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van Waaij K, Keçe F, de Riva M, Alizadeh Dehnavi R, Wijnmaalen AP, Piers SRD, Mertens BJ, Zeppenfeld K, Trines SA. Validation of a prediction model for early reconnection after cryoballoon ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01811-0. [PMID: 38743141 DOI: 10.1007/s10840-024-01811-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND We previously developed an early reconnection/dormant conduction (ERC) prediction model for cryoballoon ablation to avoid a 30-min waiting period with adenosine infusion. We now aimed to validate this model based on time to isolation, number of unsuccessful cryo-applications, and nadir balloon temperature. METHODS Consecutive atrial fibrillation patients who underwent their first cryoballoon ablation in 2018-2019 at the Leiden University Medical Center were included. Model performance at the previous and at a new optimal cutoff value was determined. RESULTS A total of 201 patients were included (85.57% paroxysmal AF, 139 male, median age 61 years (IQR 53-69)). ERC was found in 35 of 201 included patients (17.41%) and in 41 of 774 veins (5.30%). In the present study population, the previous cutoff value of - 6.7 provided a sensitivity of 37.84% (previously 70%) and a specificity of 89.07% (previously 86%). Shifting the cutoff value to - 7.2 in both study populations resulted in a sensitivity of 72.50% and 72.97% and a specificity of 78.22% and 78.63% in data from the previous and present study respectively. Negative predictive values were 96.55% and 98.11%. Applying the model on the 101 patients of the present study with all necessary data for all veins resulted in 43 out of 101 patients (43%) not requiring a 30-min waiting period with adenosine testing. Two patients (2%) with ERC would have been missed when applying the model. CONCLUSIONS The previously established ERC prediction model performs well, recommending its use for centers routinely using adenosine testing following PVI.
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Affiliation(s)
- Kevin van Waaij
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fehmi Keçe
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Marta de Riva
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Reza Alizadeh Dehnavi
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sebastiaan R D Piers
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Bart J Mertens
- Bioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Serge A Trines
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
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Smit JM, Rocchiccioli S, Signore G, Michelucci E, Di Giorgi N, van Rosendael AR, El Mahdiui M, Neglia D, Knuuti J, Saraste A, Buechel RR, Teresinska A, Pizzi MN, Roque A, Poddighe R, Mertens BJ, Caselli C, Parodi O, Pelosi G, Scholte AJ. Plasma Lipidomics and Coronary Plaque Changes: A Substudy of the SMARTool Clinical Trial. Eur Heart J Cardiovasc Imaging 2024:jeae058. [PMID: 38445505 DOI: 10.1093/ehjci/jeae058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 03/07/2024] Open
Abstract
AIMS To date, no studies have investigated the association between lipid species and coronary plaque changes over time, quantitatively assessed by serial imaging. We aimed to prospectively determine the association between lipid species quantified by plasma lipidomic analysis, with coronary plaque changes according to composition assessed by quantitative serial analysis of coronary computed tomography angiography (CTA). METHODS AND RESULTS Patients with suspected coronary artery disease (CAD) undergoing baseline coronary CTA were prospectively enrolled by 7 EU Centers in the SMARTool study and submitted to clinical, molecular and coronary CTA re-evaluation at follow-up (interscan period 6.39 ± 1.17 years). From the 202 patients that were analysed in the SMARTool main clinical study, lipidomic analysis was performed in 154 patients before the baseline coronary CTA, and this group was included in the present study. Quantitative CTA analysis was performed by a separate core laboratory blinded from clinical data. In univariable analysis, no lipid species were significantly associated with annual total and calcified plaque changes. After adjusting for clinical variables at baseline and statin use, 3 lipid species were significantly associated with non-calcified plaque progression. In detail, cholesteryl ester (CE)(20:3), sphingomyelin (SM)(40:3) and SM(41:1) were found positively related to non-calcified plaque progression (Bonferroni adjusted P-value = 0.005, 0.016 and 0.004, respectively). CONCLUSION The current study showed an independent relationship between specific lipid species determined by plasma lipidomic analysis, and non-calcified coronary plaque progression assessed by serial, quantitative coronary CTA analysis.
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Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology CNR, Pisa, Viale Giuseppe Moruzzi 1 56124, Italy
| | - Giovanni Signore
- Department of Biology, Biochemistry Unit, University of Pisa, 56126, Pisa, Italy
| | - Elena Michelucci
- Institute of Clinical Physiology CNR, Pisa, Viale Giuseppe Moruzzi 1 56124, Italy
| | - Nicoletta Di Giorgi
- Institute of Clinical Physiology CNR, Pisa, Viale Giuseppe Moruzzi 1 56124, Italy
| | | | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Danilo Neglia
- Fondazione Toscana Gabriele Monasterio, Pisa, Viale Giuseppe Moruzzi 1 56124, Italy
| | - Juhani Knuuti
- Heart Center and PET Centre, Turku University Hospital and University of Turku, 20520, Turku, Finland
| | - Antti Saraste
- Heart Center and PET Centre, Turku University Hospital and University of Turku, 20520, Turku, Finland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Switzerland
| | - Anna Teresinska
- Department of Nuclear Medicine, National Institute of Cardiology, Warsaw, Poland
| | - Maria N Pizzi
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Albert Roque
- Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Chiara Caselli
- Institute of Clinical Physiology CNR, Pisa, Viale Giuseppe Moruzzi 1 56124, Italy
| | - Oberdan Parodi
- Cardiovascular Department, Fondazione Toscana G. Monasterio, Via G. Moruzzi 1, Pisa, Italy
| | - Gualtiero Pelosi
- Institute of Clinical Physiology CNR, Pisa, Viale Giuseppe Moruzzi 1 56124, Italy
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Tong WH, Mertens BJ. More Updates to Come of Tisagenlecleucel in Pediatric and Young Adult Patients With Relapsed/Refractory Acute Lymphoblastic Leukemia in the ELIANA Trial: Could the Statistical Methodology Be Further Improved? J Clin Oncol 2023; 41:2450-2451. [PMID: 36898080 DOI: 10.1200/jco.22.02839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Affiliation(s)
- Wing H Tong
- Wing H. Tong, MD, PhD, MSc, Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands, Argos Zorggroep "DrieMaasStede," Center for Specialized Geriatric Care, Schiedam, the Netherlands; and Bart J. Mertens, PhD, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart J Mertens
- Wing H. Tong, MD, PhD, MSc, Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands, Argos Zorggroep "DrieMaasStede," Center for Specialized Geriatric Care, Schiedam, the Netherlands; and Bart J. Mertens, PhD, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Tong WH, Mertens BJ. Comment on 'risk factors associated with nausea and vomiting in children with cancer receiving chemotherapy'. J Oncol Pharm Pract 2023; 29:772-773. [PMID: 36718516 PMCID: PMC10068391 DOI: 10.1177/10781552231152787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Wing H Tong
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center (LUMC), Leiden, The Netherlands.,Argos Zorggroep "DrieMaasStede", Center for Specialized Geriatric Care, Schiedam, The Netherlands
| | - Bart J Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Tong WH, Mertens BJ, de Faber JT. Comment on: Ocular abnormalities at diagnosis and after the completion of treatment in children and adolescents with newly diagnosed acute lymphoblastic leukemia. Pediatr Blood Cancer 2022; 69:e29700. [PMID: 35404536 DOI: 10.1002/pbc.29700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Wing H Tong
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, The Netherlands.,Argos Zorggroep "DrieMaasStede", Center for Specialized Geriatric Care, Schiedam, The Netherlands
| | - Bart J Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan T de Faber
- The Rotterdam Eye Hospital Rotterdam, Rotterdam, The Netherlands
