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Simon J, Smit JM, El Mahdiui M, Száraz L, van Rosendael AR, Zsarnóczay E, Nagy AI, Gellér L, van der Geest RJ, Bax JJ, Maurovich-Horvat P, Merkely B. Association of Left Atrial Appendage Morphology and Function With Stroke and Transient Ischemic Attack in Atrial Fibrillation Patients. Am J Cardiol 2024; 221:37-43. [PMID: 38552710 DOI: 10.1016/j.amjcard.2024.03.025] [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: 10/10/2023] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
We aimed to correlate left atrial appendage (LAA) structure and function with the history of stroke/transient ischemic attack (TIA) in patients with atrial fibrillation (AF). We analyzed the data of 649 patients with AF who were scheduled for catheter ablation. Patients underwent cardiac computed tomography and transesophageal echocardiography before ablation. The LAA morphologies depicted by cardiac computed tomography were categorized into 4 groups: cauliflower, chicken wing, swan, and windsock shapes. The mean age was 61.3 ± 10.5 years, 33.9% were women. The prevalence of stroke/TIA was 7.1%. After adjustment for the main risk factors, the LAA flow velocity ≤35.3 cm/s (odds ratio [OR] 2.18, 95% confidence interval [CI] 1.09 to 4.61, p = 0.033) and the swan LAA shape (OR 2.69, 95% CI 0.96 to 6.86, p = 0.047) independently associated with a higher risk of stroke/TIA, whereas the windsock LAA morphology proved to be protective (OR 0.32, 95% CI 0.12 to 0.77, p = 0.017) compared with the cauliflower LAA shape. Comparing the differences between the LAA morphology groups, we measured a significantly smaller LAA orifice area (389.3 ± 137.7 mm2 in windsock vs 428.3 ± 158.9 ml in cauliflower, p = 0.021) and LAA volume (7.4 ± 3.0 mm2 in windsock vs 8.5 ± 4.8 mm2 in cauliflower, p = 0.012) in patients with windsock LAA morphology, whereas the LAA flow velocity did not differ significantly. Reduced LAA function and swan LAA morphology were independently associated with a higher prevalence of stroke/TIA, whereas the windsock LAA shape proved to be protective. Comparing the differences between the various LAA morphology types, significantly lower LAA volume and LAA orifice area were measured in the windsock LAA shape than in the cauliflower LAA shape.
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Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands
| | - Lili Száraz
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary
| | | | - Emese Zsarnóczay
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary
| | - Anikó Ilona Nagy
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lászlo Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center Leiden, The Netherlands; Heart Center, Turku University Hospital Turku, Finland; University of Turku, Turku, Finland
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Medical Imaging Centre, Budapest, Hungary.
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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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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Smit JM, Krijthe JH, Kant WMR, Labrecque JA, Komorowski M, Gommers DAMPJ, van Bommel J, Reinders MJT, van Genderen ME. Causal inference using observational intensive care unit data: a scoping review and recommendations for future practice. NPJ Digit Med 2023; 6:221. [PMID: 38012221 PMCID: PMC10682453 DOI: 10.1038/s41746-023-00961-1] [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] [Received: 06/23/2023] [Accepted: 11/05/2023] [Indexed: 11/29/2023] Open
Abstract
This scoping review focuses on the essential role of models for causal inference in shaping actionable artificial intelligence (AI) designed to aid clinicians in decision-making. The objective was to identify and evaluate the reporting quality of studies introducing models for causal inference in intensive care units (ICUs), and to provide recommendations to improve the future landscape of research practices in this domain. To achieve this, we searched various databases including Embase, MEDLINE ALL, Web of Science Core Collection, Google Scholar, medRxiv, bioRxiv, arXiv, and the ACM Digital Library. Studies involving models for causal inference addressing time-varying treatments in the adult ICU were reviewed. Data extraction encompassed the study settings and methodologies applied. Furthermore, we assessed reporting quality of target trial components (i.e., eligibility criteria, treatment strategies, follow-up period, outcome, and analysis plan) and main causal assumptions (i.e., conditional exchangeability, positivity, and consistency). Among the 2184 titles screened, 79 studies met the inclusion criteria. The methodologies used were G methods (61%) and reinforcement learning methods (39%). Studies considered both static (51%) and dynamic treatment regimes (49%). Only 30 (38%) of the studies reported all five target trial components, and only seven (9%) studies mentioned all three causal assumptions. To achieve actionable AI in the ICU, we advocate careful consideration of the causal question of interest, describing this research question as a target trial emulation, usage of appropriate causal inference methods, and acknowledgement (and examination of potential violations of) the causal assumptions.
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Affiliation(s)
- J M Smit
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands.
- Pattern Recognition & Bioinformatics group, EEMCS, Delft University of Technology, Delft, The Netherlands.
| | - J H Krijthe
- Pattern Recognition & Bioinformatics group, EEMCS, Delft University of Technology, Delft, The Netherlands
| | - W M R Kant
- Data Science group, Institute for Computing and Information Sciences, Radboud University, Nijmegen, The Netherlands
| | - J A Labrecque
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Komorowski
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
- Intensive Care Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - D A M P J Gommers
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J van Bommel
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M J T Reinders
- Pattern Recognition & Bioinformatics group, EEMCS, Delft University of Technology, Delft, The Netherlands
| | - M E van Genderen
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
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Heldeweg MLA, Mousa A, Lieveld AWE, Smit JM, Haaksma ME, Tuinman PR. Authors' reply: "Lung ultrasound to predict gas-exchange response to prone positioning in COVID-19 patients: A prospective study in pilot and confirmation cohorts". J Crit Care 2023:154321. [PMID: 37137783 PMCID: PMC10149293 DOI: 10.1016/j.jcrc.2023.154321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/24/2023] [Indexed: 05/05/2023]
Affiliation(s)
- Micah L A Heldeweg
- Department of intensive care medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands..
| | - Amne Mousa
- Department of intensive care medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands..
| | - Arthur W E Lieveld
- Department of intensive care medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands..
| | - J M Smit
- Department of intensive care medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands..
| | - M E Haaksma
- Department of intensive care medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands..
| | - Pieter Roel Tuinman
- Department of intensive care medicine, Amsterdam University Medical Centers, location VUmc, Amsterdam, the Netherlands..
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Smit JM, El Mahdiui M, de Graaf MA, Montero-Cabezas JM, Reiber JHC, Jukema JW, Scholte AJ, Knuuti J, Wijns W, Narula J, Bax JJ. Relation Between Coronary Plaque Composition Assessed by Intravascular Ultrasound Virtual Histology and Myocardial Ischemia Assessed by Quantitative Flow Ratio. Am J Cardiol 2023; 186:228-235. [PMID: 36333150 DOI: 10.1016/j.amjcard.2022.10.005] [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: 07/12/2022] [Revised: 09/10/2022] [Accepted: 10/03/2022] [Indexed: 11/13/2022]
Abstract
Coronary plaque composition may play an important role in the induction of myocardial ischemia. Our objective was to further clarify the relation between coronary plaque composition and myocardial ischemia in patients with chest pain symptoms. The study population consisted of 103 patients who presented to the outpatient clinic or emergency department with chest pain symptoms and were referred for diagnostic invasive coronary angiography. Intravascular ultrasound virtual histology was used for the assessment of coronary plaque composition. A noncalcified plaque was defined as a combination of necrotic core and fibrofatty tissue. Quantitative flow ratio (QFR), which is a coronary angiography-based technique used to calculate fractional flow reserve without the need for hyperemia induction or for a pressure wire, was used as the reference standard for the evaluation of myocardial ischemia. Coronary artery plaques with QFR of ≤0.80 were considered abnormal-that is, ischemia-generating. In total, 149 coronary plaques were analyzed, 21 of which (14%) were considered abnormal according to QFR. The percentage of noncalcified tissue was significantly higher in plaques with abnormal QFR (38.2 ± 6.5% vs 33.1 ± 9.0%, p = 0.014). After univariable analysis, both plaque load (odds ratio [OR] per 1% increase 1.081, p <0.001) and the percentage of noncalcified tissue (OR per 1% increase 1.070, p = 0.020) were significantly associated with reduced QFR. However, after multivariable analysis, only plaque load remained significantly associated with abnormal QFR (OR per 1% increase 1.072, p <0.001). In conclusion, the noncalcified plaque area was significantly higher in hemodynamically significant coronary lesions than in nonsignificant lesions. Although an increase in the noncalcified plaque area was significantly associated with a reduced QFR, this association lost significance after adjustment for localized plaque load.
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Affiliation(s)
- Jeff M Smit
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Michiel A de Graaf
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | | | - Johan H C Reiber
- Medis Medical Imaging, Leiden, The Netherlands; Departments of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J Wouter Jukema
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Arthur J Scholte
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands
| | - Juhani Knuuti
- Heart Center, University of Turku and Turku University Hospital, Turku, Finland
| | - William Wijns
- Lambe Institute for Translational Medicine and Curam, National University of Ireland Galway and Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland
| | - Jagat Narula
- Division of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeroen J Bax
- Departments of Cardiology Leiden University Medical Center, Leiden, The Netherlands; Heart Center, University of Turku and Turku University Hospital, Turku, Finland.
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van Rosendael AR, Smit JM, El'Mahdiui M, van Rosendael PJ, Leung M, Delgado V, Bax JJ. Association between left atrial epicardial fat, left atrial volume, and the severity of atrial fibrillation. Europace 2022; 24:1223-1228. [PMID: 35355079 DOI: 10.1093/europace/euac031] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 04/27/2021] [Accepted: 03/03/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Left atrial (LA) volume and LA epicardial fat are both substrates for atrial fibrillation (AF), but may relate with AF at different (early vs. late) stages in the AF disease process. We evaluated associations between LA epicardial fat and LA volume in patients with sinus rhythm (SR), paroxysmal AF (PAF), and persistent/permanent AF. METHODS AND RESULTS In total, 300 patients (100 with SR, 100 with PAF, and 100 with persistent/permanent AF) who underwent cardiac computed tomography angiography (CTA) were included. The epicardial fat mass posterior to the LA and the LA volume were quantified from CTA and compared between patients with SR, PAF, and persistent/permanent AF. Furthermore, four groups were created by classifying LA epicardial fat and LA volume into large or small according to their median. The mean age of the population was 58.9 ± 10.5 years and 69.7% was male. Left atrial epicardial fat mass was larger in patients with PAF compared with SR, but did not further increase from PAF to persistent/permanent AF. Left atrial volume increased significantly from SR to PAF and to persistent/permanent AF. Left atrial epicardial fat and LA volume were both concordantly large or small in 184 (61%) patients, and discordant in 116 (39%). When both were small, 65.2% of the patients had SR, 23.9% PAF, and 10.9% persistent/permanent AF. When the LA epicardial fat mass was large and the LA volume small (compared with both being small), patients were significantly more often in PAF (55.2 vs. 23.9, P < 0.05), less frequently in SR (32.8% vs. 65.2%, P < 0.05) but showed comparable rates of persistent/permanent AF (12.0% vs. 10.9%, P < 0.05). When the LA volume was large, most patients had persistent/permanent AF. CONCLUSION Left atrial epicardial fat mass was larger in PAF vs. SR, possibly indicating a marker of early disease, while large LA volumes were associated with a high prevalence of persistent/permanent AF. Elevated LA epicardial fat mass without large LA volume may reflect the early AF disease process.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.,Department of Radiology, Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Mohammed El'Mahdiui
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Philippe J van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Melissa Leung
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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Szegedi N, Simon J, Szilveszter B, Salló Z, Herczeg S, Száraz L, Kolossváry M, Orbán G, Széplaki G, Nagy KV, Mahdiui ME, Smit JM, Delgado V, Bax JJ, Maurovich-Horvat P, Merkely B, Gellér L. Abutting Left Atrial Appendage and Left Superior Pulmonary Vein Predicts Recurrence of Atrial Fibrillation After Point-by-Point Pulmonary Vein Isolation. Front Cardiovasc Med 2022; 9:708298. [PMID: 35242821 PMCID: PMC8885731 DOI: 10.3389/fcvm.2022.708298] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 05/11/2021] [Accepted: 01/24/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe role of the spatial relationship between the left superior pulmonary vein (LSPV) and left atrial appendage (LAA) is unknown. We sought to evaluate whether an abutting LAA and LSPV play a role in AF recurrence after catheter ablation for paroxysmal AF.MethodsConsecutive patients, who underwent initial point-by-point radiofrequency catheter ablation for paroxysmal AF at the Heart and Vascular Center of Semmelweis University, Budapest, Hungary, between January of 2014 and December of 2017, were enrolled in the study. All patients underwent pre-procedural cardiac CT to assess left atrial (LA) and pulmonary vein (PV) anatomy. Abutting LAA-LSPV was defined as cases when the minimum distance between the LSPV and LAA was less than 2 mm.ResultsWe included 428 patients (60.7 ± 10.8 years, 35.5% female) in the analysis. AF recurrence rate was 33.4%, with a median recurrence-free time of 21.2 (8.8–43.0) months. In the univariable analysis, female sex (HR = 1.45; 95%CI = 1.04–2.01; p = 0.028), LAA flow velocity (HR = 1.01; 95%CI = 1.00–1.02; p = 0.022), LAA orifice area (HR = 1.00; 95%CI = 1.00–1.00; p = 0.028) and abutting LAA-LSPV (HR = 1.53; 95%CI = 1.09–2.14; p = 0.013) were associated with AF recurrence. In the multivariable analysis, abutting LAA-LSPV (adjusted HR = 1.55; 95%CI = 1.04–2.31; p = 0.030) was the only independent predictor of AF recurrence.ConclusionAbutting LAA-LSPV predisposes patients to have a higher chance for arrhythmia recurrence after catheter ablation for paroxysmal AF.
