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Halfmann MC, Hopman LHGA, Körperich H, Blaszczyk E, Gröschel J, Schulz-Menger J, Salatzki J, André F, Friedrich S, Emrich T. Reproducibility assessment of rapid strains in cardiac MRI: Insights and recommendations for clinical application. Eur J Radiol 2024; 174:111386. [PMID: 38447431 DOI: 10.1016/j.ejrad.2024.111386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 03/08/2024]
Abstract
PURPOSE Studies have shown the incremental value of strain imaging in various cardiac diseases. However, reproducibility and generalizability has remained an issue of concern. To overcome this, simplified algorithms such as rapid atrioventricular strains have been proposed. This multicenter study aimed to assess the reproducibility of rapid strains in a real-world setting and identify potential predictors for higher interobserver variation. METHODS A total of 4 sites retrospectively identified 80 patients and 80 healthy controls who had undergone cardiac magnetic resonance imaging (CMR) at their respective centers using locally available scanners with respective field strengths and imaging protocols. Strain and volumetric parameters were measured at each site and then independently re-evaluated by a blinded core lab. Intraclass correlation coefficients (ICC) and Bland-Altman plots were used to assess inter-observer agreement. In addition, backward multiple linear regression analysis was performed to identify predictors for higher inter-observer variation. RESULTS There was excellent agreement between sites in feature-tracking and rapid strain values (ICC ≥ 0.96). Bland-Altman plots showed no significant bias. Bi-atrial feature-tracking and rapid strains showed equally excellent agreement (ICC ≥ 0.96) but broader limits of agreement (≤18.0 % vs. ≤3.5 %). Regression analysis showed that higher field strength and lower temporal resolution (>30 ms) independently predicted reduced interobserver agreement for bi-atrial strain parameters (ß = 0.38, p = 0.02 for field strength and ß = 0.34, p = 0.02 for temporal resolution). CONCLUSION Simplified rapid left ventricular and bi-atrial strain parameters can be reliably applied in a real-world multicenter setting. Due to the results of the regression analysis, a minimum temporal resolution of 30 ms is recommended when assessing atrial deformation.
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Affiliation(s)
- Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, the Netherlands.
| | - Hermann Körperich
- Institute for Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center NRW, Ruhr-University of Bochum, 32545 Bad Oeynhausen, Germany.
| | - Edyta Blaszczyk
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin 13125, Germany; German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| | - Jan Gröschel
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin 13125, Germany; German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| | - Jeanette Schulz-Menger
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a joint cooperation between the Charité Medical Faculty and the Max Delbrueck Center for Molecular Medicine, Lindenberger Weg 80, Berlin 13125, Germany; German Center for Cardiovascular Research (DZHK), Partner Site, Berlin, Germany.
| | - Janek Salatzki
- Department of Cardiology, Angiology, Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Germany.
| | - Florian André
- Department of Cardiology, Angiology, Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69121 Heidelberg, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Heidelberg-Mannheim, Germany.
| | | | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Germany.
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Hopman LHGA, Frenaij IM, Heidendael JF, Selder JL, Robbers LFHJ. Cardiovascular magnetic resonance imaging characteristics of a myocardial metastatic melanoma. Eur Heart J Cardiovasc Imaging 2024; 25:e154. [PMID: 37990941 PMCID: PMC11057919 DOI: 10.1093/ehjci/jead326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/16/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023] Open
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Irene M Frenaij
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Josephine F Heidendael
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Jasper L Selder
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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3
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Hopman LHGA, Solís-Lemus JA, Hofman MBM, Bhagirath P, Borodzicz-Jazdzyk S, van Pouderoijen N, Krafft AJ, Schmidt M, Allaart CP, Niederer SA, Götte MJW. Performance of Image-navigated and Diaphragm-navigated 3D Late Gadolinium-enhanced Cardiac MRI for the Assessment of Atrial Fibrosis. Radiol Cardiothorac Imaging 2024; 6:e230172. [PMID: 38573128 PMCID: PMC11056763 DOI: 10.1148/ryct.230172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/19/2023] [Accepted: 02/29/2024] [Indexed: 04/05/2024]
Abstract
Purpose To perform a qualitative and quantitative evaluation of the novel image-navigated (iNAV) 3D late gadolinium enhancement (LGE) cardiac MRI imaging strategy in comparison with the conventional diaphragm-navigated (dNAV) 3D LGE cardiac MRI strategy for the assessment of left atrial fibrosis in atrial fibrillation (AF). Materials and Methods In this prospective study conducted between April and September 2022, 26 consecutive participants with AF (mean age, 61 ± 11 years; 19 male) underwent both iNAV and dNAV 3D LGE cardiac MRI, with equivalent spatial resolution and timing in the cardiac cycle. Participants were randomized in the acquisition order of iNAV and dNAV. Both, iNAV-LGE and dNAV-LGE images were analyzed qualitatively using a 5-point Likert scale and quantitatively (percentage of atrial fibrosis using image intensity ratio threshold 1.2), including testing for overlap in atrial fibrosis areas by calculating Dice score. Results Acquisition time of iNAV was significantly lower compared with dNAV (4.9 ± 1.1 minutes versus 12 ± 4 minutes, P < .001, respectively). There was no evidence of a difference in image quality for all prespecified criteria between iNAV and dNAV, although dNAV was the preferred image strategy in two-thirds of cases (17/26, 65%). Quantitative assessment demonstrated that mean fibrosis scores were lower for iNAV compared with dNAV (12 ± 8% versus 20 ± 12%, P < .001). Spatial correspondence between the atrial fibrosis maps was modest (Dice similarity coefficient, 0.43 ± 0.15). Conclusion iNAV-LGE acquisition in individuals with AF was more than twice as fast as dNAV acquisition but resulted in a lower atrial fibrosis score. The differences between these two strategies might impact clinical interpretation. ©RSNA, 2024.
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Affiliation(s)
- Luuk H. G. A. Hopman
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - José A. Solís-Lemus
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Mark B. M. Hofman
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Pranav Bhagirath
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Sonia Borodzicz-Jazdzyk
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Nikki van Pouderoijen
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Axel J. Krafft
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Michaela Schmidt
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Cornelis P. Allaart
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Steven A. Niederer
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
| | - Marco J. W. Götte
- From the Department of Cardiology, Amsterdam University Medical
Center, De Boelelaan 1118, 1081 HV, Amsterdam, the Netherlands (L.H.G.A.H.,
P.B., S.B.J., N.v.P., C.P.A., M.J.W.G.); Division of Imaging Sciences and
Biomedical Engineering, King’s College London, London, United Kingdom
(J.A.S.L., S.A.N.); Department of Radiology and Nuclear Medicine, Amsterdam UMC,
Amsterdam, the Netherlands (M.B.M.H.); First Department of Cardiology, Medical
University of Warsaw, Warsaw, Poland (S.B.J.); and Siemens Healthineers,
Erlangen, Germany (A.J.K., M.S.)
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Demirkiran A, Beijnink CWH, Kloner RA, Hopman LHGA, van der Hoeven NW, van Pouderoijen N, Janssens GN, Everaars H, van Leeuwen MAH, van Rossum AC, van Royen N, Robbers LFHJ, Nijveldt R. Impact of symptom-to-reperfusion-time on transmural infarct extent and left ventricular strain in patients with ST-segment elevation myocardial infarction: a 3D view on the wavefront phenomenon. Eur Heart J Cardiovasc Imaging 2024; 25:347-355. [PMID: 37812691 PMCID: PMC10883731 DOI: 10.1093/ehjci/jead258] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/11/2023] Open
Abstract
AIMS We examined the association between the symptom-to-reperfusion-time and cardiovascular magnetic resonance (CMR)-derived global strain parameters and transmural infarct extent in ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS The study included 108 STEMI patients who underwent successful primary percutaneous coronary intervention (PPCI). Patients were categorized according to the median symptom-to-reperfusion-time: shorter (<160 min, n = 54) and longer times (>160 min, n = 54). CMR was performed 2-7 days after PPCI and at 1 month. CMR cine imaging was performed for functional assessment and late gadolinium enhancement to evaluate transmural infarct extent. Myocardial feature-tracking was used for strain analysis. Groups were comparable in relation to incidence of LAD disease and pre- and post-PPCI thrombolysis in myocardial infarction (TIMI) flow grades. The mean transmural extent score at follow-up was lower in patients with shorter reperfusion time (P < 0.01). Both baseline and follow-up maximum transmural extent scores were smaller in patients with shorter reperfusion time (P = 0.03 for both). Patients with shorter reperfusion time had more favourable global left ventricular (LV) circumferential strain (baseline, P = 0.049; follow-up, P = 0.01) and radial strain (baseline, P = 0.047; follow-up, P < 0.01), whilst LV longitudinal strain appeared comparable for both baseline and follow-up (P > 0.05 for both). In multi-variable regression analysis including all three strain directions, baseline LV circumferential strain was independently associated with the mean transmural extent score at follow-up (β=1.89, P < 0.001). CONCLUSION In STEMI patients, time-to-reperfusion was significantly associated with smaller transmural extent of infarction and better LV circumferential and radial strain. Moreover, infarct transmurality and residual LV circumferential strain are closely linked.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Kocaeli City Hospital, Tavşantepe, 41060 İzmit/Kocaeli, Türkiye
| | - Casper W H Beijnink
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Robert A Kloner
- Cardiovascular Research, Huntington Medical Research Institutes, Pasadena, CA, USA
- Division of Cardiovascular Medicine, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Nina W van der Hoeven
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Nikki van Pouderoijen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Gladys N Janssens
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
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Hopman LHGA, Zweerink A, van de Veerdonk MC, van der Lingen ALCJ, Huntelaar MJ, Robbers LFHJ, van Rossum AC, Götte MJW, van Halm VP, Allaart CP. Post-implantation CMR imaging to study biventricular pacing effects on the right ventricle in left bundle branch block patients. Pacing Clin Electrophysiol 2024; 47:121-123. [PMID: 38055567 DOI: 10.1111/pace.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
Cardiac resynchronization therapy (CRT) is an established treatment for heart failure patients with left ventricular dysfunction and a left bundle branch block. However, its impact on right ventricular (RV) function remains uncertain. This cardiac magnetic resonance imaging study found that CRT did not improve RV volumes and function, and CRT-off during follow-up had an immediate detrimental effect on the RV, which may suggest potential unfavorable RV remodeling with RV pacing during CRT.