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Stassen J, Ewe SH, Butcher SC, Amanullah MR, Mertens BJ, Hirasawa K, Singh GK, Sin KY, Ding ZP, Pio SM, Sia CH, Chew N, Kong W, Poh KK, Cohen D, Généreux P, Leon MB, Ajmone Marsan N, Delgado V, Bax JJ. Prognostic implications of left ventricular diastolic dysfunction in moderate aortic stenosis. Heart 2022; 108:1401-1407. [PMID: 35688475 DOI: 10.1136/heartjnl-2022-320886] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 04/13/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To investigate the prognostic impact of left ventricular (LV) diastolic dysfunction in patients with moderate aortic stenosis (AS) and preserved LV systolic function. METHODS Patients with a first diagnosis of moderate AS (aortic valve area >1.0 and ≤1.5 cm2) and preserved LV systolic function (LV ejection fraction ≥50%) were identified. LV diastolic function was evaluated using echocardiographic criteria according to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Clinical outcomes were defined as all-cause mortality and a composite of all-cause mortality and aortic valve replacement (AVR). RESULTS Of 1247 patients (age 74±10 years, 47% men), 535 (43%) had LV diastolic dysfunction at baseline. Patients with LV diastolic dysfunction showed significantly higher mortality rates at 1-year, 3-year and 5-year follow-up (13%, 30% and 41%, respectively) when compared with patients with normal LV diastolic function (6%, 17% and 29%, respectively) (p<0.001). On multivariable analysis, LV diastolic dysfunction was independently associated with all-cause mortality (HR 1.368; 95% CI 1.085 to 1.725; p=0.008) and the composite endpoint of all-cause mortality and AVR (HR 1.241; 95% CI 1.035 to 1.488; p=0.020). CONCLUSIONS LV diastolic dysfunction is independently associated with all-cause mortality and the composite endpoint of all-cause mortality and AVR in patients with moderate AS and preserved LV systolic function. Assessment of LV diastolic function therefore contributes significantly to the risk stratification of patients with moderate AS. Future clinical trials are needed to investigate whether patients with moderate AS and LV diastolic dysfunction may benefit from earlier valve intervention.
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Affiliation(s)
- Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - See Hooi Ewe
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Steele C Butcher
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bart J Mertens
- Department of Bioinformatics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kensuke Hirasawa
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Gurpreet K Singh
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Kenny Y Sin
- Department of Cardiothoracic Surgery, National Heart Centre Singapore, Singapore
| | - Zee Pin Ding
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Stephan M Pio
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, Singapore
| | - William Kong
- Department of Cardiology, National University Heart Centre, Singapore
| | - Kian Keong Poh
- Department of Cardiology, National University Heart Centre, Singapore
| | - David Cohen
- Department of Cardiology, Saint Francis Hospital The Heart Center, Roslyn, New York, USA
| | - Philippe Généreux
- Department of Cardiology, Morristown Medical Center, Morristown, New Jersey, USA
| | - Martin B Leon
- Department of Cardiology, Columbia University Medical Center, New York, New York, USA
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands .,Department of Cardiology, Turku Heart Center, Turku, Finland
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Harlaar N, Oudeman MA, Trines SA, de Ruiter GS, Mertens BJ, Khan M, Klautz RJM, Zeppenfeld K, Tjon A, Braun J, van Brakel TJ. Long-term follow-up of thoracoscopic ablation in long-standing persistent atrial fibrillation. Interact Cardiovasc Thorac Surg 2022; 34:990-998. [PMID: 34957518 PMCID: PMC9159446 DOI: 10.1093/icvts/ivab355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/23/2021] [Accepted: 11/23/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Catheter ablation of long-standing persistent atrial fibrillation (LSPAF) remains challenging, with suboptimal success rates obtained following multiple procedures. Thoracoscopic ablation has shown effective at creating transmural lesions around the pulmonary veins and box; however, long-term rhythm follow-up data are lacking. This study aims, for the first time, to assess the long-term outcomes of thoracoscopic pulmonary vein and box ablation in LSPAF. METHODS Rhythm follow-up consisted of continuous rhythm monitoring using implanted loop recorders or 24-h Holter recordings. Rhythm status and touch-up interventions were assessed up to 5 years. RESULTS Seventy-seven patients with symptomatic LSPAF underwent thoracoscopic ablation in 2 centres. Freedom from atrial arrhythmias at 5 years was 50% following a single thoracoscopic procedure and 68% allowing endocardial touch-up procedures (performed in 21% of patients). The mean atrial fibrillation burden in patients with continuous monitoring was reduced from 100% preoperatively to 0.1% at the end of the blanking period and 8.0% during the second year. Antiarrhythmic drug use decreased from 49.4% preoperative to 12.1% and 14.3% at 2 and 5 years, respectively (P < 0.001). Continuous rhythm monitoring resulted in higher recurrence detection rates compared to 24-h Holter monitoring at 2-year follow-up (hazard ratio: 6.5, P = 0.003), with comparable recurrence rates at 5-year follow-up. CONCLUSIONS Thoracoscopic pulmonary vein and box isolation are effective in long-term restoration of sinus rhythm in LSPAF, especially when complemented by endocardial touch-up procedures, as demonstrated by the 68% freedom rate at 5 years. Continuous rhythm monitoring revealed earlier, but not more numerous documentation of recurrences at 5-year follow-up.
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Affiliation(s)
- Niels Harlaar
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Serge A Trines
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Bart J Mertens
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands
| | - Muchtair Khan
- Department of Cardiology, OLVG, Amsterdam, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Andrew Tjon
- Department of Cardiothoracic Surgery, OLVG, Amsterdam, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Thomas J van Brakel
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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Keçe F, de Riva M, Alizadeh Dehnavi R, Wijnmaalen AP, Mertens BJ, Schalij MJ, Zeppenfeld K, Trines SA. Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters. Heart Rhythm O2 2021; 2:290-297. [PMID: 34337580 PMCID: PMC8322820 DOI: 10.1016/j.hroo.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. OBJECTIVE To identify procedural and biophysical parameters predicting ERC. METHODS Consecutive atrial fibrillation (AF) patients undergoing a first cryoballoon ablation (Arctic Front Advance) between 2014 and 2017 were included. ERC was defined as manifest or dormant pulmonary vein (PV) reconnection with adenosine 30 minutes after PVI. Time to isolation (TTI), balloon temperatures (BT), and thawing times were evaluated as potential predictors for ERC. Based on a multivariable model, cut-off-values were defined and a formula was constructed to be used in clinical practice. RESULTS A total of 136 patients (60 ± 10 years, 96 male, 95% paroxysmal AF) were included. ERC was found in 40 (29%) patients (ERC group) and in 53 of 575 (9%) veins. Procedural and total ablation time and the number of unsuccessful freezes were significantly longer/higher in the ERC group compared to the non-ERC group (150 ± 40 vs 125 ± 34 minutes; 24 ± 5 vs 17 ± 4 minutes, and 38% vs 24%, respectively (P = .028). Multivariable analysis showed that a higher nadir balloon temperature (hazard ratio [HR] 1.17 [1.09-1.23, P < .001), a higher number of unsuccessful freezes (HR 1.69 [1.15-2.49], P = .008) and a longer TTI (HR 1.02 [1.01-1.03], P < .001) were independently associated with ERC, leading to the following formula: 0.02 × TTI + 0.5 × number of unsuccessful freezes + 0.2 × nadir BT with a cut-off value of ≤-6.7 to refrain from a waiting period with adenosine testing. CONCLUSION Three easily available parameters were associated with ERC. Using these parameters during ablation can help to avoid a 30-minute waiting period and adenosine testing.
