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Joosen RS, Voskuil M, Krings GJ, Handoko ML, Dickinson MG, van de Veerdonk MC, Breur JMPJ. The impact of unilateral pulmonary artery stenosis on right ventricular to pulmonary arterial coupling in patients with transposition of the great arteries. Catheter Cardiovasc Interv 2024. [PMID: 38577955 DOI: 10.1002/ccd.31036] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/21/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Unilateral pulmonary artery (PA) stenosis is common in the transposition of the great arteries (TGA) after arterial switch operation (ASO) but the effects on the right ventricle (RV) remain unclear. AIMS To assess the effects of unilateral PA stenosis on RV afterload and function in pediatric patients with TGA-ASO. METHODS In this retrospective study, eight TGA patients with unilateral PA stenosis underwent heart catheterization and cardiac magnetic resonance (CMR) imaging. RV pressures, RV afterload (arterial elastance [Ea]), PA compliance, RV contractility (end-systolic elastance [Ees]), RV-to-PA (RV-PA) coupling (Ees/Ea), and RV diastolic stiffness (end-diastolic elastance [Eed]) were analyzed and compared to normal values from the literature. RESULTS In all TGA patients (mean age 12 ± 3 years), RV afterload (Ea) and RV pressures were increased whereas PA compliance was reduced. RV contractility (Ees) was decreased resulting in RV-PA uncoupling. RV diastolic stiffness (Eed) was increased. CMR-derived RV volumes, mass, and ejection fraction were preserved. CONCLUSION Unilateral PA stenosis results in an increased RV afterload in TGA patients after ASO. RV remodeling and function remain within normal limits when analyzed by CMR but RV pressure-volume loop analysis shows impaired RV diastolic stiffness and RV contractility leading to RV-PA uncoupling.
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Affiliation(s)
- Renée S Joosen
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gregor J Krings
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Michael G Dickinson
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marielle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Johannes M P J Breur
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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2
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Man JP, Klopotowska J, Asselbergs FW, Handoko ML, Chamuleau SAJ, Schuuring MJ. Digital Solutions to Optimize Guideline-Directed Medical Therapy Prescriptions in Heart Failure Patients: Current Applications and Future Directions. Curr Heart Fail Rep 2024; 21:147-161. [PMID: 38363516 PMCID: PMC10924030 DOI: 10.1007/s11897-024-00649-x] [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] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
PURPOSEOF REVIEW Guideline-directed medical therapy (GDMT) underuse is common in heart failure (HF) patients. Digital solutions have the potential to support medical professionals to optimize GDMT prescriptions in a growing HF population. We aimed to review current literature on the effectiveness of digital solutions on optimization of GDMT prescriptions in patients with HF. RECENT FINDINGS We report on the efficacy, characteristics of the study, and population of published digital solutions for GDMT optimization. The following digital solutions are discussed: teleconsultation, telemonitoring, cardiac implantable electronic devices, clinical decision support embedded within electronic health records, and multifaceted interventions. Effect of digital solutions is reported in dedicated studies, retrospective studies, or larger studies with another focus that also commented on GDMT use. Overall, we see more studies on digital solutions that report a significant increase in GDMT use. However, there is a large heterogeneity in study design, outcomes used, and populations studied, which hampers comparison of the different digital solutions. Barriers, facilitators, study designs, and future directions are discussed. There remains a need for well-designed evaluation studies to determine safety and effectiveness of digital solutions for GDMT optimization in patients with HF. Based on this review, measuring and controlling vital signs in telemedicine studies should be encouraged, professionals should be actively alerted about suboptimal GDMT, the researchers should consider employing multifaceted digital solutions to optimize effectiveness, and use study designs that fit the unique sociotechnical aspects of digital solutions. Future directions are expected to include artificial intelligence solutions to handle larger datasets and relieve medical professional's workload.
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Affiliation(s)
- Jelle P Man
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Joanna Klopotowska
- Department of Medical Informatics, Amsterdam University Medical Center, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam, The Netherlands
| | - Folkert W Asselbergs
- Institute of Health Informatics, University College London, London, UK
- The National Institute for Health Research University College London Hospitals Biomedical Research Centre, University College London, London, UK
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Steven A J Chamuleau
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Mark J Schuuring
- Department of Cardiology, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
- Netherlands Heart Institute, Utrecht, The Netherlands.
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3
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Hoek AG, Dal Canto E, Wenker E, Bindraban N, Handoko ML, Elders PJM, Beulens JWJ. Epidemiology of heart failure in diabetes: a disease in disguise. Diabetologia 2024; 67:574-601. [PMID: 38334818 PMCID: PMC10904471 DOI: 10.1007/s00125-023-06068-2] [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: 05/01/2023] [Accepted: 09/12/2023] [Indexed: 02/10/2024]
Abstract
Left ventricular diastolic dysfunction (LVDD) without symptoms, and heart failure (HF) with preserved ejection fraction (HFpEF) represent the most common phenotypes of HF in individuals with type 2 diabetes mellitus, and are more common than HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF) and left ventricular systolic dysfunction (LVSD) in these individuals. However, diagnostic criteria for HF have changed over the years, resulting in heterogeneity in the prevalence/incidence rates reported in different studies. We aimed to give an overview of the diagnosis and epidemiology of HF in type 2 diabetes, using both a narrative and systematic review approach; we focus narratively on diagnosing (using the 2021 European Society of Cardiology [ESC] guidelines) and screening for HF in type 2 diabetes. We performed an updated (2016-October 2022) systematic review and meta-analysis of studies reporting the prevalence and incidence of HF subtypes in adults ≥18 years with type 2 diabetes, using echocardiographic data. Embase and MEDLINE databases were searched and data were assessed using random-effects meta-analyses, with findings presented as forest plots. From the 5015 studies found, 209 were screened using the full-text article. In total, 57 studies were included, together with 29 studies that were identified in a prior meta-analysis; these studies reported on the prevalence of LVSD (n=25 studies, 24,460 individuals), LVDD (n=65 studies, 25,729 individuals), HFrEF (n=4 studies, 4090 individuals), HFmrEF (n=2 studies, 2442 individuals) and/or HFpEF (n=8 studies, 5292 individuals), and on HF incidence (n=7 studies, 17,935 individuals). Using Hoy et al's risk-of-bias tool, we found that the studies included generally had a high risk of bias. They showed a prevalence of 43% (95% CI 37%, 50%) for LVDD, 17% (95% CI 7%, 35%) for HFpEF, 6% (95% CI 3%, 10%) for LVSD, 7% (95% CI 3%, 15%) for HFrEF, and 12% (95% CI 7%, 22%) for HFmrEF. For LVDD, grade I was found to be most prevalent. Additionally, we reported a higher incidence rate of HFpEF (7% [95% CI 4%, 11%]) than HFrEF 4% [95% CI 3%, 7%]). The evidence is limited by the heterogeneity of the diagnostic criteria over the years. The systematic section of this review provides new insights on the prevalence/incidence of HF in type 2 diabetes, unveiling a large pre-clinical target group with LVDD/HFpEF in which disease progression could be halted by early recognition and treatment.Registration PROSPERO ID CRD42022368035.
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Affiliation(s)
- Anna G Hoek
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands.
| | - Elisa Dal Canto
- Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Eva Wenker
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Navin Bindraban
- Heartcenter, Department of Cardiology, Amsterdam UMC, location AMC, Amsterdam, the Netherlands
| | - M Louis Handoko
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Heartcenter, Department of Cardiology, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Petra J M Elders
- Department of General Practice, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
| | - Joline W J Beulens
- Epidemiology and Data Science, Amsterdam UMC, location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Amsterdam Public Health, Amsterdam UMC, Amsterdam, the Netherlands
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4
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Colombijn JMT, Idema DL, van Beem S, Blokland AM, van der Braak K, Handoko ML, in ’t Veld LFH, Kaul T, Kolagasigil-Akdemir N, Kusters MPT, Meijvis SCA, Oosting IJ, Spijker R, Bots ML, Hooft L, Verhaar MC, Vernooij RWM. Representation of Patients With Chronic Kidney Disease in Clinical Trials of Cardiovascular Disease Medications: A Systematic Review. JAMA Netw Open 2024; 7:e240427. [PMID: 38451526 PMCID: PMC10921252 DOI: 10.1001/jamanetworkopen.2024.0427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/27/2023] [Indexed: 03/08/2024] Open
Abstract
Importance Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease, but their systematic underrepresentation in cardiovascular randomized clinical trials (RCTs) limits the generation of appropriate evidence to guide cardiovascular risk management (CVRM). Objective To evaluate the underrepresentation of patients with CKD in cardiovascular RCTs, and to highlight evidence gaps in CVRM medications in this population. Evidence Review A systematic search was conducted in ClinicalTrials.gov from February 2000 through October 2021 for RCTs with full-text publications. If no full-text publications were found in ClinicalTrials.gov, MEDLINE, Embase, and Google Scholar were also searched. Eligible RCTs were those evaluating the effectiveness of antiplatelets, anticoagulants, blood pressure-lowering drugs, glucose-lowering drugs, or cholesterol-lowering drugs in adults with cardiovascular disease or cardiovascular risk factors. Trials with a sample size of fewer than 100 patients were excluded. Findings In total, 1194 RCTs involving 2 207 677 participants (mean [SD] age, 63 [6] years; 1 343 970 males [64%]) were included. Since 2000, the percentage of cardiovascular RCTs excluding patients with CKD has increased from 66% to 79% (74% overall [884 RCTs]). In 864 RCTs (72%), more patients were excluded than anticipated on safety grounds (63% [306] of trials required no dose adjustment, and 79% [561] required dose adjustment). In total, 158 RCTs (13%) reported results for patients with CKD separately (eg, in subgroup analyses). Significant evidence gaps exist in most CVRM interventions for patients with CKD, particularly for those with CKD stages 4 to 5. Twenty-three RCTs (2%) reported results for patients with an estimated glomerular filtration rate less than 30 mL/min/1.73 m2, 15 RCTs (1%) reported for patients receiving dialysis, and 1 RCT (0.1%) reported for recipients of kidney transplant. Conclusions and Relevance Results of this systematic review suggest that representation of patients with CKD in cardiovascular RCTs has not improved in the past 2 decades and that these RCTs excluded more patients with CKD than expected on safety grounds. Lack of reporting or underreporting of results for this patient population is associated with evidence gaps in the effectiveness of most CVRM medications in patients with all stages of CKD, particularly CKD stages 4 to 5.