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Affiliation(s)
| | - Alwin Zweerink
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | | | | | | | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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6
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Hopman LHGA, Beunder KP, Borodzicz-Jazdzyk S, Götte MJW, van Halm VP. Loss of capture of conduction system pacemaker caused by fibrosis surrounding the lead: a case report. BMC Cardiovasc Disord 2023; 23:621. [PMID: 38114911 PMCID: PMC10729341 DOI: 10.1186/s12872-023-03656-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/04/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Conduction system pacing (CSP) is a novel technique that involves pacing the His-Purkinje system instead of the traditional right ventricular (RV) apex. This technique aims to avoid the adverse effects of RV apical pacing, which can lead to ventricular dyssynchrony and heart failure over time. CSP is gaining popularity but its long-term efficacy and challenges remain uncertain. This report discusses a case where CSP was initially successful but faced complications due to an increasing pacing threshold. CASE PRESENTATION A 65-year-old female with total atrioventricular block was referred for brady-pacing. Due to the potential for chronic RV pacing, CSP was chosen. The CSP implantation involved subcutaneous device placement, with a CSP lead in the left bundle branch area (LBBA) and an RV backup lead. A year after successful implantation, the LBBA pacing threshold progressively increased. Subsequent efforts to correct it led to anodal capture and battery depletion. Cardiac magnetic resonance imaging (CMR) revealed mid-septal fibrosis at the area of LBBA lead placement and suggested cardiac sarcoidosis as a possible cause. CONCLUSION CSP is a promising technique for treating bradyarrhythmias, but this case underscores the need for vigilance in monitoring pacing thresholds. Increasing thresholds can render CSP ineffective, necessitating alternative pacing methods. The CMR findings of mid-septal fibrosis and the potential diagnosis of cardiac sarcoidosis emphasize the importance of pre-implantation assessment, as CSP may be compromised by underlying structural abnormalities. This report highlights the complexities of pacing strategy selection and the significance of comprehensive evaluation before adopting CSP.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Kyle P Beunder
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Sonia Borodzicz-Jazdzyk
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- 1st Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
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Roney CH, Solis Lemus JA, Lopez Barrera C, Zolotarev A, Ulgen O, Kerfoot E, Bevis L, Misghina S, Vidal Horrach C, Jaffery OA, Ehnesh M, Rodero C, Dharmaprani D, Ríos-Muñoz GR, Ganesan A, Good WW, Neic A, Plank G, Hopman LHGA, Götte MJW, Honarbakhsh S, Narayan SM, Vigmond E, Niederer S. Constructing bilayer and volumetric atrial models at scale. Interface Focus 2023; 13:20230038. [PMID: 38106921 PMCID: PMC10722212 DOI: 10.1098/rsfs.2023.0038] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 11/15/2023] [Indexed: 12/19/2023] Open
Abstract
To enable large in silico trials and personalized model predictions on clinical timescales, it is imperative that models can be constructed quickly and reproducibly. First, we aimed to overcome the challenges of constructing cardiac models at scale through developing a robust, open-source pipeline for bilayer and volumetric atrial models. Second, we aimed to investigate the effects of fibres, fibrosis and model representation on fibrillatory dynamics. To construct bilayer and volumetric models, we extended our previously developed coordinate system to incorporate transmurality, atrial regions and fibres (rule-based or data driven diffusion tensor magnetic resonance imaging (MRI)). We created a cohort of 1000 biatrial bilayer and volumetric models derived from computed tomography (CT) data, as well as models from MRI, and electroanatomical mapping. Fibrillatory dynamics diverged between bilayer and volumetric simulations across the CT cohort (correlation coefficient for phase singularity maps: left atrial (LA) 0.27 ± 0.19, right atrial (RA) 0.41 ± 0.14). Adding fibrotic remodelling stabilized re-entries and reduced the impact of model type (LA: 0.52 ± 0.20, RA: 0.36 ± 0.18). The choice of fibre field has a small effect on paced activation data (less than 12 ms), but a larger effect on fibrillatory dynamics. Overall, we developed an open-source user-friendly pipeline for generating atrial models from imaging or electroanatomical mapping data enabling in silico clinical trials at scale (https://github.com/pcmlab/atrialmtk).
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Affiliation(s)
- Caroline H. Roney
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Jose Alonso Solis Lemus
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Carlos Lopez Barrera
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
- Center for Research in Advanced Materials S.C (CIMAV), Chihuahua, Mexico
| | - Alexander Zolotarev
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Onur Ulgen
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Eric Kerfoot
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
| | - Laura Bevis
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Semhar Misghina
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Caterina Vidal Horrach
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Ovais A. Jaffery
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Mahmoud Ehnesh
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Cristobal Rodero
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Dhani Dharmaprani
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Gonzalo R. Ríos-Muñoz
- Bioengineering Department, Universidad Carlos III de Madrid, Madrid 28911, Spain
- Department of Cardiology, Gregorio Marañón Health Research Institute (IiSGM), Hospital General Universitario Gregorio Marañón, Madrid 28007, Spain
- Center for Biomedical Research in Cardiovascular Disease Network (CIBERCV), Madrid 28029, Spain
| | - Anand Ganesan
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | | | | | - Gernot Plank
- Gottfried Schatz Research Center-Biophysics, Medical University of Graz, Graz, Austria
- BioTechMed-Graz, Graz, Austria
| | | | | | - Shohreh Honarbakhsh
- Electrophysiology Department, Barts Heart Centre, Barts Health NHS Trust, London, UK
| | - Sanjiv M. Narayan
- Department of Medicine and Cardiovascular Institute, Stanford University, Palo Alto, CA, USA
| | - Edward Vigmond
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Bordeaux, France
- IMB, UMR 5251, University Bordeaux, Talence 33400, France
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
- Turing Research and Innovation Cluster in Digital Twins (TRIC: DT), The Alan Turing Institute, London, UK
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8
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Hopman LHGA, van Pouderoijen N, Mulder MJ, van der Laan AM, Bhagirath P, Nazarian S, Niessen HWM, Ferrari VA, Allaart CP, Götte MJW. Atrial Ablation Lesion Evaluation by Cardiac Magnetic Resonance: Review of Imaging Strategies and Histological Correlations. JACC Clin Electrophysiol 2023; 9:2665-2679. [PMID: 37737780 DOI: 10.1016/j.jacep.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023]
Abstract
Cardiac magnetic resonance (CMR) imaging is a valuable noninvasive tool for evaluating tissue response following catheter ablation of atrial tissue. This review provides an overview of the contemporary CMR strategies to visualize atrial ablation lesions in both the acute and chronic postablation stages, focusing on their strengths and limitations. Moreover, the accuracy of CMR imaging in comparison to atrial lesion histology is discussed. T2-weighted CMR imaging is sensitive to edema and tends to overestimate lesion size in the acute stage after ablation. Noncontrast agent-enhanced T1-weighted CMR imaging has the potential to provide more accurate assessment of lesions in the acute stage but may not be as effective in the chronic stage. Late gadolinium enhancement imaging can be used to detect chronic atrial scarring, which may inform repeat ablation strategies. Moreover, novel imaging strategies are being developed, but their efficacy in characterizing atrial lesions is yet to be determined. Overall, CMR imaging has the potential to provide virtual histology that aids in evaluating the efficacy and safety of catheter ablation and monitoring of postprocedural myocardial changes. However, technical factors, scanning during arrhythmia, and transmurality assessment pose challenges. Therefore, further research is needed to develop CMR strategies to visualize the ablation lesion maturation process more effectively.
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Affiliation(s)
| | | | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Saman Nazarian
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | - Hans W M Niessen
- Department of Pathology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Victor A Ferrari
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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9
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Hopman LHGA, Baalman SWE, de Groot JR, Knops RE, van Halm VP. Towards continuous optimization of CRT settings: the relationship between pulmonary artery dP/dt and Left ventricular dP/dt measurements. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01700-y. [PMID: 37991666 DOI: 10.1007/s10840-023-01700-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/13/2023] [Indexed: 11/23/2023]
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Sarah W E Baalman
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Joris R de Groot
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Vokko P van Halm
- Department of Cardiology, Amsterdam UMC, Amsterdam, The Netherlands.
- Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
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10
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Jukema RA, de Winter RW, Hopman LHGA, Driessen RS, van Diemen PA, Appelman Y, Twisk JWR, Planken RN, Raijmakers PG, Knaapen P, Danad I. Impact of cardiac history and myocardial scar on increase of myocardial perfusion after revascularization. Eur J Nucl Med Mol Imaging 2023; 50:3897-3909. [PMID: 37561140 PMCID: PMC10611874 DOI: 10.1007/s00259-023-06356-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 07/22/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE We sought to assess the impact of coronary revascularization on myocardial perfusion and fractional flow reserve (FFR) in patients without a cardiac history, with prior myocardial infarction (MI) or non-MI percutaneous coronary intervention (PCI). Furthermore, we studied the impact of scar tissue. METHODS Symptomatic patients underwent [15O]H2O positron emission tomography (PET) and FFR before and after revascularization. Patients with prior CAD, defined as prior MI or PCI, underwent scar quantification by magnetic resonance imaging late gadolinium enhancement. RESULTS Among 137 patients (87% male, age 62.2 ± 9.5 years) 84 (61%) had a prior MI or PCI. The increase in FFR and hyperemic myocardial blood flow (hMBF) was less in patients with prior MI or non-MI PCI compared to those without a cardiac history (FFR: 0.23 ± 0.14 vs. 0.20 ± 0.12 vs. 0.31 ± 0.18, p = 0.02; hMBF: 0.54 ± 0.75 vs. 0.62 ± 0.97 vs. 0.91 ± 0.96 ml/min/g, p = 0.04). Post-revascularization FFR and hMBF were similar across patients without a cardiac history or with prior MI or non-MI PCI. An increase in FFR was strongly associated to hMBF increase in patients without a cardiac history or with prior MI/non-MI PCI (r = 0.60 and r = 0.60, p < 0.01 for both). Similar results were found for coronary flow reserve. In patients with prior MI scar was negatively correlated to hMBF increase and independently predictive of an attenuated CFR increase. CONCLUSIONS Post revascularization FFR and perfusion were similar among patients without a cardiac history, with prior MI or non-MI PCI. In patients with prior MI scar burden was associated to an attenuated perfusion increase.
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Affiliation(s)
- Ruurt A Jukema
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Roel S Driessen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Yolande Appelman
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - R Nils Planken
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Radiology, Nuclear Medicine & PET Research, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Paul Knaapen
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Departments of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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11
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Hopman LHGA, van der Lingen ACJ, van Pouderoijen N, Krabbenborg J, Mulder MJ, Rijnierse MT, Bhagirath P, Robbers LFHJ, van Rossum AC, van Halm VP, Götte MW, Allaart CP. Cardiac Magnetic Resonance Imaging-Derived Left Atrial Characteristics in Relation to Atrial Fibrillation Detection in Patients With an Implantable Cardioverter-Defibrillator. J Am Heart Assoc 2023; 12:e028014. [PMID: 37489727 PMCID: PMC10492968 DOI: 10.1161/jaha.122.028014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/24/2023] [Indexed: 07/26/2023]
Abstract
Background Among patients with an implantable cardioverter-defibrillator, a high prevalence of atrial fibrillation (AF) is present. Identification of AF predictors in this patient group is of clinical importance to initiate appropriate preventive therapeutic measures to reduce the risk of AF-related complications. This study assesses whether cardiac magnetic resonance imaging-derived atrial characteristics are associated with AF development in patients with a dual-chamber implantable cardioverter-defibrillator or cardiac resynchronization therapy defibrillator, as detected by the cardiac implantable electronic device. Methods and Results This single-center retrospective study included 233 patients without documented AF history at the moment of device implantation (dual-chamber implantable cardioverter-defibrillator [63.5%] or cardiac resynchronization therapy defibrillator [36.5%]). All patients underwent cardiac magnetic resonance imaging before device implantation. Cardiac magnetic resonance-derived features of left atrial (LA) remodeling were evaluated in all patients. Detection of AF episodes was based on cardiac implantable electronic device interrogation. During a median follow-up of 6.1 years, a newly diagnosed AF episode was detected in 88 of the 233 (37.8%) patients with an ICD. In these patients, increased LA volumes and impaired LA function (LA emptying fraction and LA strain) were found as compared with patients without AF during follow-up. However, a significant association was only found in patients with dilated cardiomyopathy and not in patients with ischemic cardiomyopathy. Conclusions LA remodeling characteristics were associated with development of AF in patients with dilated cardiomyopathy but not patients with ischemic cardiomyopathy, suggesting different mechanisms of AF development in ischemic cardiomyopathy and dilated cardiomyopathy. Assessment of LA remodeling before device implantation might identify high-risk patients for AF.