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Affiliation(s)
- Fehmi Keçe
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta de Riva
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Reza Alizadeh Dehnavi
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Adrianus P. Wijnmaalen
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart J. Mertens
- Bioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J. Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Serge A. Trines
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
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El Mahdiui M, Smit JM, van Rosendael AR, Neglia D, Knuuti J, Saraste A, Buechel RR, Teresinska A, Pizzi MN, Roque A, Magnacca M, Mertens BJ, Caselli C, Rocchiccioli S, Parodi O, Pelosi G, Scholte AJ. Sex differences in coronary plaque changes assessed by serial computed tomography angiography. Int J Cardiovasc Imaging 2021; 37:2311-2321. [PMID: 33694122 PMCID: PMC8286938 DOI: 10.1007/s10554-021-02204-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/22/2021] [Indexed: 01/03/2023]
Abstract
Long-term data on sex-differences in coronary plaque changes over time is lacking in a low-to-intermediate risk population of stable coronary artery disease (CAD). The aim of this study was to evaluate the role of sex on long-term plaque progression and evolution of plaque composition. Furthermore, the influence of menopause on plaque progression and composition was also evaluated. Patients that underwent a coronary computed tomography angiography (CTA) were prospectively included to undergo a follow-up coronary CTA. Total and compositional plaque volumes were normalized using the vessel volume to calculate a percentage atheroma volume (PAV). To investigate the influence of menopause on plaque progression, patients were divided into two groups, under and over 55 years of age. In total, 211 patients were included in this analysis, 146 (69%) men. The mean interscan period between baseline and follow-up coronary CTA was 6.2 ± 1.4 years. Women were older, had higher HDL levels and presented more often with atypical chest pain. Men had 434 plaque sites and women 156. On a per-lesion analysis, women had less fibro-fatty PAV compared to men (β -1.3 ± 0.4%; p < 0.001), with no other significant differences. When stratifying patients by 55 years age threshold, fibro-fatty PAV remained higher in men in both age groups (p < 0.05) whilst women younger than 55 years demonstrated more regression of fibrous (β -0.8 ± 0.3% per year; p = 0.002) and non-calcified PAV (β -0.7 ± 0.3% per year; p = 0.027). In a low-to-intermediate risk population of stable CAD patients, no significant sex differences in total PAV increase over time were observed. Fibro-fatty PAV was lower in women at any age and women under 55 years demonstrated significantly greater reduction in fibrous and non-calcified PAV over time compared to age-matched men. (ClinicalTrials.gov number, NCT04448691.)
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Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Danilo Neglia
- Fondazione Toscana Gabriele Monasterio, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Juhani Knuuti
- Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Antti Saraste
- Heart Center and PET Centre, Turku University Hospital and University of Turku, Turku, Finland
| | - Ronny R Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Maria N Pizzi
- Department of Cardiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | - Albert Roque
- Department of Radiology, Hospital Universitari Vall D'Hebron, Barcelona, Spain
| | | | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Chiara Caselli
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Silvia Rocchiccioli
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Oberdan Parodi
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy.,Institute of Information Science and Technologies CNR, Pisa, Italy
| | - Gualtiero Pelosi
- Institute of Clinical Physiology CNR, Viale Giuseppe Moruzzi 1 56124, Pisa, Italy
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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10
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Smit JM, Koning G, van Rosendael AR, El Mahdiui M, Mertens BJ, Schalij MJ, Jukema JW, Delgado V, Reiber JHC, Bax JJ, Scholte AJ. Referral of patients for fractional flow reserve using quantitative flow ratio. Eur Heart J Cardiovasc Imaging 2020; 20:1231-1238. [PMID: 30535361 DOI: 10.1093/ehjci/jey187] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/10/2018] [Indexed: 01/11/2023] Open
Abstract
AIMS Quantitative flow ratio (QFR) is a recently developed technique to calculate fractional flow reserve (FFR) based on 3D quantitative coronary angiography and computational fluid dynamics, obviating the need for a pressure-wire and hyperaemia induction. QFR might be used to guide patient selection for FFR and subsequent percutaneous coronary intervention (PCI) referral in hospitals not capable to perform FFR and PCI. We aimed to investigate the feasibility to use QFR to appropriately select patients for FFR referral. METHODS AND RESULTS Patients who underwent invasive coronary angiography in a hospital where FFR and PCI could not be performed and were referred to our hospital for invasive FFR measurement, were included. Angiogram images from the referring hospitals were retrospectively collected for QFR analysis. Based on QFR cut-off values of 0.77 and 0.86, our patient cohort was reclassified to 'no referral' (QFR ≥0.86), referral for 'FFR' (QFR 0.78-0.85), or 'direct PCI' (QFR ≤0.77). In total, 290 patients were included. Overall accuracy of QFR to detect an invasive FFR of ≤0.80 was 86%. Based on a QFR cut-off value of 0.86, a 50% reduction in patient referral for FFR could be obtained, while only 5% of these patients had an invasive FFR of ≤0.80 (thus, these patients were incorrectly reclassified to the 'no referral' group). Furthermore, 22% of the patients that still need to be referred could undergo direct PCI, based on a QFR cut-off value of 0.77. CONCLUSION QFR is feasible to use for the selection of patients for FFR referral.
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Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Gerhard Koning
- Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Johan H C Reiber
- Medis Medical Imaging Systems B.V., Schuttersveld 9, XG Leiden, The Netherlands.,Department of Radiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, ZA Leiden, The Netherlands
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11
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Smit JM, van Rosendael AR, El Mahdiui M, Neglia D, Knuuti J, Saraste A, Buechel RR, Teresinska A, Pizzi MN, Roque A, Poddighe R, Mertens BJ, Caselli C, Rocchiccioli S, Parodi O, Pelosi G, Scholte AJ. Impact of Clinical Characteristics and Statins on Coronary Plaque Progression by Serial Computed Tomography Angiography. Circ Cardiovasc Imaging 2020; 13:e009750. [DOI: 10.1161/circimaging.119.009750] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background
Progression of coronary artery disease using serial coronary computed tomography angiography (CTA) is of clinical interest. Our primary aim was to prospectively assess the impact of clinical characteristics and statin use on quantitatively assessed coronary plaque progression in a low-risk study population during long-term follow-up.
