TY - JOUR AU - Hulshof, H.G. AU - Dijk, A.P.J. van AU - Hopman, M.T.E. AU - Heesakkers, H.G.P. AU - George, K.P. AU - Oxborough, D.L. AU - Thijssen, D.H.J. PY - 2021 UR - https://hdl.handle.net/2066/229776 AB - AIMS: Patients with pre-capillary pulmonary hypertension (PH) show poor survival, often related to right ventricular (RV) dysfunction. In this study, we assessed the 5-year prognostic value of a novel echocardiographic measure that examines RV function through the temporal relation between RV strain (ϵ) and area (i.e. RV ϵ-area loop) for all-cause mortality in PH patients. METHODS AND RESULTS: Echocardiographic assessments were performed in 143 PH patients (confirmed by right heart catheterization). Transthoracic echocardiography was utilized to assess RV ϵ-area loop. Using receiver operating characteristic curve-derived cut-off values, we stratified patients in low- vs. high-risk groups for all-cause mortality. Kaplan-Meier survival curves and uni-/multivariable cox-regression models were used to assess RV ϵ-area loop's prognostic value (independent of established predictors: age, sex, N-terminal pro B-type natriuretic peptide, 6-min walking distance). During follow-up 45 (31%) patients died, who demonstrated lower systolic slope, peak ϵ, and late diastolic slope (all P < 0.05) at baseline. Univariate cox-regression analyses identified early systolic slope, systolic slope, peak ϵ, early diastolic uncoupling, and early/late diastolic slope to predict all-cause mortality (all P < 0.05), whilst peak ϵ possessed independent prognostic value (P < 0.05). High RV loop-score (i.e. based on number of abnormal characteristics) showed poorer survival compared to low RV loop-score (Kaplan-Meier: P < 0.01). RV loop-score improved risk stratification in high-risk patients when added to established predictors. CONCLUSION: Our data demonstrate the potential for RV ϵ-area loops to independently predict all-cause mortality in patients with pre-capillary PH. The non-invasive nature and simplicity of measuring the RV ϵ-area loop, support the potential clinical relevance of (repeated) echocardiography assessment of PH patients. TI - 5-Year prognostic value of the right ventricular strain-area loop in patients with pulmonary hypertension. EP - 195 SN - 2047-2404 IS - iss. 2 SP - 188 JF - European Heart Journal Cardiovascular Imaging VL - vol. 22 DO - https://doi.org/10.1093/ehjci/jeaa143 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/229776/229776.pdf?sequence=1 ER - TY - JOUR AU - Yang, H. AU - Bouma, B.J. AU - Dimopoulos, K. AU - Khairy, P. AU - Ladouceur, M. AU - Niwa, K. AU - Dijk, A.P. van AU - Aboulhosn, J. AU - Mulder, B. J. M. PY - 2020 UR - https://hdl.handle.net/2066/214082 TI - Non-vitamin K antagonist oral anticoagulants (NOACs) for thromboembolic prevention, are they safe in congenital heart disease? Results of a worldwide study EP - 130 SN - 0167-5273 SP - 123 JF - International Journal of Cardiology VL - vol. 299 DO - https://doi.org/10.1016/j.ijcard.2019.06.014 ER - TY - JOUR AU - Sadeghi, A.H. AU - Woestijne, P. van de AU - Taverne, Y.J.H.J. AU - Dijk, A.P.J. van AU - Bogers, A. PY - 2020 UR - https://hdl.handle.net/2066/225333 AB - Associated cardiovascular malformations in congenitally corrected transposition of the great arteries (CCTGA) should not be missed when a patient requires surgical correction. We present a case of an adult CCTGA patient who required redo surgery for recurrent tricuspid (left atrioventricular) valve regurgitation and previously unidentified partial anomalous pulmonary venous return. Publisher: Abstract available from the publisher. TI - An unusual case of redo tricuspid valve replacement and repair of a previously unidentified anomalous pulmonary venous return in a patient with congenitally corrected transposition of the great arteries EP - 1246 SN - 2050-0904 IS - iss. 7 SP - 1241 JF - Clinical Case Reports VL - vol. 8 DO - https://doi.org/10.1002/ccr3.2902 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/225333/225333.pdf?sequence=1 ER - TY - JOUR AU - Kleinnibbelink, G. AU - Stens, Niels A. AU - Fornasiero, Alessandro AU - Speretta, Guilherme F. AU - Dijk, A.P.J. van AU - Low, David A. AU - Oxborough, D.L. AU - Thijssen, D.H.J. PY - 2020 UR - https://hdl.handle.net/2066/226158 TI - The acute and chronic effects of high-intensity exercise in hypoxia on blood pressure and post-exercise hypotension A randomized cross-over trial SN - 0025-7974 IS - iss. 39 JF - Medicine (Baltimore) VL - vol. 99 DO - https://doi.org/10.1097/MD.0000000000022411 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/226158/226158.pdf?sequence=1 ER - TY - JOUR AU - Heuvel, F.M.A. van den AU - Vos, J.L. AU - Koop, Y. AU - Dijk, A.P.J. van AU - Duijnhouwer, A.L. AU - Mast, Q. de AU - Veerdonk, F.L. van de AU - Bosch, F.H. AU - Netea, M.G. AU - Hoogerwerf, J.J. AU - Hoefsloot, W. AU - Tjwa, E.T. AU - Korte, C.L. de AU - Kimmenade, R.R.J. van AU - Nijveldt, R. PY - 2020 UR - https://hdl.handle.net/2066/221441 TI - Cardiac function in relation to myocardial injury in hospitalised patients with COVID-19 EP - 417 SN - 1568-5888 IS - iss. 7-8 SP - 410 JF - Netherlands Heart Journal VL - vol. 28 DO - https://doi.org/10.1007/s12471-020-01458-2 ER - TY - JOUR AU - Siegmund, A.S. AU - Willems, T.P. AU - Pieper, P.G. AU - Bilardo, C.M. AU - Gorter, Thomas M. AU - Bouma, B.J. AU - Dijk, A.P.J. van AU - Veldhuisen, D.J. van AU - Dickinson, Michael G. PY - 2020 UR - https://hdl.handle.net/2066/221567 TI - Reduced right ventricular function on cardiovascular magnetic resonance imaging is associated with uteroplacental impairment in tetralogy of Fallot SN - 1097-6647 IS - iss. 1 JF - Journal of Cardiovascular Magnetic Resonance VL - vol. 22 DO - https://doi.org/10.1186/s12968-020-00645-9 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/221567/221567.pdf?sequence=1 ER - TY - JOUR AU - Duijnhouwer, A.L. AU - Lemmers, J.M.J. AU - Smit, J. AU - Haren-Willems, J.H. Van AU - Knaapen-Hans, H.K.A. AU - Cate, T.J.F. ten AU - Hagmolen Of ten Have, Wanda AU - Boer, M.J. de AU - Roos-Hesselink, J. AU - Vonk, M.C. AU - Dijk, A.P.J. van PY - 2020 UR - https://hdl.handle.net/2066/229214 AB - BACKGROUND: Pulmonary artery (PA) dilatation is often seen in pulmonary hypertension (PH) and is considered a long-term consequence of elevated pressure. The PA dilates over time and therefore may reflect disease severity and duration. Survival is related to the stage of the disease at the time of diagnosis and therefore PA diameter might be used to predict prognosis. This study evaluates the outcome of patients with pulmonary arterial hypertension (PAH) and chronic thrombo-embolic pulmonary hypertension (CTEPH) and investigates whether PA diameter at the time of diagnosis is associated with mortality. METHODS: Patients visiting an outpatient clinic of a tertiary centre between 2004 and 2018 with a cardiac catheterisation confirmed diagnosis of PAH or CTEPH and a CT scan available for PA diameter measurement were included. PA diameter and established predictors of survival were collected (New York Heart Association (NYHA) class, N‑terminal pro-brain natriuretic peptide (NT-proBNP) level and 6‑min walking distance (6MWD)). RESULTS: In total 217 patients were included (69% female, 71% NYHA class ≥III). During a median follow-up of 50 (22-92) months, 54% of the patients died. Overall survival was 87% at 1 year, 70% at 3 years and 58% at 5 years. The mean PA diameter was 34.2 ± 6.2 mm and was not significantly different among all the diagnosis groups. We found a weak correlation between PA diameter and mean PA pressure ( r = 0.23, p < 0.001). Male sex, higher age, shorter 6MWD and higher NT-proBNP level were independently associated with mortality, but PA diameter was not. CONCLUSION: The prognosis of PAH and CTEPH is still poor. Known predictors of survival were confirmed, but PA diameter at diagnosis was not associated with survival in PAH or CTEPH patients. TI - The outcome of pulmonary hypertension and its association with pulmonary artery dilatation EP - 655 SN - 1568-5888 IS - iss. 12 SP - 645 JF - Netherlands Heart Journal VL - vol. 28 DO - https://doi.org/10.1007/s12471-020-01467-1 ER - TY - JOUR AU - Duijnhouwer, A.L. AU - Hoven, Allard van den AU - Merkx, R. AU - Schokking, M. AU - Kimmenade, R.R. van AU - Kempers, M.J.E. AU - Dijk, A.P.J. van AU - Boer, M.J. de AU - Roos-Hesselink, J.W. PY - 2020 UR - https://hdl.handle.net/2066/217329 TI - Differences in Aortopathy in Patients with a Bicuspid Aortic Valve with or without Aortic Coarctation SN - 2077-0383 IS - iss. 2 JF - Journal of Clinical Medicine VL - vol. 9 DO - https://doi.org/10.3390/jcm9020290 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/217329/217329.pdf?sequence=1 ER - TY - JOUR AU - Bosch, Eva van den AU - Bogers, A.J.J.C. AU - Roos-Hesselink, J.W. AU - Dijk, A.P.J. van AU - Wijngaarden, M.H.E.J. van AU - Boersma, E. AU - Nijveld, A. AU - Luijten, L.W.G. AU - Tanke, R.B. AU - Koopman, L.P. AU - Helbing, W.A. PY - 2020 UR - https://hdl.handle.net/2066/219863 AB - OBJECTIVES: Our goal was to report the long-term serial follow-up after transatrial-transpulmonary repair of tetralogy of Fallot (TOF) and to describe the influence of the timing of the repair on outcome. METHODS: We included all patients with TOF who had undergone transatrial-transpulmonary repair between 1970 and 2012. Records were reviewed for patient demographics, operative details and events during the follow-up period (death, pulmonary valve replacement, cardiac reinterventions and hospitalization/intervention for arrhythmias). In patients with elective early primary repair of TOF after 1990, a subanalysis of the optimal timing of TOF repair was performed. RESULTS: A total of 453 patients were included (63% male patients; 65% had transannular patch); 261 patients underwent primary elective repair after 1990. The median age at TOF repair was 0.7 years (25th-75th percentile 0.3-1.3) and decreased from 1.7 to 0.4 years from before 1990 to after 2000, respectively (P < 0.001). The median follow-up duration after TOF repair was 16.8 years (9.6-24.7). Events developed in 182 (40%) patients. In multivariable analysis, early repair of TOF (<6 months) [hazard ratio (HR) 3.06; P < 0.001] and complications after TOF repair (HR 2.18; P = 0.006) were found to be predictive for an event. In a subanalysis of the primary repair of TOF after 1990, the patients (n = 125) with elective early repair (<6 months) experienced significantly worse event-free survival compared to patients who had elective repair later (n = 136). In multivariable analysis, early repair (HR 3.00; P = 0.001) and postoperative complications (HR 2.12; P = 0.010) were associated with events in electively repaired patients with TOF. CONCLUSIONS: Transatrial-transpulmonary repair of TOF before the age of 6 months may be associated with more events during the long-term follow-up period. TI - Long-term follow-up after transatrial-transpulmonary repair of tetralogy of Fallot: influence of timing on outcome. EP - 643 SN - 1010-7940 IS - iss. 4 SP - 635 JF - European Journal of Cardio-Thoracic Surgery VL - vol. 57 DO - https://doi.org/10.1093/ejcts/ezz331 ER - TY - JOUR AU - Siegmund, A.S. AU - Pieper, P.G. AU - Mulder, B. J. M. AU - Sieswerda, G.T. AU - Dijk, A.P. van AU - Roos-Hesselink, J.W. AU - Veldhuisen, D.J. van AU - Aalberts, Jan J.J. PY - 2020 UR - https://hdl.handle.net/2066/218094 TI - Doppler gradients, valve area and ventricular function in pregnant women with aortic or pulmonary valve disease: Left versus right EP - 157 SN - 0167-5273 SP - 152 JF - International Journal of Cardiology VL - vol. 306 DO - https://doi.org/10.1016/j.ijcard.2019.11.118 ER - TY - JOUR AU - Woudstra, Odilia, I AU - Dissel, Alexandra C. van AU - Bom, Teun van der AU - Bruin-Bon, Rianne H. A. C. M. de AU - Melle, Joost P. van AU - Dijk, A.P.J. van AU - Meijboom, F.J. AU - Bouma, B.J. PY - 2020 UR - https://hdl.handle.net/2066/226261 TI - Myocardial Deformation in the Systemic Right Ventricle: Strain Imaging Improves Prediction of the Failing Heart EP - 1533 SN - 0828-282X IS - iss. 9 SP - 1525 JF - Canadian Journal of Cardiology VL - vol. 36 DO - https://doi.org/10.1016/j.cjca.2019.12.014 ER - TY - JOUR AU - Breetveld, Nicolette M. AU - Alers, Robert-Jan AU - Geerts, Lauren AU - Kuijk, Sander M.J. van AU - Dijk, A.P.J. van AU - Vlugt, M.J. van der AU - Heidema, W.M. AU - Scholten, R.R. AU - Ghossein-Doha, Chahinda AU - Spaanderman, M.E.A. PY - 2020 UR - https://hdl.handle.net/2066/226252 TI - Low Plasma Volume and Increased Pressure Load Relate to Concentric Left Ventricular Remodeling After Preeclampsia: A Longitudinal Study SN - 2047-9980 IS - iss. 19 JF - Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease VL - vol. 9 DO - https://doi.org/10.1161/JAHA.119.015043 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/226252/226252.pdf?sequence=1 ER - TY - JOUR AU - Hulshof, H.G. AU - Dijk, A.P.J. van AU - Hopman, M.T.E. AU - Sluijs, C.F. van der AU - George, K.P. AU - Oxborough, D.L. AU - Thijssen, D.H.J. PY - 2020 UR - https://hdl.handle.net/2066/219274 AB - Chronic changes in left ventricular (LV) hemodynamics, such as those induced by increased afterload (i.e., hypertension), mediate changes in LV function. This study examined the proof of concept that 1) the LV longitudinal strain (epsilon)-volume loop is sensitive to detecting an acute increase in afterload, and 2) these effects differ between healthy young versus older men. Thirty-five healthy male volunteers were recruited, including 19 young (24 +/- 2 yr) and 16 older participants (67 +/- 5 yr). Tests were performed before, during, and after 10-min recovery from acute manipulation of afterload. Real-time hemodynamic data were obtained and LV longitudinal epsilon-volume loops were calculated from four-chamber images using two-dimensional echocardiography. Inflation of the anti-gravity (anti-G) suit resulted in an immediate increase in heart rate, blood pressure, and systemic vascular resistance and a decrease in stroke volume (all P < 0.05). This was accompanied by a decrease in LV peak epsilon, slower slope of the epsilon-volume relationship during early diastole, and an increase in uncoupling (i.e., compared with systole; little change in epsilon per volume decline during early diastole and large changes in epsilon per volume decline during late diastole) (all P < 0.05). All values returned to baseline levels after recovery (all P > 0.05). Manipulation of cardiac hemodynamics caused comparable effects in young versus older men (all P > 0.05). Acute increases in afterload immediately change the diastolic phase of the LV longitudinal epsilon-volume loop in young and older men. This supports the potency of the LV longitudinal epsilon-volume loop to provide novel insights into dynamic cardiac function in humans in vivo. TI - Acute impact of changes to hemodynamic load on the left ventricular strain-volume relationship in young and older men. EP - R750 SN - 0363-6119 IS - iss. 4 SP - R743 JF - American Journal of Physiology : Regulatory Integrative and Comparative Physiology VL - vol. 318 DO - https://doi.org/10.1152/ajpregu.00215.2019 ER - TY - JOUR AU - Yang, Hayang AU - Veldtman, Gruschen R. AU - Bouma, B.J. AU - Budts, Werner AU - Niwa, Koichiro AU - Meijboom, Folkert AU - Dijk, A.P. van AU - Mulder, B. J. M. AU - Aboulhosn, Jamil PY - 2019 UR - https://hdl.handle.net/2066/205037 TI - Non-vitamin K antagonist oral anticoagulants in adults with a Fontan circulation: are they safe SN - 2053-3624 IS - iss. 1 JF - Open Heart VL - vol. 6 DO - https://doi.org/10.1136/openhrt-2018-000985 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/205037/205037.pdf?sequence=1 ER - TY - JOUR AU - Woudstra, Odilia, I AU - Kuijpers, Joey M. AU - Meijboom, F.J. AU - Post, M.C. AU - Jongbloed, M.R. AU - Duijnhouwer, A.L. AU - Dijk, A.P.J. van AU - Mulder, B. J. M. AU - Bouma, B.J. PY - 2019 UR - https://hdl.handle.net/2066/209444 TI - High burden of drug therapy in adult congenital heart disease: polypharmacy as marker of morbidity and mortality EP - 225 SN - 2055-6837 IS - iss. 4 SP - 216 JF - European Heart Journal - Cardiovascular Pharmacotherapy VL - vol. 5 DO - https://doi.org/10.1093/ehjcvp/pvz014 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/209444/209444.pdf?sequence=1 ER - TY - JOUR AU - Driesen, B.W. AU - Warmerdam, E.G. AU - Sieswerda, G.J. AU - Meijboom, F.J. AU - Molenschot, M.M.C. AU - Doevendans, P.A. AU - Krings, G.J. AU - Dijk, A.P.J. van AU - Voskuil, M. PY - 2019 UR - https://hdl.handle.net/2066/209486 AB - Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in the majority of cases. Since their introduction in 2000, the number of percutaneous pulmonary valve implantations (PPVI) has grown and reached over 10,000 procedures worldwide. Overall, PPVI has been proven safe and effective, but some anatomical variations can limit procedural success. This review discusses the current status and future perspectives of the procedure. TI - Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives EP - 273 SN - 1573-403X IS - iss. 4 SP - 262 JF - Current Cardiology Reviews VL - vol. 15 DO - https://doi.org/10.2174/1573403X15666181224113855 ER - TY - JOUR AU - Bosch, E.W. van den AU - Bossers, S.S. AU - Bogers, A. AU - Robbers-Visser, D. AU - Dijk, A.P.J. van AU - Roos-Hesselink, J.W. AU - Breur, H. AU - Haas, F. de AU - Kapusta, L. AU - Helbing, W.A. PY - 2019 UR - https://hdl.handle.net/2066/208417 AB - OBJECTIVES: Our goals were to compare the outcome of the intra-atrial lateral tunnel (ILT) and the extracardiac conduit (ECC) techniques for staged total cavopulmonary connection (TCPC) and to compare the current modifications of the TCPC technique, i.e. the prosthetic ILT technique with the current ECC technique with a >/=18-mm conduit. METHODS: We included patients who had undergone a staged TCPC between 1988 and 2008. Records were reviewed for patient demographics, operative details and events during follow-up (death, surgical and catheter-based reinterventions and arrhythmias). RESULTS: Of the 208 patients included, 103 had the ILT (51 baffle, 52 prosthetic) technique and 105 had the ECC technique. Median follow-up duration was 13.2 years (interquartile range 9.5-16.3). At 15 years after the TCPC, the overall survival rate was comparable (81% ILT vs 89% ECC; P = 0.12). Freedom from late surgical and catheter-based reintervention was higher for patients who had ILT than for those who had ECC (63% vs 44%; P = 0.016). However, freedom from late arrhythmia was lower for patients who had ILT than for those who had ECC (71% vs 85%, P = 0.034). In a subgroup of patients who had the current TCPC technique, when we compared the use of a prosthetic ILT with >/=18-mm ECC, we found no differences in freedom from late arrhythmias (82% vs 86%, P = 0.64) or in freedom from late reinterventions (70% vs 52%, P = 0.14). CONCLUSIONS: A comparison between the updated prosthetic ILT and current >/=18-mm ECC techniques revealed no differences in late arrhythmia-free survival or late reintervention-free survival. Overall, outcomes after the staged TCPC were relatively good and reinterventions occurred more frequently in the ECC group, whereas late arrhythmias were more common in the ILT group. TI - Staged total cavopulmonary connection: serial comparison of intra-atrial lateral tunnel and extracardiac conduit taking account of current surgical adaptations EP - 460 SN - 1569-9293 IS - iss. 3 SP - 453 JF - Interactive Cardiovascular and Thoracic Surgery VL - vol. 29 DO - https://doi.org/10.1093/icvts/ivz081 ER - TY - JOUR AU - Lodeweges, Joyce E. AU - Dikkers, Frederik G. AU - Mulder, B. J. M. AU - Roos-Hesselink, J.W. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Ebels, T. AU - Melle, Joost P. van PY - 2019 UR - https://hdl.handle.net/2066/202610 TI - The Natural and Unnatural History of Congenital Aortic Arch Abnormalities Evaluated in an Adult Survival Cohort EP - 445 SN - 0828-282X IS - iss. 4 SP - 438 JF - Canadian Journal of Cardiology VL - vol. 35 DO - https://doi.org/10.1016/j.cjca.2018.12.004 ER - TY - JOUR AU - Dissel, Alexandra C. van AU - Winter, M.M. AU - Bom, Teun van der AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Pieper, P.G. AU - Mulder, B. J. M. AU - Bouma, B.J. PY - 2019 UR - https://hdl.handle.net/2066/201158 TI - Long-term clinical outcomes of valsartan in patientswith a systemic right ventricle: Follow-up of a multicenter randomized controlled trial EP - 87 SN - 0167-5273 SP - 84 JF - International Journal of Cardiology VL - vol. 278 DO - https://doi.org/10.1016/j.ijcard.2018.11.027 ER - TY - JOUR AU - Hulshof, H.G. AU - Oorschot, F. van AU - Dijk, A.P. van AU - Hopman, M.T.E. AU - George, K.P. AU - Oxborough, D.L. AU - Thijssen, D.H.J. PY - 2019 UR - https://hdl.handle.net/2066/207308 TI - Changes in dynamic left ventricular function, assessed by the strain-volume loop, relate to reverse remodeling after aortic valve replacement EP - 422 SN - 8750-7587 IS - iss. 2 SP - 415 JF - Journal of Applied Physiology VL - vol. 127 DO - https://doi.org/10.1152/japplphysiol.00190.2019 ER - TY - JOUR AU - Siegmund, A.S. AU - Kampman, M.A.M. AU - Oudijk, M.A. AU - Mulder, B. J. M. AU - Sieswerda, G.T. AU - Koenen, S.V. AU - Dijk, A.P.J. van AU - Bilardo, C.M. AU - Pieper, P.G. PY - 2019 UR - https://hdl.handle.net/2066/208020 TI - Maternal right ventricular function, uteroplacental circulation in first trimester and pregnancy outcome in women with congenital heart disease EP - 366 SN - 0960-7692 IS - iss. 3 SP - 359 JF - Ultrasound in Obstetrics & Gynecology VL - vol. 54 DO - https://doi.org/10.1002/uog.20148 ER - TY - JOUR AU - Pragt, Hanna AU - Pieper, P.G. AU - Slooten, Y.J. van AU - Freling, H.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Ebels, T. AU - Melle, Joost P. van PY - 2019 UR - https://hdl.handle.net/2066/208051 TI - Quality of Life Among Patients With Congenital Heart Disease After Valve Replacement EP - 558 SN - 1043-0679 IS - iss. 3 SP - 549 JF - Seminars in Thoracic and Cardiovascular Surgery VL - vol. 31 DO - https://doi.org/10.1053/j.semtcvs.2019.02.002 ER - TY - JOUR AU - Duijnhouwer, A.L. AU - Bons, Lidia R. AU - Timmers, H.J.L.M. AU - Kimmenade, R.R. van AU - Snoeren, M.M. AU - Timmermans, J. AU - Kempers, M.J.E. AU - Dijk, A.P.J. van AU - Fleischer, K. AU - Roos-Hesselink, J.W. PY - 2019 UR - https://hdl.handle.net/2066/204780 TI - Aortic dilatation and outcome in women with Turner syndrome EP - 700 SN - 1355-6037 IS - iss. 9 SP - 693 JF - Heart VL - vol. 105 DO - https://doi.org/10.1136/heartjnl-2018-313716 ER - TY - JOUR AU - Thijssen, D.H.J. AU - Benda, N.M.M. AU - Kerstens, T.P. AU - Seeger, J.P.H. AU - Dijk, A.P.J. van AU - Hopman, M.T.E. PY - 2019 UR - https://hdl.handle.net/2066/202009 TI - 12-Week Exercise Training, Independent of the Type of Exercise, Attenuates Endothelial Ischaemia-Reperfusion Injury in Heart Failure Patients SN - 1664-042X JF - Frontiers in Physiology VL - vol. 10 DO - https://doi.org/10.3389/fphys.2019.00264 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/202009/202009.pdf?sequence=1 ER - TY - JOUR AU - Dissel, A.C. van AU - Blok, I.M. AU - Zwinderman, A.H. AU - Dijk, A.P.J. van AU - Duijnhouwer, A.L. AU - Winter, R.J. de AU - Mulder, B. J. M. AU - Bouma, B.J. PY - 2019 UR - https://hdl.handle.net/2066/202687 TI - Prognostic value of multiple repeated biomarkers in pulmonary arterial hypertension associated with congenital heart disease EP - 251 SN - 1388-9842 IS - iss. 2 SP - 249 JF - European Journal of Heart Failure VL - vol. 21 DO - https://doi.org/10.1002/ejhf.1363 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/202687/202687.pdf?sequence=1 ER - TY - JOUR AU - Hulshof, H.G. AU - Eijsvogels, T.M.H. AU - Kleinnibbelink, G. AU - Dijk, A.P.J. van AU - George, K.P. AU - Oxborough, D.L. AU - Thijssen, D.H.J. PY - 2019 UR - https://hdl.handle.net/2066/202688 AB - AIMS: Pulmonary hypertension (PH) is associated with high morbidity and mortality and the predictive capacity of traditional functional echocardiographic measures is poor. Recent studies assessed the predictive capacity of right ventricular longitudinal strain (RVLS). Diversity in methods between these studies resulted in conflicting outcomes. The purpose of this systematic review and meta-analysis was to determine the independent prognostic value of RVLS for PH-related events and all-cause mortality. METHODS AND RESULTS: A systematic search in Pubmed (MEDLINE), Embase, the Cochrane Library, and Web of Science was performed to identify studies that examined the prognostic value of RVLS in patients with PH. Studies reporting Cox regression based hazard ratios (HRs) for a combined endpoint of mortality and PH-related events or all-cause mortality for echocardiographic derived RVLS were included. A weighted mean of the multivariate HR was used to determine the independent predictive value of RVLS. Eleven studies met our criteria, including 1169 patients with PH (67% female, 0.6-3.8 years follow-up). PH patients with a relative reduction of RVLS of 19% had a significantly higher risk for the combined endpoint [HR 1.22, 95% confidence interval (CI) 1.07-1.40], while patients with a relative reduction of RVLS of 22% had a significantly higher risk for all-cause mortality (HR 2.96, 95% CI 2.00-4.38). CONCLUSION: This systematic review and meta-analysis showed that RVLS has independent prognostic value for a combined endpoint and all-cause mortality in patients with PH. Collectively, these findings emphasize that RVLS may have value for optimizing current predictive models for clinical events or mortality in patients with PH. TI - Prognostic value of right ventricular longitudinal strain in patients with pulmonary hypertension: a systematic review and meta-analysis. EP - 484 SN - 2047-2404 IS - iss. 4 SP - 475 JF - European Heart Journal Cardiovascular Imaging VL - vol. 20 DO - https://doi.org/10.1093/ehjci/jey120 ER - TY - JOUR AU - Munsterman, I.D. AU - Duijnhouwer, A.L. AU - Kendall, T.J. AU - Bronkhorst, C.M. AU - Ronot, M. AU - Wettere, M. van AU - Dijk, A.P.J. van AU - Drenth, J.P.H. AU - Tjwa, E.T. PY - 2019 UR - https://hdl.handle.net/2066/202700 AB - AIMS: Liver fibrosis and cirrhosis are a consequence of a Fontan physiology, and determine prognosis. It is unclear whether non-invasive assessment of liver pathology is helpful to provide clinically relevant information. The aims of this study were to assess the spectrum of Fontan-associated liver disease (FALD) and usefulness of non-invasive methods to assess biopsy confirmed liver fibrosis. METHODS AND RESULTS: Hepatic screening of consecutive patients consisted of a blood panel, ultrasonography, elastography, contrast-enhanced magnetic resonance imaging (MRI)/computed tomography (CT) scan, and liver biopsy (scored with Fontan specific fibrosis scores and collagen proportionate area; CPA). Fibrosis parameters, varices, ascites, and splenomegaly were measured on imaging. Thirty-eight of 49 referred patients (27 +/- 6.6 years, 73.7% male) underwent the complete screening protocol. Liver fibrosis on biopsy was present in all patients, and classified as severe (Stages 3-4) in 68%. Median CPA was 22.5% (16.9-29.5) and correlated with individual fibrosis scores. ELF(R) and liver stiffness were elevated, but MELD-XI scores were low in all patients. Fibrosis severity neither correlated to ELF(R) and liver stiffness, nor to (semi-) quantitative fibrosis parameters on MRI/CT. Varices were present in 50% and hyperenhancing nodules in 25% of patients, both independent of fibrosis stage, but varices were associated with higher CPA values. CONCLUSION: The FALD spectrum includes both hepatic congestion and severe fibrosis, with signs of portal hypertension and hyperenhancing nodules as significant manifestations. Routine imaging, transient elastography, and serum biomarkers are unable to accurately assess severity of liver fibrosis in this cohort. Future research should focus on validating new diagnostic tools with biopsy as the reference standard. TI - The clinical spectrum of Fontan-associated liver disease: results from a prospective multimodality screening cohort EP - 1068 SN - 0195-668X IS - iss. 13 SP - 1057 JF - European Heart Journal VL - vol. 40 DO - https://doi.org/10.1093/eurheartj/ehy620 ER - TY - JOUR AU - Romeo, Jamie L.R. AU - Takkenberg, J.J. AU - Roos-Hesselink, J.W. AU - Hanif, Milad AU - Cornette, Jerome M.J. AU - Leeuwen, Wouter J. van AU - Dijk, A.P.J. van AU - Bogers, A. AU - Mokhles, M.Mostafa PY - 2018 UR - https://hdl.handle.net/2066/192627 TI - Outcomes of Pregnancy After Right Ventricular Outflow Tract Reconstruction With an Allograft Conduit EP - 2665 SN - 0735-1097 IS - iss. 23 SP - 2656 JF - Journal of the American College of Cardiology VL - vol. 71 DO - https://doi.org/10.1016/j.jacc.2018.03.522 ER - TY - JOUR AU - Kouijzer, I.J.E. AU - Berrevoets, M.A.H. AU - Aarntzen, E.H.J.G. AU - Vries, J. de AU - Dijk, A.P.J. van AU - Oyen, W.J.G. AU - Geus-Oei, L.F. de AU - Bleeker-Rovers, C.P. PY - 2018 UR - https://hdl.handle.net/2066/194380 TI - F-18-fluorodeoxyglucose positron-emission tomography combined with computed tomography as a diagnostic tool in native valve endocarditis EP - 752 SN - 0143-3636 IS - iss. 8 SP - 747 JF - Nuclear Medicine Communications VL - vol. 39 DO - https://doi.org/10.1097/MNM.0000000000000864 ER - TY - JOUR AU - Joustra, R. AU - Dijk, A.P.J. van AU - Meijburg, H.W. AU - Boulaksil, M. PY - 2018 UR - https://hdl.handle.net/2066/200446 TI - A freaky artery EP - 578 SN - 1568-5888 IS - iss. 11 SP - 577 JF - Netherlands Heart Journal VL - vol. 26 DO - https://doi.org/10.1007/s12471-018-1189-y L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/200446/200446.pdf?sequence=1 ER - TY - JOUR AU - Cate, T.J.F. ten AU - Dijk, A.P.J. van PY - 2018 UR - https://hdl.handle.net/2066/200248 TI - Mind the gap: closure of right to left shunts for rare indications EP - 534 SN - 1568-5888 IS - iss. 11 SP - 533 JF - Netherlands Heart Journal VL - vol. 26 DO - https://doi.org/10.1007/s12471-018-1164-7 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/200248/200248.pdf?sequence=1 ER - TY - JOUR AU - Driessen, Mieke M.P. AU - Schings, Marjolijn A. AU - Sieswerda, G.T. AU - Doevendans, Pieter A. AU - Hulzebos, Erik H. AU - Post, M.C. AU - Dijk, A.P.J. van AU - Meijboom, F.J. AU - Leiner, T. PY - 2018 UR - https://hdl.handle.net/2066/184077 TI - Tricuspid flow and regurgitation in congenital heart disease and pulmonary hypertension: comparison of 4D flow cardiovascular magnetic resonance and echocardiography SN - 1097-6647 JF - Journal of Cardiovascular Magnetic Resonance VL - vol. 20 DO - https://doi.org/10.1186/s12968-017-0426-7 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/184077/184077.pdf?sequence=1 ER - TY - JOUR AU - Yang, H. AU - Heidendael, J.F. AU - Groot, J.R. de AU - Konings, T.C. AU - Veen, G. AU - Dijk, A.P.J. van AU - Mulder, B. J. M. AU - Bouma, B.J. PY - 2018 UR - https://hdl.handle.net/2066/190134 TI - Oral anticoagulant therapy in adults with congenital heart disease and atrial arrhythmias: Implementation of guidelines EP - 74 SN - 0167-5273 SP - 67 JF - International Journal of Cardiology VL - vol. 257 DO - https://doi.org/10.1016/j.ijcard.2017.12.038 ER - TY - JOUR AU - Driesen, B.W. AU - Warmerdam, Evangeline G. AU - Sieswerda, G.T. AU - Schoof, Paul H. AU - Meijboom, F.J. AU - Haas, Felix AU - Dijk, A.P.J. van AU - Voskuil, Michiel PY - 2018 UR - https://hdl.handle.net/2066/194247 TI - Anomalous coronary artery originating from the opposite sinus of Valsalva (ACAOS), fractional flow reserve- and intravascular ultrasound-guided management in adult patients EP - 75 SN - 1522-1946 IS - iss. 1 SP - 68 JF - Catheterization and Cardiovascular Interventions VL - vol. 92 DO - https://doi.org/10.1002/ccd.27578 ER - TY - JOUR AU - Lameijer, Heleen AU - Slooten, Y.J. van AU - Jongbloed, M.R. AU - Oudijk, M.A. AU - Kampman, M.A.M. AU - Dijk, A.P.J. van AU - Melle, J.P. van AU - Pieper, P.G. PY - 2018 UR - https://hdl.handle.net/2066/194403 TI - Biological versus mechanical heart valve prosthesis during pregnancy in women with congenital heart disease EP - 112 SN - 0167-5273 SP - 106 JF - International Journal of Cardiology VL - vol. 268 DO - https://doi.org/10.1016/j.ijcard.2018.05.038 ER - TY - JOUR AU - Breetveld, N.M. AU - Ghossein-Doha, C. AU - Neer, J. van AU - Sengers, M. J. J. M. AU - Geerts, L. AU - Kuijk, S.M. van AU - Dijk, A.P. van AU - Vlugt, M.J. van der AU - Heidema, W.M. AU - Scholten, R.R. AU - Spaanderman, M.E.A. PY - 2018 UR - https://hdl.handle.net/2066/194440 TI - Decreased endothelial function and increased subclinical heart failure in women several years after pre-eclampsia EP - 204 SN - 0960-7692 IS - iss. 2 SP - 196 JF - Ultrasound in Obstetrics & Gynecology VL - vol. 52 DO - https://doi.org/10.1002/uog.17534 ER - TY - JOUR AU - Bokma, J.P. AU - Winter, M.M. AU - Dijk, A.P.J. van AU - Vliegen, H.W. AU - Melle, J.P. van AU - Meijboom, F.J. AU - Mulder, B. J. M. AU - Bouma, B.J. PY - 2018 UR - https://hdl.handle.net/2066/190873 TI - Effect of Losartan on Right Ventricular Dysfunction Results From the Double-Blind, Randomized REDEFINE Trial (Right Ventricular Dysfunction in Tetralogy of Fallot: Inhibition of the Renin-Angiotensin-Aldosterone System) in Adults With Repaired Tetralogy of Fallot EP - 1471 SN - 0009-7322 IS - iss. 14 SP - 1463 JF - Circulation VL - vol. 137 DO - https://doi.org/10.1161/CIRCULATIONAHA.117.031438 ER - TY - JOUR AU - Driessen, Mieke M. P. AU - Leiner, T. AU - Sieswerda, G.T. AU - Dijk, A.P.J. van AU - Post, M.C. AU - Friedberg, Mark K. AU - Hulzebos, Erik H. AU - Meijboom, F.J. PY - 2018 UR - https://hdl.handle.net/2066/197709 TI - RV adaptation to increased afterload in congenital heart disease and pulmonary hypertension SN - 1932-6203 IS - iss. 10 JF - PLoS One VL - vol. 13 DO - https://doi.org/10.1371/journal.pone.0205196 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/197709/197709.pdf?sequence=1 ER - TY - JOUR AU - Kouijzer, I.J.E. AU - Berrevoets, M.A.H. AU - Aarntzen, E.H.J.G. AU - Vries, J. de AU - Dijk, A.P.J. van AU - Oyen, W.J.G. AU - Geus-Oei, L.F. de AU - Bleeker-Rovers, C.P. PY - 2018 UR - https://hdl.handle.net/2066/196054 AB - OBJECTIVE: The aim of the study was to investigate the value of F-fluorodeoxyglucose positron-emission tomography combined with computed tomography (F-FDG-PET/CT) in diagnosing native valve endocarditis (NVE). PATIENTS AND METHODS: All patients with bacteremia and suspicion of NVE between January 2013 and June 2016 were identified from the hospitals' register and retrospectively included if echocardiography and F-FDG-PET/CT were performed within 14 days. F-FDG-PET/CT scans were scored independently by two nuclear medicine physicians. F-FDG-PET/CT was compared with the modified-Duke criteria and a multidisciplinary consensus. RESULTS: A total of 88 patients were included. In 10 patients with definite NVE according to the modified-Duke criteria, three (30.0%) patients had increased F-FDG uptake in or around the heart valves and seven (70.0%) patients had no increased F-FDG uptake. In patients without definite NVE according to the modified-Duke criteria, 89.7% (70/78) of the patients had no increased F-FDG uptake in or around the heart valves. Of all 20 patients with NVE according to multidisciplinary consensus, nine (45.0%) patients had increased F-FDG uptake in or around the heart valves and 11 (55.0%) patients had a normal F-FDG-PET/CT result. CONCLUSION: A negative F-FDG-PET/CT result should not be interpreted as an exclusion of NVE. In patients with possible or rejected NVE according to the modified-Duke criteria, F-FDG-PET/CT could be used in case of sustained suspicion of NVE owing to its high specificity in case of abnormal FDG uptake at the valve region. F-FDG-PET/CT is important for detecting metastatic infection which already warrants the need to perform F-FDG-PET/CT in all patients with suspected NVE. TI - 18F-fluorodeoxyglucose positron-emission tomography combined with computed tomography as a diagnostic tool in native valve endocarditis EP - 752 SN - 0143-3636 IS - iss. 8 SP - 747 JF - Nuclear Medicine Communications VL - vol. 39 DO - https://doi.org/10.1097/MNM.0000000000000864 ER - TY - JOUR AU - Burg, Jennifer J. van der AU - Warmerdam, Evangeline G. AU - Krings, Gregor J. AU - Meijboom, F.J. AU - Dijk, A.P. van AU - Post, M.C. AU - Voskuil, Michiel AU - Sieswerda, G.T. PY - 2018 UR - https://hdl.handle.net/2066/199469 TI - Effect of stent implantation on blood pressure control in adults with coarctation of the aorta EP - 950 SN - 1878-0938 IS - iss. 8 SP - 944 JF - Cardiovascular Revascularization Medicine VL - vol. 19 DO - https://doi.org/10.1016/j.carrev.2018.03.018 ER - TY - JOUR AU - Yang, H. AU - Kuijpers, J.M. AU - Groot, J.R. de AU - Konings, T.C. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Mulder, B. J. M. AU - Bouma, B.J. PY - 2017 UR - https://hdl.handle.net/2066/189909 TI - Impact of atrial arrhythmias on outcome in adults with congenital heart disease EP - 154 SN - 0167-5273 SP - 152 JF - International Journal of Cardiology VL - vol. 248 DO - https://doi.org/10.1016/j.ijcard.2017.06.073 ER - TY - JOUR AU - Blok, I.M. AU - Riel, A.C. van AU - Dijk, A.P.J. van AU - Mulder, B.J. AU - Bouma, B.J. PY - 2017 UR - https://hdl.handle.net/2066/169672 TI - From bosentan to macitentan for pulmonary arterial hypertension and adult congenital heart disease: Further improvement? EP - 52 SN - 0167-5273 SP - 51 JF - International Journal of Cardiology VL - vol. 227 DO - https://doi.org/10.1016/j.ijcard.2016.11.211 ER - TY - JOUR AU - Bokma, J.P. AU - Winter, M.M. AU - Vehmeijer, J.T. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Melle, J.P. van AU - Meijboom, F.J. AU - Post, M.C. AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2017 UR - https://hdl.handle.net/2066/182901 AB - BACKGROUND: Although QRS duration >180 ms has prognostic value in adults with tetralogy of Fallot (TOF), its sensitivity to predict mortality is low. Fragmented QRS complexes, a simple measurement on ECG, are related to myocardial fibrosis and dysfunction in patients with TOF. Our objective was to determine whether QRS fragmentation predicts major outcomes in TOF. METHODS: This multicentre study included adult patients with TOF from a prospective registry. Notches in the QRS complex in >/=2 contiguous leads on a 12-lead ECG, not related to bundle branch block, were defined as QRS fragmentation, which was classified as none, moderate (/=5 leads). The primary and secondary outcomes were all-cause mortality and clinical ventricular arrhythmia, respectively. RESULTS: A total of 794 adult patients with TOF (median age 27 years, 55% male; 52% no QRS fragmentation, 32% moderate, 16% severe) were included. During long-term (median 10.4 years) follow-up, 46 (6%) patients died and 35 (4%) patients had ventricular arrhythmias. Overall, 10-year survival was 98% in patients without fragmented QRS complexes, 93% in patients with moderate QRS fragmentation and 81% in patients with severe QRS fragmentation. In multivariable Cox hazards regression analysis, extent of QRS fragmentation (HR: 2.24/class, 95% CI 1.48 to 3.40, p<0.001) remained independently predictive for mortality, whereas QRS duration was not predictive (p=0.85). The extent of QRS fragmentation was also independently predictive for ventricular arrhythmia (HR: 2.00/class, 95% CI 1.26 to 3.16, p=0.003). CONCLUSIONS: The extent of QRS fragmentation is superior to QRS duration in predicting mortality in adult patients with TOF and may be used in risk stratification. TI - QRS fragmentation is superior to QRS duration in predicting mortality in adults with tetralogy of Fallot EP - 671 SN - 1355-6037 IS - iss. 9 SP - 666 JF - Heart VL - vol. 103 DO - https://doi.org/10.1136/heartjnl-2016-310068 ER - TY - JOUR AU - Bokma, J.P. AU - Winter, M.M. AU - Kornaat, E.M. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Melle, J.P. van AU - Meijboom, F.J. AU - Post, M.C. AU - Berbee, J.K. AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2017 UR - https://hdl.handle.net/2066/182910 AB - Renin-angiotensin-aldosterone system (RAAS) inhibition with angiotensin II receptor blockers or angiotensin-converting enzyme inhibitors is beneficial in patients with acquired left ventricular dysfunction. Adult patients with tetralogy of Fallot (TOF) with right ventricular (RV) dysfunction are at high risk for heart failure, arrhythmias, and sudden cardiac death. However, the efficacy of RAAS inhibition has not been established in these patients. METHODS: The REDEFINE is an investigator-initiated, multicenter, prospective, randomized, double-blind, placebo-controlled trial to study the effects of the angiotensin II receptor blocker losartan (target dosage of 150 mg once daily) in adult patients with TOF. Patients with RV dysfunction in the absence of severe valvular dysfunction are eligible for inclusion. The primary end point is the change in RV ejection fraction after 18 to 24 months, as measured by cardiovascular magnetic resonance imaging. In addition, laboratory measurements, echocardiography, and cardiopulmonary exercise testing are performed. CONCLUSION: The REDEFINE trial will study the effects of RAAS inhibition with losartan in TOF patients with RV dysfunction. TI - Right vEntricular Dysfunction in tEtralogy of Fallot: INhibition of the rEnin-angiotensin-aldosterone system (REDEFINE) trial: Rationale and design of a randomized, double-blind, placebo-controlled clinical trial EP - 90 SN - 0002-8703 SP - 83 JF - American Heart Journal VL - vol. 186 DO - https://doi.org/10.1016/j.ahj.2016.12.014 ER - TY - JOUR AU - Etnel, J.R. AU - Dijk, A.P.J. van AU - Kluin, J. AU - Bertels, R.A. AU - Utens, E. AU - Galen, E. van AU - Bogers, A. AU - Takkenberg, J.J. PY - 2017 UR - https://hdl.handle.net/2066/182730 AB - OBJECTIVES: In response to an increased need for patient information on congenital heart disease in the Netherlands, we initiated a nationwide initiative to develop an online, evidence-based patient information portal, starting with a pilot project aimed at the subgroup of patients with congenital aortic and pulmonary valve disease. METHODS AND RESULTS: We developed an information portal that aims to (1) improve patient knowledge and involvement and to subsequently reduce anxiety and decisional conflict and improve mental quality of life and (2) to support physicians in informing and communicating with their patients. The information portal was developed according to the systematic International Patient Decision Aid Standards development process employing Delphi techniques by a multidisciplinary workgroup of pediatric and adult congenital cardiologists, a congenital cardiothoracic surgeon, a psychologist, an epidemiologist, a patient representative, and web and industrial design experts. First, patients and physicians were surveyed and interviewed to assess the current state of patient information and explore their preferences and needs to determine the focus for the development of the information portal. We found that patient knowledge and numeracy are limited, reliable information is scarce, physicians inform patients selectively and patient involvement is suboptimal, and there is a need for more reliable, tailored, and multi-faceted information. Based on the findings of these surveys and interviews, a patient-tailored information portal was designed that presents evidence-based disease- and age-specific medical and psychosocial information about diagnosis, treatment, prognosis, and impact on daily life in a manner that is comprehensible and digestible for patients and that meets the needs expressed by both patients and physicians. The effect of the website on patient outcome is currently being assessed in a multicenter stepped-wedge implementation trial. CONCLUSION: The present pilot project succeeded in developing an online, evidence-based information portal that is supported by both patients and physicians. The information portal will be further developed and expanded to include all other major forms of congenital heart disease, translations into other languages, and a public information portal to serve patients' relatives and the general public at large. TI - Development of an Online, Evidence-Based Patient Information Portal for Congenital Heart Disease: A Pilot Study SN - 2297-055X JF - Frontiers in Cardiovascular Medicine VL - vol. 4 DO - https://doi.org/10.3389/fcvm.2017.00025 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/182730/182730.pdf?sequence=1 ER - TY - JOUR AU - Siegmund, A.S. AU - Kampman, M.A.M. AU - Bilardo, C.M. AU - Balci, A. AU - Dijk, A.P.J. van AU - Oudijk, M.A. AU - Mulder, B.J. AU - Roos-Hesselink, J.W. AU - Sieswerda, G.T. AU - Koenen, S.V. AU - Sollie-Szarynska, K.M. AU - Ebels, T. AU - Veldhuisen, D.J. van AU - Pieper, P.G. PY - 2017 UR - https://hdl.handle.net/2066/182641 AB - OBJECTIVE: Women with repaired coarctation of the aorta (rCoA) are at risk of hypertensive disorders and other complications during pregnancy. Hypertensive disorders in pregnant women are associated with inadequate uteroplacental flow, which is related to adverse offspring outcome. The aim of this study was to investigate the relationship of maternal cardiac function, placental function and pregnancy complications in women with rCoA. METHODS: We included 49 pregnant women with rCoA and 69 controls from the prospective ZAHARA-studies (Zwangerschap bij Aangeboren HARtAfwijkingen, pregnancy in congenital heart disease). Clinical evaluation, echocardiography and uteroplacental Doppler flow (UDF) measurements were performed at 20 and 32weeks gestation. Univariable regression analysis was performed. RESULTS: Comparison of rCoA and healthy women. In women with rCoA, tricuspid annular plane systolic excursion (TAPSE) decreased during pregnancy (25.7mm to 22.8mm, P=0.006). UDF indices and pregnancy complication rates were similar in both groups. Offspring of rCoA women had lower birth weight (3233g versus 3578g, P=0.001), which was associated with beta-blocker use during pregnancy (beta=-418.0, P=0.01). Association of cardiac function and UDF. Right ventricular (RV) function before pregnancy (TAPSE) and at 20weeks gestation (TAPSE and RV fractional area change) were associated with impaired UDF indices (umbilical artery pulsatility index at 20weeks beta=-0.02, P=0.01, resistance index at 20 and 32weeks beta=-0.01, P=0.02 and beta=-0.02, P=0.01 and uterine artery pulsatility and resistance index at 20weeks gestation beta=-0.02, P=0.05 and beta=-0.01, P=0.02). CONCLUSIONS: Women with rCoA tolerate pregnancy well. However, RV function is altered and is associated with impaired placentation. TI - Pregnancy in women with corrected aortic coarctation: Uteroplacental Doppler flow and pregnancy outcome EP - 150 SN - 0167-5273 SP - 145 JF - International Journal of Cardiology VL - vol. 249 DO - https://doi.org/10.1016/j.ijcard.2017.09.167 ER - TY - JOUR AU - Ghossein-Doha, C. AU - Neer, J. van AU - Wissink, B. AU - Breetveld, N.M. AU - Windt, L.J. de AU - Dijk, A.P.J. van AU - Vlugt, M.J. van der AU - Janssen, M.C. AU - Heidema, W.M. AU - Scholten, R.R. AU - Spaanderman, M.E.A. PY - 2017 UR - https://hdl.handle.net/2066/169789 AB - OBJECTIVES: Pre-eclampsia (PE) is associated with both postpartum structural asymptomatic heart disease (i.e. heart failure Stage B (HF-B)) and conventional cardiovascular (CV) risk factors. We aimed to evaluate the extent to which PE, adjusted for conventional CV risk factors, is associated independently with asymptomatic cardiac abnormalities postpartum. METHODS: In this cross-sectional cohort study, 107 formerly pre-eclamptic women and 41 women with uneventful previous pregnancy (controls) were invited for CV risk assessment 4-10 years postpartum. This included cardiac ultrasound, blood pressure (BP) measurement and evaluation of metabolic syndrome determinants. Asymptomatic structural and functional cardiac abnormalities were classified as HF-B, according to the American Heart Association guidelines. Prehypertension was defined as systolic BP of 120-139 mmHg and/or diastolic BP of 80-89 mmHg. Univariate and multivariate regression analyses were performed to calculate associations of PE and conventional risk factors with HF-B. RESULTS: The prevalence of asymptomatic HF-B was approximately 3.5-fold higher in the PE group compared with controls (25% vs 7%, P < 0.01); 67% of this group had concentric remodeling and 22% had mildly impaired ejection fraction. After adjustment for postpartum interval, hypertension and high-density lipoprotein, PE was significantly associated with HF-B (adjusted odds ratio, 4.4 (95% CI, 1.0-19.1)). Moreover, in the formerly pre-eclamptic group, prehypertension was associated significantly with HF-B (odds ratio, 4.3 (95% CI, 1.4-12.7)), while metabolic syndrome determinants were not. CONCLUSION: PE is associated with a four-fold increased female-specific risk of asymptomatic cardiac abnormalities. Prehypertension apparently increases this risk significantly, while metabolic syndrome determinants do not. Copyright (c) 2016 ISUOG. Published by John Wiley & Sons Ltd. TI - Pre-eclampsia: an important risk factor for asymptomatic heart failure EP - 149 SN - 0960-7692 IS - iss. 1 SP - 143 JF - Ultrasound in Obstetrics & Gynecology VL - vol. 49 DO - https://doi.org/10.1002/uog.17343 ER - TY - JOUR AU - Schuijt, M.T.U. AU - Blok, I.M. AU - Zwinderman, A.H. AU - Riel, A. van AU - Schuuring, M.J. AU - Winter, R.J. de AU - Duijnhouwer, A.L. AU - Dijk, A.P.J. van AU - Mulder, B.J. AU - Bouma, B.J. PY - 2017 UR - https://hdl.handle.net/2066/176893 AB - BACKGROUND: Adult patients with pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) suffer from high mortality. This underlines the importance of adequate risk stratification to guide treatment decisions. Several baseline parameters are associated with mortality, however, their prognostic value may weaken after years of follow-up. Therefore we investigated the prognostic value of serial changes in standard clinical parameters in PAH-CHD. METHODS: In this prospective observational cohort study we included consecutive PAH-CHD adults, between 2005 and 2016. Control visits to the outpatient clinic were standardized, including functional, biochemical and echocardiographic tests, according to the guidelines. The prognostic value of serial changes was determined with time-dependent Cox regression. RESULTS: Ninety-two patients with PAH-CHD were included (age 43+/-15years, 34% male, 38% Down, 73% Eisenmenger). During a median follow-up of 6.0 (IQR 3.7-9.3) years, 35 (38%) patients died. Serial changes in World Health Organization functional classification (WHO-FC, HR 18.34 for onset class IV), six-minute walk distance (6-MWD, HR 0.65 per 50m), oxygen saturation at peak exercise (peak SaO2, HR 0.74 per 5%), NTproBNP (HR 2.25 per 1000ng/l) and echocardiographic right ventricular function (TAPSE, HR 0.80 per 0.5cm) significantly predicted mortality. Moreover, serial changes in these parameters were more potent predictors compared to baseline parameters, based on reduction in -2 log likelihood. CONCLUSIONS: Serial changes in standard clinical parameters have more prognostic value compared to baseline parameters in PAH-CHD. Our results emphasize the importance of screening for serial changes since periodical assessment could guide treatment decisions to delay disease progression. TI - Mortality in pulmonary arterial hypertension due to congenital heart disease: Serial changes improve prognostication EP - 453 SN - 0167-5273 SP - 449 JF - International Journal of Cardiology VL - vol. 243 DO - https://doi.org/10.1016/j.ijcard.2017.05.101 ER - TY - JOUR AU - Hulshof, H.G. AU - Dijk, A.P.J. van AU - George, K.P. AU - Hopman, M.T.E. AU - Thijssen, D.H.J. AU - Oxborough, D.L. PY - 2017 UR - https://hdl.handle.net/2066/174541 AB - KEY POINTS: Severe aortic valve diseases are common cardiac abnormalities that are associated with poor long-term survival. Before any reduction in left ventricular (LV) function, the left ventricle undergoes structural remodelling under the influence of changing haemodynamic conditions. In this study, we combined temporal changes in LV structure (volume) with alterations in LV functional characteristics (strain, ) into a -volume loop, in order to provide novel insight into the haemodynamic cardiac consequences of aortic valve diseases in those with preserved LV ejection fraction. We showed that our novel -volume loop and the specific loop characteristics provide additional insight into the functional and mechanical haemodynamic consequences of severe aortic valve diseases (with preserved LV ejection fraction). Finally, we showed that the -volume loop characteristics provide discriminative capacity compared with conventional measures of LV function. ABSTRACT: The purpose of this study was to examine left ventricular (LV) strain ()-volume loops to provide novel insight into the haemodynamic cardiac consequences of aortic valve stenosis (AS) and aortic valve regurgitation (AR). Twenty-seven participants were retrospectively recruited: AR (n = 7), AS (n = 10) and control subjects (n = 10). Standard transthoracic echocardiography was used to obtain apical four-chamber images to construct -volume relationships, which were assessed using the following parameters: early systolic (_ES); slope of -volume relationship during systole (Sslope); end-systolic peak (peak ); and diastolic uncoupling (systolic -diastolic at same volume) during early diastole (UNCOUP_ED) and late diastole (UNCOUP_LD). Receiver operating characteristic curves were used to determine the ability to detect impaired LV function. Although LV ejection fraction was comparable between groups, longitudinal peak was reduced compared with control subjects. In contrast, _ES and Sslope were lower in both pathologies compared with control subejcts (P < 0.01), but also different between AS and AR (P < 0.05). UNCOUP_ED and UNCOUP_LD were significantly higher in both patient groups compared with control subjects (P < 0.05). Receiver operating characteristic curves revealed that loop characteristics (AUC = 0.99, 1.00 and 1.00; all P < 0.01) were better able then peak (AUC = 0.75, 0.89 and 0.76; P = 0.06, <0.01 and 0.08, respectively) and LV ejection fraction (AUC = 0.56, 0.69 and 0.69; all P > 0.05) to distinguish AS vs control, AR vs control and AS vs AR groups, respectively. Temporal changes in -volume characteristics provide novel insight into the haemodynamic cardiac impact of AS and AR. Contrary to traditional measures (i.e. ejection fraction, peak ), these novel measures successfully distinguish between the haemodynamic cardiac impact of AS and AR. TI - Exploratory assessment of left ventricular strain-volume loops in severe aortic valve diseases. EP - 3971 SN - 0022-3751 IS - iss. 12 SP - 3961 JF - Journal of Physiology VL - vol. 595 DO - https://doi.org/10.1113/JP273526 ER - TY - JOUR AU - Bokma, J.P. AU - Wilde, K.C. de AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Melle, J.P. van AU - Meijboom, F.J. AU - Zwinderman, A.H. AU - Groenink, M. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2017 UR - https://hdl.handle.net/2066/176958 AB - Importance: Adults late after total correction of tetralogy of Fallot (TOF) are at risk for major complications. Cardiovascular magnetic resonance (CMR) imaging is recommended to quantify right ventricular (RV) and left ventricular (LV) function. However, a commonly used risk model by Khairy et al requires invasive investigations and lacks CMR imaging to identify high-risk patients. Objective: To implement CMR imaging in noninvasive risk stratification to predict major adverse clinical outcomes. Design, Setting, and Participants: This multicenter study included 575 adult patients with TOF (4.083 patient-years at risk) from a prospective nationwide registry in whom CMR was performed. This study involved 5 tertiary referral centers with a specialized adult congenital heart disease unit. Multivariable Cox hazards regression analysis was performed to determine factors associated with the primary end point. The CMR variables were combined with the noninvasive components of the Khairy et al risk model, and the C statistic of the final noninvasive risk model was determined using bootstrap sampling. The data analysis was conducted from January to December 2016. Main Outcomes and Measures: The composite primary outcome was defined as all-cause mortality or ventricular arrhythmia, defined as aborted cardiac arrest or documented ventricular fibrillation and ventricular tachycardia (lasting >/=30 seconds or recurrent symptomatic). Results: Of the 575 patients with TOF, 57% were male, and the mean (SD) age was 31 (11) years. During a mean (SD) follow-up of 7.1 (3.5) years, the primary composite end point occurred in 35 patients, including all-cause mortality in 13 patients. Mean (SD) RV ejection fraction (EF) was 44% (10%), and mean (SD) LV EF was 53% (8%). There was a correlation between RV EF and LV EF (R, 0.36; 95% CI, 0.29-0.44; P < .001). Optimal thresholds for ventricular function (RV EF <30%: hazard ratio, 3.90; 95% CI, 1.84-8.26; P < .001 and LV EF <45%: hazard ratio, 3.23; 95% CI, 1.57-6.65; P = .001) were independently predictive in multivariable analysis. Both thresholds were included in a point-based noninvasive risk model (C statistic, 0.75; 95% CI, 0.63-0.85) and combined with the noninvasive components of the Khairy et al risk model. Conclusions and Relevance: In patients with repaired TOF, biventricular dysfunction on CMR imaging was associated with major adverse clinical outcomes. The quantified thresholds (RV EF <30% and LV EF <45%) may be implemented in noninvasive risk stratification. TI - Value of Cardiovascular Magnetic Resonance Imaging in Noninvasive Risk Stratification in Tetralogy of Fallot EP - 683 SN - 2380-6583 IS - iss. 6 SP - 678 JF - JAMA Cardiology VL - vol. 2 DO - https://doi.org/10.1001/jamacardio.2016.5818 ER - TY - JOUR AU - Hulshof, H.G. AU - Dijk, A.P.J. van AU - George, K.P. AU - Merkus, D. AU - Stam, K. AU - Duin, R.W. van AU - Tertholen, K. van AU - Hopman, M.T.E. AU - Haddad, F. AU - Thijssen, D.H.J. AU - Oxborough, D.L. PY - 2017 UR - https://hdl.handle.net/2066/177714 TI - Echocardiographic-Derived Strain-Area Loop of the Right Ventricle is Related to Pulmonary Vascular Resistance in Pulmonary Arterial Hypertension. EP - 1288 SN - 1936-878X IS - iss. 10 SP - 1286 JF - Jacc. Cardiovascular Imaging VL - vol. 10 DO - https://doi.org/10.1016/j.jcmg.2017.05.018 ER - TY - JOUR AU - Breetveld, N.M. AU - Ghossein-Doha, C. AU - Kuijk, S.M. van AU - Dijk, A.P.J. van AU - Vlugt, M.J. van der AU - Heidema, W.M. AU - Neer, J. van AU - Empel, V. Van AU - Brunner-La Rocca, H.P. AU - Scholten, R.R. AU - Spaanderman, M.E.A. PY - 2017 UR - https://hdl.handle.net/2066/169794 AB - OBJECTIVES: After pre-eclampsia (PE), the prevalence of structural heart disease without symptoms, i.e. heart failure Stage B (HF-B), may be as high as one in four women in the first year postpartum. We hypothesize that a significant number of formerly pre-eclamptic women with HF-B postpartum are still in their resolving period and will not have HF-B during follow-up. METHODS: In this prospective longitudinal cohort study, we included 69 formerly pre-eclamptic women who underwent serial echocardiographic measurements at 1 and 4 years postpartum. HF-B was diagnosed as left ventricular hypertrophy (left ventricular mass index (LVMi) > 95 g/m2 ), concentric remodeling (relative wall thickness > 0.42 and LVMi 40% and < 55%) or asymptomatic valvular disease. Women were subdivided and analyzed according to HF-B outcome: no HF-B at either visit; HF-B at first visit only; HF-B at second visit only; HF-B at both visits. RESULTS: The prevalence of HF-B in formerly pre-eclamptic women was 23% in the first year postpartum and 23% after 4 years. At the second visit, HF-B had resolved in 62.5% of affected women but was newly developed in 19% of initially unaffected women. At the first visit, 56% of women diagnosed with HF-B had reduced systolic function whereas at the second visit 69% of women with HF-B had concentric remodeling with mostly normal ejection fraction, consistent with diastolic dysfunction. CONCLUSIONS: The prevalence of HF-B can be considered consistently high (1 in 4) amongst formerly pre-eclamptic women at follow-up. Nonetheless, at an individual level, more than 60% of women found initially to be affected by HF-B will recover, whilst about 20% of formerly pre-eclamptic women with normal echocardiography in the first year postpartum will develop HF-B over the following years. Copyright (c) 2016 ISUOG. Published by John Wiley & Sons Ltd. TI - Prevalence of asymptomatic heart failure in formerly pre-eclamptic women: a cohort study EP - 142 SN - 0960-7692 IS - iss. 1 SP - 134 JF - Ultrasound in Obstetrics & Gynecology VL - vol. 49 DO - https://doi.org/10.1002/uog.16014 ER - TY - JOUR AU - Maessen, M.F.H. AU - Eijsvogels, T.M.H. AU - Stevens, G.G. AU - Dijk, A.P.J. van AU - Hopman, M.T.E. PY - 2017 UR - https://hdl.handle.net/2066/182252 AB - Background Endurance exercise training induces cardio-protective effects, but athletes are not exempted from a myocardial infarction. Evidence from animal studies suggests that exercise training attenuates pathological left ventricular remodelling following myocardial infarction. We tested the hypothesis that lifelong exercise training is related to attenuated pathological left ventricular remodelling after myocardial infarction as evidenced by better left ventricular systolic function in veteran athletes compared to sedentary peers. Design This was a cross-sectional study. Methods Sixty-five males (60 +/- 6 years) were included and allocated to four groups based on lifelong exercise training volumes: (a) athletes ( n = 18), (b) post-myocardial infarction athletes (athletes + myocardial infarction, n = 20), (c) sedentary controls ( n = 13), and (d) post-myocardial infarction controls (sedentary controls + myocardial infarction, n = 14). Athletes were lifelong (>/=20 years) highly physically active (>/=30 metabolic equivalent of task (MET)-h/week), whereas sedentary controls did not meet the exercise guidelines (<10 MET-h/week) for the past 20 years. left ventricular systolic function, diastolic function and wall strain were measured using echocardiography. Results Cardiac enzyme markers (creatine-kinase, creatinine, aspartate transaminase and lactate dehydrogenase) following myocardial infarction and infarct location did not differ between athletes + myocardial infarction and sedentary controls + myocardial infarction. Left ventricular ejection fraction was significantly higher in athletes (61% +/- 4), athletes + myocardial infarction (58% +/- 4) and sedentary controls (57% +/- 6) compared to sedentary controls + myocardial infarction (51% +/- 7; p < 0.01). Left ventricular circumferential strain was superior in athletes (-19% (-21% to -17%), athletes + myocardial infarction (-16% (-20% to -12%)), and sedentary controls (-15% (-18% to -14%) compared to sedentary controls + myocardial infarction (-13% (-15% to -8%), p < 0.01). Diastolic function parameters did not differ across groups. Conclusion These findings suggest that lifelong exercise training may preserve left ventricular systolic function and possibly attenuates or minimises the deleterious effects of pathological post-myocardial infarction left ventricular remodelling in veteran athletes. TI - Benefits of lifelong exercise training on left ventricular function after myocardial infarction EP - 1866 SN - 2047-4873 IS - iss. 17 SP - 1856 JF - European Journal of Preventive Cardiology VL - vol. 24 DO - https://doi.org/10.1177/2047487317728765 ER - TY - JOUR AU - Riel, A.C. van AU - Schuuring, M.J. AU - Hessen, I.D. van AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Yip, J.W. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2016 UR - https://hdl.handle.net/2066/171851 AB - BACKGROUND: Advanced treatment of pulmonary arterial hypertension (PAH) in congenital heart disease (CHD) is increasingly applied worldwide following the-mainly Western world based-international PAH-CHD guidelines. However, studies comparing clinical presentation and outcome after the initiation of PAH-specific treatment are lacking. We aimed to analyse this in a Singaporean and Dutch cohort of PAH-CHD patients. METHODS: Adult CHD patients starting PAH-specific therapy, enrolled in two nationwide registries, were analysed. Patients received phosphodiesterase-type-5 inhibitors, endothelin receptor antagonists, or a combination. Change in six-minute walk test (6MWT) during follow-up was analysed using linear mixed model analysis. Determinants for mortality were assessed using Cox proportional hazard analyses. RESULTS: A total of 74 patients, 45 Dutch (mean age 47 +/- 14 years) and 29 Singaporean (mean age 41 +/- 14 years) were analysed. Despite a lower 6MWT (312 versus 395 metres, p = 0.01) and peak VO2 (35 versus 49 % of predicted, p = 0.01) at baseline in Singaporean patients, the treatment effect was similar in the two populations. Age at initiation of therapy (per 5 year lower age, beta = + 4.5, p = 0.017) was the strongest predictor of improvement in exercise capacity, corrected for ethnicity, baseline 6MWT, sex and CHD defect. CONCLUSIONS: Patients from Singapore had a worse clinical performance at baseline compared with the PAH-CHD patients from the Netherlands. No relation between ethnicity and improvement in 6MWT after PAH-specific therapy was found. Age at initiation of PAH-specific therapy was the strongest predictor of treatment efficacy and mortality, emphasising the need for early initiation of treatment in these patients. TI - Treatment of pulmonary arterial hypertension in congenital heart disease in Singapore versus the Netherlands: age exceeds ethnicity in influencing clinical outcome EP - 416 SN - 1568-5888 IS - iss. 6 SP - 410 JF - Netherlands Heart Journal VL - vol. 24 DO - https://doi.org/10.1007/s12471-016-0820-z L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/171851/171851.pdf?sequence=1 ER - TY - JOUR AU - Post, M.C. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Bogaard, H.J. AU - Empel, V. Van AU - Boomars, K.A. PY - 2016 UR - https://hdl.handle.net/2066/171308 TI - PulmoCor: national registry for pulmonary hypertension EP - 430 SN - 1568-5888 IS - iss. 6 SP - 425 JF - Netherlands Heart Journal VL - vol. 24 DO - https://doi.org/10.1007/s12471-016-0830-x L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/171308/171308.pdf?sequence=1 ER - TY - JOUR AU - Blok, I.M. AU - Riel, A.C. van AU - Schuuring, M.J. AU - Bruin-Bon, R.H. de AU - Dijk, A.P. van AU - Hoendermis, E.S. AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2016 UR - https://hdl.handle.net/2066/171773 AB - BACKGROUND: Adults with pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) have a poor prognosis. Identifying patients with a high risk for clinical events and death is important because their prognosis can be improved by intensifying their treatment. Cystatin C, a novel cardiac biomarker, correlates with right ventricular dimensions in patients with idiopathic PAH, giving it potential to determine prognosis in PAH-CHD patients. We investigated the predictive value of cystatin C for long-term mortality and clinical events. METHODS: Fifty-nine PAH-CHD patients (mean age 42 SD 13 years, 42% male) were included in this prospective observational study, with cystatin C measurements between 2005 and 2015 on the outpatient clinic. Patients were evaluated with a standardized evaluation protocol including laboratory, functional and echocardiographic variables. Clinical events comprised worsening functional classification, worsening heart failure, symptomatic hyperviscosity, haemoptysis and arrhythmia. We used Cox regression to determine predictors for mortality and clinical events. RESULTS: Mean follow-up was 4.4years, during which 12 (20%) patients died. Cystatin C (HR 1.3, p<0.001), creatinine (HR 1.2, p<0.001), NT-pro-BNP (HR 2.0, p=0.012), hs-troponin T (HR 1.9, p=0.005), 6-MWD (HR 0.8, p=0.044) and TAPSE (HR 0.8, p<0.001) predicted mortality. Similar results were found for the prediction of clinical events. When adjusted for NT-pro-BNP or glomerular filtration rate in multivariate analysis, cystatin C remained predictive for mortality. CONCLUSIONS: Cystatin C, a novel cardiac biomarker, predicts long-term mortality and clinical events in patients with PAH-CHD. Consequently, cystatin C may attribute to clinical decision making regarding treatment intensity. TI - The role of cystatin C as a biomarker for prognosis in pulmonary arterial hypertension due to congenital heart disease EP - 247 SN - 0167-5273 SP - 242 JF - International Journal of Cardiology VL - vol. 209 DO - https://doi.org/10.1016/j.ijcard.2016.02.003 ER - TY - JOUR AU - Bokma, J.P. AU - Winter, M.M. AU - Oosterhof, T. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Pieper, P.G. AU - Meijboom, F.J. AU - Groenink, M. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2016 UR - https://hdl.handle.net/2066/171309 TI - Pulmonary Valve Replacement After Repair of Pulmonary Stenosis Compared With Tetralogy of Fallot EP - 1124 SN - 0735-1097 IS - iss. 9 SP - 1123 JF - Journal of the American College of Cardiology VL - vol. 67 DO - https://doi.org/10.1016/j.jacc.2015.12.032 ER - TY - JOUR AU - Schoonbeek, R.C. AU - Pieper, P.G. AU - Slooten, Y.J. van AU - Freling, H.G. AU - Sieswerda, G.T. AU - Dijk, A.P.J. van AU - Jongbloed, M.R. AU - Post, M.C. AU - Bouma, B.J. AU - Berger, R.M. AU - Ebels, T. AU - Melle, J.P. van PY - 2016 UR - https://hdl.handle.net/2066/171019 AB - OBJECTIVES: N-terminal Btype natriuretic peptide (NT-proBNP) is an important biomarker for the detection of heart failure. Adults with congenital heart disease (ACHD) and a prosthetic heart valve are at risk for heart failure. This study aimed to determine the value of NT-proBNP in ACHD patients with a prosthetic valve and investigate its relationship with cardiac function and exercise capacity. METHODS: In this multi-centre cross-sectional observational study, data regarding medical history, echocardiography, exercise testing (VO2peak) and laboratory blood evaluation (including NT-proBNP) were collected in ACHD patients with a single prosthetic valve (either homografts, heterografts or mechanical valves). RESULTS: A total of 306 ACHD patients with pulmonary valve replacement (PVR, n = 139), aortic valve replacement (n = 141), mitral valve replacement (n = 21) or tricuspid valve replacement (n = 5) were investigated. The majority of patients (77 %) were in NYHA class I or II. Elevated NT-proBNP levels (cut-off >/=125 pg/ml) were found in 50 % of the patients, with the highest levels in patients with mitral valve replacements. In this study population, NT-proBNP levels were associated with gender (p = 0.029) and VO2max (p < 0.001). In PVR patients, NT-proBNP levels were associated with lower VO2peak, also after adjustment for age, gender and age at valve replacement in a multivariate model (p = 0.015). CONCLUSIONS: In patients with ACHD and a prosthetic valve, elevated NT-proBNP levels are frequently observed despite preserved NYHA class. In PVR patients, a higher NT-proBNP level was associated with a lower VO2peak. These results may be of importance in the ongoing discussion about the timing of valve replacement in patients with CHD. TI - NT-proBNP and exercise capacity in adult patients with congenital heart disease and a prosthetic valve: a multicentre PROSTAVA study EP - 665 SN - 1568-5888 IS - iss. 11 SP - 653 JF - Netherlands Heart Journal VL - vol. 24 DO - https://doi.org/10.1007/s12471-016-0896-5 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/171019/171019.pdf?sequence=1 ER - TY - JOUR AU - Baggen, V.J. AU - Leiner, T. AU - Post, M.C. AU - Dijk, A.P.J. van AU - Roos-Hesselink, J.W. AU - Boersma, E. AU - Habets, J. AU - Sieswerda, G.T. PY - 2016 UR - https://hdl.handle.net/2066/172074 AB - OBJECTIVES: To provide a comprehensive overview of all reported cardiac magnetic resonance (CMR) findings that predict clinical deterioration in pulmonary arterial hypertension (PAH). METHODS: MEDLINE and EMBASE electronic databases were systematically searched for longitudinal studies published by April 2015 that reported associations between CMR findings and adverse clinical outcome in PAH. Studies were appraised using previously developed criteria for prognostic studies. Meta-analysis using random effect models was performed for CMR findings investigated by three or more studies. RESULTS: Eight papers (539 patients) investigating 21 different CMR findings were included. Meta-analysis showed that right ventricular (RV) ejection fraction was the strongest predictor of mortality in PAH (pooled HR 1.23 [95 % CI 1.07-1.41], p = 0.003) per 5 % decrease. In addition, RV end-diastolic volume index (pooled HR 1.06 [95 % CI 1.00-1.12], p = 0.049), RV end-systolic volume index (pooled HR 1.05 [95 % CI 1.01-1.09], p = 0.013) and left ventricular end-diastolic volume index (pooled HR 1.16 [95 % CI 1.00-1.34], p = 0.045) were of prognostic importance. RV and LV mass did not provide prognostic information (p = 0.852 and p = 0.983, respectively). CONCLUSION: This meta-analysis substantiates the clinical yield of specific CMR findings in the prognostication of PAH patients. Decreased RV ejection is the strongest and most well established predictor of mortality. KEY POINTS: * Cardiac magnetic resonance imaging is useful for prognostication in pulmonary arterial hypertension. * Right ventricular ejection fraction is the strongest predictor of mortality. * Serial CMR evaluation seems to be of additional prognostic importance. * Accurate prognostication can aid in adequate and timely intensification of PAH-specific therapy. TI - Cardiac magnetic resonance findings predicting mortality in patients with pulmonary arterial hypertension: a systematic review and meta-analysis EP - 3780 SN - 0938-7994 IS - iss. 11 SP - 3771 JF - European Radiology VL - vol. 26 DO - https://doi.org/10.1007/s00330-016-4217-6 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/172074/172074.pdf?sequence=1 ER - TY - JOUR AU - Baggen, V.J. AU - Driessen, M.M.P. AU - Post, M.C. AU - Dijk, A.P.J. van AU - Roos-Hesselink, J.W. AU - Bosch, A.E. van den AU - Takkenberg, J.J. AU - Sieswerda, G.T. PY - 2016 UR - https://hdl.handle.net/2066/172394 AB - BACKGROUND: Identification of patients at risk of deterioration is essential to guide clinical management in pulmonary arterial hypertension (PAH). This study aims to provide a comprehensive overview of well-investigated echocardiographic findings that are associated with clinical deterioration in PAH. METHODS: MEDLINE and EMBASE databases were systematically searched for longitudinal studies published by April 2015 that reported associations between echocardiographic findings and mortality, transplant or clinical worsening. Meta-analysis using random effect models was performed for echocardiographic findings investigated by four or more studies. In case of statistical heterogeneity a sensitivity analysis was conducted. RESULTS: Thirty-seven papers investigating 51 echocardiographic findings were included. Meta-analysis of univariable hazard ratios (HRs) and sensitivity analysis showed that presence of pericardial effusion (pooled HR 1.70; 95 % CI 1.44-1.99), right atrial area (pooled HR 1.71; 95 % CI 1.38-2.13) and tricuspid annular plane systolic excursion (TAPSE; pooled HR 1.72; 95 % CI 1.34-2.20) were the most well-investigated and robust predictors of mortality or transplant. CONCLUSIONS: This meta-analysis substantiates the clinical yield of specific echocardiographic findings in the prognostication of PAH patients in day-to-day practice. In particular, pericardial effusion, right atrial area and TAPSE are of prognostic value. TI - Echocardiographic findings associated with mortality ortransplant in patients with pulmonary arterial hypertension:A systematic review and meta-analysis EP - 389 SN - 1568-5888 IS - iss. 6 SP - 374 JF - Netherlands Heart Journal VL - vol. 24 DO - https://doi.org/10.1007/s12471-016-0845-3 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/172394/172394.pdf?sequence=1 ER - TY - JOUR AU - Duijnhouwer, A.L. AU - Navarese, E.P. AU - Dijk, A.P.J. van AU - Loeys, B.L. AU - Roos-Hesselink, J.W. AU - Boer, M.J. de PY - 2016 UR - https://hdl.handle.net/2066/171371 AB - BACKGROUND: Pulmonary artery (PA) aneurysms are rare and their related complications like dissection or rupture have been so far reported in a few reports, and a systematic description of the disease is lacking. To identify patients with PA aneurysm, at high-risk for complications, is critical. We performed a systematic review of the literature to determine characteristics that could identify high-risk patients. METHOD: A systematic search strategy was established and executed in Pubmed, Embase, Cochrane Central Register of Controlled Trials and Google scholar. Case reports were included if a minimal set of data were described. RESULTS: After executing the search strategy and exclusion of non-relevant or duplicate articles, 38 original articles, reviews and 169 case reports could be included. Articles were classified in high and low-pressure PA aneurysms and subdivided in six groups on basis of the causative mechanisms. PA dilatation was most common in association with pulmonary hypertension, but only one dissection was reported in 6 original articles containing 153 patients. Analysis of the case reports suggests that predictors of high-risk patients are: pulmonary hypertension in congenital heart disease, fast PA diameter growth (>2 mm/year), tissue weakness due to infection and possibly pregnancy especially in combination. Except for 2 cases, PA dissection did not occur, when the PA diameter was <75 mm and the PA pressure <50 mmHg. CONCLUSION: High-risk PA aneurysms maybe identified by evaluating: the causative mechanism(s) for PA dilatation, absolute PA diameter and growth rate and by evaluating the PA systolic pressure. TI - Aneurysm of the Pulmonary Artery, a Systematic Review and Critical Analysis of Current Literature EP - 109 SN - 1747-079X IS - iss. 2 SP - 102 JF - Congenital Heart Disease VL - vol. 11 DO - https://doi.org/10.1111/chd.12316 ER - TY - JOUR AU - Nillesen, M.M. AU - Dijk, A.P. van AU - Duijnhouwer, A.L. AU - Thijssen, J.M. AU - Korte, C.L. de PY - 2016 UR - https://hdl.handle.net/2066/171983 AB - Assessment of right ventricular (RV) function is known to be of diagnostic value in patients with RV dysfunction. Because of its complex anatomic shape, automated determination of the RV volume is difficult and strong reliance on geometric assumptions is not desired. A method for automated RV assessment was developed using three-dimensional (3-D) echocardiography without relying on a priori knowledge of the cardiac anatomy. A 3-D adaptive filtering technique that optimizes the discrimination between blood and myocardium was applied to facilitate endocardial border detection. Filtered image data were incorporated in a segmentation model to automatically detect the endocardial RV border. End-systolic and end-diastolic RV volumes, as well as ejection fraction, were computed from the automatically segmented endocardial surfaces and compared against reference volumes manually delineated by two expert cardiologists. The results reported good performance in terms of correlation and agreement with the results from the reference volumes. TI - Automated Assessment of Right Ventricular Volumes and Function Using Three-Dimensional Transesophageal Echocardiography EP - 606 SN - 0301-5629 IS - iss. 2 SP - 596 JF - Ultrasound in Medicine and Biology VL - vol. 42 DO - https://doi.org/10.1016/j.ultrasmedbio.2015.10.018 ER - TY - JOUR AU - Schoormans, D. AU - Sprangers, M.A. AU - Melle, J.P. van AU - Pieper, P.G. AU - Dijk, A.P. van AU - Sieswerda, G.T. AU - Hulsbergen-Zwarts, M.S. AU - Plokker, T.H. AU - Brunninkhuis, L.G. AU - Vliegen, H.W. AU - Mulder, B.J. PY - 2016 UR - https://hdl.handle.net/2066/172128 AB - BACKGROUND: To deliver adequate care to patients with congenital heart disease (CHD), it is important to know which patients use what type of care. This knowledge is valuable, as modification of these factors may be used as means to regulate healthcare use. Our objective was to examine the predictive value of psychological characteristics for future healthcare use, independent of clinical characteristics. METHODS: In total 845 adult CHD-patients participated in a longitudinal questionnaire study, with a two-year follow-up period. Linear regression analyses with negative binomial log link function were performed predicting healthcare used during the previous year. Psychological predictors were Type D personality, quality of life (QoL), depressive symptoms, trait-anxiety, happiness, optimism, and illness perceptions, independent of the number of co-morbidities, disease complexity and functional status. To control for clustering we included the variable type of centre (regional versus tertiary referral). RESULTS: Patients who reported more healthcare use had a complex defect, a poor functional status, no Type D personality, and a poor QoL. They moreover felt their CHD had a severe impact on their life and believed their CHD could be managed by themselves or treatment. CONCLUSIONS: Healthcare use is not entirely determined by disease complexity and functional status but also by psychological patient characteristics. It can by hypothesised that reducing the negative impact experienced and informing patients about strategies to manage their CHD, will modify their future healthcare use. Additional research is necessary to examine this possibility. TI - Clinical and psychological characteristics predict future healthcare use in adults with congenital heart disease EP - 81 SN - 1474-5151 IS - iss. 1 SP - 72 JF - European Journal of Cardiovascular Nursing VL - vol. 15 DO - https://doi.org/10.1177/1474515114555819 ER - TY - JOUR AU - Benda, N.M.M. AU - Eijsvogels, T.M.H. AU - Dijk, A.P.J. van AU - Bellersen, L. AU - Thijssen, D.H.J. AU - Hopman, M.T.E. PY - 2016 UR - https://hdl.handle.net/2066/171049 AB - BACKGROUND: Exercise training represents a central aspect of rehabilitation of heart failure patients. Previous work on passive heating suggests impaired thermoregulatory responses in heart failure patients. However, no previous study directly examined thermoregulatory responses to an exercise bout, that is, active heating, as typically applied in rehabilitation settings in heart failure. DESIGN: Cross-sectional observational study to compare changes in core body temperature (Tcore) and skin temperature (Tskin) during exercise between heart failure patients and controls. METHODS: Fourteen heart failure subjects (65 +/- 7 years, 13:1 male:female) and 14 healthy controls (61 +/- 5 years, 12:2 male:female) were included. Tcore (telemetric temperature pill) and Tskin (skin thermistors) were measured continuously during a 45-min cycle exercise at comparable relative exercise intensity. RESULTS: Tcore increased to a similar extent in both groups (controls 1.1 +/- 0.4, heart failure patients 0.9 +/- 0.3, 'time*group': p = 0.15). Tskin decreased during the initial phase of exercise in both groups, followed by an increase in Tskin in controls (1.2 +/- 1.0), whilst Tskin remained low in HF patients (-0.3 +/- 1.4) ('time*group': p < 0.001). Furthermore, we found that a given change in Tcore was associated with a smaller increase in Tskin in heart failure patients compared with controls. When comparing heart failure patients and controls who performed exercise at similar absolute workload, between-group differences disappeared (p-values > 0.05). CONCLUSION: Heart failure patients and controls show comparable exercise-induced increase in Tcore, whilst heart failure patients demonstrate altered Tskin responses to exercise and attenuated elevation in Tskin per increase in Tcore. These impaired thermoregulatory responses to exercise are, at least partly, explained by the lower absolute workload and lower physical fitness level in heart failure patients. TI - Altered core and skin temperature responses to endurance exercise in heart failure patients and healthy controls. EP - 144 SN - 2047-4873 IS - iss. 2 SP - 137 JF - European Journal of Preventive Cardiology VL - vol. 23 N1 - 1 januari 2016 DO - https://doi.org/10.1177/2047487315574281 ER - TY - JOUR AU - Seeger, J.P.H. AU - Benda, N.M.M. AU - Riksen, N.P. AU - Dijk, A.P.J. van AU - Bellersen, L. AU - Hopman, M.T. AU - Cable, N.T. AU - Thijssen, D.H.J. PY - 2016 UR - https://hdl.handle.net/2066/172657 AB - BACKGROUND: Reperfusion is mandatory after ischaemia, but it also triggers ischaemia-reperfusion (IR)-injury. It is currently unknown whether heart failure alters the magnitude of IR-injury. Ischaemic preconditioning can limit IR-injury. Since ischaemic preconditioning is typically applied in subjects at risk for cardiovascular complications, it is of clinical importance to understand its efficacy in heart failure patients. OBJECTIVE: To examine the magnitude of endothelial IR-injury, and the ability of ischaemic preconditioning to protect against endothelial IR-injury in heart failure. METHODS: We included 15 subjects with heart failure (67 +/- 10 years, New York Heart Association class II/III) and 15 healthy, age- and sex-matched controls (65 +/- 9 years). We examined brachial artery endothelial function using flow-mediated dilation before and after arm IR (induced by 5-min ischaemic handgrip exercise +15 min reperfusion). IR was preceded by ischaemic preconditioning (consisting in three cycles of 5-min upper arm cuff inflation to 220 mmHg) or no inflation. RESULTS: A significant interaction-effect was found for the change in flow-mediated dilation after IR between groups (two-way ANOVA interaction-effect: p = 0.01). Whilst post-hoc analysis revealed a significantly decline in flow-mediated dilation in both groups (p < 0.05), the decline in flow-mediated dilation in heart failure patients (6.2 +/- 3.6% to 3.3 +/- 1.8%) was significantly larger than that observed in controls (4.9 +/- 2.1 to 4.1 +/- 2.0). Neither in heart failure patients nor controls was the decrease in flow-mediated dilation after IR altered by ischaemic preconditioning (three-way ANOVA interaction: p = 0.87). CONCLUSION: We found that patients with heart failure are associated with exaggerated endothelial IR-injury compared with age- and sex-matched, healthy controls, which may contribute to the poor clinical prognosis in heart failure. Furthermore, we found no protective effect of ischaemic preconditioning (3 x 5-min forearm ischaemia) against endothelial IR-injury in heart failure patients. TI - Heart failure is associated with exaggerated endothelial ischaemia-reperfusion injury and attenuated effect of ischaemic preconditioning EP - 40 SN - 2047-4873 IS - iss. 1 SP - 33 JF - European Journal of Preventive Cardiology VL - vol. 23 DO - https://doi.org/10.1177/2047487314558377 ER - TY - JOUR AU - Benda, N.M.M. AU - Hopman, M.T.E. AU - Dijk, A.P.J. van AU - Oxborough, D. AU - George, K.P. AU - Thijssen, D.H.J. AU - Eijsvogels, T.M.H. PY - 2016 UR - https://hdl.handle.net/2066/172761 AB - BACKGROUND AND DESIGN: Previous studies have demonstrated that endurance exercise can cause an acute transient decrease in cardiac function in healthy subjects. Whether this also occurs in cardiac patients is unknown. We investigated the impact of prolonged single day and three-day walking exercise on cardiac function and cardiac biomarkers between cardiac patients and healthy controls in an observational study. METHODS: We recruited 10 cardiac patients (nine males, one female, 68 +/- 5 years) and 10 age- and sex-matched healthy control subjects (nine males, one female, 68 +/- 4 years) to perform 30 or 40 km of walking exercise per day for three consecutive days. Cardiac function was examined using echocardiography and cardiac biomarkers (cardiac troponin and B-type natriuretic peptide) with blood samples. Data were collected before walking and directly after walking on day 1 and day 3. RESULTS: Post-exercise early systolic tissue contraction velocity of the left ventricle (p = 0.005) and global longitudinal left ventricle strain (P = 0.026) were increased in both groups compared with baseline. Post-exercise right ventricle peak early diastolic tissue filling velocity and systolic blood pressure/left ventricle end-systolic volume ratio decreased in both groups (p = 0.043 and p = 0.028, respectively). Post-exercise cardiac troponin levels increased (p = 0.045) but did not differ across groups (p = 0.60), whereas B-type natriuretic peptide levels did not change (p = 0.43). CONCLUSION: This study suggests that stable cardiac patients are capable of performing three days of prolonged walking exercise without clinically significant acute overall deterioration in cardiac function or more pronounced increase in cardiac biomarkers compared with healthy controls. TI - Impact of prolonged walking exercise on cardiac structure and function in cardiac patients versus healthy controls. EP - 1260 SN - 2047-4873 IS - iss. 12 SP - 1252 JF - European Journal of Preventive Cardiology VL - vol. 23 DO - https://doi.org/10.1177/2047487316631389 ER - TY - JOUR AU - Gilbers, M.D. AU - Li, W.W.L. AU - Dijk, A.P.J. van AU - Morshuis, W.J. PY - 2016 UR - https://hdl.handle.net/2066/170871 TI - Left ventricular-right atrial communication caused by infective endocarditis: a peculiar presentation EP - 2202 SN - 0195-668X IS - iss. 27 SP - 2202 JF - European Heart Journal VL - vol. 37 DO - https://doi.org/10.1093/eurheartj/ehw091 ER - TY - JOUR AU - Bom, T. van der AU - Mulder, B.J.M. AU - Meijboom, F.J. AU - Dijk, A.P.J. van AU - Pieper, P.G. AU - Vliegen, H.W. AU - Konings, T.C. AU - Zwinderman, A.H. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/152069 AB - BACKGROUND: Survival data that are applicable to the current population of adults with congenital heart disease (CHD) are not available. OBJECTIVES: Using an alternative survival analysis with age as the primary time scale, we assessed the contemporary survival of adult patients with CHD. METHODS: Survival was assessed using prospective data of the national registry of adult patients with CHD of the Netherlands. Survival was stratified by severity and lesion, and compared with a standardised general population. RESULTS: Mean age at inclusion was 37 years, and 49% of the study population was male. During a cumulative prospective follow-up of 90 270 patient-years in 14 327 patients, 535 deaths occurred. Median survival was 53.4 (95% CI 49.9 to 60.7), 75.4 (95% CI 72.9 to 79.1) and 84.1 (95% CI 81.9 to 87.0) years for patients with severe, moderate and mild lesions, respectively. Survival of most patients with mild lesions did not differ from the general population, while, as expected, survival of patients with severe and moderate lesions was substantially lower (<0.001). CONCLUSIONS: The present study gives insight in the contemporary survival of adults with CHD. This may aid patient counselling, timing of interventions and future research. TI - Contemporary survival of adults with congenital heart disease EP - 1995 SN - 1355-6037 IS - iss. 24 SP - 1989 JF - Heart VL - vol. 101 DO - https://doi.org/10.1136/heartjnl-2015-308144 ER - TY - JOUR AU - Bokma, J.P. AU - Winter, M.M. AU - Oosterhof, T. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Hazekamp, M.G. AU - Koolbergen, D.R. AU - Groenink, M. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/152364 AB - BACKGROUND: In patients with repaired tetralogy of Fallot (rTOF), multiple reoperations or percutaneous interventions after pulmonary valve replacement (PVR) may be necessary due to limited homograft durability. However, data to guide individualised prediction of homograft durability remain scarce. The aim of this study was to provide risk models for RV to pulmonary artery homograft durability. METHODS: This retrospective multicentre study included consecutive patients with rTOF who had undergone PVR at an age of >12 years. Homograft dysfunction was defined as at least moderate pulmonary regurgitation (PR) or pulmonary stenosis (PS) (pressure gradient >/=36 mm Hg) as assessed by echocardiography. Reintervention was defined as percutaneous intervention or redo-PVR. RESULTS: A total of 153 patients with rTOF were included (62% male, mean age at PVR 31+/-11 years, pulmonary homograft 96%, follow-up 9.6 years (IQR 5.9, 13.3)). Average freedom from homograft dysfunction and reintervention after 10 years was 74% and 89%, respectively. In multivariable Cox proportional hazards analysis, postoperative PS >/=20 mm Hg (HR 6.52, 95% CI 3.09 to 13.7), postoperative PR >/= grade 1 (HR 3.13, 95% CI 1.45 to 6.74) and age at PVR <18 years (HR 3.52, 95% CI 1.64 to 7.53) were independently predictive for homograft dysfunction. In patients without any risk factor, 10-year freedom from homograft dysfunction and reintervention was excellent (91% and 96%, respectively) in contrast to patients with >/=2 risk factors (25% and 73%, respectively). CONCLUSIONS: Individualised prediction of homograft durability in patients with rTOF can be guided by early postoperative echocardiography. In adult patients without early postoperative PS or PR, homograft dysfunction and reintervention are unlikely to occur within 10 years, and follow-up may be less stringent. TI - Individualised prediction of pulmonary homograft durability in tetralogy of Fallot EP - 1723 SN - 1355-6037 IS - iss. 21 SP - 1717 JF - Heart VL - vol. 101 DO - https://doi.org/10.1136/heartjnl-2015-307754 ER - TY - JOUR AU - Riel, A.C. van AU - Blok, I.M. AU - Zwinderman, A.H. AU - Wajon, E.M. AU - Sadee, A.S. AU - Bakker-de Boo, M. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Riezebos, R.K. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/153280 TI - Lifetime Risk of Pulmonary Hypertension for All Patients After Shunt Closure EP - 1086 SN - 0735-1097 IS - iss. 9 SP - 1084 JF - Journal of the American College of Cardiology VL - vol. 66 DO - https://doi.org/10.1016/j.jacc.2015.06.1318 ER - TY - JOUR AU - Bom, T. van der AU - Winter, M.M. AU - Knaake, J.L. AU - Cervi, E. AU - Vries, L.S. de AU - Balducci, A. AU - Meregalli, P.G. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Bonvicini, M. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/153303 AB - OBJECTIVES: The aim of the present study is to determine the long-term effects of a ten-week exercise training program in adult patients with a systemic right ventricle. METHODS: All patients who participated in a 2009 randomized controlled trial were approached. At approximately three years of follow-up from initial baseline, patients underwent cardiopulmonary exercise testing, filled out two quality of life questionnaires, and NT proBNP levels were measured. All examinations were performed according to the protocols of the 2009 trial. In addition, patients were asked about their current sports habits. RESULTS: Of the 54 patients who were randomized in the 2009-trial 40 participated in the current re-evaluation (male 50%, ccTGA 35%, age 36 +/- 10 years, intervention group n=22, control group n=18). After three years, no persistent effect of exercise training on V'O(2)peak training remained (-2% of predicted, 95% CI -3% to 5%; p=.56). However, patients who already participated in regular sports or exercise at baseline (n=23/40 (58%)) showed higher V'O(2)peak of 13% of predicted (95% CI 4% to 23%; p>.01) and a decrease of 62% in plasma NT-proBNP (95% CI -115% to -10%; p>.03) during follow-up, when compared to patients who did not. Moreover, sports were associated with a lower incidence of clinical events (p=.032). CONCLUSION: Short-term beneficial effects of exercise training did not persist over a three-year follow-up period. However, sports participation at baseline was associated with better exercise capacity, lower neurohormone levels, and increased event-free survival. TI - Long-term benefits of exercise training in patients with a systemic right ventricle EP - 111 SN - 0167-5273 SP - 105 JF - International Journal of Cardiology VL - vol. 179 DO - https://doi.org/10.1016/j.ijcard.2014.10.042 ER - TY - JOUR AU - Schuuring, M.J. AU - Riel, A.C. van AU - Vis, J.C. AU - Duffels, M.G. AU - Dijk, A.P.J. van AU - Bruin-Bon, R.H. de AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/153498 AB - BACKGROUND: Patients with CHD-PAH have a limited prognosis. In daily practice, combination therapy is often initiated after a clinical event. Although clinical events have been associated with a poor prognosis in idiopathic PAH, data on this association are limited in CHD-PAH. The aim of this study was to determine whether baseline characteristics and clinical events associate with mortality in patients with pulmonary hypertension (PAH) due to congenital heart disease (CHD). METHODS: In total 91 consecutive adults (42 +/- 14 year) with CHD-PAH were referred for therapy between January 2005 and June 2013. Cox proportional hazard analysis was performed to identify determinants of mortality, including clinical events as time dependent covariates. RESULTS: Twenty-four patients (nine with Down) died during the median follow-up of 4.7 (range 0.1-7.9) years. The one and eight year mortality rates were 7.3% and 37.3%, respectively. Clinical events included admission for heart failure (n=9), arrhythmias (n=9), haemoptysis (n=5), change to a worse NYHA class (n=16), vascular events (n=1), syncope (n=1) and need for red blood cell depletion (n=4). In univariate analysis, both baseline characteristics and clinical events were associated with mortality. In multivariate analysis, only baseline NT-pro-BNP serum level >/= 500 ng/L and TAPSE<15mm at echocardiography were significant determinants of mortality. None of the clinical events remained significant. Patients with both a NT-pro-BNP serum level >/= 500 ng/L and TAPSE<15mm at echocardiography have a nine fold higher mortality rate than patients without both risk factors. CONCLUSION: Prognosis is still poor in contemporary patients with CHD-PAH. Both baseline NT-pro-BNP serum level and right ventricular function are superior to clinical events in prognostication. These two baseline characteristics should have a major impact on therapeutic management in patients with CHD-PAH, such as initiation of combination therapy. TI - New predictors of mortality in adults with congenital heart disease and pulmonary hypertension: Midterm outcome of a prospective study EP - 276 SN - 0167-5273 SP - 270 JF - International Journal of Cardiology VL - vol. 181 DO - https://doi.org/10.1016/j.ijcard.2014.11.222 ER - TY - JOUR AU - Bokma, J.P. AU - Winter, M.M. AU - Oosterhof, T. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Hazekamp, M.G. AU - Koolbergen, D.R. AU - Groenink, M. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/153953 AB - OBJECTIVE: Patients with surgically repaired tetralogy of Fallot (rTOF) may develop functional tricuspid regurgitation (TR) due to annulus dilation. Guidelines suggest pulmonary valve replacement (PVR) in patients with rTOF with progressive TR, but data on clinical outcomes are lacking. Our objective was to determine whether TR was predictive for adverse events after PVR. METHODS: In this retrospective, multicenter cohort study, patients with rTOF who had undergone PVR after preoperative echocardiographic assessment of TR grade were included. Preoperative and postoperative imaging data and a composite of adverse clinical events (death, sustained ventricular tachycardia, heart failure, or supraventricular tachycardia) were collected. Multivariate Cox hazards regression analysis was used to determine which factors were predictive for adverse events after PVR. RESULTS: A total of 129 patients (61% men, age at PVR 32.9+/-10.4 years) were included. The composite endpoint occurred in 39 patients during 8.4+/-4.2 years of follow-up. In multivariate analysis, severe preoperative TR (HR 2.49, 95% CI 1.11 to 5.52), right ventricular end-systolic volume (HR 1.02/mL/m(2), 95% CI 1.01 to 1.03) and age at PVR (HR 1.07/year, 95% CI 1.04 to 1.09) were predictive for adverse events. Early postoperative TR was not predictive for adverse events (p=0.96). In patients without any risk factor (age >40 years, right ventricular end-systolic volume >90 mL/m(2) or severe TR), 5-year event-free survival was 100% as compared with 61% in patients with two or three risk factors. CONCLUSIONS: In patients with rTOF, severe preoperative TR was predictive for adverse events after PVR. Close surveillance is warranted in these patients irrespective of postoperative TR. TI - Severe tricuspid regurgitation is predictive for adverse events in tetralogy of Fallot EP - 799 SN - 1355-6037 IS - iss. 10 SP - 794 JF - Heart VL - vol. 101 DO - https://doi.org/10.1136/heartjnl-2014-306919 ER - TY - JOUR AU - Kuijpers, J.M. AU - Bom, T. van der AU - Riel, A.C. van AU - Meijboom, F.J. AU - Dijk, A.P.J. van AU - Pieper, P.G. AU - Vliegen, H.W. AU - Waskowsky, W.M. AU - Oomen, T. AU - Zomer, A.C. AU - Wagenaar, L.J. AU - Heesen, W.F. AU - Roos-Hesselink, J.W. AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/153933 AB - AIMS: The identification of sex differences in the prognosis of adults with a secundum atrial septal defect (ASD2) could help tailor their clinical management, as it has in other cardiovascular diseases. We investigated whether disparity between the sexes exists in long-term outcome of adult ASD2 patients. METHODS AND RESULTS: Patients with ASD2 classified as the primary defect were selected from the Dutch national registry of adult congenital heart disease. Survival stratified by sex was compared with a sex-matched general population. In a total of 2207 adult patients (mean age at inclusion 44.8 years, 33.0% male), 102 deaths occurred during a cumulative follow-up of 13 584 patient-years. Median survival was 79.7 years for men and 85.6 years for women with ASD2. Compared with the age- and sex-matched general population, survival was lower for male, but equal for female patients (P = 0.015 and 0.766, respectively). Logistic regression analyses showed that men had a higher risk of conduction disturbances (OR = 1.63; 95% CI, 1.22-2.17) supraventricular dysrhythmias (OR = 1.41; 1.12-1.77), cerebrovascular thromboembolic events (OR = 1.53; 1.10-2.12), and heart failure (OR = 1.91; 1.06-3.43). CONCLUSION: In contrast to women, adult men with an ASD2 have worse survival than a sex-matched general population. Male patients also have a greater risk of morbidity during adult life. Sex disparity in survival and morbidity suggests the need for a sex-specific clinical approach towards these patients. TI - Secundum atrial septal defect is associated with reduced survival in adult men EP - 2086 SN - 0195-668X IS - iss. 31 SP - 2079 JF - European Heart Journal VL - vol. 36 DO - https://doi.org/10.1093/eurheartj/ehv097 ER - TY - JOUR AU - Blok, I.M. AU - Riel, A.C. van AU - Schuuring, M.J. AU - Duffels, M.G. AU - Vis, J.C. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/154944 AB - BACKGROUND: Decrease in quality of life (QoL) in left-sided heart failure precedes poor survival, which can be reversed with exercise training. We investigated whether QoL is associated with mortality in pulmonary arterial hypertension due to congenital heart disease (PAH-CHD) patients. METHODS: In this observational study, PAH-CHD adults referred for PAH-specific therapy were included. QoL surveys (SF36) were recorded during 2 years of therapy. Based on shift in SF36 scores during this period, patients had either decreased or non-decreased QoL. Subsequently, the patients were followed for mortality. RESULTS: Thirty-nine PAH-CHD patients (mean age 42, 44 % male, 49 % Down's syndrome) were analysed. Following PAH-specific therapy, SF36 physical component summary (PCS) decreased in 13 (35-31 points, p = 0.001) and showed no decrease in 26 patients (34-43 points, mean values, p < 0.001). Post-initiation phase, median follow-up was 4.5 years, during which 12 deaths occurred (31 %), 10 (56 %) in the decreased and 2 (10 %) in the non-decreased group (p = 0.002). Cox regression showed a decrease in SF36 PCS predicted mortality (HR 3.4, 95 % CI 1.03-11, p = 0.045). CONCLUSIONS: In PAH-CHD patients, decrease in SF36 PCS following initiation of PAH-specific therapy is a determinant of mortality. TI - Decrease in quality of life predicts mortality in adult patients with pulmonary arterial hypertension due to congenital heart disease EP - 284 SN - 1568-5888 IS - iss. 5 SP - 278 JF - Netherlands Heart Journal VL - vol. 23 DO - https://doi.org/10.1007/s12471-015-0666-9 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/154944/154944.pdf?sequence=1 ER - TY - JOUR AU - Kampman, M.A.M. AU - Balci, A. AU - Groen, H. AU - Dijk, A.P.J. van AU - Roos-Hesselink, J.W. AU - Melle, J.P. van AU - Sollie-Szarynska, K.M. AU - Wajon, E.M. AU - Mulder, B.J. AU - Veldhuisen, D.J. van AU - Pieper, P.G. PY - 2015 UR - https://hdl.handle.net/2066/154706 AB - BACKGROUND: Pregnancy is increasingly common in women with congenital heart disease (CHD), but little is known about long-term cardiovascular outcome after pregnancy in these patients. We studied the incidence of cardiovascular events 1-year postpartum and compared cardiac function prepregnancy and 1-year postpartum in women with CHD. METHODS: From our national, prospective multicenter cohort study, 172 women were studied. Follow-up with clinical evaluation and echocardiography and NT-proBNP measurement were performed during pregnancy and 12 months postpartum. Cardiovascular events were defined as need for an urgent invasive cardiovascular procedure, heart failure, arrhythmia, thromboembolic events, myocardial infarction, cardiac arrest, cardiac death, endocarditis, and aortic dissection. RESULTS: Cardiovascular events were observed after 11 pregnancies (6.4%). Women with cardiovascular events postpartum had significant higher NT-proBNP values at 20-week gestation (191 [137-288] vs 102.5 [57-167]; P = .049) and 1-year postpartum compared with women without cardiovascular events postpartum (306 [129-592] vs 105 [54-187] pg/mL; P = .014). Women with cardiovascular events during pregnancy were at higher risk for late cardiovascular events (HR 7.1; 95% CI 2.0-25.3; P = .003). In women with cardiovascular events during pregnancy, subpulmonary end-diastolic diameter had significantly increased 1-year postpartum (39.0 [36.0-48.0] to 44.0 [40.0-50.0]; P = .028). No other significant differences were found in cardiac function or size 1-year postpartum compared with preconception values. CONCLUSIONS: Cardiovascular events are relatively rare 1 year after pregnancy in women with CHD. Women with cardiovascular events during pregnancy are prone to develop cardiovascular events 1-year postpartum and have increased subpulmonary ventricular diameter compared with preconception values. TI - Cardiac function and cardiac events 1-year postpartum in women with congenital heart disease EP - 304 SN - 0002-8703 IS - iss. 2 SP - 298 JF - American Heart Journal VL - vol. 169 DO - https://doi.org/10.1016/j.ahj.2014.11.010 ER - TY - JOUR AU - Breetveld, N.M. AU - Ghossein-Doha, C. AU - Kuijk, S. van AU - Dijk, A.P.J. van AU - Vlugt, M.J. van der AU - Heidema, W.M. AU - Scholten, R.R. AU - Spaanderman, M.E.A. PY - 2015 UR - https://hdl.handle.net/2066/154708 AB - OBJECTIVE: To analyse the predicted 10- and 30-year risk scores for cardiovascular disease (CVD) in patients who experienced preeclampsia (PE) 5-10 years previously compared with healthy parous controls. DESIGN: Observational study. SETTING: Tertiary referral hospital in the Netherlands. POPULATION: One hundred and fifteen patients with a history of PE and 50 controls. PE patients were categorised into two groups, hypertensive (n = 21) and normotensive (n = 94), based on use of antihypertensive medication, and next categorised into subgroups based on the onset of PE: early-onset PE (n = 39) and late-onset PE (n = 76). METHODS: All participants underwent cardiovascular risk screening 5-10 years after index pregnancy. We measured body mass, height and blood pressure. Blood was analysed for fasting glucose, insulin and lipid levels. All participants completed a validated questionnaire. The 10- and 30-year Framingham risk scores were calculated and compared. MAIN OUTCOME MEASURES: Estimated Framingham 10- and 30-year risk scores for CVD. RESULTS: The overall 10- and 30-year CVD median risks weighing subjects' lipids were comparable between formerly PE women and controls; 1.6 versus 1.5% (P = 0.22) and 9.0 versus 9.0% (P = 0.49), respectively. However, hypertensive formerly PE women have twice the CVD risk as normotensive formerly PE women: 10- and 30-year CVD median risks were 3.1 versus 1.5% (P < 0.01) and 19.0% versus 8.0% (P < 0.01), respectively. Risk estimates based on BMI rather than lipid profile show comparable results. Early-onset PE clustered more often in the hypertensive formerly PE group and showed significantly higher 10- and 30-year CVD risk estimates based on lipids compared with the late-onset PE group: 1.7 versus 1.3% (P < 0.05) and 10.0 versus 7.0% (P < 0.05), respectively. CONCLUSIONS: Women who are hypertensive after preeclampsia, have a twofold risk of developing CVD in the next 10-30 years. Formerly PE women who are normotensive in the first 10 years after their preeclamptic pregnancy have a comparable future cardiovascular risk to healthy controls. TI - Cardiovascular disease risk is only elevated in hypertensive, formerly preeclamptic women EP - 1100 SN - 1470-0328 IS - iss. 8 SP - 1092 JF - Bjog : an International Journal of Obstetrics and Gynaecology VL - vol. 122 DO - https://doi.org/10.1111/1471-0528.13057 ER - TY - JOUR AU - Dulfer, K. AU - Duppen, N. AU - Dijk, A.P.J. van AU - Kuipers, I.M. AU - Domburg, R.T. van AU - Verhulst, F.C. AU - Ende, J. van den AU - Helbing, W.A. AU - Utens, E.M. PY - 2015 UR - https://hdl.handle.net/2066/153587 AB - To evaluate the moderating influence of parental variables on changes in health-related quality of life (HRQoL) in adolescents with Tetralogy of Fallot (ToF) or a Fontan circulation after participation in standardized exercise training. A multicenter randomized controlled trail in which 56 patients, aged 10-15, were randomly allocated (stratified by age, gender, and congenital heart disease) to a 12-week period with either: (a) 3 times per week standardized exercise training or (b) care-as-usual (randomization ratio 2:1). Adolescents and their parents filled in online questionnaires at baseline and at 12-week follow-up. In this randomized controlled trail, primary analyses involved influence of parental mental health and parental social support for exercise on changes in the TNO/AZL Child Quality of Life Questionnaire Child Form at follow-up. Secondary analyses concerned comparing levels of parental characteristics with normative data. Compared with controls, adolescents in the exercise group reported a decrease in social functioning when their parents had more anxiety/insomnia or severe depression themselves. Adolescents also reported a decrease in social functioning when their parents showed poorer overall mental health themselves. Parents reported comparable or even better mental health compared with normative data. The effect of a standardized exercise program on HRQoL changes in adolescents with ToF or a Fontan circulation is moderated by parental mental health, more specifically by parental anxiety/insomnia and severe depression. The trial registration number of this article is NTR2731 ( www.trialregister.nl ). TI - Parental mental health moderates the efficacy of exercise training on health-related quality of life in adolescents with congenital heart disease EP - 40 SN - 0172-0643 IS - iss. 1 SP - 33 JF - Pediatric Cardiology VL - vol. 36 DO - https://doi.org/10.1007/s00246-014-0961-z ER - TY - JOUR AU - Bom, T. van der AU - Romeih, S. AU - Groenink, M. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Helbing, W.A. AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2015 UR - https://hdl.handle.net/2066/155213 AB - OBJECTIVE: To evaluate differences in functional parameters and reproducibility between short axis and axial slice orientation in the quantitative evaluation of the systemic right ventricle by cardiovascular magnetic resonance. DESIGN: Cross-sectional evaluation comparing two methods (Bland-Altman). SETTING: Tertiary care outpatients. INTERVENTIONS: Quantitative cardiovascular magnetic resonance evaluation using short axis or axial slice orientation. MAIN OUTCOME MEASURES: Intraobserver variance, interobserver variance and systematic differences in systemic right ventricular volumes, ejection fraction, and mass between both methods. PATIENTS: Twenty-two patients (mean age 33 +/- 7 years) with systemic right ventricle (three with congenitally corrected transposition of the great arteries and 19 with atrially switched transposition of the great arteries). RESULTS: Compared with short axis slices, analysis of axial slices resulted in higher end systolic volume (6.6%, P < .01), while mass (-10.8%, P < .01) and ejection fraction (-8.9%, P < .01) turned out lower. Intraobserver and interobserver reproducibility were similar for both methods when measuring end-diastolic and end-systolic volumes. However, ejection fraction and stroke volume were measured more consistently in axial orientation, while ventricular mass was measured more consistently in short axis orientation. CONCLUSION: There are significant differences in volume, mass, and function between measurements in axial and short axis orientation. Ejection fraction and stroke volume, which have a high clinical relevance, were measured more consistently in axial slice orientation. Consequently, we recommend using axial slice orientation in patients with a systemic right ventricle. TI - Evaluating the systemic right ventricle by cardiovascular magnetic resonance: short axis or axial slices? EP - 77 SN - 1747-079X IS - iss. 1 SP - 69 JF - Congenital Heart Disease VL - vol. 10 DO - https://doi.org/10.1111/chd.12182 ER - TY - JOUR AU - Duppen, N. AU - Geerdink, L.M. AU - Kuipers, I.M. AU - Bossers, S.S. AU - Koopman, L.P. AU - Dijk, A.P.J. van AU - Roos-Hesselink, J.W. AU - Korte, C.L. de AU - Helbing, W.A. AU - Kapusta, L. PY - 2015 UR - https://hdl.handle.net/2066/153840 AB - BACKGROUND: Public-health guidelines recommend patients with congenital heart disease to exercise. Studies have shown that patients with congenital heart disease can improve physical exercise capacity. The effect of training on regional ventricular performance has hardly been studied. We performed a pilot study to assess whether an exercise training program would result in adverse changes of regional ventricular performance in patients with corrected tetralogy of Fallot. METHODS AND RESULTS: Multicenter prospective randomized controlled pilot study in patients with tetralogy of Fallot aged 10 to 25 years. A 12-week standardized aerobic dynamic exercise training program (3 one-hour sessions per week) was used. Pre- and post-training cardiopulmonary exercise tests, MRI, and echocardiography, including tissue-Doppler imaging, were performed. Patients were randomized to the exercise group (n=28) or control group (n=20). One patient in the exercise group dropped out. Change in tissue-Doppler imaging parameters was similar in the exercise group and control group (change in right ventricle free wall peak velocity E' exercise group, 0.8+/-2.6 cm/s; control group, 0.9+/-4.1; peak velocity A' exercise group, 0.4+/-2.4 m/s; control group 4.6+/-18.1 cm/s). CONCLUSIONS: This randomized controlled pilot study provides preliminary data suggesting that regional ventricular performance is well maintained during 3-month aerobic dynamic exercise training in children and young adults with repaired tetralogy of Fallot. This information might help patients adhere to current public-health guidelines. CLINICAL TRIAL REGISTRATION: URL: http//:www.trialregister.nl. Unique identifier: NTR2731. TI - Regional ventricular performance and exercise training in children and young adults after repair of tetralogy of fallot: randomized controlled pilot study SN - 1941-9651 IS - iss. 4 JF - Circulation-Cardiovascular Imaging VL - vol. 8 DO - https://doi.org/10.1161/CIRCIMAGING.114.002006 ER - TY - JOUR AU - Oudegeest-Sander, M.H. AU - Thijssen, D.H.J. AU - Smits, P. AU - Dijk, A.P. van AU - Olde Rikkert, M.G.M. AU - Hopman, M.T. PY - 2015 UR - https://hdl.handle.net/2066/154589 AB - It is currently unknown whether differences in physical fitness in older, nonexercising individuals affect cardiovascular risk profile and vascular function. To examine this, 40 healthy older individuals (age 69 +/- 4 years) who were classified as nonexercising for the past 5-10 years were allocated to a lower physical fitness (LF; VO2max 20.7 +/- 2.4 mlO2/min/kg) or higher physical fitness group (HF; VO2max 29.1 +/- 2.8 mlO2/ min/kg, p < .001). Cardiovascular risk profile was calculated using the Lifetime Risk Score (LRS). Vascular function was examined using the gold standard venous occlusion plethysmography to assess blood flow changes in response to intra-arterial infusion of acetylcholine, sodium nitroprusside, and L-NNMA. Daily life activity level of the HF group was higher compared with the LF group (p = .04). LRS was higher (p < .001) and blood flow ratio response to acetylcholine was lower (p = .04) in the LF group. This study shows that a higher physical fitness level is associated with better cardiovascular health and vascular function in nonexercising older individuals. TI - Association of Fitness Level With Cardiovascular Risk and Vascular Function in Older Nonexercising Individuals EP - 424 SN - 1063-8652 IS - iss. 3 SP - 417 JF - Journal of Aging and Physical Activity VL - vol. 23 DO - https://doi.org/10.1123/japa.2013-0139 ER - TY - JOUR AU - Benda, N.M.M. AU - Eijsvogels, T.M.H. AU - Dijk, A.P.J. van AU - Hopman, M.T.E. AU - Thijssen, D.H.J. PY - 2015 UR - https://hdl.handle.net/2066/154747 TI - Changes in BNP and cardiac troponin I after high-intensity interval and endurance exercise in heart failure patients and healthy controls. EP - 427 SN - 0167-5273 SP - 426 JF - International Journal of Cardiology VL - vol. 184 DO - https://doi.org/10.1016/j.ijcard.2015.02.083 ER - TY - JOUR AU - Benda, N.M.M. AU - Seeger, J.P.H. AU - Lier, D.P. van AU - Bellersen, L. AU - Dijk, A.P.J. van AU - Hopman, M.T.E. AU - Thijssen, D.H.J. PY - 2015 UR - https://hdl.handle.net/2066/152961 AB - NEW FINDINGS: What is the central question of this study? We explored whether heart failure (HF) patients demonstrate different exercise-induced brachial artery shear rate patterns compared with control subjects. What is the main finding and its importance? Moderate-intensity cycle exercise in HF patients is associated with an attenuated increase in brachial artery anterograde and mean shear rate and skin temperature. Differences between HF patients and control subjects cannot be explained fully by differences in workload. HF patients demonstrate a less favourable shear rate pattern during cycle exercise compared with control subjects. Repeated elevations in shear rate (SR) in conduit arteries, which occur during exercise, represent a key stimulus to improve vascular function. We explored whether heart failure (HF) patients demonstrate distinct changes in SR in response to moderate-intensity cycle exercise compared with healthy control subjects. We examined brachial artery SR during 40 min of cycle exercise at a work rate equivalent to 65% peak oxygen uptake in 14 HF patients (65 +/- 7 years old, 13 men and one woman) and 14 control subjects (61 +/- 5 years old, 12 men and two women). Brachial artery diameter, SR and oscillatory shear index (OSI) were assessed using ultrasound at baseline and during exercise. The HF patients demonstrated an attenuated increase in mean and anterograde brachial artery SR during exercise compared with control subjects (time x group interaction, P = 0.003 and P < 0.001, respectively). Retrograde SR increased at the onset of exercise and remained increased throughout the exercise period in both groups (time x group interaction, P = 0.11). In control subjects, the immediate increase in OSI during exercise (time, P < 0.001) was normalized after 35 min of cycling. In contrast, the increase in OSI after the onset of exercise did not normalize in HF patients (time x group interaction, P = 0.029). Subgroup analysis of five HF patients and five control subjects with comparable workload (97 +/- 13 versus 90 +/- 22 W, P = 0.59) confirmed the presence of distinct changes in mean SR during exercise (time x group interaction, P = 0.030). Between-group differences in anterograde/retrograde SR or OSI did not reach statistical significance (time x group interactions, P > 0.05). In conclusion, HF patients demonstrate a less favourable SR pattern during cycle exercise than control subjects, characterized by an attenuated mean and anterograde SR and by increased OSI. TI - Heart failure patients demonstrate impaired changes in brachial artery blood flow and shear rate pattern during moderate-intensity cycle exercise. EP - 474 SN - 0958-0670 IS - iss. 4 SP - 463 JF - Experimental Physiology VL - vol. 100 DO - https://doi.org/10.1113/EP085040 ER - TY - JOUR AU - Scholten, R.R. AU - Lotgering, F.K. AU - Hopman, M.T.E. AU - Dijk, A.P.J. van AU - Vlugt, M.J. van der AU - Janssen, M.C.H. AU - Spaanderman, M.E.A. PY - 2015 UR - https://hdl.handle.net/2066/153316 AB - Formerly preeclamptic women are at risk for cardiovascular disease. Low plasma volume may reflect latent hypertension and potentially links preeclampsia with chronic cardiovascular disease. We hypothesized that low plasma volume in normotensive formerly preeclamptic women predisposes to hypertension. We longitudinally studied n=104 formerly preeclamptic women in whom plasma volume was measured 3 to 30 months after the preeclamptic pregnancy. Cardiovascular variables were assessed at 2 points in time (3-30 months postpartum and 2-5 years thereafter). Study population was divided into low plasma volume (1373 mL/m(2)). Primary end point was hypertension at the second visit: defined as >/=140 mm Hg systolic or >/=90 mm Hg diastolic. Secondary outcome of this study was change in traditional cardiovascular risk profile between visits. Variables correlating univariately with change in blood pressure between visits were introduced in regression analysis. Eighteen of 104 (17%) formerly preeclamptic women who were normotensive at first visit had hypertension at second evaluation 2 to 5 years later. Hypertension developed more often in women with low plasma volume (10/35 [29%]) than in women with normal plasma volume (8/69 [12%]; odds ratio, 3.2; 95% confidence interval, 1.4-8.6). After adjustments, relationship between plasma volume status and subsequent hypertension persisted (adjusted odds ratio, 3.0; 95% confidence interval, 1.1-8.5). Mean arterial pressure at second visit correlated inverse linearly with plasma volume (r=-0.49; P<0.01). Initially normotensive formerly preeclamptic women have 17% chance to develop hypertension within 5 years. Women with low plasma volume have higher chance to develop hypertension than women with normal plasma volume. Clinically, follow-up of blood pressure seems warranted in women with history of preeclampsia, even when initially normotensive. TI - Low Plasma Volume in Normotensive Formerly Preeclamptic Women Predisposes to Hypertension. EP - 1072 SN - 0194-911X IS - iss. 5 SP - 1066 JF - Hypertension VL - vol. 66 N1 - 1 november 2015 DO - https://doi.org/10.1161/HYPERTENSIONAHA.115.05934 ER - TY - JOUR AU - Benda, N.M.M. AU - Seeger, J.P.H. AU - Stevens, G.G. AU - Hijmans-Kersten, B.T.P. AU - Dijk, A.P.J. van AU - Bellersen, L. AU - Lamfers, E.J. AU - Hopman, M.T.E. AU - Thijssen, D.H.J. PY - 2015 UR - https://hdl.handle.net/2066/152164 AB - INTRODUCTION: Physical fitness is an important prognostic factor in heart failure (HF). To improve fitness, different types of exercise have been explored, with recent focus on high-intensity interval training (HIT). We comprehensively compared effects of HIT versus continuous training (CT) in HF patients NYHA II-III on physical fitness, cardiovascular function and structure, and quality of life, and hypothesize that HIT leads to superior improvements compared to CT. METHODS: Twenty HF patients (male:female 19:1, 64+/-8 yrs, ejection fraction 38+/-6%) were allocated to 12-weeks of HIT (10*1-minute at 90% maximal workload-alternated by 2.5 minutes at 30% maximal workload) or CT (30 minutes at 60-75% of maximal workload). Before and after intervention, we examined physical fitness (incremental cycling test), cardiac function and structure (echocardiography), vascular function and structure (ultrasound) and quality of life (SF-36, Minnesota living with HF questionnaire (MLHFQ)). RESULTS: Training improved maximal workload, peak oxygen uptake (VO2peak) related to the predicted VO2peak, oxygen uptake at the anaerobic threshold, and maximal oxygen pulse (all P<0.05), whilst no differences were present between HIT and CT (N.S.). We found no major changes in resting cardiovascular function and structure. SF-36 physical function score improved after training (P<0.05), whilst SF-36 total score and MLHFQ did not change after training (N.S.). CONCLUSION: Training induced significant improvements in parameters of physical fitness, although no evidence for superiority of HIT over CT was demonstrated. No major effect of training was found on cardiovascular structure and function or quality of life in HF patients NYHA II-III. TRIAL REGISTRATION: Nederlands Trial Register NTR3671. TI - Effects of High-Intensity Interval Training versus Continuous Training on Physical Fitness, Cardiovascular Function and Quality of Life in Heart Failure Patients. SN - 1932-6203 IS - iss. 10 JF - PLoS One VL - vol. 10 DO - https://doi.org/10.1371/journal.pone.0141256 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/152164/152164.pdf?sequence=1 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 - 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 - 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 - 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 - 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 - 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 - 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 - Koyak, Z. AU - Kroon, B. AU - Groot, J.R. de AU - Wagenaar, L.J. AU - Dijk, A.P.J. van AU - Mulder, B.A. AU - Gelder, I.C. AU - Post, M.C. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2013 UR - https://hdl.handle.net/2066/125401 AB - Supraventricular tachycardias (SVTs) are a major cause of morbidity in adults with congenital heart disease (CHD). Few data exist on safety and efficacy of antiarrhythmic drugs in this population. Our aim was to determine the efficacy of antiarrhythmic drugs in adults with CHD and first-onset SVT on maintaining sinus rhythm after conversion. This was a multicenter retrospective study including adults with CHD and first-onset SVT from January 2008 to January 2011. First-onset SVT occurred in 92 of 7,171 patients without previous SVT (mean age 51 +/- 16 years, 57% women). SVTs included atrial fibrillation and flutter in >80% of the patients. Most of these patients had septal defects (50%) and left-sided lesions (21%). The acute management of SVTs resulted in sinus rhythm in 83 patients, and 89% of these patients were instituted on oral antiarrhythmics to prevent SVT recurrence. After a mean follow-up of 2.5 +/- 1.4 years, only 45% of the patients were free from SVT. Class III antiarrhythmics (85% sotalol and 15% amiodarone) were associated with a significantly lesser risk of SVT recurrence compared with all other antiarrhythmic drugs (hazard ratio 0.5, 95% confidence interval 0.27 to 0.96, p = 0.036). However, adverse effects of medication occurred in 22% of the patients, mainly in patients taking amiodarone. In conclusion, in adults with CHD and first-onset SVTs, class III antiarrhythmics are more efficacious in maintaining sinus rhythm after cardioversion than other antiarrhythmics. Sotalol may be considered as the first-choice therapy as this is associated with fewer adverse effects than amiodarone. TI - Efficacy of antiarrhythmic drugs in adults with congenital heart disease and supraventricular tachycardias EP - 1467 SN - 0002-9149 IS - iss. 9 SP - 1461 JF - American Journal of Cardiology VL - vol. 112 DO - https://doi.org/10.1016/j.amjcard.2013.07.029 ER - TY - JOUR AU - Vis, J.C. AU - Duffels, M.G. AU - Mulder, P. AU - Bruin-Bon, R.H. de AU - Bouma, B.J. AU - Berger, R.M. AU - Hoendermis, E.S. AU - Dijk, A.P.J. van AU - Mulder, B.J. PY - 2013 UR - https://hdl.handle.net/2066/125810 AB - Pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD) due to systemic to pulmonary shunting is associated with a high risk of morbidity and mortality. In this study we evaluated 4 years treatment effect of bosentan on exercise capacity and quality of life and survival rates in 64 adult patients with PAH associated with CHD, including patients with Down syndrome (DS). All patients were evaluated at baseline and during follow-up with laboratory tests, 6-minute walk test, quality of life questionnaires, and Doppler echocardiography. In total, 13 patients (20%) died during 4-years of follow-up; 4 patients with DS and 9 patients without DS. Mean follow-up of all patients treated with bosentan was 3.5 +/- 1.2 year. We analyzed treatment efficacy separately within patients without DS (n=34) and patients with DS (n=30). Mean 6-minute walking distance (6 MWD) in patients without DS significantly increased at 6 months from 417 +/- 108 to 458 +/- 104 m (+41 m; p=0.002) and significant improvement continued to exist during at least 2.5 years of follow-up (p=0.003). Moreover, stroke volume increased significantly (p=0.02). In the patients with DS, 6-MWD, stroke volume and quality of life remained stable during treatment. In this study we demonstrate a prolonged beneficial effect of bosentan treatment on exercise capacity, stroke volume and quality of life in patients without DS. However the mortality rate of 20% of patients after 4 years of follow-up remains high. TI - Prolonged beneficial effect of bosentan treatment and 4-year survival rates in adult patients with pulmonary arterial hypertension associated with congenital heart disease EP - 69 SN - 0167-5273 IS - iss. 1 SP - 64 JF - International Journal of Cardiology VL - vol. 164 DO - https://doi.org/10.1016/j.ijcard.2011.06.064 ER - TY - JOUR AU - Schuuring, M.J. AU - Vis, J.C. AU - Dijk, A.P.J. van AU - Melle, J.P. van AU - Vliegen, H.W. AU - Pieper, P.G. AU - Sieswerda, G.T. AU - Bruin-Bon, R.H. de AU - Mulder, B.J. AU - Bouma, B.J. PY - 2013 UR - https://hdl.handle.net/2066/125939 AB - AIMS: An endothelin-1 receptor blocker, shown to be effective in patients with pulmonary arterial hypertension, might decrease pulmonary vascular resistance to increase cardiac filling and consequently improve exercise capacity in Fontan patients. METHODS AND RESULTS: This was a prospective, multicentre randomized open label trial in Fontan patients. One group received bosentan for 6 months. The other group did not receive study medication for the first 3 months, followed by bosentan for 6 months. The primary endpoint was exercise capacity, and secondary endpoints were NT-proBNP level, cardiac output, SF-36 (Short Form-36) quality of life (QoL), and NYHA class. Forty-two adults (median age 29 (range 18-56) years, 52% male, 88% NYHA class I-II) from five tertiary referral centres participated in the study. Ten patients were on diuretics. Ten patients were not motivated to finish the study. Analysis of all 32 patients who finished the study at 6 months of treatment showed that mean peak V'O2 (24 vs. 25 mL/kg/min), median SQUASH score (6614 vs. 6390), median NT-proBNP (314 vs. 274 ng/L), and mental QoL (50 vs. 51) remained unchanged as compared with baseline (P = NS, for all). After treatment, NYHA class had improved in 6 (19%), was unchanged in 24 (75%), and declined in 2 (6%) patients. Subgroup analysis on age, ventricular morphology, type of Fontan circulation, or baseline NT-proBNP level did not reveal efficacy of bosentan. Six transient adverse effects were reported. CONCLUSION: An increased NT-proBNP level was present in the majority of Fontan patients. Six months of bosentan treatment was not beneficial. Trial registration NTR1557. TI - Impact of bosentan on exercise capacity in adults after the Fontan procedure: a randomized controlled trial EP - 698 SN - 1388-9842 IS - iss. 6 SP - 690 JF - European Journal of Heart Failure VL - vol. 15 DO - https://doi.org/10.1093/eurjhf/hft017 ER - TY - JOUR AU - Linde, D. van der AU - Rossi, A. de AU - Yap, S.C. AU - McGhie, J.S. AU - Bosch, A.E. van den AU - Kirschbaum, S.W. AU - Russo, B. AU - Dijk, A.P.J. van AU - Moelker, A. AU - Krestin, G.P. AU - Geuns, R.J. van AU - Roos-Hesselink, J.W. PY - 2013 UR - https://hdl.handle.net/2066/125248 AB - OBJECTIVES/BACKGROUND: Congenital aortic stenosis (AS) is the most common obstructive left heart lesion in the young adult population and often complicated by aortic dilatation. Our objective was to evaluate accuracy of aortic imaging with transthoracic echocardiography (TTE) compared with cardiac magnetic resonance (CMR). METHODS: Aortic diameters were measured at 4 levels by CMR and TTE. Agreement and concordance were assessed by Pearson's correlation and Bland-Altman analysis. RESULTS: Fifty-nine patients (age 33 +/- 8 years; 66% male) with congenital AS and a bicuspid aortic valve (BAV) were included. Aortic diameters were generally smaller with TTE than with CMR. The best correlation was found at the level of the sinotubular junction (R(2) = 0.78) with a bias of 1.46 mm (limits of agreement: -5.47 to +8.39 mm). In patients with an aortic aneurysm >40 mm (n = 29) the correlation and agreement between TTE and CMR were found to be less good when compared with patients with normal aortic diameters, especially at the level of the proximal ascending aorta. The correlation and agreement between both imaging modalities were better in patients with type 1 BAV compared with type 2 BAV. Intra- and interobserver variability was smaller with CMR (1.8-5.9%) compared with TTE (6.9-15.0%). CONCLUSIONS: CMR was found to be superior to TTE for imaging of the aorta in patients with congenital AS, especially at the level of the proximal ascending aorta when an aortic aneurysm is present. Therefore, ideally CMR should be performed at least once to ensure an ascending aortic aneurysm is not missed. TI - Ascending aortic diameters in congenital aortic stenosis: cardiac magnetic resonance versus transthoracic echocardiography EP - 504 SN - 0742-2822 IS - iss. 5 SP - 497 JF - Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques VL - vol. 30 DO - https://doi.org/10.1111/echo.12086 ER - TY - JOUR AU - Opic, P. AU - Yap, S.C. AU - Kranenburg, M. van AU - Dijk, A.P.J. van AU - Budts, W. AU - Vliegen, H.W. AU - Erven, L. van AU - Can, A. AU - Sahin, G. AU - Groot, N.M. de AU - Witsenburg, M. AU - Roos-Hesselink, J.W. PY - 2013 UR - https://hdl.handle.net/2066/125261 AB - AIMS: To determine whether atrial-based pacing prevents atrial arrhythmias in adults with congenital heart disease (CHD) compared with ventricular pacing. METHODS AND RESULTS: All adult CHD patients from four participating centres with a permanent pacemaker were identified. Patients with permanent atrial arrhythmias at pacemaker implantation and patients who received a pacemaker for treatment of drug-refractory atrial arrhythmias were excluded. The final study population consisted of 211 patients (52% male, 36% complex CHD) who received a first pacemaker for sick sinus dysfunction (n = 82) or atrioventricular block (n = 129) at a median age of 24 years [interquartile range (IQR), 12-34]. A history of atrial arrhythmias at implantation was present in 49 patients (23%). Atrial-based pacing was the initial pacing mode in 139 patients (66%) while the others (34%) received ventricular pacing. During a median follow-up of 13 years (IQR, 7-21), 90 patients (43%) developed an atrial arrhythmia. Multivariate analysis demonstrated no significant effect of atrial-based pacing on subsequent atrial arrhythmias [hazard ratio (HR), 1.53; 95% confidence interval (CI), 0.91-2.56; P = 0.1]. Independent predictors of atrial arrhythmia were history of atrial arrhythmias (HR, 5.55; 95% CI, 3.47-8.89; P< 0.0001), older age (>/=18 years) at pacemaker implantation (HR, 2.29; 95% CI, 1.29-4.04; P = 0.005), and complex CHD (HR, 1.57; 95% CI, 1.01-2.45; P = 0.04). CONCLUSION: In contrast to the general population, atrial-based pacing was not associated with a lower incidence of atrial arrhythmia in adults with CHD. TI - Atrial-based pacing has no benefit over ventricular pacing in preventing atrial arrhythmias in adults with congenital heart disease EP - 1762 SN - 1099-5129 IS - iss. 12 SP - 1757 JF - Europace VL - vol. 15 DO - https://doi.org/10.1093/europace/eut213 ER - TY - JOUR AU - Bom, T. van der AU - Winter, M.M. AU - Bouma, B.J. AU - Groenink, M. AU - Vliegen, H.W. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Roos-Hesselink, J.W. AU - Zwinderman, A.H. AU - Mulder, B.J. PY - 2013 UR - https://hdl.handle.net/2066/125382 AB - BACKGROUND: The role of angiotensin II receptor blockers in patients with a systemic right ventricle has not been elucidated. METHODS AND RESULTS: We conducted a multicenter, double-blind, parallel, randomized controlled trial of angiotensin II receptor blocker valsartan 160 mg twice daily compared with placebo in patients with a systemic right ventricle caused by congenitally or surgically corrected transposition of the great arteries. The primary end point was change in right ventricular ejection fraction during 3-year follow-up, determined by cardiovascular magnetic resonance imaging or, in patients with contraindication for magnetic resonance imaging, multirow detector computed tomography. Secondary end points were change in right ventricular volumes and mass, Vo(2)peak, and quality of life. Primary analyses were performed on an intention-to-treat basis. A total of 88 patients (valsartan, n=44; placebo, n=44) were enrolled in the trial. No serious adverse effects occurred in either group. There was no significant effect of 3-year valsartan therapy on systemic right ventricular ejection fraction (treatment effect, 1.3%; 95% confidence interval, -1.3% to 3.9%; P=0.34), maximum exercise capacity, or quality of life. There was a larger increase in right ventricular end-diastolic volume (15 mL; 95% confidence interval, 3-28 mL; P<0.01) and mass (8 g; 95% confidence interval, 2-14 g; P=0.01) in the placebo group than in the valsartan group. CONCLUSIONS: There was no significant treatment effect of valsartan on right ventricular ejection fraction, exercise capacity, or quality of life. Valsartan was associated with a similar frequency of significant clinical events as placebo. Small but significant differences between valsartan and placebo were present for change in right ventricular volumes and mass. CLINICAL TRIAL REGISTRATION: URL: http://www.controlled-trials.com. Unique identifier: ISRCTN52352170. TI - Effect of valsartan on systemic right ventricular function: a double-blind, randomized, placebo-controlled pilot trial EP - 330 SN - 0009-7322 IS - iss. 3 SP - 322 JF - Circulation VL - vol. 127 DO - https://doi.org/10.1161/CIRCULATIONAHA.112.135392 ER - TY - JOUR AU - Opic, P. AU - Kranenburg, M. van AU - Yap, S.C. AU - Dijk, A.P.J. van AU - Budts, W. AU - Vliegen, H.W. AU - Erven, L. van AU - Can, A. AU - Sahin, G. AU - Theuns, D.A. AU - Witsenburg, M. AU - Roos-Hesselink, J.W. PY - 2013 UR - https://hdl.handle.net/2066/125572 AB - BACKGROUND: This study aims to investigate indications and complications of permanent cardiac pacing in adults with congenital heart disease (CHD). METHODS AND RESULTS: Two-hundred and seventy-four CHD patients were identified who underwent permanent pacemaker implantation between 1972 and 2009. The indication for pacing was acquired sinus node or AV node conduction disease (63%), sinus node or AV node conduction disease after cardiac surgery (28%), and drug/arrhythmia-related indications (9%). Patients with complex CHD received a pacemaker at younger age (23 versus 31years, p<0.0001) and more often received an epicardial pacing system (51% versus 23%, p<0.0001) compared to those with simple or moderate CHD. Twenty-nine patients (10.6%) had a periprocedural complication during the primary pacemaker implantation (general population: 5.2%). The most common acute complications were lead dysfunction (4.0%), bleeding (2.6%), pocket infection (1.5%) and pneumothorax (1.5%). During a median follow-up of 12years, pacemaker-related complications requiring intervention occurred in 95 patients (34.6%). The most common late pacemaker-related complications included lead failure (24.8%), pacemaker dysfunction/early battery depletion (5.1%), pacemaker migration (4.7%) and erosion (4.7%). Pacemaker implantation at younger age (<18years) was an independent predictor of late pacemaker-related complication (adjusted hazard ratio 1.68, 95% confidence interval 1.07 to 2.63, p=0.023). CONCLUSIONS: The risk of periprocedural complications seems higher in the CHD population compared to the general population and more than one-third of CHD patients encountered a pacemaker-related complication during long-term follow-up. This risk increases for those who receive a pacemaker at younger age. TI - Complications of pacemaker therapy in adults with congenital heart disease: A multicenter study EP - 3216 SN - 0167-5273 IS - iss. 4 SP - 3212 JF - International Journal of Cardiology VL - vol. 168 DO - https://doi.org/10.1016/j.ijcard.2013.04.114 ER - TY - JOUR AU - Linde, D. van der AU - Andrinopoulou, E.R. AU - Oechslin, E.N. AU - Budts, W. AU - Dijk, A.P.J. van AU - Pieper, P.G. AU - Wajon, E.M. AU - Post, M.C. AU - Witsenburg, M. AU - Silversides, C.K. AU - Oxenius, A. AU - Bogers, A.J. AU - Takkenberg, J.J. AU - Roos-Hesselink, J.W. PY - 2013 UR - https://hdl.handle.net/2066/125577 AB - BACKGROUND: Congenital aortic stenosis (AS) is the most common obstructive left-sided cardiac lesion in young adults, however little is known about the progression in adults. Therefore, we aimed to evaluate the progression rate of AS and aortic dilatation in a large multicenter retrospective cohort of asymptomatic young adults with congenital valvular AS. METHODS: Data were obtained from chart abstraction. Linear mixed-effects models were used to evaluate the progression of AS and aortic dilatation over time. A joint model combining longitudinal echocardiographic and survival data was used for survival analysis. RESULTS: A total of 414 patients (age 29 +/- 10 years, 68% male) were included. Median follow-up duration was 4.1 (2.5-5.1) years (1587 patient-years). Peak aortic velocity was 3.4 +/- 0.7 m/s at baseline and did not change over time in the total patient population (-0.01 +/- 0.03 m/s/year). Increased left ventricular mass was significantly associated with faster AS progression (p<0.001). Aortic dilatation was present in 34% at baseline and 48% at follow-up (p<0.001). The aortic diameter linearly increased over time with a rate of 0.7 +/- 0.2mm/year. Rate of aortic dissection was 0.06% per patient-year. Seventy patients required an aortic valve intervention (4.4% per patient-year), with AS progression rate as most powerful predictor (HR 5.11 (95% CI 3.47-7.53)). CONCLUSIONS: In the majority of patients with mild-to-moderate congenital AS, AS severity does not progress over time. However patients with left ventricular hypertrophy are at risk for faster progression and should be monitored carefully. Although aortic dissections rarely occur, aortic dilatation is common and steadily progresses over time, warranting serial aortic imaging. TI - Congenital valvular aortic stenosis in young adults: predictors for rate of progression of stenosis and aortic dilatation EP - 870 SN - 0167-5273 IS - iss. 2 SP - 863 JF - International Journal of Cardiology VL - vol. 168 DO - https://doi.org/10.1016/j.ijcard.2012.10.027 ER - TY - JOUR AU - Linde, D. van der AU - Takkenberg, J.J. AU - Rizopoulos, D. AU - Heuvelman, H.J. AU - Budts, W. AU - Dijk, A.P.J. van AU - Witsenburg, M. AU - Yap, S.C. AU - Bogers, A.J. AU - Silversides, C.K. AU - Oechslin, E.N. AU - Roos-Hesselink, J.W. PY - 2013 UR - https://hdl.handle.net/2066/125699 AB - AIMS: Discrete subaortic stenosis (DSS) is often diagnosed early in life and known for its sometimes rapid haemodynamic progression in childhood and strong association with aortic regurgitation (AR). However, data about the evolution of DSS in adulthood are scarce. Therefore, we aimed to evaluate the natural history of DSS, and identify risk factors for the progression of DSS, AR, and intervention-free survival. METHODS AND RESULTS: Conservatively managed adult DSS patients were included in this retrospective multicentre cohort study. Mixed-effects and joint models were used to assess the progression of DSS and AR, and intervention-free survival. Longitudinal natural history data were available for 149 patients [age 20 (IQR: 18-34) years, 48% male]. Sixty patients (40.3%) had associated congenital heart defects (CHDs). The median follow-up duration was 6.3 (IQR: 3.0-12.4) years. The baseline peak left ventricular outflow tract (LVOT) gradient was 32.3 +/- 17.0 mmHg and increased by 0.8 +/- 0.1 mmHg/year. While the baseline LVOT gradient (P = 0.891) or age (P = 0.421) did not influence the progression rate, the presence of associated CHD was associated with faster progression (P = 0.005). Mild AR was common (58%), but did not significantly progress over time (P = 0.701). The median intervention-free survival was 16 years and associated with the baseline LVOT gradient [hazard ratio (HR) = 3.9 (95% CI: 2.0-7.6)], DSS progression [HR = 2.6 (95% CI: 2.0-3.5)], and AR [HR = 6.4 (95% CI 2.6-15.6)]. CONCLUSION: In contrast to children, DSS progresses slowly in adulthood. In particular, patients with associated CHD are at risk for faster progression and should be monitored cautiously. Discrete subaortic stenosis progression is not influenced by the baseline LVOT gradient or age. Mild AR is common, but non-progressive over time. TI - Natural history of discrete subaortic stenosisin adults: a multicentre study EP - 1556 SN - 0195-668X IS - iss. 21 SP - 1548 JF - European Heart Journal VL - vol. 34 DO - https://doi.org/10.1093/eurheartj/ehs421 ER - TY - JOUR AU - Bom, T. van der AU - Winter, M.M. AU - Groenink, M. AU - Vliegen, H.W. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Roos-Hesselink, J.W. AU - Zwinderman, A.H. AU - Mulder, B.J. AU - Bouma, B.J. PY - 2013 UR - https://hdl.handle.net/2066/125877 AB - OBJECTIVES: The aim of this study was to identify which patients with a systemic right ventricle are at risk for clinical events. BACKGROUND: In patients with congenitally or atrially corrected transposition of the great arteries, worsening of the systemic right ventricle is accompanied by clinical events such as clinical heart failure or the occurrence of arrhythmia. METHODS: At baseline, all subjects underwent electrocardiography, echocardiography, cardiopulmonary exercise testing, and cardiovascular magnetic resonance imaging. Clinical events comprised death, vascular events, tricuspid regurgitation requiring surgery, worsening heart failure, and (supra)ventricular arrhythmia. A Cox proportional hazards analysis was used to assess the most valuable determinants of clinical events. RESULTS: A total of 88 patients with a mean age of 33 years were included in the study. Sixty-five percent were men, and 28% had congenitally corrected transposition of the great arteries. During a follow-up period of 4.3 years, 31 patients (35%) experienced 46 clinical events for an annual risk of 12%. Right ventricular end-diastolic volume index measured by means of cardiovascular magnetic resonance imaging or multirow detector computed tomography (hazard ratio: 1.20; p < 0.01) and peak exercise systolic blood pressure (hazard ratio: 0.86; p = 0.02) were the strongest determinants of clinical events. Patients with a right ventricular end-diastolic volume index above 150 ml/m(2) and peak exercise systolic blood pressure below 180 mm Hg were most likely to experience clinical events with an annual event rate of 19% versus 0.9% in patients without these risk factors. CONCLUSIONS: Patients with a right ventricular end-diastolic volume index above 150 ml/m(2) and peak exercise systolic blood pressure below 180 mm Hg had a 20-fold higher annual event rate than patients without these risk factors. Regular cardiovascular magnetic resonance imaging and exercise testing are important in the risk assessment of these patients. TI - Right ventricular end-diastolic volume combined with peak systolic blood pressure during exercise identifies patients at risk for complications in adults with a systemic right ventricle EP - 936 SN - 0735-1097 IS - iss. 10 SP - 926 JF - Journal of the American College of Cardiology VL - vol. 62 DO - https://doi.org/10.1016/j.jacc.2013.06.026 ER - TY - JOUR AU - Linde, D. van der AU - Roos-Hesselink, J.W. AU - Rizopoulos, D. AU - Heuvelman, H.J. AU - Budts, W. AU - Dijk, A.P.J. van AU - Witsenburg, M. AU - Yap, S.C. AU - Oxenius, A. AU - Silversides, C.K. AU - Oechslin, E.N. AU - Bogers, A.J. AU - Takkenberg, J.J. PY - 2013 UR - https://hdl.handle.net/2066/126286 AB - BACKGROUND: Discrete subaortic stenosis is notable for its unpredictable hemodynamic progression in childhood and high reoperation rate; however, data about adulthood are scarce. METHODS AND RESULTS: Adult patients who previously underwent surgery for discrete subaortic stenosis were included in this retrospective multicenter cohort study. Mixed-effects and joint models were used to assess the postoperative progression of discrete subaortic stenosis and aortic regurgitation, as well as reoperation. A total of 313 patients at 4 centers were included (age at baseline, 20.2 years [25th-75th percentile, 18.4-31.0 years]; 52% male). Median follow-up duration was 12.9 years (25th-75th percentile, 6.2-20.1 years), yielding 5617 patient-years. The peak instantaneous left ventricular outflow tract gradient decreased from 75.7+/-28.0 mm Hg preoperatively to 15.1+/-14.1 mm Hg postoperatively (P<0.001) and thereafter increased over time at a rate of 1.31+/-0.16 mm Hg/y (P=0.001). Mild aortic regurgitation was present in 68% but generally did not progress over time (P=0.76). A preoperative left ventricular outflow tract gradient >/=80 mm Hg was a predictor for progression to moderate aortic regurgitation postoperatively. Eighty patients required at least 1 reoperation (1.8% per patient-year). Predictors for reoperation included female sex (hazard ratio, 1.53; 95% confidence interval, 1.02-2.30) and left ventricular outflow tract gradient progression (hazard ratio, 1.45; 95% confidence interval, 1.31-1.62). Additional myectomy did not reduce the risk for reoperation (P=0.92) but significantly increased the risk of a complete heart block requiring pacemaker implantation (8.1% versus 1.7%; P=0.005). CONCLUSIONS: Survival is excellent after surgery for discrete subaortic stenosis; however, reoperation for recurrent discrete subaortic stenosis is not uncommon. Over time, the left ventricular outflow tract gradient slowly increases and mild aortic regurgitation is common, although generally nonprogressive over time. Myectomy does not show additional advantages, and because it is associated with an increased risk of complete heart block, it should not be performed routinely. TI - Surgical outcome of discrete subaortic stenosis in adults: a multicenter study EP - 91, e1-4 SN - 0009-7322 IS - iss. 11 SP - 1184 JF - Circulation VL - vol. 127 DO - https://doi.org/10.1161/CIRCULATIONAHA.112.000883 ER - TY - JOUR AU - Oudegeest-Sander, M.H. AU - Olde Rikkert, M.G.M. AU - Smits, P. AU - Thijssen, D.H.J. AU - Dijk, A.P.J. van AU - Levine, B.D. AU - Hopman, M.T.E. PY - 2013 UR - https://hdl.handle.net/2066/140545 AB - Aging leads to accumulation of irreversible advanced glycation end-products (AGEs), contributing to vascular stiffening and endothelial dysfunction. When combined with the AGE-crosslink breaker Alagebrium, exercise training reverses cardiovascular aging in experimental animals. This study is the first to examine the effect of Alagebrium, with and without exercise training, on endothelial function, arterial stiffness and cardiovascular risk in older individuals. Forty-eight non-exercising individuals (mean age 70 +/- 4 years) without manifest diseases or use of medication were allocated into 4 groups for a 1-year intervention: Exercise training & Alagebrium (200 mg/day); exercise training & placebo; no exercise training & Alagebrium (200 mg/day); and no exercise training & placebo. We performed a maximal exercise test (VO2max) and measured endothelial function using venous occlusion plethysmography and intra-arterial infusion of acetylcholine, sodium nitroprusside and NG-monomethyl-l-arginine. Arterial stiffness was measured using pulse wave velocity. Cardiovascular risk was calculated using the Lifetime Risk Score (LRS). In the exercise training groups, LRS and VO2max improved significantly (23.9 +/- 4.5 to 27.2 +/- 4.6mLO2/min/kg, p < 0.001). Endothelial response to the vasoactive substances did not change, nor did arterial stiffness in any of the four groups. In conclusion, one year of exercise training significantly improved physical fitness and lifetime risk for cardiovascular disease without affecting endothelial function or arterial stiffness. The use of the AGE-crosslink breaker Alagebrium had no independent effect on vascular function, nor did it potentiate the effect of exercise training. Despite the clinical benefits of exercise training for older individuals, neither exercise training nor Alagebrium (alone or in combination) was able to reverse the vascular effects of decades of sedentary aging. TI - The effect of an advanced glycation end-product crosslink breaker and exercise training on vascular function in older individuals: a randomized factorial design trial. EP - 1517 SN - 0531-5565 IS - iss. 12 SP - 1509 JF - Experimental Gerontology VL - vol. 48 N1 - 1 december 2013 DO - https://doi.org/10.1016/j.exger.2013.10.009 ER - TY - JOUR AU - Stekkinger, E. AU - Scholten, R.R. AU - Vlugt, M.J. van der AU - Dijk, A.P.J. van AU - Janssen, M.C.H. AU - Spaanderman, M.E.A. PY - 2013 UR - https://hdl.handle.net/2066/119141 AB - OBJECTIVE: To compare the prevalence of recurrent pre-eclampsia between women who have and do not have metabolic syndrome when non-pregnant. DESIGN: Retrospective cohort study. SETTING: Three tertiary referral hospitals in the Netherlands. POPULATION: Formerly pre-eclamptic women. METHODS: The presence or absence of metabolic syndrome was assessed in 480 women at least 6 months after their first pre-eclamptic pregnancy using World Health Organization criteria. We compared the prevalence of recurrent pre-eclampsia in the subsequent pregnancy, calculating odds ratios (OR), adjusted for confounders. MAIN OUTCOME MEASURE: Recurrence of pre-eclampsia in the subsequent pregnancy. RESULTS: Subsequent pregnancy outcome data were available for 197 women. Forty women had metabolic syndrome after previous pregnancy (20%). The prevalence of recurrent pre-eclampsia was 18/40 (45%) in women with metabolic syndrome versus 27/157 (17%) in women without metabolic syndrome; OR 3.94 (95% confidence interval [CI] 1.86-8.33, adjusted OR 3.77 (95% CI 1.61-8.81). The risk of recurrent pre-eclampsia increased with each extra component of the metabolic syndrome from 11.8% for absent components up to 43.9% for three or more (P for trend < 0.001). CONCLUSIONS: Interpregnancy metabolic syndrome predisposes to recurrent pre-eclampsia. TI - Metabolic syndrome and the risk for recurrent pre-eclampsia: a retrospective cohort study EP - 986 SN - 1470-0328 IS - iss. 8 SP - 979 JF - Bjog : an International Journal of Obstetrics and Gynaecology VL - vol. 120 DO - https://doi.org/10.1111/1471-0528.12189 ER - TY - JOUR AU - Kouijzer, I.J. AU - Vos, F.J. AU - Janssen, M.J. AU - Dijk, A.P.J. van AU - Bleeker-Rovers, C.P. AU - Oyen, W.J.G. PY - 2013 UR - https://hdl.handle.net/2066/117576 TI - Reply to comment by Treglia and Bertagna: FDG PET/CT for detection of infectious endocarditis EP - 1115 SN - 1619-7070 IS - iss. 7 SP - 1114 JF - European Journal of Nuclear Medicine and Molecular Imaging VL - vol. 40 DO - https://doi.org/10.1007/s00259-013-2428-5 ER - TY - JOUR AU - Kouijzer, I.J. AU - Vos, F.J. AU - Janssen, M.J.R. AU - Dijk, A.P.J. van AU - Oyen, W.J.G. AU - Bleeker-Rovers, C.P. PY - 2013 UR - https://hdl.handle.net/2066/117857 AB - PURPOSE: Early detection of infectious endocarditis is challenging. For diagnosing infectious endocarditis, the revised Duke criteria are the gold standard. Evidence of endocardial involvement on echocardiography is a major criterion, but sensitivity and specificity of echocardiography are not optimal. Here we investigated the utility of (18)F-fluorodeoxyglucose (FDG) positron emission tomography and computed tomography (PET/CT) to diagnose infectious endocarditis in patients with gram-positive bacteraemia. METHODS: Seventy-two patients with gram-positive bacteraemia were prospectively included. Patients with a positive blood culture growing Staphylococcus aureus, Streptococcus species or Enterococcus species were eligible when a risk factor for developing metastatic infectious foci was present. Infectious endocarditis was defined according to the revised Duke criteria. All patients underwent (18)F-FDG PET/CT and echocardiography. (18)F-FDG uptake in or around the heart valves was evaluated independently by two nuclear medicine physicians. RESULTS: Sensitivity for diagnosing infectious endocarditis with (18)F-FDG PET/CT was 39% and specificity was 93%. The positive predictive value was 64% and negative predictive value was 82%. The mortality rate in patients without infectious endocarditis and without increased (18)F-FDG uptake in or around the heart valves was 18%, and in patients without infectious endocarditis but with high (18)F-FDG uptake in or around the heart valves the mortality rate was 50% (p = 0.181). CONCLUSION: (18)F-FDG PET/CT is currently not sufficiently adequate for the diagnosis of infectious endocarditis because of its low sensitivity. Improvements such as patient preparation with low carbohydrate-fat allowed diet and technical advances in the newest PET/CT scanners may increase sensitivity in future studies. TI - The value of 18F-FDG PET/CT in diagnosing infectious endocarditis EP - 1107 SN - 1619-7070 IS - iss. 7 SP - 1102 JF - European Journal of Nuclear Medicine and Molecular Imaging VL - vol. 40 DO - https://doi.org/10.1007/s00259-013-2376-0 ER - TY - JOUR AU - Scholten, R.R. AU - Hopman, M.T.E. AU - Sweep, C.G.J. AU - Vlugt, M.J. van der AU - Dijk, A.P. van AU - Oyen, W.J.G. AU - Lotgering, F.K. AU - Spaanderman, M.E.A. PY - 2013 UR - https://hdl.handle.net/2066/118162 AB - OBJECTIVE: Formerly preeclamptic women are at increased risk for remote cardiovascular and thrombotic diseases. We studied co-occurrence of cardiovascular and prothrombotic risk factors within a cohort of formerly preeclamptic women and tested if prevalence of these risk profiles related to onset of preeclampsia in previous pregnancy. METHODS: We evaluated 1,297 nonpregnant formerly preeclamptic women (6-12 months postpartum) for the presence of four risk profiles: circulatory risk profile (hypertension or latent hypertension [low plasma volume, increased vascular resistance, or both]; metabolic syndrome (World Health Organization criteria); thrombophilia (factor V Leiden, prothrombin mutation, or protein C or S deficiency); and hyperhomocysteinemia. Trends between prevalence of these four profiles and onset of preeclampsia were studied using linear regression analysis. RESULTS: After exclusion of 63 women (4.9%) because of incomplete data, 1,234 women were included. One or more risk profiles were detected in 958 of 1,234 (77.6%) formerly preeclamptic women. Circulatory risk profile was more prevalent (66.1%) than hyperhomocysteinemia (18.7%), metabolic syndrome (15.4%), or thrombophilia (10.8%). Prevalence of circulatory risk profile, metabolic syndrome, and hyperhomocysteinemia decreased significantly with gestational age at delivery, whereas thrombophilia did not (P=.22). There was minimal overlap (less than 2%) between metabolic syndrome, thrombophilic profile, and hyperhomocysteinemia. CONCLUSION: Circulatory risk profile is present in two thirds of formerly preeclamptic women. Metabolic syndrome, thrombophilia, and hyperhomocysteinemia are prevalent in 10-20%. There is considerable overlap between circulatory risk profile and other profiles, but not among the three other profiles. Prevalence of these risk factors, except thrombophilia, decreases with gestational age at delivery in preceding pregnancy. LEVEL OF EVIDENCE: : II. TI - Co-occurrence of cardiovascular and prothrombotic risk factors in women with a history of preeclampsia EP - 105 SN - 0029-7844 IS - iss. 1 SP - 97 JF - Obstetrics and Gynecology VL - vol. 121 DO - https://doi.org/10.1097/AOG.0b013e318273764b ER - TY - JOUR AU - Gevers, T.J.G. AU - Koning, D.B. de AU - Dijk, A.P.J. van AU - Drenth, J.P.H. PY - 2012 UR - https://hdl.handle.net/2066/108570 TI - Low prevalence of cardiac valve abnormalities in patients with autosomal dominant polycystic liver disease. EP - 692 SN - 1478-3223 IS - iss. 4 SP - 690 JF - Liver International VL - vol. 32 N1 - 1 april 2012 DO - http://dx.doi.org/10.1111/j.1478-3231.2011.02683.x ER - TY - JOUR AU - Freling, H.G. AU - van Slooten, Y.J. AU - Melle, J.P. van AU - Mulder, B.J. AU - Dijk, A.P. van AU - Hillege, H.L. AU - Post, M.C. AU - Sieswerda, G.T. AU - Jongbloed, M.R. AU - Willems, T.P. AU - Pieper, P.G. PY - 2012 UR - https://hdl.handle.net/2066/109213 AB - BACKGROUND: Data on long-term complications in adult patients with congenital heart disease (ACHD) and a prosthetic valve are scarce. Moreover, the influence of prosthetic valves on quality of life (QoL) and functional outcome in ACHD patients with prosthetic valves has not been studied. OBJECTIVES: The primary objective of the PROSTAVA study is to investigate the relation between prosthetic valve characteristics (type, size and location) and functional outcome as well as QoL in ACHD patients. The secondary objectives are to investigate the prevalence and predictors of prosthesis-related complications including prosthesis-patient mismatch. METHODS: The PROSTAVA study, a multicentre cross-sectional observational study, will include approximately 550 ACHD patients with prosthetic valves. Primary outcome measures are maximum oxygen uptake during cardiopulmonary exercise testing and QoL. Secondary outcomes are the prevalence and incidence of valve-related complications including prosthesis-patient mismatch. Other evaluations are medical history, physical examination, echocardiography, MRI, rhythm monitoring and laboratory evaluation (including NT-proBNP). IMPLICATIONS: Identification of the relation between prosthetic valve characteristics in ACHD patients on one hand and functional outcome, QoL, the prevalence and predictors of prosthesis-related complications on the other hand may influence the choice of valve prosthesis, the indication for more extensive surgery and the indication for re-operation. TI - Prosthetic valves in adult patients with congenital heart disease: Rationale and design of the Dutch PROSTAVA study EP - 424 SN - 1568-5888 IS - iss. 10 SP - 419 JF - Netherlands Heart Journal VL - vol. 20 DO - https://doi.org/10.1007/s12471-012-0308-4 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 - Veen, G. AU - Zwinderman, A.H. AU - Mulder, B.J. PY - 2012 UR - https://hdl.handle.net/2066/109279 AB - BACKGROUND: HMG-coA-reductase-inhibitors (statins) have been proven to reduce atherosclerosis progression as observed by carotid intima-media thickness in patients with known coronary heart disease, independent of lipid lowering. Cardiovascular complications are common in patients after successful coarctation repair. The effect of statins on cardiovascular risk in adults after successful coarctation repair has not yet been established. METHODS: We designed a multicentre, prospective, randomised, open label trial to evaluate the effect of the HMGcoA-reductase-inhibitor (Atorvastatin) on atherosclerotic progression in adult post-coarctectomy patients. The primary endpoint in this study is the carotid intima-media thickness as measured by Bmode ultrasonography of the carotid arteries. CONCLUSION: This large prospective, randomised, open label trial will establish the effect of HMG-coA-reductase inhibitors (Atorvastatin) on cardiovascular risk in adult patients after successful coarctation repair. TI - Rationale and design of a trial on the effect of high dose statins on cardiovascular risk in adults after successful coarctation repair. EP - 416 SN - 1551-7144 IS - iss. 2 SP - 410 JF - Contemporary Clinical Trials VL - vol. 33 N1 - 1 maart 2012 DO - https://doi.org/10.1016/j.cct.2011.11.011 ER - TY - JOUR AU - Winter, M.M. AU - Bom, T. van der AU - Vries, L.C. de AU - Balducci, A. AU - Bouma, B.J. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Plas, M.N. van der AU - Picchio, F.M. AU - Mulder, B.J. PY - 2012 UR - https://hdl.handle.net/2066/107819 AB - OBJECTIVE: To assess whether exercise training in adult patients with a systemic right ventricle (RV) improves exercise capacity and quality of life and lowers serum N-terminal prohormone brain natriuretic peptide (NT-proBNP) levels. DESIGN: Multi-centre parallel randomized controlled trial. PARTICIPANTS: Patients with a systemic RV due to congenitally or surgically corrected transposition of the great arteries. METHODS: Fifty-four adult patients with a systemic RV, were randomized using unmarked opaque envelopes to an intervention group (n = 28) with three training sessions per week for 10 consecutive weeks, and a control group (n = 26). Randomization was stratified by participating centre. At baseline, and follow-up, we determined maximal exercise capacity (V'O(2peak)), serum NT-proBNP levels, and quality of life by means of the SF-36, and the TAAQOL Congenital Heart Disease questionnaires. The final analysis was performed by linear regression, taking into account the stratified randomization. RESULTS: Forty-six patients were analysed (male 50%, age 32 +/- 11 years, intervention group n = 24, control group n = 22). Analysis at 10 weeks showed a significant difference in V'O(2peak) (3.4 mL/kg/min, 95% CI: 0.2 to 6.7; P = 0.04) and resting systolic blood pressure (-7.6 mmHg, 95% CI: -14.0 to -1.3; P = 0.03) in favour of the exercise group. No significant changes were found in serum NT-proBNP levels or quality of life in the intervention group or in the control group nor between groups. None of the patients in the intervention group had to discontinue the training programme due to adverse events. CONCLUSION: In adult patients with a systemic RV exercise training improve exercise capacity. We recommend to revise restrictive guidelines, and to encourage patients to become physically active. (Trial registration: The study was registered at http://trialregister.nl. Identifier: NTR1909.). TI - Exercise training improves exercise capacity in adult patients with a systemic right ventricle: a randomized clinical trial. EP - 1385 SN - 0195-668X IS - iss. 11 SP - 1378 JF - European Heart Journal VL - vol. 33 N1 - 1 juni 2012 DO - https://doi.org/10.1093/eurheartj/ehr396 ER - TY - JOUR AU - Koyak, Z. AU - Groot, J.R. de AU - Gelder, I.C. AU - Bouma, B.J. AU - Dessel, P.F. van AU - Budts, W. AU - Erven, L. van AU - Dijk, A.P.J. van AU - Wilde, A.A. AU - Pieper, P.G. AU - Sieswerda, G.T. AU - Mulder, B.J. PY - 2012 UR - https://hdl.handle.net/2066/108249 AB - BACKGROUND: The value of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (CHD) is unknown. We investigated the long-term outcome after ICD implantation and developed a simple risk stratification score for ICD therapy. METHODS AND RESULTS: A total of 136 adults with CHD and ICD (mean age+/-SD, 41+/-13 years; 67% male) were identified from 10 tertiary referral centers in the Netherlands and Belgium. The indication for ICD implantation was primary prevention in 50% of patients. Diagnoses included tetralogy of Fallot (51%), septal defects (20%), (congenitally corrected) transposition of the great arteries (13%), and other (16%). Thirty-nine patients (29%) received appropriate ICD shocks during a median follow-up of 4.6 years. Secondary prevention indication (hazard ratio [HR], 3.6; 95% CI, 1.3-9.5; P=0.009), coronary artery disease (HR, 2.7; 95% CI, 1.0-7.2; P=0.042), and symptomatic nonsustained ventricular tachycardia (NSVT; HR, 9.1; 95% CI, 2.8-29.2; P=0.001) were associated with appropriate ICD shocks. A risk score was developed to evaluate the likelihood of appropriate ICD shocks. The 8-year survival curve to first appropriate shocks was 94%, 57%, and 26% for low-, intermediate-, and high-risk patients, respectively. In primary prevention, symptomatic NSVTs (HR, 8.0; 95% CI, 2.3-27.1; P=0.001) and subpulmonary ventricular dysfunction (HR, 3.0; 95% CI, 1.2-12.6; P=0.02) were associated with appropriate shocks in univariable analysis. Inappropriate shocks occurred in 41 patients (30%). In addition, 40 patients (29%) experienced 45 implantation-related complications. CONCLUSIONS: Adults with CHD and ICDs receive high rates of appropriate and effective shocks. Patients with secondary prevention indication, coronary artery disease, and symptomatic NSVT are at highest risk of receiving appropriate ICD shocks. ICD implantation is accompanied by considerable morbidity, including inappropriate shocks and procedure- related complications. TI - Implantable cardioverter defibrillator therapy in adults with congenital heart disease: who is at risk of shocks? EP - 110 SN - 1941-3149 IS - iss. 1 SP - 101 JF - Circulation-Arrhythmia and Electrophysiology VL - vol. 5 N1 - 1 februari 2012 DO - https://doi.org/10.1161/CIRCEP.111.966754 ER - TY - JOUR AU - Opic, P. AU - Utens, E.M. AU - Moons, P. AU - Theuns, D.A. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Vliegen, H.W. AU - Groot, N.M. de AU - Witsenburg, M. AU - Schalij, M. AU - Roos-Hesselink, J.W. PY - 2012 UR - https://hdl.handle.net/2066/109228 AB - OBJECTIVE: To investigate the psychosocial impact of having an implantable cardioverter defibrillator (ICD) in adults with Tetralogy of Fallot (ToF). METHODS: Included were 26 ToF-patients with an ICD (age 44 +/- 12 years), and two control groups consisting of 28 ToF-patients without an ICD (age 40 +/- 10 years) and a group of 35 ICD-patients of older age without ToF (age 72.0 +/- 8 years). This last control group was chosen to represent the "older general ICD population" with acquired heart disease seen at the out-patient clinic. Psychosocial functioning encompassed daily functioning, subjective health status, quality of life, anxiety, depression, coping and social support. RESULTS: ToF-patients with ICD showed diminished psychosocial functioning in comparison to ToF-patients without ICD. This was reflected by diminished subjectively perceived physical functioning (p = 0.01), general health perception (p < 0.01) and a lower satisfaction with life (p = 0.02). In comparison to older ICD-patients, ToF-patients with ICD showed less satisfaction with life (p = 0.03), experienced more anxiety (p = 0.01) and showed less favourable coping styles, although physical functioning was better for ToF-patients with ICD than for older ICD-patients (p = 0.01). More inappropriate shocks were found in ToF-patients with ICD compared to the older ICD-patients. CONCLUSION: In patients with ToF, ICD implantation had a major impact on psychosocial functioning which should be taken into account when considering ICD implantation in these young patients. To help improve psychosocial functioning, psychological counselling attuned to the specific needs of these patients may be useful. TI - Psychosocial impact of implantable cardioverter defibrillators (ICD) in young adults with Tetralogy of Fallot. EP - 519 SN - 1861-0684 IS - iss. 7 SP - 509 JF - Clinical Research in Cardiology VL - vol. 101 N1 - 1 juli 2012 DO - https://doi.org/10.1007/s00392-012-0420-x ER - TY - JOUR AU - Schoormans, D. AU - Mulder, B.J. AU - Melle, J.P. van AU - Pieper, E.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.J. AU - Hulsbergen-Zwarts, M.S. AU - Plokker, T.H. AU - Brunninkhuis, L.G. AU - Vliegen, H.W. AU - Sprangers, M.A.G. PY - 2012 UR - https://hdl.handle.net/2066/108996 AB - Background: Type D personality, characterized by high levels of negative affectivity and social inhibition, is related to mortality, morbidity, poor health status, quality of life (QoL) and less healthcare utilization in various cardiovascular patient groups. To date, studies in patients with congenital heart disease (CHD) are lacking. Aims: (1) To examine the prevalence of Type D personality in CHD patients; (2) to compare Type D to non-Type D patients with regard to disease severity, functional status, health status and QoL; and (3) to examine the extent to which Type D personality is independently related to healthcare utilization. Methods: A total of 1109 adult CHD patients were included in a questionnaire survey. Due to missing data, 302 patients were excluded. Results: The prevalence of Type D personality was 20.4%. Type D patients reported a poorer functional status, health status and QoL than non-Type D patients (p<0.05). Type D patients reported less healthcare use than non-Type D patients (primary and cardiac outpatient healthcare: adjusted OR=0.56, 95% CI=0.35-0.90; inpatient healthcare: adjusted OR=0.38, 95% CI=0.17-0.83). Results of a post-hoc analysis showed a high prevalence of Type D personality in patients with a poor functional status who did not consult their cardiologist. Conclusion: Type D patients report a poorer functional status, health status and QoL, but less healthcare utilization. In clinical practice, patients should be screened for Type D personality, since social inhibition may prevent them from contacting a healthcare provider in the event of symptom aggravation. TI - Patients with a congenital heart defect and Type D personality feel functionally more impaired, report a poorer health status and quality of life, but use less healthcare. EP - 355 SN - 1474-5151 IS - iss. 3 SP - 349 JF - European Journal of Cardiovascular Nursing VL - vol. 11 N1 - 1 september 2012 DO - https://doi.org/10.1177/1474515112437828 ER - TY - JOUR AU - Vos, F.J. AU - Kullberg, B.J. AU - Sturm, P.D.J. AU - Krabbe, P.F.M. AU - Dijk, A.P.J. van AU - Wanten, G.J.A. AU - Oyen, W.J.G. AU - Bleeker-Rovers, C.P. PY - 2012 UR - https://hdl.handle.net/2066/108659 AB - Early detection of metastatic infection in patients with Gram-positive bacteremia is important as morbidity and mortality are higher in the presence of these foci, probably due to incomplete eradication of clinically silent foci during initial treatment. We performed a prospective study in 115 patients with Staphylococcus aureus or Streptococcus species bacteremia with at least 1 risk factor for the development of metastatic foci, such as community acquisition, treatment delay, persistently positive blood cultures for >48 hours, and persistent fever >72 hours after initiation of treatment. An intensive search for metastatic infectious foci was performed including (1)(8)F-fluorodeoxyglucose-positron emission tomography in combination with low-dose computed tomography scanning for optimizing anatomical correlation (FDG-PET/CT) and echocardiography in the first 2 weeks of admission. Metastatic infectious foci were detected in 84 of 115 (73%) patients. Endocarditis (22 cases), endovascular infections (19 cases), pulmonary abscesses (16 cases), and spondylodiscitis (11 cases) were diagnosed most frequently. The incidence of metastatic infection was similar in patients with Streptococcus species and patients with S. aureus bacteremia. Signs and symptoms guiding the attending physician in the diagnostic workup were present in only a minority of cases (41%). An unknown portal of entry, treatment delay >48 hours, and the presence of foreign body material were significant risk factors for developing metastatic foci. Mean C-reactive protein levels on admission were significantly higher in patients with metastatic infectious foci (74 vs. 160 mg/L). FDG-PET/CT was the first technique to localize metastatic infectious foci in 35 of 115 (30%) patients. As only a minority of foci were accompanied by guiding signs or symptoms, the number of foci revealed by symptom-guided CT, ultrasound, and magnetic resonance imaging remained low. Mortality tended to be lower in patients without complicated infection compared to those with metastatic foci (16% vs. 25%, respectively). Five of 31 patients (16%) without proven metastatic foci died. In retrospect, 3 of these 5 patients likely had metastatic foci that could not be diagnosed while alive. In patients with Gram-positive bacteremia and a high risk of developing complicated infection, a structured protocol including echocardiography and FDG-PET/CT aimed at detecting metastatic infectious foci can contribute to improved outcome. TI - Metastatic infectious disease and clinical outcome in Staphylococcus aureus and Streptococcus species bacteremia. EP - 94 SN - 0025-7974 IS - iss. 2 SP - 86 JF - Medicine (Baltimore) VL - vol. 91 N1 - 1 maart 2012 DO - https://doi.org/10.1097/MD.0b013e31824d7ed2 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/108659/108659.pdf?sequence=1 ER - TY - JOUR AU - Schuuring, M.J. AU - Vis, J.C. AU - Bouma, B.J. AU - Dijk, A.P. van AU - Melle, J.P. van AU - Pieper, P.G. AU - Vliegen, H.W. AU - Sieswerda, G.T. AU - Mulder, B.J. PY - 2011 UR - https://hdl.handle.net/2066/98285 AB - BACKGROUND: The Fontan circulation is a palliative procedure performed in patients with complex congenital heart disease (CHD), making transpulmonary blood flow dependent on the systemic venous pressure. In a Fontan circulation a low pulmonary vascular resistance (PVR) is crucial, as is epitomized by the observation that a high PVR is a strong predictor of mortality. Long-term follow-up has shown that PVR may rise many years after the Fontan procedure has been performed, possibly due to micro-emboli from a dilated right atrium or from the venous system. Other mechanisms of increased PVR might be aging, obstructed airways caused by lymphatic dysfunction, lack of pulsatile pulmonary flow causing a release of endothelium-derived vasoactive molecules, and prolonged overexpression of vasoconstrictors such as endothelin-1. Mean plasma level of endothelin-1 has been shown to be significantly higher in Fontan patients compared to healthy controls. In patients with pulmonary arterial hypertension (PAH), therapy with bosentan, an endothelin-1 receptor antagonist, has demonstrated to improve exercise capacity and to reduce the elevated PVR. In addition, reduction of PVR is shown early and late after the Fontan procedure on treatment with exogenous NO, another advanced PAH therapy. However, the long term effect of reducing the PVR by bosentan treatment on exercise capacity in Fontan patients is still unknown. METHODS: We designed a prospective, multicenter, randomized open label trial to study the effect of bosentan in Fontan patients. The primary endpoint will be the change in maximum exercise capacity (peak V'O2). CONCLUSION: We hypothesize that treatment with bosentan, an endothelin-1 receptor antagonist, improves maximum exercise capacity and functional capacity in adult Fontan patients. TI - Rationale and design of a trial on the role of bosentan in Fontan patients: improvement of exercise capacity? EP - 591 SN - 1551-7144 IS - iss. 4 SP - 586 JF - Contemporary Clinical Trials VL - vol. 32 DO - https://doi.org/10.1016/j.cct.2011.04.001 ER - TY - JOUR AU - Balci, A. AU - Sollie, K.M. AU - Mulder, B.J. AU - Laat, M.W. de AU - Roos-Hesselink, J.W. AU - Dijk, A.P. 