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Affiliation(s)
- Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Anne‐Lotte C. J. van der Lingen
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Nikki van Pouderoijen
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Judith Krabbenborg
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Mark J. Mulder
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Mischa T. Rijnierse
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Lourens F. H. J. Robbers
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Vokko P. van Halm
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMCVrije Universiteit Amsterdam, Amsterdam Cardiovascular SciencesAmsterdamthe Netherlands
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12
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Hopman LHGA, Zweerink A, van der Lingen ALCJ, Huntelaar MJ, Mulder MJ, Robbers LFHJ, van Rossum AC, van Halm VP, Götte MJW, Allaart CP. Feasibility of CMR Imaging during Biventricular Pacing: Comparison with Invasive Measurement as a Pathway towards a Novel Optimization Strategy. J Clin Med 2023; 12:3998. [PMID: 37373691 PMCID: PMC10298880 DOI: 10.3390/jcm12123998] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
OBJECTIVES This prospective pilot study assessed the feasibility of cardiovascular magnetic resonance (CMR) imaging during biventricular (BIV) pacing in patients with a CMR conditional cardiac resynchronization therapy defibrillator (CRT-D) and compared the results with invasive volume measurements. METHODS Ten CRT-D patients underwent CMR imaging prior to device implantation (baseline) and six weeks after device implantation, including CRT-on and CRT-off modes. Left ventricular (LV) function, volumes, and strain measurements of LV dyssynchrony and dyscoordination were assessed. Invasive pressure-volume measurements were performed, matching the CRT settings used during CMR. RESULTS Post-implantation imaging enabled reliable cine assessment, but showed artefacts on late gadolinium enhancement images. After six weeks of CRT, significant reverse remodeling was observed, with a 22.7 ± 11% reduction in LV end-systolic volume during intrinsic rhythm (CRT-off). During CRT-on, the LV ejection fraction significantly improved from 27.4 ± 5.9% to 32.2 ± 8.7% (p < 0.01), and the strain assessment showed the abolition of the left bundle branch block contraction pattern. Invasively measured and CMR-assessed LV hemodynamics during BIV pacing were significantly associated. CONCLUSIONS Post-CRT implantation CMR assessing acute LV pump function is feasible and provides important insights into the effects of BIV pacing on cardiac function and contraction patterns. LV assessment during CMR may constitute a future CRT optimization strategy.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; (L.H.G.A.H.)
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13
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Hopman LHGA, Frenaij IM, Solís-Lemus JA, el Mathari S, Niederer SA, Allaart CP, Götte MJW. Quantification of left atrial appendage fibrosis by cardiac magnetic resonance: an accurate surrogate for left atrial fibrosis in atrial fibrillation patients? Europace 2023; 25:euad084. [PMID: 36960602 PMCID: PMC10228533 DOI: 10.1093/europace/euad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/06/2023] [Indexed: 03/25/2023] Open
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
| | - Irene M Frenaij
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
| | - José A Solís-Lemus
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Sulayman el Mathari
- Department of Cardiothoracic Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Steven A Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, Amsterdam 1081 HZ, The Netherlands
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14
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el Mathari S, Kluin J, Hopman LHGA, Bhagirath P, Oudeman MAP, Vonk ABA, Nederveen AJ, Eberl S, Klautz RJM, Chamuleau SAJ, van Ooij P, Götte MJW. The role and implications of left atrial fibrosis in surgical mitral valve repair as assessed by CMR: the ALIVE study design and rationale. Front Cardiovasc Med 2023; 10:1166703. [PMID: 37252116 PMCID: PMC10213679 DOI: 10.3389/fcvm.2023.1166703] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 04/03/2023] [Indexed: 05/31/2023] Open
Abstract
Background Patients with mitral regurgitation (MR) commonly suffer from left atrial (LA) remodeling. LA fibrosis is considered to be a key player in the LA remodeling process, as observed in atrial fibrillation (AF) patients. Literature on the presence and extent of LA fibrosis in MR patients however, is scarce and its clinical implications remain unknown. Therefore, the ALIVE trial was designed to investigate the presence of LA remodeling including LA fibrosis in MR patients prior to and after mitral valve repair (MVR) surgery. Methods The ALIVE trial is a single center, prospective pilot study investigating LA fibrosis in patients suffering from MR in the absence of AF (identifier NCT05345730). In total, 20 participants will undergo a CMR scan including 3D late gadolinium enhancement (LGE) imaging 2 week prior to MVR surgery and at 3 months follow-up. The primary objective of the ALIVE trial is to assess the extent and geometric distribution of LA fibrosis in MR patients and to determine effects of MVR surgery on reversed atrial remodelling. Implications This study will provide novel insights into the pathophysiological mechanism of fibrotic and volumetric atrial (reversed) remodeling in MR patients undergoing MVR surgery. Our results may contribute to improved clinical decision making and patient-specific treatment strategies in patients suffering from MR.
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Affiliation(s)
- Sulayman el Mathari
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Jolanda Kluin
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Maurice A. P. Oudeman
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Alexander B. A. Vonk
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Susanne Eberl
- Department of Anesthesiology, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Robert J. M. Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, Netherlands
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Rotterdam, Netherlands
| | | | - Pim van Ooij
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Netherlands
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15
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Hopman LHGA, Mulder MJ, van der Laan AM, Bhagirath P, Demirkiran A, von Bartheld MB, Kemme MJB, van Rossum AC, Allaart CP, Götte MJW. Left atrial strain is associated with arrhythmia recurrence after atrial fibrillation ablation: Cardiac magnetic resonance rapid strain vs. feature tracking strain. Int J Cardiol 2023; 378:23-31. [PMID: 36804765 DOI: 10.1016/j.ijcard.2023.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/17/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE The present study assesses different left atrial (LA) strain approaches in relation to atrial fibrillation (AF) recurrence after ablation and compares LA feature tracking (FT) strain to novel rapid LA strain approaches in AF patients. METHODS This retrospective single-center study comprised of 110 prospectively recruited AF patients who underwent cardiac magnetic resonance (CMR) imaging in sinus rhythm prior to their first pulmonary vein isolation ablation. LA rapid strain (long axis strain and atrioventricular (AV)-junction strain), LA FT strain, and LA volumes were derived from 2-chamber and 4-chamber cine images. AF recurrence was followed up for 12 months using either 12‑lead ECGs or rhythm Holter monitoring. RESULTS Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (122-286) days. LA long axis strain, AV-junction strain, and FT strain were all more impaired in patients with AF recurrence compared to patients without AF recurrence (long axis strain: P < 0.01; AV-junction strain: P < 0.001; FT strain: P < 0.01, respectively). Area under the curve (AUC) values for LA remodeling parameters in association with AF recurrence were 0.68 for long axis strain, 0.68 for AV-junction strain, 0.66 for FT strain, 0.66 for LA volume index. Phasic FT LA strain demonstrated that contractile strain had the highest AUC (0.70). CONCLUSION Both LA rapid strain and LA FT strain are associated with arrhythmia recurrence after ablation in AF patients. LA rapid strain can be a convenient and reproducible alternative for LA FT strain to assess LA function in clinical practice.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
| | | | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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16
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Hopman LHGA, Frenaij IM, van Luijk RD, van de Veerdonk MC, Götte MJW, Allaart CP. A comprehensive view on real-time magnetic resonance-guided flutter ablation image planes from an electrophysiological perspective. Eur Heart J Cardiovasc Imaging 2023; 24:401-403. [PMID: 36726026 PMCID: PMC10029834 DOI: 10.1093/ehjci/jead014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/15/2023] [Indexed: 02/03/2023] Open
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
| | - Irene M Frenaij
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
| | - Raschel D van Luijk
- Department of Radiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam, De Boelelaan 1118, 1081 HV, The Netherlands
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17
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Demirkiran A, van der Geest RJ, Hopman LHGA, Robbers LFHJ, Handoko ML, Nijveldt R, Greenwood JP, Plein S, Garg P. Association of left ventricular flow energetics with remodeling after myocardial infarction: New hemodynamic insights for left ventricular remodeling. Int J Cardiol 2022; 367:105-114. [PMID: 36007668 DOI: 10.1016/j.ijcard.2022.08.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/08/2022] [Accepted: 08/18/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Myocardial infarction leads to complex changes in left ventricular (LV) hemodynamics. It remains unknown how four-dimensional acute changes in LV-cavity blood flow kinetic energy affects LV-remodeling. METHODS AND RESULTS In total, 69 revascularised ST-segment elevation myocardial infarction (STEMI) patients were enrolled. All patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart four-dimensional flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction, mitral inflow, and blood flow KEi (kinetic energy indexed to end-diastolic volume) characteristics were obtained. Adverse LV-remodeling was defined and categorized according to increase in LV end-diastolic volume of at least 10%, 15%, and 20%. Twenty-four patients (35%) developed at least 10%, 17 patients (25%) at least 15%, 11 patients (16%) at least 20% LV-remodeling. Demographics and clinical history were comparable between patients with/without LV-remodeling. In univariable regression-analysis, A-wave KEi was associated with at least 10%, 15%, and 20% LV-remodeling (p = 0.03, p = 0.02, p = 0.02, respectively), whereas infarct size only with at least 10% LV-remodeling (p = 0.02). In multivariable regression-analysis, A-wave KEi was identified as an independent marker for at least 10%, 15%, and 20% LV-remodeling (p = 0.09, p < 0.01, p < 0.01, respectively), yet infarct size only for at least 10% LV-remodeling (p = 0.03). CONCLUSION In patients with STEMI, LV hemodynamic assessment by LV blood flow kinetic energetics demonstrates a significant inverse association with adverse LV-remodeling. Late-diastolic LV blood flow kinetic energetics early after acute MI was independently associated with adverse LV-remodeling.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Pankaj Garg
- Department of Cardiology, Norfolk Medical School, University of East Anglia, Norwich, United Kingdom.