Methods
Patients who previously underwent coronary CTA for suspected coronary artery disease were prospectively included to undergo follow-up coronary CTA. The primary end point was coronary artery disease progression, defined as the absolute annual increase in total, calcified, and noncalcified plaque volume by quantitative CTA analysis.
Results
In total, 202 patients underwent serial coronary CTA with a mean interscan period of 6.2±1.4 years. On a per-plaque basis, increasing age (β=0.070;
P
=0.058) and hypertension (β=1.380;
P
=0.075) were nonsignificantly associated with annual total plaque progression. Male sex (β=1.676;
P
=0.009), diabetes mellitus (β=1.725;
P
=0.012), and statin use (β=1.498;
P
=0.046) showed an independent association with annual progression of calcified plaque. While hypertension (β=2.259;
P
=0.015) was an independent determinant of noncalcified plaque progression, statin use (β=−2.178;
P
=0.050) was borderline significantly associated with a reduced progression of noncalcified plaque.
Conclusions
Statin use was associated with an increased progression of calcified coronary plaque and a reduced progression of noncalcified coronary plaque, potentially reflecting calcification of the noncalcified plaque component. Whereas hypertension was the only modifiable risk factor predictive of noncalcified plaque progression, diabetes mellitus mainly led to an increase in calcified plaque. These findings could yield the need for intensified preventive treatment of patients with diabetes mellitus and hypertension to slow and stabilize coronary artery disease progression and improve clinical outcome.
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Affiliation(s)
- Jeff M. Smit
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.M.S., A.R.v.R., M.E.M., A.J.S.)
| | - Alexander R. van Rosendael
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.M.S., A.R.v.R., M.E.M., A.J.S.)
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.M.S., A.R.v.R., M.E.M., A.J.S.)
| | - Danilo Neglia
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy (D.N.)
| | - Juhani Knuuti
- Heart Center and PET Centre, Turku University Hospital, University of Turku, Finland (J.K., A.S.)
| | - Antti Saraste
- Heart Center and PET Centre, Turku University Hospital, University of Turku, Finland (J.K., A.S.)
| | - Ronny R. Buechel
- Department of Nuclear Medicine, Cardiac Imaging, University Hospital and University of Zurich, Switzerland (R.R.B.)
| | - Anna Teresinska
- Instytut Kardiologii im. Prymasa Tysiąclecia Stefana Kardynała Wyszyńskiego, ul. Alpejska, Warszawa, Poland (A.T.)
| | | | - Albert Roque
- Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain (A.R.)
| | | | - Bart J. Mertens
- Department of Medical Statistics, Leiden University Medical Center, The Netherlands (B.J.M.)
| | - Chiara Caselli
- Institute of Clinical Physiology CNR, Pisa, Italy (C.C., S.R., G.P.)
| | | | - Oberdan Parodi
- Institute of Clinical Physiology CNR, Pisa, Italy (C.C., S.R., G.P.)
- Institute of Information Science and Technologies CNR, Pisa, Italy (O.P.)
| | - Gualtiero Pelosi
- Institute of Clinical Physiology CNR, Pisa, Italy (C.C., S.R., G.P.)
| | - Arthur J. Scholte
- Department of Cardiology, Leiden University Medical Center, The Netherlands (J.M.S., A.R.v.R., M.E.M., A.J.S.)
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12
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Smit JM, Hermans MP, Dimitriu-Leen AC, van Rosendael AR, Dibbets-Schneider P, de Geus-Oei LF, Mertens BJ, Schalij MJ, Bax JJ, Scholte AJ. Long-term prognostic value of single-photon emission computed tomography myocardial perfusion imaging after primary PCI for STEMI. Eur Heart J Cardiovasc Imaging 2018; 19:1287-1293. [PMID: 29315366 DOI: 10.1093/ehjci/jex332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 12/04/2017] [Indexed: 11/14/2022] Open
Abstract
Aims The aim of this study was to determine the long-term prognostic value of infarct size and myocardial ischaemia on single-photon emission computed tomography myocardial perfusion imaging (SPECT MPI) after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). Methods and results In total, 1092 STEMI patients who underwent primary PCI and SPECT MPI within 1-6 months were included (median follow-up time of 6.9 years). In the entire cohort, SPECT infarct size was independently associated with the composite of cardiac death or reinfarction [hazard ratio (HR) per 10% increase in summed rest score 1.33; 95% confidence interval (95% CI) 1.12-1.58; P = 0.001], whereas myocardial ischaemia was not (HR per 5% increase in summed difference score 1.18; 95% CI 0.94-1.48; P = 0.16). Addition of SPECT infarct size to a model including the clinical variables provided significant incremental prognostic value for the prediction of cardiac death or reinfarction (global χ2 13.8 vs. 24.2; P = 0.002), whereas addition of SPECT ischaemia did not add significantly (global χ2 24.2 vs. 25.6; P = 0.24). In the subgroup of patients with left ventricular ejection fraction (LVEF) ≤ 45%, SPECT infarct size was independently associated with cardiac death or reinfarction (HR 1.59; 95% CI 1.15-2.22; P = 0.006), whereas in patients with LVEF > 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction (HR 1.28; 95% CI 1.00-1.63; P = 0.050). Conclusion In patients with first STEMI and primary PCI, SPECT infarct size was independently associated with cardiac death and/or reinfarction, whereas myocardial ischaemia was not. In patients with LVEF ≤ 45%, SPECT infarct size was independently associated with cardiac death or reinfarction, whereas myocardial ischaemia was not. Conversely, in patients with LVEF > 45%, only SPECT ischaemia was independently associated with cardiac death or reinfarction.
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Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Maaike P Hermans
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Aukelien C Dimitriu-Leen
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Petra Dibbets-Schneider
- Department of Nuclear Medicine, Leiden University Medical Center, 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Nuclear Medicine, Leiden University Medical Center, 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands.,Biomedical Photonic Imaging Group, Science and Technology Faculty, University of Twente, 7500 AE, Drienerlolaan 5, NB, Enschede, The Netherlands
| | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center, 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Postal Zone 2300 RC, Albinusdreef 2, ZA, Leiden, The Netherlands
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13
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Corver J, Sen J, Hornung BVH, Mertens BJ, Berssenbrugge EKL, Harmanus C, Sanders IMJG, Kumar N, Lawley TD, Kuijper EJ, Hensbergen PJ, Nicolardi S. Identification and validation of two peptide markers for the recognition of Clostridioides difficile MLST-1 and MLST-11 by MALDI-MS. Clin Microbiol Infect 2018; 25:904.e1-904.e7. [PMID: 31130255 DOI: 10.1016/j.cmi.2018.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/08/2018] [Accepted: 10/13/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Clostridioides difficile infection (CDI) has become the main cause of nosocomial infective diarrhoea. To survey and control the spread of different C. difficile strains, there is a need for suitable rapid tests. The aim of this study was to identify peptide/protein markers for the rapid recognition of C. difficile strains by matrix-assisted laser desorption/ionization mass spectrometry (MALDI-MS). METHODS We analysed 44 well-characterized strains, belonging to eight different multi-locus sequence types (MLST), using ultrahigh-resolution Fourier transform ion cyclotron resonance (FTICR) MS. The amino acid sequence of two peptide markers specific for MLST-1 and MLST-11 strains was elucidated by MALDI-TOF-MS/MS. The investigation of 2689 C. difficile genomes allowed the determination of the sensitivity and specificity of these markers. C18-solid-phased extraction was used to enrich the MLST-1 marker. RESULTS Two peptide markers (m/z 4927.81 and m/z 5001.84) were identified and characterized for MLST-1 and MLST-11 strains, respectively. The MLST-1 marker was found in 786 genomes of which three did not belong to MLST-1. The MLST-11 marker was found in 319 genomes, of which 14 did not belong to MLST-11. Importantly, all MLST-1 and MLST-11 genomes were positive for their respective marker. Furthermore, a peptide marker (m/z 5015.86) specific for MLST-15 was found in 59 genomes. We translated our findings into a fast and simple method that allowed the unambiguous identification of the MLST-1 marker on a MALDI-TOF-MS platform. CONCLUSIONS MALDI-FTICR MS-based peptide profiling resulted in the identification of peptide markers for C. difficile MLST-1 and MLST-11.