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Affiliation(s)
- Nándor Szegedi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- *Correspondence: Nándor Szegedi
| | - Judit Simon
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Salló
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Szilvia Herczeg
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Lili Száraz
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Orbán
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Széplaki
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Heart and Vascular Centre, Mater Private Hospital, Dublin, Ireland
| | | | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeff M. Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jeroen J. Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Department of Radiology, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Timmermans FW, Mokken SE, Smit JM, Bouman MB, van de Grift TC, Mullender MG, Middelkoop E. The Impact of Incisional Negative Pressure Wound on Scar Quality and Patient Reported Outcomes: a Within-Patient Controlled, Randomized Trial. Wound Repair Regen 2022; 30:210-221. [PMID: 35146830 PMCID: PMC9306814 DOI: 10.1111/wrr.13001] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/04/2022] [Accepted: 01/09/2022] [Indexed: 11/28/2022]
Abstract
Literature provides a moderate level of evidence for the beneficial effects of incisional negative pressure wound therapy (iNPWT) on scar quality. The purpose of this study was to establish if iNPWT results in improved scar outcomes in comparison to the standard of care. Therefore, a within‐patient randomised controlled, open‐label trial was conducted in transgender men undergoing gender‐affirming mastectomies. A unilateral side was randomised to receive iNPWT (PICO™, Smith&Nephew) without suction drains and contrastingly the standard dressing (Steri‐Strips™) with suction drain. Scar quality and questionnaires were bilaterally measured by means of objective assessments and patient‐reported outcome measures (PROM) at 1, 3 and 12 months. Objective scar outcomes were scar pliability (Cutometer®), colouration (DSM‐II) and scar width (3‐D imaging). PROM outcomes were related to scars (POSAS and SCAR‐Q) and body satisfaction (BODY‐Q). From 85 included patients, 80 were included for analyses. No significant difference between treatments was seen in the quantitative outcomes of scar pliability, colour, and width. For qualitative scar outcomes, several significant findings for iNPWT were found for several subscales of the POSAS, SCAR‐Q, and BODY‐Q. These effects could not be substantiated with linear mixed‐model regression, signifying no statically more favourable outcome for either treatment option. In conclusion, this study demonstrated that some PROM outcomes were more favourable for the iNPWT compared to standard treatment. In contrast, the quantitative outcomes showed no beneficial effects of iNPWT on scar outcomes. This suggests that iNPWT is of little benefit as a scar‐improving therapy.
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Affiliation(s)
- F W Timmermans
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - S E Mokken
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - J M Smit
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands
| | - M B Bouman
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - T C van de Grift
- Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - M G Mullender
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Public Health, Amsterdam, the Netherlands
| | - E Middelkoop
- Amsterdam UMC, location VUmc, Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Amsterdam UMC, location VUmc, Center of Expertise on Gender Dysphoria, Amsterdam, The Netherlands.,Association of Dutch Burn Centers, Red Cross Hospital, Vondellaan 13, Beverwijk, the Netherlands
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9
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Smit JM, van Genderen ME, Reinders MJT, Gommers DAMPJ, Krijthe JH, Van Bommel J. Demystifying machine learning for mortality prediction. Crit Care 2021; 25:447. [PMID: 34949229 PMCID: PMC8697544 DOI: 10.1186/s13054-021-03868-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 11/27/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- J M Smit
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands. .,EEMCS, Pattern Recognition and Bio-informatics Group, Delft University of Technology, Delft, Netherlands.
| | - M E van Genderen
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands
| | - M J T Reinders
- EEMCS, Pattern Recognition and Bio-informatics Group, Delft University of Technology, Delft, Netherlands
| | - D A M P J Gommers
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J H Krijthe
- EEMCS, Pattern Recognition and Bio-informatics Group, Delft University of Technology, Delft, Netherlands
| | - J Van Bommel
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, Netherlands
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10
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Simon J, El Mahdiui M, Smit JM, Száraz L, van Rosendael AR, Herczeg S, Zsarnóczay E, Nagy AI, Kolossváry M, Szilveszter B, Szegedi N, Nagy KV, Tahin T, Gellér L, van der Geest RJ, Bax JJ, Maurovich-Horvat P, Merkely B. Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation. Clin Cardiol 2021; 45:273-281. [PMID: 34799870 PMCID: PMC8922535 DOI: 10.1002/clc.23748] [Citation(s) in RCA: 12] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/12/2021] [Accepted: 10/29/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction There are no consistently confirmed predictors of atrial fibrillation (AF) recurrence after catheter ablation. Therefore, we aimed to study whether left atrial appendage volume (LAAV) and function influence the long‐term recurrence of AF after catheter ablation, depending on AF type. Methods AF patients who underwent point‐by‐point radiofrequency catheter ablation after cardiac computed tomography (CT) were included in this analysis. LAAV and LAA orifice area were measured by CT. Uni‐ and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence. Results In total, 561 AF patients (61.9 ± 10.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence‐free time of 22.7 (9.3–43.1) months. Patients with persistent AF had significantly higher body surface area‐indexed LAV, LAAV, and LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment left ventricular ejection fraction (LVEF) <50% (HR = 2.17; 95% CI = 1.38–3.43; p < .001) and LAAV (HR = 1.06; 95% CI = 1.01–1.12; p = .029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF. Conclusion The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF.
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Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lili Száraz
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Szilvia Herczeg
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Emese Zsarnóczay
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Anikó Ilona Nagy
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Tamás Tahin
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Heat and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Rob J van der Geest
- Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.,Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.,Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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11
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Simon J, Mahdiui ME, Smit JM, Szaraz L, Herczeg SZ, Van Rosendael AR, Zsarnoczay E, Nagy AI, Kolossvary M, Szilveszter B, Szegedi N, Geller L, Bax JJ, Maurovich-Horvat P, Merkely B. Left atrial appendage size is a marker of atrial fibrillation recurrence after radiofrequency catheter ablation in patients with persistent atrial fibrillation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0384] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Catheter ablation is an established therapy for rhythm control in patients with drug-refractory atrial fibrillation (AF), however, recurrence is frequent particularly in persistent AF. There are no consistently confirmed predictors of AF recurrence after catheter ablation. The left atrial appendage (LAA) potentially plays an important role in AF recurrence, although the exact mechanism and pathophysiology are still unclear.
Purpose
We aimed to study whether LAA volume (LAAV) and function influence the long-term recurrence of AF after point-by-point radiofrequency catheter ablation, depending on AF type.
Methods
AF patients who underwent point-by-point radiofrequency catheter ablation after preprocedural cardiac computed tomography (CT) and transthoracic and transesophageal echocardiography (TEE) were included in this retrospective analysis. LAAV and LAA orifice area were measured by CT and LAA flow velocity assessed by TEE and was used as a surrogate marker of LAA function. Uni- and multivariable Cox proportional hazard regression models were performed to determine the predictors of AF recurrence.
Results
In total, 561 AF patients (61.9±10.2 years, 34.9% females) were included in the study. Recurrence of AF was detected in 40.8% of the cases (34.6% in patients with paroxysmal and 53.5% in those with persistent AF) with a median recurrence-free time of 22.7 [9.3–43.1] months. Patients with AF recurrence had significantly higher body surface area-indexed left atrial volume (iLAV), LAAV and LAA orifice area, as compared to those without recurrence. Moreover, patients with persistent AF had significantly higher iLAV, LAAV, LAA orifice area and lower LAA flow velocity, than those with paroxysmal AF. After adjustment for the main cardiovascular risk factors and comorbidities left ventricular ejection fraction (LVEF) <50% (HR=2.17; 95% CI=1.38–3.43; p<0.001) and LAAV (HR=1.06; 95% CI=1.01–1.12; p=0.029) were independently associated with AF recurrence in persistent AF, while no independent predictors could be identified in paroxysmal AF.
Conclusions
The current study demonstrates that beyond left ventricular systolic dysfunction, LAA enlargement is associated with higher rate of AF recurrence after catheter ablation in persistent AF, but not in patients with paroxysmal AF. Our results suggest that preprocedural assessment of LVEF and LAAV might contribute to optimal patient selection and aid to improve long-term results of ablation procedures in patients with persistent AF.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Simon
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - M E Mahdiui
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - J M Smit
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - L Szaraz
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - S Z Herczeg
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | | | - E Zsarnoczay
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - A I Nagy
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - M Kolossvary
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - B Szilveszter
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - N Szegedi
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - L Geller
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - J J Bax
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - P Maurovich-Horvat
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
| | - B Merkely
- Semmelweis University, MTA-SE Cardiovascular Research Group, Heart and Vascular Center, Budapest, Hungary
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12
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El Mahdiui M, Smit JM, van Rosendael AR, Jukema JW, Bax JJ, Scholte AJHA. Relationship between coronary artery calcification and myocardial ischemia on computed tomography myocardial perfusion in patients with stable chest pain. J Nucl Cardiol 2021; 28:1707-1714. [PMID: 31529386 PMCID: PMC8421270 DOI: 10.1007/s12350-019-01869-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 07/08/2019] [Accepted: 08/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) score has shown to provide incremental prognostic information when added to the Framingham risk score. Although the relation between CAC and myocardial ischemia has been evaluated, there has been little evaluation of the relationship between CAC score and inducible myocardial ischemia on computed tomography myocardial perfusion (CTP). METHODS AND RESULTS Patients who were referred with stable chest pain from the outpatient clinic and who underwent non-contrast computed tomography scan, coronary computed tomography angiography, and adenosine stress CTP were included in this study. CAC score was subdivided in four groups (1 to 99; 100 to 399, 400 to 999, and ≥ 1000). Inducible myocardial ischemia was considered when reversible perfusion defects were observed in ≥ 1 segment. A total of 131 patients (age 62 ± 9.4 years; 56% male) were included. The median CAC score was 241 (73 to 539). Forty-nine patients (37%) had evidence of inducible myocardial ischemia. The presence of inducible myocardial ischemia increased with increasing CAC score from 22% in the CAC score 1 to 99 subgroup to 35, 47, and 65% in the 100 to 399, 400 to 999, and ≥ 1000 CAC score subgroup, respectively. In multivariable analysis CAC score was the only determinant that significantly predicted the presence of inducible myocardial ischemia on CTP. CONCLUSIONS In a population of symptomatic patients, the majority of patients with extensive calcification had evidence of inducible myocardial ischemia on CTP. CAC score was the only independent predictor of inducible myocardial ischemia on CTP.