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18
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Demirkiran A, Robbers LFHJ, van der Hoeven NW, Everaars H, Hopman LHGA, Janssens GN, Berkhof HJ, Lemkes JS, van de Bovenkamp AA, van Leeuwen MAH, Nap A, van Loon RB, de Waard GA, van Rossum AC, van Royen N, Nijveldt R. The Dynamic Relationship Between Invasive Microvascular Function and Microvascular Injury Indicators, and Their Association With Left Ventricular Function and Infarct Size at 1-Month After Reperfused ST-Segment-Elevation Myocardial Infarction. Circ Cardiovasc Interv 2022; 15:892-902. [PMID: 36305318 DOI: 10.1161/circinterventions.122.012081] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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] [Indexed: 01/10/2023]
Abstract
BACKGROUND The invasive microvascular function indices, coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR), exhibit a dynamic pattern after ST-segment-elevation myocardial infarction. The effects of microvascular injury on the evolution of the microvascular function and the prognostic significance of the evolution of microvascular function are unknown. We investigated the relationship between the temporal changes of CFR and IMR, and cardiovascular magnetic resonance-derived microvascular injury characteristics in reperfused ST-segment-elevation myocardial infarction patients, and their association with 1-month left ventricular ejection fraction and infarct size (IS). METHODS In 109 ST-segment-elevation myocardial infarction patients who underwent angiography for primary percutaneous coronary intervention (PPCI) and at 1-month follow-up, invasive assessment of CFR and IMR were performed in the culprit artery during both procedures. Cardiovascular magnetic resonance was performed 2 to 7 days after PPCI and at 1 month and provided assessment of left ventricular ejection fraction, IS, microvascular obstruction, and intramyocardial hemorrhage. RESULTS CFR and IMR significantly changed over 1 month (both, P<0.001). The absolute IMR change over 1 month (ΔIMR) showed association with both microvascular obstruction and intramyocardial hemorrhage presence (both, P=0.01). ΔIMR differed between patients with/without microvascular obstruction (P=0.02) and with/without intramyocardial hemorrhage (P=0.04) but not ΔCFR for both. ΔIMR demonstrated association with both left ventricular ejection fraction and IS at 1 month (P<0.001, P=0.001, respectively), but not ΔCFR for both. Receiver-operating characteristics curve analysis of ΔIMR showed a larger area under the curve than post-PPCI CFR and IMR, and ΔCFR to be associated with both 1-month left ventricular ejection fraction >50% and extensive IS (the highest quartile). CONCLUSIONS In reperfused ST-segment-elevation myocardial infarction patients, CFR and IMR significantly improved 1 month after PPCI; the temporal change in IMR is closely related to the presence/absence of microvascular damage and IS. ΔIMR exhibits a stronger association for 1-month functional outcome than post-PPCI CFR, IMR, or ΔCFR.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Nina W van der Hoeven
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Gladys N Janssens
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Hans J Berkhof
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, the Netherlands (H.J.B.)
| | - Jorrit S Lemkes
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Arno A van de Bovenkamp
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | | | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Guus A de Waard
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.)
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R., R.N.)
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands (A.D., L.F.H.J.R.' N.W.v.d.H., H.E., L.H.G.A.H.' G.N.J., J.S.L., A.A.v.d.B., A.N., R.B.v.L., G.A.d.W., A.C.v.R., R.N.).,Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands (N.v.R., R.N.)
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Hopman LHGA, van de Veerdonk MC, Nelissen JL, Allaart CP, Götte MJW. Real-time magnetic resonance-guided right atrial flutter ablation after cryo-balloon pulmonary vein isolation. Eur Heart J Cardiovasc Imaging 2022; 24:e23. [PMID: 36288513 PMCID: PMC9762942 DOI: 10.1093/ehjci/jeac211] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | | | - Jules L Nelissen
- Department of Radiology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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20
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Hopman LHGA, Bhagirath P, Götte MJW. MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation for Patients With Persistent Atrial Fibrillation. JAMA 2022; 328:1643-1644. [PMID: 36282264 DOI: 10.1001/jama.2022.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Pranav Bhagirath
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, England
| | - Marco J W Götte
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, the Netherlands
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21
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Demirkiran A, Van Der Geest RJ, Hopman LHGA, Robbers LFHJ, Handoko ML, Nijveldt R, Greenwood JP, Plein S, Garg P. Post-myocardial infarction late diastolic left ventricular blood flow energetics are independently associated with left ventricular remodeling. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1297] [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
Post-myocardial infarction (MI) left ventricular (LV) remodeling emerges as a compensatory mechanism and leads to complex pathophysiological changes in LV blood flow hemodynamics. The interplay, if any, between LV blood flow energetics and remodeling remains unknown. We hypothesized that LV blood flow energetics early after MI are independently related to the temporal changes in LV end-diastolic volume (LVEDV).
Methods
In this prospective cohort study, 69 patients with acute re-perfused ST-segment elevation MI (STEMI) were included. The patients underwent cardiovascular magnetic resonance (CMR) examination within 2 days of the index event and at 3-month. CMR examination included cine, late gadolinium enhancement, and whole-heart 4D flow acquisitions. LV volume-function, infarct size (indexed to body surface area), microvascular obstruction (MVO), mitral inflow, and 4D blood flow kinetic energy (KE) characteristics were obtained. LV mean and peak KEi (indexed to LVEDV) were quantified for all time parameters (entire cardiac cycle, during systole/diastole, at E- and A-waves).
Results
In univariable linear regression analysis, peak KEi (R-R interval), mean systolic KEi, A-wave KEi, MVO presence were all associated with the relative change (%) of LVEDV (p=0.03, p=0.01, p<0.01, P=0.03, respectively). In multivariable linear regression analysis, A-wave KEi was identified as the only independent marker for association with the relative change of LVEDV (p=0.02). In another univariable linear regression analysis, A-wave KEi, infarct size, and MVO presence were all associated with the absolute change of LVEDV (p=0.03, p=0.04, p=0.04, respectively). In multivariable linear regression analysis, A-wave KEi was determined as the only independent marker for association with the absolute change of LVEDV (p=0.02). No significant association was observed between mitral inflow characteristics and relative and absolute change of LVEDV.
Conclusion
Late diastolic LV blood flow energetics early after acute MI are independently associated with both absolute and relative longitudinal changes in LVEDV and may provide incremental value over infarct and mitral inflow characteristics to be associated with post-MI LV remodeling.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): British Heart Foundation
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Affiliation(s)
- A Demirkiran
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | - R J Van Der Geest
- Leiden University Medical Center, Radiology , Leiden , The Netherlands
| | - L H G A Hopman
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | | | - M L Handoko
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | - R Nijveldt
- Radboud University Medical Centre, Cardiology , Nijmegen , The Netherlands
| | - J P Greenwood
- University of Leeds, Cardiology , Leeds , United Kingdom
| | - S Plein
- University of Leeds, Cardiology , Leeds , United Kingdom
| | - P Garg
- University of East Anglia and Norfolk and Norwich University Hospital , Norwich , United Kingdom
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22
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Hopman LHGA, Bhagirath P, Mulder MJ, Eggink IN, van Rossum AC, Allaart CP, Götte MJW. Quantification of left atrial fibrosis by 3D late gadolinium-enhanced cardiac magnetic resonance imaging in patients with atrial fibrillation: impact of different analysis methods. Eur Heart J Cardiovasc Imaging 2022; 23:1182-1190. [PMID: 35947873 PMCID: PMC9365307 DOI: 10.1093/ehjci/jeab245] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Various methods and post-processing software packages have been developed to quantify left atrial (LA) fibrosis using 3D late gadolinium-enhancement cardiac magnetic resonance (LGE-CMR) images. Currently, it remains unclear how the results of these methods and software packages interrelate.
Methods and results
Forty-seven atrial fibrillation (AF) patients underwent 3D-LGE-CMR imaging prior to their AF ablation. LA fibrotic burden was derived from the images using open-source CEMRG software and commercially available ADAS 3D-LA software. Both packages were used to calculate fibrosis based on the image intensity ratio (IIR)-method. Additionally, CEMRG was used to quantify LA fibrosis using three standard deviations (3SD) above the mean blood pool signal intensity. Intraclass correlation coefficients were calculated to compare LA fibrosis quantification methods and different post-processing software outputs. The percentage of LA fibrosis assessed using IIR threshold 1.2 was significantly different from the 3SD-method (29.80 ± 14.15% vs. 8.43 ± 5.42%; P < 0.001). Correlation between the IIR-and SD-method was good (r = 0.85, P < 0.001) although agreement was poor [intraclass correlation coefficient (ICC) = 0.19; P < 0.001]. One-third of the patients were allocated to a different fibrosis category dependent on the used quantification method. Fibrosis assessment using CEMRG and ADAS 3D-LA showed good agreement for the IIR-method (ICC = 0.93; P < 0.001).
Conclusions
Both, the IIR1.2 and 3SD-method quantify atrial fibrotic burden based on atrial wall signal intensity differences. The discrepancy in the amount of LA fibrosis between these methods may have clinical implications when patients are classified according to their fibrotic burden. There was no difference in results between post-processing software packages to quantify LA fibrosis if an identical quantification method including the threshold was used.
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Affiliation(s)
- Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Iris N Eggink
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences , De Boelelaan 1118, 1081 HV Amsterdam , The Netherlands
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23
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Hopman LHGA, Visch JE, Bhagirath P, van der Laan AM, Mulder MJ, Razeghi O, Kemme MJB, Niederer SA, Allaart CP, Götte MJW. Right atrial function and fibrosis in relation to successful atrial fibrillation ablation. Eur Heart J Cardiovasc Imaging 2022; 24:336-345. [PMID: 35921538 PMCID: PMC9936834 DOI: 10.1093/ehjci/jeac152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/10/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Bi-atrial remodelling in patients with atrial fibrillation (AF) is rarely assessed and data on the presence of right atrial (RA) fibrosis, the relationship between RA and left atrial (LA) fibrosis, and possible association of RA remodelling with AF recurrence after ablation in patients with AF is limited. METHODS AND RESULTS A total of 110 patients with AF undergoing initial pulmonary vein isolation (PVI) were included in the present study. All patients were in sinus rhythm during cardiac magnetic resonance (CMR) imaging performed prior to ablation. LA and RA volumes and function (volumetric and feature tracking strain) were derived from cine CMR images. The extent of LA and RA fibrosis was assessed from 3D late gadolinium enhancement images. AF recurrence was followed up for 12 months after PVI using either 12-lead electrocardiograms or Holter monitoring. Arrhythmia recurrence was observed in 39 patients (36%) after the 90-day blanking period, occurring at a median of 181 (interquartile range: 122-286) days. RA remodelling parameters were not significantly different between patients with and without AF recurrence after ablation, whereas LA remodelling parameters were different (volume, emptying fraction, and strain indices). LA fibrosis had a strong correlation with RA fibrosis (r = 0.88, P < 0.001). Both LA and RA fibrosis were not different between patients with and without AF recurrence. CONCLUSIONS This study shows that RA remodelling parameters were not predictive of AF recurrence after AF ablation. Bi-atrial fibrotic remodelling is present in patients with AF and moreover, the amount of LA fibrosis had a strong correlation with the amount of RA fibrosis.
