aging congenital heart disease (CHD) population is prone to develop a variety of sequelae, including pulmonary arterial hypertension (PAH). Previous prevalence estimates are limited in applicability due to the use of tertiary centers, or database encoding only. We aimed to investigate the contemporary prevalence of PAH in adult CHD patients, using a nationwide population. METHODS: A cross-sectional study was performed, using the population-based Dutch CONgenital CORvitia (CONCOR) registry. All patients born with a systemic-to-pulmonary shunt, thereby at risk of developing PAH, were identified. From this cohort, a random sample was obtained and carefully reviewed. RESULTS: Of 12,624 registered adults with CHD alive in 2011, 5,487 (44%) were at risk of PAH. The random sample consisted of 1,814 patients (mean age 40 +/- 15 years) and 135 PAH cases were observed. PAH prevalence in patients born with a systemic-to-pulmonary shunt was 7.4%. The prevalence of PAH after corrective cardiac surgery was remarkably high (5.7%). Furthermore, PAH prevalence increased with age, from 2.5% under 30 years until 35% in the eldest. PAH prevalence in the entire CHD population was 3.2%. Based on 3000 per million adult CHD patients in the general population, we can assume that PAH-CHD is present in 100 per million. CONCLUSIONS: This new approach using a nationwide CHD population reports a PAH prevalence of 3.2% in CHD patients, and 100 per million in the general adult population. Especially in patients after shunt closure and the elderly, physicians should be aware of PAH-CHD, to provide optimal therapeutic and clinical care. TI - Contemporary prevalence of pulmonary arterial hypertension in adult congenital heart disease following the updated clinical classification EP - 305 SN - 0167-5273 IS - iss. 2 SP - 299 JF - International Journal of Cardiology VL - vol. 174 DO - https://doi.org/10.1016/j.ijcard.2014.04.072 ER - TY - JOUR AU - Luca, G. De AU - Dirksen, M.T. AU - Spaulding, C. AU - Kelbaek, H. AU - Schalij, M. AU - Thuesen, L. AU - Hoeven, B. van der AU - Vink, M.A. AU - Kaiser, C. AU - Musto, C. AU - Chechi, T. AU - Spaziani, G. AU - Diaz de la Llera, L.S. AU - Pasceri, V. AU - Lorenzo, E. Di AU - Violini, R. AU - Suryapranata, H. AU - Stone, G.W. PY - 2014 UR - https://hdl.handle.net/2066/134033 AB - BACKGROUND: Several concerns have emerged on the higher risk of in-stent thrombosis after drug-eluting stent (DES) implantation, especially in the setting of STEMI patients. Few data have even been reported in high-risk patients, such as those with anterior MI. Therefore this represents the aim of the current study. METHODS: The literature was scanned by formal searches of electronic databases (MEDLINE and CENTRAL). We examined all completed randomized trials of DES for STEMI. The following key words were used for study selection: randomized trial, myocardial infarction, reperfusion, primary angioplasty, stenting, DES, sirolimus-eluting stent (SES), Cypher, paclitaxel-eluting stent (PES), Taxus. No language restrictions were enforced. RESULTS: Individual patient's data were obtained from 11 out of 13 trials, including a total of 2,782 patients with anterior MI [1,739 or 62.5 % randomized to DES and 1,043 or 37.5 % randomized to bare-metal stent (BMS)]. At long-term follow-up, no significant benefit was observed with DES as compared to BMS in terms of mortality [9.8 vs 10.9 %, HR (95 % CI) = 0.81 (0.61, 1.07), p = 0.13, p heterogeneity = 0.18], reinfarction [8.8 vs 6.4 %, respectively; HR (95 % CI) = 1.14 (0.80, 1.61), p = 0.47, p heterogeneity = 0.82], and stent thrombosis [5.6 vs 5 %, OR (95 % CI) = 0.88 (0.59, 1.30), p = 0.51, p heterogeneity = 0.65], whereas DES was associated with a significant reduction in terms of target-vessel revascularization (TVR) [13.7 vs 23.4 %; OR (95 % CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] that was observed at both early (within 1 year) [7 vs 14.7 %, HR (95 % CI) = 0.56 (0.46, 0.69), p < 0.0001, p het = 0.81] and late (>1 year) follow-up [7.2 vs 9 %, HR (95 % CI) = 0.67 (0.47, 0.96), p = 0.03, p het = 0.96]. CONCLUSIONS: This study showed that among patients with anterior STEMI undergoing primary angioplasty, SES and PES, as compared to BMS, are associated with a significant reduction in TVR at long-term follow-up. No concerns were found with the use of first-generation DES in terms of mortality. TI - Drug-eluting stents in patients with anterior STEMI undergoing primary angioplasty: a substudy of the DESERT cooperation EP - 699 SN - 1861-0684 IS - iss. 9 SP - 685 JF - Clinical Research in Cardiology VL - vol. 103 DO - https://doi.org/10.1007/s00392-014-0702-6 ER - TY - JOUR AU - Verdoia, M. AU - Schaffer, A. AU - Barbieri, L. AU - Sinigaglia, F. AU - Marino, P. AU - Suryapranata, H. AU - Luca, G. De PY - 2014 UR - https://hdl.handle.net/2066/134039 AB - BACKGROUND: Eosinophils have been involved in a wide spectrum of pro-inflammatory and pro-thrombotic conditions, with the development of cardiovascular complications in a significant proportion of hypereosinophilic patients. However, no study has so far evaluated the impact of eosinophils levels on periprocedural myocardial infarction (PMI) in patients undergoing non-urgent percutaneous coronary interventions (PCI), that was, then, aim of current study. METHODS: In a consecutive cohort of patients, myonecrosis biomarkers were dosed at intervals from 6 to 48 h after PCI. Periprocedural myonecrosis was defined as troponin I increase by 3 times the ULN or by 50% of an elevated baseline value, whereas PMI as CKMB increase by 3 times the ULN or 50% of baseline. RESULTS: Our population is represented by 1543 patients who were divided according to tertiles of absolute eosinophils count (AEC 0.2 x 10^3/ml). Higher AEC was related to male gender (p = 0.002), arterial hypertension (p = 0.02), diabetes (p = 0.001), previous coronary revascularization (p = 0.003 for PCI, p = 0.03 for CABG), treatment with ARBs, beta-blockers, diuretics and ASA (p < 0.001), statins (p = 0.02), calcium antagonists (p = 0.05), glycosylated hemoglobin (p < 0001), creatinine levels (p = 0.001) and platelet count (p = 0.01), while inversely with acute presentation (p < 0.001), glycemia (p = 0.03), HDL-cholesterol and C-reactive protein (p = 0.02). AEC related with multivessel coronary artery disease (p = 0.05), lesion length (p = 0.01), drug eluting stents implantation (p = 0.001) and use of kissing balloon technique (p = 0.05), while inversely to intracoronary thrombus (p < 0.001) and thrombectomy (p = 0.04). AEC did not influence the occurrence of PMI (p = 0.06, adjusted OR [95% CI] = 1.06 [0.86-1.31], p = 0.57) or myonecrosis (p = 0.15, adjusted OR [95% CI] = 1.06 [0.88-1.27], p = 0.53). Results were confirmed at subgroup analysis in higher-risk subsets of patients. CONCLUSION: In patients undergoing non-urgent PCI, eosinophils levels are not associated with the occurrence of periprocedural myocardial infarction or myonecrosis. TI - Eosinophils count and periprocedural myocardial infarction in patients undergoing percutaneous coronary interventions EP - 174 SN - 0021-9150 IS - iss. 1 SP - 169 JF - Atherosclerosis VL - vol. 236 DO - https://doi.org/10.1016/j.atherosclerosis.2014.06.023 ER - TY - JOUR AU - Schaffer, A. AU - Verdoia, M. AU - Barbieri, L. AU - Aprami, T.M. AU - Suryapranata, H. AU - Marino, P. AU - Luca, G.D. PY - 2014 UR - https://hdl.handle.net/2066/134063 AB - Our goal was to estimate the role of high-density lipoprotein cholesterol (HDL-C) in predicting the prevalence and extent of coronary artery disease (CAD) in 3280 patients undergoing coronary angiography. Predictors of lower HDL levels (<32 mg/dL) were male gender (P < .001), diabetes mellitus (P = .03), renal failure (P = .01), higher low-density lipoprotein and total cholesterol (P < .001, respectively), triglycerides (P < .001), and white blood cells (P < .001), aging (P < .001), previous myocardial infarction (P = .02) and hemoglobin (P < .001), treatment with angiotensin-receptor blockers (P < .001), and statins (P = .002). The HDL-C levels were significantly inversely associated with prevalence of CAD (P < .001, adjusted odds ratio [OR] [95% confidence interval, CI] = 1.35 [1.25-1.45], P < .001), and HDL-C <44 mg/dL was best the predictive value of the risk of CAD, (adjusted OR [95%CI] = 1.61 [1.24-2.1], P < .001). We found significant association between HDL-C and the risk of CAD; a value <44 mg/dL was the best cutoff in the prediction of CAD. TI - High-density lipoproteins and coronary artery disease: a single-center cohort study EP - 702 SN - 0003-3197 IS - iss. 8 SP - 696 JF - Angiology VL - vol. 65 DO - https://doi.org/10.1177/0003319713502253 ER - TY - JOUR AU - Tarantini, G. AU - Brener, S.J. AU - Barioli, A. AU - Gratta, A. AU - Parodi, G. AU - Rossini, R. AU - Navarese, E.P. AU - Niccoli, G. AU - Frigo, A.C. AU - Musumeci, G. AU - Iliceto, S. AU - Stone, G.W. PY - 2014 UR - https://hdl.handle.net/2066/134072 AB - BACKGROUND: Bivalirudin significantly reduces 30-day major and minor bleeding compared with unfractionated heparin (UFH), while resulting in similar or lower rates of ischemic events in both patients with stable and unstable coronary disease undergoing percutaneous coronary intervention. We performed a meta-analysis of randomized trials to evaluate the impact of bivalirudin compared with UFH, with or without glycoprotein IIb/IIIa receptor inhibitors (GPI), on the rates of mortality, myocardial infarction (MI), and major bleeding. METHODS: We searched electronic databases for randomized controlled trials with >100 patients comparing bivalirudin (+/-provisional GPI) with UFH with either routine or provisional GPI in patients undergoing percutaneous coronary intervention. The principal efficacy end points were mortality and MI within 30 day, whereas major bleeding was the principal safety end point. We assessed the benefit of bivalirudin for each efficacy end point relative to the baseline bleeding risk, using the control (UFH) major bleeding rate as proxy for that risk. RESULTS: A total of 12 randomized trials that enrolled 33,261 patients were included. Overall, there was no significant difference in mortality and MI between bivalirudin monotherapy and UFH (+/-GPI), whereas major bleeding was significantly lower with bivalirudin. Bivalirudin reduced major and minor bleeding across the entire bleeding risk spectrum. CONCLUSIONS: Bivalirudin significantly reduces major and minor bleeding regardless of the estimated baseline hemorrhagic risk. TI - Impact of baseline hemorrhagic risk on the benefit of bivalirudin versus unfractionated heparin in patients treated with coronary angioplasty: A meta-regression analysis of randomized trials EP - 412 e6 SN - 0002-8703 IS - iss. 3 SP - 401 JF - American Heart Journal VL - vol. 167 DO - https://doi.org/10.1016/j.ahj.2013.11.013 ER - TY - JOUR AU - Luca, G. De AU - Dirksen, M.T. AU - Spaulding, C. AU - Kelbaek, H. AU - Schalij, M. AU - Thuesen, L. AU - Hoeven, B. van der AU - Vink, M.A. AU - Kaiser, C. AU - Musto, C. AU - Chechi, T. AU - Spaziani, G. AU - Diaz de la Llera, L.S. AU - Pasceri, V. AU - Lorenzo, E. Di AU - Violini, R. AU - Suryapranata, H. AU - Stone, G.W. AU - et al. PY - 2014 UR - https://hdl.handle.net/2066/134073 AB - BACKGROUND: Hypertension is a well known risk factor for atherosclerosis. However, data on the prognostic impact of hypertension in patients with ST elevation myocardial infarction (STEMI) are inconsistent and mainly related to studies performed in the thrombolytic era, with very few data in patients undergoing primary angioplasty. Therefore, the aim of the current study was to evaluate the impact hypertension on clinical outcome in STEMI patients undergoing primary PCI with BMS or DES. METHODS: Our population is represented by 6298 STEMI patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES vs BMS for STEMI. RESULTS: Hypertension was observed in 2764 patients (43.9%), and associated with ageing (p<0.0001), female gender (p<0.001), diabetes (p<0.0001), hypercholesterolemia (p<0.0001), previous MI (p=0.002), previous revascularization (p=0.002), longer time-to-treatment (p<0.001), preprocedural TIMI 3 flow, and with a lower prevalence of smoking (41% vs 53.9%, p<0.001) and anterior MI (42% vs 45.9%, p=0.002). Hypertension was associated with impaired postprocedural TIMI 0-2 flow (Adjusted OR [95% CI]=1.22 [1.01-1.47], p=0.034). At a follow-up of 1201+/-440days, hypertension was associated with higher mortality (adjusted HR [95% CI]=1.24 [1.01-1.54], p=0.048), reinfarction (adjusted HR [95% CI]=1.31 [1.03-1.66], p=0.027), stent thrombosis (adjusted HR [95% CI]=1.29 [0.98-1.71], p=0.068) and TVR (adjusted HR [95% CI]=1.22 [1.04-1.44], p=0.013). CONCLUSIONS: This study showed that among STEMI patients undergoing primary angioplasty with DES or BMS, hypertension is independently associated with impaired epicardial reperfusion, mortality, reinfarction and TVR, and a trend in higher ST. TI - Impact of hypertension on clinical outcome in STEMI patients undergoing primary angioplasty with BMS or DES: Insights from the DESERT cooperation EP - 54 SN - 0167-5273 IS - iss. 1 SP - 50 JF - International Journal of Cardiology VL - vol. 175 DO - https://doi.org/10.1016/j.ijcard.2014.04.180 ER - TY - JOUR AU - Kubica, J. AU - Kozinski, M. AU - Navarese, E.P. AU - Tantry, U. AU - Kubica, A. AU - Siller-Matula, J.M. AU - Jeong, Y.H. AU - Fabiszak, T. AU - Andruszkiewicz, A. AU - Gurbel, P.A. PY - 2014 UR - https://hdl.handle.net/2066/134092 AB - OBJECTIVES: To perform a systematic up-to-date review and critical discussion of potential clinical applications of cangrelor based on its pharmacologic properties and the main findings from randomized clinical studies. METHODS: A database search (PubMed, CENTRAL and Google Scholar) by two independent investigators, including proceedings from scientific sessions of ACC, AHA, ESC, TCT and EuroPCR, from January 1998 through December 2013. RESULTS: Cangrelor is a potent, intravenous, direct-acting P2Y12 antagonist with rapid onset and quickly reversible action. In contrast to ticagrelor, cangrelor's interaction with thienopiridines requires termination of cangrelor infusion before switching to clopidogrel or prasugrel. According to randomized trials, a cangrelor-clopidogrel combination is relatively safe and more effective than the standard clopidogrel regimen in both urgent and elective percutaneous coronary intervention (PCI) settings, with the advantage of this drug combination fully evident when the universal definition of myocardial infarction is applied. In contrast to available antiplatelet drugs with delayed onset and offset of action, its favorable properties make cangrelor a desirable agent for ad hoc elective PCI, high risk acute coronary syndromes treated with immediate coronary stenting and for bridging those surgery patients who require periprocedural P2Y12 inhibition. Current evidence on cangrelor therapy is limited by the lack of adequately powered studies assessing cangrelor co-administration either with prasugrel or ticagrelor, suboptimal design of some of the trials favoring cangrelor, potentially attenuated benefits with modern stent design, and finally, by the lack of survival advantage. CONCLUSIONS: With its pharmacokinetic and pharmacodynamic advantages, allowing consistent and strong P2Y12 inhibition, and with its rapid onset and swift reversal of action devoid of need for an antidote, cangrelor might improve clinical outcomes in clopidogrel-treated patients by reducing ischemic events, while maintaining a favorable safety profile. However, further studies, addressing the safety and efficacy of cangrelor on top of novel oral P2Y12 inhibitors, are warranted. TI - Cangrelor: an emerging therapeutic option for patients with coronary artery disease EP - 828 SN - 0300-7995 IS - iss. 5 SP - 813 JF - Current Medical Research and Opinion VL - vol. 30 DO - https://doi.org/10.1185/03007995.2014.880050 ER - TY - JOUR AU - Garcia, D. AU - Alexander, J.H. AU - Wallentin, L. AU - Wojdyla, D.M. AU - Thomas, L. AU - Hanna, M. AU - Al-Khatib, S.M. AU - Dorian, P. AU - Ansell, J. AU - Commerford, P. AU - Flaker, G. AU - Lanas, F. AU - Vinereanu, D. AU - Xavier, D. AU - Hylek, E.M. AU - Held, C. AU - Verheugt, F.W. AU - Granger, C.B. AU - Lopes, R.D. PY - 2014 UR - https://hdl.handle.net/2066/135959 AB - Using data from ARISTOTLE, we describe the periprocedural management of anticoagulation and rates of subsequent clinical outcomes among patients chronically anticoagulated with warfarin or apixaban. We recorded whether (and for how long) anticoagulant therapy was interrupted preprocedure, whether bridging therapy was used, and the proportion of patients who experienced important clinical outcomes during the 30 days postprocedure. Of 10 674 procedures performed during follow-up in 5924 patients, 9260 were included in this analysis. Anticoagulant treatment was not interrupted preprocedure 37.5% of the time. During the 30 days postprocedure, stroke or systemic embolism occurred after 16/4624 (0.35%) procedures among apixaban-treated patients and 26/4530 (0.57%) procedures among warfarin-treated patients (odds ratio [OR] 0.601; 95% confidence interval [CI] 0.322-1.120). Major bleeding occurred in 74/4560 (1.62%) procedures in the apixaban arm and 86/4454 (1.93%) in the warfarin arm (OR 0.846; 95% CI 0.614-1.166). The risk of death was similar with apixaban (54/4624 [1.17%]) and warfarin (49/4530 [1.08%]) (OR 1.082; 95% CI 0.733-1.598). Among patients in ARISTOTLE, the 30-day postprocedure stroke, death, and major bleeding rates were low and similar in apixaban- and warfarin-treated patients, regardless of whether anticoagulation was stopped beforehand. Our findings suggest that many patients on chronic anticoagulation can safely undergo procedures; some will not require a preprocedure interruption of anticoagulation. ARISTOTLE was registered at www.clinicaltrials.gov as #NCT00412984. TI - Management and clinical outcomes in patients treated with apixaban vs warfarin undergoing procedures EP - 3698 SN - 0006-4971 IS - iss. 25 SP - 3692 JF - Blood VL - vol. 124 DO - https://doi.org/10.1182/blood-2014-08-595496 ER - TY - JOUR AU - Kozinski, M. AU - Obonska, K. AU - Stankowska, K. AU - Navarese, E.P. AU - Fabiszak, T. AU - Stolarek, W. AU - Kasprzak, M. AU - Siller-Matula, J.M. AU - Rosc, D. AU - Kubica, J. AU - Servi, S. De PY - 2014 UR - https://hdl.handle.net/2066/136022 AB - BACKGROUND: The aim of this study was to assess antiplatelet effect of prasugrel in acute coronary syndrome (ACS) patients with high on-treatment platelet reactivity (HTPR) on clopidogrel, undergoing percutaneous coronary intervention (PCI). METHODS: A prospective, platelet reactivity-guided, parallel-group, open-label study including 71 patients pretreated with clopidogrel 600 mg and assigned either to prasugrel (30 mg loading dose, 10 mg maintenance dose; n = 46) or clopidogrel (150 mg maintenance dose for 6 days and thereafter 75 mg maintenance dose; n = 25) regimen, based on vasodilator-stimulated phosphoprotein (VASP)-assessed platelet reactivity index (PRI; > 50% vs. /=0.5mg/dL or a relative >/=25% increase in creatinine level at 24-48h after the procedure. RESULTS: Patients with elevated glycated-haemoglobin were older, with hypertension, metabolic syndromes, previous history of AMI, PCI and CABG. They had higher gycaemia, fasting-glycaemia and triglycerides but lower HDL-cholesterol. Patients with higher glycated-haemoglobin were more often on therapy with statins, diuretics and calcium-antagonist at admission, had higher basal, 24 and 48h creatinine, lower creatinine clearance and lower ejection fraction. They had the highest incidence of PCI and contrast volume-eGFR rate. CIN occurred in 10.6% of patients with a linear association with glycated-haemoglobin (p=0.001). No relationship was found between glycaemia/fasting glycaemia at admission and CIN. The multivariate analysis confirmed the association between elevated glycated haemoglobin (above the median value 5.7%) and the risk of CIN after adjustment for baseline confounding factors (Adjusted OR [95% CI]=1.69 [1.14-2.51], p=0.009). In fact, the results were consistent in major high-risk subgroups. CONCLUSION: This is the first study showing that among patients without diabetes undergoing coronary angiography/PCI elevated glycated-haemoglobin but not glucose levels is independently associated with the risk of CIN. TI - Pre-diabetes and the risk of contrast induced nephropathy in patients undergoing coronary angiography or percutaneous intervention EP - 464 SN - 0168-8227 IS - iss. 3 SP - 458 JF - Diabetes Research and Clinical Practice VL - vol. 106 DO - https://doi.org/10.1016/j.diabres.2014.09.041 ER - TY - JOUR AU - Luca, G. De AU - Verdoia, M. AU - Schaffer, A. AU - Suryapranata, H. AU - Parodi, G. AU - Antoniucci, D. AU - Marino, P. PY - 2014 UR - https://hdl.handle.net/2066/136097 AB - Prasugrel has been shown to be superior to clopidogrel in the setting of ACS patients undergoing coronary angioplasty. However, few data have been reported so far on those patients who switch from clopidogrel to prasugrel after coronary angioplasty. Aim of the current study was to evaluate the safety of prasugrel loading dose administration in ACS patients undergoing PCI and pretreated with high-dose clopidogrel. From May 2010 to December 2011 150 ACS patients undergoing coronary angioplasty and pretreated with high-dose clopidogrel, were switched to prasugrel loading dose soon after the procedure. They were matched (ratio 1:2) according to sex and age with a group of 300 ACS patients undergoing angioplasty and treated with high-dose clopidogrel only from May 2010 to December 2011. All demographic clinical and angiographic were collected. Primary endpoint was the rate of major bleeding complications (according to ACUITY trial definition) at 30-day follow-up. Secondary endpoints were: TIMI major and minor bleeding, definite stent thrombosis, major adverse cardiac events (MACE) and Net adverse cardiac events (NACE) at 30-day followup. The two groups of patients showed similar baseline demographic, and clinical characteristics. Most of the patients had unstable angina or non-ST segment elevation myocardial infarction. Almost (about 95 %) all patients underwent radial approach. No difference was observed in major bleeding complications according to both ACUITY (2.0 vs 2.0 %) and TIMI Major (0.7 vs 1.3 %) definition. No difference between the two groups was observed in terms of in-stent thrombosis, MACE and NACE at 30-day follow-up. Our observational study showed that switching to prasugrel with loading dose soon after angioplasty among ACS patients who were pretreated with clopidogrel seems to be well tolerated without overt evidence of heightened major bleeding. Future large randomized trials are certainly needed to confirm these findings. TI - Switching from high-dose clopidogrel to prasugrel in ACS patients undergoing PCI: a single-center experience EP - 394 SN - 0929-5305 IS - iss. 3 SP - 388 JF - Journal of Thrombosis and Thrombolysis VL - vol. 38 DO - https://doi.org/10.1007/s11239-013-1039-0 ER - TY - JOUR AU - Balci, A. AU - Sollie-Szarynska, K.M. AU - Bijl, A.G. van der AU - Ruys, T.P. AU - Mulder, B.J. AU - Roos-Hesselink, J.W. AU - Dijk, A.P.J. van AU - Wajon, E.M. AU - Vliegen, H.W. AU - Drenthen, W. AU - Hillege, H.L. AU - Aarnoudse, J.G. AU - Veldhuisen, D.J. van AU - Pieper, P.G. PY - 2014 UR - https://hdl.handle.net/2066/133863 AB - OBJECTIVES: Adequate prepregnancy prediction of maternal cardiovascular and offspring risk is important for counselling and management of pregnancy in women with congenital heart disease (CHD). Therefore we performed a study to identify the optimal assessment strategy for estimating the risk of pregnancy in women with CHD. METHODS: In this prospective study, we determined the outcomes of 213 pregnancies in 203 women with CHD. The ZAHARA I (Zwangerschap bij Aangeboren HARtAfwijkingen I) and CARPREG (CARdiac disease in PREGnancy) risk scores were calculated for each pregnancy, as was the total number of cardiovascular (TPc) or offspring risk predictors (TPo) from these and other studies combined. Pregnancies were also classified according to the modified WHO classification of maternal cardiovascular risk and according to disease complexity (DC). RESULTS: Maternal cardiovascular events occurred during 22 pregnancies (10.3%). Offspring events occurred during 77 pregnancies in 81 children (37.3%). Cardiovascular and offspring event rates increased with higher risk scores, higher TPc or TPo, higher WHO class and greater DC. The highest area under the curve (AUC) for maternal cardiovascular risk was achieved by the WHO class (AUC: 0.77, p<0.0001). AUC for the ZAHARA I risk score was 0.71 (p=0.001), and for the CARPREG risk score 0.57 (p=0.32). All models performed insufficiently in predicting offspring events (AUC128 pg/mL at 20-week gestation, the presence of a mechanical valve, and subpulmonary ventricular dysfunction before conception were independently associated with events [odds ratio (OR) 10.6 (P = 0.039), OR 12.0 (P = 0.016), and OR 4.2 (P = 0.041), respectively]. The negative predictive value of NT-proBNP levels <128 pg/mL was 96.9%. N-terminal pro-B-type natriuretic peptide levels >128 pg/mL at 20 weeks of gestation had an additional value in predicting the occurrence of adverse cardiovascular events on the top of the