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Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
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13
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Smit JM, Simon J, El Mahdiui M, Szaraz L, van Rosendael PJ, Kolassváry M, Szilveszter B, Delgado V, Merkely B, Maurovich-Horvat P, Bax JJ. Anatomical Characteristics of the Left Atrium and Left Atrial Appendage in Relation to the Risk of Stroke in Patients With Versus Without Atrial Fibrillation. Circ Arrhythm Electrophysiol 2021; 14:e009777. [PMID: 34279121 DOI: 10.1161/circep.121.009777] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.M.S., M.E.M., P.J.v.R., V.D., J.J.B.)
| | - Judit Simon
- Cardiovascular Imaging Research Group, Heart and Vascular Center (J.S., L.S., M.K., B.S., B.M., P.M.-H.), Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.M.S., M.E.M., P.J.v.R., V.D., J.J.B.)
| | - Lili Szaraz
- Cardiovascular Imaging Research Group, Heart and Vascular Center (J.S., L.S., M.K., B.S., B.M., P.M.-H.), Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Philippe J van Rosendael
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.M.S., M.E.M., P.J.v.R., V.D., J.J.B.)
| | - Márton Kolassváry
- Cardiovascular Imaging Research Group, Heart and Vascular Center (J.S., L.S., M.K., B.S., B.M., P.M.-H.), Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Balint Szilveszter
- Cardiovascular Imaging Research Group, Heart and Vascular Center (J.S., L.S., M.K., B.S., B.M., P.M.-H.), Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.M.S., M.E.M., P.J.v.R., V.D., J.J.B.)
| | - Béla Merkely
- Cardiovascular Imaging Research Group, Heart and Vascular Center (J.S., L.S., M.K., B.S., B.M., P.M.-H.), Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- Cardiovascular Imaging Research Group, Heart and Vascular Center (J.S., L.S., M.K., B.S., B.M., P.M.-H.), Medical Imaging Centre, Semmelweis University, Budapest, Hungary.,Department of Radiology (P.M.-H.), Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.M.S., M.E.M., P.J.v.R., V.D., J.J.B.).,Heart Center, University of Turku, Turku University Hospital, Finland (J.J.B.)
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14
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Bodini A, Michelucci E, Di Giorgi N, Caselli C, Signore G, Neglia D, Smit JM, Scholte AJHA, Mincarone P, Leo CG, Pelosi G, Rocchiccioli S. Predictive Added Value of Selected Plasma Lipids to a Re-estimated Minimal Risk Tool. Front Cardiovasc Med 2021; 8:682785. [PMID: 34336947 PMCID: PMC8322727 DOI: 10.3389/fcvm.2021.682785] [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] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/10/2021] [Indexed: 01/13/2023] Open
Abstract
Background: Lipidomics is emerging for biomarker discovery in cardiovascular disease, and circulating lipids are increasingly incorporated in risk models to predict cardiovascular events. Moreover, specific classes of lipids, such as sphingomyelins, ceramides, and triglycerides, have been related to coronary artery disease (CAD) severity and plaque characteristics. To avoid unnecessary testing, it is important to identify individuals at low CAD risk. The only pretest model available so far to rule out the presence of coronary atherosclerosis in patients with chest pain, but normal coronary arteries, is the minimal risk tool (MRT). Aim: Using state-of-the-art statistical methods, we aim to verify the additive predictive value of a set of lipids, derived from targeted plasma lipidomics of suspected CAD patients, to a re-estimated version of the MRT for ruling out the presence of coronary atherosclerosis assessed by coronary CT angiography (CCTA). Methods: Two hundred and fifty-six subjects with suspected stable CAD recruited from five European countries within H2020-SMARTool, undergoing CCTA and blood sampling for clinical biochemistry and lipidomics, were selected. The MRT was validated by regression methods and then re-estimated (reMRT). The reMRT was used as a baseline model in a likelihood ratio test approach to assess the added predictive value of each lipid from 13 among ceramides, triglycerides, and sphingomyelins. Except for one lipid, the analysis was carried out on more than 240 subjects for each lipid. A sensitivity analysis was carried out by considering two alternative models developed on the cohort as baseline models. Results: In 205 subjects, coronary atherosclerosis ranged from minimal lesions to overt obstructive CAD, while in 51 subjects (19.9%) the coronary arteries were intact. Four triglycerides and seven sphingomyelins were significantly (p < 0.05) and differentially expressed in the two groups and, at a lesser extent, one ceramide (p = 0.067). The probability of being at minimal risk was significantly better estimated by adding either Cer(d18:1/16:0) (p = 0.01), SM(40:2) (p = 0.04), or SM(41:1) at a lesser extent (p = 0.052) to reMRT than by applying the reMRT alone. The sensitivity analysis confirmed the relevance of these lipids. Furthermore, the addition of SM(34:1), SM(38:2), SM(41:2), and SM(42:4) improved the predictive performance of at least one of the other baseline models. None of the selected triglycerides was found to provide an added value. Conclusions: Plasma lipidomics can be a promising source of diagnostic and prognostic biomarkers in cardiovascular disease, exploitable not only to assess the risk of adverse events but also to identify subjects without coronary atherosclerosis, thus reducing unnecessary further testing in normal subjects.
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Affiliation(s)
- Antonella Bodini
- Institute for Applied Mathematics and Information Technologies "E. Magenes," National Research Council, Milan, Italy
| | - Elena Michelucci
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Chiara Caselli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.,Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Giovanni Signore
- NEST, Scuola Normale Superiore, Pisa, Italy.,Fondazione Pisana per la Scienza, San Giuliano Terme, Italy
| | - Danilo Neglia
- Cardiovascular Department, Fondazione Toscana G. Monasterio, Pisa, Italy
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Pierpaolo Mincarone
- Institute for Research on Population and Social Policies, National Research Council, Brindisi, Italy
| | - Carlo G Leo
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Gualtiero Pelosi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
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15
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Timmermans FW, Mokken SE, Smit JM, Zwanenburg PR, van Hout N, Bouman MB, Middelkoop E, Mullender MG. Within-patient randomized clinical trial comparing incisional negative-pressure wound therapy with suction drains in gender-affirming mastectomies. Br J Surg 2021; 108:925-933. [PMID: 34244715 PMCID: PMC10364878 DOI: 10.1093/bjs/znab204] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 05/06/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Incisional negative-pressure wound therapy (iNPWT) is widely adopted by different disciplines for multiple indications. Questions about the most appropriate uses and value of iNPWT have been raised. METHODS An open-label within-patient RCT was conducted in transgender men undergoing gender-affirming mastectomies. The objective was to determine the effect of iNPWT as a substitute for standard dressing and suction drains on wound healing complications. One chest side was randomized to receive the iNPWT intervention, and the other to standard dressing with suction drain. The primary endpoints were wound healing complications (haematoma, seroma, infection, and dehiscence) after three months. Additional outcomes were pain according to a numerical rating scale and patient satisfaction one week after surgery. RESULTS Eighty-five patients were included, of whom 81 received both the iNPWT and standard treatment. Drain removal criteria were met within 24 h in 95 per cent of the patients. No significant decrease in wound healing complications was registered on the iNPWT side, but the seroma rate was significantly increased. In contrast, patients experienced both significantly less pain and increased comfort on the iNPWT side. No medical device-related adverse events were registered. CONCLUSION Substituting short-term suction drains with iNPWT in gender-affirming mastectomies increased the seroma rates and did not decrease the amount of wound healing complications. Registration number: NTR7412 (Netherlands Trial Register).
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Affiliation(s)
- F W Timmermans
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S E Mokken
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - P R Zwanenburg
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - N van Hout
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - E Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk, the Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Centre of Expertise on Gender Dysphoria, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam Medical Centre, Amsterdam, the Netherlands
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16
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van Rosendael AR, Bax AM, Smit JM, van den Hoogen IJ, Ma X, Al'Aref S, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Gransar H, Lu Y, Peña JM, Lin FY, Shaw LJ, Min JK, Bax JJ. Clinical risk factors and atherosclerotic plaque extent to define risk for major events in patients without obstructive coronary artery disease: the long-term coronary computed tomography angiography CONFIRM registry. Eur Heart J Cardiovasc Imaging 2021; 21:479-488. [PMID: 32065624 DOI: 10.1093/ehjci/jez322] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 04/17/2019] [Revised: 11/01/2019] [Accepted: 02/11/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS In patients without obstructive coronary artery disease (CAD), we examined the prognostic value of risk factors and atherosclerotic extent. METHODS AND RESULTS Patients from the long-term CONFIRM registry without prior CAD and without obstructive (≥50%) stenosis were included. Within the groups of normal coronary computed tomography angiography (CCTA) (N = 1849) and non-obstructive CAD (N = 1698), the prognostic value of traditional clinical risk factors and atherosclerotic extent (segment involvement score, SIS) was assessed with Cox models. Major adverse cardiac events (MACE) were defined as all-cause mortality, non-fatal myocardial infarction, or late revascularization. In total, 3547 patients were included (age 57.9 ± 12.1 years, 57.8% male), experiencing 460 MACE during 5.4 years of follow-up. Age, body mass index, hypertension, and diabetes were the clinical variables associated with increased MACE risk, but the magnitude of risk was higher for CCTA defined atherosclerotic extent; adjusted hazard ratio (HR) for SIS >5 was 3.4 (95% confidence interval [CI] 2.3-4.9) while HR for diabetes and hypertension were 1.7 (95% CI 1.3-2.2) and 1.4 (95% CI 1.1-1.7), respectively. Exclusion of revascularization as endpoint did not modify the results. In normal CCTA, presence of ≥1 traditional risk factors did not worsen prognosis (log-rank P = 0.248), while it did in non-obstructive CAD (log-rank P = 0.025). Adjusted for SIS, hypertension and diabetes predicted MACE risk in non-obstructive CAD, while diabetes did not increase risk in absence of CAD (P-interaction = 0.004). CONCLUSION Among patients without obstructive CAD, the extent of CAD provides more prognostic information for MACE than traditional cardiovascular risk factors. An interaction was observed between risk factors and CAD burden, suggesting synergistic effects of both.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - A Maxim Bax
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Xiaoyue Ma
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medical College, 402 East 67th St, New York, NY 10065, USA
| | - Subhi Al'Aref
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, 6565 Fannin St, Houston, TX 77030, USA
| | - Daniele Andreini
- Department of Radiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea 4, Milan, Lombardy 20138, Italy
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, 8700 Beverly Blvd, Taper 1258, Los Angeles, CA 90048, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, 10833 Le Conte Ave, Torrance, Los Angeles, CA 90095, USA
| | - Filippo Cademartiri
- Department of Radiology, Cardiovascular Imaging Center, SDN IRCCS, Via Emanuele Gianturco 113, Naples, 80143 NA, Italy
| | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, 353 New Shackle Island Rd, Ste 300C, Hendersonville, TN 37075, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, 50-1 Yonsei-Ro, Seodaemun-gu, Seoul 120-752, South Korea
| | - Kavitha Chinnaiyan
- Department of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, 501 Smyth Rd, Ottawa, ON K1H 8L6, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, 8900 N Kendall Dr, Miami, FL 33176, USA
| | - Augustin DeLago
- Department of Cardiology, Capitol Cardiology Associates, 7 Southwoods Blvd, Albany, NY 12211, USA
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52A, 6020 Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Lazarettstraße 36, 80636 Munich, Germany
| | - Joerg Hausleiter
- Department of Cardiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Ziemssenstraße 1, 80336 Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, University of Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University Hospital, 101 Daehak-ro, Yeongeon-dong, Jongno-gu, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, BC V6T 1Z4, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Via Ceccarini, Urbino, 61302 Fano PU, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Av. Lusíada 100, 1500-650 Lisboa, Portugal
| | | | - Gianluca Pontone
- Department of Radiology, Centro Cardiologico Monzino, IRCCS Milan, Via Carlo Parea 4, Milan, Lombardy 20138, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, 3601 West 13 Mile Rd, Royal Oak, MI 48073, USA
| | - Ronen Rubinshtein
- Department of Cardiology, Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Mikhal St 7, Haifa, 3436212, Israel
| | - Todd C Villines
- Department of Medicine, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22903, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, Weill Cornell Medical College, 402 East 67th St, New York, NY 10065, USA
| | - Jessica M Peña
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital, Weill Cornell Medicine, 413 East 69th St, Belfer Research Building, New York, NY 10021, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
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17
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Michelucci E, Giorgi ND, Finamore F, Smit JM, Scholte AJHA, Signore G, Rocchiccioli S. Lipid biomarkers in statin users with coronary artery disease annotated by coronary computed tomography angiography. Sci Rep 2021; 11:12899. [PMID: 34145378 PMCID: PMC8213699 DOI: 10.1038/s41598-021-92339-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 06/09/2021] [Indexed: 01/07/2023] Open
Abstract
Molecular markers are suggested to improve the diagnostic and prognostic accuracy in patients with coronary artery disease (CAD) beyond current clinical scores based on age, gender, symptoms and traditional risk factors. In this context, plasma lipids are emerging as predictors of both plaque composition and risk of future events. We aim to identify plasma lipid biomarkers associated to CAD indexes of stenosis severity, plaque lipid content and a comprensive score of CAD extent and its risk. We used a simple high performance liquid chromatography-tandem mass spectrometry method to identify 69 plasma lipids in 132 subjects referred to Coronary Computed Tomography Angiography (CCTA) for suspected CAD, all under statin treatment. Patients were stratified in groups using three different CCTA-based annotations: CTA-risk score, lipid plaque prevalence (LPP) ratio and the coronary artery disease-reporting and data system (CAD-RADS). We identified a common set of lipid biomarkers composed of 7 sphingomyelins and 3 phosphatidylethanolamines, which discriminates between high risk CAD patients and controls regardless of the CAD annotations used (CTA score, LPP ratio, or CAD-RADS). These results highlight the potential of circulating lipids as biomarkers of stenosis severity, non calcified plaque composition and overall plaque risk of events.