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Affiliation(s)
- J Corver
- Leiden University Medical Centre, Centre of Infectious Diseases, Department Medical Microbiology, Section Experimental Bacteriology, Leiden, the Netherlands; Centre for Microbiota Analysis and Therapeutics, Department Medical Microbiology, Leiden University, Leiden, the Netherlands
| | - J Sen
- Leiden University Medical Centre, Centre for Proteomics and Metabolomics, Leiden, the Netherlands
| | - B V H Hornung
- Leiden University Medical Centre, Centre of Infectious Diseases, Department Medical Microbiology, Section Experimental Bacteriology, Leiden, the Netherlands; Centre for Microbiota Analysis and Therapeutics, Department Medical Microbiology, Leiden University, Leiden, the Netherlands
| | - B J Mertens
- Leiden University Medical Centre, Department of Medical Statistics and Bioinformatics, Leiden, the Netherlands
| | - E K L Berssenbrugge
- Leiden University Medical Centre, Centre of Infectious Diseases, Department Medical Microbiology, Section Experimental Bacteriology, Leiden, the Netherlands
| | - C Harmanus
- Leiden University Medical Centre, Centre of Infectious Diseases, Department Medical Microbiology, Section Experimental Bacteriology, Leiden, the Netherlands
| | - I M J G Sanders
- Leiden University Medical Centre, Centre of Infectious Diseases, Department Medical Microbiology, Section Experimental Bacteriology, Leiden, the Netherlands
| | - N Kumar
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, UK
| | - T D Lawley
- Host-Microbiota Interactions Laboratory, Wellcome Sanger Institute, Hinxton, UK
| | - E J Kuijper
- Leiden University Medical Centre, Centre of Infectious Diseases, Department Medical Microbiology, Section Experimental Bacteriology, Leiden, the Netherlands; Centre for Microbiota Analysis and Therapeutics, Department Medical Microbiology, Leiden University, Leiden, the Netherlands
| | - P J Hensbergen
- Leiden University Medical Centre, Centre for Proteomics and Metabolomics, Leiden, the Netherlands.
| | - S Nicolardi
- Leiden University Medical Centre, Centre for Proteomics and Metabolomics, Leiden, the Netherlands.
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14
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Smit JM, Koning G, Van Rosendael AR, El Mahdiui M, Mertens BJ, Schalij MJ, Jukema JW, Delgado V, Reiber JHC, Bax JJ, Scholte AJ. P4635Referral of patients for fractional flow reserve using quantitative flow ratio. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- J M Smit
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - G Koning
- Medis Medical Imaging Systems bv, Leiden, Netherlands
| | - A R Van Rosendael
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - M El Mahdiui
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - B J Mertens
- Leiden University Medical Center, Department of Medical Statistics, Leiden, Netherlands
| | - M J Schalij
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - J W Jukema
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - V Delgado
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - J H C Reiber
- Medis Medical Imaging Systems bv, Leiden, Netherlands
| | - J J Bax
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
| | - A J Scholte
- Leiden University Medical Center, Department of Cardiology, Leiden, Netherlands
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15
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Debonnaire P, Joyce E, Hiemstra Y, Mertens BJ, Atsma DE, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Left Atrial Size and Function in Hypertrophic Cardiomyopathy Patients and Risk of New-Onset Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004052. [PMID: 28183843 DOI: 10.1161/circep.116.004052] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 12/23/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The value of left atrial (LA) diameter, volume, and strain to risk stratify hypertrophic cardiomyopathy patients for new-onset atrial fibrillation (AF) was explored. METHODS AND RESULTS A total of 242 hypertrophic cardiomyopathy patients without AF history were evaluated by (speckle-tracking) echocardiography. During mean follow-up of 4.8±3.7 years, 41 patients (17%) developed new-onset AF. Multivariable analysis showed LA volume (≥37 mL/m2; hazard ratio, 2.68; 95% confidence interval, 1.30-5.54; P=0.008) and LA strain (≤23.4%; hazard ratio, 3.22; 95% confidence interval, 1.50-6.88; P=0.003), but not LA diameter (≥45 mm; hazard ratio, 1.67; 95% confidence interval, 0.84-3.32; P=0.145), as independent AF correlates. Importantly, 59% (n=24) of AF events occurred despite a baseline LA diameter <45 mm, observed in 185 patients. In this patient subset, LA strain (area under the curve 0.73) and LA volume (area under the curve 0.83) showed good predictive value for new-onset AF. Furthermore, patients with LA volume <37 versus ≥37 mL/m2 and LA strain >23.4% versus ≤23.4% had superior 5-year AF-free survival of 93% versus 80% (P=0.003) and 98% versus 74% (P=0.002), respectively. Importantly, LA volume <37 mL/m2 and strain >23.4% yielded high negative predictive value (93% and 98%, respectively) for new-onset AF. Likelihood ratio test indicated incremental value of LA volume assessment (P=0.011) on top of LA diameter to predict new-onset AF in hypertrophic cardiomyopathy patients with LA diameter <45 mm, which tended to increase further by addition of LA strain (P=0.126). CONCLUSIONS LA diameter, volume, and strain all relate to new-onset AF in hypertrophic cardiomyopathy patients. In patients with normal LA size, however, both LA volume and strain further refine risk stratification for new-onset AF.