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Affiliation(s)
- Julia M. T. Colombijn
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Demy L. Idema
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sanne van Beem
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Anna Marthe Blokland
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kim van der Braak
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - M. Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences (Heart Failure and Arrhythmias), Amsterdam, the Netherlands
| | - Linde F. Huis in ’t Veld
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Tabea Kaul
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Nurda Kolagasigil-Akdemir
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Mike P. T. Kusters
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Sabine C. A. Meijvis
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ilse J. Oosting
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Rene Spijker
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - Michiel L. Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Lotty Hooft
- Cochrane Netherlands, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Robin W. M. Vernooij
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
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5
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Handoko ML, de Man FS, Brugts JJ, van der Meer P, Rhodius-Meester HFM, Schaap J, van de Kamp HJR, Houterman S, van Veghel D, Uijl A, Asselbergs FW. Embedding routine health care data in clinical trials: with great power comes great responsibility. Neth Heart J 2024; 32:106-115. [PMID: 38224411 PMCID: PMC10884372 DOI: 10.1007/s12471-023-01837-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 01/16/2024] Open
Abstract
Randomised clinical trials (RCTs) are vital for medical progress. Unfortunately, 'traditional' RCTs are expensive and inherently slow. Moreover, their generalisability has been questioned. There is considerable overlap in routine health care data (RHCD) and trial-specific data. Therefore, integration of RHCD in an RCT has great potential, as it would reduce the effort and costs required to collect data, thereby overcoming some of the major downsides of a traditional RCT. However, use of RHCD comes with other challenges, such as privacy issues, as well as technical and practical barriers. Here, we give a current overview of related initiatives on national cardiovascular registries (Netherlands Heart Registration, Heart4Data), showcasing the interrelationships between and the relevance of the different registries for the practicing physician. We then discuss the benefits and limitations of RHCD use in the setting of a pragmatic RCT from a cardiovascular perspective, illustrated by a case study in heart failure.
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Affiliation(s)
- M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands.
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences, Pulmonary Hypertension and Thrombosis, Amsterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thorax Centre, Erasmus Medical Centre, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Peter van der Meer
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Hanneke F M Rhodius-Meester
- Department of Internal Medicine, Geriatrics Section, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Neurology, Alzheimer Centre Amsterdam, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Geriatric Medicine, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Jeroen Schaap
- Department of Cardiology, Amphia Hospital, Breda, The Netherlands
- Dutch Network for Cardiovascular Research, Utrecht, The Netherlands
| | | | | | | | - Alicia Uijl
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Heart Failure and Arrhythmias, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
- Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, UK
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Man JP, Dijkgraaf MG, Handoko ML, de Lange FJ, Winter MM, Schijven MP, Stienen S, Meregalli P, Kok WE, Kuipers DI, van der Harst P, Koole MA, Chamuleau SA, Schuuring MJ. Digital consults to optimize guideline-directed therapy: design of a pragmatic multicenter randomized controlled trial. ESC Heart Fail 2024; 11:560-569. [PMID: 38146630 PMCID: PMC10804150 DOI: 10.1002/ehf2.14634] [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: 08/28/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023] Open
Abstract
AIMS Many heart failure (HF) patients do not receive optimal guideline-directed medical therapy (GDMT) despite clear benefit on morbidity and mortality outcomes. Digital consults (DCs) have the potential to improve efficiency on GDMT optimization to serve the growing HF population. The investigator-initiated ADMINISTER trial was designed as a pragmatic multicenter randomized controlled open-label trial to evaluate efficacy and safety of DC in patients on HF treatment. METHODS AND RESULTS Patients (n = 150) diagnosed with HF with a reduced ejection fraction will be randomized to DC or standard care (1:1). The intervention group receives multifaceted DCs including (i) digital data sharing (e.g. exchange of pharmacotherapy use and home-measured vital signs), (ii) patient education via an e-learning, and (iii) digital guideline recommendations to treating clinicians. The consults are performed remotely unless there is an indication to perform the consult physically. The primary outcome is the GDMT prescription rate score, and secondary outcomes include time till full GDMT optimization, patient and clinician satisfaction, time spent on healthcare, and Kansas City Cardiomyopathy Questionnaire. Results will be reported in accordance to the CONSORT statement. CONCLUSIONS The ADMINISTER trial will offer the first randomized controlled data on GDMT prescription rates, time till full GDMT optimization, time spent on healthcare, quality of life, and patient and clinician satisfaction of the multifaceted patient- and clinician-targeted DC for GDMT optimization.
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Affiliation(s)
- Jelle P. Man
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Marcel G.W. Dijkgraaf
- Department of Epidemiology and Data ScienceAmsterdam UMCAmsterdamThe Netherlands
- Department of MethodologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - M. Louis Handoko
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Frederik J. de Lange
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Michiel M. Winter
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
| | | | - Susan Stienen
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Paola Meregalli
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wouter E.M. Kok
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Dorianne I. Kuipers
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Pim van der Harst
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
| | - Maarten A.C. Koole
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Cardiology Center of the NetherlandsAmsterdamThe Netherlands
- Department of CardiologyRed Cross HospitalBeverwijkThe Netherlands
| | - Steven A.J. Chamuleau
- Department of CardiologyAmsterdam UMC location AMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mark J. Schuuring
- Department of CardiologyAmsterdam UMC location VUmcAmsterdamThe Netherlands
- Netherlands Heart InstituteUtrechtThe Netherlands
- Amsterdam Cardiovascular ScienceUniversity of AmsterdamAmsterdamThe Netherlands
- Department of CardiologyUniversity Medical Center UtrechtHeidelberglaan 1003584 CXUtrechtThe Netherlands
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7
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Nijskens CM, Thomas EG, Rhodius‐Meester HFM, Daemen MJAP, Biessels GJ, Handoko ML, Muller M. Is it time for Heart-Brain clinics? A clinical survey and proposition to improve current care for cognitive problems in heart failure. Clin Cardiol 2024; 47:e24200. [PMID: 38183320 PMCID: PMC10785189 DOI: 10.1002/clc.24200] [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: 09/29/2023] [Accepted: 11/20/2023] [Indexed: 01/08/2024] Open
Abstract
BACKGROUND Cognitive impairment is highly prevalent among patients with heart failure (HF). International guidelines on the management of HF recommend screening for cognitive impairment and tailored care for patients with cognitive impairment. However, practical guidance is lacking. In this study, we explore cardiologists' perspective on screening and care for cognitive impairment in patients with HF. We give an example of a multidisciplinary Heart-Brain care pathway that facilitates screening for cognitive impairment in patients with HF. METHODS We distributed an online survey to cardiologists from the Dutch working groups on Geriatric Cardiology and Heart Failure. It covered questions about current clinical practice, impact of cognitive impairment on clinical decision-making, and their knowledge and skills to recognize cognitive impairment. RESULTS Thirty-six out of 55 invited cardiologists responded. Only 3% performed structured cognitive screening, while 83% stated that not enough attention is paid to cognitive impairment. More than half of the cardiologists desired more training in recognizing cognitive impairment and three-quarters indicated that knowing about cognitive impairment would change their treatment plan. Eighty percent agreed that systematic cognitive screening would benefit their patients and 74% wished to implement a Heart-Brain clinic. Time and expertise were addressed as the major barriers to screening for cognitive impairment. CONCLUSION Although cardiologists are aware of the clinical relevance of screening for cognitive impairment in cardiology patients, such clinical conduct is not yet commonly practiced due to lack of time and expertise. The Heart-Brain care pathway could facilitate this screening, thus improving personalized care in cardiology.