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 - 2011 UR - https://hdl.handle.net/2066/96656 AB - BACKGROUND: Previous research has shown that women with congenital heart disease (CHD) are more susceptible to cardiovascular, obstetric, and offspring events. The causative pathophysiologic mechanisms are incompletely understood. Inadequate uteroplacental circulation is an important denominator in adverse obstetric events and offspring outcome. The relation between cardiac function and uteroplacental perfusion has not been investigated in women with CHD. Moreover, the effects of physiologic changes on pregnancy-related events are unknown. In addition, long-term effects of pregnancy on cardiac function and exercise capacity are scarce. METHODS: Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II, a prospective multicenter cohort study, investigates changes in and relations between cardiovascular parameters and uteroplacental Doppler flow patterns during pregnancy in women with CHD compared to matched healthy controls. The relation between cardiovascular parameters and uteroplacental Doppler flow patterns and the occurrence of cardiac, obstetric, and offspring events will be investigated. At 20 and 32 weeks of gestation, clinical, neurohumoral, and echocardiographic evaluation and fetal growth together with Doppler flow measurements in fetal and maternal circulation are performed. Maternal evaluation is repeated 1 year postpartum. IMPLICATIONS: By identifying the factors responsible for pregnancy-related events in women with CHD, risk stratification can be refined, which may lead to better pre-pregnancy counseling and eventually improve treatment of these women. TI - Associations between cardiovascular parameters and uteroplacental Doppler (blood) flow patterns during pregnancy in women with congenital heart disease: Rationale and design of the Zwangerschap bij Aangeboren Hartafwijking (ZAHARA) II study EP - 275 e1 SN - 0002-8703 IS - iss. 2 SP - 269 JF - American Heart Journal VL - vol. 161 DO - https://doi.org/10.1016/j.ahj.2010.10.024 ER - TY - JOUR AU - Klok, F.A. AU - Surie, S. AU - Kempf, T. AU - Eikenboom, J. AU - Straalen, J.P. van AU - Kralingen, K.W. van AU - Dijk, A.P. van AU - Vliegen, H.W. AU - Bresser, P. AU - Wollert, K.C. AU - Huisman, M.V. PY - 2011 UR - https://hdl.handle.net/2066/95601 AB - BACKGROUND: Our aim was to construct a diagnostic model for ruling out chronic thromboembolic pulmonary hypertension (CTEPH) in symptomatic patients after acute pulmonary embolism (PE) that is based on simple, non-invasive tests. METHODS: Plasma levels of various CTEPH associated biomarkers and conventional ECG criteria for right ventricular pressure overload were assessed in 82 consecutive patients with confirmed CTEPH and 160 consecutive patients with a history of PE who were suspected to have CTEPH, but in whom this disease was ruled out. RESULTS: ECG criteria of right ventricular hypertrophy were detected more frequently in patients with CTEPH (77%) than in the patients without CTEPH (11%, Odds ratio 26, 95% confidence interval [CI] 13-53). Also, clotting factor FVIII activity and the levels of N-terminal-pro-brain-type natriuretic peptide (NT-pro-BNP), Growth Differentiation Factor-15, C-reactive protein and urate, but not D-dimer level, were higher in patients with CTEPH. A diagnostic model including ECG criteria and NT-pro-BNP levels had a sensitivity of 94% (95% CI 86-98%) and a specificity of 65% (95% CI 56-72%). The area under the receiver-operator-characteristic curve was 0.80 (95% CI 0.74-0.85) for the diagnosis of CTEPH. Even with high disease prevalences of up to 10%, the negative predictive value of this model proved to be very high (99%, 95% CI 97-100%). CONCLUSIONS: Ruling out CTEPH in patients after acute PE seems to be safe without additional diagnostic testing in absence of ECG criteria indicative of right ventricular hypertrophy and a normal NT-pro-BNP level. TI - A simple non-invasive diagnostic algorithm for ruling out chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism EP - 26 SN - 0049-3848 IS - iss. 1 SP - 21 JF - Thrombosis Research VL - vol. 128 DO - https://doi.org/10.1016/j.thromres.2011.03.004 ER - TY - JOUR AU - Linde, D. van der AU - Yap, S.C. AU - Dijk, A.P. van AU - Budts, W. AU - Pieper, P.G. AU - Burgh, P.H. van der AU - Mulder, B.J. AU - Witsenburg, M. AU - Cuypers, J.A. AU - Lindemans, J. AU - Takkenberg, J.J. AU - Roos-Hesselink, J.W. PY - 2011 UR - https://hdl.handle.net/2066/96861 AB - Recent trials have failed to show that statin therapy halts the progression of calcific aortic stenosis (AS). We hypothesized that statin therapy in younger patients with congenital AS would be more beneficial, because the valve is less calcified. In the present double-blind, placebo-controlled trial, 63 patients with congenital AS (age 18 to 45 years) were randomly assigned to receive either 10 mg of rosuvastatin daily (n = 30) or matched placebo (n = 33). The primary end point was the progression of peak aortic valve velocity. The secondary end points were temporal changes in the left ventricular mass, ascending aortic diameter, and N-terminal pro-brain natriuretic peptide (NT-proBNP). The median follow-up was 2.4 years (interquartile range 1.9 to 3.0). The mean increase in peak velocity was 0.05 +/- 0.21 m/s annually in the rosuvastatin group and 0.09 +/- 0.24 m/s annually in the placebo group (p = 0.435). The annualized change in the ascending aorta diameter (0.4 +/- 1.7 mm with rosuvastatin vs 0.5 +/- 1.6 mm with placebo; p = 0.826) and left ventricular mass (1.1 +/- 15.8 g with rosuvastatin vs -3.7 +/- 30.9 g with placebo; p = 0.476) were not significantly different between the 2 groups. Within the statin group, the NT-proBNP level was 50 pg/ml (range 19 to 98) at baseline and 21 pg/ml (interquartile range 12 to 65) at follow-up (p = 0.638). NT-proBNP increased from 40 pg/ml (interquartile range 20 to 92) to 56 pg/ml (range 26 to 130) within the placebo group (p = 0.008). In conclusion, lipid-lowering therapy with rosuvastatin 10 mg did not reduce the progression of congenital AS in asymptomatic young adult patients. Interestingly, statins halted the increase in NT-proBNP, suggesting a potential positive effect of statins on cardiac function in young patients with congenital AS. TI - Effects of rosuvastatin on progression of stenosis in adult patients with congenital aortic stenosis (PROCAS Trial) EP - 271 SN - 0002-9149 IS - iss. 2 SP - 265 JF - American Journal of Cardiology VL - vol. 108 DO - https://doi.org/10.1016/j.amjcard.2011.03.032 ER - TY - JOUR AU - Balci, A. AU - Drenthen, W. AU - Mulder, B.J. AU - Roos-Hesselink, J.W. AU - Voors, A.A. AU - Vliegen, H.W. AU - Moons, P. AU - Sollie, K.M. AU - Dijk, A.P.J. van AU - Veldhuisen, D.J. van AU - Pieper, P.G. PY - 2011 UR - https://hdl.handle.net/2066/97245 AB - BACKGROUND: In women with corrected tetralogy of Fallot (ToF), pregnancy is associated with maternal cardiac, obstetric, and offspring complications. Our aim is to investigate the magnitude and determinants of pregnancy outcome in women with corrected ToF. METHODS: In this retrospective international multicenter study using 2 congenital heart disease registries, 204 women with corrected ToF were identified. Within this group, 74 women had 157 pregnancies, including 30 miscarriages and 4 terminations of pregnancy. Detailed information on each completed pregnancy (n = 123) was obtained using medical records and supplementary interviews. RESULTS: Cardiovascular events occurred during 10 (8.1%) pregnancies, mainly (supra)ventricular arrhythmias. Obstetric and offspring events occurred in 73 (58.9%) and 42 (33.9%) pregnancies, respectively, including offspring mortality in 8 (6.4%). The most important predictor was use of cardiac medication before pregnancy (odds ratio for cardiac events 11.7, 95% CI 2.2-62.7; odds ratio for offspring events 8.4, 95% CI 1.4-48.6). In pregnancies with cardiovascular events, significantly more small-for-gestational-age children were born (P value < .01). CONCLUSIONS: Cardiovascular, obstetric, and offspring events occur frequently during pregnancies in women with ToF. Maternal use of cardiovascular medication is associated with pregnancy outcome, and maternal cardiovascular events during pregnancy are highly associated with offspring events. TI - Pregnancy in women with corrected tetralogy of Fallot: occurrence and predictors of adverse events EP - 313 SN - 0002-8703 IS - iss. 2 SP - 307 JF - American Heart Journal VL - vol. 161 DO - https://doi.org/10.1016/j.ahj.2010.10.027 ER - TY - JOUR AU - Eijsvogels, T.M.H. AU - Shave, R. AU - Dijk, A.P.J. van AU - Hopman, M.T.E. AU - Thijssen, D.H.J. PY - 2011 UR - https://hdl.handle.net/2066/97897 AB - Exercise training represents a successful and powerful strategy to prevent future cardiovascular disease. Paradoxically, performance of exercise is also associated with an increased risk of acute cardiac events. Accordingly, patients may present to hospital with cardiac symptoms following a bout of unaccustomed physical effort (e.g. exercise). Current guidelines for the identification of an acute myocardial infarction (AMI) importantly depend on the presence of cardiac troponin as a highly sensitive marker of cardiac damage. However, a number of studies have reported elevated cardiac troponin levels in asymptomatic, healthy subjects after endurance exercise (such as a marathon, prolonged cycling or prolonged walking). These observations indicate that elevated cardiac troponin levels can be the result of cardiac ischemia, and subsequent necrosis, but also may be related to strenuous exercise. In this paper, we present three different clinical cases of post-exercise elevations in cardiac troponins, each with a distinct clinical presentation. These case studies emphasize that a detailed assessment of all symptoms and a thorough patient-history are prerequisite for accurate interpretation of a positive cardiac troponin test following exercise. TI - Exercise-induced cardiac troponin release: real-life clinical confusion EP - 3461 SN - 0929-8673 IS - iss. 23 SP - 3457 JF - Current Medicinal Chemistry VL - vol. 18 ER - TY - JOUR AU - Schoormans, D. AU - Sprangers, M.A.G. AU - Pieper, P.G. AU - Melle, J.P. van AU - Dijk, A.P. van AU - Sieswerda, G.T. AU - Hulsbergen-Zwarts, M.S. AU - Plokker, T.H. AU - Brunninkhuis, L.G. AU - Vliegen, H.W. AU - Mulder, B.J. PY - 2011 UR - https://hdl.handle.net/2066/97445 AB - OBJECTIVE: A first step in the delivery of tailored care is answering the following question: does health care meet the needs of patients? Therefore patients' perspective on health care use and their needs was examined. The design used was cross-sectional questionnaire study. PATIENTS: A total of 1109 adult congenital heart defect (CHD) patients attending one of eight Dutch hospitals were randomly selected from a national database (10% of all registered patients). MAIN OUTCOME MEASURES: Patient reported questionnaires on in- and outpatient health care use during the past year and need for additional care. RESULTS: A total of 66% and 40% of patients had contact with their cardiologist and general practitioner, respectively. Six to 10 percent were hospitalized, operated upon, or visited the emergency room. For the majority, the amount of contact was sufficient. Most patients indicated that the communication skills and expertise of the cardiologist and general practitioner were sufficient, and health care improvements were not necessary. Frequent health care users had a poor functional status and frequent contact with their cardiologist and general practitioner. Patients who want more contact with their cardiologist rated the communication skills of the cardiologist as insufficient. CONCLUSIONS: For most patients, the amount and quality of care are both sufficient. Patients who rate the communication skills of the cardiologist as insufficient have need more contact. In addition to the recommended training program as described in the American College of Cardiology/American Heart Association (ACC/AHA) and European Society of Cardiology (ESC) guidelines, we recommend the incorporation of communication training. This is the first study to provide insight into health care use and needs of CHD patients in countries with a compulsory health insurance system from the patient perspective. TI - The perspective of patients with congenital heart disease: does health care meet their needs? EP - 227 SN - 1747-079X IS - iss. 3 SP - 219 JF - Congenital Heart Disease VL - vol. 6 DO - https://doi.org/10.1111/j.1747-0803.2011.00521.x ER - TY - JOUR AU - Vos, F.J. AU - Bleeker-Rovers, C.P. AU - Sturm, P.D.J. AU - Krabbe, P.F.M. AU - Dijk, A.P.J. van AU - Oyen, W.J.G. AU - Kullberg, B.J. PY - 2011 UR - https://hdl.handle.net/2066/96870 AB - BACKGROUND: Despite firm recommendations to perform echocardiography in high-risk patients with Gram-positive bacteraemia, routine echocardiography is not embedded in daily practice in many settings. The aim of this study was to evaluate whether a regime including routine echocardiography results in better outcome. METHODS: A total of 115 patients with Gram-positive bacteraemia and at least one risk factor for developing metastatic infection were prospectively included. Routine echocardiography was advocated and facilitated in these patients. Results were compared with a matched historical control group of 230 patients in whom echocardiography was performed at the discretion of the attending physician. Endocarditis was diagnosed according to the Duke criteria. RESULTS: Echocardiography was performed more often in the study group (82 vs 27%, p. TI - Endocarditis: effects of routine echocardiography during Gram-positive bacteraemia EP - 340 SN - 0300-2977 IS - iss. 7 SP - 335 JF - Netherlands Journal of Medicine VL - vol. 69 ER - TY - JOUR AU - Scholten, R.R. AU - Oyen, W.J.G. AU - Vlugt, M.J. van der AU - Dijk, A.P.J. van AU - Hopman, M.T.E. AU - Lotgering, F.K. AU - Spaanderman, M.E.A. PY - 2011 UR - https://hdl.handle.net/2066/97020 AB - OBJECTIVE: : To estimate whether normotensive women who were born small for gestational age have low plasma volume in adult life, which is associated with later chronic hypertension. METHODS: : In 280 normotensive women with a history of hypertension in pregnancy, we recorded recalled gestational age and weight at birth and measured plasma volume (I-human serum albumin indicator dilution method). To correct for possible confounders, we recorded recent obstetric history and measured in each individual all constituents of the metabolic syndrome (World Health Organization criteria), sex hormones (progesterone and estradiol), renal function, and cardiac performance at rest (echocardiography). We estimated daily activity level with a validated questionnaire (Short Questionnaire to Assess Health-enhancing physical activity). We studied the relation between women's own birth weight centile and her adult plasma volume (mL) and adjusted for the effects of confounding variables using multiple linear regression analysis. RESULTS: : Birth weight correlated positively with adult plasma volume (P<.001). Linear regression analysis demonstrated that each 10 centile change in birth weight is associated with an average change of 46.6 mL (95% confidence interval [CI] 30.8-62.3) in adult plasma volume. This association persisted after adjustment for confounding factors (current body surface area, mean arterial pressure, total vascular resistance, glomerular filtration rate, and a total 24 hours of sodium output). After adjustment, each 10 centile change in birth weight was associated with an average change of 32.1 mL (95% CI 19.6-44.6) in adult plasma volume. Birth centile contributes 14% to the variation in total adult plasma volume. CONCLUSION: : Impaired fetal growth is associated with low plasma volume in adult life. LEVEL OF EVIDENCE: : II. TI - Impaired fetal growth and low plasma volume in adult life EP - 1322 SN - 0029-7844 IS - iss. 6 SP - 1314 JF - Obstetrics and Gynecology VL - vol. 118 DO - https://doi.org/10.1097/AOG.0b013e3182383781 ER - TY - JOUR AU - Marcus, K.A. AU - Mavinkurve-Groothuis, A.M.C. AU - Barends, M. AU - Dijk, A.P.J. van AU - Feuth, T. AU - Korte, C.L. de AU - Kapusta, L. PY - 2011 UR - https://hdl.handle.net/2066/96272 AB - BACKGROUND: The accurate evaluation of intrinsic myocardial contractility in children with or without congenital heart disease (CHD) has turned out to be a challenge. Two-dimensional strain echocardiographic (2DSTE) imaging or two-dimensional speckle-tracking echocardiographic imaging appears to hold significant promise as a tool to improve the assessment of ventricular myocardial function. The aim of this study was to estimate left ventricular myocardial systolic function using 2DSTE imaging in a large cohort consisting of healthy children and young adults to establish reference strain values. METHODS: Transthoracic echocardiograms were acquired in 195 healthy subjects (139 children, 56 young adults) and were retrospectively analyzed. Longitudinal, circumferential, and radial peak systolic strain values were determined by means of speckle tracking. Nonlinear regression analysis was performed to assess the effect of aging on these 2DSTE parameters. RESULTS: There was a strong, statistically significant second-order polynomial relation (P < .001) between global peak systolic strain parameters and age. Global peak systolic strain values were lowest in the youngest and oldest age groups. CONCLUSION: This is the first report to establish age-dependent reference values per cardiac segment for myocardial strain in all three directions assessed using 2DSTE imaging in a large pediatric and young adult cohort. There is a need to use age-specific reference values for the adequate interpretation of 2DSTE measurements. TI - Reference values for myocardial two-dimensional strain echocardiography in a healthy pediatric and young adult cohort EP - 636 SN - 0894-7317 IS - iss. 6 SP - 625 JF - Journal of the American Society of Echocardiography VL - vol. 24 DO - https://doi.org/10.1016/j.echo.2011.01.021 ER - TY - JOUR AU - Bom, T. van der AU - Winter, M.M. AU - Bouma, B.J. AU - Groenink, M. AU - Vliegen, H.W. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Sieswerda, G.T. AU - Roos-Hesslink, J.W. AU - Zwinderman, A.H. AU - Mulder, B.J. PY - 2010 UR - https://hdl.handle.net/2066/89513 AB - BACKGROUND: Angiotensin II receptor blockers have been proven to be beneficial in left ventricular failure. In patients with a morphologic right ventricle supporting the systemic circulation, its efficacy has not yet been established. METHODS: We designed a multicenter, prospective, randomized, double-blind, placebo-controlled trial studying the effect of valsartan in patients with a systemic right ventricle due to a congenitally or surgically corrected transposition of the great arteries. The primary end point is the change in right ventricular ejection fraction as measured by cardiovascular magnetic resonance or multidetector row cardiac computed tomography in case of pacemaker patients. CONCLUSION: This large prospective, double-blind, randomized, placebo-controlled trial will establish the role of angiotensin II receptor blockers (valsartan) in the treatment of patients with a systemic right ventricle. TI - Rationale and design of a trial on the effect of angiotensin II receptor blockers on the function of the systemic right ventricle. EP - 818 SN - 0002-8703 IS - iss. 5 SP - 812 JF - American Heart Journal VL - vol. 160 N1 - 1 november 2010 DO - https://doi.org/10.1016/j.ahj.2010.08.005 ER - TY - JOUR AU - Klok, F.A. AU - Kralingen, K.W. van AU - Dijk, A.P.J. van AU - Heyning, F.H. AU - Vliegen, H.W. AU - Kaptein, A.A. AU - Huisman, M.V. PY - 2010 UR - https://hdl.handle.net/2066/89526 AB - BACKGROUND: To our knowledge, studies evaluating the quality of life (QoL) in patients with a history of acute pulmonary embolism (PE) are not available, even though QoL is a key outcome component of medical care and a predictor of disease-specific prognosis. METHODS: As part of a large follow-up study, the Short Form 36 (SF-36) was presented to consecutive patients who had survived one or more episodes of acute PE. The results of all nine subscales of the SF-36 were compared with sex- and age-adjusted Dutch population norms. Single and multivariate analyses were performed to identify independent determinants of the QoL in our study population. RESULTS: The SF-36 was completed by 392 patients. Except for the health change subscale, patients had substantially lower QoL than population norms on all eight remaining subscales. After multivariate analysis, the time interval between the last thromboembolic episode and study inclusion was inversely related to QoL, and significant determinants of poor QoL were prior PE, age, obesity, active malignancy, and cardiopulmonary comorbid conditions. Regression models that included all identified significant determinants proved to be quite modest predictors for QoL in the individual patient. Awareness of illness, coping mechanisms, and self-management behavior might be additional important indicators of QoL in our study population but require further investigation. CONCLUSION: We identified several PE- and non-PE-related determinants of QoL in patients with a history of acute PE, which is impaired compared with sex- and age-adjusted population norms. QoL after acute PE should be studied more extensively and added as a standard measure to outcome studies. TI - Quality of life in long-term survivors of acute pulmonary embolism. EP - 1440 SN - 0012-3692 IS - iss. 6 SP - 1432 JF - Chest VL - vol. 138 N1 - 1 december 2010 DO - https://doi.org/10.1378/chest.09-2482 ER - TY - JOUR AU - Klok, F.A. AU - Kralingen, K.W. van AU - Dijk, A.P.J. van AU - Heyning, F.H. AU - Vliegen, H.W. AU - Huisman, M.V. PY - 2010 UR - https://hdl.handle.net/2066/89579 AB - BACKGROUND: Chronic thromboembolic pulmonary hypertension after pulmonary embolism is associated with high morbidity and mortality. Understanding the incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism is important for evaluating the need for screening but is also a subject of debate because of different inclusion criteria among previous studies. We determined the incidence of chronic thromboembolic pulmonary hypertension after acute pulmonary embolism and the utility of a screening program for this disease. DESIGN AND METHODS: We conducted a cohort screening study in an unselected series of consecutive patients (n=866) diagnosed with acute pulmonary embolism between January 2001 and July 2007. All patients who had not been previously diagnosed with pulmonary hypertension (PH) and had survived until study inclusion were invited for echocardiography. Patients with echocardiographic suspicion of PH underwent complete work-up for chronic thromboembolic pulmonary hypertension, including ventilation-perfusion scintigraphy and right heart catheterization. RESULTS: After an average follow-up of 34 months of all 866 patients, PH was diagnosed in 19 patients by routine clinical care and in 10 by our screening program; 4 patients had chronic thromboembolic pulmonary hypertension, all diagnosed by routine clinical care. The cumulative incidence of chronic thromboembolic pulmonary hypertension after all cause pulmonary embolism was 0.57% (95% confidence interval [CI] 0.02-1.2%) and after unprovoked pulmonary embolism 1.5% (95% CI 0.08-3.1%). CONCLUSIONS: Because of the low incidence of chronic thromboembolic pulmonary hypertension after pulmonary embolism and the very low yield of the echocardiography based screening program, wide scale implementation of prolonged follow-up including echocardiography of all patients with pulmonary embolism to detect chronic thromboembolic pulmonary hypertension does not seem to be warranted. TI - Prospective cardiopulmonary screening program to detect chronic thromboembolic pulmonary hypertension in patients after acute pulmonary embolism. EP - 975 SN - 0390-6078 IS - iss. 6 SP - 970 JF - Haematologica VL - vol. 95 N1 - 1 juni 2010 DO - https://doi.org/10.3324/haematol.2009.018960 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/89579/89579.pdf?sequence=1 ER - TY - JOUR AU - Klok, F.A. AU - Kralingen, K.W. van AU - Dijk, A.P.J. van AU - Heyning, F.H. AU - Vliegen, H.W. AU - Huisman, M.V. PY - 2010 UR - https://hdl.handle.net/2066/89635 AB - BACKGROUND: The exact prevalence and etiology of exertional dyspnea in the clinical course of acute pulmonary embolism (PE) have not yet been established. METHODS: A large cohort of consecutive patients diagnosed with acute PE was subjected to a dyspnea questionnaire and invited for cardiopulmonary work-up including the 6-min walk test, spirometry and echocardiography. The prevalence, severity, determinants and underlying diseases of exertional dyspnea were evaluated. RESULTS: Of the registered 877 patients, 259 (30%) had died and 11 (1.3%) were excluded for geographical reasons. From the remaining 607 patients, 217 reported exertional dyspnea (36%; 95% CI 32-40%) 3.6 +/- 1.7 years after the PE. In 76% this dyspnea had developed or worsened after the acute PE. 421 patients completed the cardiopulmonary work-up. Cardiopulmonary comorbidity (OR 12; 95% CI 6.5-20), advanced age (OR 1.02 per year; 95% CI 1.01-1.03), higher BMI (OR 1.06 per kg/m(2); 95% CI 1.01-1.1) and a smoking history (OR 1.6; 95% CI 1.02-2.6) were identified as independent predictors of exertional dyspnea. A pre-defined dyspnea explaining diagnosis could be established in all patients with exertional dyspnea. In only 4 patients, this diagnosis was directly correlated to the acute PE. Increased severity of dyspnea was associated with decreased exercise performance (p < 0.001) and a higher number of dyspnea-related diagnoses (p < 0.001). CONCLUSION: Exertional dyspnea is a frequent symptom in the long term clinical course of acute PE. More severe dyspnea results in decreased exercise capacity and increased burden of cardiopulmonary comorbidity. This dyspnea is likely to be unrelated to the past thromboembolic event in the vast majority of patients. TI - Prevalence and potential determinants of exertional dyspnea after acute pulmonary embolism. EP - 1749 SN - 0954-6111 IS - iss. 11 SP - 1744 JF - Respiratory Medicine VL - vol. 104 N1 - 1 november 2010 DO - https://doi.org/10.1016/j.rmed.2010.06.006 ER - TY - JOUR AU - Klok, F.A. AU - Zondag, W. AU - Kralingen, K.W. van AU - Dijk, A.P.J. van AU - Tamsma, J.T. AU - Heyning, F.H. AU - Vliegen, H.W. AU - Huisman, M.V. PY - 2010 UR - https://hdl.handle.net/2066/89853 AB - RATIONALE: There is a lack of information on the long-term prognosis of patients with acute pulmonary embolism (PE). OBJECTIVES: To assess the long-term risk for adverse events after PE. METHODS: Consecutive patients diagnosed with PE between January 2001 and July 2007, and patients in whom PE was ruled out from a previous study were followed until July 2008 for the occurrence of adverse clinical events: mortality, symptomatic recurrent venous thromboembolism, cancer, arterial cardiovascular events and chronic thromboembolic pulmonary hypertension. Hazard ratios (HR) for all endpoints and a combined endpoint were calculated and adjusted for potential confounders. MEASUREMENTS AND MAIN RESULTS: Three hundred eight patients with unprovoked, 558 with provoked, and 334 without PE were studied with a median follow-up period of 3.3 years. Patients with unprovoked PE had a lower overall risk for mortality than patients with provoked PE (HR, 0.59; 95% confidence interval [CI], 0.43-0.82), but a higher risk for nonmalignancy-related mortality (HR, 1.8; 95% CI, 1.3-2.5), recurrent venous thromboembolism (HR, 2.1; 95% CI, 1.3-3.1), cancer (HR, 4.4; 95% CI, 2.0-10), cardiovascular events (HR, 2.6; 95% CI, 1.5-3.8) and chronic thromboembolic pulmonary hypertension (1.5 vs. 0%). The risk for the combined endpoint did not differ between both groups (HR, 0.98; 95% CI, 0.82-1.1). Patients without PE had similar risks for malignancy and cardiovascular events than patients with provoked PE, but lower risks for the remaining outcomes. The fraction of both patients with provoked and unprovoked PE without events after 1 year was only 70% and decreased to fewer than 60% after 2 years and fewer than 50% after 4 years, whereas this latter was 84% for the control patients. CONCLUSIONS: The clinical course of acute PE is complicated by high rates of serious adverse events, which occur in half of the patients within 4 years. TI - Patient outcomes after acute pulmonary embolism. A pooled survival analysis of different adverse events. EP - 506 SN - 1073-449X IS - iss. 5 SP - 501 JF - American Journal of Respiratory and Critical Care Medicine VL - vol. 181 DO - https://doi.org/10.1164/rccm.200907-1141OC ER - TY - JOUR AU - Duffels, M.G. AU - Mulder, K.M. AU - Trip, M.D. AU - Groot, E. de AU - Gort, J. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Daliento, L. AU - Zwinderman, A.H. AU - Berger, R.M. AU - Mulder, B.J. PY - 2010 UR - https://hdl.handle.net/2066/88391 AB - BACKGROUND: Cyanotic patients with congenital heart disease (CHD) might be protected against atherosclerosis. METHODS AND RESULTS: Atherosclerotic risk factors and carotid intima - media thickness (IMT) were investigated in adults with cyanotic CHD and in unaffected age- and sex-matched controls. Fifty-four cyanotic patients (30 men, mean age 38, range 19-60 years) and 54 controls were included. Mean transcutaneous saturation of the cyanotic patients was 81+/-6%. Mean carotid IMT adjusted for age was significantly decreased in cyanotic patients compared to controls (0.55+/-0.1 mm vs 0.58+/-0.08 mm: DeltaIMT =0.04 mm [SE 0.015], P=0.01). In cyanotic patients lower total cholesterol levels were observed (4.4+/-1 mmol/L vs 4.9+/-1 mmol/L; P=0.02), as well as lower thrombocyte levels (173+/-81 x 10(9) /L vs 255+/-54 x 10(9) /L; P<0.01), higher bilirubin levels (18.6+/-11 micromol/L vs 12.7+/-6 micromol/L; P<0.01), and lower diastolic and systolic blood pressure (71+/-9 mmHg vs 76+/-9 mmHg, P<0.01; 113+/-14 mmHg vs 124+/-12 mmHg, P<0.01, respectively). CONCLUSIONS: In patients with cyanotic CHD carotid IMT, and hence atherosclerosis disease risk, was decreased. This might be due to a combination of reduced atherosclerotic risk factors such as lower blood pressure, lower total cholesterol levels, higher bilirubin levels and lower thrombocyte levels. TI - Atherosclerosis in patients with cyanotic congenital heart disease. EP - 1441 SN - 1346-9843 IS - iss. 7 SP - 1436 JF - Circulation Journal VL - vol. 74 DO - https://doi.org/10.1253/circj.CJ-09-0858 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/88391/88391.pdf?sequence=1 ER - TY - JOUR AU - Winter, M.M. AU - Bouma, B.J. AU - Hardziyenka, M. AU - Bruin-Bon, R.H. de AU - Tan, H.L. AU - Konings, T.C. AU - Dijk, A.P.J. van AU - Mulder, B.J. PY - 2010 UR - https://hdl.handle.net/2066/88781 AB - BACKGROUND: Ventricular systolic and diastolic function, as measured by echocardiography, are diminished in patients with a systemic right ventricle (RV). As the clinical implications of these finding remained unknown, we aimed to identify echocardiographic parameters of systolic and diastolic ventricular function that are independent determinants of the clinical condition in these patients. METHODS: Forty-six adult patients (61% male; mean age 33 [range 18-69] years) with a systemic RV underwent echocardiography to assess qualitative and quantitative systolic and diastolic function of the systemic RV and the subpulmonary left ventricle (LV). Uni- and multivariate linear regression analyses were performed to identify independent echocardiographic determinants for NYHA class, maximal exercise capacity (V'O(2peak)) and NT-proBNP levels. RESULTS: We found qualitative assessment of RV and LV function to be significantly associated with NYHA class (RV: beta= 0.26; P = 0.05 and LV: beta= 0.82; P < 0.01), V'O(2peak) (RV: beta=-10.4; P < 0.05 and LV: beta=-18.4; P < 0.05) and NT-proBNP levels (RV: beta= 0.58; P < 0.01 and LV: beta= 1.40; P < 0.001). Tricuspid annulus plane systolic excursion (TAPSE) was significantly associated with NYHA class (beta=-0.92; P = 0.001), V'O(2peak) (beta= 18.5; P = 0.05), and serum NT-proBNP levels (beta=-1.00; P < 0.05). Associations between quantitative parameters of systolic subpulmonary LV function and clinical parameters were less distinct. We found no associations between RV and LV diastolic function and clinical parameters. CONCLUSIONS: Qualitative function of the systemic RV and the subpulmonary LV, and TAPSE, are determinants of clinical condition in patients with a systemic RV. These patients' clinical condition could not be determined by echocardiographically measured diastolic RV function, and systolic and diastolic LV function. TI - Echocardiographic determinants of the clinical condition in patients with a systemic right ventricle. EP - 1255 SN - 0742-2822 IS - iss. 10 SP - 1247 JF - Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques VL - vol. 27 N1 - 1 november 2010 DO - https://doi.org/10.1111/j.1540-8175.2010.01233.x ER - TY - JOUR AU - Verheugt, C.L. AU - Uiterwaal, C.S. AU - Velde, E.T. van der AU - Meijboom, F.J. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Vliegen, H.W. AU - Grobbee, D.E. AU - Mulder, B.J. PY - 2010 UR - https://hdl.handle.net/2066/89235 AB - AIMS: Mortality in adults with congenital heart disease is known to be increased, yet its extent and the major mortality risks are unclear. METHODS AND RESULTS: The Dutch CONCOR national registry for adult congenital heart disease was linked to the national mortality registry. Cox's regression was used to assess mortality predictors. Of 6933 patients, 197 (2.8%) died during a follow-up of 24 865 patient-years. Compared with the general national population, there was excess mortality, particularly in the young. Median age at death was 48.8 years. Of all deaths, 77% had a cardiovascular origin; 45% were due to chronic heart failure (26%, age 51.0 years) or sudden death (19%, age 39.1 years). Age predicted mortality, as did gender, severity of defect, number of interventions, and number of complications [hazard ratio (HR) range 1.1-5.9, P < 0.05]. Several complications predicted all-cause mortality beyond the effects of age, gender, and congenital heart disease severity, i.e. endocarditis, supraventricular arrhythmias, ventricular arrhythmias, conduction disturbances, myocardial infarction, and pulmonary hypertension (HR range 1.4-3.1, P < 0.05). These risks were similar in patients above and below 40 years of age. Almost all complications predicted death due to heart failure (HR range 2.0-5.1, P < 0.05); conduction disturbances and pulmonary hypertension predicted sudden death (HR range 2.0-4.7, P < 0.05). CONCLUSION: Mortality is increased in adults with congenital heart disease, particularly in the young. The vast majority die from cardiovascular causes. Mortality risk, particularly by heart failure, is increased by virtually all complications. Complications are equally hazardous in younger as in older patients. TI - Mortality in adult congenital heart disease. EP - 1229 SN - 0195-668X IS - iss. 10 SP - 1220 JF - European Heart Journal VL - vol. 31 N1 - 1 mei 2010 DO - https://doi.org/10.1093/eurheartj/ehq032 ER - TY - JOUR AU - Winter, M.M. AU - Reisma, C. AU - Kedde, H. AU - Bouma, B.J. AU - Vis, J.C. AU - Luijendijk, P. AU - Witte, P. de AU - Zwinderman, A.H. AU - Vliegen, H.W. AU - Pieper, P.G. AU - Dijk, A.P.J. van AU - Mulder, B.J. PY - 2010 UR - https://hdl.handle.net/2066/89274 AB - Data on relational and sexuality issues in adult patients with congenital heart disease (CHD) are scarce. The present study aimed to evaluate relational and sexual behaviors, satisfaction, and functioning in a representative sample of patients with CHD and their partners. In addition, we aimed to evaluate the relation between sexuality parameters and quality of life. Relational and sexuality issues were assessed using a sexuality questionnaire in 133 patients (52% men, 37 +/- 13 years old) with CHD (43 with coarctation of the aorta, 42 with transposition of great arteries, 36 with Marfan syndrome, and 12 with Eisenmenger syndrome), and 74 partners. Quality of life was assessed using the Dutch translation of the Medical Outcomes Study Short Form 36-Item Health Survey. Data were compared to an age- and gender-matched control group (n = 3,642). Seventy-one percent of patients with CHD were involved in a relationship, which was significantly less compared to controls (79%, p < 0.05). Nonetheless, patients perceived their relationship as more satisfactory compared to controls (p < 0.05). Overall, sexual satisfaction was equal in patients compared to controls, although they perceived lower body esteem (p < 0.001), decreased sexual esteem (p < 0.05), and more distress during sex (p < 0.001). Patients reported no more erectile and lubrication problems compared to partners and to controls. We found significant associations between most relational and sexual parameters and quality of life. In conclusion, many aspects of sexuality are affected in adult patients with CHD, whereas their partners remain relatively unaffected. Moreover, sexuality is an important aspect of quality of life in these patients. We advise physicians to be receptive to discuss sexuality issues and provide patients with adequate therapy. TI - Sexuality in adult patients with congenital heart disease and their partners. EP - 8 SN - 0002-9149 IS - iss. 8 SP - 1163-8, 1168.e1 JF - American Journal of Cardiology VL - vol. 106 DO - https://doi.org/10.1016/j.amjcard.2010.06.027 ER - TY - JOUR AU - Drenthen, W. AU - Boersma, E. AU - Balci, A. AU - Moons, P. AU - Roos-Hesselink, J.W. AU - Mulder, B.J. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Voors, A.A. AU - Yap, S.C. AU - Veldhuisen, D.J. van AU - Pieper, P.G. PY - 2010 UR - https://hdl.handle.net/2066/89656 AB - AIMS: Data regarding pregnancy outcome in women with congenital heart disease (CHD) are limited. METHODS AND RESULTS: In 1802 women with CHD, 1302 completed pregnancies were observed. Independent predictors of cardiac, obstetric, and neonatal complications were calculated using logistic regression. The most prevalent cardiac complications during pregnancy were arrhythmias (4.7%) and heart failure (1.6%). Factors independently associated with maternal cardiac complications were the presence of cyanotic heart disease (corrected/uncorrected) (P < 0.0001), the use of cardiac medication before pregnancy (P < 0.0001), and left heart obstruction (P < 0.0001). New characteristics were mechanical valve replacement (P = 0.0014), and systemic (P = 0.04) or pulmonary atrioventricular valve regurgitation related with the underlying (moderately) complex CHD (P = 0.03). A new risk score for cardiac complications is proposed. The most prevalent obstetric complications were hypertensive complications (12.2%). No correlation of maternal characteristics with adverse obstetric outcome was found. The most prevalent neonatal complications were premature birth (12%), small for gestational age (14%), and mortality (4%). Cyanotic heart disease (corrected/uncorrected) (P = 0.0003), mechanical valve replacement (P = 0.03), maternal smoking (P = 0.007), multiple gestation (P = 0.0014), and the use of cardiac medication (P = 0.0009) correlated with adverse neonatal outcome. CONCLUSION: In our tertiary CHD cohort, cardiac, obstetric, and neonatal complications were frequently encountered, and (new) correlations of maternal baseline data with adverse outcome are reported. A new risk score for adverse cardiac complications is proposed, although prospective validation remains necessary. TI - Predictors of pregnancy complications in women with congenital heart disease. EP - 2132 SN - 0195-668X IS - iss. 17 SP - 2124 JF - European Heart Journal VL - vol. 31 N1 - 1 september 2010 DO - https://doi.org/10.1093/eurheartj/ehq200 ER - TY - JOUR AU - Zandstra, M. AU - Stekkinger, E. AU - Vlugt, M.J. van der AU - Dijk, A.P.J. van AU - Lotgering, F.K. AU - Spaanderman, M.E.A. PY - 2010 UR - https://hdl.handle.net/2066/88168 AB - OBJECTIVE: To estimate whether women with a recent history of a placental syndrome and concomitant metabolic syndrome have reduced cardiac diastolic function. METHODS: In this cohort study, women with a history of a placental syndrome were included. We assessed body mass index, blood pressure, fasting serum lipids, glucose and insulin levels, and 24-hour urinary protein and albumin output after an interval of at least 6 months postpartum. Cardiac diastolic function was assessed by echocardiography. RESULTS: Metabolic syndrome was found in 22% of the women evaluated. Diastolic dysfunction was seen in 24% of the women with the metabolic syndrome compared with 6.3% in those without (odds ratio 4.77, 95% confidence interval 2.18-10.41; adjusted odds ratio 6.09, 95% confidence interval 2.64-14.04). Univariable analysis showed that all the constituents of the metabolic syndrome related to diastolic dysfunction. CONCLUSION: In women with a history of placental syndrome complicating pregnancy, the presence of metabolic syndrome increases the risk of cardiac diastolic dysfunction fourfold. LEVEL OF EVIDENCE: II. TI - Cardiac diastolic dysfunction and metabolic syndrome in young women after placental syndrome. EP - 108 SN - 0029-7844 IS - iss. 1 SP - 101 JF - Obstetrics and Gynecology VL - vol. 115 N1 - 1 januari 2010 DO - https://doi.org/10.1097/AOG.0b013e3181c4f1e8 ER - TY - JOUR AU - Beek, E. van AU - Binkhorst, M. AU - Hoog, M. de AU - Groot, P.C.E. de AU - Dijk, A.P.J. van AU - Schokking, M. AU - Hopman, M.T.E. PY - 2010 UR - https://hdl.handle.net/2066/88660 AB - The exercise capacity of children after arterial switch for transposition of the great arteries (TGA) is known to be at the lower limit of normal. We aimed to ascertain whether this results from compromised hemodynamics or deconditioning. A total of 17 children with TGA (12 male and 5 female children; age 12.1 + or - 2.0 years) treated with the arterial switch operation were compared with 20 age-matched controls (13 male and 7 female children; age 12.8 + or - 2.4 years) regarding their peak exercise capacity, peak workload, and peak heart rate, as assessed by cycle ergometry. The children's physical activity level was monitored for a 7-day period using a pedometer and diary, and a questionnaire was used to assess physical activity participation and overprotection. The results demonstrated that TGA children showed a significantly reduced peak exercise capacity (47.4 + or - 6.4 vs 41.1 + or - 6.6 ml/kg/min; p <0.05), maximal workload (3.7 + or - 0.5 vs 3.1 + or - 0.6 W/kg; p <0.01), and maximal heart rate (189 + or - 9 vs 180 + or - 14 beats/min; p <0.05) compared to the controls. No significant differences were found in the physical activity pattern or overprotection. In conclusion, given the comparable physical activity level, but reduced exercise capacity in the TGA children, these children most likely fall short in their exercise performance because of restrictive hemodynamics rather than deconditioning from reduced daily life activity. TI - Exercise performance and activity level in children with transposition of the great arteries treated by the arterial switch operation. EP - 403 SN - 0002-9149 IS - iss. 3 SP - 398 JF - American Journal of Cardiology VL - vol. 105 DO - https://doi.org/10.1016/j.amjcard.2009.09.048 ER - TY - JOUR AU - Nijboer, W.N. AU - Ottens, P.J. AU - Dijk, A.P.J. van AU - Goor, H. van AU - Ploeg, R.J. AU - Leuvenink, H.G. PY - 2010 UR - https://hdl.handle.net/2066/88860 AB - OBJECTIVE: We hypothesized that donor treatment of deceased brain dead donors would lead to a decrease in inflammatory responses seen in brain death and lead to a restoration of kidney function. DESIGN: A standardized slow-induction rat brain death model followed by evaluation of kidney function in an isolated perfused kidney model. SETTINGS: Surgery Research Laboratory, University Medical Center Groningen, the Netherlands. SUBJECTS: Male Fisher rats. INTERVENTIONS: Donor treatment with erythropoietin, carbamylated erythropoietin, which lacks erythropoietic activity, or vehicle. MEASUREMENTS AND MAIN RESULTS: In brain death, carbamylated erythropoietin and, to a lesser extent, erythropoietin were able to decrease the expression of several proinflammatory genes and to decrease the infiltration of polymorphonuclear cells in the kidney. No effect on tubular injury parameters was seen. Kidney function decreased almost by 50% after brain death but was fully restored after treatment with both carbamylated erythropoietin and erythropoietin. CONCLUSIONS: Carbamylated erythropoietin can inhibit the inflammatory response caused by brain death more effectively than erythropoietin, whereas both substances can restore kidney function after brain death. TI - Donor pretreatment with carbamylated erythropoietin in a brain death model reduces inflammation more effectively than erythropoietin while preserving renal function. EP - 1161 SN - 0090-3493 IS - iss. 4 SP - 1155 JF - Critical Care Medicine VL - vol. 38 N1 - 1 april 2010 DO - https://doi.org/10.1097/CCM.0b013e3181cf6e78 ER - TY - JOUR AU - Yap, S.C. AU - Drenthen, W. AU - Pieper, P.G. AU - Moons, P. AU - Mulder, B.J. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Meijboom, F.J. AU - Jaddoe, V.W. AU - Steegers, E.A.P. AU - Boersma, E. AU - Roos-Hesselink, J.W. PY - 2010 UR - https://hdl.handle.net/2066/89661 AB - OBJECTIVE: To compare the risks of pregnancy complications in women with repaired and unrepaired isolated ventricular septal defect (VSD). DESIGN: A retrospective multicentre study. SETTING: Tertiary centres in the Netherlands and Belgium. METHODS: Women were identified using two congenital heart disease registries. Eighty-eight women were identified who had experienced 202 pregnancies, including 46 miscarriages and nine terminations of pregnancy. Information on each completed pregnancy (n = 147; unrepaired VSD, n = 104; repaired VSD, n = 43) was obtained using medical records and telephone interviews. Data from the Generation R database (prospective cohort study; n = 9667) were used to determine the background risk (controls). Odds ratios and 95% CI were estimated using general estimation equation analysis adjusted for multiple pregnancies per woman, maternal age and parity status. MAIN OUTCOME MEASURES: Adjusted odds ratios (AORs) for developing pregnancy complications in relation to corrective status. RESULTS: Pregnancies in women with an unrepaired VSD were associated with a higher risk of pre-eclampsia (AOR 4.59, 95% CI 2.01-10.5, P < 0.001) compared with controls. No differences were observed when comparing women with repaired VSD and controls. Pregnancies in women with repaired VSD were associated with a higher risk of premature labour (AOR 4.02, 95% CI 1.12-14.4, P = 0.03) and small-for-gestational-age (SGA) births (AOR 4.09, 95% CI 1.27-13.2, P = 0.02) compared with women with unrepaired VSD. CONCLUSIONS: Women with unrepaired VSD are at increased risk of pre-eclampsia, which suggests that it is not a benign condition. In addition, women with repaired VSD are at increased risk of premature labour and SGA births compared with women with unrepaired VSD. TI - Pregnancy outcome in women with repaired versus unrepaired isolated ventricular septal defect. EP - 689 SN - 1470-0328 IS - iss. 6 SP - 683 JF - Bjog : an International Journal of Obstetrics and Gynaecology VL - vol. 117 N1 - 1 mei 2010 DO - https://doi.org/10.1111/j.1471-0528.2010.02512.x ER - TY - JOUR AU - Vos, F.J. AU - Bleeker-Rovers, C.P. AU - Sturm, P.D.J. AU - Krabbe, P.F.M. AU - Dijk, A.P.J. van AU - Cuijpers, M.L.H. AU - Adang, E.M.M. AU - Wanten, G.J.A. AU - Kullberg, B.J. AU - Oyen, W.J.G. PY - 2010 UR - https://hdl.handle.net/2066/89699 AB - The timely detection of metastatic infectious foci in gram-positive bacteremia is crucial, because these foci often require prolonged antibiotic treatment or drainage. The diagnosis of metastatic infectious foci is difficult because localizing symptoms are often absent. We investigated whether (18)F-FDG PET/CT was able to detect such foci and whether detection influenced clinical outcome. METHODS: One hundred fifteen nonneutropenic patients with gram-positive bacteremia were prospectively included. Patients with positive blood cultures growing Staphylococcus aureus, Streptococcus species, or Enterococcus species were eligible when a risk factor for developing metastatic infectious foci was present. (18)F-FDG PET/CT was performed within 2 wk after the first positive blood culture. Abnormal (18)F-FDG uptake had to be confirmed by radiologic, microbiologic, or pathologic studies. Results were compared with a matched historical control group of 230 patients in whom no (18)F-FDG PET/CT was performed. RESULTS: Significantly more patients were diagnosed with metastatic foci in the study group (67.8% vs. 35.7%). Of the imaging investigations performed, (18)F-FDG PET/CT was the first to delineate infectious foci in 35 patients (30%). In the remaining 70%, either symptoms on physical examination or other imaging techniques first revealed infectious foci. The sensitivity, specificity, negative predictive value, and positive predictive value of (18)F-FDG PET/CT were 100%, 87%, 100%, and 89%, respectively. Relapse rates decreased from 7.4% to 2.6% among study patients (P = 0.09) and from 8.9% to 1.4% in patients with S. aureus (P = 0.04). Overall mortality after 6 mo decreased from 32.2% to 19.1% in the (18)F-FDG PET/CT group (P = 0.014). CONCLUSION: In the diagnostic work-up of high-risk patients with gram-positive bacteremia, (18)F-FDG PET/CT is a valuable technique that results in lower mortality rates. In patients with S. aureus bacteremia, relapse rates decreased significantly after the addition of (18)F-FDG PET/CT. TI - 18F-FDG PET/CT for detection of metastatic infection in gram-positive bacteremia. EP - 1240 SN - 0161-5505 IS - iss. 8 SP - 1234 JF - The Journal of Nuclear Medicine (1978) VL - vol. 51 N1 - 1 augustus 2010 DO - https://doi.org/10.2967/jnumed.109.072371 ER - TY - JOUR AU - Vonk, M.C. AU - Broers, B. AU - Heijdra, Y.F. AU - Ton, E. AU - Snijder, R. AU - Dijk, A.P.J. van AU - Laar, J.M. van AU - Bootsma, H.J. AU - Hal, P.T. van AU - Hoogen, F.H.J. van den AU - Daele, P.L. van PY - 2009 UR - https://hdl.handle.net/2066/81439 AB - The prevalence and incidence of systemic sclerosis (SSc) in The Netherlands is unknown. The same holds true for its leading causes of death: pulmonary fibrosis and pulmonary arterial hypertension (PAH), for which effective treatment options have recently become available. OBJECTIVE: To establish the prevalence and incidence of SSc and its pulmonary complications. METHODS: Detailed information on patients in the POEMAS registry, "Pulmonary Hypertension Screening, a Multidisciplinary Approach in Scleroderma", consisting of 819 patients, was combined with a nationwide questionnaire. RESULTS: By combining the two sources the prevalence of SSc was found to be 8.9 per 100 000 adults. The incidence was 0.77 patients per 100 000 per year. PAH was diagnosed in 9.9% of SSc patients. The prevalence of interstitial lung disease in SSc varied from 19% to 47% depending on the definition used. CONCLUSION: This study clarifies the epidemiology of SSc in The Netherlands and confirms the frequent occurrence of pulmonary complications, based on 654 cases. This can and will be studied further in the ongoing POEMAS study. TI - Systemic sclerosis and its pulmonary complications in The Netherlands: an epidemiological study. EP - 965 SN - 0003-4967 IS - iss. 6 SP - 961 JF - Annals of the Rheumatic Diseases VL - vol. 68 DO - https://doi.org/10.1136/ard.2008.091710 ER - TY - JOUR AU - Duffels, M.G. AU - Plas, M.N. van der AU - Surie, S. AU - Winter, M.M. AU - Bouma, B. AU - Groenink, M. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Berger, R.M. AU - Bresser, P. AU - Mulder, B.J. PY - 2009 UR - https://hdl.handle.net/2066/80796 AB - Background. In patients with pulmonary hypertension, it is unknown whether the treatment effect of bosentan is dependent on the duration of pulmonary vessel changes. Therefore, we studied the response to bosentan in patients with life-long pulmonary vessel changes (pulmonary arterial hypertension (PAH) due to congenital heart disease (CHD)) and in patients with subacutely induced pulmonary vessel changes (chronic thromboembolic pulmonary hypertension (CTEPH)).Methods. In this open-label study, 18 patients with PAH due to CHD and 16 patients with CTEPH were treated with bosentan for at least one year. All patients were evaluated at baseline and during follow-up by means of the six-minute walk distance (6-MWD) and laboratory tests.Results. Improvement of 6-MWD was comparable in patients with PAH due to CHD (444+/-112 m to 471+/-100 m, p=0.02), and in CTEPH (376+/-152 m to 423+/-141 m, p=0.03) after three months of treatment. After this improvement, 6-MWD stabilised in both groups.Conclusion. Although duration of pulmonary vessel changes is strikingly different in patients with PAH due to CHD and CTEPH, the effect of one year of bosentan treatment was comparable. The main treatment effect appears to be disease stabilisation and decreasing the rate of deterioration. (Neth Heart J 2009;17:334-8.). TI - Bosentan in pulmonary arterial hypertension: a comparison between congenital heart disease and chronic pulmonary embolism. EP - 338 SN - 1568-5888 IS - iss. 9 SP - 334 JF - Netherlands Heart Journal VL - vol. 17 DO - https://doi.org/10.1007/BF03086279 ER - TY - JOUR AU - Duffels, M.G. AU - Vis, J.C. AU - Loon, R.L. van AU - Nieuwkerk, P.T. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Bruin-Bon, R.H. de AU - Bouma, B.J. AU - Bresser, P. AU - Berger, R.M. AU - Mulder, B.J. PY - 2009 UR - https://hdl.handle.net/2066/80845 AB - Pulmonary arterial hypertension associated with congenital heart disease caused by systemic-to-pulmonary shunting was associated with a high risk of morbidity and mortality. In this retrospective study, the longer term treatment effect of bosentan on exercise capacity and quality of life (QoL) were evaluated in 58 adult patients (>18 years) with pulmonary arterial hypertension associated with congenital heart disease, including patients with Down's syndrome. All patients were evaluated at baseline and during follow-up using laboratory tests, 6-minute walk test, QoL questionnaires, and Doppler echocardiography. Treatment efficacy was analyzed separately for patients without (n = 30) and with Down's syndrome (n = 28). Median follow-up of all patients treated with bosentan was 22 months (range 3 to 36). In patients without Down's syndrome, mean 6-minute walk distance increased from 427 +/- 97 to 461 +/- 104 m (p <0.01) after 6 months of treatment, followed by a gradual return to baseline and disease stabilization. QoL improved significantly during treatment and was maintained during 18 months of follow-up (p <0.05). In patients with Down's syndrome, 6-minute walk distance and QoL were stable during treatment. In conclusion, findings suggested that in patients without Down's syndrome, longer term bosentan treatment resulted in a persistent improvement in QoL and stabilization of exercise capacity. TI - Effect of bosentan on exercise capacity and quality of life in adults with pulmonary arterial hypertension associated with congenital heart disease with and without Down's syndrome. EP - 1315 SN - 0002-9149 IS - iss. 9 SP - 1309 JF - American Journal of Cardiology VL - vol. 103 DO - https://doi.org/10.1016/j.amjcard.2009.01.021 ER - TY - JOUR AU - Duffels, M.G. AU - Vis, J.C. AU - Loon, R.L. van AU - Berger, R.M. AU - Hoendermis, E.S. AU - Dijk, A.P.J. van AU - Bouma, B.J. AU - Mulder, B.J. PY - 2009 UR - https://hdl.handle.net/2066/80912 AB - BACKGROUND: Favorable results of treatment with bosentan in patients with Eisenmenger syndrome are available. However, data in Down patients are lacking. In this study, we evaluate the therapeutic role of bosentan treatment in Down patients with Eisenmenger syndrome. METHODS: In this open-label study, 24 Down patients (>18 years) with Eisenmenger syndrome (17 males) were treated with bosentan. Their mean age was 38 years (range 19-55 years). All Down patients were evaluated at baseline and during follow-up with laboratory tests, six-minute walk test (6-MWT), Doppler echocardiography, and quality of life questionnaires. RESULTS: The median follow-up of Down patients treated with bosentan was 11.5 months (range 3-23 months). Induction of oral bosentan therapy was well tolerated among all 24 Down patients. Bosentan treatment was generally well tolerated. No serious adverse drug reactions were noted. Median 6-MWT increased from 296 m (range 40-424 m) to 325 m (range 84-459 m, p<0.05) after 12 weeks. After 26 and 52 weeks of treatment with bosentan, median 6-MWT distance was 276 m (range 140-462 m, n=15, p=0.6) and 287 m (range 131-409 m, n=7, p=0.3), respectively. Quality of life questionnaire scores remained stable during treatment. CONCLUSION: Also patients with Down syndrome may benefit from bosentan treatment when they have Eisenmenger syndrome. Medical treatment appears to be safe and the treatment effects do not deviate from those observed in Eisenmenger patients without Down syndrome. TI - Down patients with Eisenmenger syndrome: Is bosentan treatment an option? EP - 383 SN - 0167-5273 IS - iss. 3 SP - 378 JF - International Journal of Cardiology VL - vol. 134 DO - https://doi.org/10.1016/j.ijcard.2008.02.025 ER - TY - JOUR AU - Duffels, M.G. AU - Hardziyenka, M. AU - Surie, S. AU - Bruin-Bon, R.H. de AU - Hoendermis, E.S. AU - Dijk, A.P.J. van AU - Bouma, B.J. AU - Tan, H.L. AU - Berger, R.M. AU - Bresser, P. AU - Mulder, B.J. PY - 2009 UR - https://hdl.handle.net/2066/80922 AB - AIMS: In patients with pulmonary hypertension (PH), elevated endothelin-1 levels are associated with prolonged duration of right ventricular (RV) contraction, which induces leftward ventricular septal bowing with impaired left diastolic filling. We hypothesized that baseline RV contraction duration predicts efficacy of endothelin receptor antagonist, bosentan. METHODS AND RESULTS: Eighteen PH patients (age 57, range 35-79 years, 33% male) received bosentan. Six minute walk distance (6-MWD) and echocardiography were performed at baseline and after 1 year follow-up. After 1 year of treatment, 6-MWD increased (mean 60 +/- 41 m) in 67% of patients (responders). Baseline RV contraction duration was longer in responders, compared with non-responders (612 +/- 66 vs. 514 +/- 23 ms; P < 0.01). A baseline RV contraction duration >550 ms was associated with improved 6-MWD (sensitivity 83%, specificity 83%; P < 0.01). CONCLUSION: An improvement of 6-MWD during bosentan treatment was associated with a decrease in RV contraction duration and could be predicted by a baseline RV contraction duration >550 ms. TI - Duration of right ventricular contraction predicts the efficacy of bosentan treatment in patients with pulmonary hypertension. EP - 438 SN - 1525-2167 IS - iss. 3 SP - 433 JF - European Journal of Echocardiography VL - vol. 10 DO - https://doi.org/10.1093/ejechocard/jen308 ER - TY - JOUR AU - Vis, J.C. AU - Thoonsen, H. AU - Duffels, M.G. AU - Bruin-Bon, R.A. de AU - Huisman, S.A. AU - Dijk, A.P.J. van AU - Hoendermis, E.S. AU - Berger, R.M. AU - Bouma, B.J. AU - Mulder, B.J. PY - 2009 UR - https://hdl.handle.net/2066/81543 AB - OBJECTIVES: To examine the validity of the six-minute walk test (6MWT) as a tool to evaluate functional exercise performance in patients with Down syndrome (DS). DESIGN: Comparison of the six-minute walk distance (6MWD) in 2 distinct groups of DS patients: with and without severe cardiac disease. To test reproducibility, a group of patients with DS performed the 6MWT twice. SETTING: Tertiary referral centers for patients with congenital heart defects and outpatient clinics for people with intellectual disabilities. PARTICIPANTS: Adult patients with DS with (n=29) and without (n=52) severe cardiac disease categorized by cardiac echocardiography. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Distance walked on the 6MWT. RESULTS: The mean 6MWD in the group with severe cardiac disease was 289+/-104 m and in the group without severe cardiac disease 280+/-104 m (P=.70). Older age, female sex, and severe level of intellectual disability were all found to be independently and significantly correlated with a lower 6MWD (r=.67, P<.001). The paired 6MWD was not significantly different (310+/-88 m vs 317+/-85 m; P=.40) in patients who performed the 6MWT twice. The coefficient of variation was 11%. CONCLUSIONS: The 6MWD between the 2 groups was not significantly different. However, the walking distance inversely correlated with the level of intellectual disability. Therefore, the 6MWT is not a valid test to examine cardiac restriction in adult patients with DS. TI - Six-minute walk test in patients with Down syndrome: validity and reproducibility. EP - 1427 SN - 0003-9993 IS - iss. 8 SP - 1423 JF - Archives of Physical Medicine and Rehabilitation VL - vol. 90 DO - https://doi.org/10.1016/j.apmr.2009.02.015 ER - TY - JOUR AU - Yap, S.C. AU - Drenthen, W. AU - Meijboom, F.J. AU - Moons, P. AU - Mulder, B.J. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Jaddoe, V.W. AU - Steegers, E.A.P. AU - Roos-Hesselink, J.W. AU - Pieper, P.G. PY - 2009 UR - https://hdl.handle.net/2066/81862 AB - OBJECTIVE: To compare the risks of complications during pregnancy in women with repaired and unrepaired atrial septal defects (ASDs) without associated complex cardiac lesions. DESIGN: A retrospective multicentre study. SETTING: Tertiary centres in the Netherlands and Belgium. POPULATION: Women with ASD without associated complex cardiac lesions. METHODS: Women were identified using two congenital heart disease registries. One hundred women were identified who had 243 pregnancies, including 49 miscarriages and six terminations of pregnancy. Detailed information on each completed pregnancy (n = 188; unrepaired ASD, n = 133; repaired ASD, n = 55) was obtained using medical records and telephone interviews. In addition, data from the Generation R database (a prospective cohort study; n = 9667) were used to determine the background risk (control group). MAIN OUTCOME MEASURES: Adjusted odds ratios (AORs) for cardiac, obstetric and neonatal events controlled for multiple pregnancies per woman using general estimating equation analysis. RESULTS: Women with an unrepaired ASD had a higher risk of neonatal events (AOR = 2.99, 95% confidence interval [CI] 1.14-7.89, P = 0.027) than women with a repaired ASD. The risk of cardiac and obstetric complications was comparable between women with unrepaired and repaired ASDs. Compared with the general population, women with an unrepaired ASD had higher risks of pre-eclampsia (AOR = 3.54, 95% CI 1.26-9.98, P = 0.017), small-for-gestational-age births (AOR = 1.95, 95% CI 1.15-3.30, P = 0.013) and fetal mortality (AOR = 5.55, 95% CI 1.77-17.4, P = 0.003). By contrast, no differences were observed when comparing women with a repaired ASD versus controls. CONCLUSIONS: Women with an unrepaired ASD are at increased risk of neonatal events in comparison with women with a repaired ASD. Compared with the general population, women with an unrepaired ASD are at increased risk of pre-eclampsia, small-for-gestational-age births and fetal mortality. TI - Comparison of pregnancy outcomes in women with repaired versus unrepaired atrial septal defect. EP - 1601 SN - 1470-0328 IS - iss. 12 SP - 1593 JF - Bjog : an International Journal of Obstetrics and Gynaecology VL - vol. 116 DO - https://doi.org/10.1111/j.1471-0528.2009.02301.x ER - TY - JOUR AU - Mulder, A.H. AU - Dijk, A.P.J. van AU - Smits, P. AU - Tack, C.J.J. PY - 2008 UR - https://hdl.handle.net/2066/71261 AB - OBJECTIVE: Muscle capillary perfusion can be measured by contrast-enhanced ultrasound. We examined whether a less time-consuming ultrasound technique, called "real-time imaging," could be used to measure capillary recruitment in human forearm skeletal muscle. METHODS: We measured microvascular blood volume and microvascular flow velocity using bolus injections of contrast microbubbles after forearm muscle exercise and a two-hour infusion of insulin into the brachial artery (both associated with capillary recruitment) and after sodium nitroprusside infusion (no changes in flow distribution). RESULTS: After an intravenous bolus injection of the contrast agent, the steady-state concentration of contrast agent in forearm muscle lasted long enough (approximately 190 seconds) for the duration of the measurements (which take 70-80 seconds), rendering the continuous infusion of microbubbles unnecessary. Microvascular blood-volume measurements showed a good short-time reproducibility and a good reproducibility after repositioning of the forearm. Reproducibility of microvascular flow velocity was too low. Exercise and insulin infusion both increased microvascular blood volume, consistent with capillary recruitment. Sodium nitroprusside had no effect. CONCLUSION: Real-time contrast imaging, after bolus injections of an ultrasound contrast agent, provides reliable information about capillary recruitment in human forearm skeletal muscle, and may offer a valuable tool in studying human (patho)physiology. TI - Real-time contrast imaging: a new method to monitor capillary recruitment in human forearm skeletal muscle. EP - 213 SN - 1073-9688 IS - iss. 3 SP - 203 JF - Microcirculation VL - vol. 15 DO - http://dx.doi.org/10.1080/10739680701610681 ER - TY - JOUR AU - Pieper, P.G. AU - Balci, A. AU - Dijk, A.P.J. van PY - 2008 UR - https://hdl.handle.net/2066/71380 AB - Pregnancy in women with mechanical valve prostheses has a high maternal complication rate including valve thrombosis and death. Coumarin derivatives are relatively safe for the mother with a lower incidence of valve thrombosis than un-fractionated and low-molecular-weight heparin, but carry the risk of embryopathy, which is probably dose-dependent. The different anticoagulation regimens are discussed in this review. When valve thrombosis occurs during pregnancy, thrombolysis is the preferable therapeutic option. Bioprostheses have a more favourable pregnancy outcome than mechanical prostheses but due to the high re-operation rate in young women they do not constitute the ideal alternative. When women with native valve stenosis need pre-pregnancy intervention, mitral balloon valvuloplasty is the best option in mitral stenosis, while the Ross operation or homograft implantation may be the preferable surgical regimen in aortic stenosis. (Neth Heart J 2008;16:406-11.). TI - Pregnancy in women with prosthetic heart valves. EP - 411 SN - 1568-5888 IS - iss. 12 SP - 406 JF - Netherlands Heart Journal VL - vol. 16 DO - https://doi.org/10.1007/BF03086187 ER - TY - JOUR AU - Verheugt, C.L. AU - Uiterwaal, C.S. AU - Velde, E.T. van der AU - Meijboom, F.J. AU - Pieper, P.G. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Bouma, B.J. AU - Grobbee, D.E. AU - Mulder, B.J.M. PY - 2008 UR - https://hdl.handle.net/2066/70221 AB - BACKGROUND: Gender differences in prognosis have frequently been reported in cardiovascular disease but less so in congenital heart disease. We investigated whether gender is associated with outcome in adult patients with congenital heart disease. METHODS AND RESULTS: From the CONgenital CORvitia (CONCOR) national registry for adults with congenital heart disease, 7414 patients were identified. All outcomes before entry into the registry and during subsequent follow-up were recorded, and differences between men and women were analyzed with the underlying congenital heart defect taken into account. Median age at the end of follow-up was 35 years (range, 17 to 91 years); 49.8% were female. No gender difference in mortality was found. Women had a 33% higher risk of pulmonary hypertension (odds ratio [OR]=1.33; 95% CI, 1.07 to 1.65; P=0.01), a 33% lower risk of aortic outcomes (OR=0.67; 95% CI, 0.50 to 0.90; P=0.007), a 47% lower risk of endocarditis (OR=0.53; 95% CI, 0.40 to 0.70; P<0.001), and a 55% lower risk of an implantable cardioverter-defibrillator (OR=0.45; 95% CI, 0.26 to 0.80; P=0.006). Furthermore, the risk of arrhythmias appeared to be lower in women (OR=0.88; 95% CI, 0.77 to 1.02; P=0.08). CONCLUSIONS: The risk of several major cardiac outcomes in adult patients with congenital heart disease appears to vary by gender. TI - Gender and outcome in adult congenital heart disease. EP - 32 SN - 0009-7322 IS - iss. 1 SP - 26 JF - Circulation VL - vol. 118 DO - https://doi.org/10.1161/CIRCULATIONAHA.107.758086 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/70221/70221.pdf?sequence=1 ER - TY - JOUR AU - Winter, M.M. AU - Bouma, B.J. AU - Dijk, A.P.J. van AU - Groenink, M. AU - Nieuwkerk, P.T. AU - Plas, M.N. van der AU - Sieswerda, G.T. AU - Konings, T.C. AU - Mulder, B.J.M. PY - 2008 UR - https://hdl.handle.net/2066/71206 AB - Exercise is recommended in patients with left ventricular failure. Although right ventricular failure is common in patients with a systemic right ventricle (RV), no data are available on the effect of physical activity in these patients. The aim of this study was to evaluate the relation of physical activity and cardiac function, exercise capacity, and quality of life in patients with a systemic RV. Forty-seven patients (64% men, mean age 35 years, range 21 to 69) with a systemic RV (31 with an atrially switched transposition of the great arteries and 16 with a congenitally corrected transposition of the great arteries) were included. Cardiac function was assessed by cardiovascular magnetic resonance or computed tomography, exercise tests, and serum N-terminal prohormone brain natriuretic peptide (NT-pro-BNP) levels. Habitual physical activity was assessed using the Short Questionnaire to Assess Health-Enhancing Physical Activity (SQUASH) and quality of life using the Medical Outcomes Study Short Form 36-Item Health Survey. Mean systemic right ventricular ejection fraction was impaired (36.8 +/- 7.8%), as was maximal exercise capacity (78.5 +/- 23.9% of predicted). NT-pro-BNP level was increased (median 269 ng/L, range 34 to 4,476). Mean SQUASH score was 6,808 +/- 3,241, indicating a decreased level of habitual physical activity. Although patients' scores on mental quality-of-life domains were comparable to the general population, scores on most physical quality-of-life domains were significantly lower. SQUASH scores were found to be a significant predictor for exercise capacity (p <0.01) and physical quality of life (p <0.001). However, we found no relation between SQUASH scores and right ventricular ejection fraction or NT-pro-BNP. In conclusion, physical activity in patients with a systemic RV is positively associated with exercise capacity and quality of life, irrespective of cardiac performance. TI - Relation of physical activity, cardiac function, exercise capacity, and quality of life in patients with a systemic right ventricle. EP - 1262 SN - 0002-9149 IS - iss. 9 SP - 1258 JF - American Journal of Cardiology VL - vol. 102 DO - https://doi.org/10.1016/j.amjcard.2008.06.053 ER - TY - JOUR AU - Drenthen, W. AU - Hoendermis, E.S. AU - Moons, P. AU - Heida, K.Y. AU - Roos-Hesselink, J.W. AU - Mulder, B.J.M. AU - Dijk, A.P.J. van AU - Vliegen, H.W. AU - Sollie, K.M. AU - Berger, R.M. AU - Lely, A.T. AU - Canobbio, M.M. AU - Pieper, P.G. PY - 2008 UR - https://hdl.handle.net/2066/69199 AB - OBJECTIVES: To investigate the age at menarche, the prevalence of menstrual cycle (interval) disorders, and determinants in women with congenital heart disease (CHD). DESIGN: Using two CHD registries, 1802 (82%) of the 2196 women with CHD contacted (aged 18-58 years) provided written informed consent. After exclusion of patients with genetic disorders known to be associated with menstrual cycle disorders, 1593 eligible patients remained. Interviews by telephone and reviews of medical records were conducted. RESULTS: Overall, the age at menarche was slightly increased in women with CHD (13.3 vs. 13.1 years in the general population), mainly attributable to an increased prevalence of primary amenorrhea (n = 147; 9.2%). Other menstrual cycle disorders were documented: secondary amenorrhea (n = 181, 11.4%), polymenorrhea (n = 103, 6.5%), oligomenorrhea (n = 90, 5.6%), and menorrhagia (n = 117, 6.5%). The occurrence of these disorders also depended on the presence of cyanotic heart disease, surgical status, the number of surgical interventions, and the severity of CHD. DISCUSSION: Menstrual cycle disturbances, in particular primary amenorrhea, were frequently observed in this population. Patients with complex (cyanotic) heart disease needing repeated surgical interventions prior to menarche are especially at risk. TI - Menstrual cycle and its disorders in women with congenital heart disease. EP - 283 SN - 1747-079X IS - iss. 4 SP - 277 JF - Congenital Heart Disease VL - vol. 3 ER - TY - JOUR AU - Vonk, M.C. AU - Marjanovic, Z. AU - Hoogen, F.H.J. van den AU - Zohar, S. AU - Schattenberg, A.V.M.B. AU - Fibbe, W.E. AU - Larghero, J. AU - Gluckman, E. AU - Preijers, F.W.M.B. AU - Dijk, A.P.J. van AU - Bax, J.J. AU - Roblot, P. AU - Riel, P.L.C.M. van AU - Laar, J.M. van AU - Farge, D. PY - 2008 UR - https://hdl.handle.net/2066/69053 AB - OBJECTIVE: Systemic sclerosis (SSc) is a generalised autoimmune disease, causing morbidity and a reduced life expectancy, especially in patients with rapidly progressive diffuse cutaneous SSc. As no proven treatment exists, autologous haematopoietic stem cell transplantation (HSCT) is employed as a new therapeutic strategy in patients with a poor prognosis. This study reports the effects on survival, skin and major organ function of HSCT in patients with severe diffuse cutaneous SSc. PATIENTS AND METHODS: A total of 26 patients were evaluated. Peripheral blood stem cells were collected using cyclophosphamide (4 g/m2) and rHu G-CSF (5 to 10 microg/kg/day) and were reinfused after positive CD34+ selection. For conditioning, cyclophosphamide 200 mg/kg was used. RESULTS: After a median follow-up of 5.3 (1-7.5) years, 81% (n = 21/26) of the patients demonstrated a clinically beneficial response. The Kaplan-Meier estimated survival at 5 years was 96.2% (95% CI 89-100%) and at 7 years 84.8% (95% CI 70.2-100%) and event-free survival, defined as survival without mortality, relapse or progression of SSc, resulting in major organ dysfunction was 64.3% (95% CI 47.9-86%) at 5 years and 57.1% (95% CI 39.3-83%) at 7 years. CONCLUSION: This study confirms that autologous HSCT in selected patients with severe diffuse cutaneous SSc results in sustained improvement of skin thickening and stabilisation of organ function up to 7 years after transplantation. TI - Long-term follow-up results after autologous haematopoietic stem cell transplantation for severe systemic sclerosis. EP - 104 SN - 0003-4967 IS - iss. 1 SP - 98 JF - Annals of the Rheumatic Diseases VL - vol. 67 DO - https://doi.org/10.1136/ard.2007.071464 ER - TY - JOUR AU - Slikkerveer, J. AU - Dijkmans, P.A. AU - Sieswerda, G.T. AU - Doevendans, P.A. AU - Dijk, A.P.J. van AU - Verheugt, F.W.A. AU - Porter, T.R. AU - Kamp, O. PY - 2008 UR - https://hdl.handle.net/2066/70525 AB - ABSTRACT: BACKGROUND -: Experimental studies have shown that ultrasound contrast agents enhance the effectiveness of thrombolytic agents in the presence of ultrasound in vitro and in vivo. Recently, we have launched a clinical pilot study, called "Sonolysis", to study this effect in patients with ST-elevation myocardial infarction based on proximal lesions of the infarct-related artery. METHODS/DESIGN -: In our multicenter, randomized, placebo controlled clinical trial we will include patients between 18 and 80 years of age with their first ST-elevation myocardial infarction based on a proximal lesion of the infarct-related artery. After receiving a single bolus alteplase 50 mg IV (Actilyse(R) Boehringer Ingelheim GmbH), a loading dose of aspirin 500 mg, and heparin 5000 IU in the ambulance according to the prehospital thrombolysis protocol, patients, following oral informed consent, are randomized to undergo 15 minutes of pulsatile ultrasound with intravenous administration of ultrasound contrast agent or placebo without ultrasound. Afterwards coronary angiography and, if indicated, percutaneous coronary intervention will take place. A total of 60 patients will be enrolled in approximately 1 year.The primary endpoints are based on the coronary angiogram and consist of TIMI flow, corrected TIMI frame count, and myocardial blush grade. Follow-up includes 12-lead ECG, 2D-echocardiography, cardiac MRI, and enzyme markers to obtain our secondary endpoints, including the infarct size, wall motion abnormalities, and the global left ventricular function. DISCUSSION -: The Sonolysis study is the first multicenter, randomized, placebo controlled clinical trial investigating the therapeutic application of ultrasound and microbubbles in acute ST-elevation myocardial infarction patients. A positive finding may stimulate further research and technical innovations to implement the treatment in the ambulance and maybe obtain even more patency at an earlier stage. TRIAL REGISTRATION -: Trialregister NTR161. TI - Ultrasound enhanced prehospital thrombolysis using microbubbles infusion in patients with acute ST elevation myocardial infarction: Rationale and design of the Sonolysis study SN - 1745-6215 JF - Trials VL - vol. 9 DO - https://doi.org/10.1186/1745-6215-9-72 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/70525/70525.pdf?sequence=1 ER - TY - JOUR AU - Krabbendam, I. AU - Janssen, B.J. AU - Dijk, A.P.J. van AU - Jongsma, H.W. AU - Oyen, W.J.G. AU - Lotgering, F.K. AU - Spaanderman, M.E.A. PY - 2008 UR - https://hdl.handle.net/2066/70694 AB - OBJECTIVE: Prepregnant low plasma volume (LPV) is associated with subsequent gestational hypertensive disease. It is unknown to what extent an LPV affects the venous reserve capacity (VRC). We tested the hypothesis that LPV reduces the VRC, as indicated by presyncope or altered cardiovascular changes in response to head-up tilt. STUDY DESIGN: In 52 nonpregnant women with a history of preeclampsia or recurrent miscarriage, the authors assessed plasma volume, stroke volume, and cardiac output and determined blood pressure, heart rate, and autonomic responses to stepwise inflicted head-up tilt. RESULTS: 12 participants had LPV, which related to presyncope when compared with subjects with normal plasma volume (NPV). Women with LPV without presyncope demonstrated a circulatory response comparable to NPV women at the expense of consistently higher heart rate. CONCLUSION: LPV decreases the capacity to cope with head-up tilt without affecting the response pattern, suggesting reduced VRC. TI - The relation between venous reserve capacity and low plasma volume. EP - 612 SN - 1933-7191 IS - iss. 6 SP - 604 JF - Reproductive Sciences VL - vol. 15 DO - https://doi.org/10.1177/1933719108316983 ER - TY - JOUR AU - Winter, M.M. AU - Bernink, F.J. AU - Groenink, M. AU - Bouma, B.J. AU - Dijk, A.P.J. van AU - Helbing, W.A. AU - Tijssen, J.G.P. AU - Mulder, B.J.M. PY - 2008 UR - https://hdl.handle.net/2066/70334 AB - BACKGROUND: The method used to delineate the boundary of the right ventricle (RV), relative to the trabeculations and papillary muscles in cardiovascular magnetic resonance (CMR) ventricular volume analysis, may matter more when these structures are hypertrophied than in individuals with normal cardiovascular anatomy. This study aimed to compare two methods of cavity delineation in patients with systemic RV. METHODS: Twenty-nine patients (mean age 34.7 +/- 12.4 years) with a systemic RV (12 with congenitally corrected transposition of the great arteries (ccTGA) and 17 with atrially switched (TGA) underwent CMR. We compared measurements of systemic RV volumes and function using two analysis protocols. The RV trabeculations and papillary muscles were either included in the calculated blood volume, the boundary drawn immediately within the apparently compacted myocardial layer, or they were manually outlined and excluded. RV stroke volume (SV) calculated using each method was compared with corresponding left ventricular (LV) SV. Additionally, we compared the differences in analysis time, and in intra- and inter-observer variability between the two methods. Paired samples t-test was used to test for differences in volumes, function and analysis time between the two methods. Differences in intra- and inter-observer reproducibility were tested using an extension of the Bland-Altman method. RESULTS: The inclusion of trabeculations and papillary muscles in the ventricular volume resulted in higher values for systemic RV end diastolic volume (mean difference 28.7 +/- 10.6 ml, p < 0.001) and for end systolic volume (mean difference 31.0 +/- 11.5 ml, p < 0.001). Values for ejection fraction were significantly lower (mean difference -7.4 +/- 3.9%, p < 0.001) if structures were included. LV SV did not differ significantly from RV SV for both analysis methods (p = NS). Including structures resulted in shorter analysis time (p < 0.001), and showed better inter-observer reproducibility for ejection fraction (p < 0.01). CONCLUSION: The choice of method for systemic RV cavity delineation significantly affected volume measurements, given the CMR acquisition and analysis systems used. We recommend delineation outside the trabeculations for routine clinical measurements of systemic RV volumes as this approach took less time and gave more reproducible measurements. TI - Evaluating the systemic right ventricle by CMR: the importance of consistent and reproducible delineation of the cavity. EP - 40 SN - 1097-6647 IS - iss. 1 SP - 40 JF - Journal of Cardiovascular Magnetic Resonance VL - vol. 10 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/70334/70334.pdf?sequence=1 ER - TY - JOUR AU - Yap, S.C. AU - Drenthen, W. AU - Pieper, P.G. AU - Moons, P. AU - Mulder, B.J.M. AU - Mostert, B. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Meijboom, F.J. AU - Steegers, E.A.P. AU - Roos-Hesselink, J.W. PY - 2008 UR - https://hdl.handle.net/2066/71123 AB - BACKGROUND: Pregnancy in women with congenital aortic stenosis (AS) is associated with increased cardiac complications. Data on non-cardiac complications are limited, and this information is crucial for prenatal counselling and perinatal care. The aim of this study was to present the maternal and perinatal outcome of pregnancy in women with congenital AS. METHODS: By review of the Dutch CONCOR national registry and a local Belgian tertiary care centre database, 35 women with congenital AS with a history of completed pregnancy before aortic valve replacement were enrolled in this study. Medical history and maternal and perinatal outcome were determined. RESULTS: Thirty-five women had 58 pregnancies resulting in 53 successful pregnancies, three miscarriages, and two abortions. The most serious cardiac complications were heart failure (n=2, 3.8%) and atrial arrhythmia (n=3, 5.7%). Although cardiac complications were present (9.4%), obstetric (22.6%) and perinatal (24.5%) complications were observed more often. A total of six pregnancies (11.3%) were complicated by hypertension-related disorders, including one case of eclampsia. Furthermore, 7 premature births (13.2%) and 7 small-for-gestational-age births (13.2%) were encountered. Pregnancy in women with severe AS was characterized by an increased incidence of heart failure and premature labour, and shorter pregnancy duration. Older women (>30 years) were at increased risk of perinatal events (odds ratio 4.38, 95% confidence interval 1.02 to 18.81). CONCLUSIONS: Pregnancy is generally well tolerated in women with congenital AS. Importantly, an excess of obstetric and perinatal complications was found, requiring more meticulous attention. TI - Risk of complications during pregnancy in women with congenital aortic stenosis. EP - 246 SN - 0167-5273 IS - iss. 2 SP - 240 JF - International Journal of Cardiology VL - vol. 126 DO - https://doi.org/10.1016/j.ijcard.2007.03.134 ER - TY - JOUR AU - Yap, S.C. AU - Roos-Hesselink, J.W. AU - Hoendermis, E.S. AU - Budts, W. AU - Vliegen, H.W. AU - Mulder, B.J.M. AU - Dijk, A.P.J. van AU - Schalij, M.J. AU - Drenthen, W. PY - 2007 UR - https://hdl.handle.net/2066/51420 AB - AIMS: To investigate outcome and complications of implantable cardioverter defibrillators (ICDs) in adults with congenital heart disease (CHD) and to identify predictors of (in-) appropriate shocks. METHODS AND RESULTS: Sixty-four CHD patients >/= 18 years at first ICD implantation [63% tetralogy of Fallot (TOF) and age at implantation 37 +/- 13 years] were identified using the Dutch adult CHD registry and a Belgian tertiary care centre database. Median follow-up duration was 3.7 years. Early complications included pocket haematoma (n = 3), lead failure (n = 2), and pneumothorax (n = 2). Late complications occurred in 11 (17%) patients, including lead failure (n = 6) and and electrical storm (n = 3). Overall, 30 device-related re-interventions were performed in 20 patients (31%), including four premature generator changes and seven lead replacements. Half of the patients received one or more shocks, and 46 shocks in 15 patients (23%) were classified as appropriate. One hundred and sixty shocks in 26 patients (41%) were classified as inappropriate. No predictors of (in-)appropriate shocks were identified, except TOF being associated with less appropriate shocks than patients with other CHD (HR 0.29, P = 0.02). CONCLUSION: The ICD provided effective therapy in a quarter of adults with CHD with low complication rates. The incidence of inappropriate shocks, however, appeared to be excessive and warrants further attention. TI - Outcome of implantable cardioverter defibrillators in adults with congenital heart disease: a multi-centre study. EP - 1861 SN - 0195-668X IS - iss. 15 SP - 1854 JF - European Heart Journal VL - vol. 28 DO - https://doi.org/10.1093/eurheartj/ehl306 ER - TY - JOUR AU - Yap, S.C. AU - Drenthen, W. AU - Pieper, P.G. AU - Moons, P. AU - Mulder, B.J.M. AU - Klieverik, L.M. AU - Vliegen, H.W. AU - Dijk, A.P.J. van AU - Meijboom, F.J. AU - Roos-Hesselink, J.W. PY - 2007 UR - https://hdl.handle.net/2066/52389 AB - BACKGROUND AND AIM OF THE STUDY: The pulmonary autograft has been recommended as the valve of choice for aortic valve replacement (AVR) in young women contemplating pregnancy. However, current information on maternal and perinatal outcome of pregnancy in women with pulmonary autograft valve replacement is limited. METHODS: Using a nationwide Dutch registry (CONCOR) and a local Belgian tertiary care center database, 17 women (age range: 18 to 45 years) with pulmonary autograft valve replacement were enrolled into the study. Twelve pregnancies were observed among five different women, including one miscarriage and one elective abortion. RESULTS: Clinically significant (non-)cardiac complications were documented in two of 10 completed pregnancies. Complications included: (i) placental abruption necessitating Cesarean delivery at 29 weeks' gestation, further complicated by postpartum hemorrhage; and (ii) preterm premature rupture of the membranes resulting in premature delivery at 29 weeks' gestation with postpartum demise of the immature born child. Two women reported primary female infertility, but both became pregnant after hormonal substitution therapy. Four women reported irregularities of their natural menstrual cycle (menorrhagia, dysmenorrhea, polymenorrhea, oligomenorrhea, or amenorrhea). CONCLUSION: Successful pregnancy in women with pulmonary autograft valve replacement is possible, although serious and clinically significant events occurred during gestation. Infertility and menstrual cycle disorders appear to be more prevalent. TI - Outcome of pregnancy in women after pulmonary autograft valve replacement for congenital aortic valve disease. EP - 403 SN - 0966-8519 IS - iss. 4 SP - 398 JF - Journal of Heart Valve Disease VL - vol. 16 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/52389/52389.pdf?sequence=1 ER - TY - JOUR AU - Drenthen, W. AU - Pieper, P.G. AU - Roos-Hesselink, J.W. AU - Lottum, W.A. van AU - Voors, A.A. AU - Mulder, B.J.M. AU - Dijk, A.P.J. van AU - Vliegen, H.W. AU - Yap, S.C. AU - Moons, P. AU - Ebels, T. AU - Veldhuisen, D.J. van PY - 2007 UR - https://hdl.handle.net/2066/52390 AB - A search of peer-reviewed literature was conducted to identify reports that provide data on complications associated with pregnancy in women with structural congenital heart disease (CHD). This review describes the outcome of 2,491 pregnancies, including 377 miscarriages (15%) and 114 elective abortions (5%). Important cardiac complications were seen in 11% of the pregnancies. Obstetric complications do not appear to be more prevalent. In complex CHD, premature delivery rates are high, and more children are small for gestational age. The offspring mortality was high throughout the spectrum and was related to the relatively high rate of premature delivery and recurrence of CHD. TI - Outcome of pregnancy in women with congenital heart disease: a literature review. EP - 2311 SN - 0735-1097 IS - iss. 24 SP - 2303 JF - Journal of the American College of Cardiology VL - vol. 49 DO - https://doi.org/10.1016/j.jacc.2007.03.027 ER - TY - JOUR AU - Oosterhof, T. AU - Straten, A. van AU - Vliegen, H.W. AU - Meijboom, F.J. AU - Dijk, A.P.J. van AU - Spijkerboer, A.M. AU - Bouma, B.J. AU - Zwinderman, A.H. AU - Hazekamp, M.G. AU - Roos, A. AU - Mulder, B.J.M. PY - 2007 UR - https://hdl.handle.net/2066/53365 AB - BACKGROUND: To facilitate the optimal timing of pulmonary valve replacement, we analyzed preoperative thresholds of right ventricular (RV) volumes above which no decrease or normalization of RV size takes place after surgery. METHODS AND RESULTS: Between 1993 and 2006, 71 adult patients with corrected tetralogy of Fallot underwent pulmonary valve replacement in a nationwide, prospective follow-up study. Patients were evaluated with cardiovascular magnetic resonance both preoperatively and postoperatively. Changes in RV volumes were expressed as relative change from baseline. RV volumes decreased with a mean of 28%. RV ejection fraction did not change significantly after surgery (from 42+/-10% to 43+/-10%; P=0.34). Concomitant RV outflow tract reduction resulted in a 25% larger decrease of RV volumes. After correction for surgical RV outflow tract reduction, higher preoperative RV volumes (mL/m2) were independently associated with a larger decrease of RV volumes (RV end-diastolic volume: beta=0.41; P<0.001). Receiver operating characteristic analysis revealed a cutoff value of 160 mL/m2 for normalization of RV end-diastolic volume or 82 mL/m2 for RV end-systolic volume. CONCLUSIONS: Overall, we could not find a threshold above which RV volumes did not decrease after surgery. Preoperative RV volumes were independently associated with RV remodeling and also when corrected for a surgical reduction of the RV outflow tract. However, normalization could be achieved when preoperative RV end-diastolic volume was <160 mL/m2 or RV end-systolic volume was <82 mL/m2. TI - Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. EP - 551 SN - 0009-7322 IS - iss. 5 SP - 545 JF - Circulation VL - vol. 116 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/53365/53365.pdf?sequence=1 ER - TY - JOUR AU - Vonk, M.C. AU - Sander, M. AU - Hoogen, F.H.J. van den AU - Riel, P.L.C.M. van AU - Verheugt, F.W.A. AU - Dijk, A.P.J. van PY - 2007 UR - https://hdl.handle.net/2066/51750 AB - OBJECTIVE: To assess the accuracy of echocardiography for predicting pulmonary arterial hypertension (PAH) in a cohort of patients with systemic sclerosis and other connective tissue diseases, and to evaluate whether addition of the right ventricular (RV) Tei-index contributes to the non-invasive diagnosis of PAH in this patient group. PATIENTS AND METHODS: Ninety-eight patients with systemic sclerosis and other connective tissue diseases in whom an echocardiography was performed in the period from January 1st 2004 to July 1st 2005 were included. Echocardiographic systolic pulmonary arterial pressure (PAP), end-diastolic PAP and RV Tei-index were calculated. In cases with a high suspicion of PAH right heart catheterization was performed and systolic, diastolic and mean PAP as well as pulmonary wedge pressure, cardiac output and pulmonary vascular resistance were obtained. These results were compared to the echocardiographic measurements. RESULTS: The average RV Tei-index of our patients was substantially above normal values. In 35 (36%) patients a right heart catheterization was performed and PAH was confirmed in 28 patients. In 6 of 7 patients without PAH, the RV Tei-index was below the upper limit of normal. A significant correlation was found between the RV Tei-index and the catheterization parameters such as systolic PAP, diastolic PAP and mean PAP. CONCLUSION: The accuracy of echocardiography for the detection of PAH increases when the echocardiographic systolic PAP is combined with an elevated RV Tei-index. As a result, by applying the Tei-index, the number of negative catheterizations can be minimized. TI - Right ventricle Tei-index: a tool to increase the accuracy of non-invasive detection of pulmonary arterial hypertension in connective tissue diseases. EP - 321 SN - 1525-2167 IS - iss. 5 SP - 317 JF - European Journal of Echocardiography VL - vol. 8 DO - https://doi.org/10.1016/j.euje.2006.06.002 ER - TY - JOUR AU - Kuilenburg, J.T. van AU - Verheugt, F.W.A. AU - Dijk, A.P.J. van PY - 2007 UR - https://hdl.handle.net/2066/53166 AB - In pregnant patients with a prosthetic heart valve (PHV), anticoagulation with warfarin is associated with embryopathy, foetal loss early in pregnancy and maternal bleeding complications in the delivery period. The optimal anticoagulation strategy in the pre-pregnancy period and during pregnancy itself is controversial and a matter of debate. We describe a patient with PHV in the pre-pregnancy period and in a subsequent pregnancy. The optimal anticoagulation treatment strategy in women in their reproductive years with mechanical valve thrombosis is discussed. (Neth Heart J 2007;15:306-9). TI - Prosthetic heart valve thrombosis, anticoagulation and pregnancy: a case report and review of literature. EP - 309 SN - 1568-5888 IS - iss. 9 SP - 306 JF - Netherlands Heart Journal VL - vol. 15 ER - TY - JOUR AU - Cuijpers, M.L.H. AU - Vos, F.J. AU - Bleeker-Rovers, C.P. AU - Krabbe, P.F.M. AU - Pickkers, P. AU - Dijk, A.P.J. van AU - Wanten, G.J.A. AU - Sturm, P.D.J. AU - Oyen, W.J.G. AU - Kullberg, B.J. PY - 2007 UR - https://hdl.handle.net/2066/53587 AB - Complicating infectious foci resulting from haematogenous or local spread of microorganisms are observed frequently in patients with Staphylococcus aureus bacteraemia (SAB) or Streptococcus species bacteraemia (SSB). The aim of this study was to compare the epidemiology of complicating infectious foci during SAB and SSB in a university hospital in The Netherlands. The charts of all adult patients diagnosed with SAB or SSB (except for Streptococcus pneumoniae bacteraemia) from July 2002 until December 2004 were reviewed retrospectively. Overall, 180 immunocompetent patients were identified, 127 with SAB and 53 with SSB. The percentage of patients with complicating infectious foci (39% of SAB patients, 25% of SSB patients) did not differ significantly between the groups. Endocarditis and cerebral involvement, however, were significantly more common in the SSB group. Of all complicating infectious foci, 32% lacked guiding signs or symptoms and 10% were detected only at autopsy. Factors associated with the development of complicating infectious foci were a delay in treatment for more than 48 h after the onset of symptoms, community acquisition, persistently positive blood cultures, congenital heart disease, and the presence of foreign bodies or prosthetic valves. Infection-related mortality was 18% in SAB patients and 11% in SSB patients and was significantly higher in patients with complicating infectious foci (29 vs. 9%). In conclusion, complicating infectious foci develop in approximately one-third of all patients with SAB and SSB. An active approach that entails searching for the complicating infectious foci is warranted in these patients, because only two-thirds of complicated infectious foci have guiding symptoms or signs, and infection-related mortality is significantly increased in patients with complicating infectious foci compared to patients without these infections. TI - Complicating infectious foci in patients with Staphylococcus aureus or Streptococcus species bacteraemia. EP - 113 SN - 0934-9723 IS - iss. 2 SP - 105 JF - European Journal of Clinical Microbiology and Infectious Diseases VL - vol. 26 PS - 9 p. DO - https://doi.org/10.1007/s10096-006-0238-4 ER - TY - JOUR AU - Ploeg, M. AU - Drenthen, W. AU - Dijk, A.P.J. van AU - Pieper, P.G. PY - 2006 UR - https://hdl.handle.net/2066/50456 TI - Successful pregnancy after an arterial switch procedure for complete transposition of the great arteries. EP - 244 SN - 1470-0328 IS - iss. 2 SP - 243 JF - Bjog : an International Journal of Obstetrics and Gynaecology VL - vol. 113 DO - https://doi.org/10.1111/j.1471-0528.2006.00816.x ER - TY - JOUR AU - Drenthen, W. AU - Pieper, P.G. AU - Roos-Hesselink, J.W. AU - Schmidt, A.C. AU - Mulder, B.J.M. AU - Dijk, A.P.J. van AU - Vliegen, H.W. AU - Sollie, K.M. AU - Voors, A.A. AU - Ebels, T. AU - Veldhuisen, D.J. van PY - 2006 UR - https://hdl.handle.net/2066/49575 AB - BACKGROUND: Information on the outcome of pregnancy in patients with pulmonary valvar stenosis is scarce, mostly limited to cardiac complications observed during pregnancy. OBJECTIVES: To investigate the magnitude and determinants of non-cardiac and fetal risks during pregnancy of women with isolated pulmonary valvar stenosis. METHODS: Using the nationwide registry (CONgenital CORvitia), 106 women with (un-)corrected pulmonary valvar stenosis receiving care in six tertiary medical centres in The Netherlands were included. A total of 51 women had 108 pregnancies, including 21 (19%) miscarriages and 6 elective abortions. RESULTS: In the 81 completed (>20 weeks of gestation) pregnancies, we observed a high number of hypertension-related disorders (n = 12, 15%, including pre-eclampsia (n = 4) and eclampsia (n = 2)), premature deliveries (n = 14, 17%, including one twin) and thromboembolic events (n = 3, 3.7%). Furthermore, recurrence of congenital heart defects in the offspring was detected in three children (3.7%, pulmonary valvar stenosis (n = 2) and complete transposition of the great arteries in combination with anencephaly). In addition to the intrauterine fetal demise of the transposition child, three other children died shortly after birth owing to immaturity, hydrocephalus combined with prematurity and meningitis (overall offspring mortality, 4.8%). CONCLUSION: In this largest report on pregnancy in women with (un-) corrected isolated pulmonary valvar stenosis, an excessive number of (serious) non-cardiac complications and mortality were observed in the offspring. TI - Non-cardiac complications during pregnancy in women with isolated congenital pulmonary valvar stenosis. EP - 1843 SN - 1355-6037 IS - iss. 12 SP - 1838 JF - Heart VL - vol. 92 DO - https://doi.org/10.1136/hrt.2006.093849 ER - TY - JOUR AU - Drenthen, W. AU - Pieper, P.G. AU - Roos-Hesselink, J.W. AU - Lottum, W.A. van AU - Voors, A.A. AU - Mulder, B.J.M. AU - Dijk, A.P.J. van AU - Vliegen, H.W. AU - Sollie, K.M. AU - Moons, P. AU - Ebels, T. AU - Veldhuisen, D.J. van PY - 2006 UR - https://hdl.handle.net/2066/49586 AB - OBJECTIVES: To evaluate the outcome of pregnancy in women after Fontan palliation and to assess the occurrence of infertility and menstrual cycle disorders. DESIGN AND PATIENTS: Two congenital heart disease registries were used to investigate 38 female patients who had undergone Fontan palliation (aged 18-45 years): atriopulmonary anastomosis (n = 23), atrioventricular connection (n = 5) and total cavopulmonary connection (n = 10). RESULTS: Six women had 10 pregnancies, including five miscarriages (50%) and one aborted ectopic pregnancy. During the remaining four live-birth pregnancies clinically significant complications were encountered: New York Heart Association class deterioration; atrial fibrillation; gestational hypertension; premature rupture of membranes; premature delivery; fetal growth retardation and neonatal death. Four of seven women who had attempted to become pregnant reported female infertility: non-specified secondary infertility (n = 2), uterus bicornis (n = 1) and related to endometriosis (n = 1). Moreover, several important menstrual cycle disorders were documented. In particular, the incidence of primary amenorrhoea was high (n = 15, 40%), which resulted in a significant increase in age at menarche (14.6 (SD 2.1) years, p < 0.0001, compared with the general population). CONCLUSION: Women can successfully complete pregnancy after adequate Fontan palliation without important long-term sequelae, although it is often complicated by clinically significant (non-)cardiac events. In addition, subfertility or infertility and menstrual disorders were common. TI - Pregnancy and delivery in women after Fontan palliation. EP - 1294 SN - 1355-6037 IS - iss. 9 SP - 1290 JF - Heart VL - vol. 92 DO - https://doi.org/10.1136/hrt.2005.085407 ER - TY - JOUR AU - Drenthen, W. AU - Pieper, P.G. AU - Roos-Hesselink, J.W. AU - Zoon, N. AU - Voors, A.A. AU - Mulder, B.J.M. AU - Dijk, A.P.J. van AU - Vliegen, H.W. AU - Sollie, K.M. AU - Ebels, T. AU - Veldhuisen, D.J. van PY - 2006 UR - https://hdl.handle.net/2066/49347 AB - The objective of the present study to investigate fertility, pregnancy, and delivery in women with biventricular repair for pulmonary atresia with an intact ventricular septum (PAIVS). Using a nationwide registry (CONCOR), 37 patients with pulmonary atresia were identified, 6 of whom (aged 21 to 34 years) had biventricular repair for PAIVS. Three PAIVS patients had a total of 5 pregnancies, including 1 abortion and 1 ectopic pregnancy. Besides minor noncardiac complications, the 3 live-birth pregnancies were successful. None of the women reported infertility or irregularities (hypermenorrhea, dysmenorrhea, polymenorrhoea, oligomenorrhea, or amenorrhea) of their natural menstrual cycle. In conclusion, successful pregnancy in women with biventricular repair for PAIVS is possible, and only minor complications were observed. Infertility and menstrual cycle disorders do not appear to be more prevalent than usual. TI - Fertility, pregnancy, and delivery after biventricular repair for pulmonary atresia with an intact ventricular septum. EP - 261 SN - 0002-9149 IS - iss. 2 SP - 259 JF - American Journal of Cardiology VL - vol. 98 DO - https://doi.org/10.1016/j.amjcard.2006.01.090 ER - TY - JOUR AU - Drenthen, W. AU - Pieper, P.G. AU - Zoon, N. AU - Roos-Hesselink, J.W. AU - Voors, A.A. AU - Mulder, B.J.M. AU - Dijk, A.P.J. van AU - Sollie, K.M. AU - Vliegen, H.W. AU - Ebels, T. AU - Veldhuisen, D.J. van PY - 2006 UR - https://hdl.handle.net/2066/49585 AB - Information on pregnancy and delivery in women with biventricular repair for isolated noncomplex pulmonary atresia with a ventricular septal defect (PAVSD) is limited. Using a nationwide congenital heart disease registry (CONgenital CORvitia [CONCOR]), 9 women with biventricular repair for PAVSD (aged 21 to 38 years) were identified. Ten pregnancies were observed in 5 different women with PAVSD, including 3 spontaneous miscarriages. Clinically significant (non)cardiac complications were documented in 3 of 7 completed pregnancies. These complications were: (1) atrioventricular reentry tachycardia with symptomatic right-sided heart failure; (2) eclampsia with hemolysis, elevated liver enzymes, and low platelets syndrome further complicated by abruptio placentae leading to premature delivery of a small-for-gestational-age child; and (3) premature delivery due to cervical insufficiency with antepartum demise of an immature child. Furthermore, none of the women reported infertility. Moreover, none of the women reported irregularities of their natural menstrual cycle (age at menarche 13 years; cycle duration 28 days), with the exception of delayed menarche (>16 years) in 2 patients. In conclusion, successful pregnancy in patients with biventricular repair of PAVSD is possible, although often complicated by serious clinically significant events. Infertility and menstrual cycle disorders do not appear to be more prevalent, except for a high incidence of primary amenorrhea. TI - Pregnancy after biventricular repair for pulmonary atresia with ventricular septal defect. EP - 266 SN - 0002-9149 IS - iss. 2 SP - 262 JF - American Journal of Cardiology VL - vol. 98 DO - https://doi.org/10.1016/j.amjcard.2006.01.094 ER - TY - JOUR AU - Oosterhof, T. AU - Meijboom, F.J. AU - Vliegen, H.W. AU - Hazekamp, M.G. AU - Zwinderman, A.H. AU - Bouma, B.J. AU - Dijk, A.P.J. van AU - Mulder, B.J.M. PY - 2006 UR - https://hdl.handle.net/2066/50692 AB - AIMS: To analyse the long-term outcomes after pulmonary valve replacement (PVR) in patients with a previous correction for tetralogy of Fallot. METHODS AND RESULTS: In a retrospective study, 158 adult patients with a diagnosis of tetralogy of Fallot, who had undergone a PVR after initial total correction in childhood, were identified from the CONCOR (CONgenital CORvitia) registry. All patients underwent 175 PVRs between June 1986 and June 2005. To analyse the predictors for homograft dysfunction and adverse events (death, reoperations, balloon angioplasty), Cox-regression analysis was performed. Overall freedom from significant homograft dysfunction was 66% after 5 years and 47% after 10 years. We could not identify predictors for combined homograft dysfunction. Event-free survival was 78% at 10 years and 68% at 15 years after PVR. Both early significant pulmonary regurgitation (PR) (HR 6.8, P = 0.017) and pulmonary stenosis (PS) (HR 4.0, P = 0.037) after surgery were associated with adverse events. When analysing direct post-operative PR or PS, we observed that in patients with severe, pre-operative PR, right ventricular aneurysm/patch resection resulted in a lower post-operative PR (mean difference grade 0.38 +/- 0.14, P = 0.01). Less significant post-operative PS was associated with a higher diameter of the homograft (HR 0.37, P = 0.006). CONCLUSION: While 47% of the patients in our study were free from homograft dysfunction at 10 years after PVR, event-free survival after PVR remained fairly good (78%). Significant residual lesions directly after surgery influenced event-free survival. A smaller diameter of the pulmonary homograft and severe pre-surgical PR were related to early homograft dysfunction after surgery. TI - Long-term follow-up of homograft function after pulmonary valve replacement in patients with tetralogy of Fallot. EP - 1484 SN - 0195-668X IS - iss. 12 SP - 1478 JF - European Heart Journal VL - vol. 27 DO - https://doi.org/10.1093/eurheartj/ehl033 ER - TY - JOUR AU - Vos, F.J. AU - Bleeker-Rovers, C.P. AU - Dijk, A.P.J. van AU - Oyen, W.J.G. PY - 2006 UR - https://hdl.handle.net/2066/50371 TI - Detection of pacemaker and lead infection with FDG-PET. EP - 1245 SN - 1619-7070 IS - iss. 10 SP - 1245 JF - European Journal of Nuclear Medicine and Molecular Imaging VL - vol. 33 DO - https://doi.org/10.1007/s00259-006-0145-z ER - TY - JOUR AU - Meijer, J.M. AU - Pieper, P.G. AU - Drenthen, W. AU - Voors, A.A. AU - Roos-Hesselink, J.W. AU - Dijk, A.P.J. van AU - Mulder, B.J.M. AU - Ebels, T. AU - Veldhuisen, D.J. van PY - 2005 UR - https://hdl.handle.net/2066/47548 AB - OBJECTIVE: To determine in women with surgically corrected tetralogy of Fallot the risk of pregnancy for mother and fetus, whether fertility was compromised, and the recurrence risk of congenital heart disease. DESIGN: Data were collected from 83 patients through interviews and review of medical records. RESULTS: In 29 patients 63 pregnancies were observed, of which 13 ended in an abortion. Fifty successful pregnancies were observed in 26 patients. During six successful pregnancies (12%) complications (symptomatic right sided heart failure, arrhythmias, or both) occurred. Both patients who developed symptomatic heart failure had severe pulmonary regurgitation. No clear relation between offspring mortality, premature birth or being small for gestational age, and cardiac characteristics of the mother was identified. Fifty seven patients were childless (41 (72%) voluntarily). Recurrence risk for congenital heart disease was 2.2%. Infertility was uncommon. CONCLUSIONS: Although complications did occur in five of 26 (19%) of the patients with a corrected tetralogy of Fallot, pregnancy was generally well tolerated in this largest report so far. No obvious predictors for maternal events or child outcome were determined, except for a possible relation between severe pulmonary regurgitation and symptomatic heart failure. TI - Pregnancy, fertility, and recurrence risk in corrected tetralogy of Fallot. EP - 805 SN - 1355-6037 IS - iss. 6 SP - 801 JF - Heart VL - vol. 91 DO - https://doi.org/10.1136/hrt.2004.034108 ER - TY - JOUR AU - Vonk, M.C. AU - Dijk, A.P.J. van AU - Heijdra, Y.F. AU - Heijden, E. van der AU - Bredie, S.J.H. AU - Hoogen, F.H.J. van den PY - 2005 UR - https://hdl.handle.net/2066/48211 AB - Pulmonary hypertension is a devastating complication of various, but rare diseases and can also occur as an isolated entity. It causes morbidity and mortality in all patients. Ongoing research has provided some insight into the pathophysiology and clinical manifestations, and new therapeutic options have recently become available for some types of pulmonary hypertension. In order to provide optimal care for an individual patient it is mandatory to establish the type and severity of the pulmonary hypertension in each patient. The diagnostic protocol used in our hospital is presented along with a description of two case histories. An algorithm of the different therapeutic strategies now available is given as well as recommendations for follow-up. TI - Pulmonary hypertension: its diagnosis and management, a multidisciplinary approach. EP - 198 SN - 0300-2977 IS - iss. 6 SP - 193 JF - Netherlands Journal of Medicine VL - vol. 63 ER - TY - JOUR AU - Kamphuisen, P.W. AU - Heijdra, Y.F. AU - Die, C.E. van AU - Dijk, A.P.J. van AU - Bredie, S.J.H. PY - 2005 UR - https://hdl.handle.net/2066/48300 AB - 3 patients, 2 women aged 64 and 44 and 1 man aged 67, had severe dyspnoea and a large centrally-located pulmonary embolism (PE) without any accompanying arterial hypotension. They were all given conventional anticoagulation therapy, although thrombolytic therapy was also considered. The women recovered but the man eventually died of a second massive embolism. PE is a disease with a potentially high mortality. Patients with cardiogenic shock due to PE are candidates for thrombolytic therapy. A subset of patients with right-ventricular dysfunction (submassive PE) also have a poorer prognosis despite the absence ofarterial hypotension or shock. Spiral CT-scan is becoming the first-line imaging test of preference in patients with suspected PE. Spiral CT enables the accurate visualization ofthrombi. The value of risk management using cardial biomarkers, spiral CT and echocardiography is not yet clear. There is no evidence that thrombolytic therapy is beneficial in patients with acute PE and right-ventricular dysfunction without overt shock. TI - [Therapeutic dilemmas in patients with a centrally-located pulmonary embolism confirmed by spiral CT-scan but with no cardiogenic shock] J2 - [Therapeutic dilemmas in patients with a centrally-located pulmonary embolism confirmed by spiral CT-scan but with no cardiogenic shock] EP - 1405 SN - 0028-2162 IS - iss. 25 SP - 1400 JF - Nederlands Tijdschrift voor Geneeskunde VL - vol. 149 ER - TY - JOUR AU - Hoogendoorn, L. AU - Heijer, M. den AU - Dijk, A.P.J. van AU - Hermus, A.R.M.M. PY - 2004 UR - https://hdl.handle.net/2066/59336 AB - Subclinical hyperthyroidism may be defined as the presence of free thyroxine and tri-iodothyronine levels within the reference range and a reduced serum thyroid stimulating hormone (TSH) level. In this review the prevalence of low TSH in the population and health consequences of subclinical hyperthyroidism, for example, effects on heart and bone mass, are discussed. Guidelines for treatment are given, based on expert opinion. TI - Subclinical hyperthyroidism: to treat or not to treat? EP - 398 SN - 0032-5473 IS - iss. 945 SP - 394 JF - Postgraduate Medical Journal VL - vol. 80 DO - https://doi.org/10.1136/pgmj.2003.017095 ER - TY - JOUR AU - Hoogendoorn, L. AU - Oyen, W.J.G. AU - Dijk, A.P.J. van AU - Meer, J.W.M. van der PY - 2003 UR - https://hdl.handle.net/2066/185134 AB - We describe an 82-year-old male with pneumococcal aortitis of the descending aorta, visualized by echocardiography and positron emission tomography using fluorinated deoxyglucose (FDG-PET). Computed tomography is considered to be the best diagnostic imaging modality in infected aortic lesions; in this case, the use of FDG-PET, which gives the opportunity to distinguish between inflammatory and non-inflammatory aortic aneurysms, made an important contribution to the diagnosis. TI - Pneumococcal aortitis, report of a case with emphasis on the contribution to diagnosis of positron emission tomography using fluorinated deoxyglucose. EP - 76 SN - 1198-743X IS - iss. 1 SP - 73 JF - Clinical Microbiology and Infection VL - vol. 9 DO - https://doi.org/10.1046/j.1469-0691.2003.00563.x ER - TY - JOUR AU - Fikkers, B.G. AU - Bello, J.L. AU - Dijk, A.P.J. van PY - 2001 UR - https://hdl.handle.net/2066/151515 TI - Electric cardioversion of atrial flutter in a critically ill patient in the prone position. SN - 0342-4642 IS - iss. 2 SP - 449 JF - Intensive Care Medicine VL - vol. 27 DO - https://doi.org/10.1007/s001340000823 ER - TY - JOUR AU - Dijk, A.P.J. van PY - 1996 UR - https://hdl.handle.net/2066/23172 TI - The noninvasive determination of pulmonary hypertension in congenital heart disease EP - 287 SN - 0376-7442 IS - iss. 6 SP - 287 JF - Tijdschrift voor Kindergeneeskunde VL - vol. 64 L1 - https://repository.ubn.ru.nl/bitstream/handle/2066/23172/23172___.PDF?sequence=1 ER -