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Affiliation(s)
- Elena Michelucci
- Istituto di Fisiologia Clinica-CNR, via Giuseppe Moruzzi 1, 56124, Pisa, Italy.
| | - Nicoletta Di Giorgi
- Istituto di Fisiologia Clinica-CNR, via Giuseppe Moruzzi 1, 56124, Pisa, Italy
| | - Francesco Finamore
- Istituto di Fisiologia Clinica-CNR, via Giuseppe Moruzzi 1, 56124, Pisa, Italy
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Giovanni Signore
- Fondazione Pisana per la Scienza Onlus, via Ferruccio Giovannini 13, 56017, San Giuliano Terme, Italy
| | - Silvia Rocchiccioli
- Istituto di Fisiologia Clinica-CNR, via Giuseppe Moruzzi 1, 56124, Pisa, Italy.
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18
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El Mahdiui M, Simon J, Smit JM, Kuneman JH, van Rosendael AR, Steyerberg EW, van der Geest RJ, Száraz L, Herczeg S, Szegedi N, Gellér L, Delgado V, Merkely B, Bax JJ, Maurovich-Horvat P. Posterior Left Atrial Adipose Tissue Attenuation Assessed by Computed Tomography and Recurrence of Atrial Fibrillation After Catheter Ablation. Circ Arrhythm Electrophysiol 2021; 14:e009135. [PMID: 33720759 DOI: 10.1161/circep.120.009135] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [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] [Indexed: 12/12/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Jeff M Smit
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Jurrien H Kuneman
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences (E.W.S.), Leiden University Medical Center, the Netherlands
| | - Rob J van der Geest
- Division of Image Processing (R.J.v.d.G.), Leiden University Medical Center, the Netherlands
| | - Lili Száraz
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Szilvia Herczeg
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Nándor Szegedi
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - László Gellér
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Victoria Delgado
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Bela Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary
| | - Jeroen J Bax
- Department of Cardiology (M.E.M., J.M.S., J.H.K., A.R.v.R., V.D., J.J.B.), Leiden University Medical Center, the Netherlands
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart & Vascular Center (J.S., L.S., S.H., N.S., L.G., B.M., P.M.-H.), Semmelweis University, Budapest, Hungary.,Department of Radiology, Medical Imaging Centre (P.M.-H.), Semmelweis University, Budapest, Hungary
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19
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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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20
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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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21
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van Rosendael AR, Bax AM, van den Hoogen IJ, Smit JM, Al'Aref SJ, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Gransar H, Lu Y, Peña JM, Lin FY, Shaw LJ, Narula J, Min JK, Bax JJ. Associations between dyspnoea, coronary atherosclerosis, and cardiovascular outcomes: results from the long-term follow-up CONFIRM registry. Eur Heart J Cardiovasc Imaging 2020; 23:266-274. [PMID: 33538308 DOI: 10.1093/ehjci/jeaa323] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 11/17/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The relationship between dyspnoea, coronary artery disease (CAD), and major cardiovascular events (MACE) is poorly understood. This study evaluated (i) the association of dyspnoea with the severity of anatomical CAD by coronary computed tomography angiography (CCTA) and (ii) to which extent CAD explains MACE in patients with dyspnoea. METHODS AND RESULTS From the international COronary CT Angiography EvaluatioN for Clinical Outcomes: An InteRnational Multicenter (CONFIRM) registry, 4425 patients (750 with dyspnoea) with suspected but without known CAD were included and prospectively followed for ≥5 years. First, the association of dyspnoea with CAD severity was assessed using logistic regression analysis. Second, the prognostic value of dyspnoea for MACE (myocardial infarction and death), and specifically, the interaction between dyspnoea and CAD severity was investigated using Cox proportional-hazard analysis. Mean patient age was 60.3 ± 11.9 years, 63% of patients were male and 592 MACE events occurred during a median follow-up duration of 5.4 (IQR 5.1-6.0) years. On uni- and multivariable analysis (adjusting for age, sex, body mass index, chest pain typicality, and risk factors), dyspnoea was associated with two- and three-vessel/left main (LM) obstructive CAD. The presence of dyspnoea increased the risk for MACE [hazard ratio (HR) 1.57, 95% confidence interval (CI): 1.29-1.90], which was modified after adjusting for clinical predictors and CAD severity (HR 1.26, 95% CI: 1.02-1.55). Conversely, when stratified by CAD severity, dyspnoea did not provide incremental prognostic value in one-, two-, or three-vessel/LM obstructive CAD, but dyspnoea did provide incremental prognostic value in non-obstructive CAD. CONCLUSION In patients with suspected CAD, dyspnoea was independently associated with severe obstructive CAD on CCTA. The severity of obstructive CAD explained the elevated MACE rates in patients presenting with dyspnoea, but in patients with non-obstructive CAD, dyspnoea portended additional risk.
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Affiliation(s)
- Alexander R van Rosendael
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA.,Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - A Maxim Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Inge J van den Hoogen
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Subhi J Al'Aref
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Mouaz H Al-Mallah
- Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Daniele Andreini
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | - Filippo Cademartiri
- Department of Radiology, Cardiovascular Imaging Center, SDN IRCCS, Naples, Italy
| | - Tracy Q Callister
- Department of Cardiology, Tennessee Heart and Vascular Institute, Hendersonville, TN, USA
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Department of Radiology, Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland.,Department of Medicine, University of Zurich, Zurich, Switzerland
| | - Yong-Jin Kim
- Department of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- Department of Cardiology, UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | - Gianluca Pontone
- Department of Cardiology, Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
| | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Todd C Villines
- Department of Cardiology, Cardiology Service, Walter Reed National Military Center, Bethesda, MD, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital, The Weill Cornell Medical College, New York, NY, USA
| | - Jessica M Peña
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Fay Y Lin
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Leslee J Shaw
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jagat Narula
- Department of Cardiology, Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - James K Min
- Department of Radiology, New York-Presbyterian Hospital and Weill Cornell Medicine, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
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22
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van den Hoogen IJ, van Rosendael AR, Lin FY, Lu Y, Dimitriu-Leen AC, Smit JM, Scholte AJHA, Achenbach S, Al-Mallah MH, Andreini D, Berman DS, Budoff MJ, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJW, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Raff GL, Rubinshtein R, Villines TC, Gransar H, Jones EC, Peña JM, Shaw LJ, Min JK, Bax JJ. Coronary atherosclerosis scoring with semiquantitative CCTA risk scores for prediction of major adverse cardiac events: Propensity score-based analysis of diabetic and non-diabetic patients. J Cardiovasc Comput Tomogr 2020; 14:251-257. [PMID: 31836415 DOI: 10.1016/j.jcct.2019.11.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 01/15/2019] [Revised: 11/20/2019] [Accepted: 11/27/2019] [Indexed: 01/09/2023]
Abstract
AIMS We aimed to compare semiquantitative coronary computed tomography angiography (CCTA) risk scores - which score presence, extent, composition, stenosis and/or location of coronary artery disease (CAD) - and their prognostic value between patients with and without diabetes mellitus (DM). Risk scores derived from general chest-pain populations are often challenging to apply in DM patients, because of numerous confounders. METHODS Out of a combined cohort from the Leiden University Medical Center and the CONFIRM registry with 5-year follow-up data, we performed a secondary analysis in diabetic patients with suspected CAD who were clinically referred for CCTA. A total of 732 DM patients was 1:1 propensity-matched with 732 non-DM patients by age, sex and cardiovascular risk factors. A subset of 7 semiquantitative CCTA risk scores was compared between groups: 1) any stenosis ≥50%, 2) any stenosis ≥70%, 3) stenosis-severity component of the coronary artery disease-reporting and data system (CAD-RADS), 4) segment involvement score (SIS), 5) segment stenosis score (SSS), 6) CT-adapted Leaman score (CT-LeSc), and 7) Leiden CCTA risk score. Cox-regression analysis was performed to assess the association between the scores and the primary endpoint of all-cause death and non-fatal myocardial infarction. Also, area under the receiver-operating characteristics curves were compared to evaluate discriminatory ability. RESULTS A total of 1,464 DM and non-DM patients (mean age 58 ± 12 years, 40% women) underwent CCTA and 155 (11%) events were documented after median follow-up of 5.1 years. In DM patients, the 7 semiquantitative CCTA risk scores were significantly more prevalent or higher as compared to non-DM patients (p ≤ 0.022). All scores were independently associated with the primary endpoint in both patients with and without DM (p ≤ 0.020), with non-significant interaction between the scores and diabetes (interaction p ≥ 0.109). Discriminatory ability of the Leiden CCTA risk score in DM patients was significantly better than any stenosis ≥50% and ≥70% (p = 0.003 and p = 0.007, respectively), but comparable to the CAD-RADS, SIS, SSS and CT-LeSc that also focus on the extent of CAD (p ≥ 0.265). CONCLUSION Coronary atherosclerosis scoring with semiquantitative CCTA risk scores incorporating the total extent of CAD discriminate major adverse cardiac events well, and might be useful for risk stratification of patients with DM beyond the binary evaluation of obstructive stenosis alone.