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Affiliation(s)
- Charlotte M. Nijskens
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
| | - Elias G. Thomas
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
| | - Hanneke F. M. Rhodius‐Meester
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Neurology, Alzheimer Center AmsterdamAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Department of Geriatric MedicineOslo University HospitalOsloNorway
- Amsterdam NeuroscienceAmsterdam UMCAmsterdamThe Netherlands
| | - Mat J. A. P. Daemen
- Department of PathologyAmsterdam UMC Location University of AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain CenterUniversity Medical CenterUtrechtThe Netherlands
| | - M. Louis Handoko
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
- Department of CardiologyAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Majon Muller
- Department of Internal Medicine, Geriatrics SectionAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Public HealthAmsterdam UMCAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdam UMCAmsterdamThe Netherlands
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8
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Weerts J, Amin H, Barandiarán Aizpurua A, Gevaert AB, Handoko ML, Dauw J, Tun HN, Rommel K, Verbrugge FH, Kresoja K, Sanders‐van Wijk S, Brunner‐La Rocca H, Bayés‐Genís A, Lumens J, Knackstedt C, van Empel VP. Webtool to enhance the accuracy of diagnostic algorithms for HFpEF: a prospective cross-over study. ESC Heart Fail 2023; 10:3493-3503. [PMID: 37724334 PMCID: PMC10682885 DOI: 10.1002/ehf2.14525] [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: 08/22/2023] [Indexed: 09/20/2023] Open
Abstract
AIMS Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be challenging. This study aimed to evaluate the potential of a webtool to enhance the scoring accuracy when applying the complex HFA-PEFF and H2 FPEF algorithms, which are commonly used for diagnosing HFpEF. METHODS AND RESULTS We developed an online tool, the HFpEF calculator, that enables the automatic calculation of current HFpEF algorithms. We assessed the accuracy of manual vs. automatic scoring, defined as the percentage of correct scores, in a cohort of cardiologists with varying clinical experience. Cardiologists scored eight online clinical cases using a triple cross-over design (i.e. two manual-two automatic-two manual-two automatic). Data were analysed in study completers (n = 55, 29% heart failure specialists, 42% general cardiologists, and 29% cardiology residents). Manually calculated scores were correct in 50% (HFA-PEFF: 50% [50-75]; H2 FPEF: 50% [38-50]). Correct scoring improved to 100% using the HFpEF calculator (HFA-PEFF: 100% [88-100], P < 0.001; H2 FPEF: 100% [75-100], P < 0.001). Time spent on clinical cases was similar between scoring methods (±4 min). When corrections for faulty algorithm scores were displayed, cardiologists changed their diagnostic decision in up to 67% of cases. At least 67% of cardiologists preferred using the online tool for future cases in clinical practice. CONCLUSIONS Manual calculation of HFpEF diagnostic algorithms is often inaccurate. Using an automated webtool to calculate HFpEF algorithms significantly improved correct scoring. This new approach may impact the eventual diagnostic decision in up to two-thirds of cases, supporting its routine use in clinical practice.
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Affiliation(s)
- Jerremy Weerts
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+)PO Box 6166200 MDMaastrichtThe Netherlands
| | - Hesam Amin
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+)PO Box 6166200 MDMaastrichtThe Netherlands
- Department of CardiologyThoraxcentrum Twente, Medisch Spectrum TwenteEnschedeThe Netherlands
| | - Arantxa Barandiarán Aizpurua
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+)PO Box 6166200 MDMaastrichtThe Netherlands
| | - Andreas B. Gevaert
- Research Group Cardiovascular Diseases, GENCOR DepartmentUniversity of AntwerpAntwerpBelgium
- Department of CardiologyAntwerp University Hospital (UZA)EdegemBelgium
| | - M. Louis Handoko
- Department of CardiologyAmsterdam University Medical Centers, Vrije UniversiteitAmsterdamThe Netherlands
- Amsterdam Cardiovascular Sciences/Heart Failure and ArrhythmiasAmsterdamThe Netherlands
| | - Jeroen Dauw
- Department of CardiologyAZ Sint‐LucasGhentBelgium
| | - Han Naung Tun
- Larner College of MedicineUniversity of VermontBurlingtonVTUSA
| | - Karl‐Philipp Rommel
- Department of Internal Medicine/CardiologyHeart Center Leipzig, Leipzig UniversityLeipzigGermany
| | - Frederik H. Verbrugge
- Centre for Cardiovascular DiseasesUniversity Hospital BrusselsJetteBelgium
- Faculty of Medicine and PharmacyVrije Universiteit BrusselBrusselsBelgium
| | - Karl‐Patrik Kresoja
- Department of Internal Medicine/CardiologyHeart Center Leipzig, Leipzig UniversityLeipzigGermany
| | | | - Hans‐Peter Brunner‐La Rocca
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+)PO Box 6166200 MDMaastrichtThe Netherlands
| | - Antoni Bayés‐Genís
- Heart Institute, Hospital Universitari Germans Trias I Pujol, CIBERCVBadalonaSpain
| | - Joost Lumens
- Department of Biomedical EngineeringCardiovascular Research Institute Maastricht (CARIM), Maastricht UniversityMaastrichtThe Netherlands
| | - Christian Knackstedt
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+)PO Box 6166200 MDMaastrichtThe Netherlands
| | - Vanessa P.M. van Empel
- Department of CardiologyCardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Centre+ (MUMC+)PO Box 6166200 MDMaastrichtThe Netherlands
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9
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Harskamp RE, De Clercq L, Veelers L, Schut MC, van Weert HCPM, Handoko ML, Moll van Charante EP, Himmelreich JCL. Diagnostic properties of natriuretic peptides and opportunities for personalized thresholds for detecting heart failure in primary care. Diagnosis (Berl) 2023; 10:432-439. [PMID: 37667563 DOI: 10.1515/dx-2023-0089] [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: 07/13/2023] [Accepted: 08/25/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Heart failure (HF) is a prevalent syndrome with considerable disease burden, healthcare utilization and costs. Timely diagnosis is essential to improve outcomes. This study aimed to compare the diagnostic performance of B-type natriuretic peptide (BNP) and N-terminal proBNP (NT-proBNP) in detecting HF in primary care. Our second aim was to explore if personalized thresholds (using age, sex, or other readily available parameters) would further improve diagnostic accuracy over universal thresholds. METHODS A retrospective study was performed among patients without prior HF who underwent natriuretic peptide (NP) testing in the Amsterdam General Practice Network between January 2011 and December 2021. HF incidence was based on registration out to 90 days after NP testing. Diagnostic accuracy was evaluated with AUROC, sensitivity and specificity based on guideline-recommended thresholds (125 ng/L for NT-proBNP and 35 ng/L for BNP). We used inverse probability of treatment weighting to adjust for confounding. RESULTS A total of 15,234 patients underwent NP testing, 6,870 with BNP (4.5 % had HF), and 8,364 with NT-proBNP (5.7 % had HF). NT-proBNP was more accurate than BNP, with an AUROC of 89.9 % (95 % CI: 88.4-91.2) vs. 85.9 % (95 % CI 83.5-88.2), with higher sensitivity (95.3 vs. 89.7 %) and specificity (59.1 vs. 58.0 %). Differentiating NP cut-off by clinical variables modestly improved diagnostic accuracy for BNP and NT-proBNP compared with a universal threshold. CONCLUSIONS NT-proBNP outperforms BNP for detecting HF in primary care. Personalized instead of universal diagnostic thresholds led to modest improvement.
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Affiliation(s)
- Ralf E Harskamp
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Lukas De Clercq
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Lieke Veelers
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Laboratory Medicine, Translational AI. Amsterdam UMC, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC Location VU University, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jelle C L Himmelreich
- Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, The Netherlands
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10
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Waddingham MT, Sequeira V, Kuster DWD, Dal Canto E, Handoko ML, de Man FS, da Silva Gonçalves Bós D, Ottenheijm CA, Shen S, van der Pijl RJ, van der Velden J, Paulus WJ, Eringa EC. Geranylgeranylacetone reduces cardiomyocyte stiffness and attenuates diastolic dysfunction in a rat model of cardiometabolic syndrome. Physiol Rep 2023; 11:e15788. [PMID: 37985159 PMCID: PMC10659935 DOI: 10.14814/phy2.15788] [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: 12/27/2022] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 11/22/2023] Open
Abstract
Titin-dependent stiffening of cardiomyocytes is a significant contributor to left ventricular (LV) diastolic dysfunction in heart failure with preserved LV ejection fraction (HFpEF). Small heat shock proteins (HSPs), such as HSPB5 and HSPB1, protect titin and administration of HSPB5 in vitro lowers cardiomyocyte stiffness in pressure-overload hypertrophy. In humans, oral treatment with geranylgeranylacetone (GGA) increases myocardial HSP expression, but the functional implications are unknown. Our objective was to investigate whether oral GGA treatment lowers cardiomyocyte stiffness and attenuates LV diastolic dysfunction in a rat model of the cardiometabolic syndrome. Twenty-one-week-old male lean (n = 10) and obese (n = 20) ZSF1 rats were studied, and obese rats were randomized to receive GGA (200 mg/kg/day) or vehicle by oral gavage for 4 weeks. Echocardiography and cardiac catheterization were performed before sacrifice at 25 weeks of age. Titin-based stiffness (Fpassive ) was determined by force measurements in relaxing solution with 100 nM [Ca2+ ] in permeabilized cardiomyocytes at sarcomere lengths (SL) ranging from 1.8 to 2.4 μm. In obese ZSF1 rats, GGA reduced isovolumic relaxation time of the LV without affecting blood pressure, EF or LV weight. In cardiomyocytes, GGA increased myofilament-bound HSPB5 and HSPB1 expression. Vehicle-treated obese rats exhibited higher cardiomyocyte stiffness at all SLs compared to lean rats, while GGA reduced stiffness at SL 2.0 μm. In obese ZSF1 rats, oral GGA treatment improves cardiomyocyte stiffness by increasing myofilament-bound HSPB1 and HSPB5. GGA could represent a potential novel therapy for the early stage of diastolic dysfunction in the cardiometabolic syndrome.