other identified predictors (area under the curve 0.90 vs. 0.78, P = 0.035). CONCLUSION: Increased NT-proBNP levels at 20 weeks of gestation are an independent risk predictor of cardiovascular events during pregnancy in women with CHD. TI - N-terminal pro-B-type natriuretic peptide predicts cardiovascular complications in pregnant women with congenital heart disease EP - 715 SN - 0195-668X IS - iss. 11 SP - 708 JF - European Heart Journal VL - vol. 35 DO - https://doi.org/10.1093/eurheartj/eht526 ER - TY - JOUR AU - Kilic, S. AU - Ottervanger, J.P. AU - Dambrink, J.H. AU - Hoorntje, J.C.A. AU - Koopmans, P.C. AU - Gosselink, A.T.M. AU - Suryapranata, H. AU - Hof, A.W. van 't AU - et al. PY - 2014 UR - https://hdl.handle.net/2066/133900 AB - It was the purpose of this study to assess the effect of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) on reperfusion and clinical outcome in a real-world STEMI population. The decision to use TA (Export catheter, Medtronic) was at the discretion of the treating cardiologist. The primary endpoint was mortality at short (in-hospital) and long term (one year) follow-up. Secondary end points were post-PCI TIMI flow, residual ST deviation and enzymatic infarct size. Cox proportional hazard models (propensity-weighted) and logistic regression analysis were used to adjust for known covariates, associated with mortality. We performed a retrospective analysis of prospectively collected data on 2,552 consecutive PPCI-treated STEMI patients between 2007 and 2010. Use of TA increased from 6.9% in 2007 to 62.2% in 2010 (p<0.001). TA was performed in 899 patients (35.2%). In-hospital and one-year mortality rates were 3.0% and 6.0%, respectively, in the TA group and 3.5% and 7.6% in the no-TA group. After multivariate analysis, TA was not significantly associated with in-hospital mortality (adjusted odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.33-1.49, p=0.36) nor one year mortality (adjusted hazard ratio [HR]: 0.75, 95%CI: 0.47-1.20, p=0.23) or cardiac mortality (HR: 0.81; 95%CI: 0.45-1.46, p=0.49). After matching on the propensity score, the HR in the TA group for one year mortality was 0.70 (95%CI: 0.41-1.20, p=0.19) and for one-year cardiac mortality 0.70 (95%CI: 0.36-1.34, p=0.28). In conclusion, no significant relationship of TA with one of the secondary end points was found. The use of TA increased over the last years but clinical outcome was similar in both groups (TA vs no-TA) in this large cohort of real-world, unselected STEMI patients. TI - The effect of thrombus aspiration during primary percutaneous coronary intervention on clinical outcome in daily clinical practice EP - 171 SN - 0340-6245 IS - iss. 1 SP - 165 JF - Thrombosis and Haemostasis VL - vol. 111 DO - https://doi.org/10.1160/TH13-05-0433 ER - TY - JOUR AU - Postma, S. AU - Dambrink, J.H. AU - Ottervanger, J.P. AU - Gosselink, A.T.M. AU - Koopmans, P.C. AU - Berg, J.M. van den AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/134034 AB - Pre-hospital infarct diagnosis gives the opportunity to start anti-platelet and anti-thrombotic agents before arrival at the PCI centre. However, more evidence is necessary to demonstrate whether high dose (HD) clopidogrel (600 mg) administered in the ambulance is associated with improved initial patency of the infarct related vessel (IRV) and/or clinical outcome compared to in-hospital initiation of HD clopidogrel. From 2001 until 2009 all consecutive ST-Segment Elevation Myocardial Infarction (STEMI) patients who underwent pre-hospital diagnosis and therapy in the ambulance were prospectively included in our single-centre cohort study. We compared initial patency of the IRV and clinical outcome in patients treated from 2001 until June 2006 (in-hospital HD clopidogrel) with patients treated from July 2006 until 2009 (ambulance HD clopidogrel). A total of 2,475 patients with STEMI were registered; of these 1,110 (44.8%) received in-hospital HD clopidogrel and 1,365 (55.2%) received ambulance HD clopidogrel. Ambulance HD clopidogrel was not independently associated with initial patency (TIMI-2/3-flow pre-PCI (odds ratio: 1.18, 95% confidence interval [CI] 0.96-1.44); however, it was associated with fewer recurrent myocardial infarctions at 30 days (hazard ratio [HR]: 0.45, 95% CI 0.22-0.93) and at one year (HR: 0.45, 95% CI 0.25-0.80). No difference in TIMI 2/3 flow post-PCI, major bleeding, mortality, MACE - and the combination of mortality and recurrent myocardial infarction at 30-days and at one year was present between the two groups. In conclusion, early in-ambulance as compared to in-hospital initiation of HD clopidogrel in STEMI patients did not improve initial patency of the IRV or clinical outcome, except for a reduction of recurrent myocardial infarction. Therefore, early administration of HD clopidogrel seems to have net clinical benefit for these patients. TI - Early ambulance initiation versus in-hospital initiation of high dose clopidogrel in ST-segment elevation myocardial infarction EP - 613 SN - 0340-6245 IS - iss. 3 SP - 606 JF - Thrombosis and Haemostasis VL - vol. 112 DO - https://doi.org/10.1160/TH13-11-0951 ER - TY - JOUR AU - Mouden, M. AU - Ottervanger, J.P. AU - Knollema, S. AU - Timmer, J.R. AU - Reiffers, S. AU - Oostdijk, A.H. AU - Boer, M.J. de AU - Jager, P.L. De PY - 2014 UR - https://hdl.handle.net/2066/133837 AB - PURPOSE: Recently introduced ultrafast cardiac SPECT cameras with cadmium zinc telluride-based (CZT) detectors may provide superior image quality allowing faster acquisition with reduced radiation doses. Although the level of concordance between conventional SPECT and invasive fractional flow reserve (FFR) measurement has been studied, that between FFR and CZT-based SPECT is not yet known. Therefore, we aimed to assess the level of concordance between CZT SPECT and FFR in a large patient group with stable coronary artery disease. METHODS: Both invasive FFR and myocardial perfusion imaging with a CZT-based SPECT camera, using Tc-tetrofosmin as tracer, were performed in 100 patients with stable angina and intermediate grade stenosis on invasive coronary angiography. A cut-off value of <0.75 was used to define abnormal FFR. RESULTS: The mean age of the patients was 64 +/- 11 years, and 64 % were men. SPECT demonstrated ischaemia in 31 % of the patients, and 20 % had FFR <0.75. The concordance between CZT SPECT and FFR was 73 % on a per-patient basis and 79 % on a per-vessel basis. Discordant findings were more often seen in older patients and were mainly (19 %) the result of ischaemic SPECT findings in patients with FFR >/= 0.75, whereas only 8 % had an abnormal FFR without ischaemia as demonstrated by CZT SPECT. CONCLUSION: Only 20 - 30 % of patients with intermediate coronary stenoses had significant ischaemia as assessed by CZT SPECT or invasive FFR. CZT SPECT showed a modest degree of concordance with FFR, which is comparable with previous results with conventional SPECT. Further investigations are particularly necessary in patients with normal SPECT and abnormal FFR, especially to determine whether these patients should undergo revascularization. TI - Myocardial perfusion imaging with a cadmium zinc telluride-based gamma camera versus invasive fractional flow reserve EP - 962 SN - 1619-7070 IS - iss. 5 SP - 956 JF - European Journal of Nuclear Medicine and Molecular Imaging VL - vol. 41 DO - https://doi.org/10.1007/s00259-013-2630-5 ER - TY - JOUR AU - Postma, S. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Gosselink, A.T.M. AU - Ottervanger, J.P. AU - Koopmans, P.C. AU - Berg, J.M. van den AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/136116 AB - AIMS: To evaluate the relation between residential distance and total ischaemic time in patients with acute ST-elevation myocardial infarction (STEMI). METHODS: STEMI patients were transported to the Isala Hospital Zwolle with the intention to perform primary percutaneous coronary intervention PCI (pPCI) from 2004 until 2010 (n = 4149). Of these, 1424 patients (34 %) were referred via a non-PCI 'spoke' centre ('spoke' patients) and 2725 patients (66 %) were referred via field triage in the ambulance (ambulance patients). RESULTS: A longer residential distance increased median total ischaemic time in 'spoke' patients (0-30 km: 228 min, >30-60 km: 235 min, >60-90 km: 264 min, p < 0.001), however not in ambulance patients (0-30 km: 179 min, >30-60 km: 175 min, >60-90 km: 186 min, p = 0.225). After multivariable linear regression analysis, in 'spoke' patients residential distance of >30-60 km compared with 0-30 km was not independently associated with ischaemic time; however, a residential distance of >60-90 km (exp (B) = 1.11, 95 % CI 1.01-1.12) compared with 0-30 km was independently related with ischaemic time. In ambulance patients, residential distance of >30-60 and >60-90 km compared with 0-30 km was not independently associated with ischaemic time. CONCLUSION: A longer distance from the patient's residence to a PCI centre was associated with a small but significant increase in time to treatment in 'spoke' patients, however not in ambulance patients. Therefore, referral via field triage in the ambulance did not lead to a significant increase in time to treatment, especially at long distances (up to 90 km). TI - The influence of residential distance on time to treatment in ST-elevation myocardial infarction patients EP - 519 SN - 1568-5888 IS - iss. 11 SP - 513 JF - Netherlands Heart Journal VL - vol. 22 DO - https://doi.org/10.1007/s12471-014-0599-8 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/136116/136116.pdf?sequence=1 ER - TY - JOUR AU - Kristensen, S.D. AU - Laut, K.G. AU - Fajadet, J. AU - Kaifoszova, Z. AU - Kala, P. AU - Mario, C. de AU - Wijns, W. AU - Clemmensen, P. AU - Agladze, V. AU - Antoniades, L. AU - Alhabib, K.F. AU - Boer, M.J. de AU - Claeys, M.J. AU - Deleanu, D. AU - Dudek, D. AU - Erglis, A. AU - Gilard, M. AU - Goktekin, O. AU - Guagliumi, G. AU - Gudnason, T. AU - Hansen, K.W. AU - Huber, K. AU - James, S. AU - Janota, T. AU - Jennings, S. AU - Kajander, O. AU - Kanakakis, J. AU - Karamfiloff, K.K. AU - Kedev, S. AU - Kornowski, R. AU - Ludman, P.F. AU - Merkely, B. AU - Milicic, D. AU - Najafov, R. AU - Nicolini, F.A. AU - Noc, M. AU - Ostojic, M. AU - Pereira, H. AU - Radovanovic, D. AU - Sabate, M. AU - Sobhy, M. AU - Sokolov, M. AU - Studencan, M. AU - Terzic, I. AU - Wahler, S. AU - Widimsky, P. AU - et al. PY - 2014 UR - https://hdl.handle.net/2066/133877 AB - AIMS: Primary percutaneous coronary intervention (PPCI) is the preferred reperfusion therapy in ST-elevation myocardial infarction (STEMI). We conducted this study to evaluate the contemporary status on the use and type of reperfusion therapy in patients admitted with STEMI in the European Society of Cardiology (ESC) member countries. METHODS AND RESULTS: A cross-sectional descriptive study based on aggregated country-level data on the use of reperfusion therapy in patients admitted with STEMI during 2010 or 2011. Thirty-seven ESC countries were able to provide data from existing national or regional registries. In countries where no such registries exist, data were based on best expert estimates. Data were collected on the use of STEMI reperfusion treatment and mortality, the numbers of cardiologists, and the availability of PPCI facilities in each country. Our survey provides a brief data summary of the degree of variation in reperfusion therapy across Europe. The number of PPCI procedures varied between countries, ranging from 23 to 884 per million inhabitants. Primary percutaneous coronary intervention and thrombolysis were the dominant reperfusion strategy in 33 and 4 countries, respectively. The mean population served by a single PPCI centre with a 24-h service 7 days a week ranged from 31 300 inhabitants per centre to 6 533 000 inhabitants per centre. Twenty-seven of the total 37 countries participated in a former survey from 2007, and major increases in PPCI utilization were observed in 13 of these countries. CONCLUSION: Large variations in reperfusion treatment are still present across Europe. Countries in Eastern and Southern Europe reported that a substantial number of STEMI patients are not receiving any reperfusion therapy. Implementation of the best reperfusion therapy as recommended in the guidelines should be encouraged. TI - Reperfusion therapy for ST elevation acute myocardial infarction 2010/2011: current status in 37 ESC countries EP - 1970 SN - 0195-668X IS - iss. 29 SP - 1957 JF - European Heart Journal VL - vol. 35 DO - https://doi.org/10.1093/eurheartj/eht529 ER - TY - JOUR AU - Navarese, E.P. AU - Kowalewski, M. AU - Cortese, B. AU - Kandzari, D. AU - Dias, S. AU - Wojakowski, W. AU - Buffon, A. AU - Lansky, A. AU - Angelini, P. AU - Torguson, R. AU - Kubica, J. AU - Kelm, M. AU - Boer, M.J. de AU - Waksman, R. AU - Suryapranata, H. PY - 2014 UR - https://hdl.handle.net/2066/133889 AB - BACKGROUND: The efficacy and safety of polymer-free drug-eluting stents (DESs) in clinical practice is currently subject of debate; randomized trials (RCTs) conducted so far provided conflicting results or were underpowered to definitively address this question; we aimed to investigate the efficacy and safety profile of polymer-free vs. durable polymer DES by a comprehensive meta-analysis of RCTs. METHODS: MEDLINE, Google Scholar, EMBASE and Cochrane databases were searched for RCTs comparing polymer-free to durable polymer DES. Safety endpoints at short-term (1-year) were: death, myocardial infarction (MI) and stent thrombosis (ST); main efficacy endpoints were: target lesion revascularization (TLR) and target vessel revascularization (TVR). RESULTS: Eight RCTs including 6178 patients were included. No significant differences in mortality were observed between polymer-free and durable polymer DESs at both short- and long-follow up (OR [95% CI] = 0.79 [0.58-1.08], p = 0.14; and 0.80 [0.58-1.10], p = 0.17 respectively); polymer free and durable polymer DESs provided comparable short and long-term MI rates; at short-term: OR [95% CI] = 1.13 [0.83-1.54], p = 0.44 and at long-term: OR [95% CI] = 1.27 [0.87-1.85], p = 0.22. Similarly, these two different devices proved equally effective in regards to ST, TLR and TVR over the short and long follow-up period. CONCLUSIONS: Polymer-free DESs are as safe and effective as durable polymer DES; however, there is no evidence of any additional benefits provided by this new technology. TI - Short and long-term safety and efficacy of polymer-free vs. durable polymer drug-eluting stents. A comprehensive meta-analysis of randomized trials including 6178 patients EP - 231 SN - 0021-9150 IS - iss. 1 SP - 224 JF - Atherosclerosis VL - vol. 233 DO - https://doi.org/10.1016/j.atherosclerosis.2013.12.024 ER - TY - JOUR AU - Elias-Smale, S.E. AU - Boer, M.J. de AU - Maas, A.H.E.M. PY - 2014 UR - https://hdl.handle.net/2066/133923 AB - Gender differences play an important role in coronary heart disease (CHD). Not only in the presentation of symptoms, but also in their underlying pathophysiology. Women with persistent angina without obstructive coronary artery disease (CAD) pose a diagnostic and therapeutic challenge. Half of these women have microvascular coronary dysfunction (MCD). The 2013 guidelines on management of stable angina now acknowledge this condition, but our understanding of MCD is still limited. In this clinical case presentation we elaborate on contemporary methods of diagnosing and managing microvascular angina based on the cases of two women who attended our outpatient clinic. The availability of non-invasive tools to diagnose MCD is still limited. Current treatment is based on reduction of cardiovascular risk factors but physicians and patients should be aware that although therapy usually reduces symptoms, they do not completely disappear. More research on diagnostic methods and effective therapy for MCD is eagerly awaited. TI - [Microvascular angina in women: a diagnostic and therapeutic challenge] SN - 0028-2162 SP - A7185 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 158 ER - TY - JOUR AU - Boer, M.J. de AU - Bilo, H.J. PY - 2014 UR - https://hdl.handle.net/2066/134017 TI - Clinical decision making and cardiovascular risk factors: what about the Heart Team? EP - 201 SN - 0014-2565 IS - iss. 4 SP - 200 JF - Revista Clínica Espanõla VL - vol. 214 DO - https://doi.org/10.1016/j.rce.2014.02.006 ER - TY - JOUR AU - Remkes, W.S. AU - Somi, S. AU - Roolvink, V. AU - Rasoul, S. AU - Ottervanger, J.P. AU - Gosselink, A.T.M. AU - Hoorntje, J.C.A. AU - Dambrink, J.H. AU - Boer, M.J. de AU - Suryapranata, H. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/134030 AB - OBJECTIVES: The aim was to investigate whether a strategy of direct drug-eluting stent (DES) implantation without pre-dilation is associated with a reduced incidence of restenosis compared with CS with pre-dilation or provisional stenting (PS). BACKGROUND: Previous studies were performed comparing direct stenting (DS) with conventional stenting (CS) after pre-dilation; however, none of these in the DES era. Therefore, the STRESSED (direct Stenting To reduce REStenosis in Stent Era with Drug elution) study was designed and carried out. METHODS: A total of 600 patients with angina pectoris or recent myocardial infarction were randomized to a DS, CS, or PS strategy. The primary endpoint was the mean minimal lumen diameter at 9-month follow-up angiography. Secondary endpoints were clinical procedural success defined as angiographic success without in-hospital major adverse cardiac events (MACE), and MACE at 9-month and 2-year follow-up. RESULTS: Stent implantation in the DS group was 98%, 99% in the CS group, and 77% in the PS group. Percutaneous coronary intervention success was 99% in all groups. The minimal lumen diameter at 9-month follow-up was 2.12 +/- 0.58 mm (DS), 2.17 +/- 0.67 mm (CS), and 1.99 +/- 0.69 mm (PS), p = 0.556 for comparison of DS with CS, p = 0.073 for comparison of DS with PS. The absolute difference was -0.05 (DS to CS), 95% confidence interval: -0.19 to -0.09, p = 0.48 and 0.13 (DS to PS), confidence interval: -0.02 to -0.27, p = 0.087. Restenosis was found in 3.4% (DS), 6.7% (CS), and 11.5% (PS), p = 0.025. At 9-month and 2-year follow-up, MACE occurred in 6.8% and 11.5% (DS), 4.6% and 10.3% (CS), and 7.6% and 13.8% (PS) (p = 0.439 and 0.536), respectively. CONCLUSIONS: Direct DES implantation compared with conventional DES implantation did not reduce restenosis. Provisional stenting, however, was associated with a higher rate of restenosis. This did not translate into a difference in the rate of MACE. (STRESSED study: direct Stenting To reduce REStenosis in Stent Era with Drug elution; ISRCTN41213536). TI - Direct drug-eluting stenting to reduce stent restenosis: a randomized comparison of direct stent implantation to conventional stenting with pre-dilation or provisional stenting in elective PCI patients EP - 758 SN - 1936-8798 IS - iss. 7 SP - 751 JF - Jacc. Cardiovascular Interventions VL - vol. 7 DO - https://doi.org/10.1016/j.jcin.2014.02.012 ER - TY - JOUR AU - Lincoff, A.M. AU - Roe, M. AU - Aylward, P. AU - Galla, J. AU - Rynkiewicz, A. AU - Guetta, V. AU - Zelizko, M. AU - Kleiman, N. AU - White, H. AU - McErlean, E. AU - Erlinge, D. AU - Laine, M. AU - Ferreira, J.M. Dos Santos AU - Goodman, S. AU - Mehta, S. AU - Atar, D. AU - Suryapranata, H. AU - Jensen, S.E. AU - Forster, T. AU - Fernandez-Ortiz, A. AU - Schoors, D. AU - Radke, P. AU - Belli, G. AU - Brennan, D. AU - Bell, G. AU - Krucoff, M. AU - et al. PY - 2014 UR - https://hdl.handle.net/2066/135937 AB - AIMS: Delcasertib is a selective inhibitor of delta-protein kinase C (delta-PKC), which reduced infarct size during ischaemia/reperfusion in animal models and diminished myocardial necrosis and improved reperfusion in a pilot study during primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI). METHODS AND RESULTS: A multicentre, double-blind trial was performed in patients presenting within 6 h and undergoing primary PCI for anterior (the primary analysis cohort, n = 1010 patients) or inferior (an exploratory cohort, capped at 166 patients) STEMI. Patients with anterior STEMI were randomized to placebo or one of three doses of delcasertib (50, 150, or 450 mg/h) by intravenous infusion initiated before PCI and continued for approximately 2.5 h. There were no differences between treatment groups in the primary efficacy endpoint of infarct size measured by creatine kinase MB fraction area under the curve (AUC) (median 5156, 5043, 4419, and 5253 ng h/mL in the placebo, delcasertib 50, 150, and 450 mg/mL groups, respectively) in the anterior STEMI cohort. No treatment-related differences were seen in secondary endpoints of infarct size, electrocardiographic ST-segment recovery AUC or time to stable ST recovery, or left ventricular ejection fraction at 3 months. No differences in rates of adjudicated clinical endpoints (death, heart failure, or serious ventricular arrhythmias) were observed. CONCLUSIONS: Selective inhibition of delta-PKC with intravenous infusion of delcasertib during PCI for acute STEMI in a population of patients treated according to contemporary standard of care did not reduce biomarkers of myocardial injury. TI - Inhibition of delta-protein kinase C by delcasertib as an adjunct to primary percutaneous coronary intervention for acute anterior ST-segment elevation myocardial infarction: results of the PROTECTION AMI Randomized Controlled Trial EP - 2523 SN - 0195-668X IS - iss. 37 SP - 2516 JF - European Heart Journal VL - vol. 35 DO - https://doi.org/10.1093/eurheartj/ehu177 ER - TY - JOUR AU - Wik, L. AU - Olsen, J.A. AU - Persse, D. AU - Sterz, F. AU - Lozano Jr, M. AU - Brouwer, M.A. AU - Westfall, M. AU - Souders, C.M. AU - Malzer, R. AU - Grunsven, P.M. van AU - Travis, D.T. AU - Whitehead, A. AU - Herken, U.R. AU - Lerner, E.B. PY - 2014 UR - https://hdl.handle.net/2066/133824 AB - OBJECTIVE: To compare integrated automated load distributing band CPR (iA-CPR) with high-quality manual CPR (M-CPR) to determine equivalence, superiority, or inferiority in survival to hospital discharge. METHODS: Between March 5, 2009 and January 11, 2011 a randomized, unblinded, controlled group sequential trial of adult out-of-hospital cardiac arrests of presumed cardiac origin was conducted at three US and two European sites. After EMS providers initiated manual compressions patients were randomized to receive either iA-CPR or M-CPR. Patient follow-up was until all patients were discharged alive or died. The primary outcome, survival to hospital discharge, was analyzed adjusting for covariates, (age, witnessed arrest, initial cardiac rhythm, enrollment site) and interim analyses. CPR quality and protocol adherence were monitored (CPR fraction) electronically throughout the trial. RESULTS: Of 4753 randomized patients, 522 (11.0%) met post enrollment exclusion criteria. Therefore, 2099 (49.6%) received iA-CPR and 2132 (50.4%) M-CPR. Sustained ROSC (emergency department admittance), 24h survival and hospital discharge (unknown for 12 cases) for iA-CPR compared to M-CPR were 600 (28.6%) vs. 689 (32.3%), 456 (21.8%) vs. 532 (25.0%), 196 (9.4%) vs. 233 (11.0%) patients, respectively. The adjusted odds ratio of survival to hospital discharge for iA-CPR compared to M-CPR, was 1.06 (95% CI 0.83-1.37), meeting the criteria for equivalence. The 20 min CPR fraction was 80.4% for iA-CPR and 80.2% for M-CPR. CONCLUSION: Compared to high-quality M-CPR, iA-CPR resulted in statistically equivalent survival to hospital discharge. TI - Manual vs. integrated automatic load-distributing band CPR with equal survival after out of hospital cardiac arrest. The randomized CIRC trial EP - 748 SN - 0300-9572 IS - iss. 6 SP - 741 JF - Resuscitation VL - vol. 85 DO - https://doi.org/10.1016/j.resuscitation.2014.03.005 ER - TY - JOUR AU - Beek, M.H.C.T. van AU - Oude Voshaar, R.C. AU - Deelen, F.M. van AU - Balkom, A.J.L.M. van AU - Pop, G.A. AU - Speckens, A.E.M. PY - 2014 UR - https://hdl.handle.net/2066/134076 AB - OBJECTIVE: General anxiety in cardiac patients is associated with worsened cardiac course. An acute coronary syndrome (ACS) might evoke specific cardiac anxiety. We explored the characteristics associated with cardiac anxiety in ACS patients. METHODS: We assessed cardiac anxiety in 237 patients admitted with ACS using the Cardiac Anxiety Questionnaire and gathered information on sociodemographic, psychological, and cardiac disease characteristics. Univariate, multivariate logistic, and linear regression analyses were used to determine which characteristics were associated with cardiac anxiety. RESULTS: Cardiac anxiety was not associated with sociodemographic variables. More severe cardiac injury, as indicated by ST-elevated myocardial infarction and troponin level, was associated with less cardiac anxiety. Psychological variables (depressive symptoms, agoraphobic cognitions, avoidance behavior) were associated with more cardiac anxiety. DISCUSSION: Cardiac anxiety in ACS patients is associated with more psychological distress but lower severity of cardiac injury as indicated by ST-elevated myocardial infarction and troponin level. Two explanations seem likely for this latter finding. First, anxious persons might seek help earlier, thus being diagnosed more often with minor cardiac pathology. Second, cardiac anxiety might partly be caused by diagnostic uncertainty. Future