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Affiliation(s)
- Inge J van den Hoogen
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Yao Lu
- Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | | | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Germany
| | - Mouaz H Al-Mallah
- King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | | | - Daniel S Berman
- Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Matthew J Budoff
- Department of Medicine, Los Angeles Biomedical Research Institute, Torrance, CA, USA
| | | | | | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
| | | | - Benjamin J W Chow
- Department of Medicine and Radiology, University of Ottawa, ON, Canada
| | - Ricardo C Cury
- Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
| | | | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Joerg Hausleiter
- Medizinische Klinik I der Ludwig-Maximilians-UniversitätMünchen, Munich, Germany
| | - Philipp A Kaufmann
- Department of Nuclear Medicine, University Hospital, Zurich, Switzerland and University of Zurich, Switzerland
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | | | | | - Gilbert L Raff
- Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Todd C Villines
- Cardiology Service, Walter Reed National Military Center, Bethesda, MD, USA
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Jessica M Peña
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Leslee J Shaw
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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23
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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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24
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Egorova AD, Smit JM, Kiès P. A 55-year-old man with mild shortness of breath. Neth Heart J 2020; 28:104-107. [PMID: 31338748 PMCID: PMC6977788 DOI: 10.1007/s12471-019-01312-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- A D Egorova
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands.
| | - J M Smit
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Kiès
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
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25
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Egorova AD, Smit JM, Kiès P. A 55-year-old man with mild shortness of breath. Neth Heart J 2020; 28:110-111. [PMID: 31338749 PMCID: PMC6977793 DOI: 10.1007/s12471-019-01313-z] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- A D Egorova
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands.
| | - J M Smit
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
| | - P Kiès
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Leiden, The Netherlands
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26
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Haaksma ME, Smit JM, Heldeweg MLA, Pisani L, Elbers P, Tuinman PR. Lung ultrasound and B-lines: B careful! Intensive Care Med 2020; 46:544-545. [PMID: 31996959 DOI: 10.1007/s00134-019-05911-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/21/2019] [Indexed: 12/21/2022]
Affiliation(s)
- M E Haaksma
- Department of Intensive Care Medicine, Amsterdam Leiden IC Focused Echography (ALIFE), Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - J M Smit
- Department of Intensive Care Medicine, Amsterdam Leiden IC Focused Echography (ALIFE), Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - M L A Heldeweg
- Department of Intensive Care Medicine, Amsterdam Leiden IC Focused Echography (ALIFE), Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - L Pisani
- Laboratory of Experimental Intensive Care and Anesthesiology (LEICA), Department of Intensive Care Medicine, Amsterdam UMC, Location AMC, Universiteit van Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - P Elbers
- Department of Intensive Care Medicine, Amsterdam Leiden IC Focused Echography (ALIFE), Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam Leiden IC Focused Echography (ALIFE), Research VUmc Intensive Care (REVIVE), Amsterdam Medical Data Science (AMDS), Amsterdam Cardiovascular Science (ACS), Amsterdam Infection and Immunity Institute (AI&II), Amsterdam UMC, Location VUmc, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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27
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El Mahdiui M, Smit JM, van Rosendael AR, Delgado V, Marsan NA, Jukema JW, Scholte AJHA, Bax JJ. Correction to: Characterization of the left ventricular arrhythmogenic substrate with multimodality imaging: role of innervation imaging and left ventricular global longitudinal strain. Eur J Hybrid Imaging 2019; 3:19. [PMID: 34196849 PMCID: PMC8218130 DOI: 10.1186/s41824-019-0069-z] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
The original publication of this article El Mahdiui et al., 2019 contained 2 errors that could not be updated prior to publication. The correct and incorrect information is shown below for clarification. The changed information is shown in bold. These changes do not affect the interpretation and conclusion of the article.
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Affiliation(s)
- Mohammed El Mahdiui
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands
| | - Jeff M Smit
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands
| | - Alexander R van Rosendael
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre, Albinusdreef 2, 2300, RC, Leiden, The Netherlands.
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28
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Smit JM, El Mahdiui M, van Rosendael AR, Jukema JW, Koning G, Reiber JHC, Bax JJ, Scholte AJ. Comparison of Diagnostic Performance of Quantitative Flow Ratio in Patients With Versus Without Diabetes Mellitus. Am J Cardiol 2019; 123:1722-1728. [PMID: 30853082 DOI: 10.1016/j.amjcard.2019.02.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 02/10/2019] [Accepted: 02/13/2019] [Indexed: 12/21/2022]
Abstract
Quantitative flow ratio (QFR) is a novel technique to calculate fractional flow reserve (FFR), without hyperemia induction or a pressure wire, and has not yet been validated in patients with diabetes mellitus (DM), who are at increased risk of coronary microvascular dysfunction. The purpose of our study was to compare the diagnostic performance of QFR in diabetic and nondiabetic patients. Patients who underwent invasive coronary angiography and subsequent invasive FFR measurement within 6 months were included. QFR was determined in all coronary arteries in which invasive FFR was performed, using a dedicated software package. Diagnostic accuracy and the area under the receiver-operating characteristic curve (AUC) were determined for QFR, using an invasive FFR cut-off value of ≤0.80 as the reference standard. In total, 320 coronary arteries from 66 (25%) diabetic and 193 (75%) nondiabetic patients were analyzed. On a vessel-based analysis, diagnostic accuracy, sensitivity, and specificity showed no significant difference between diabetic and nondiabetic patients: 88% versus 85% (p = 0.47), 71% versus 69% (p = 0.72), and 95% versus 91% (p = 0.24). Moreover, the AUC was not significantly different between patients with and without DM, 0.91 versus 0.93 (p = 0.74). The per-vessel AUC was significantly higher for QFR compared with percent diameter stenosis in both diabetic and nondiabetic patients, 0.91 versus 0.76 (p <0.05) and 0.93 versus 0.77 (p <0.001), respectively. In conclusion, we showed a good diagnostic performance of QFR which was independent of the presence of DM.
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Affiliation(s)
- Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Gerhard Koning
- Medis Medical Imaging Systems B.V., Leiden, the Netherlands
| | - Johan H C Reiber
- Medis Medical Imaging Systems B.V., Leiden, the Netherlands; Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
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29
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Negenborn VL, Smit JM, Dikmans REG, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Tuinder S, Eltahir Y, Posch NAS, van Steveninck-Barends JM, van der Hulst RRWJ, Ritt MJPF, Bouman MB, Mullender MG. Short-term cost-effectiveness of one-stage implant-based breast reconstruction with an acellular dermal matrix versus two-stage expander-implant reconstruction from a multicentre randomized clinical trial. Br J Surg 2019; 106:586-595. [PMID: 30835827 PMCID: PMC6593424 DOI: 10.1002/bjs.11102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 06/19/2018] [Revised: 10/11/2018] [Accepted: 12/02/2018] [Indexed: 11/25/2022]
Abstract
Background Implant‐based breast reconstruction (IBBR) is the most commonly performed reconstructive procedure and its economic impact is significant. This study aimed to analyse whether a direct one‐stage IBBR with use of an acellular dermal matrix (ADM) is more cost‐effective than two‐stage (expander‐implant) breast reconstruction. Methods The BRIOS (Breast Reconstruction In One Stage) study was an open‐label multicentre RCT in which women scheduled for skin‐sparing mastectomy and immediate IBBR were randomized between one‐stage IBBR with ADM or two‐stage IBBR. Duration of surgery and hospital stay, and visits for the primary surgery, unplanned and cosmetic procedures were recorded. Costs were estimated at an institutional level. Health status was assessed by means of the EuroQol Five Dimensions 5L questionnaire. Results Fifty‐nine patients (91 breasts) underwent one‐stage IBBR with ADM and 62 patients (92 breasts) two‐stage IBBR. The mean(s.d.) duration of surgery in the one‐stage group was significantly longer than that for two‐stage IBBR for unilateral (2·52(0·55) versus 2·02(0·35) h; P < 0·001) and bilateral (4·03(1·00) versus 3·25(0·58) h; P = 0·017) reconstructions. Costs were higher for one‐stage compared with two‐stage IBBR for both unilateral (€12 448 (95 per cent c.i. 10 722 to 14 387) versus €9871 (9373 to 10 445) respectively; P = 0·025) and bilateral (€16 939 (14 887 to 19 360) versus €13 383 (12 414 to 14 669); P = 0·002) reconstructions. This was partly related to the use of relatively expensive ADM. There was no difference in postoperative health status between the groups. Conclusion One‐stage IBBR with ADM was associated with higher costs, but similar health status, compared with conventional two‐stage IBBR. Registration number: NTR5446 (
http://www.trialregister.nl).
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Affiliation(s)
- V L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - R E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, the Netherlands
| | - P Q Ruhé
- Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, the Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - S Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Y Eltahir
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Groningen, Groningen, the Netherlands
| | - N A S Posch
- Department of Plastic, Reconstructive and Hand Surgery, Haga Ziekenhuis, Den Haag, the Netherlands
| | | | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Orbis Medical Centrum, Sittard, the Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands
| | - M-B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Alexander Monro Breast Cancer Hospital, Bilthoven, the Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, the Netherlands.,Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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van Rosendael AR, Shaw LJ, Xie JX, Dimitriu-Leen AC, Smit JM, Scholte AJ, van Werkhoven JM, Callister TQ, DeLago A, Berman DS, Hadamitzky M, Hausleiter J, Al-Mallah MH, Budoff MJ, Kaufmann PA, Raff G, Chinnaiyan K, Cademartiri F, Maffei E, Villines TC, Kim YJ, Feuchtner G, Lin FY, Jones EC, Pontone G, Andreini D, Marques H, Rubinshtein R, Achenbach S, Dunning A, Gomez M, Hindoyan N, Gransar H, Leipsic J, Narula J, Min JK, Bax JJ. Superior Risk Stratification With Coronary Computed Tomography Angiography Using a Comprehensive Atherosclerotic Risk Score. JACC Cardiovasc Imaging 2019; 12:1987-1997. [PMID: 30660516 DOI: 10.1016/j.jcmg.2018.10.024] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 06/21/2018] [Revised: 09/19/2018] [Accepted: 10/19/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVES This study was designed to assess the prognostic value of a new comprehensive coronary computed tomography angiography (CTA) score compared with the stenosis severity component of the Coronary Artery Disease-Reporting and Data System (CAD-RADS). BACKGROUND Current risk assessment with coronary CTA is mainly focused on maximal stenosis severity. Integration of plaque extent, location, and composition in a comprehensive model may improve risk stratification. METHODS A total of 2,134 patients with suspected but without known CAD were included. The predictive value of the comprehensive CTA score (ranging from 0 to 42 and divided into 3 groups: 0 to 5, 6 to 20, and >20) was compared with the CAD-RADS combined into 3 groups (0% to 30%, 30% to 70% and ≥70% stenosis). Its predictive performance was internally and externally validated (using the 5-year follow-up dataset of the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry], n = 1,971). RESULTS The mean age of patients was 55 ± 13 years, mean follow-up 3.6 ± 2.8 years, and 130 events (myocardial infarction or death) occurred. The new, comprehensive CTA score showed strong and independent predictive value using the Cox proportional hazard analysis. A model including clinical variables plus comprehensive CTA score showed better discrimination of events compared with a model consisting of clinical variables plus CAD-RADS (0.768 vs. 0.742, p = 0.001). Also, the comprehensive CTA score correctly reclassified a significant proportion of patients compared with the CAD-RADS (net reclassification improvement 12.4%, p < 0.001). Good predictive accuracy was reproduced in the external validation cohort. CONCLUSIONS The new comprehensive CTA score provides better discrimination and reclassification of events compared with the CAD-RADS score based on stenosis severity only. The score retained similar prognostic accuracy when externally validated. Anatomic risk scores can be improved with the addition of extent, location, and compositional measures of atherosclerotic plaque. (Comprehensive CTA risk score calculator is available at: http://18.224.14.19/calcApp/).