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Affiliation(s)
| | - Julia E Visch
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Orod Razeghi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | | | - Steven A Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, UK
| | | | - Marco J W Götte
- Corresponding author. Tel: +31 20 444 0123; Fax: +31 20 4442446. E-mail:
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24
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Demirkiran A, van der Hoeven NW, Janssens GN, Lemkes JS, Everaars H, van de Ven PM, van Pouderoijen N, van Cauteren YJM, van Leeuwen MAH, Nap A, Teunissen PF, Hopman LHGA, Bekkers SCAM, Smulders MW, van Royen N, van Rossum AC, Robbers LFHJ, Nijveldt R. Left ventricular function, strain, and infarct characteristics in patients with transient ST-segment elevation myocardial infarction compared to ST-segment and non-ST-segment elevation myocardial infarctions. Eur Heart J Cardiovasc Imaging 2022; 23:836-845. [PMID: 34195800 PMCID: PMC9159742 DOI: 10.1093/ehjci/jeab114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022] Open
Abstract
AIMS This study aims to explore cardiovascular magnetic resonance (CMR)-derived left ventricular (LV) function, strain, and infarct size characteristics in patients with transient ST-segment elevation myocardial infarction (TSTEMI) compared to patients with ST-segment and non-ST-segment elevation myocardial infarctions (STEMI and NSTEMI, respectively). METHODS AND RESULTS In total, 407 patients were enrolled in this multicentre observational prospective cohort study. All patients underwent CMR examination 2-8 days after the index event. CMR cine imaging was performed for functional assessment and late gadolinium enhancement to determine infarct size and identify microvascular obstruction (MVO). TSTEMI patients demonstrated the highest LV ejection fraction and the most preserved global LV strain (longitudinal, circumferential, and radial) across the three groups (overall P ≤ 0.001). The CMR-defined infarction was less frequently observed in TSTEMI than in STEMI patients [77 (65%) vs. 124 (98%), P < 0.001] but was comparable with NSTEMI patients [77 (65%) vs. 66 (70%), P = 0.44]. A remarkably smaller infarct size was seen in TSTEMI compared to STEMI patients [1.4 g (0.0-3.9) vs. 13.5 g (5.3-26.8), P < 0.001], whereas infarct size was not significantly different from that in NSTEMI patients [1.4 g (0.0-3.9) vs. 2.1 g (0.0-8.6), P = 0.06]. Whilst the presence of MVO was less frequent in TSTEMI compared to STEMI patients [5 (4%) vs. 53 (31%), P < 0.001], no significant difference was seen compared to NSTEMI patients [5 (4%) vs. 5 (5%), P = 0.72]. CONCLUSION TSTEMI yielded favourable cardiac LV function, strain, and infarct-related scar mass compared to STEMI and NSTEMI. LV function and infarct characteristics of TSTEMI tend to be more similar to NSTEMI than STEMI.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Nina W van der Hoeven
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Gladys N Janssens
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jorrit S Lemkes
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Henk Everaars
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nikki van Pouderoijen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | | | - Alexander Nap
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Paul F Teunissen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Martijn W Smulders
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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25
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Huntelaar MJ, Mulder MJ, Kemme MJB, Hopman LHGA, Hauer HA, Tahapary GJM, Allaart CP. Benefit of atrial fibrillation ablation on symptoms and quality of life does not differ between patients with paroxysmal and persistent atrial fibrillation. Europace 2022. [DOI: 10.1093/europace/euac053.209] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Indications for atrial fibrillation (AF) ablation in current ESC and ACC/HRS guidelines are different for paroxysmal and persistent AF patients. Although previous research has established that the AF recurrence rate after AF ablation is lower in paroxysmal AF patients, there is little data on differences in post-ablation improvement of quality of life (QoL) and AF-related symptoms.
Purpose
This study aimed to determine whether QoL and symptom improvement differ between patients with paroxysmal and persistent AF after AF ablation.
Methods
From December 2017 to June 2020, patients undergoing first AF ablation at a medical center were included in a prospective registry. Circumferential pulmonary vein isolation (PVI) was performed using radiofrequency ablation with a contact force-sensing catheter. Patient reported outcomes were assessed at baseline, 4 months follow-up, and 1 year follow-up using the Toronto Atrial Fibrillation Severity Scale (AFSS). The AFSS was used to quantify global well-being (scale 1-10), patient-perceived AF burden (scale 3-30), and AF symptom severity (scale 0-35). AF symptom severity was based on 7 questions (scale 0-5) leading to a 0-35 scale. AF recurrence was defined as any documented episode of AF or atrial flutter after a blanking period of 3 months.
Results
The study population consisted of 306 AF patients (66% paroxysmal AF, 68% male, mean age 64±8 years). AF recurrence during 1 year follow-up occurred in 29% of paroxysmal AF patients and in 42% of persistent AF patients (p=0.021). At baseline, patient perceived AF burden was lower in paroxysmal AF patients than in persistent AF patients (18.4±3.7 vs. 20.2±5.0, p=0.001), whereas symptom severity (10.6±6.5 vs. 9.9±6.7, p=0.384) and global well-being (7.1±1.5 vs. 7.3±1.4, p=0.327) were similar. Paroxysmal AF patients reported more palpitations (2.4±1.3 vs. 1.6±1.5, p<0.001) and less shortness of breath during physical activity (1.9±1.6 vs. 2.3±1.7, p=0.048) than patients with persistent AF.
Significant improvements in global well-being (0.5±1.7, p<0.001), symptom severity (3.8±7.2, p<0.001), and patient-perceived AF burden (7.2±7.5, p<0.001) were found in the entire study cohort between baseline and 1 year follow-up, without differences between paroxysmal and persistent patients (Figure).
Conclusion
Although persistent AF patients have a higher chance of recurrent AF after AF ablation, symptom severity and QoL improve equally in paroxysmal and persistent AF patients. These results suggest that different recommendations for AF ablation to improve symptoms in paroxysmal and persistent AF patients may not be justified.
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Affiliation(s)
| | - MJ Mulder
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | - MJB Kemme
- Amsterdam UMC, Amsterdam, Netherlands (The)
| | | | - HA Hauer
- Cardiology centre Netherlands, Amsterdam, Netherlands (The)
| | - GJM Tahapary
- Northwest Clinics, Cardiology, Alkmaar, Netherlands (The)
| | - CP Allaart
- Amsterdam UMC, Amsterdam, Netherlands (The)
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El Kadi S, Porter TR, Zanstra M, Siegers A, Van Loon RB, Hopman LHGA, Van Rossum AC, Kamp O. Feasibility of sonothrombolysis in the ambulance for ST-elevation myocardial infarction. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.415] [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: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Lantheus Medical Imaging, Inc., North Billerica, MA
Background
Patients with ST-elevation myocardial infarction (STEMI) due to coronary occlusion require immediate restoration of epicardial and microvascular blood flow. A potentially new reperfusion method is the use of ultrasound and microbubbles, also called sonothrombolysis. The oscillation and collapse of intravenously administered microbubbles upon exposure to high mechanical index (MI) ultrasound pulses results in thrombus dissolution and stimulates nitric oxide-mediated increases in tissue perfusion. The aim of this study was to assess feasibility of sonothrombolysis in the ambulance for STEMI patients.
Methods
Patients presenting with chest pain and ST-elevations on initial electrocardiogram were included. Sonothrombolysis was applied in the ambulance during patient transfer to the percutaneous coronary intervention (PCI) center. Feasibility was assessed based on duration of sonothrombolysis treatment and number of high MI pulses applied. Vital parameters, ST-resolution, pre- and post-PCI coronary flow and cardiovascular magnetic resonance images were analyzed. Follow up was performed at six months after STEMI.
Results
Twelve patients were screened, of which three patients were included in the study. Sonothrombolysis duration and number of high MI pulses ranged between 12-17 minutes and 32-60 flashes respectively. No changes in vital parameters were observed during and directly after sonothrombolysis. In one case, sonothrombolysis on top of regular pre-hospital care resulted in reperfusion, in another case the effect was inconclusive, and in the last case no effect was seen on reperfusion or definite infarct size.
Conclusion
Sonothrombolysis in the ambulance for STEMI patients is feasible. Larger clinical trials on efficacy and safety of pre-hospital sonothrombolysis are needed. Abstract Figure. Sonothrombolysis set-up in the ambulance Abstract Figure. Sonothrombolysis case with reperfusion
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Affiliation(s)
- S El Kadi
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - TR Porter
- University of Nebraska Medical Center, Cardiology, Omaha, United States of America
| | - M Zanstra
- Ambulance Amsterdam, Amsterdam, Netherlands (The)
| | - A Siegers
- Ambulance Amsterdam, Amsterdam, Netherlands (The)
| | - RB Van Loon
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - LHGA Hopman
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - AC Van Rossum
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - O Kamp
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
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Hopman LHGA, Bhagirath P, Mulder MJ, Eggink IN, van Rossum AC, Allaart CP, Götte MJW. Extent of Left Atrial Fibrosis Correlates with Descending Aorta Proximity at 3D Late Gadolinium Enhancement Cardiac MRI in Patients with Atrial Fibrillation. Radiol Cardiothorac Imaging 2022; 4:e210192. [PMID: 35795718 PMCID: PMC8893208 DOI: 10.1148/ryct.210192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 11/15/2021] [Accepted: 11/29/2021] [Indexed: 05/04/2023]
Abstract
PURPOSE To determine whether the distance between the descending aorta and left atrial (LA) wall correlates with the amount of fibrosis quantified in the posterior left inferior pulmonary vein (LIPV) area of the LA in patients with atrial fibrillation (AF). MATERIALS AND METHODS In this retrospective study, patients with AF underwent cardiac MRI in sinus rhythm prior to a pulmonary vein isolation procedure (July 2018 to February 2020). The mean distance (distancemean) and shortest distance (distanceshort) between the descending aorta and the LA wall were measured on three-dimensional (3D) contrast-enhanced MR angiograms; distancemean was defined as the average of five measurements at different levels between the descending aorta and the LA wall. The extent of LA fibrosis, both global fibrosis and regional fibrosis within the LIPV area, was derived from postprocessed, 3D, late gadolinium-enhanced images. Associations between the extent of fibrosis and the proximity of the descending aorta were analyzed by using correlative and multivariable analyses. RESULTS A total of 47 (mean age, 60 years ± 8 [standard deviation]; 31 men) patients were included for analysis. The extent of fibrosis in the posterior LIPV area was correlated with the distancemean (r s = -0.48; P < .01) and distanceshort (r s = -0.49; P < .01). Patients with a short distance between the descending aorta and LA wall (defined as a distanceshort < 2 mm) had a higher percentage of fibrosis in the posterior LIPV area than patients with a distanceshort greater than 2 mm (38.7% ± 22.7 vs 21.2% ± 17.8; P < .01). CONCLUSION The distance between the descending aorta and LA was correlated with the extent of quantified fibrosis within the posterior LIPV area.Keywords: MRI, Cardiac, Left Atrium Supplemental material is available for this article. © RSNA, 2022.
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El Kadi S, Porter TR, Zanstra M, Siegers A, van Loon RB, Hopman LHGA, van Rossum AC, Kamp O. Feasibility of sonothrombolysis in the ambulance for ST-elevation myocardial infarction. Int J Cardiovasc Imaging 2021; 38:10.1007/s10554-021-02487-7. [PMID: 34877619 DOI: 10.1007/s10554-021-02487-7] [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] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
Patients with ST-elevation myocardial infarction (STEMI) due to coronary occlusion require immediate restoration of epicardial and microvascular blood flow. A potentially new reperfusion method is the use of ultrasound and microbubbles, also called sonothrombolysis. The oscillation and collapse of intravenously administered microbubbles upon exposure to high mechanical index (MI) ultrasound pulses results in thrombus dissolution and stimulates nitric oxide-mediated increases in tissue perfusion. The aim of this study was to assess feasibility of sonothrombolysis in the ambulance for STEMI patients. Patients presenting with chest pain and ST-elevations on initial electrocardiogram were included. Sonothrombolysis was applied in the ambulance during patient transfer to the percutaneous coronary intervention (PCI) center. Feasibility was assessed based on duration of sonothrombolysis treatment and number of high MI pulses applied. Vital parameters, ST-resolution, pre- and post-PCI coronary flow and cardiovascular magnetic resonance images were analyzed. Follow up was performed at six months after STEMI. Twelve patients were screened, of which three patients were included in the study. Sonothrombolysis duration and number of high MI pulses ranged between 12 and 17 min and 32-60 flashes respectively. No arrhythmias or changes in vital parameters were observed during and directly after sonothrombolysis, although one patient developed in-hospital ventricular fibrillation 20 min after sonothrombolysis completion but before PCI. In one case, sonothrombolysis on top of regular pre-hospital care resulted in reperfusion before PCI. This is the first report on the feasibility of performing sonothrombolysis to treat myocardial infarction in an ambulance. To assess efficacy and safety of pre-hospital sonothrombolysis, clinical trials with greater patient numbers should be performed. EU Clinical Trials Register (identifier: 2019-001883-31), registered 2020-02-25.