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Affiliation(s)
- Mark T. Waddingham
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
- Department of Cardiac PhysiologyNational Cerebral and Cardiovascular CenterSuitaJapan
| | - Vasco Sequeira
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Diederik W. D. Kuster
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Elisa Dal Canto
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
- Laboratory of Experimental CardiologyUniversity Medical Center UtrechtUtrechtThe Netherlands
- Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - M. Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Frances S. de Man
- Department of Pulmonology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
| | | | - Coen A. Ottenheijm
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
- Cellular and Molecular MedicineUniversity of ArizonaTucsonArizonaUSA
| | - Shengyi Shen
- Cellular and Molecular MedicineUniversity of ArizonaTucsonArizonaUSA
| | | | - Jolanda van der Velden
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Walter J. Paulus
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
| | - Etto C. Eringa
- Department of Physiology, Amsterdam Cardiovascular SciencesAmsterdam University Medical CentersAmsterdamThe Netherlands
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11
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De Clercq L, Er A, Handoko ML, van Weert HCPM, Schut MC, Moll van Charante EP, Himmelreich JCL, Harskamp RE. Characteristics of heart failure in the Amsterdam metropolitan area (AMSTERDAM-HF): Data from a dynamic general practice cohort (2011-2021). Int J Cardiol 2023; 389:131217. [PMID: 37499948 DOI: 10.1016/j.ijcard.2023.131217] [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: 05/30/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Heart failure (HF) is a common cardiac syndrome with a high disease burden and poor prognosis in our aging populations. Understanding the characteristics of patients with newly diagnosed HF is essential for improving care and outcomes. The AMSTERDAM-HF study is aimed to examine the population characteristics of patients with incident HF. METHODS We performed a retrospective dynamic cohort study in the Amsterdam general practice network consisting of 904,557 individuals. Incidence HF rates, geographical demographics, patient characteristics, risk factors, symptoms prior to HF diagnosis, and prognosis were reported. RESULTS The study identified 10,067 new cases of HF over 6,816,099 person-years. The median age of patients was 77 years (25th-75th percentile: 66-85), and 48% were male. The incidence rate of HF was 213.44 per 100,000 patient-years, and was higher in male versus female patients (incidence rate ratio: 1.08, 95%-CI:1.04-1.13). Hypertension (men 46.3% and women 55.8%), coronary artery disease (men 36% and women 25%) and diabetes mellitus (men 30.5% and women 26.8%) were the most common risk factors. Dyspnoea and oedema were key reported symptoms prior to HF diagnosis. Survival rates at 10-year follow-up were poor, particularly in men (36.4%) compared to women (39.7%). Incidence rates, comorbidity burden and prognosis were worse in city districts with high ethnic diversity and low socio-economic position. CONCLUSION Our study provides insights into incident HF in a contemporary Western European, multi-ethnic, urban population. It highlights notable sex, age, and geographical differences in incidence rates, risk factors, symptoms and prognosis.
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Affiliation(s)
- Lukas De Clercq
- Amsterdam UMC location University of Amsterdam, Department of General Practice, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Amine Er
- Amsterdam UMC location University of Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - M Louis Handoko
- Amsterdam UMC location VU University, Department of Cardiology, Amsterdam, Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands
| | - Henk C P M van Weert
- Amsterdam UMC location University of Amsterdam, Department of General Practice, Amsterdam, Netherlands
| | - Martijn C Schut
- Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Department of Laboratory Medicine, Translational AI. Amsterdam UMC, Netherlands
| | - Eric P Moll van Charante
- Amsterdam UMC location University of Amsterdam, Department of General Practice, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Jelle C L Himmelreich
- Amsterdam UMC location University of Amsterdam, Department of General Practice, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Ralf E Harskamp
- Amsterdam UMC location University of Amsterdam, Department of General Practice, Amsterdam, Netherlands; Amsterdam Public Health Research Institute, Amsterdam, Netherlands; Amsterdam Cardiovascular Sciences Research Institute, Amsterdam, Netherlands.
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12
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Meijs C, Handoko ML, Savarese G, Vernooij RWM, Vaartjes I, Banerjee A, Koudstaal S, Brugts JJ, Asselbergs FW, Uijl A. Discovering Distinct Phenotypical Clusters in Heart Failure Across the Ejection Fraction Spectrum: a Systematic Review. Curr Heart Fail Rep 2023; 20:333-349. [PMID: 37477803 PMCID: PMC10589200 DOI: 10.1007/s11897-023-00615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 07/22/2023]
Abstract
REVIEW PURPOSE This systematic review aims to summarise clustering studies in heart failure (HF) and guide future clinical trial design and implementation in routine clinical practice. FINDINGS 34 studies were identified (n = 19 in HF with preserved ejection fraction (HFpEF)). There was significant heterogeneity invariables and techniques used. However, 149/165 described clusters could be assigned to one of nine phenotypes: 1) young, low comorbidity burden; 2) metabolic; 3) cardio-renal; 4) atrial fibrillation (AF); 5) elderly female AF; 6) hypertensive-comorbidity; 7) ischaemic-male; 8) valvular disease; and 9) devices. There was room for improvement on important methodological topics for all clustering studies such as external validation and transparency of the modelling process. The large overlap between the phenotypes of the clustering studies shows that clustering is a robust approach for discovering clinically distinct phenotypes. However, future studies should invest in a phenotype model that can be implemented in routine clinical practice and future clinical trial design. HF = heart failure, EF = ejection fraction, HFpEF = heart failure with preserved ejection fraction, HFrEF = heart failure with reduced ejection fraction, CKD = chronic kidney disease, AF = atrial fibrillation, IHD = ischaemic heart disease, CAD = coronary artery disease, ICD = implantable cardioverter-defibrillator, CRT = cardiac resynchronization therapy, NT-proBNP = N-terminal pro b-type natriuretic peptide, BMI = Body Mass Index, COPD = Chronic obstructive pulmonary disease.
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Affiliation(s)
- Claartje Meijs
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Helmholtz Zentrum München GmbH - German Research Center for Environmental Health, Institute of Computational Biology, Neuherberg, Germany
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Robin W M Vernooij
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
- Department of Nephrology and Hypertension, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ilonca Vaartjes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Amitava Banerjee
- Health Data Research UK London, Institute for Health Informatics, University College London, London, UK
| | - Stefan Koudstaal
- Department of Cardiology, Green Heart Hospital, Gouda, the Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Thoraxcenter, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Folkert W Asselbergs
- Health Data Research UK London, Institute for Health Informatics, University College London, London, UK
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Alicia Uijl
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
- Department of Cardiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.
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13
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van de Bovenkamp AA, Geurkink KTJ, Oosterveer FT, de Man FS, Kok WE, Bronzwaer PN, Allaart CP, Nederveen AJ, van Rossum AC, Bakermans AJ, Handoko ML. Trimetazidine in heart failure with preserved ejection fraction: a randomized controlled cross-over trial. ESC Heart Fail 2023; 10:2998-3010. [PMID: 37530098 PMCID: PMC10567667 DOI: 10.1002/ehf2.14418] [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: 02/16/2023] [Revised: 05/04/2023] [Accepted: 05/11/2023] [Indexed: 08/03/2023] Open
Abstract
AIMS Impaired myocardial energy homeostasis plays an import role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Left ventricular relaxation has a high energy demand, and left ventricular diastolic dysfunction has been related to impaired energy homeostasis. This study investigated whether trimetazidine, a fatty acid oxidation inhibitor, could improve myocardial energy homeostasis and consequently improve exercise haemodynamics in patients with HFpEF. METHODS AND RESULTS The DoPING-HFpEF trial was a phase II single-centre, double-blind, placebo-controlled, randomized cross-over trial. Patients were randomized to trimetazidine treatment or placebo for 3 months and switched after a 2-week wash-out period. The primary endpoint was change in pulmonary capillary wedge pressure, measured with right heart catheterization at multiple stages of bicycling exercise. Secondary endpoint was change in myocardial phosphocreatine/adenosine triphosphate, an index of the myocardial energy status, measured with phosphorus-31 magnetic resonance spectroscopy. The study included 25 patients (10/15 males/females; mean (standard deviation) age, 66 (10) years; body mass index, 29.8 (4.5) kg/m2 ); with the diagnosis of HFpEF confirmed with (exercise) right heart catheterization either before or during the trial. There was no effect of trimetazidine on the primary outcome pulmonary capillary wedge pressure at multiple levels of exercise (mean change 0 [95% confidence interval, 95% CI -2, 2] mmHg over multiple levels of exercise, P = 0.60). Myocardial phosphocreatine/adenosine triphosphate in the trimetazidine arm was similar to placebo (1.08 [0.76, 1.76] vs. 1.30 [0.95, 1.86], P = 0.08). There was no change by trimetazidine compared with placebo in the exploratory parameters: 6-min walking distance (mean change of -6 [95% CI -18, 7] m vs. -5 [95% CI -22, 22] m, respectively, P = 0.93), N-terminal pro-B-type natriuretic peptide (5 (-156, 166) ng/L vs. -13 (-172, 147) ng/L, P = 0.70), overall quality-of-life (KCCQ and EQ-5D-5L, P = 0.78 and P = 0.51, respectively), parameters for diastolic function measured with echocardiography and cardiac magnetic resonance, or metabolic parameters. CONCLUSIONS Trimetazidine did not improve myocardial energy homeostasis and did not improve exercise haemodynamics in patients with HFpEF.