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Affiliation(s)
- Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Leslee J Shaw
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Joe X Xie
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | | | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur J Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | - Daniel S Berman
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California
| | - Martin Hadamitzky
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Jeorg Hausleiter
- Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King AbdulAziz Cardiac Center, Ministry of National Guard, Health Affairs, Riyadh, Saudi Arabia
| | - Matthew J Budoff
- Department of Medicine, Harbor UCLA Medical Center, Los Angeles, California
| | | | | | | | | | - Erica Maffei
- Department of Radiology, Area Vasta 1/ASUR Marche, Urbino, Italy
| | - Todd C Villines
- Department of Medicine, Walter Reed National Military Medical Center, Bethesda
| | - Yong-Jin Kim
- Seoul National University Hospital, Seoul, South Korea
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Fay Y Lin
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Erica C Jones
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Gianluca Pontone
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Daniele Andreini
- Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy
| | - Hugo Marques
- UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
| | - Ronen Rubinshtein
- Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | | | | | - Millie Gomez
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Niree Hindoyan
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Heidi Gransar
- Department of Imaging, Cedars Sinai Medical Center, Los Angeles, California
| | - Jonathon Leipsic
- Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jagat Narula
- Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - James K Min
- Dalio Institute of Cardiovascular Imaging, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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31
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Hensen LCR, Mahdiui ME, van Rosendael AR, Smit JM, Jukema JW, Bax JJ, Delgado V. Prevalence and Prognostic Implications of Mitral and Aortic Valve Calcium in Patients With Chronic Kidney Disease. Am J Cardiol 2018; 122:1732-1737. [PMID: 30270179 DOI: 10.1016/j.amjcard.2018.08.009] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Revised: 07/28/2018] [Accepted: 08/02/2018] [Indexed: 11/19/2022]
Abstract
Calcium in the cardiac valves can be observed in patients with severe chronic kidney disease (CKD). However, the prevalence and prognostic implications of left-sided cardiac valve calcium in patients with stage 2 and 3 CKD (estimated glomerular filtration rate (eGFR) of 60 to 89 and 30 to 59 ml/min/1.73 m² respectively) is unknown. The present study investigates the prevalence of mitral and aortic valve calcium in patients with stage 2 and 3 CKD and evaluates its association with all-cause mortality. In patients with stage 2 and 3 CKD who underwent clinically indicated coronary computed tomography angiography, the presence of mitral and/or aortic valve calcium was assessed. Patients were divided into 2 groups according to the presence of mitral and/or aortic valve calcium on coronary computed tomography angiography. Patients were followed for the occurrence of all-cause mortality (primary end point). Of 204 stage 2 and 3 CKD patients (54% men, mean age 60 ± 10 years), 66 (32%) patients had mitral and/or aortic valve calcium. During a median follow-up of 6 years (IQR; 2, 9 years), 29 (14%) patients died. Patients with mitral and/or aortic valve calcium showed significantly higher mortality rates compared with patients without left-sided valve calcium (log-rank p = 0.009). Mitral valve calcium was independently associated with increased risk of all-cause mortality, whereas aortic valve calcium was not. In conclusion, the prevalence of left-sided valve calcium in patients with stage 2 and 3 CKD is high. Mitral valve calcium was independently associated with increased risk of all-cause mortality, whereas aortic valve calcium was not.
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Affiliation(s)
- Liselotte C R Hensen
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mohammed El Mahdiui
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
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32
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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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33
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Smit JM, Koning G, Van Rosendael AR, El Mahdiui M, Jukema JW, Reiber JHC, Bax JJ, Scholte AJ. P2263Diagnostic performance of quantitative flow ratio in diabetic and non-diabetic patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2263] [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: 11/13/2022] Open
Affiliation(s)
- J M Smit
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - G Koning
- Medis medical imaging systems bv, Leiden, Netherlands
| | | | - M El Mahdiui
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J W Jukema
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - J H C Reiber
- Medis medical imaging systems bv, Leiden, Netherlands
| | - J J Bax
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | - A J Scholte
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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34
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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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35
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Smit JM, Van Rosendael AR, Barbon F, Neglia D, Knuuti J, Buechel R, Teresinska A, Pizzi MN, Poddighe R, Caselli C, Rocchiccioli S, Parodi O, Pelosi G, Scholte AJ. 3009Quantitative CTA analysis of coronary plaque progression in SMARTool clinical study: the association between baseline clinical parameters and plaque progression. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3009] [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] [Indexed: 11/14/2022] Open
Affiliation(s)
- J M Smit
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
| | | | | | - D Neglia
- Gabriele Monasterio Foundation, Pisa, Italy
| | - J Knuuti
- Turku University Hospital, Turku, Finland
| | - R Buechel
- University of Zurich, Zurich, Switzerland
| | | | - M N Pizzi
- University Hospital Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - R Poddighe
- ASL12 U.O.C. Cardiologia, Viareggio, Italy
| | - C Caselli
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | | | - O Parodi
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | - G Pelosi
- Institute of Clinical Physiology, CNR, Pisa, Italy
| | - A J Scholte
- Leiden University Medical Center, Cardiology, Leiden, Netherlands
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36
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Negenborn VL, Dikmans REG, Bouman MB, Winters HAH, Twisk JWR, Ruhé PQ, Mureau MAM, Smit JM, Tuinder S, Hommes J, Eltahir Y, Posch NAS, van Steveninck-Barends JM, Meesters-Caberg MA, van der Hulst RRWJ, Ritt MJPF, Mullender MG. Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial. Br J Surg 2018; 105:1305-1312. [PMID: 29663320 PMCID: PMC6099293 DOI: 10.1002/bjs.10865] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 11/12/2017] [Accepted: 02/19/2018] [Indexed: 11/05/2022]
Abstract
BACKGROUND In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction. METHODS Data were obtained from the BRIOS study, including all patients treated with DTI ADM-assisted breast reconstruction. Logistic regression analyses were performed to identify factors predictive of postoperative complications. RESULTS Fifty-nine patients (91 breasts) were included, of whom 27 (35 breasts) developed a surgical complication. Reoperations were performed in 29 breasts (32 per cent), with prosthesis removal in 22 (24 per cent). In multivariable analyses, mastectomy weight was associated with complications (odds ratio (OR) 1·94, 95 per cent c.i. 1·33 to 2·83), reoperations (OR 1·70, 1·12 to 2·59) and removal of the implant (OR 1·55, 1·11 to 2·17). Younger patients (OR 1·07, 1·01 to 1·13) and those who received adjuvant chemotherapy (OR 4·83, 1·15 to 20·24) more frequently required reoperation. In univariable analyses, adjuvant radiotherapy showed a trend towards more complications (OR 7·23, 0·75 to 69·95) and removal of the implant (OR 5·12, 0·76 to 34·44), without reaching statistical significance. CONCLUSION Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).
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Affiliation(s)
- V L Negenborn
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - R E G Dikmans
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - M B Bouman
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - H A H Winters
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
| | - P Q Ruhé
- Department of Plastic, Reconstructive and Hand Surgery, Meander Medical Centre, Amersfoort, The Netherlands
| | - M A M Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - J M Smit
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Department of Plastic Surgery, Alexander Monro Breast Cancer Hospital, Bilthoven, The Netherlands
| | - S Tuinder
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Hommes
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Y Eltahir
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Centre Groningen, Groningen, The Netherlands
| | - N A S Posch
- Department of Plastic, Reconstructive and Hand Surgery, Haga Ziekenhuis, The Hague, The Netherlands
| | | | - M A Meesters-Caberg
- Department of Plastic, Reconstructive and Hand Surgery, Orbis Medical Centre, Sittard, The Netherlands
| | - R R W J van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands
| | - M G Mullender
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Centre, Amsterdam, The Netherlands.,Amsterdam Public Health, Amsterdam, The Netherlands
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37
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van Rosendael AR, Daniëls LA, Dimitriu-Leen AC, Smit JM, van Rosendael PJ, Schalij MJ, Bax JJ, Scholte AJ. Different manifestation of irradiation induced coronary artery disease detected with coronary computed tomography compared with matched non-irradiated controls. Radiother Oncol 2017; 125:55-61. [DOI: 10.1016/j.radonc.2017.09.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 09/03/2017] [Accepted: 09/06/2017] [Indexed: 01/27/2023]
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38
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van Rosendael AR, Koning G, Dimitriu-Leen AC, Smit JM, Montero-Cabezas JM, van der Kley F, Jukema JW, Reiber JHC, Bax JJ, Scholte AJHA. Accuracy and reproducibility of fast fractional flow reserve computation from invasive coronary angiography. Int J Cardiovasc Imaging 2017. [PMID: 28642995 PMCID: PMC5539270 DOI: 10.1007/s10554-017-1190-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fractional flow reserve (FFR) guided percutaneous coronary intervention (PCI) is associated with favourable outcome compared with revascularization based on angiographic stenosis severity alone. The feasibility of the new image-based quantitative flow ratio (QFR) assessed from 3D quantitative coronary angiography (QCA) and thrombolysis in myocardial infarction (TIMI) frame count using three different flow models has been reported recently. The aim of the current study was to assess the accuracy, and in particular, the reproducibility of these three QFR techniques when compared with invasive FFR. QFR was derived (1) from adenosine induced hyperaemic coronary angiography images (adenosine-flow QFR [aQFR]), (2) from non-hyperemic images (contrast-flow QFR [cQFR]) and (3) using a fixed empiric hyperaemic flow [fixed-flow QFR (fQFR)]. The three QFR values were calculated in 17 patients who prospectively underwent invasive FFR measurement in 20 vessels. Two independent observers performed the QFR analyses. Mean difference, standard deviation and 95% limits of agreement (LOA) between invasive FFR and aQFR, cQFR and fQFR for observer 1 were: 0.01 ± 0.04 (95% LOA: -0.07; 0.10), 0.01 ± 0.05 (95% LOA: -0.08; 0.10), 0.01 ± 0.04 (95% LOA: -0.06; 0.08) and for observer 2: 0.00 ± 0.03 (95% LOA: -0.06; 0.07), -0.01 ± 0.03 (95% LOA: -0.07; 0.05), 0.00 ± 0.03 (95% LOA: -0.06; 0.05). Values between the 2 observers were (to assess reproducibility) for aQFR: 0.01 ± 0.04 (95% LOA: -0.07; 0.09), for cQFR: 0.02 ± 0.04 (95% LOA: -0.06; 0.09) and for fQFR: 0.01 ± 0.05 (95% LOA: -0.07; 0.10). In a small number of patients we showed good accuracy of three QFR techniques (aQFR, cQFR and fQFR) to predict invasive FFR. Furthermore, good inter-observer agreement of the QFR values was observed between two independent observers.
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Affiliation(s)
- A R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - G Koning
- Medis Medical Imaging Systems B.V., Leiden, The Netherlands
| | - A C Dimitriu-Leen
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - J M Smit
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - J M Montero-Cabezas
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - F van der Kley
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - J W Jukema
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - J H C Reiber
- Medis Medical Imaging Systems B.V., Leiden, The Netherlands
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J J Bax
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands
| | - A J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.
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Dimitriu-Leen AC, van Rosendael AR, Smit JM, van Elst T, van Geloven N, Maaniitty T, Jukema JW, Delgado V, Scholte AJHA, Saraste A, Knuuti J, Bax JJ. Long-Term Prognosis of Patients With Intramural Course of Coronary Arteries Assessed With CT Angiography. JACC Cardiovasc Imaging 2017; 10:1451-1458. [PMID: 28528150 DOI: 10.1016/j.jcmg.2017.02.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 11/01/2016] [Revised: 02/14/2017] [Accepted: 02/16/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of the present study was to evaluate, in low-to-intermediate pre-test probability patients who were referred for coronary computed tomography angiography (CTA) and did not show obstructive coronary artery disease (CAD), whether an intramural course of a coronary artery is associated with worse outcome compared with patients without an intramural course of the coronary arteries. BACKGROUND The prognostic value of an intramural course of the coronary arteries on coronary CTA in patients without obstructive CAD is not well-known. METHODS The study population consisted of 947 patients with a low-to-intermediate pre-test probability who were referred for coronary CTA and who did not have obstructive CAD. During follow-up, the occurrence of unstable angina pectoris that required hospitalization, nonfatal myocardial infarction, and all-cause mortality was evaluated. RESULTS On coronary CTA, 210 patients (22%) had an intramural course of a coronary artery. The median depth of the intramural course was 1.9 mm (interquartile range: 1.4 to 2.6 mm). In 84 patients (40%), the depth of the intramural course was considered deep (>2 mm surrounded by myocardium). During a median follow-up of 4.9 years (interquartile range: 3.2 to 6.9 years), a total of 43 events occurred: hospitalization due to unstable angina pectoris in 13 patients (1.4%); 7 patients (0.7%) had a nonfatal myocardial infarction; and 23 patients died (2.4%). The 6-year cumulative event rate of unstable angina pectoris requiring hospitalization (0.0% vs. 1.1%), nonfatal myocardial infarction (0.5% vs. 0.4%), all-cause mortality (1.9% vs. 2.2%) as well as the combined endpoint of all 3 events (2.4% vs. 3.7%) was similar in patients with and without an intramural course of a coronary artery. CONCLUSIONS In patients without obstructive CAD on coronary CTA, the presence of an intramural course of a coronary artery was not associated with worse outcome.