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Affiliation(s)
- Philippe Debonnaire
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Emer Joyce
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Yasmine Hiemstra
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Bart J Mertens
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Douwe E Atsma
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Martin J Schalij
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Jeroen J Bax
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Victoria Delgado
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Nina Ajmone Marsan
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
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16
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Debonnaire P, Joyce E, Hiemstra Y, Mertens BJ, Atsma DE, Schalij MJ, Bax JJ, Delgado V, Marsan NA. Left Atrial Size and Function in Hypertrophic Cardiomyopathy Patients and Risk of New-Onset Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017. [PMID: 28183843 DOI: 10.1161/circep.116.004052.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The value of left atrial (LA) diameter, volume, and strain to risk stratify hypertrophic cardiomyopathy patients for new-onset atrial fibrillation (AF) was explored. METHODS AND RESULTS A total of 242 hypertrophic cardiomyopathy patients without AF history were evaluated by (speckle-tracking) echocardiography. During mean follow-up of 4.8±3.7 years, 41 patients (17%) developed new-onset AF. Multivariable analysis showed LA volume (≥37 mL/m2; hazard ratio, 2.68; 95% confidence interval, 1.30-5.54; P=0.008) and LA strain (≤23.4%; hazard ratio, 3.22; 95% confidence interval, 1.50-6.88; P=0.003), but not LA diameter (≥45 mm; hazard ratio, 1.67; 95% confidence interval, 0.84-3.32; P=0.145), as independent AF correlates. Importantly, 59% (n=24) of AF events occurred despite a baseline LA diameter <45 mm, observed in 185 patients. In this patient subset, LA strain (area under the curve 0.73) and LA volume (area under the curve 0.83) showed good predictive value for new-onset AF. Furthermore, patients with LA volume <37 versus ≥37 mL/m2 and LA strain >23.4% versus ≤23.4% had superior 5-year AF-free survival of 93% versus 80% (P=0.003) and 98% versus 74% (P=0.002), respectively. Importantly, LA volume <37 mL/m2 and strain >23.4% yielded high negative predictive value (93% and 98%, respectively) for new-onset AF. Likelihood ratio test indicated incremental value of LA volume assessment (P=0.011) on top of LA diameter to predict new-onset AF in hypertrophic cardiomyopathy patients with LA diameter <45 mm, which tended to increase further by addition of LA strain (P=0.126). CONCLUSIONS LA diameter, volume, and strain all relate to new-onset AF in hypertrophic cardiomyopathy patients. In patients with normal LA size, however, both LA volume and strain further refine risk stratification for new-onset AF.
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Affiliation(s)
- Philippe Debonnaire
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Emer Joyce
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Yasmine Hiemstra
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Bart J Mertens
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Douwe E Atsma
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Martin J Schalij
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Jeroen J Bax
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Victoria Delgado
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.)
| | - Nina Ajmone Marsan
- From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
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Mertens BJ, Kwint HF, Bouvy ML, van Marum RJ. [Multidose drug dispensing: what does it really involve?]. Ned Tijdschr Geneeskd 2017; 161:D1770. [PMID: 29303089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
- Multidose drug dispensing (MDD) systems are individualised forms of distribution that give structure to medication use. - Starting to use a multidose drug dispensing system must be initiated in joint discussion with the patient, once alternatives such as dosing schemes or automatic repeat-prescription services have been considered. The patient's autonomy and self-management are central.- Studies have shown positive effects of individualised forms of distribution on intermediary outcome measures such as HbA1c, LDL cholesterol, blood pressure and adherence. - Changes in medication should preferably be implemented when the pharmacist orders a new multidose drug dispensing system. It is difficult for the pharmacist to determine whether an immediate change is necessary if the indication and other possible reasons for change are not known. - The prescriber should preferably enquire whether the patient has a multidose dispensing system and should state the moment or the reason for the change on the prescription.- Pharmacotherapy in patients using a multidose drug dispensing system should be reviewed annually.
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Affiliation(s)
- B J Mertens
- SIR Institute for Pharmacy Practice and Policy, Leiden
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Potjer TP, Mertens BJ, Nicolardi S, van der Burgt YEM, Bonsing BA, Mesker WE, Tollenaar RAEM, Vasen HFA. Application of a Serum Protein Signature for Pancreatic Cancer to Separate Cases from Controls in a Pancreatic Surveillance Cohort. Transl Oncol 2016; 9:242-7. [PMID: 27267843 PMCID: PMC4907893 DOI: 10.1016/j.tranon.2016.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 03/02/2016] [Accepted: 03/08/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Pancreatic cancer (PC) surveillance is currently offered to individuals with a genetic predisposition to PC, but routinely used radiological screening modalities are not entirely reliable in detecting early-stage PC or its precursor lesions. We recently identified a discriminating PC biomarker signature in a sporadic patient cohort. In this study, we investigated if protein profiling can accurately distinguish PC from non-PC in a pancreatic surveillance cohort of genetically predisposed individuals. METHODS Serum samples of 66 individuals with a CDKN2A germline mutation who participated in the pancreatic surveillance program (5 cases, 61 controls) were obtained following a standardized protocol. After sample clean-up, peptide and protein profiles were obtained on an ultrahigh-resolution matrix-assisted laser desorption/ionization-Fourier transform ion cyclotron resonance mass spectrometry platform. A discriminant score for each sample was calculated with a previously designed prediction rule, and the median discriminant scores of cases and controls were compared. Individuals with precursor lesions of PC (n = 4) and individuals with a recent diagnosis of melanoma (n = 4) were also separately considered. RESULTS Cases had a higher median discriminant score than controls (0.26 vs 0.016; P = .001). The only individual with pathologically confirmed precursor lesions of PC could also be clearly distinguished from controls, and having a (recent) medical history of melanoma did not influence the protein signatures. CONCLUSIONS Peptide and protein signatures are able to accurately distinguish PC cases from controls in a pancreatic surveillance setting. Mass spectrometry-based protein profiling therefore seems to be a promising candidate for implementation in the pancreatic surveillance program as an additional screening modality.
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Affiliation(s)
- Thomas P Potjer
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands.
| | - Bart J Mertens
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands
| | - Simone Nicolardi
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, the Netherlands
| | - Bert A Bonsing
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands
| | - Hans F A Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, the Netherlands
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Fleurbaaij F, Kraakman MEM, Claas ECJ, Knetsch CW, van Leeuwen HC, van der Burgt YEM, Veldkamp KE, Vos MC, Goessens W, Mertens BJ, Kuijper EJ, Hensbergen PJ, Nicolardi S. Typing Pseudomonas aeruginosa Isolates with Ultrahigh Resolution MALDI-FTICR Mass Spectrometry. Anal Chem 2016; 88:5996-6003. [PMID: 27123572 DOI: 10.1021/acs.analchem.6b01037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The introduction of standardized matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) platforms in the medical microbiological practice has revolutionized the way microbial species identification is performed on a daily basis. To a large extent, this is due to the ease of operation. Acquired spectra are compared to profiles obtained from cultured colonies present in a reference spectra database. It is fast and reliable, and costs are low compared to previous diagnostic approaches. However, the low resolution and dynamic range of the MALDI-TOF profiles have shown limited applicability for the discrimination of different bacterial strains, as achieved with typing based on genetic markers. This is pivotal in cases where certain strains are associated with, e.g., virulence or antibiotic resistance. Ultrahigh resolution MALDI-FTICR MS allows the measurement of small proteins at isotopic resolution and can be used to analyze complex mixtures with increased dynamic range and higher precision than MALDI-TOF MS, while still generating results in a similar time frame. Here, we propose to use ultrahigh resolution 15T MALDI-Fourier transform ion cyclotron resonance (FTICR) MS to discriminate clinically relevant bacterial strains after species identification performed by MALDI-TOF MS. We used a collection of well characterized Pseudomonas aeruginosa strains, featuring distinct antibiotic resistance profiles, and isolates obtained during hospital outbreaks. Following cluster analysis based on amplification fragment length polymorphism (AFLP), these strains were grouped into three different clusters. The same clusters were obtained using protein profiles generated by MALDI-FTICR MS. Subsequent intact protein analysis by electrospray ionization (ESI)-collision-induced dissociation (CID)-FTICR MS was applied to identify protein isoforms that contribute to the separation of the different clusters, illustrating the additional advantage of this analytical platform.