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Affiliation(s)
- Arno A. van de Bovenkamp
- Department of CardiologyAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Kiki T. J. Geurkink
- Department of CardiologyAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Frank T.P. Oosterveer
- Department of Pulmonary MedicineAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Frances S. de Man
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
- Department of Pulmonary MedicineAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Wouter E.M. Kok
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
- Department of Clinical and Experimental CardiologyAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | | | - Cor P. Allaart
- Department of CardiologyAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear MedicineAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - Albert C. van Rossum
- Department of CardiologyAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
| | - Adrianus J. Bakermans
- Department of Radiology and Nuclear MedicineAmsterdam University Medical Centers, University of AmsterdamAmsterdamThe Netherlands
| | - M. Louis Handoko
- Department of CardiologyAmsterdam University Medical Centers, Vrije Universiteit AmsterdamAmsterdamThe Netherlands
- Amsterdam Cardiovascular SciencesAmsterdamThe Netherlands
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14
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van de Veerdonk MC, Savarese G, Handoko ML, Beulens JWJ, Asselbergs F, Uijl A. Multimorbidity in Heart Failure: Leveraging Cluster Analysis to Guide Tailored Treatment Strategies. Curr Heart Fail Rep 2023; 20:461-470. [PMID: 37658971 PMCID: PMC10589138 DOI: 10.1007/s11897-023-00626-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 09/05/2023]
Abstract
REVIEW PURPOSE This review summarises key findings on treatment effects within phenotypical clusters of patients with heart failure (HF), making a distinction between patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). FINDINGS Treatment response differed among clusters; ACE inhibitors were beneficial in all HFrEF phenotypes, while only some studies show similar beneficial prognostic effects in HFpEF patients. Beta-blockers had favourable effects in all HFrEF patients but not in HFpEF phenotypes and tended to worsen prognosis in older, cardiorenal patients. Mineralocorticoid receptor antagonists had more favourable prognostic effects in young, obese males and metabolic HFpEF patients. While a phenotype-guided approach is a promising solution for individualised treatment strategies, there are several aspects that still require improvements before such an approach could be implemented in clinical practice. Stronger evidence from clinical trials and real-world data may assist in establishing a phenotype-guided treatment approach for patient with HF in the future.
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Affiliation(s)
- Mariëlle C van de Veerdonk
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Gianluigi Savarese
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, Vrije Universiteit Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Public Health Institute, Amsterdam, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Folkert Asselbergs
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
- Health Data Research UK London, Institute for Health Informatics, University College London, London, UK
| | - Alicia Uijl
- Department of Cardiology, Amsterdam University Medical Centers, Amsterdam Cardiovascular Sciences, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
- Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
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15
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Wessels JN, van Wezenbeek J, de Rover J, Smal R, Llucià-Valldeperas A, Celant LR, Marcus JT, Meijboom LJ, Groeneveldt JA, Oosterveer FPT, Winkelman TA, Niessen HWM, Goumans MJ, Bogaard HJ, Noordegraaf AV, Strijkers GJ, Handoko ML, Westerhof BE, de Man FS. Right Atrial Adaptation to Precapillary Pulmonary Hypertension: Pressure-Volume, Cardiomyocyte, and Histological Analysis. J Am Coll Cardiol 2023; 82:704-717. [PMID: 37587582 DOI: 10.1016/j.jacc.2023.05.063] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 05/25/2023] [Accepted: 05/31/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Precapillary pulmonary hypertension (precPH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness. OBJECTIVES This study aimed to investigate RA function using pressure-volume (PV) loops, isolated cardiomyocyte, and histological analyses. METHODS RA PV loops were constructed in control subjects (n = 9) and precPH patients (n = 27) using magnetic resonance and catheterization data. RA stiffness (pressure rise during atrial filling) and right atrioventricular coupling index (RA minimal volume / RV end-diastolic volume) were compared in a larger cohort of patients with moderate (n = 39) or severe (n = 41) RV diastolic stiffness. Cardiomyocytes were isolated from RA tissue collected from control subjects (n = 6) and precPH patients (n = 9) undergoing surgery. Autopsy material was collected from control subjects (n = 6) and precPH patients (n = 4) to study RA hypertrophy, capillarization, and fibrosis. RESULTS RA PV loops showed 3 RA cardiac phases (reservoir, passive emptying, and contraction) with dilatation and elevated pressure in precPH. PrecPH patients with severe RV diastolic stiffness had increased RA stiffness and worse right atrioventricular coupling index. Cardiomyocyte cross-sectional area was increased 2- to 3-fold in precPH, but active tension generated by the sarcomeres was unaltered. There was no increase in passive tension of the cardiomyocytes, but end-stage precPH showed reduced number of capillaries per mm2 accompanied by interstitial and perivascular fibrosis. CONCLUSIONS RA PV loops show increased RA stiffness and suggest atrioventricular uncoupling in patients with severe RV diastolic stiffness. Isolated RA cardiomyocytes of precPH patients are hypertrophied, without intrinsic sarcomeric changes. In end-stage precPH, reduced capillary density is accompanied by interstitial and perivascular fibrosis.
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Affiliation(s)
- Jeroen N Wessels
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jessie van Wezenbeek
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Jari de Rover
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Rowan Smal
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Aida Llucià-Valldeperas
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Lucas R Celant
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - J Tim Marcus
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lilian J Meijboom
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joanne A Groeneveldt
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Frank P T Oosterveer
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Toon A Winkelman
- Department of Cardiothoracic Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - Hans W M Niessen
- Department of Pathology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Marie-José Goumans
- Department of Cell and Chemical Biology, Leiden UMC, Leiden, the Netherlands
| | - Harm Jan Bogaard
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Anton Vonk Noordegraaf
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands
| | - M Louis Handoko
- Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands; Department of Cardiology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Berend E Westerhof
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Frances S de Man
- PHEniX Laboratory, Department of Pulmonary Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Pulmonary Hypertension and Thrombosis, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands.
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van Poelgeest EP, Handoko ML, Muller M, van der Velde N. Diuretics, SGLT2 inhibitors and falls in older heart failure patients: to prescribe or to deprescribe? A clinical review. Eur Geriatr Med 2023; 14:659-674. [PMID: 36732414 PMCID: PMC10447274 DOI: 10.1007/s41999-023-00752-7] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 01/25/2023] [Indexed: 02/04/2023]
Abstract
PURPOSE Both heart failure and its treatment with diuretics or SGLT2 inhibitors increase fall risk in older adults. Therefore, decisions to continue or deprescribe diuretics or SGLT2 inhibitors in older heart failure patients who have fallen are generally highly complex and challenging for clinicians. However, a comprehensive overview of information required for rationale and safe decision-making is lacking. The aim of this clinical review was to assist clinicians in safe (de)prescribing of these drug classes in older heart failure patients. METHODS We comprehensively searched and summarized published literature and international guidelines on the efficacy, fall-related safety issues, and deprescribing of the commonly prescribed diuretics and SGLT2 inhibitors in older adults. RESULTS Both diuretics and SGLT2 inhibitors potentially cause various fall-related adverse effects. Their fall-related side effect profiles partly overlap (e.g., tendency to cause hypotension), but there are also important differences; based on the currently available evidence of this relatively new drug class, SGLT2 inhibitors seem to have a favorable fall-related adverse effect profile compared to diuretics (e.g., low/absent tendency to cause hyperglycemia or electrolyte abnormalities, low risk of worsening chronic kidney disease). In addition, SGLT2 inhibitors have potential beneficial effects (e.g., disease-modifying effects in heart failure, renoprotective effects), whereas diuretic effects are merely symptomatic. CONCLUSION (De)prescribing diuretics and SGLT2 inhibitors in older heart failure patients who have fallen is often highly challenging, but this clinical review paper assists clinicians in individualized and patient-centered rational clinical decision-making: we provide a summary of available literature on efficacy and (subclass-specific) safety profiles of diuretics and SGLT2 inhibitors, and practical guidance on safe (de)prescribing of these drugs (e.g. a clinical decision tree for deprescribing diuretics in older adults who have fallen).
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Affiliation(s)
- Eveline P van Poelgeest
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands.