research should focus on communication strategies to reassure patients more efficiently. TI - Inverse correlation between cardiac injury and cardiac anxiety: a potential role for communication EP - 453 SN - 0889-4655 IS - iss. 5 SP - 448 JF - Journal of Cardiovascular Nursing VL - vol. 29 DO - https://doi.org/10.1097/JCN.0b013e3182982550 ER - TY - JOUR AU - Thompson, P.L. AU - Verheugt, F.W.A. PY - 2014 UR - https://hdl.handle.net/2066/133823 AB - PURPOSE: Atrial fibrillation (AF) and coronary heart disease (CHD) commonly occur together. Previous consensus guidelines were published before the wide availability of novel oral anticoagulants (NOACs) and newer P2Y12 antiplatelet agents. We examine recent evidence to guide management in 3 categories of patients with AF and CHD: patients with stable CHD, nonstented patients with recent acute coronary syndrome, and patients with a coronary stent requiring dual-antiplatelet therapy. METHODS: We conducted a literature search by evaluation of PubMed and other data sources including international meeting reports. We critically reviewed recent clinical trial and relevant registry evidence to update European and US consensus documents. FINDINGS: Oral anticoagulation with warfarin or NOACs is required to prevent embolic stroke in AF, and antiplatelet therapy is insufficient for this purpose. Antiplatelet therapy using monotherapy with aspirin is the standard of care in stable CHD. Dual-antiplatelet therapy with aspirin and clopidogrel or a new P2Y12 inhibitor (dual-antiplatelet therapy) is needed to reduce coronary events after an acute coronary syndrome or after percutaneous coronary intervention. Combinations of these agents increase the risk of bleeding, and limited clinical trial evidence suggests that withdrawal of aspirin may reduce bleeding without increasing coronary events. IMPLICATIONS: Available clinical trials and registries provide remarkably little evidence to guide difficult clinical decision making in patients with combined AF and CHD. In patients on triple antithrombotic therapy with vitamin K antagonists, aspirin, and clopidogrel, a single clinical trial indicates that withdrawal of aspirin may reduce bleeding risk without increasing the risk of coronary thrombosis. It is unclear whether this evidence applies to combinations of NOACs and newer P2Y12 inhibitors. Clinical trials of combinations of the newer antithrombotic agents are urgently needed to guide clinical care. TI - Managing antithrombotic therapy in patients with both atrial fibrillation and coronary heart disease EP - 1181 SN - 0149-2918 IS - iss. 9 SP - 1176 JF - Clinical Therapeutics VL - vol. 36 DO - https://doi.org/10.1016/j.clinthera.2014.08.010 ER - TY - JOUR AU - Verheugt, F.W. AU - Geersing, G.J. AU - Kappelle, L.J. PY - 2014 UR - https://hdl.handle.net/2066/136165 AB - - Platelet aggregation inhibitors reduce the risk of complications during and after acute coronary syndromes and after a TIA or stroke.- Acetylsalicylic acid plays a major role in secondary prevention; the combination of acetylsalicylic acid and a platelet ADP receptor antagonist, such as clopidogrel, may have added value.- In percutaneous coronary intervention, dual platelet inhibition appears to be effective in the prevention of stent thrombosis.- Long-term (> 1 year) use of dual platelet inhibition has an unfavourable risk-benefit profile, partly due to an increase in the number of bleeding events, particularly in the stomach.- The use of the combination of acetylsalicylic acid and clopidogrel may be helpful after a TIA or minor stroke, but further research is needed to identify the group of patients for whom this combination would be applicable.- This article provides an overview of the modern cardiological and neurological indications for platelet inhibition as well as the risk factors for severe bleeding events when using dual antiplatelet therapy. TI - [Added value of clopidogrel in cardiology and neurology] SN - 0028-2162 IS - iss. 0 SP - A7609 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 158 ER - TY - JOUR AU - Grobben, R.B. AU - Nathoe, H.M. AU - Januzzi, J.L., Jr. AU - Kimmenade, R.R.J. van PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127543 AB - Differentiation between procedure-related necrosis and postprocedural myocardial infarction (MI) is challenging because of the inherent association of these procedures to varying levels of myocardial injury. To improve risk stratification of patients at risk of an acute MI, the universal definition of MI implemented cardiac biomarker thresholds. The cutoff points for these thresholds, however, are largely arbitrary and lack therapeutic implications. Measurement of cardiac marker concentrations after percutaneous coronary intervention and cardiac surgery should, therefore, be used as a marker of baseline risk, atherosclerosis burden, and procedural complexity rather than a conclusive marker to diagnose acute MI. TI - Cardiac markers following cardiac surgery and percutaneous coronary intervention EP - 111, vii SN - 0272-2712 IS - iss. 1 SP - 99 JF - Clinics in Laboratory Medicine VL - vol. 34 DO - https://doi.org/10.1016/j.cll.2013.11.013 ER - TY - JOUR AU - Jaspers Focks, J. AU - Tielemans, M.M. AU - Rossum, L.G.M. van AU - Eikendal, T. AU - Brouwer, M.A. AU - Jansen, J.B.M.J. AU - Laheij, R.J.F. AU - Verheugt, F.W.A. AU - Oijen, M.G.H. van PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127588 AB - BACKGROUND: Aspirin is associated with gastrointestinal side effects such as gastric ulcers, gastric bleeding and dyspepsia. High-dose effervescent calcium carbasalate (ECC), a buffered formulation of aspirin, is associated with reduced gastric toxicity compared with plain aspirin in healthy volunteers, but at lower cardiovascular doses no beneficial effects were observed. AIM: To compare the prevalence of self-reported gastrointestinal symptoms between low-dose plain aspirin and ECC. METHODS: A total of 51,869 questionnaires were sent to a representative sample of the Dutch adult general population in December 2008. Questions about demographics, gastrointestinal symptoms in general and specific symptoms, comorbidity, and medication use including bioequivalent doses of ECC (100 mg) and plain aspirin (80 mg) were stated. We investigated the prevalence of self-reported gastrointestinal symptoms on ECC compared with plain aspirin using univariate and multivariate logistic regression analyses. RESULTS: A total of 16,715 questionnaires (32 %) were returned and eligible for analysis. Of these, 911 (5 %) respondents reported the use of plain aspirin, 633 (4 %) ECC and 15,171 reported using neither form of aspirin (91 %). The prevalence of self-reported gastrointestinal symptoms in general was higher in respondents using ECC (27.5 %) compared with plain aspirin (26.3 %), but did not differ significantly with either univariate (OR 1.06, 95 %CI 0.84-1.33), or multivariate analysis (aOR 1.08, 95 %CI 0.83-1.41). Also, none of the specific types of symptoms differed between the two aspirin formulations. CONCLUSIONS: In this large cohort representative of the general Dutch population, low-dose ECC is not associated with a reduction in self-reported gastrointestinal symptoms compared with plain aspirin. TI - Gastrointestinal symptoms in low-dose aspirin users: a comparison between plain and buffered aspirin EP - 112 SN - 1568-5888 IS - iss. 3 SP - 107 JF - Netherlands Heart Journal VL - vol. 22 DO - https://doi.org/10.1007/s12471-014-0522-3 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/127588/127588.pdf?sequence=1 ER - TY - JOUR AU - Januzzi Jr, J.L. AU - Kimmenade, R.R.J. van PY - 2014 UR - https://hdl.handle.net/2066/135929 TI - Importance of rigorous evaluation in comparative biomarker studies EP - 169 SN - 0735-1097 IS - iss. 2 SP - 167 JF - Journal of the American College of Cardiology VL - vol. 63 DO - https://doi.org/10.1016/j.jacc.2013.09.005 ER - TY - JOUR AU - Schurink, B. AU - Tielemans, M.M. AU - Aaldering, B.R. AU - Eikendal, T. AU - Jaspers Focks, J. AU - Laheij, R.J.F. AU - Jansen, J.B.M.J. AU - Rossum, L.G.M. van AU - Oijen, M.G.H. van PY - 2014 UR - https://hdl.handle.net/2066/136013 AB - BACKGROUND: Gastrointestinal symptoms are frequently reported adverse effects of antidepressants, but antidepressants are also a treatment modality in functional gastrointestinal disorders. We aimed to assess the association between antidepressant use and gastrointestinal symptoms in the general adult population. METHODS: We assessed gastrointestinal symptoms, medication use, and comorbidity through structured questionnaires in randomly selected individuals. We compared presence of gastrointestinal symptoms in respondents who reported antidepressant use with those who did not. We used multivariable regression analysis to verify the association between antidepressant use and gastrointestinal symptoms. RESULTS: In total, 16,758 questionnaires were returned and eligible for analysis. Antidepressant use was reported by 701 respondents (4.2%). Gastrointestinal symptoms were more frequently reported by antidepressant users compared with nonusers (40% vs 25%, P < 0.01). This apparent association between antidepressant use and gastrointestinal symptoms did not remain after adjusting for demographic factors, comorbidity, and use of other medications (adjusted odds ratio, 0.94; 95% confidence interval, 0.74-1.18). CONCLUSIONS: In our cross-sectional population-based study, we did not find an association between antidepressant use and gastrointestinal symptoms. TI - Antidepressants and gastrointestinal symptoms in the general Dutch adult population EP - 71 SN - 0271-0749 IS - iss. 1 SP - 66 JF - Journal of Clinical Psychopharmacology VL - vol. 34 DO - https://doi.org/10.1097/JCP.0000000000000055 ER - TY - JOUR AU - Jaspers Focks, J. AU - Brouwer, M.A. PY - 2014 UR - https://hdl.handle.net/2066/133844 TI - Novel oral anticoagulants: the translation of 'de Leidraad' into daily clinical practice EP - 296 SN - 1568-5888 IS - iss. 6 SP - 295 JF - Netherlands Heart Journal VL - vol. 22 DO - https://doi.org/10.1007/s12471-014-0557-5 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/133844/133844.pdf?sequence=1 ER - TY - JOUR AU - Tielemans, M.M. AU - Rossum, L.G. van AU - Eikendal, T. AU - Jaspers Focks, J. AU - Laheij, R.J.F. AU - Jansen, J.B. AU - Oijen, M.G. van PY - 2014 UR - https://hdl.handle.net/2066/135899 AB - AIM: Non-steroidal anti-inflammatory drug (NSAID) use is widespread and associated with gastrointestinal symptoms and complications. The aims of this study were to assess (i) gastrointestinal symptoms in users of prescribed and over-the-counter (OTC) NSAIDs and (ii) proton pump inhibitor (PPI) co-prescription rates in NSAID users at increased risk for gastrointestinal complications. METHODS: Surveys were sent to a randomly selected sample of the adult Dutch general population in December 2008. Questions included demographics, gastrointestinal symptoms, medication use and comorbidity. Main outcome measure was presence of gastrointestinal symptoms. RESULTS: A total of 18,317 surveys were returned (response rate 35%), of which 16,758 surveys were eligible for analysis. Of these, 3233 participants (19%) reported NSAID use. NSAID users more frequently reported gastrointestinal symptoms than persons not using NSAIDs (33% vs. 24%, p < 0.01). Respondents who specified on prescription NSAID use (n = 683) were older, reported more comorbidity, and experienced more gastrointestinal symptoms (41%) compared with OTC users (n = 894, 33%, p < 0.01). This difference was not statistically significant after adjustment for confounders (0.99, 95% CI 0.71-1.37). In respondents with an increased gastrointestinal risk profile, PPI co-prescription rates were 51% for on prescription users and 25% for OTC users. CONCLUSIONS: Prevalence of gastrointestinal symptoms was high in both prescribed and OTC NSAID users, emphasising the side effects of both types of NSAIDs. PPI co-prescription rates in NSAID users at risk for gastrointestinal complication were low. TI - Gastrointestinal symptoms in NSAID users in an 'average risk population': results of a large population-based study in randomly selected Dutch inhabitants EP - 519 SN - 1368-5031 IS - iss. 4 SP - 512 JF - International Journal of Clinical Practice VL - vol. 68 DO - https://doi.org/10.1111/ijcp.12346 ER - TY - JOUR AU - Messaoudi, S. El AU - Wouters, C.W. AU - Swieten, H.A. van AU - Pickkers, P. AU - Noyez, L. AU - Kievit, P.C. AU - Abbink-Zandbergen, E.J. AU - Rading-Hoogveld, A. AU - Bouw, M.P.W.J.M. AU - Peters, M.J.W. AU - Donders, A.R.T. AU - Riksen, N.P. AU - Rongen, G.A.P.J.M. PY - 2014 UR - https://hdl.handle.net/2066/136253 TI - Dipyridamole Does not Limit Myocardial