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Affiliation(s)
- Soufiane El Kadi
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Thomas R Porter
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Mark Zanstra
- Ambulance Amsterdam, Zaanstreek-Waterland, Zaandam, The Netherlands
| | - Arjen Siegers
- Ambulance Amsterdam, Zaanstreek-Waterland, Zaandam, The Netherlands
| | - Ramon B van Loon
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Otto Kamp
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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Mulder MJ, Kemme MJB, Hopman LHGA, Kuşgözoğlu E, Gülçiçek H, van de Ven PM, Hauer HA, Tahapary GJM, Götte MJW, van Rossum AC, Allaart CP. Comparison of the predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation. Int J Cardiol 2021; 344:103-110. [PMID: 34555444 DOI: 10.1016/j.ijcard.2021.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/09/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Various risk scores have been described that may predict outcomes after AF ablation. In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications. METHODS A total of 482 AF patients (63% paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography (TTE) and either cardiac CT imaging or CMR imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2DS2-VASc, DR-FLASH, HATCH, LAGO and MB-LATER. RESULTS Median follow-up was 16 (12-31) months. AF recurrence after a 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days. AF recurrence was less frequent in paroxysmal AF patients compared to non-paroxysmal AF patients (34% vs. 54%, p < 0.001). Overall periprocedural complication rate was 6%. All scores, except the HATCH score, demonstrated statistically significant but poor predictive value for recurrent AF after ablation (area under curve [AUC] 0.553-0.669). CHA2DS2-VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). CONCLUSIONS Currently available risk scores perform poorly in predicting outcomes after AF ablation. These data suggest that the utility of these scores for clinical decision-making is limited.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Elif Kuşgözoğlu
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Hatice Gülçiçek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Cardiology Centers of the Netherlands, Amsterdam, the Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, North West Clinics, Alkmaar, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Mulder MJ, Kemme MJB, Hopman LHGA, Hagen AMD, van de Ven PM, Hauer HA, Tahapary GJM, van Rossum AC, Allaart CP. Ablation Index-guided point-by-point ablation versus Grid annotation-guided dragging for pulmonary vein isolation: A randomized controlled trial. J Cardiovasc Electrophysiol 2021; 33:64-72. [PMID: 34820931 PMCID: PMC9299027 DOI: 10.1111/jce.15294] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 12/03/2022]
Abstract
Introduction Radiofrequency (RF) atrial fibrillation (AF) ablation using a catheter dragging technique may shorten procedural duration and improve durability of pulmonary vein isolation (PVI) by creating uninterrupted linear ablation lesions. We compared a novel AF ablation approach guided by Grid annotation allowing for “drag lesions” with a standard point‐by‐point ablation approach in a single‐center randomized study. Methods Eighty‐eight paroxysmal or persistent AF patients were randomized 1:1 to undergo RF‐PVI with either a catheter dragging ablation technique guided by Grid annotation or point‐by‐point ablation guided by Ablation Index (AI) annotation. In the Grid annotation arm, ablation was visualized using 1 mm³ grid points coloring red after meeting predefined stability and contact force criteria. In the AI annotation arm, ablation lesions were created in a point‐by‐point fashion with AI target values set at 380 and 500 for posterior/inferior and anterior/roof segments, respectively. Patients were followed up for 12 months after PVI using ECGs, 24‐h Holter monitoring and a mobile‐based one‐lead ECG device. Results Procedure time was not different between the two randomization arms (Grid annotation 71 ± 19 min, AI annotation 72 ± 26 min, p = .765). RF time was significantly longer in the Grid annotation arm compared with the AI annotation arm (49 ± 8 min vs. 37 ± 8 min, respectively, p < .001). Atrial tachyarrhythmia recurrence was documented in 10 patients (23%) in the Grid annotation arm compared with 19 patients (42%) in the AI annotation arm with time to recurrence not reaching statistical significance (p = .074). Conclusions This study shows that a Grid annotation‐guided dragging approach provides an alternative to point‐by‐point RF‐PVI using AI annotation.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Amaya M D Hagen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, The Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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31
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Hopman LHGA, Mulder MJ, van der Laan AM, Demirkiran A, Bhagirath P, van Rossum AC, Allaart CP, Götte MJW. Impaired left atrial reservoir and conduit strain in patients with atrial fibrillation and extensive left atrial fibrosis. J Cardiovasc Magn Reson 2021; 23:131. [PMID: 34758820 PMCID: PMC8582184 DOI: 10.1186/s12968-021-00820-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with profound structural and functional changes in the atria. In the present study, we investigated the association between left atrial (LA) phasic function and the extent of LA fibrosis using advanced cardiovascular magnetic resonance (CMR) imaging techniques, including 3-dimensional (3D) late gadolinium enhancement (LGE) and feature tracking. METHODS Patients with paroxysmal and persistent AF (n = 105) underwent CMR in sinus rhythm. LA global reservoir strain, conduit strain and contractile strain were derived from cine CMR images using CMR feature tracking. The extent of LA fibrosis was assessed from 3D LGE images. Healthy subjects underwent CMR and served as controls (n = 19). RESULTS Significantly lower LA reservoir strain, conduit strain and contractile strain were found in AF patients, as compared to healthy controls (- 15.9 ± 3.8% vs. - 21.1 ± 3.6% P < 0.001, - 8.7 ± 2.7% vs. - 12.6 ± 2.5% P < 0.001 and - 7.2 ± 2.3% vs. - 8.6 ± 2.2% P = 0.02, respectively). Patients with a high degree of LA fibrosis (dichotomized by the median value) had lower reservoir strain and conduit strain compared to patients with a low degree of LA fibrosis (- 15.0 ± 3.9% vs. - 16.9 ± 3.3%, P = 0.02 and - 7.9 ± 2.7% vs. - 9.5 ± 2.6%, P = 0.01, respectively). In contrast, no difference was found for LA contractile strain (- 7.1 ± 2.4% vs. - 7.4 ± 2.3%, P = 0.55). CONCLUSIONS Impaired LA reservoir and conduit strain are present in AF patients with extensive atrial fibrosis. Future studies are needed to examine the biologic nature of this association and possible therapeutic implications.
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Affiliation(s)
- Luuk H. G. A. Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Mark J. Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Anja M. van der Laan
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Albert C. van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P. Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Marco J. W. Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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Mulder MJ, Kemme MJB, Hopman LHGA, Kusgozoglu E, Gulcicek H, Van De Ven PM, Hauer HA, Tahapary GJM, Van Rossum AC, Allaart CP. Predictive value of ten risk scores for outcomes of atrial fibrillation patients undergoing radiofrequency pulmonary vein isolation. Europace 2021. [DOI: 10.1093/europace/euab116.231] [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] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction:
A significant number of patients experience recurrent atrial fibrillation (AF) after ablation. Predicting who will or will not benefit from AF ablation is challenging. Although various risk scores have been designed to predict outcomes after AF ablation, comparative data are sparse and external risk score validation is often lacking.
Purpose
In this study, we aimed to compare ten previously described risk scores with regard to their predictive value for post-ablation AF recurrence and procedural complications.
Methods
A total of 482 AF patients (37% non-paroxysmal AF, 66% male, mean age 62 ± 9 years) undergoing initial radiofrequency pulmonary vein isolation (RF-PVI) were included in the present analysis. Prior to ablation, all patients underwent both transthoracic echocardiography and either cardiac computed tomography imaging or cardiac magnetic resonance imaging. The following risk scores were calculated for each patient: APPLE, ATLAS, BASE-AF2, CAAP-AF, CHADS2, CHA2DS2-VASc, DR-FLASH, HATCH, LAGO and MB-LATER. The predictive performance of the risk scores for AF recurrence and complications were assessed separately by receiver operating characteristic (ROC) curves.
Results
Median follow-up was 16 (12-31) months. AF recurrence after the 90-day blanking period was observed in 199 patients (41%), occurring after a median of 183 (124-360) days after ablation. Overall procedural adverse event rate was 6%. The HATCH score was the only score without predictive value for recurrent AF after ablation (area under curve [AUC] 0.545). All other investigated scores demonstrated statistically significant but poor predictive value for recurrent AF after ablation (AUC 0.553-0.669). CHA2DS2-VASc and CAAP-AF were the only risk scores with predictive value for procedural complications (AUC 0.616, p = 0.043; AUC 0.615, p = 0.044; respectively). ROC curve analyses of the studied risk scores for the prediction of AF recurrence and complications are shown in Figure.
Conclusion
Currently available risk scores perform poorly in predicting outcomes after RF-PVI. These data suggest that the utility of these scores for clinical decision-making is limited. Abstract Figure. ROC curve analyses of risk scores
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Affiliation(s)
- MJ Mulder
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - MJB Kemme
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - LHGA Hopman
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - E Kusgozoglu
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - H Gulcicek
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - PM Van De Ven
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - HA Hauer
- Cardiology Centres of the Netherlands, Amsterdam, Netherlands (The)
| | - GJM Tahapary
- Northwest Clinics, Cardiology, Alkmaar, Netherlands (The)
| | - AC Van Rossum
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - CP Allaart
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
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Everaars H, van Diemen PA, Biesbroek PS, Hopman LHGA, Bom MJ, Schumacher SP, de Winter RW, van de Ven PM, Raijmakers PG, Lammertsma AA, Hofman MBM, Nijveldt R, Götte MJ, van Rossum AC, Danad I, Driessen RS, Knaapen P. Comparison between cardiac magnetic resonance stress T1 mapping and [15O]H2O positron emission tomography in patients with suspected obstructive coronary artery disease. Eur Heart J Cardiovasc Imaging 2021; 23:229-237. [PMID: 33982071 DOI: 10.1093/ehjci/jeab073] [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: 09/16/2020] [Accepted: 04/07/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS To compare cardiac magnetic resonance (CMR) measurement of T1 reactivity (ΔT1) with [15O]H2O positron emission tomography (PET) measurements of quantitative myocardial perfusion. METHODS AND RESULTS Forty-three patients with suspected obstructed coronary artery disease underwent [15O]H2O PET and CMR at 1.5-T, including rest and adenosine stress T1 mapping (ShMOLLI) and late gadolinium enhancement to rule out presence of scar tissue. ΔT1 was determined for the three main vascular territories and compared with [15O]H2O PET-derived regional stress myocardial blood flow (MBF) and myocardial flow reserve (MFR). ΔT1 showed a significant but poor correlation with stress MBF (R2 = 0.04, P = 0.03) and MFR (R2 = 0.07, P = 0.004). Vascular territories with impaired stress MBF (i.e. ≤2.30 mL/min/g) demonstrated attenuated ΔT1 compared with vascular territories with preserved stress MBF (2.9 ± 2.2% vs. 4.1 ± 2.2%, P = 0.008). In contrast, ΔT1 did not differ between vascular territories with impaired (i.e. <2.50) and preserved MFR (3.2 ± 2.6% vs. 4.0 ± 2.1%, P = 0.25). Receiver operating curve analysis of ΔT1 resulted in an area under the curve of 0.66 [95% confidence interval (CI): 0.57-0.75, P = 0.009] for diagnosing impaired stress MBF and 0.62 (95% CI: 0.53-0.71, P = 0.07) for diagnosing impaired MFR. CONCLUSIONS CMR stress T1 mapping has poor agreement with [15O]H2O PET measurements of absolute myocardial perfusion. Stress T1 and ΔT1 are lower in vascular territories with reduced stress MBF but have poor accuracy for detecting impaired myocardial perfusion.