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centers, De Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Majon Muller
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Department of Internal Medicine/Geriatrics, Amsterdam University Medical Centers, Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Aging and Later Life, Amsterdam, The Netherlands
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Braams NJ, Kianzad A, Meijboom LJ, Westenberg J, Spruijt OA, Smits J, Vonk Noordegraaf A, Boonstra A, Nossent EJ, Oosterveer F, Handoko ML, Symersky P, de Man FS, Bogaard HJ. Right Ventricular Function During Exercise After Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension. J Am Heart Assoc 2023; 12:e027638. [PMID: 36789863 PMCID: PMC10111481 DOI: 10.1161/jaha.122.027638] [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] [Indexed: 02/16/2023]
Abstract
Background Pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension improves resting hemodynamics and right ventricular (RV) function. Because exercise tolerance frequently remains impaired, RV function may not have completely normalized after PEA. Therefore, we performed a detailed invasive hemodynamic study to investigate the effect of PEA on RV function during exercise. Methods and Results In this prospective study, all consenting patients with chronic thromboembolic pulmonary hypertension eligible for surgery and able to perform cycle ergometry underwent cardiac magnetic resonance imaging, a maximal cardiopulmonary exercise test, and a submaximal invasive cardiopulmonary exercise test before and 6 months after PEA. Hemodynamic assessment and analysis of RV pressure curves using the single-beat method was used to determine load-independent RV contractility (end systolic elastance), RV afterload (arterial elastance), RV-arterial coupling (end systolic elastance-arterial elastance), and stroke volume both at rest and during exercise. RV rest-to-exercise responses were compared before and after PEA using 2-way repeated-measures analysis of variance with Bonferroni post hoc correction. A total of 19 patients with chronic thromboembolic pulmonary hypertension completed the entire study protocol. Resting hemodynamics improved significantly after PEA. The RV exertional stroke volume response improved 6 months after PEA (79±32 at rest versus 102±28 mL during exercise; P<0.01). Although RV afterload (arterial elastance) increased during exercise, RV contractility (end systolic elastance) did not change during exercise either before (0.43 [0.32-0.58] mm Hg/mL versus 0.45 [0.22-0.65] mm Hg/mL; P=0.6) or after PEA (0.32 [0.23-0.40] mm Hg/mL versus 0.28 [0.19-0.44] mm Hg/mL; P=0.7). In addition, mean pulmonary artery pressure-cardiac output and end systolic elastance-arterial elastance slopes remained unchanged after PEA. Conclusions The exertional RV stroke volume response improves significantly after PEA for chronic thromboembolic pulmonary hypertension despite a persistently abnormal afterload and absence of an RV contractile reserve. This may suggest that at mildly elevated pulmonary pressures, stroke volume is less dependent on RV contractility and afterload and is primarily determined by venous return and conduit function.
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Affiliation(s)
- Natalia J Braams
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Azar Kianzad
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Jesper Westenberg
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Onno A Spruijt
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Josien Smits
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Anco Boonstra
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Frank Oosterveer
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Petr Symersky
- Department of Cardiothoracic Surgery Onze Lieve Vrouwe Gasthuis Amsterdam The Netherlands
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam The Netherlands
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De Clercq L, Schut MC, Bossuyt PMM, van Weert HCPM, Handoko ML, Harskamp RE. TARGET-HF: developing a model for detecting incident heart failure among symptomatic patients in general practice using routine health care data. Fam Pract 2023; 40:188-194. [PMID: 35778772 PMCID: PMC9909665 DOI: 10.1093/fampra/cmac069] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Timely diagnosis of heart failure (HF) is essential to optimize treatment opportunities that improve symptoms, quality of life, and survival. While most patients consult their general practitioner (GP) prior to HF, the early stages of HF may be difficult to identify. An integrated clinical support tool may aid in identifying patients at high risk of HF. We therefore constructed a prediction model using routine health care data. METHODS Our study involved a dynamic cohort of patients (≥35 years) who consulted their GP with either dyspnoea and/or peripheral oedema within the Amsterdam metropolitan area from 2011 to 2020. The outcome of interest was incident HF, verified by an expert panel. We developed a regularized, cause-specific multivariable proportional hazards model (TARGET-HF). The model was evaluated with bootstrapping on an isolated validation set and compared to an existing model developed with hospital insurance data as well as patient age as a sole predictor. RESULTS Data from 31,905 patients were included (40% male, median age 60 years) of whom 1,301 (4.1%) were diagnosed with HF over 124,676 person-years of follow-up. Data were allocated to a development (n = 25,524) and validation (n = 6,381) set. TARGET-HF attained a C-statistic of 0.853 (95% CI, 0.834 to 0.872) on the validation set, which proved to provide a better discrimination than C = 0.822 for age alone (95% CI, 0.801 to 0.842, P < 0.001) and C = 0.824 for the hospital-based model (95% CI, 0.802 to 0.843, P < 0.001). CONCLUSION The TARGET-HF model illustrates that routine consultation codes can be used to build a performant model to identify patients at risk for HF at the time of GP consultation.
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Affiliation(s)
- Lukas De Clercq
- Department of General Practice, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Martijn C Schut
- Department of Medical Informatics, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Patrick M M Bossuyt
- Department of Public Health and Clinical Epidemiology, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Location VU Medical Center, Vrije Universiteit, Amsterdam, The Netherlands
| | - Ralf E Harskamp
- Department of General Practice, Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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19
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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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20
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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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Van De Bovenkamp AA, Bakermans AJ, Geurkink KJT, Oosterveer FTP, De Man FS, De Kok WEM, Nederveen AJ, Van Rossum AC, Handoko ML. Trimetazidine in heart failure with preserved ejection fracton: a randomized, double-blind cross-over trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.776] [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
Introduction
Impaired myocardial mitochondrial function plays an import role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Left ventricular relaxation has a high energy demand, and there is evidence indicative of a causal relationship between observed impaired energy homeostasis and diastolic dysfunction. Improvement of mitochondrial function with metabolism-modulating drugs may be a promising novel therapeutic approach in HFpEF. Trimetazidine – a fatty acid oxidation inhibitor – shifts mitochondrial metabolism towards glucose oxidation, which results in higher mitochondrial oxygen efficiency. In this study we investigated whether trimetazidine improves diastolic function during exercise in HFpEF by improving the myocardial energy homeostasis.
Methods
The DoPING-HFpEF trial was a phase II single-center, double-blind, placebo-controlled, randomized cross-over trial. The study consisted of two treatment periods of three months separated by a 2-week wash-out period (Figure 1). Patients were treated with placebo or trimetazidine three times a day (or twice daily in case of an impaired kidney function). The primary endpoint was change in pulmonary capillary wedge pressure (PCWP) measured with right heart catheterization at multiple stages of exercise. Secondary endpoint was change in phosphocreatine (PCr)/adenosine triphosphate (ATP) ratio, an index of the myocardial energy status, measured with phosphorus-31 magnetic resonance (MR) spectroscopy. Additional exploratory endpoints were 6-minute-walking-distance, diastolic and systolic parameters measured with echocardiography or cardiac MR, NT-proBNP levels, and quality of life.
Results
Twenty-five HFpEF patients were included and completed the trial, 80% of which were included based on previously established elevated (exercise) PCWP, and 20% were included based on diastolic dysfunction grade ≥II on echocardiography and elevated NT-proBNP levels. There was no effect on the primary outcome PCWP at multiple levels of exercise, with an average change in PCWP of 0±4 (SD) mmHg (Figure 2A, P=0.97). Myocardial PCr/ATP in the trimetazidine arm was similar to placebo (Figure 2B, P=0.08). There was no change by trimetazidine in the exploratory parameters 6-minute walking distance, NT-proBNP, overall quality of life, or other parameters for diastolic function measured with echocardiography and cardiac MR. There was no indication of period or cross over effect.
Conclusion
Trimetazidine did not improve diastolic function or myocardial energy homeostasis in patients with HFpEF.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation (DHF) and “Out-of-the-Box” grant from the Amsterdam Cardiovascular Sciences (ACS) Institute, Amsterdam, The Netherlands.