Ischemia-Reperfusion Injury. A Double-Blind Randomized Placebo-Controlled Trial in Patients Undergoing Elective Coronary Artery Bypass Surgery SN - 0149-2918 IS - iss. 8 SP - 13 JF - Clinical Therapeutics VL - vol. 36 ER - TY - JOUR AU - Navarese, E.P. AU - Kowalewski, M. AU - Andreotti, F. AU - Wely, M.H. van AU - Camaro, C. AU - Kolodziejczak, M. AU - Gorny, B. AU - Wirianta, J. AU - Kubica, J. AU - Kelm, M. AU - Boer, M.J. de AU - Suryapranata, H. PY - 2014 UR - https://hdl.handle.net/2066/133832 AB - Patients with acute coronary syndromes (ACSs) still experience high rates of recurrent coronary events, particularly, early in their presentation. Statins yield substantial cardiovascular benefits, but the optimal timing of their administration, before or after percutaneous coronary intervention (PCI), remains unclear. We aimed to perform a meta-analysis of randomized controlled trials of statin administration before or after PCI versus no statin or low-dose statin in patients with ACS. Primary end points were 30-day all-cause mortality and 30-day myocardial infarction (MI) stratified by pre- and post-PCI statin administration. Secondary end points were major adverse cardiac events (MACEs) or major adverse cardiac and cerebrovascular events (MACCEs). Long-term analysis beyond 30 days was also performed. Twenty randomized controlled trials enrolling 8,750 patients were included. At 30 days, the rate of MI was significantly lower in the statin group (odds ratio [OR] 0.67, 95% confidence interval [CI] 0.53 to 0.84, p = 0.0007) with a trend toward reduced mortality (p = 0.06) and significant reductions in MACE and MACCE compared with no or low-dose statin. The 30-day incidence of MI was markedly lower when statins were administered before PCI (OR 0.38, 95% CI 0.24 to 0.59, p <0.0001) rather than after PCI (p = 0.28). The direction and magnitude of the estimates for before and after PCI versus no statin or low-dose statin were sustained at long term, not reaching statistical significance for MI (OR 0.81, 95% CI 0.65 to 1.01, p = 0.06) but with significant reductions in MACE (p = 0.0002). By meta-regression, earlier statin administration correlated significantly with lower risk of MI, MACE, and MACCE at 30 days. In conclusion, the present meta-analysis indicates a time-related impact of statin therapy on clinical outcomes of patients with ACS undergoing PCI: the earlier the administration before PCI, the greater the benefits. TI - Meta-analysis of time-related benefits of statin therapy in patients with acute coronary syndrome undergoing percutaneous coronary intervention EP - 1764 SN - 0002-9149 IS - iss. 10 SP - 1753 JF - American Journal of Cardiology VL - vol. 113 DO - https://doi.org/10.1016/j.amjcard.2014.02.034 ER - TY - JOUR AU - Cramer, G.E. AU - Bakker, J. AU - Gommans, F. AU - Brouwer, M.A. AU - Kurvers, M. AU - Fouraux, M. AU - Verheugt, F.W.A. AU - Kofflard, M. PY - 2014 UR - https://hdl.handle.net/2066/133874 AB - Elevated cardiac troponin can be seen in patients with left ventricular (LV) hypertrophy and in asymptomatic subjects with a high a priori risk of cardiovascular disease (CVD). In hypertrophic cardiomyopathy (HC) troponin can be detected as well, but little is known about the contribution of LV mass, on the one hand, and the long-term risk of CVD, on the other. In an observational single-center study of 62 patients with HC, without a history of CVD, we assessed the Framingham Heart 10-year risk score (FH10yrs), LV mass index (LVMI) using magnetic resonance imaging, and highly sensitive cardiac troponin T (hs-cTnT). Hs-cTnT (>3 ng/L) was detectable in 74% of patients (46 of 62). Hs-cTnT was elevated in 26% (16 of 62) of patients (ninety-ninth percentile reference limit of 14 ng/L or more). From 3 to 14 ng/L, patients were older, more often had hypertension, and the FH10yrs was higher. Hs-cTnT correlated positively with LVMI (p <0.001) and maximal wall thickness (p <0.001). In addition, LVMI and hypertension were independently associated with increasing hs-cTnT concentrations in linear regression. Using multivariate binary logistic regression, both LVMI and FH10yrs were independently associated with detectable hs-cTnT levels. In contrast, only LVMI was associated with elevated hs-cTnT levels. In conclusion, hs-cTnT was detectable in 3 quarters and elevated in a quarter of our patients with HC. Although detectable hs-cTnT is associated with both LV mass and CVD risk, elevated hs-cTnT relates to LV mass only. This indicates that hypertrophy more than the risk of CVD seems the most important drive for hs-cTnT to occur in these patients. TI - Relation of highly sensitive cardiac troponin T in hypertrophic cardiomyopathy to left ventricular mass and cardiovascular risk EP - 1245 SN - 0002-9149 IS - iss. 7 SP - 1240 JF - American Journal of Cardiology VL - vol. 113 DO - https://doi.org/10.1016/j.amjcard.2013.12.033 ER - TY - JOUR AU - Riksen, N.P. AU - El Messaoudi, S. AU - Rongen, G.A. PY - 2014 UR - https://hdl.handle.net/2066/135947 TI - It takes more than one CAMERA to study cardiovascular protection by metformin EP - 106 SN - 2213-8587 IS - iss. 2 SP - 105 JF - Lancet Diabetes & Endocrinology VL - vol. 2 DO - https://doi.org/10.1016/S2213-8587(13)70207-9 ER - TY - JOUR AU - Monteferrario, D. AU - Bolar, N.A. AU - Marneth, A.E. AU - Hebeda, K.M. AU - Bergevoet, S.M. AU - Veenstra, H. AU - Laros-van Gorkom, B.A.P. AU - MacKenzie, M.A. AU - Khandanpour, C. AU - Botezatu, L. AU - Fransen, E. AU - Camp, G. van AU - Duijnhouwer, A.L. AU - Salemink, S. AU - Willemsen, B. AU - Huls, G.A. AU - Preijers, F.W. AU - Heerde, W.L. van AU - Jansen, J.H. AU - Kempers, M.J.E. AU - Loeys, B.L. AU - Laer, L. van AU - Reijden, B.A. van der PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127547 AB - The gray platelet syndrome is a hereditary, usually autosomal recessive bleeding disorder caused by a deficiency of alpha granules in platelets. We detected a nonsense mutation in the gene encoding the transcription factor GFI1B (growth factor independent 1B) that causes autosomal dominant gray platelet syndrome. Both gray platelets and megakaryocytes had abnormal marker expression. In addition, the megakaryocytes had dysplastic features, and they were abnormally distributed in the bone marrow. The GFI1B mutant protein inhibited nonmutant GFI1B transcriptional activity in a dominant-negative manner. Our studies show that GFI1B, in addition to being causally related to the gray platelet syndrome, is key to megakaryocyte and platelet development. TI - A dominant-negative GFI1B mutation in the gray platelet syndrome EP - 253 SN - 0028-4793 IS - iss. 3 SP - 245 JF - The New England Journal of Medicine VL - vol. 370 DO - https://doi.org/10.1056/NEJMoa1308130 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/127547/127547.pdf?sequence=1 ER - TY - JOUR AU - Gillis, E. AU - Kempers, M. AU - Salemink, S. AU - Timmermans, J. AU - Cheriex, E.C. AU - Bekkers, S.C. AU - Fransen, E. AU - Die-Smulders, C.E.M. de AU - Loeys, B.L. AU - Laer, L. van PY - 2014 UR - https://hdl.handle.net/2066/134037 AB - Marfan syndrome (MFS) is caused by mutations in the FBN1 (fibrillin-1) gene, but approximately 10% of MFS cases remain genetically unsolved. Here, we report a new FBN1 mutation in an MFS family that had remained negative after extensive molecular genomic DNA FBN1 testing, including denaturing high-performance liquid chromatography, Sanger sequencing, and multiplex ligation-dependent probe amplification. Linkage analysis in the family and cDNA sequencing of the proband revealed a deep intronic point mutation in intron 56 generating a new splice donor site. This mutation results in the integration of a 90-bp pseudo-exon between exons 56 and 57 containing a stop codon, causing nonsense-mediated mRNA decay. Although more than 90% of FBN1 mutations can be identified with regular molecular testing at the genomic level, deep intronic mutations will be missed and require cDNA sequencing or whole-genome sequencing. TI - An FBN1 deep intronic mutation in a familial case of Marfan syndrome: an explanation for genetically unsolved cases? EP - 574 SN - 1059-7794 IS - iss. 5 SP - 571 JF - Human Mutation VL - vol. 35 DO - https://doi.org/10.1002/humu.22540 ER - TY - JOUR AU - Arntz, R.M. AU - Alebeek, M.E. van AU - Synhaeve, N.E. AU - Brouwers, P.J. AU - Dijk, G.W. van AU - Gons, R.A.R. AU - Heijer, T. AU - Kort, P.L.M. de AU - Laat, K.F. de AU - Norden, A.G.W. van AU - Vermeer, S.E. AU - Vlugt, M.J. van der AU - Kessels, R.P.C. AU - Dijk, E.J. van AU - Leeuw, F.E. de PY - 2014 UR - https://hdl.handle.net/2066/159089 AB - Background: The proportion of strokes occurring in younger adults has been rising over the past decade. Due to the far longer life expectancy in the young, stroke in this group has an even larger socio-economic impact. However, information on etiology and prognosis remains scarce. Methods/design: ODYSSEY is a multicentre prospective cohort study on the prognosis and risk factors of patients with a first-ever TIA, ischemic stroke or intracerebral hemorrhage aged 18 to 49 years. Our aim is to include 1500 patients. Primary outcome will be all cause mortality and risk of recurrent vascular events. Secondary outcome will be the risk of post-stroke epilepsy and cognitive impairment. Patients will complete structured questionnaires on outcome measures and risk factors. Both well-documented and less well-documented risk factors and potentially acute trigger factors will be investigated. Patients will be followed every 6 months for at least 3 years. In addition, an extensive neuropsychological assessment will be administered both at baseline and 1 year after the stroke/TIA. Furthermore we will include 250 stroke-free controls, who will complete baseline assessment and one neuropsychological assessment. Discussion: ODYSSEY is designed to prospectively determine prognosis after a young stroke and get more insight into etiology of patients with a TIA, ischemic stroke and intracerebral hemorrhage in patients aged 18 to 49 years old in a large sample size. TI - Observational Dutch Young Symptomatic StrokE studY (ODYSSEY): Study rationale and protocol of a multicentre prospective cohort study SN - 1471-2377 JF - BMC Neurology VL - vol. 14 PS - 9 p. DO - https://doi.org/10.1186/1471-2377-14-55 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/159089/159089.pdf?sequence=1 ER - TY - JOUR AU - Dulfer, K. AU - Duppen, N. AU - Blom, N.A. AU - Dijk, A.P.J. van AU - Helbing, W.A. AU - Verhulst, F.C. AU - Utens, E.M. PY - 2014 UR - https://hdl.handle.net/2066/134038 AB - OBJECTIVE: The aim of this study was to evaluate the effects of a standardized exercise program on sports enjoyment and leisure-time spending in adolescents with congenital heart disease and to know what the moderating impact of their baseline health behavior and disease knowledge is. METHODS: Included were 93 patients, aged 10 to 25, with surgical repair for tetralogy of Fallot or with a Fontan circulation for single-ventricle physiology, of 5 participating centers of pediatric cardiology in The Netherlands. They were randomly allocated, stratified for age, gender, and type of congenital heart disease to a 12-week period with either: (1) three times per week standardized exercise training or (2) care as usual (randomization ratio 2:1). At baseline and after 12 weeks, participants completed Web-based questionnaires and were interviewed by phone. OUTCOME MEASURES: Primary analyses tested changes from baseline to follow-up in sports enjoyment and leisure-time spending in the exercise group vs. control group. Secondary analyses concerned the moderating influence of baseline health behavior and disease knowledge on changes from baseline to follow-up, and comparison with normative data. RESULTS: At follow-up, the exercise group reported a decrease in passive leisure-time spending (watching television and computer usage) compared with controls. Exercise training had no effect on sports enjoyment and active leisure-time spending. Disease knowledge had a moderating effect on improvement in sports enjoyment, whereas health behavior did not. Compared with normative data, patients obtained similar leisure time scores and lower frequencies as to drinking alcohol and smoking. CONCLUSIONS: Exercise training decreased passive, but not active, leisure-time spending. It did not influence sports enjoyment. TI - Effect of Exercise Training on Sports Enjoyment and Leisure-time Spending in Adolescents with Complex Congenital Heart Disease: The Moderating Effect of Health Behavior and Disease Knowledge EP - 423 SN - 1747-079X IS - iss. 5 SP - 415 JF - Congenital Heart Disease VL - vol. 9 DO - https://doi.org/10.1111/chd.12154 ER - TY - JOUR AU - Schellings, D.A.A.M. AU - Adiyaman, A. AU - Giannitsis, E. AU - Hamm, C. AU - Suryapranata, H. AU - Berg, J.M. van den AU - Hoorntje, J.C. AU - Hof, A.W. van 't PY - 2014 UR - https://hdl.handle.net/2066/136268 AB - BACKGROUND: The Zwolle Risk Score (ZRS) identifies ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) eligible for early discharge. We aimed to investigate whether baseline N-terminal pro-brain natriuretic peptide (NT-proBNP) is also able to identify these patients and could improve future risk strategies. METHODS AND RESULTS: PPCI patients included in the Ongoing Tirofiban in Myocardial Infarction Evaluation (On-TIME) II study were candidates (N=861). We analyzed whether ZRS and baseline NT-proBNP predicted 30-day mortality and assessed the occurrence of major adverse cardiac events (MACEs) and major bleeding. Receiver operating characteristic curve analysis was used to assess discriminative accuracy for ZRS, NT-pro-BNP, and their combination. After multiple imputation, 845 patients were included. Both ZRS >3 (hazard ratio [HR]=9.42; P<0.001) and log NT-pro-BNP (HR=2.61; P<0.001) values were associated with 30-day mortality. On multivariate analysis, both the ZRS (HR=1.41; 95% confidence interval [CI]=1.27 to 1.56; P<0.001) and log NT-proBNP (HR=2.09; 95% CI=1.59 to 2.74; P<0.001) independently predicted death at 30 days. The area under the curve for 30-day mortality for combined ZRS/NT-proBNP was 0.94 (95% CI=0.90 to 0.99), with optimal predictive values of a ZRS >/=2 and a NT-proBNP value of >/=200 pg/mL. Using these cut-off values, 64% of the study population could be identified as very low risk with zero mortality at 30 days follow-up and low occurrence of MACEs and major bleeding between 48 hours and 10 days (1.3% and 0.6%, respectively). CONCLUSION: Baseline NT-proBNP identifies a large group of low-risk patients who may be eligible for early (48- to 72-hour) discharge, whereas optimal predictive accuracy is reached by the combination of both baseline NT-proBNP and ZRS. TI - Early discharge after primary percutaneous coronary intervention: the added value of N-terminal pro-brain natriuretic Peptide to the zwolle risk score SN - 2047-9980 IS - iss. 6 SP - e001089 JF - Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease VL - vol. 3 DO - https://doi.org/10.1161/JAHA.114.001089 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/136268/136268.pdf?sequence=1 ER - TY - JOUR AU - Yarde, F. AU - Maas, A.H.E.M. AU - Franx, A. AU - Eijkemans, M.J. AU - Drost, J.T. AU - Rijn, B.B. van AU - Eyck, J. van AU - Schouw, Y.T. van der AU - Broekmans, F.J. PY - 2014 UR - https://hdl.handle.net/2066/133886 AB - Context: The association between early menopause and vascular disease as a possible causative factor has recently received attention. Preeclampsia (PE) is associated with future cardiovascular risk factors, and this premature vascular aging potentially modifies the ovarian aging process. OBJECTIVE: The purpose of this study was to assess whether women with a history of PE have lower anti-Mullerian hormone (AMH) levels than women with normotensive pregnancies. DESIGN: This was a retrospective cohort study. SETTING: The study was conducted in a tertiary referral center. PATIENTS: Clinical data and blood samples of participants in the Preeclampsia Risk EValuation in FEMales study were used (336 women with a history of PE and 329 women after a normotensive pregnancy). Interventions: There were no interventions. MAIN OUTCOME MEASURES: The relative decrease in AMH levels was assessed after a median follow-up of 10.5 years. RESULTS: The mean AMH level was 2.00 +/- 1.87 mug/L in the PE group compared with 2.26 +/- 2.56 mug/L in the reference group. Linear regression analysis with censoring for undetectable AMH levels, adjusted for age, smoking, and hormonal contraceptive use, showed a relative reduction in AMH levels of 20.9% at any age (fold change 0.79, 95% confidence interval, 0.67-0.94). CONCLUSIONS: We demonstrate that women with a history of PE have significantly lower AMH levels than women with normotensive pregnancies. Calculations based on a reference population indicate advancement of reproductive age of approximately 1.5 years. Because PE is considered a manifestation of impaired vascular health, these results support the hypothesis that compromised vascular health could act as a causative mechanism in early ovarian aging. TI - Serum AMH levels in women with a history of preeclampsia suggest a role for vascular factors in ovarian aging EP - 586 SN - 0021-972X IS - iss. 2 SP - 579 JF - Journal of Clinical Endocrinology and Metabolism VL - vol. 99 DO - https://doi.org/10.1210/jc.2013-2902 ER - TY - JOUR AU - Drost, J.T. AU - Maas, A.H.E.M. AU - Holewijn, S. AU - Joosten, L.A.B. AU - Eyck, J. van AU - Schouw, Y.T. van der AU - Graaf, J. de PY - 2014 UR - https://hdl.handle.net/2066/135990 AB - Women with a history of preeclampsia are at increased risk for future cardiovascular disease. Determination of cardiovascular biomarkers may be useful to understand the pathophysiological mechanism of cardiovascular disease development in these women.We performed an analysis in the Preeclampsia Risk EValuation in FEMales study, a retrospective cohort consisting of 339 women with a history of early preeclampsia and 332 women after normotensive pregnancy. Women attended a follow-up visit ten years after the index pregnancy. A subset of 8 different cardiovascular biomarkers was investigated, reflecting inflammatory, metabolic, thrombotic and endothelial function markers. Associations between PE and these novel biomarkers were analyzed by linear regression analysis and adjusted for traditional cardiovascular risk factors.Mean age of 671 women of the PREVFEM cohort was 39 years and women were on average 10 years post index pregnancy. Women post preeclampsia had significantly higher levels of SE-selectin (adjusted difference 4.55, 99\%CI 0.37; 8.74) and PAPPA (adjusted difference 19.08; 99\%CI 13.18; 24.99), whereas ApoB (adjusted difference -0.23 99\%CI -0.32; -0.14) was inversely associated with preeclampsia, compared to women with a previous normotensive pregnancy. Adiponectin, leptin, sICAM-1, sVCAM-1 and PAI-1 were not different between both groups.We demonstrated an independent association of preeclampsia with SE-selectin and PAPPA (markers of vascular dysfunction), which may contribute to future cardiovascular events in women post preeclampsia. However, ApoB (an apolipoprotein) was significantly lower and could point at a protective mechanism in our PE study women. TI - Novel cardiovascular biomarkers in women with a history of early preeclampsia EP - 122 SN - 0021-9150 IS - iss. 1 SP - 117 JF - Atherosclerosis VL - vol. 237 DO - https://doi.org/10.1016/j.atherosclerosis.2014.09.009 ER - TY - THES AU - Drost, J.T. PY - 2014 SN - 9789090283500 UR - https://hdl.handle.net/2066/129657 PB - [S.l. : s.n.] TI - Cardiovascular risk at intermediate term in women after hypertensive pregnancy diseases N1 - Radboud Universiteit Nijmegen, 10 september 2014 N1 - Promotores : Maas, A.H.E.M., Schouw, Y.T. van der L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/129657/129657.pdf?sequence=1 ER - TY - JOUR AU - Stevens, D.U. AU - Al-Nasiry, S. AU - Fajta, M.M. AU - Bulten, J. AU - Dijk, A.P.J. van AU - Vlugt, M.J. van der AU - Oyen, W.J.G. AU - Vugt, J.M.G. van AU - Spaanderman, M.E.A. PY - 2014 UR - https://hdl.handle.net/2066/133808 AB - OBJECTIVE: Women with a history of preeclampsia (PE) have an increased prevalence of cardiometabolic, cardiovascular, and prothrombotic risk factors. Remotely, these women are at increased risk of developing cardiovascular and thrombotic disease. Decidual vasculopathy (DV) describes vascular lesions in the maternal spiral arteries of the uterus, which are found in approximately 40-60% of women with PE. DV is thought to be related to atherosclerosis because of their morphological similarity. The aim of this study was to investigate the association of cardiovascular and thrombogenic risk factors with DV in women with a history of PE. STUDY DESIGN: We retrospectively analyzed the cardiovascular and thrombogenic risk of women with a history of PE, comparing cases with DV (n = 95) with cases without the lesions (n = 81) 7 months after the index pregnancy. Data from a cohort of patients with a history of PE were matched with records from our pathology database. RESULTS: The DV group showed higher diastolic blood pressure (73 vs 70 mm Hg, P = .031), lower left ventricular stroke volume (71 vs 76 mL, P = .032), higher total peripheral vascular resistance (1546 vs 1385, P = .009), and a higher percentage of low plasma volume (34% vs 19%, P = .030). DV did not relate to other cardiovascular parameters, urinary protein, body mass index, lipid or glucose metabolism parameters, or thrombophilia. CONCLUSION: In this study, in women with a history of PE, cases with DV had increased cardiovascular risk, exhibiting circulatory alterations, suggesting reduced venous reserves and elevated arterial tone, without metabolic or thrombophilic disturbances. TI - Cardiovascular and thrombogenic risk of decidual vasculopathy in preeclampsia. EP - 6 SN - 0002-9378 IS - iss. 6 SP - 545.e1 JF - American Journal of Obstetrics and Gynecology VL - vol. 210 N1 - 1 juni 2014 DO - https://doi.org/10.1016/j.ajog.2013.12.029 ER - TY - JOUR AU - Bulten, B.F. AU - Mavinkurve-Groothuis, A.M.C. AU - Geus-Oei, L.F. de AU - Haan, A.F.J. de AU - Korte, C.L. de AU - Bellersen, L. AU - Laarhoven, H.W.M. van AU - Kapusta, L. PY - 2014 UR - https://hdl.handle.net/2066/136270 AB - To evaluate the role of 2D myocardial strain (rate) imaging in the detection of early subclinical cardiotoxicity in breast cancer survivors treated with an anthracycline-based chemotherapeutic regimen. 57 adult breast cancer survivors were analyzed 1 year after therapy. All patients underwent biomarker analysis and 2D echocardiography consisting of conventional echocardiographic and strain (rate) parameters. Conventional echocardiographic values were normal. Global longitudinal strain was normal, but 18 % of patients showed a >2 SD decrease when individually compared to reference values. This subgroup showed a decrease in end-systolic and end-diastolic volumes and an increase in left ventricular mass. Radial and circumferential strain rates were significantly decreased in the whole study group. 2D myocardial strain (rate) imaging showed abnormalities in breast cancer survivors, while conventional echocardiographic values remained normal, rendering 2D myocardial strain (rate) imaging an interesting tool for the early detection of anthracycline-induced cardiotoxicity. TI - Early myocardial deformation abnormalities in breast cancer survivors EP - 135 SN - 0167-6806 IS - iss. 1 SP - 127 JF - Breast Cancer Research and Treatment VL - vol. 146 DO - https://doi.org/10.1007/s10549-014-2997-4 ER - TY - JOUR AU - Warle-van Herwaarden, M.F. AU - Roukens, M.M.B. AU - Pop, G.A.M. AU - Lamfers, E.J.P. AU - Smet, P.A. de AU - Kramers, C. PY - 2014 UR - http://repository.ubn.ru.nl/handle/2066/127632 AB - BACKGROUND: To prevent cardiovascular complications, sometimes double and triple therapy with a vitamin K antagonist (VKA), clopidogrel and/or acetylsalicylic acid (ASA) are indicated. These combinations increase the patient's risk of serious bleeding events. Therefore, adherence to clinical guidelines is of the utmost importance when these high-risk therapies are prescribed. METHODS: We performed a retrospective cohort study of 238 cases in a community pharmacy that were treated with a combination of VKA, clopidogrel and/or ASA between January 2006 and December 2009. Hospital records and community pharmacy records were used to obtain the indication(s), the duration of combination therapy, the presence of risk-increasing and risk-decreasing co-medications and any relevant co-morbidities. The cardiologists' attitudes towards the prescribing of antithrombotic combinations and their self-reported adherence to guidelines were assessed by a brief questionnaire. RESULTS: We found there was no guideline-based indication for 22 of the 146 cases (14%) on ASA plus clopidogrel and 19 of the 82 cases (23%) on VKA plus ASA. Of the 238 cases given antithrombotic combination therapies, 77 (32%) were placed at an additional increased risk of serious gastrointestinal events, yet 43 (56%) of these did not receive adequate gastric protection. Out of the 19 of 60 cardiologists (32%) who responded to our questionnaire; 17 (90%) and 13 (68%) stated that a strict indication is very important when initiating therapy with ASA plus clopidogrel or ASA plus VKA, respectively. CONCLUSIONS: There is room to further develop adherence to guideline-based