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Balder JW, Szymanski MK, van Laake LW, van der Harst P, Meuwese CL, Ramjankhan FZ, van der Meer MG, Hermens JAJM, Voskuil M, de Waal EEC, Donker DW, Oerlemans MIFJ, Kraaijeveld AO. ECPELLA as a bridge-to-decision in refractory cardiogenic shock: a single-centre experience. Neth Heart J 2024:10.1007/s12471-024-01872-w. [PMID: 38713449 DOI: 10.1007/s12471-024-01872-w] [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] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND In refractory cardiogenic shock, temporary mechanical support (tMCS) may be crucial for maintaining tissue perfusion and oxygen delivery. tMCS can serve as a bridge-to-decision to assess eligibility for left ventricular assist device (LVAD) implantation or heart transplantation, or as a bridge-to-recovery. ECPELLA is a novel tMCS configuration combining venoarterial extracorporeal membrane oxygenation with Impella. The present study presents the clinical parameters, outcomes, and complications of patients supported with ECPELLA. METHODS All patients supported with ECPELLA at University Medical Centre Utrecht between December 2020 and August 2023 were included. The primary outcome was 30-day mortality, and secondary outcomes were LVAD implantation/heart transplantation and safety outcomes. RESULTS Twenty patients with an average age of 51 years, and of whom 70% were males, were included. Causes of cardiogenic shock were acute heart failure (due to acute coronary syndrome, myocarditis, or after cardiac surgery) or chronic heart failure, respectively 70 and 30% of cases. The median duration of ECPELLA support was 164 h (interquartile range 98-210). In 50% of cases, a permanent LVAD was implanted. Cardiac recovery within 30 days was seen in 30% of cases and 30-day mortality rate was 20%. ECPELLA support was associated with major bleeding (40%), haemolysis (25%), vascular complications (30%), kidney failure requiring replacement therapy (50%), and Impella failure requiring extraction (15%). CONCLUSION ECPELLA can be successfully used as a bridge to LVAD implantation or as a bridge-to-recovery in patients with refractory cardiogenic shock. Despite a significant number of complications, 30-day mortality was lower than observed in previous cohorts.
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Affiliation(s)
- Jan-Willem Balder
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Mariusz K Szymanski
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Linda W van Laake
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pim van der Harst
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Christiaan L Meuwese
- Department of Cardiology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Faiz Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jeannine A J M Hermens
- Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Eric E C de Waal
- Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Dirk W Donker
- Department of Intensive Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, Tech Med Centre, University of Twente, Enschede, The Netherlands
| | | | - Adriaan O Kraaijeveld
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Loaiza N, Hartgers ML, Reeskamp LF, Balder JW, Rimbert A, Bazioti V, Wolters JC, Winkelmeijer M, Jansen HPG, Dallinga-Thie GM, Volta A, Huijkman N, Smit M, Kloosterhuis N, Koster M, Svendsen AF, van de Sluis B, Hovingh GK, Grefhorst A, Kuivenhoven JA. Taking One Step Back in Familial Hypercholesterolemia: STAP1 Does Not Alter Plasma LDL (Low-Density Lipoprotein) Cholesterol in Mice and Humans. Arterioscler Thromb Vasc Biol 2020; 40:973-985. [PMID: 31996024 PMCID: PMC7098433 DOI: 10.1161/atvbaha.119.313470] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [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: 11/16/2022]
Abstract
OBJECTIVE STAP1, encoding for STAP1 (signal transducing adaptor family member 1), has been reported as a candidate gene associated with familial hypercholesterolemia. Unlike established familial hypercholesterolemia genes, expression of STAP1 is absent in liver but mainly observed in immune cells. In this study, we set out to validate STAP1 as a familial hypercholesterolemia gene. Approach and Results: A whole-body Stap1 knockout mouse model (Stap1-/-) was generated and characterized, without showing changes in plasma lipid levels compared with controls. In follow-up studies, bone marrow from Stap1-/- mice was transplanted to Ldlr-/- mice, which did not show significant changes in plasma lipid levels or atherosclerotic lesions. To functionally assess whether STAP1 expression in B cells can affect hepatic function, HepG2 cells were cocultured with peripheral blood mononuclear cells isolated from heterozygotes carriers of STAP1 variants and controls. The peripheral blood mononuclear cells from STAP1 variant carriers and controls showed similar LDLR mRNA and protein levels. Also, LDL (low-density lipoprotein) uptake by HepG2 cells did not differ upon coculturing with peripheral blood mononuclear cells isolated from either STAP1 variant carriers or controls. In addition, plasma lipid profiles of 39 carriers and 71 family controls showed no differences in plasma LDL cholesterol, HDL (high-density lipoprotein) cholesterol, triglycerides, and lipoprotein(a) levels. Similarly, B-cell populations did not differ in a group of 10 STAP1 variant carriers and 10 age- and sex-matched controls. Furthermore, recent data from the UK Biobank do not show association between STAP1 rare gene variants and LDL cholesterol. CONCLUSIONS Our combined studies in mouse models and carriers of STAP1 variants indicate that STAP1 is not a familial hypercholesterolemia gene.