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Affiliation(s)
- Henk Everaars
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - P Stefan Biesbroek
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Michiel J Bom
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Stefan P Schumacher
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Ruben W de Winter
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Pieter G Raijmakers
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Adriaan A Lammertsma
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands
| | - Marco J Götte
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Roel S Driessen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
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Demirkiran A, Amier RP, Hofman MBM, van der Geest RJ, Robbers LFHJ, Hopman LHGA, Mulder MJ, van de Ven P, Allaart CP, van Rossum AC, Götte MJW, Nijveldt R. Altered left atrial 4D flow characteristics in patients with paroxysmal atrial fibrillation in the absence of apparent remodeling. Sci Rep 2021; 11:5965. [PMID: 33727587 PMCID: PMC7966746 DOI: 10.1038/s41598-021-85176-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 11/10/2020] [Accepted: 02/23/2021] [Indexed: 11/09/2022] Open
Abstract
The pathophysiology behind thrombus formation in paroxysmal atrial fibrillation (AF) patients is very complex. This can be due to left atrial (LA) flow changes, remodeling, or both. We investigated differences for cardiovascular magnetic resonance (CMR)-derived LA 4D flow and remodeling characteristics between paroxysmal AF patients and patients without cardiac disease. In this proof-of-concept study, the 4D flow data were acquired in 10 patients with paroxysmal AF (age = 61 ± 8 years) and 5 age/gender matched controls (age = 56 ± 1 years) during sinus rhythm. The following LA and LA appendage flow parameters were obtained: flow velocity (mean, peak), stasis defined as the relative volume with velocities < 10 cm/s, and kinetic energy (KE). Furthermore, LA global strain values were derived from b-SSFP cine images using dedicated CMR feature-tracking software. Even in sinus rhythm, LA mean and peak flow velocities over the entire cardiac cycle were significantly lower in paroxysmal AF patients compared to controls [(13.1 ± 2.4 cm/s vs. 16.7 ± 2.1 cm/s, p = 0.01) and (19.3 ± 4.7 cm/s vs. 26.8 ± 5.5 cm/s, p = 0.02), respectively]. Moreover, paroxysmal AF patients expressed more stasis of blood than controls both in the LA (43.2 ± 10.8% vs. 27.8 ± 7.9%, p = 0.01) and in the LA appendage (73.3 ± 5.7% vs. 52.8 ± 16.2%, p = 0.04). With respect to energetics, paroxysmal AF patients demonstrated lower mean and peak KE values (indexed to maximum LA volume) than controls. No significant differences were observed for LA volume, function, and strain parameters between the groups. Global LA flow dynamics in paroxysmal AF patients appear to be impaired including mean/peak flow velocity, stasis fraction, and KE, partly independent of LA remodeling. This pathophysiological flow pattern may be of clinical value to explain the increased incidence of thromboembolic events in paroxysmal AF patients, in the absence of actual AF or LA remodeling.
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Affiliation(s)
- Ahmet Demirkiran
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Raquel P Amier
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Mark B M Hofman
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rob J van der Geest
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, Leiden, The Netherlands
| | - Lourens F H J Robbers
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Peter van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam UMC, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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35
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Mulder MJ, Kemme MJB, Hagen AMD, Hopman LHGA, van de Ven PM, Hauer HA, Tahapary GJM, Götte MJW, van Rossum AC, Allaart CP. Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after Ablation Index-guided atrial fibrillation ablation. Int J Cardiol Heart Vasc 2020; 29:100574. [PMID: 32642554 PMCID: PMC7334811 DOI: 10.1016/j.ijcha.2020.100574] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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: 05/18/2020] [Accepted: 06/19/2020] [Indexed: 11/17/2022]
Abstract
Ablation Index-guided ablation allows for ablation lesions of consistent depth. Ablation Index-guided ablation is limited by ignoring local wall thickness. Local atrial wall thickness is associated with acute pulmonary vein reconnection. Wall thickness adjusted Ablation Index targets may improve ablation outcomes.
Background Although Ablation Index (AI)-guided ablation facilitates creation of lesions of consistent depth, pulmonary vein (PV) reconnection is still commonly observed after AI-guided pulmonary vein isolation (PVI). The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute PV reconnection after AI-guided atrial fibrillation (AF) ablation. Methods and results Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Occurrence of acute PV reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were retrospectively analyzed and each ablation circle was subdivided into 8 segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were determined for each segment. PV antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units. Acute reconnection occurred in 27/1120 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 19/140 ablation circles (14%). Reconnected segments were characterized by a greater local atrial wall thickness, both in anterior/roof (1.87 ± 0.42 vs. 1.54 ± 0.42 mm; p < 0.01) and posterior/inferior (1.43 ± 0.20 vs. 1.16 ± 0.22 mm; p < 0.01) segments. Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute reconnection. Conclusions Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualized AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent PV reconnection after PVI.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Amaya M D Hagen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Herbert A Hauer
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Cardiology Centers of the Netherlands, Amsterdam, the Netherlands
| | - Giovanni J M Tahapary
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands.,Department of Cardiology, North West Clinics, Alkmaar, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences Amsterdam, the Netherlands
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Mulder MJ, Kemme MJB, Visser CL, Hopman LHGA, Van Diemen PA, Van De Ven PM, Gotte MJW, Danad I, Knaapen P, Van Rossum AC, Allaart CP. P1015Left atrial sphericity as a marker of atrial remodeling: comparison of atrial fibrillation patients and controls. Europace 2020. [DOI: 10.1093/europace/euaa162.346] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Left atrial (LA) sphericity has been proposed as a more sensitive marker of atrial fibrillation (AF)-associated atrial remodeling compared to traditional markers such as LA size. However, mechanisms that underlie changes in LA sphericity are not fully understood and studies investigating the predictive value of LA sphericity for AF ablation outcome have yielded conflicting results.
Purpose
The present study aimed to assess correlates of LA sphericity and to compare LA sphericity in subjects with and without AF.
Methods
Measures of LA size (LA diameter, LA volume, LA volume index), LA sphericity and thoracic anteroposterior diameter (APd) at the level of the LA were determined in a total of 293 AF patients (62% paroxysmal AF) and 110 controls. Cardiac computed tomography (CT) images were analyzed offline by a reviewer blinded to clinical parameters. The AF cohort consisted of consecutive patients referred for cardiac CT imaging prior to first AF ablation procedure between January 2015 and January 2018. The control cohort consisted of subjects with no history of AF who underwent cardiac CT imaging between January 2012 and October 2014 to exclude coronary artery disease.
Results
LA diameter (40.1 ± 6.8 mm vs. 35.2 ± 5.1 mm; p < 0.001), LA volume (116.0 ± 33.0 ml vs. 80.3 ± 22.6 ml; p < 0.001) and LA volume index (56.1 ± 15.3 ml/m² vs. 41.6 ± 11.1 ml/m²; p < 0.001) were significantly larger in AF patients compared to controls (Figure), also after adjustment for age and sex. LA sphericity did not differ between AF patients and controls (83.7 ± 2.9 vs. 83.9 ± 2.4; p = 0.642). A moderate correlation was noted between thoracic APd and LA sphericity in both females (R = 0.521, p < 0.001) and males (R = 0.498, p < 0.001). Multivariable linear regression analysis demonstrated that LA diameter, LA volume, female sex, body length and thoracic APd were independently associated with LA sphericity.
Conclusion
The present study suggests that thoracic constraints rather than the presence of AF determine LA sphericity, implying LA sphericity to be unsuitable as a marker of AF-related atrial remodeling.
Abstract Figure. Comparison of LA imaging characteristics
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Affiliation(s)
- M J Mulder
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - M J B Kemme
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - C L Visser
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - L H G A Hopman
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - P A Van Diemen
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - P M Van De Ven
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - M J W Gotte
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - I Danad
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - P Knaapen
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - A C Van Rossum
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - C P Allaart
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
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37
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Mulder MJ, Kemme MJB, Hopman LHGA, Hauer HA, Tahapary GJM, Gotte MJW, Van Rossum AC, Allaart CP. 666Impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after ablation index-guided ablation. Europace 2020. [DOI: 10.1093/europace/euaa162.347] [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] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Pulmonary vein reconnection is considered a major determinant of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Ablation Index (AI)-guided ablation allows for the creation of ablation lesions of consistent depth and may reduce the incidence of pulmonary vein reconnection after PVI. However, anatomical and imaging studies have demonstrated an important inter- and intra-patient variability of left atrial wall thickness, which can result in non-transmural ablation lesion formation in thicker segments.
Purpose
The present study aimed to investigate the impact of local left atrial wall thickness on the incidence of acute pulmonary vein reconnection after AI-guided AF ablation.
Methods
Consecutive AF patients who underwent cardiac computed tomography (CT) imaging prior to AI-guided ablation between December 2017 and September 2019 were studied. AI targets were 500 for anterior/roof and 380 for posterior/inferior segments with a maximum interlesion distance of 6 mm. Occurrence of acute pulmonary vein reconnection after initial PVI was assessed after a 30-minute waiting period. Ablation procedures were analysed offline to determine minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance for each segment according to a 16-segment model. Pulmonary vein antrum wall thickness was assessed for each segment on reconstructed CT images based on patient-specific thresholds in Hounsfield Units, using a previously described method.
Results
Seventy patients (63% paroxysmal AF, 67% male, mean age 63 ± 8 years) who underwent preprocedural CT imaging and AI-guided AF ablation were studied. Acute reconnection (AR) occurred in 27/1152 segments (2%, 15 anterior/roof, 12 posterior/inferior) in 17/70 (24%) patients. Anterior/roof segments were thicker than posterior/inferior segments (1.48 [1.23-1.80] vs. 1.13 [1.00-1.30] mm; p < 0.01). Reconnected segments were characterised by a greater local atrial wall thickness, both in anterior/roof (1.83 [1.60-2.00] vs. 1.47 [1.20-1.80] mm; p < 0.01) and posterior/inferior (1.38 [1.25-1.50] vs. 1.13 [1.00-1.27] mm; p < 0.01) segments (Figure 1). Minimum AI, force-time integral, contact force, ablation duration, power, impedance drop and maximum interlesion distance were not associated with acute pulmonary vein reconnection.