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Affiliation(s)
- Frank Fleurbaaij
- Department of Medical Microbiology, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Margriet E M Kraakman
- Department of Medical Microbiology, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Eric C J Claas
- Department of Medical Microbiology, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Cornelis W Knetsch
- Department of Medical Microbiology, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Hans C van Leeuwen
- Department of Medical Microbiology, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Yuri E M van der Burgt
- Center for Proteomics and Metabolomics, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Karin Ellen Veldkamp
- Department of Medical Microbiology, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Disease, Erasmus MC , 3015 CN Rotterdam, The Netherlands
| | - Wil Goessens
- Department of Medical Microbiology and Infectious Disease, Erasmus MC , 3015 CN Rotterdam, The Netherlands
| | - Bart J Mertens
- Department of Medical Statistics, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Ed J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Paul J Hensbergen
- Center for Proteomics and Metabolomics, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
| | - Simone Nicolardi
- Center for Proteomics and Metabolomics, Leiden University Medical Center , 2333 ZA Leiden, The Netherlands
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Huijbers A, Mesker WE, Mertens BJ, Bladergroen MR, Deelder AM, van der Burgt YEM, Tollenaar RAEM. Case-controlled identification of colorectal cancer based on proteomic profiles and the potential for screening. Colorectal Dis 2014; 16:907-13. [PMID: 25243779 DOI: 10.1111/codi.12782] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/17/2014] [Indexed: 01/25/2023]
Abstract
AIM Colorectal cancer (CRC) screening programmes detect early cancers but unfortunately have limited sensitivity and specificity. Mass spectrometry-based determination of serum peptide and protein profiles provides a new approach for improved screening. METHOD Serum samples were obtained from 126 CRC patients before treatment and 277 control individuals. An additional group of samples from 50 CRC patients and 82 controls was used for validation. Peptide and protein enrichments were carried out using reverse-phase C18 and weak-cation exchange magnetic beads in an automated solid-phase extraction and spotting procedure. Profiles were acquired on a matrix-assisted laser desorption/ionization time-of-flight system. Discriminant rules using logistic regression were calibrated for the peptide and protein signatures separately, followed by combining the classifications to obtain double cross-validated predicted class probabilities. Results were validated on an identical patient set. RESULTS A discriminative power was found for patients with CRC representative for all histopathological stages compared with controls with an area under the curve of 0.95 in the test set (0.93 for the validation set) and with a high specificity (94-95%). CONCLUSION The study has shown that a serum peptide and protein biomarker signature can be used to distinguish CRC patients from healthy controls with high discriminative power. This relatively simple and cheap test is promising for CRC screening.
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Affiliation(s)
- A Huijbers
- Department of Surgery, Leiden Universal Medical Center, Leiden, The Netherlands
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Velstra B, Vonk MA, Bonsing BA, Mertens BJ, Nicolardi S, Huijbers A, Vasen H, Deelder AM, Mesker WE, van der Burgt YEM, Tollenaar RAEM. Serum peptide signatures for pancreatic cancer based on mass spectrometry: a comparison to CA19-9 levels and routine imaging techniques. J Cancer Res Clin Oncol 2014; 141:531-41. [DOI: 10.1007/s00432-014-1812-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 08/21/2014] [Indexed: 12/26/2022]
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Nicolardi S, Velstra B, Mertens BJ, Bonsing B, Mesker WE, Tollenaar RA, Deelder AM, van der Burgt YE. Ultrahigh resolution profiles lead to more detailed serum peptidome signatures of pancreatic cancer. Translational Proteomics 2014. [DOI: 10.1016/j.trprot.2013.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Velstra B, Bonsing BA, Mertens BJ, Burgt YEM, Huijbers A, Vasen H, Mesker WE, Deelder AM, Tollenaar RAEM. Detection of pancreatic cancer using serum protein profiling. HPB (Oxford) 2013; 15:602-10. [PMID: 23458426 PMCID: PMC3731581 DOI: 10.1111/hpb.12017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Accepted: 10/18/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND Currently, no suitable biomarkers for the early detection of pancreatic cancer (PC) are available. Proteins present in the serum could reflect a state of the disease. In this study, these profiles as a diagnostic marker for PC were evaluated. METHODS Serum samples were obtained from PC patients (n = 50 calibration set, n = 39 validation set) and healthy volunteers (n = 110 and n = 75 respectively) according to a uniform standardized collection and processing protocol. For peptide and protein isolation, automated solid-phase extraction (SPE) with Weak Cation Exchange (WCX) magnetic beads (MB) was performed using a 96-channel liquid handling platform. Protein profiles were obtained by mass spectrometry (MS) and evaluated by linear discriminant analysis with double cross-validation. RESULTS A discriminating profile for PC has been identified, with a sensitivity of 78% and a specificity of 89% in the calibration set with an area under the curve (AUC) of 90%. These results were validated with a sensitivity of 74% and a specificity of 91% (AUC 90%). CONCLUSION Serum profiles of healthy controls and PC can be discrimated between. Further research is warranted to evaluate specificity and whether this biosignature can be used for early detection in a high risk population.
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Affiliation(s)
- Berit Velstra
- Department of Surgery, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
| | - Bert A Bonsing
- Department of Surgery, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
| | - Bart J Mertens
- Department of Medical Statistics and Bioinformatics, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
| | - Yuri E M Burgt
- Department of Parasitology, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
| | - Anouck Huijbers
- Department of Surgery, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
| | - Hans Vasen
- Department of Gastroenterology and Hepatology, Leiden University Medical Center (LUMC)Leiden, the Netherlands
| | - Wilma E Mesker
- Department of Surgery, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
| | - André M Deelder
- Department of Parasitology, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Biolomolecular Mass Spectometry UnitLeiden, the Netherlands
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Velstra B, van der Burgt YEM, Mertens BJ, Mesker WE, Deelder AM, Tollenaar RAEM. Improved classification of breast cancer peptide and protein profiles by combining two serum workup procedures. J Cancer Res Clin Oncol 2012; 138:1983-92. [PMID: 22763645 PMCID: PMC3491194 DOI: 10.1007/s00432-012-1273-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/15/2012] [Indexed: 12/22/2022]
Abstract
Purpose Detection of breast cancer at early stage increases patient’s survival. Mass spectrometry-based protein analysis of serum samples is a promising approach to obtain biomarker profiles for early detection. A combination of commonly applied solid-phase extraction procedures for clean-up may increase the number of detectable peptides and proteins. In this study, we have evaluated whether the classification performance of breast cancer profiles improves by using two serum workup procedures. Methods Serum samples from 105 breast cancer patients and 202 healthy volunteers were processed according to a standardized protocol implemented on a high-end liquid-handling robot. Peptide and protein enrichments were carried out using weak-cation exchange (WCX) and reversed-phase (RP) C18 magnetic beads. Profiles were acquired on a matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometer. In this way, two different biomarker profiles were obtained for each serum sample, yielding a WCX- and RPC18-dataset. Results The profiles were statistically evaluated with double cross-validation. Classification results of WCX- and RPC18-datasets were determined for each set separately and for the combination of both sets. Sensitivity and specificity were 82 and 87 % (WCX) and 73 and 93 % (RPC18) for the individual workup procedures. These values increased up to 84 and 95 %, respectively, upon combining the data. Conclusion It was found that MALDI-TOF peptide and protein profiles can be used for classification of breast cancer with high sensitivity and specificity. The classification performance even improved when two workup procedures were applied, since these provide a greater number of features (proteins). Electronic supplementary material The online version of this article (doi:10.1007/s00432-012-1273-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Berit Velstra
- Department of Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA, Leiden, The Netherlands.