prescribing of antithrombotic combination therapies and to improve prescription of gastric protection for patients receiving these high-risk combinations. TI - Adherence to guidelines for the prescribing of double and triple combinations of antithrombotic agents EP - 243 SN - 2047-4873 IS - iss. 2 SP - 231 JF - European Journal of Preventive Cardiology VL - vol. 21 DO - https://doi.org/10.1177/2047487312451253 ER - TY - JOUR AU - Schoormans, D. AU - Mulder, B.J. AU - Melle, J.P. van AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Hulsbergen-Zwarts, M.S. AU - Plokker, T.H. AU - Brunninkhuis, L.G. AU - Vliegen, H.W. AU - Sprangers, M.A.G. PY - 2014 UR - https://hdl.handle.net/2066/134066 AB - BACKGROUND: To improve patients' quality of life (QoL) we need to identify modifiable determinants, such as illness perceptions. Patients' illness perceptions are known to regulate emotional responses and health-behaviour. Illness perceptions comprise several components: consequences, control, coherence, changeability and emotional representations. AIMS: To examine (a) the relation between patient characteristics and illness perceptions, and (b) the independent predictive value of illness perceptions for future QoL. METHODS: A longitudinal study in 845 patients with congenital heart disease was conducted. Patients completed three questionnaires: the IPQ-R (illness perceptions) and two years later the SF-36 and TAAQOL-CHD (QoL). Linear regression analyses were performed relating illness perceptions to patient characteristics (sex, age, disease complexity and functional status) and QoL. RESULTS: Patients with a complex defect or poor functional status reported poor illness perceptions. Independent of patient characteristics, poor illness perceptions (i.e. a strong belief that the illness has severe consequences; a weak belief that you have a coherent illness understanding and that the illness can be controlled by treatment; and a strong belief that the illness is changeable and causes negative emotions) were predictive of future QoL. CONCLUSION: Illness perceptions independently predict QoL, suggesting that QoL may be improved by altering patients' beliefs about their illness. For example, increasing patients' knowledge regarding their disease and informing them about treatment opportunities may enhance their QoL. TI - Illness perceptions of adults with congenital heart disease and their predictive value for quality of life two years later EP - 94 SN - 1474-5151 IS - iss. 1 SP - 86 JF - European Journal of Cardiovascular Nursing VL - vol. 13 DO - https://doi.org/10.1177/1474515113481908 ER - TY - JOUR AU - El Messaoudi, S. AU - Schreuder, T.H.A. AU - Kengen, R.D. AU - Rongen, G.A. AU - Broek, P.H.H. van den AU - Thijssen, D.H.J. AU - Riksen, N.P. PY - 2014 UR - https://hdl.handle.net/2066/135927 AB - INTRODUCTION: Large prospective studies in patients with type 2 diabetes mellitus have demonstrated that metformin treatment improves cardiovascular prognosis, independent of glycemic control. Administration of metformin potently limits infarct size in murine models of myocardial infarction. This study examined, for the first time in humans, whether metformin limits ischemia-reperfusion (IR) injury in vivo using a well-validated forearm model of endothelial IR-injury. METHODS: Twenty-eight healthy volunteers (age 41+/-6 years, 10 male/16 female) were randomized between pretreatment with metformin (500 mg three times a day for 3 days) or no treatment in a Prospective Randomized Open Blinded Endpoint study. Brachial artery flow mediated dilation (FMD) was measured before and after 20 minutes of forearm ischemia and 20 minutes of reperfusion. FMD analysis was performed offline by investigators blinded for the treatment arm. RESULTS: Baseline FMD did not differ between metformin pretreatment and no pretreatment (6.9+/-3.6% and 6.1+/-3.5%, respectively, p = 0.27, n = 26). FMD was significantly lower after forearm IR in both treatment arms (4.4+/-3.3% and 4.3+/-2.8%, respectively, P<0.001 in both conditions). A linear mixed model analysis revealed that metformin treatment did not prevent the decrease in FMD by IR. CONCLUSION: A 3 day treatment with metformin in healthy, middle-aged subjects does not protect against endothelial IR-injury, measured with brachial artery FMD after forearm ischemia. Further studies are needed to clarify what mechanism underlies the cardiovascular benefit of metformin treatment. TRIAL REGISTRATION: ClinicalTrials.gov NCT01610401. TI - Impact of metformin on endothelial ischemia-reperfusion injury in humans in vivo: a prospective randomized open, blinded-endpoint study SN - 1932-6203 IS - iss. 4 JF - PLoS One VL - vol. 9 DO - https://doi.org/10.1371/journal.pone.0096062 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/135927/135927.pdf?sequence=1 ER - TY - JOUR AU - Rutten-Jacobs, L.C.A. AU - Keurlings, P.A. AU - Arntz, R.M. AU - Maaijwee, N.A.M.M. AU - Schoonderwaldt, H.C. AU - Dorresteijn, L.D.A. AU - Vlugt, M.J. van der AU - Dijk, E.J. van AU - Leeuw, F.E. de PY - 2014 UR - https://hdl.handle.net/2066/134062 AB - BACKGROUND: Diabetes diagnosed prior to stroke in young adults is strongly associated with recurrent vascular events. The relevance of impaired fasting glucose (IFG) and incidence of diabetes after young stroke is unknown. We investigated the long-term incidence of diabetes after young stroke and evaluated the association of diabetes and impaired fasting glucose with recurrent vascular events. METHODS: This study was part of the FUTURE study. All consecutive patients between January 1, 1980, and November 1, 2010 with TIA or ischemic stroke, aged 18-50, were recruited. A follow-up assessment was performed in survivors between November 1, 2009 and January 1, 2012 and included an evaluation for diabetes, fasting venous plasma glucose and recurrent vascular events. The association of diabetes and IFG with recurrent vascular events was assessed by logistic regression analysis, adjusted for age, sex and follow-up duration. RESULTS: 427 survivors without a medical history of diabetes were included in the present analysis (mean follow-up of 10.1 (SD 8.4) years; age 40.3 (SD 7.9) years). The incidence rate of diabetes was 7.9 per 1000 person-years and the prevalence of IFG was 21.1%. Patients with diabetes and IFG were more likely to have experienced any vascular event than those with normal fasting glucose values (OR 3.5 (95%CI 1.5-8.4) for diabetes and OR 2.5 (95%CI 1.3-4.8) for IFG). CONCLUSIONS: Diabetes or IFG in young stroke survivors is frequent and is associated with recurrent vascular events. Regular screening for IFG and diabetes in this population, yields potential for secondary prevention. TI - High incidence of diabetes after stroke in young adults and risk of recurrent vascular events: the FUTURE study SN - 1932-6203 IS - iss. 1 JF - PLoS One VL - vol. 9 DO - https://doi.org/10.1371/journal.pone.0087171 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/134062/134062.pdf?sequence=1 ER - TY - JOUR AU - Meer, M.P.A. van AU - Bastiaens, G.J.H. AU - Boulaksil, M. AU - Mast, Q. de AU - Gunasekera, A. AU - Hoffman, S.L. AU - Pop, G.A.M. AU - Ven, A.J. van der AU - Sauerwein, R.W. PY - 2014 UR - https://hdl.handle.net/2066/134065 TI - Idiopathic acute myocarditis during treatment for controlled human malaria infection: a case report. SN - 1475-2875 IS - iss. 1 SP - 38 JF - Malaria Journal VL - vol. 13 DO - https://doi.org/10.1186/1475-2875-13-38 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/134065/134065.pdf?sequence=1 ER - TY - JOUR AU - Jong, M. de AU - Maas, A.H.E.M. AU - Massuger, L.F.A.G. AU - Hoogerbrugge, N. AU - Hullu, J.A. de PY - 2014 UR - https://hdl.handle.net/2066/133798 AB - BRCA1/2 mutation carriers have an elevated risk of developing breast and ovarian cancer at a relatively young age. Risk-reducing salpingo-oophorectomy is an established strategy to tremendously reduce the risk of ovarian cancer. It is recommended to perform this surgery at age 35-40 years (BRCA1) and at age 40-45 years (BRCA2) resulting in an early and abrupt menopause. BRCA1/2 mutation carriers are potentially at higher risk of cardiovascular diseases due to early surgical menopause, and cardiotoxic effects of adjuvant treatment for breast cancer. Furthermore, preliminary results of experimental studies suggest a possible causative function of the BRCA genes in cardiovascular risk. More research on cardiovascular health risks in BRCA1/2 mutation carriers is needed, especially in the field of cardio-oncology, requiring additional attention to potentially cumulative effects on cardiovascular risks in this specific group of women. TI - BRCA1/2 mutation carriers are potentially at higher cardiovascular risk EP - 171 SN - 1040-8428 IS - iss. 2 SP - 159 JF - Critical Reviews in Oncology Hematology VL - vol. 91 DO - https://doi.org/10.1016/j.critrevonc.2014.01.008 ER - TY - JOUR AU - Beulen, L. AU - Grutters, J.P.C. AU - Faas, B.H.W. AU - Feenstra, I. AU - Vugt, J.M.G. van AU - Bekker, M.N. PY - 2014 UR - https://hdl.handle.net/2066/137305 AB - OBJECTIVE: Non-invasive prenatal testing (NIPT) using cell-free fetal DNA in maternal plasma has been developed for the detection of fetal aneuploidy. Clinical trials have shown high sensitivity and specificity for trisomy 21 (T21) in both high-risk and average-risk populations. Although its great potential for prenatal medicine is evident, more information regarding the consequences of implementing NIPT in a national programme for prenatal screening is required. STUDY DESIGN: A decision-analytic model was developed to compare costs and outcomes of current clinical practice in The Netherlands using conventional screening only, with two alternatives: implementing NIPT as an optional secondary screening test for those pregnancies complicated by a high risk for T21, and implementing NIPT as primary screening test, replacing conventional screening. Probability estimates were derived from a systematic review of international literature. Costs were determined from a health-care perspective. Data were analysed to obtain outcomes, total costs, relative costs and incremental cost-effectiveness ratios (ICERs) for the different strategies. Sensitivity analysis was used to assess the impact of assumptions on model results. RESULTS: Implementing NIPT as an optional secondary, or as primary screening test will increase T21 detection rate by 36% (from 46.8% to 63.5%) and 54% (from 46.8% to 72.0%), simultaneously decreasing the average risk of procedure-related miscarriage by 44% (from 0.0168% to 0.0094% per pregnant woman) and 62% (from 0.0168% to 0.0064% per pregnant woman), respectively. None of the strategies clearly dominated: current clinical practice is the least costly, whereas implementing NIPT will cause total costs of the programme to increase by 21% (from euro257.09 to euro311.74 per pregnant woman), leading to an ICER of keuro94 per detected case of T21, when utilised as an optional secondary screening test and by 157% (from euro257.09 to euro660.94 per pregnant woman), leading to an ICER of keuro460 per detected case of T21, when utilised as primary screening test. However, implementing NIPT as triage test did result in the lowest expected relative costs per case of T21 diagnosed (keuro141). CONCLUSION: NIPT should be implemented in national health care as an optional secondary screening test for those pregnancies complicated by a high risk for T21. TI - The consequences of implementing non-invasive prenatal testing in Dutch national health care: a cost-effectiveness analysis EP - 61 SN - 0301-2115 SP - 53 JF - European Journal of Obstetrics & Gynecology and Reproductive Biology VL - vol. 182 DO - https://doi.org/10.1016/j.ejogrb.2014.08.028 ER - TY - JOUR AU - Otten, A.M. AU - Ottervanger, J.P. AU - Kloosterman, A. AU - Hof, A.W. van 't AU - Gosselink, A.T.M. AU - Dambrink, J.H. AU - Hoorntje, J.C. AU - Suryapranata, H. AU - Maas, A.H.E.M. PY - 2014 UR - https://hdl.handle.net/2066/136141 TI - Treatment assignment in young women with spontaneous coronary artery dissection EP - 1224 SN - 0167-5273 IS - iss. 3 SP - 1223 JF - International Journal of Cardiology VL - vol. 176 DO - https://doi.org/10.1016/j.ijcard.2014.07.218 ER - TY - JOUR AU - Feberwee, H.E. AU - Feenstra, I. AU - Oberoi, S. AU - Sama, I.E. AU - Ockeloen, C.W. AU - Clum, F. AU - Slavotinek, A. AU - Kuijpers, M.A. AU - Dooijes, D. AU - Kuijpers-Jagtman, A.M. AU - Kleefstra, T. AU - Carels, C.E.L. PY - 2014 UR - https://hdl.handle.net/2066/136403 TI - Novel BCOR mutations in patients with oculofaciocardiodental (OFCD) syndrome EP - 197 SN - 0009-9163 IS - iss. 2 SP - 194 JF - Clinical Genetics VL - vol. 85 DO - https://doi.org/10.1111/cge.12125 ER -