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Affiliation(s)
| | - A J Bakermans
- Amsterdam UMC - Location Academic Medical Center, Radiology & Nuclear Medicine , Amsterdam , The Netherlands
| | - K J T Geurkink
- Amsterdam UMC - Location VUmc, Cardiology , Amsterdam , The Netherlands
| | - F T P Oosterveer
- Amsterdam UMC - Location VUmc, Pulmonology , Amsterdam , The Netherlands
| | - F S De Man
- Amsterdam UMC - Location VUmc, Pulmonology , Amsterdam , The Netherlands
| | - W E M De Kok
- Amsterdam UMC - Location Academic Medical Center, Clinical and Experimental Cardiology , Amsterdam , The Netherlands
| | - A J Nederveen
- Amsterdam UMC - Location Academic Medical Center, Radiology & Nuclear Medicine , Amsterdam , The Netherlands
| | - A C Van Rossum
- Amsterdam UMC - Location VUmc, Cardiology , Amsterdam , The Netherlands
| | - M L Handoko
- Amsterdam UMC - Location VUmc, Cardiology , Amsterdam , The Netherlands
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Remmelzwaal S, van Oort S, Handoko ML, van Empel V, Heymans SRB, Beulens JWJ. Inflammation and heart failure: a two-sample Mendelian randomization study. J Cardiovasc Med (Hagerstown) 2022; 23:728-735. [PMID: 36166332 DOI: 10.2459/jcm.0000000000001373] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is hypothesized that inflammation leads to heart failure. Results from observational studies thus far have been inconsistent and it is unclear whether inflammation is causally associated with new-onset heart failure. Mendelian randomization analyses are less prone to biases common in observational studies such as reverse causation and unmeasured confounding. The aim of this study was to investigate the causal relation between various inflammatory biomarkers with risk of new-onset heart failure by using a two-sample Mendelian randomization approach. METHODS Ten inflammatory biomarkers with available genome-wide association studies (GWAS) among individuals of European ancestry were identified and included C-reactive protein (CRP), immunoglobulin E, tumour necrosis factor (TNF), toll-like receptor 4, interleukin 1 receptor antagonist, interleukin 2 receptor subunit α, interleukin 6 receptor subunit α, interleukin 16, 17 and 18. For the associations between the identified SNPs and heart failure, we used the largest GWAS meta-analysis performed by the Heart Failure Molecular Epidemiology for Therapeutic Targets Consortium with 47 309 participants with heart failure and 930 014 controls. For our main analyses, we used the inverse-variance weighted method. RESULTS We included 63 SNPs. CRP, TNF, interleukin 2, 16 and 18 were not associated with heart failure with odds ratios (ORs) of 1.01 [95% confidence interval (95% CI: 0.94-1.09), 1.11 (95% CI: 0.80-1.48), 0.97 (95% CI: 0.93-1.02), 0.99 (95% CI: 0.96-1.03) and 1.01 (95% CI: 0.97-1.06), respectively. The other biomarkers were also not associated with the risk of heart failure and suffered from weak instrument bias. CONCLUSION This Mendelian randomization study could not determine a causal relationship between inflammation and risk of heart failure. However, some biomarkers suffered from weak instrument bias.
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Affiliation(s)
- Sharon Remmelzwaal
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences
| | - Sabine van Oort
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam
| | | | - Stephane R B Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht
| | - Joline W J Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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23
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Reddy YNV, Kaye DM, Handoko ML, van de Bovenkamp AA, Tedford RJ, Keck C, Andersen MJ, Sharma K, Trivedi RK, Carter RE, Obokata M, Verbrugge FH, Redfield MM, Borlaug BA. Diagnosis of Heart Failure With Preserved Ejection Fraction Among Patients With Unexplained Dyspnea. JAMA Cardiol 2022; 7:891-899. [PMID: 35830183 DOI: 10.1001/jamacardio.2022.1916] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [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: 01/10/2023]
Abstract
Importance Diagnosis of heart failure with preserved ejection fraction (HFpEF) among dyspneic patients without overt congestion is challenging. Multiple diagnostic approaches have been proposed but are not well validated against the independent gold standard for HFpEF diagnosis of an elevated pulmonary capillary wedge pressure (PCWP) during exercise. Objective To evaluate H2FPEF and HFA-PEFF scores and a PCWP/cardiac output (CO) slope of more than 2 mm Hg/L/min to diagnose HFpEF. Design, Setting, and Participants This retrospective case-control study included patients with unexplained dyspnea from 6 centers in the US, the Netherlands, Denmark, and Australia from March 2016 to October 2020. Diagnosis of HFpEF (cases) was definitively ascertained by the presence of elevated PCWP during exertion; control individuals were those with normal rest and exercise hemodynamics. Main Outcomes and Measures Logistic regression was used to evaluate the accuracy of HFA-PEFF and H2FPEF scores to discriminate patients with HFpEF from controls. Results Among 736 patients, 563 (76%) were diagnosed with HFpEF (mean [SD] age, 69 [11] years; 334 [59%] female) and 173 (24%) represented controls (mean [SD] age, 60 [15] years; 109 [63%] female). H2FPEF and HFA-PEFF scores discriminated patients with HFpEF from controls, but the H2FPEF score had greater area under the curve (0.845; 95% CI, 0.810-0.875) compared with the HFA-PEFF score (0.710; 95% CI, 0.659-0.756) (difference, -0.134; 95% CI, -0.177 to -0.094; P < .001). Specificity was robust for both scores, but sensitivity was poorer for HFA-PEFF, with a false-negative rate of 55% for low-probability scores compared with 25% using the H2FPEF score. Use of the PCWP/CO slope to redefine HFpEF rather than exercise PCWP reclassified 20% (117 of 583) of patients, but patients reclassified from HFpEF to control by this metric had clinical, echocardiographic, and hemodynamic features typical of HFpEF, including elevated resting PCWP in 66% (46 of 70) of reclassified patients. Conclusions and Relevance In this case-control study, despite requiring fewer data, the H2FPEF score had superior diagnostic performance compared with the HFA-PEFF score and PCWP/CO slope in the evaluation of unexplained dyspnea and HFpEF in the outpatient setting.
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Affiliation(s)
- Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - David M Kaye
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Arno A van de Bovenkamp
- Department of Cardiology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, the Netherlands
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Carson Keck
- Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston
| | - Mads J Andersen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kavita Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rishi K Trivedi
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Rickey E Carter
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, Florida
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Frederik H Verbrugge
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
| | | | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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24
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Kianzad A, van Wezenbeek J, Celant LR, Oosterveer FP, Noordegraaf AV, Meijboom LJ, de Man FS, Bogaard HJ, Handoko ML. Idiopathic pulmonary arterial hypertension patients with a high H2FPEF-score: insights from the Amsterdam UMC PAH-cohort. J Heart Lung Transplant 2022; 41:1075-1085. [DOI: 10.1016/j.healun.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 04/19/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
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25
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van Ham WB, Kessler EL, Oerlemans MI, Handoko ML, Sluijter JP, van Veen TA, den Ruijter HM, de Jager SC. Clinical Phenotypes of Heart Failure With Preserved Ejection Fraction to Select Preclinical Animal Models. JACC Basic Transl Sci 2022; 7:844-857. [PMID: 36061340 PMCID: PMC9436760 DOI: 10.1016/j.jacbts.2021.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 11/18/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 11/21/2022]
Abstract
To better define HFpEF clinically, patients are nowadays often clustered into phenogroups, based on their comorbidities and symptoms Many animal models claim to mimic HFpEF, but phenogroups are not yet regularly used to cluster them HFpEF animals models often lack reports of clinical symptoms of HF, therefore mainly presenting as extended models of LVDD, clinically seen as a prestate of HFpEF We investigated if clinically relevant phenogroups can guide selection of animal models aiming at better defined animal research
At least one-half of the growing heart failure population consists of heart failure with preserved ejection fraction (HFpEF). The limited therapeutic options, the complexity of the syndrome, and many related comorbidities emphasize the need for adequate experimental animal models to study the etiology of HFpEF, as well as its comorbidities and pathophysiological changes. The strengths and weaknesses of available animal models have been reviewed extensively with the general consensus that a “1-size-fits-all” model does not exist, because no uniform HFpEF patient exists. In fact, HFpEF patients have been categorized into HFpEF phenogroups based on comorbidities and symptoms. In this review, we therefore study which animal model is best suited to study the different phenogroups—to improve model selection and refinement of animal research. Based on the published data, we extrapolated human HFpEF phenogroups into 3 animal phenogroups (containing small and large animals) based on reports and definitions of the authors: animal models with high (cardiac) age (phenogroup aging); animal models focusing on hypertension and kidney dysfunction (phenogroup hypertension/kidney failure); and models with hypertension, obesity, and type 2 diabetes mellitus (phenogroup cardiometabolic syndrome). We subsequently evaluated characteristics of HFpEF, such as left ventricular diastolic dysfunction parameters, systemic inflammation, cardiac fibrosis, and sex-specificity in the different models. Finally, we scored these parameters concluded how to best apply these models. Based on our findings, we propose an easy-to-use classification for future animal research based on clinical phenogroups of interest.
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Affiliation(s)
- Willem B. van Ham
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elise L. Kessler
- Laboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Utrecht Regenerative Medicine Center, Circulatory Health Laboratory, University of Utrecht, Utrecht, the Netherlands
| | | | - M. Louis Handoko
- Department of Cardiology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Joost P.G. Sluijter
- Laboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Utrecht Regenerative Medicine Center, Circulatory Health Laboratory, University of Utrecht, Utrecht, the Netherlands
| | - Toon A.B. van Veen
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hester M. den Ruijter
- Laboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Saskia C.A. de Jager
- Laboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Address for correspondence: Dr Saskia C.A. de Jager, Laboratory for Experimental Cardiology, Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, the Netherlands.