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Wolterbeek N, Garling EH, Mertens BJ, Nelissen RGHH, Valstar ER. Kinematics and early migration in single-radius mobile- and fixed-bearing total knee prostheses. Clin Biomech (Bristol, Avon) 2012; 27:398-402. [PMID: 22055272 DOI: 10.1016/j.clinbiomech.2011.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 10/15/2011] [Accepted: 10/17/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND The mobile-bearing variant of a single-radius design is assumed to provide more freedom of motion compared to the fixed-bearing variant because the insert does not restrict the natural movements of the femoral component. This would reduce the contact stresses and wear which in turn may have a positive effect on the fixation of the prosthesis to the bone and thereby decreases the risk for loosening. The aim of this study was to evaluate early migration of the tibial component and kinematics of a mobile-bearing and fixed-bearing total knee prosthesis of the same single-radius design. METHODS Twenty Triathlon single-radius posterior-stabilized knee prostheses were implanted (9 mobile-bearing and 11 fixed-bearing). Fluoroscopy and roentgen stereophotogrammetric analysis (RSA) were performed 6 and 12 months post-operatively. FINDINGS The 1 year post-operative RSA results showed considerable early migrations in 3 out of 9 mobile-bearing patients and 1 out of 11 fixed-bearing patients. The range of knee flexion was the same for the mobile-bearing and fixed-bearing group. The mobile insert was following the femoral component during motion. INTERPRETATION Despite the mobile insert following the femoral component during motion, and therefore performing as intended, no kinematic advantages of the mobile-bearing total knee prosthesis were seen. The fixed-bearing knee performed as good as the mobile-bearing knee and maybe even slightly better based on less irregular kinematics and less early migrations.
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Affiliation(s)
- N Wolterbeek
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
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26
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van Nieuwkoop C, Hoppe BPC, Bonten TN, Van't Wout JW, Aarts NJM, Mertens BJ, Leyten EMS, Koster T, Wattel-Louis GH, Delfos NM, Ablij HC, Elzevier HW, van Dissel JT. Predicting the need for radiologic imaging in adults with febrile urinary tract infection. Clin Infect Dis 2010; 51:1266-72. [PMID: 21034195 DOI: 10.1086/657071] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Radiologic evaluation of adults with febrile urinary tract infection (UTI) is frequently performed to exclude urological disorders. This study aims to develop a clinical rule predicting need for radiologic imaging. METHODS We conducted a prospective, observational study including consecutive adults with febrile UTI at 8 emergency departments (EDs) in the Netherlands. Outcomes of ultrasounds and computed tomographs of the urinary tract were classified as "urgent urological disorder" (pyonephrosis or abscess), "nonurgent urologic disorder," "normal," and "incidental nonurological findings." Urgent and nonurgent urologic disorders were classified as "clinically relevant radiologic findings." The data of 5 EDs were used as the derivation cohort, and 3 EDs served as the validation cohort. RESULTS Three hundred forty-six patients were included in the derivation cohort. Radiologic imaging was performed for 245 patients (71%). A prediction rule was derived, being the presence of a history of urolithiasis, a urine pH ≥7.0, and/or renal insufficiency (estimated glomerular filtration rate, ≤40 mL/min/1.73 m(3)). This rule predicts clinically relevant radiologic findings with a negative predictive value (NPV) of 93% and positive predictive value (PPV) of 24% and urgent urological disorders with an NPV of 99% and a PPV of 10%. In the validation cohort (n = 131), the NPV and PPV for clinically relevant radiologic findings were 89% and 20%, respectively; for urgent urological disorders, the values were 100% and 11%, respectively. Potential reduction of radiologic imaging by implementing the prediction rule was 40%. CONCLUSIONS Radiologic imaging can selectively be applied in adults with febrile UTI without loss of clinically relevant information by using a simple clinical prediction rule.
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Affiliation(s)
- C van Nieuwkoop
- Departments of Infectious Diseases, Leiden University Medical Center, Diaconessenhuis Hospital, Leiden, the Netherlands.
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Huijbers A, Velstra B, Dekker TJA, Mesker WE, van der Burgt YEM, Mertens BJ, Deelder AM, Tollenaar RAEM. Proteomic serum biomarkers and their potential application in cancer screening programs. Int J Mol Sci 2010; 11:4175-93. [PMID: 21151433 PMCID: PMC3000077 DOI: 10.3390/ijms11114175] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 10/16/2010] [Accepted: 10/18/2010] [Indexed: 02/06/2023] Open
Abstract
Early diagnosis of cancer is of pivotal importance to reduce disease-related mortality. There is great need for non-invasive screening methods, yet current screening protocols have limited sensitivity and specificity. The use of serum biomarkers to discriminate cancer patients from healthy persons might be a tool to improve screening programs. Mass spectrometry based proteomics is widely applied as a technology for mapping and identifying peptides and proteins in body fluids. One commonly used approach in proteomics is peptide and protein profiling. Here, we present an overview of profiling methods that have the potential for implementation in a clinical setting and in national screening programs.
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Affiliation(s)
- Anouck Huijbers
- Department of Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands; E-Mails: (A.H.); (B.V.); (W.E.M.)
| | - Berit Velstra
- Department of Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands; E-Mails: (A.H.); (B.V.); (W.E.M.)
| | - Tim J. A. Dekker
- Department of Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands; E-Mails: (A.H.); (B.V.); (W.E.M.)
| | - Wilma E. Mesker
- Department of Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands; E-Mails: (A.H.); (B.V.); (W.E.M.)
| | - Yuri E. M. van der Burgt
- Department of Parasitology, Biomolecular Mass Spectrometry Unit, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Bart J. Mertens
- Department of Medical Statistics, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - André M. Deelder
- Department of Parasitology, Biomolecular Mass Spectrometry Unit, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Rob A. E. M. Tollenaar
- Department of Surgery, Leiden University Medical Center (LUMC), Albinusdreef 2, 2333 ZA Leiden, The Netherlands; E-Mails: (A.H.); (B.V.); (W.E.M.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +317-152-636-10
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van der Woude D, Young A, Jayakumar K, Mertens BJ, Toes REM, van der Heijde D, Huizinga TWJ, van der Helm-van Mil AHM. Prevalence of and predictive factors for sustained disease-modifying antirheumatic drug-free remission in rheumatoid arthritis: Results from two large early arthritis cohorts. ACTA ACUST UNITED AC 2009; 60:2262-71. [DOI: 10.1002/art.24661] [Citation(s) in RCA: 163] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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