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Affiliation(s)
- Natalia Loaiza
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Merel L Hartgers
- Department of Vascular Medicine, Amsterdam University Medical Centers, Location AMC, the Netherlands (M.L.H., L.F.R., G.M.D.-T., G.K.H.)
| | - Laurens F Reeskamp
- Department of Vascular Medicine, Amsterdam University Medical Centers, Location AMC, the Netherlands (M.L.H., L.F.R., G.M.D.-T., G.K.H.)
| | - Jan-Willem Balder
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands.,Department of Vascular Medicine (J.-W.B.), University Medical Center Groningen, University of Groningen, the Netherlands.,Department of Cardiology, University Medical Center Utrecht, the Netherlands (J.-W.B.)
| | - Antoine Rimbert
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands.,L'institut du thorax, INSERM, CNRS, Université de Nantes, France (A.R.)
| | - Venetia Bazioti
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Justina C Wolters
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Maaike Winkelmeijer
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, Location AMC, the Netherlands (M.W., H.P.G.J., A.G.)
| | - Hans P G Jansen
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, Location AMC, the Netherlands (M.W., H.P.G.J., A.G.)
| | - Geesje M Dallinga-Thie
- Department of Vascular Medicine, Amsterdam University Medical Centers, Location AMC, the Netherlands (M.L.H., L.F.R., G.M.D.-T., G.K.H.)
| | - Andrea Volta
- Department of Experimental and Clinical Medicine, University of Florence, Italy (A.V.)
| | - Nicolette Huijkman
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Marieke Smit
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Niels Kloosterhuis
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Mirjam Koster
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Arthur F Svendsen
- Laboratory of Ageing Biology and Stem Cells, European Institute for the Biology of Aging (ERIBA) (A.F.S.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Bart van de Sluis
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands.,iPSC/CRISPR Center Groningen (B.v.d.S.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam University Medical Centers, Location AMC, the Netherlands (M.L.H., L.F.R., G.M.D.-T., G.K.H.)
| | - Aldo Grefhorst
- Department of Experimental Vascular Medicine, Amsterdam University Medical Centers, Location AMC, the Netherlands (M.W., H.P.G.J., A.G.)
| | - Jan Albert Kuivenhoven
- From the Department of Pediatrics, Molecular Genetics Section (N.L., J.-W.B., A.R., V.B., J.C.W., N.H., M.S., N.K., M.K., B.v.d.S., J.A.K.), University Medical Center Groningen, University of Groningen, the Netherlands
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Balder JW, Rimbert A, Zhang X, Viel M, Kanninga R, van Dijk F, Lansberg P, Sinke R, Kuivenhoven JA. Genetics, Lifestyle, and Low-Density Lipoprotein Cholesterol in Young and Apparently Healthy Women. Circulation 2018; 137:820-831. [DOI: 10.1161/circulationaha.117.032479] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [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: 09/22/2017] [Accepted: 01/08/2018] [Indexed: 01/02/2023]
Abstract
Background:
Atherosclerosis starts in childhood but low-density lipoprotein cholesterol (LDL-C), a causal risk factor, is mostly studied and dealt with when clinical events have occurred. Women are usually affected later in life than men and are underdiagnosed, undertreated, and understudied in cardiovascular trials and research. This study aims at a better understanding of lifestyle and genetic factors that affect LDL-C in young women.
Methods:
We randomly selected for every year of age 8 women with LDL-C ≤1st percentile (≤50 mg/dL) and 8 women with LDL-C ≥99th percentile (≥186 mg/dL) from 28 000 female participants aged between 25 to 40 years of a population-based cohort study. The resulting groups include 119 and 121 women, respectively, of an average 33 years of age. A gene-sequencing panel was used to assess established monogenic and polygenic origins of these phenotypes. Information on lifestyle was extracted from questionnaires. A healthy lifestyle score was allocated based on a recently developed algorithm.
Results:
Of the women with LDL-C ≤1st percentile, 19 (15.7%) carried mutations that are causing monogenic hypocholesterolemia and 60 (49.6%) were genetically predisposed to low LDL-C on the basis of an extremely low weighted genetic risk score. In comparison with control groups, a healthier lifestyle was not associated with low LDL-C in women without genetic predispositions. Among women with LDL-C ≥99th percentile, 20 women (16.8%) carried mutations that cause familial hypercholesterolemia, whereas 25 (21%) were predisposed to high LDL-C on the basis of a high-weighted genetic risk score. The women in whom no genetic origin for hypercholesterolemia could be identified were found to exhibit a significantly unfavorable lifestyle in comparison with controls.
Conclusions:
This study highlights the need for early assessment of the cardiovascular risk profile in apparently healthy young women to identify those with LDL-C ≥99th percentile for their age: first, because, in this study, 17% of the cases were molecularly diagnosed with familial hypercholesterolemia, which needs further attention; second, because our data indicate that an unfavorable lifestyle is significantly associated with severe hypercholesterolemia in genetically unaffected women, which may also need further attention.
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Affiliation(s)
- Jan-Willem Balder
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
- Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B.)
| | - Antoine Rimbert
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
| | - Xiang Zhang
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands (X.Z.)
| | - Martijn Viel
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Roan Kanninga
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Freerk van Dijk
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Peter Lansberg
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
| | - Richard Sinke
- Department of Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (M.V., R.K., F.v.D., R.S.)
| | - Jan Albert Kuivenhoven
- Department of Pediatrics, Section Molecular Genetics, University Medical Center Groningen, University of Groningen, the Netherlands (J.-W.B., A.R., P.L., J.A.K.)
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