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Affiliation(s)
| | - Alexander R van Rosendael
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands
| | - Jeff M Smit
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Tessa van Elst
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Nan van Geloven
- The Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, the Netherlands
| | | | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arthur J H A Scholte
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands.
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van Rosendael AR, Dimitriu-Leen AC, van Rosendael PJ, Leung M, Smit JM, Saraste A, Knuuti J, van der Geest RJ, van der Arend BW, van Zwet EW, Scholte AJ, Delgado V, Bax JJ. Association Between Posterior Left Atrial Adipose Tissue Mass and Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.116.004614. [DOI: 10.1161/circep.116.004614] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [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: 08/22/2016] [Accepted: 01/09/2017] [Indexed: 11/16/2022]
Abstract
Background—
Epicardial adipose tissue located close to the atrial wall can change the electric conduction of the left atrium, potentially leading to atrial fibrillation (AF). The aim of this study was to assess whether an increased atrial adipose tissue mass posterior to the left atrium is related to AF independent of demographical and cardiovascular risk factors.
Methods and Results—
Two hundred patients with AF and 200 patients without AF who underwent computed tomographic angiography were included. The posterior left atrial adipose tissue mass was quantified on computed tomographic angiography images as tissue with Hounsfield Units between −195 and −45. The adipose tissue mass was significantly larger in patients with AF compared with patients with sinus rhythm: 10.6±5.5 versus 4.7±3.5 g,
P
<0.001. In a multiple variable model (including age, body mass index, sex, coronary artery calcium score, diabetes mellitus, hypertension, hypercholesterolemia, family history of coronary artery disease, and known coronary artery disease), each gram increase of posterior left atrial adipose tissue was associated with 1.32 odds ratio of having AF (95% confidence interval, 1.22–1.43;
P
<0.001). Furthermore, the addition of the adipose tissue mass to the multiple variable analysis significantly increased the discriminatory ability to predict AF: increase in the area under the receiver operating characteristic, 0.88 (95% confidence interval, 0.84–0.91) versus 0.81 (0.76–0.85),
P
<0.001.
Conclusions—
Posterior left atrial adipose tissue mass is significantly larger in patients with AF versus without AF. An increase in adipose tissue was independently associated with AF and provided incremental value over well-known predictors of AF. These findings add to the hypothesis that the posterior left atrial adipose tissue mass contributes to structural and electric remodeling leading to AF.
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Affiliation(s)
- Alexander R. van Rosendael
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Aukelien C. Dimitriu-Leen
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Philippe J. van Rosendael
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Melissa Leung
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Jeff M. Smit
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Antti Saraste
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Juhani Knuuti
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Rob J. van der Geest
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Britt W.H. van der Arend
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Erik W. van Zwet
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Arthur J. Scholte
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Victoria Delgado
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
| | - Jeroen J. Bax
- From the Department of Cardiology (A.R.v.R., A.C.D.-L., P.J.v.R., M.L., J.M.S., B.W.H.v.d.A., A.J.S., V.D., J.J.B.), Division of Image Processing (R.J.v.d.G.), Department of Medical Statistics and Bio-informatics (E.W.v.Z.), Leiden University Medical Center, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands (A.R.v.R.); Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (M.L.); and The Turku PET Centre, Finland (A.S., J.K.)
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Smit JM, Mulder NH, Sleijfer DT, Bouman JG, Veeger W, Schraffordt Koops H. The effect of continuous enteral tube feeding on various nutritional parameters in patients with disseminated malignant melanoma during intensive chemotherapy. Clin Nutr 2008; 1:335-41. [PMID: 16829398 DOI: 10.1016/0261-5614(83)90012-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In a prospective study the effect of continuous enteral tube feeding was evaluated on various nutritional parameters in patients with disseminated malignant melanoma during 13 chemotherapy courses employing bleomycin, DTIC, vindesine and actinomycin D. The patients received a quantity of calories according to their pretreatment intake, but complete metabolic equilibrium could not be obtained during chemotherapy. Although the weight/height index remained unchanged, a decrease of serum albumin and prealbumin level occurred during all 13 treatment courses. Transferrin level decreased during 11 of these courses and cholinesterase level during 12. Triceps skinfold thickness and arm muscle circumference diminished equally. Serum prealbumin was the first nutritional parameter to fall during chemotherapy and seems to be a very sensitive indicator of the occurrence of nutritional imbalance. The plasma vitamin C level was low before treatment while during treatment both vitamin C and vitamin A level fell quickly even though the nutritional intake of these vitamins was adequate. We conclude that continuous enteral tube feeding, which is a feasible method of feeding, can to some extent fulfill the nutritional needs of patients treated with intensive chemotherapy.
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Affiliation(s)
- J M Smit
- University Hospital Groningen, Oostersingel 59, 9713 EZ Groningen, The Netherlands
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Hospers GAP, Schaapveld M, Nortier JWR, Wils J, van Bochove A, de Jong RS, Creemers GJ, Erjavec Z, de Gooyer DJ, Slee PHTJ, Gerrits CJH, Smit JM, Mulder NH. Randomised Phase III study of biweekly 24-h infusion of high-dose 5FU with folinic acid and oxaliplatin versus monthly plus 5-FU/folinic acid in first-line treatment of advanced colorectal cancer. Ann Oncol 2006; 17:443-9. [PMID: 16500914 DOI: 10.1093/annonc/mdj104] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND A phase III study was started to compare oxaliplatin/5FU/LV in the first-line with bolus FU/LV in metastatic colorectal cancer. PATIENTS AND METHODS 302 patients were randomised and received bolus 5-FU 425 mg/m(2) day 1-5, FA 20 mg/m(2) day 1-5, q 4 wk or oxaliplatin 85 mg/m(2), 2 h-infusion, FA 200 mg/m(2), 1-h infusion. 5-FU 2600 mg/m(2), 24-h infusion day 1, q 2 wk. The primary endpoint was response rate (RR). RESULTS The median follow-up is 31.8 months, 90.4% of the patients have died. Confirmed RR, progression free survival (PFS; months) and median overall survival (OS; months) in 5FU/LV versus 5FU/LV/oxaliplatin were respectively 18.5% versus (vs) 33.8% (P = 0.004), 5.6 vs 6.7 (P = 0.016) and 13.3 vs 13.8 (P = 0.619). In the 5FU/LV/oxaliplatin arm less grade (3/4) toxicity was measured for diarrhoea, stomatitis, an increase in idiosyncratic side effects and neurosensory events compared with 5FU/LV. The quality of life (QOL) was equal in both arms. Second line treatment was given in 62% of the patients, crossover of 5FU/LV to 5FU/LV/oxaliplatin occurred in 14%. CONCLUSIONS Oxaliplatin in the first-line resulted in an increased RR and PFS with less grade 3/4 mucositis/diarrhoea compared with 5FU/LV alone. Idiosyncratic side effects deserve attention with oxaliplatin. Despite a low treatment cross over rate, OS in both groups was comparable.
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Affiliation(s)
- G A P Hospers
- Department of Medical Oncology, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands.
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Smit JM, Bauland CG, Wijnberg DS, Spauwen PHM. Pulsed dye laser treatment, a review of indications and outcome based on published trials. ACTA ACUST UNITED AC 2005; 58:981-7. [PMID: 16039628 DOI: 10.1016/j.bjps.2005.04.057] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2004] [Accepted: 04/29/2005] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Pulsed dye laser (PDL) treatment is based on the principle of selective photothermolysis and is widely considered to be the treatment of choice for a variety of cutaneous vascular lesions. OBJECTIVE To review the indications and outcome of PDL treatment and summarise new developments. METHOD A literature-based study has been conducted entailing the review of publications over the period January 1993-December 2003 using the databases Medline and Cochrane CENTRAL. RESULTS The PDL was found to be effective in port wine stain, facial telangiectasia, leg telangiectasia <0.5 mm, scars, hypertrophic scars and ulcerated haemangioma. DISCUSSION Essential characteristics of lesions suitable for PDL treatment are discussed and guidelines are presented for future research.
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Affiliation(s)
- J M Smit
- Department of Plastic Surgery, University Medical Centre Nijmegen, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Rea DW, Nortier JWR, Ten Bokkel Huinink WW, Falk S, Richel DJ, Maughan T, Groenewegen G, Smit JM, Steven N, Bakker JM, Semiond D, Kerr DJ, Punt CJA. A phase I/II and pharmacokinetic study of irinotecan in combination with capecitabine as first-line therapy for advanced colorectal cancer. Ann Oncol 2005; 16:1123-32. [PMID: 15939714 DOI: 10.1093/annonc/mdi227] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE The aim of this study was to determine in patients with previously untreated advanced colorectal cancer the maximum tolerated dose (MTD) and safety profile of irinotecan in combination with capecitabine, to identify a recommended dose and to determine the response rate and time to disease progression. In addition, we aimed to explore the pharmacokinetic parameters of irinotecan and capecitabine when used in different sequences of administration, with irinotecan infusion either prior to or after the first intake of capecitabine. PATIENTS AND METHODS One hundred patients were included: 43 patients were recruited into an extended phase I trial of alternating escalation in dose of both drugs where irinotecan was administered intravenously (i.v) on day 1 after first intake of capecitabine taken from days 1-14 twice daily, with cycles repeated every 3 weeks. After the determination of recommended dose a further 57 patients were treated in a phase II evaluation with the reverse sequence of drugs on day 1. Pharmacokinetic analysis was performed in patients treated at the recommended dose in two cohorts of patients in which the sequence of the first administration of each drug was reversed. RESULTS The MTD of the combination was determined as irinotecan 300 mg/m2, with capecitabine 2000 mg/m2/day. Dose limiting toxicities were neutropenia and diarrhoea. The recommended dose is irinotecan intravenous (i.v.) 250 mg/m2 day 1 and capecitabine 2000 mg/m2/day days 1-14, every 3 weeks. Treatment was well tolerated, with diarrhoea the most common serious toxicity. Response rate in the phase II cohort was 42% [95% confidence interval (CI) 29% to 56%]. Median duration of response was 7.7 months (95% CI 7.5-8.9). Median time to progression was 8.3 months (95% CI 5.8-10). No significant effect on irinotecan pharmacokinetics was observed whatever the intake of capecitabine before or after irinotecan infusion. An effect of irinotecan on capecitabine and some capecitabine metabolites was observed, but irinotecan did not effect 5-fluorouracil (5-FU) pharmacokinetics. CONCLUSIONS Irinotecan in combination with capecitabine is a well tolerated regimen with an activity comparable to, but more convenient than, irinotecan-5-FU i.v. combinations in patients with previously untreated advanced colorectal cancer. The pharmacokinetic data suggest that the sequence of administration does not impact significantly on the metabolism of the two drugs.