Conclusion
Local atrial wall thickness is associated with acute pulmonary vein reconnection after AI-guided PVI. Individualised AI targets based on local wall thickness may be of use to create transmural ablation lesions and prevent pulmonary vein reconnection after PVI.
Abstract Figure. Impact of wall thickness on reconnection
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Affiliation(s)
- M J Mulder
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - M J B Kemme
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - L H G A Hopman
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - H A Hauer
- Cardiology Centres of the Netherlands, Amsterdam, Netherlands (The)
| | - G J M Tahapary
- Northwest Clinics, Cardiology, Alkmaar, Netherlands (The)
| | - M J W Gotte
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - A C Van Rossum
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - C P Allaart
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
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38
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Mulder MJ, Kemme MJB, Visser CL, Hopman LHGA, van Diemen PA, van de Ven PM, Götte MJW, Danad I, Knaapen P, van Rossum AC, Allaart CP. Left atrial sphericity as a marker of atrial remodeling: Comparison of atrial fibrillation patients and controls. Int J Cardiol 2020; 304:69-74. [PMID: 32005449 DOI: 10.1016/j.ijcard.2020.01.042] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/07/2020] [Accepted: 01/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Left atrial (LA) sphericity has been proposed as a more sensitive marker of atrial fibrillation (AF)-associated atrial remodeling compared to traditional markers such as LA size. However, mechanisms that underlie changes in LA sphericity are not fully understood and studies investigating the predictive value of LA sphericity for AF ablation outcome have yielded conflicting results. The present study aimed to assess correlates of LA sphericity and to compare LA sphericity in subjects with and without AF. METHODS Measures of LA size (LA diameter, LA volume, LA volume index), LA sphericity and thoracic anteroposterior diameter (APd) at the level of the LA were determined using computed tomography (CT) imaging data in 293 AF patients (62% paroxysmal AF) and 110 controls. RESULTS LA diameter (40.1 ± 6.8 mm vs. 35.2 ± 5.1 mm; p < 0.001), LA volume (116.0 ± 33.0 ml vs. 80.3 ± 22.6 ml; p < 0.001) and LA volume index (56.1 ± 15.3 ml/m2 vs. 41.6 ± 11.1 ml/m2; p < 0.001) were significantly larger in AF patients compared to controls, also after adjustment for covariates. LA sphericity did not differ between AF patients and controls (83.7 ± 2.9 vs. 83.9 ± 2.4; p = 0.642). Multivariable linear regression analysis demonstrated that LA diameter, LA volume, female sex, body length and thoracic APd were independently associated with LA sphericity. CONCLUSIONS The present study suggests that thoracic constraints rather than the presence of AF determine LA sphericity, implying LA sphericity to be unsuitable as a marker of AF-related atrial remodeling.
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Affiliation(s)
- Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Michiel J B Kemme
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Charlotte L Visser
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Pepijn A van Diemen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ibrahim Danad
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Paul Knaapen
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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Zweerink A, Hopman LHGA, Allaart CP. Efficiency is key. Eur Heart J Cardiovasc Imaging 2020; 21:154-156. [PMID: 31630186 PMCID: PMC7029764 DOI: 10.1093/ehjci/jez260] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences (ACS), Amsterdam University Medical Centers (AUMC), VU University Medical Center, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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Hollander MR, Jansen MF, Hopman LHGA, Dolk E, van de Ven PM, Knaapen P, Horrevoets AJ, Lutgens E, van Royen N. Stimulation of Collateral Vessel Growth by Inhibition of Galectin 2 in Mice Using a Single-Domain Llama-Derived Antibody. J Am Heart Assoc 2019; 8:e012806. [PMID: 31594443 PMCID: PMC6818022 DOI: 10.1161/jaha.119.012806] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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] [Indexed: 01/18/2023]
Abstract
Background In the presence of arterial stenosis, collateral artery growth (arteriogenesis) can alleviate ischemia and preserve tissue function. In patients with poorly developed collateral arteries, Gal‐2 (galectin 2) expression is increased. In vivo administration of Gal‐2 inhibits arteriogenesis. Blocking of Gal‐2 potentially stimulates arteriogenesis. This study aims to investigate the effect of Gal‐2 inhibition on arteriogenesis and macrophage polarization using specific single‐domain antibodies. Methods and Results Llamas were immunized with Gal‐2 to develop anti–Gal‐2 antibodies. Binding of Gal‐2 to monocytes and binding inhibition of antibodies were quantified. To test arteriogenesis in vivo, Western diet‐fed LDLR.(low‐density lipoprotein receptor)–null Leiden mice underwent femoral artery ligation and received treatment with llama antibodies 2H8 or 2C10 or with vehicle. Perfusion restoration was measured with laser Doppler imaging. In the hind limb, arterioles and macrophage subtypes were characterized by histology, together with aortic atherosclerosis. Llama‐derived antibodies 2H8 and 2C10 strongly inhibited the binding of Gal‐2 to monocytes (93% and 99%, respectively). Treatment with these antibodies significantly increased perfusion restoration at 14 days (relative to sham, vehicle: 41.3±2.7%; 2H8: 53.1±3.4%, P=0.016; 2C10: 52.0±3.8%, P=0.049). In mice treated with 2H8 or 2C10, the mean arteriolar diameter was larger compared with control (vehicle: 17.25±4.97 μm; 2H8: 17.71±5.01 μm; 2C10: 17.84±4.98 μm; P<0.001). Perivascular macrophages showed a higher fraction of the M2 phenotype in both antibody‐treated animals (vehicle: 0.49±0.24; 2H8: 0.73±0.15, P=0.007; 2C10: 0.75±0.18, P=0.006). In vitro antibody treatment decreased the expression of M1‐associated cytokines compared with control (P<0.05 for each). Atherosclerotic lesion size was comparable between groups (overall P=0.59). Conclusions Inhibition of Gal‐2 induces a proarteriogenic M2 phenotype in macrophages, improves collateral artery growth, and increases perfusion restoration in a murine hind limb model.
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Affiliation(s)
- Maurits R Hollander
- Department of Cardiology VU University Medical Centre Amsterdam The Netherlands
| | - Matthijs F Jansen
- Department of Cardiology VU University Medical Centre Amsterdam The Netherlands.,Department of Medical Biochemistry Academic Medical Centre Amsterdam The Netherlands
| | - Luuk H G A Hopman
- Department of Cardiology VU University Medical Centre Amsterdam The Netherlands
| | | | - Peter M van de Ven
- Department of Epidemiology and Biostatistics VU University Amsterdam The Netherlands
| | - Paul Knaapen
- Department of Cardiology VU University Medical Centre Amsterdam The Netherlands
| | - Anton J Horrevoets
- Department of Molecular Cell Biology and Immunology VU Medical Center Amsterdam The Netherlands
| | - Esther Lutgens
- Department of Medical Biochemistry Academic Medical Centre Amsterdam The Netherlands.,Institute for Cardiovascular Prevention (IPEK) Ludwig Maximilian's University Munich Germany
| | - Niels van Royen
- Department of Cardiology VU University Medical Centre Amsterdam The Netherlands.,Department of Cardiology Radboud University Medical Center Nijmegen The Netherlands
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Agca R, Hopman LHGA, Laan KJC, van Halm VP, Peters MJL, Smulders YM, Dekker JM, Nijpels G, Stehouwer CDA, Voskuyl AE, Boers M, Lems WF, Nurmohamed MT. Cardiovascular Event Risk in Rheumatoid Arthritis Compared with Type 2 Diabetes: A 15-year Longitudinal Study. J Rheumatol 2019; 47:316-324. [PMID: 31092721 DOI: 10.3899/jrheum.180726] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Cardiovascular (CV) disease (CVD) risk is increased in rheumatoid arthritis (RA). However, longterm followup studies investigating this risk are scarce. METHODS The CARRÉ (CARdiovascular research and RhEumatoid arthritis) study is a prospective cohort study investigating CVD and its risk factors in 353 patients with longstanding RA. CV endpoints were assessed at baseline and 3, 10, and 15 years after the start of the study and are compared to a reference cohort (n = 2540), including a large number of patients with type 2 diabetes (DM). RESULTS Ninety-five patients with RA developed a CV event over 2973 person-years, resulting in an incidence rate of 3.20 per 100 person-years. Two hundred fifty-seven CV events were reported in the reference cohort during 18,874 person-years, resulting in an incidence rate of 1.36 per 100 person-years. Age- and sex-adjusted HR for CV events were increased for RA (HR 2.07, 95% CI 1.57-2.72, p < 0.01) and DM (HR 1.51, 95% CI 1.02-2.22, p = 0.04) compared to the nondiabetic participants. HR was still increased in RA (HR 1.82, 95% CI 1.32-2.50, p < 0.01) after additional adjustment for CV risk factors. Patients with both RA and DM or insulin resistance had the highest HR for developing CVD (2.21, 95% CI 1.01-4.80, p = 0.046 and 2.67, 95% CI 1.30-5.46, p < 0.01, respectively). CONCLUSION The incidence rate of CV events in established RA was more than double that of the general population. Patients with RA have an even higher risk of CVD than patients with DM. This risk remained after adjustment for traditional CV risk factors, suggesting that systemic inflammation is an independent contributor to CV risk.
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Affiliation(s)
- Rabia Agca
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands. .,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam.
| | - Luuk H G A Hopman
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Koen J C Laan
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Vokko P van Halm
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Mike J L Peters
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Yvo M Smulders
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Jacqueline M Dekker
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Giel Nijpels
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Coen D A Stehouwer
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Alexandre E Voskuyl
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Maarten Boers
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Willem F Lems
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
| | - Michael T Nurmohamed
- From the Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade; Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center; Department of Cardiology, and Department of Internal Medicine, and Department of Epidemiology and Biostatistics, and Department of General Practice, and EMGO Institute for Health and Care Research, Amsterdam UMC, VU University Medical Center; Amsterdam UMC, Academic Medical Center, Department of Cardiology; Department of Internal Medicine, and the Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands.,R. Agca, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; L.H. Hopman, PhD student, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology; K.J. Laan, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam; V.P. van Halm, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Cardiology, and Amsterdam UMC, Academic Medical Center, Department of Cardiology; M.J. Peters, MD, PhD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; Y.M. Smulders, MD, Amsterdam UMC, VU University Medical Center, Department of Internal Medicine; J.M. Dekker, Prof. Dr., Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; G. Nijpels, MD, Amsterdam UMC, VU University Medical Center, Department of General Practice, and Amsterdam UMC, VU University Medical Center, EMGO Institute for Health and Care Research; C.D. Stehouwer, MD, Maastricht University Medical Center, Department of Internal Medicine, and Maastricht University Medical Center, CARIM; A.E. Voskuyl, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M. Boers, MD, Amsterdam UMC, VU University Medical Center, Department of Epidemiology and Biostatistics; W.F. Lems, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center; M.T. Nurmohamed, MD, Amsterdam Rheumatology and Immunology Center, Department of Rheumatology in Reade, and Amsterdam Rheumatology and Immunology Center, Department of Rheumatology, VU University Medical Center in Amsterdam
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