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Affiliation(s)
- D W Rea
- CR UK Institute for Cancer Studies, University of Birmingham, Birmingham, UK
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Arends JJ, Sleeboom HP, Leys MBL, ten Bokkel Huinink D, de Jong RS, Smit JM, Nortier JWR, Tesselaar MET. A phase II study of raltitrexed and gemcitabine in patients with advanced pancreatic carcinoma. Br J Cancer 2005; 92:445-8. [PMID: 15668704 PMCID: PMC2362068 DOI: 10.1038/sj.bjc.6602368] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Advanced adenocarcinoma of the pancreas has a very poor prognosis. The aim of this study was to assess the efficacy and tolerability of a combination of the chemotherapeutic agents gemcitabine and raltitrexed. Chemonaïve patients with advanced adenocarcinoma of the pancreas were treated with a combination of raltitrexed (3.5 mg m−2 on day 1 of a 21-day treatment cycle) and gemcitabine (800 mg m−2 intravenously (i.v.) on days 1 and 8 of a 21-day cycle). Between April 2000 and February 2003, 27 patients were enrolled onto the study. The mean duration of treatment was 11 weeks. Four of 27 patients experienced at least one episode of grade 3 or 4 neutropenia. One patient with grade 4 neutropenia died due to sepsis. Four of 27 patients experienced grade 4 diarrhoea. There was one partial remission (4%) and 12 patients experienced disease stabilisation (44%). The 6-month and 1-year survival rates were 37 and 11%, respectively. Symptomatic benefit occurred in seven (26%) patients. We conclude that a combination of raltitrexed and gemcitabine, using the schedule and doses in this study, cannot be recommended for patients with advanced pancreatic cancer.
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Affiliation(s)
- J J Arends
- Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - H P Sleeboom
- Departments of Internal Medicine, Leyenburg Hospital, PO Box 40551, 2504 LN The Hague, The Netherlands
| | - M B L Leys
- Medical Center Rijnmond, PO Box 9119, 3007 AC Rotterdam, The Netherlands
| | | | - R S de Jong
- Martini Hospital, PO Box 30033. 9700 RM Groningen
| | - J M Smit
- Gelre Hospital, PO Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - J W R Nortier
- Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - M E T Tesselaar
- Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Department of Clinical Oncology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail:
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van Seventer R, Smit JM, Schipper RM, Wicks MA, Zuurmond WWA. Comparison of TTS-fentanyl with sustained-release oral morphine in the treatment of patients not using opioids for mild-to-moderate pain. Curr Med Res Opin 2003; 19:457-69. [PMID: 14594516 DOI: 10.1185/030079903125002045] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This randomised, multicentre, direct open comparative trial evaluated the efficacy, treatment convenience, tolerability and safety aspects of transdermal therapeutic system (TTS)-fentanyl and sustained-release oral morphine (SRM) in both opioid-naïve patients with moderate-to-severe cancer-related pain and in patients who had already been using opioids for mild-to-moderate pain. The two treatment groups were run in parallel. Special attention was paid to constipation, nausea/vomiting, drowsiness and respiratory depression. PATIENTS AND METHODS The 131 enrolled patients started the 4-week treatment at low doses of opioid (25 microg/h TTS-fentanyl for 3 days or 30 mg SRM every 12 h) and were individually titrated. Tolerability, efficacy and safety were assessed throughout the study period. Frequency of constipation was the primary study variable and accordingly the study was powered for this. Both patients and investigators made a global treatment evaluation. RESULTS TTS-fentanyl and SRM were shown to be equally effective. Pain control and sleep quality improved with both treatments. None of the patients developed respiratory depression. Statistically significantly more patients in the SRM treatment group discontinued the trial prematurely (59% vs 27%; p < 0.001), particularly due to adverse events (36% vs 4%; p < 0.001). Fewer patients in the TTS-fentanyl than in the SRM treatment group reported constipation during the trial. This finding was statistically significant after 1 week of treatment (27% vs 57%; p = 0.003). The favourable tolerability profile of TTS-fentanyl was also reflected in both the patient and the investigator global evaluation of the treatment. Patient assessment favoured TTS-fentanyl treatment in terms of a significantly lower rate of troublesome side-effects ('quite a bit' to 'very much' troublesome side-effects in 14% vs 36% of patients; p = 0.003) and less interruption of daily activities (absence of any interruption of daily activities in 88% vs 63% of patients; p = 0.012). Investigators scored TTS-fentanyl as significantly better with respect to 'side-effects' (p = 0.039) and 'overall impression' (p = 0.013). Sub-analyses of opioid-naïve users gave similar results. CONCLUSION These data indicate that TTS-fentanyl, when used as an opioid of first choice in the treatment of cancer-related pain, is as effective as, but better tolerated than, SRM, including in opioid-naïve patients.
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Affiliation(s)
- R van Seventer
- Department of Anaesthesiology, Amphia Hospital, Breda, The Netherlands
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Mulder CJJ, Westerveld BD, Smit JM, Oudkerk Pool M, Otten MH, Tan TG, van Milligen de Wit AWM, de Groot GH. A double-blind, randomized comparison of omeprazole Multiple Unit Pellet System (MUPS) 20 mg, lansoprazole 30 mg and pantoprazole 40 mg in symptomatic reflux oesophagitis followed by 3 months of omeprazole MUPS maintenance treatment: a Dutch multicentre trial. Eur J Gastroenterol Hepatol 2002; 14:649-56. [PMID: 12072599 DOI: 10.1097/00042737-200206000-00010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Proton pump inhibitors (PPIs) have proved to be effective in treating reflux oesophagitis. Until now, no study had compared the PPIs omeprazole Multiple Unit Pellet System (MUPS), lansoprazole and pantoprazole in patients with reflux oesophagitis. AIM To compare omeprazole MUPS 20 mg, lansoprazole 30 mg and pantoprazole 40 mg for treatment effect in symptomatic reflux oesophagitis. METHOD Patients with grade I-IV symptomatic reflux oesophagitis were randomized to double-blind omeprazole 20 mg once morning, lansoprazole 30 mg o.m. or pantoprazole 40 mg o.m. Patient satisfaction and symptoms were evaluated after 4 and 8 weeks. Patients not satisfied after 8 weeks were treated for another 4 weeks with omeprazole 40 mg MUPS (open). Successful treatment was followed by 3 months' maintenance treatment with omeprazole MUPS 20 mg (patients satisfied after 4 or 8 weeks) or omeprazole MUPS 40 mg (patients satisfied after 12 weeks). RESULTS On intention-to-treat (ITT) analysis (n = 461) at 4 and 8 weeks, respectively, 84% and 87% (omeprazole MUPS), 78% and 81% (lansoprazole), and 84% and 89% (pantoprazole) were free of heartburn. Equivalence was found between omeprazole MUPS and pantoprazole (heartburn relief), but not with lansoprazole. Patient satisfaction after 4 and 8 weeks, respectively, was 79% and 89% (omeprazole MUPS), 76% and 86% (lansoprazole), and 79% and 91% (pantoprazole). Patient satisfaction was similar in all treatment groups. During maintenance, 87% in the omeprazole MUPS 20 mg group and 81% in the omeprazole MUPS 40 mg group were satisfied after 3 months. CONCLUSIONS Omeprazole MUPS 20 mg and pantoprazole 40 mg have equivalent efficacy in the treatment of reflux oesophagitis. Based on patient satisfaction, omeprazole MUPS 20 mg, lansoprazole 30 mg and pantoprazole 40 mg are equally effective.
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Affiliation(s)
- C J J Mulder
- Department of Gastroenterology, Rijnstate Ziekenhuis, Arnhem, The Netherlands.
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Smit JM, Klimstra WB, Ryman KD, Bittman R, Johnston RE, Wilschut J. PE2 cleavage mutants of Sindbis virus: correlation between viral infectivity and pH-dependent membrane fusion activation of the spike heterodimer. J Virol 2001; 75:11196-204. [PMID: 11602759 PMCID: PMC114699 DOI: 10.1128/jvi.75.22.11196-11204.2001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The spike glycoprotein E2 of Sindbis virus (SIN) is synthesized in the infected cell as a PE2 precursor protein, which matures through cleavage by a cellular furin-like protease. Previous work has shown that SIN mutants impaired in PE2 cleavage are noninfectious on BHK-21 cells, the block in infection being localized at a step after virus-receptor interaction but prior to RNA replication. Here, we studied the membrane fusion properties of SIN PE2 cleavage mutants and observed that these viruses are impaired in their ability to form an E1 homotrimer and to fuse with liposomes at a mildly acidic pH. The block in spike rearrangement and fusion could be overridden by exposure of the mutant viruses to very low pH (<4.5). Cleavage mutants with second-site resuscitating mutations in PE2 were highly infectious for BHK-21 cells. The ability of these viruses to form E1 homotrimers and to fuse at a mildly acidic pH was completely restored despite a sustained lack of PE2 cleavage.
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Affiliation(s)
- J M Smit
- Molecular Virology Section, Department of Medical Microbiology, University of Groningen, 9713 AV Groningen, The Netherlands
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Smit JM, Bittman R, Wilschut J. Deacylation of the transmembrane domains of Sindbis virus envelope glycoproteins E1 and E2 does not affect low-pH-induced viral membrane fusion activity. FEBS Lett 2001; 498:57-61. [PMID: 11389898 DOI: 10.1016/s0014-5793(01)02495-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The envelope glycoproteins E1 and E2 of Sindbis virus are palmitoylated at cysteine residues within their transmembrane domains (E1 at position 430, and E2 at positions 388 and 390). Here, we investigated the in vitro membrane fusion activity of Sindbis virus variants (derived from the Toto 1101 infectious clone), in which the E1 C430 and/or E2 C388/390 residues had been substituted for alanines. Both the E1 and E2 mutant viruses, as well as a triple mutant virus, fused with liposomes in a strictly low-pH-dependent manner, the fusion characteristics being indistinguishable from those of the parent Toto 1101 virus. These results demonstrate that acylation of the transmembrane domain of Sindbis virus E1 and E2 is not required for expression of viral membrane fusion activity.
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Affiliation(s)
- J M Smit
- Department of Medical Microbiology, University of Groningen, The Netherlands
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Abstract
There is controversy as to whether the cell entry mechanism of Sindbis virus (SIN) involves direct fusion of the viral envelope with the plasma membrane at neutral pH or uptake by receptor-mediated endocytosis and subsequent low-pH-induced fusion from within acidic endosomes. Here, we studied the membrane fusion activity of SIN in a liposomal model system. Fusion was followed fluorometrically by monitoring the dilution of pyrene-labeled lipids from biosynthetically labeled virus into unlabeled liposomes or from labeled liposomes into unlabeled virus. Fusion was also assessed on the basis of degradation of the viral core protein by trypsin encapsulated in the liposomes. SIN fused efficiently with receptor-free liposomes, consisting of phospholipids and cholesterol, indicating that receptor interaction is not a mechanistic requirement for fusion of the virus. Fusion was optimal at pH 5.0, with a threshold at pH 6.0, and undetectable at neutral pH, supporting a cell entry mechanism of SIN involving fusion from within acidic endosomes. Under optimal conditions, 60 to 85% of the virus fused, depending on the assay used, corresponding to all of the virus bound to the liposomes as assessed in a direct binding assay. Preincubation of the virus alone at pH 5.0 resulted in a rapid loss of fusion capacity. Fusion of SIN required the presence of both cholesterol and sphingolipid in the target liposomes, cholesterol being primarily involved in low-pH-induced virus-liposome binding and the sphingolipid catalyzing the fusion process itself. Under low-pH conditions, the E2/E1 heterodimeric envelope glycoprotein of the virus dissociated, with formation of a trypsin-resistant E1 homotrimer, which kinetically preceded the fusion reaction, thus suggesting that the E1 trimer represents the fusion-active conformation of the viral spike.
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Affiliation(s)
- J M Smit
- University of Groningen, Department of Physiological Chemistry, 9713 AV Groningen, The Netherlands
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