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26
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Ruigrok D, Handoko ML, Meijboom LJ, Nossent EJ, Boonstra A, Braams NJ, van Wezenbeek J, Tepaske R, Tuinman PR, Heunks LM, Vonk Noordegraaf A, de Man FS, Symersky P, Bogaard HJ. Non-invasive follow-up strategy after pulmonary endarterectomy for CTEPH. ERJ Open Res 2022; 8:00564-2021. [PMID: 35586450 PMCID: PMC9108966 DOI: 10.1183/23120541.00564-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/16/2022] [Indexed: 11/26/2022] Open
Abstract
Background The success of pulmonary endarterectomy (PEA) for chronic thromboembolic pulmonary hypertension (CTEPH) is usually evaluated by performing a right heart catheterisation (RHC). Here, we investigate whether residual pulmonary hypertension (PH) can be sufficiently excluded without the need for a RHC, by making use of early post-operative haemodynamics, or N-terminal pro-brain natriuretic peptide (NT-proBNP), cardiopulmonary exercise testing (CPET) and transthoracic echocardiography (TTE) 6 months after PEA. Methods In an observational analysis, residual PH after PEA measured by RHC was related to haemodynamic data from the post-operative intensive care unit time and data from a 6-month follow-up assessment including NT-proBNP, TTE and CPET. After dichotomisation and univariate analysis, sensitivity, specificity, positive predictive value, negative predictive value (NPV) and likelihood ratios were calculated. Results Thirty-six out of 92 included patients had residual PH 6 months after PEA (39%). Correlation between early post-operative and 6-month follow-up mean pulmonary artery pressure was moderate (Spearman rho 0.465, p<0.001). Early haemodynamics did not predict late success. NT-proBNP >300 ng·L−1 had insufficient NPV (0.71) to exclude residual PH. Probability for PH on TTE had a moderate NPV (0.74) for residual PH. Peak oxygen consumption (V′O2) <80% predicted had the highest sensitivity (0.85) and NPV (0.84) for residual PH. Conclusions CPET 6 months after PEA, and to a lesser extent TTE, can be used to exclude residual CTEPH, thereby safely reducing the number of patients needing to undergo re-RHC after PEA. In approximately one-third to one-half of CTEPH patients, residual pulmonary hypertension after pulmonary endarterectomy can be excluded based on cardiopulmonary exercise testing or echocardiography, without the need for right heart catheterisationhttps://bit.ly/3pbj2Ge
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27
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van de Bovenkamp AA, Wijkstra N, Oosterveer FPT, Vonk Noordegraaf A, Bogaard HJ, van Rossum AC, de Man FS, Borlaug BA, Handoko ML. The Value of Passive Leg Raise During Right Heart Catheterization in Diagnosing Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2022; 15:e008935. [PMID: 35311526 PMCID: PMC9009844 DOI: 10.1161/circheartfailure.121.008935] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [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: 11/16/2022]
Abstract
BACKGROUND Because of limited accuracy of noninvasive tests, diastolic stress testing plays an important role in the diagnostic work-up of patients with heart failure with preserved ejection fraction (HFpEF). Exercise right heart catheterization is considered the gold standard and indicated when HFpEF is suspected but left ventricular filling pressures at rest are normal. However, performing exercise during right heart catheterization is not universally available. Here, we examined whether pulmonary capillary wedge pressure (PCWP) during a passive leg raise (PLR) could be used as simple and accurate method to diagnose or rule out occult-HFpEF. METHODS In our tertiary center for pulmonary hypertension and HFpEF, all patients who received a diagnostic right heart catheterization with PCWP-measurements at rest, PLR, and exercise were evaluated (2014-2020). The diagnostic value of PCWPPLR was compared with the gold standard (PCWPEXERCISE). Cut-offs derived from our cohort were subsequently validated in an external cohort (N=74). RESULTS Thirty-nine non-HFpEF, 33 occult-HFpEF, and 37 manifest-HFpEF patients were included (N=109). In patients with normal PCWPREST (<15 mmHg), PCWPPLR significantly improved diagnostic accuracy compared with PCWPREST (AUC=0.82 versus 0.69, P=0.03). PCWPPLR ≥19 mmHg (24% of cases) had a specificity of 100% for diagnosing occult-HFpEF, irrespective of diuretic use. PCWPPLR ≥11 mmHg had a 100% sensitivity and negative predictive value for diagnosing occult-HFpEF. Both cut-offs retained a 100% specificity and 100% sensitivity in the external cohort. Absolute change in PCWPPLR or V-wave derived parameters had no incremental value in diagnosing occult-HFpEF. CONCLUSIONS PCWPPLR is a simple and powerful tool that can help to diagnose or rule out occult-HFpEF.
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Affiliation(s)
- Arno A van de Bovenkamp
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
| | - Niels Wijkstra
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
| | - Frank P T Oosterveer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Anton Vonk Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Harm Jan Bogaard
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Albert C van Rossum
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
| | - Frances S de Man
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pulmonology, Amsterdam Cardiovascular Sciences, the Netherlands (F.P.T.O., A.V.N., H.J.B., F.S.d.M.)
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - M Louis Handoko
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, the Netherlands (A.A.v.d.B., N.W., A.C.v.R., M.L.H.)
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van de Bovenkamp AA, Wijkstra N, Oosterveer F, Noordegraaf AV, Bogaard HJ, van Rossum AC, De Man FS, Borlaug B, Handoko ML. THE VALUE OF PASSIVE LEG RAISE DURING RIGHT HEART CATHETERIZATION IN DIAGNOSING HEART FAILURE WITH PRESERVED EJECTION FRACTION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
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Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
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Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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van Wezenbeek J, Kianzad A, van de Bovenkamp A, Wessels J, Mouratoglou SA, Braams NJ, Jansen SMA, Meulblok E, Meijboom LJ, Marcus JT, Vonk Noordegraaf A, José Goumans M, Jan Bogaard H, Handoko ML, de Man FS. Right Ventricular and Right Atrial Function Are Less Compromised in Pulmonary Hypertension Secondary to Heart Failure With Preserved Ejection Fraction: A Comparison With Pulmonary Arterial Hypertension With Similar Pressure Overload. Circ Heart Fail 2021; 15:e008726. [PMID: 34937392 PMCID: PMC8843396 DOI: 10.1161/circheartfailure.121.008726] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Heart failure with preserved ejection fraction (HFpEF) is a prevalent disorder for which no effective treatment yet exists. Pulmonary hypertension (PH) and right atrial (RA) and ventricular (RV) dysfunction are frequently observed. The question remains whether the PH with the associated RV/RA dysfunction in HFpEF are markers of disease severity. Methods: To obtain insight in the relative importance of pressure-overload and left-to-right interaction, we compared RA and RV function in 3 groups: 1. HFpEF (n=13); 2. HFpEF-PH (n=33), and; 3. pulmonary arterial hypertension (PAH) matched to pulmonary artery pressures of HFpEF-PH (PH limited to mPAP ≥30 and ≤50 mmHg) (n=47). Patients underwent right heart catheterization and cardiac magnetic resonance imaging. Results: The right ventricle in HFpEF-PH was less dilated and hypertrophied than in PAH. In addition, RV ejection fraction was more preserved (HFpEF-PH: 52±11 versus PAH: 36±12%). RV filling patterns differed: vena cava backflow during RA contraction was observed in PAH only. In HFpEF-PH, RA pressure was elevated throughout the cardiac cycle (HFpEF-PH: 10 [8–14] versus PAH: 7 [5–10] mm Hg), while RA volume was smaller, reflecting excessive RA stiffness (HFpEF-PH: 0.14 [0.10–0.17] versus PAH: 0.08 [0.06–0.11] mm Hg/mL). RA stiffness was associated with an increased eccentricity index (HFpEF-PH: 1.3±0.2 versus PAH: 1.2±0.1) and interatrial pressure gradient (9 [5 to 12] versus 2 [−2 to 5] mm Hg). Conclusions: RV/RA function was less compromised in HFpEF-PH than in PAH, despite similar pressure-overload. Increased RA pressure and stiffness in HFpEF-PH were explained by left atrial/RA-interaction. Therefore, our results indicate that increased RA pressure is not a sign of overt RV failure but rather a reflection of HFpEF-severity.
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Affiliation(s)
- Jessie van Wezenbeek
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | | | - Arno van de Bovenkamp
- Department of Cardiology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (A.v.d.B., M.L.H.)
| | | | - Sophia A Mouratoglou
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Natalia J Braams
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Samara M A Jansen
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Eva Meulblok
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Lilian J Meijboom
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (L.J.M., J.T.M.)
| | - J Tim Marcus
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (L.J.M., J.T.M.)
| | - Anton Vonk Noordegraaf
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - Marie José Goumans
- Department of Cell and Chemical Biology, Leiden University Medical Centre, the Netherlands (M.J.G.)
| | - Harm Jan Bogaard
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
| | - M Louis Handoko
- Department of Cardiology, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (A.v.d.B., M.L.H.)
| | - Frances S de Man
- Department of Pulmonary Medicine, Amsterdam University Medical Centres, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, the Netherlands. (J.v.W., S.A.M., N.J.B., S.M.A.J., E.M., A.V.N., H.J.B., F.S.d.M.)
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Wessels JN, Mouratoglou SA, van Wezenbeek J, Handoko ML, Marcus JT, Meijboom LJ, Westerhof BE, Jan Bogaard H, Strijkers GJ, Vonk Noordegraaf A, de Man FS. Right atrial function is associated with RV diastolic stiffness: RA-RV interaction in pulmonary arterial hypertension. Eur Respir J 2021; 59:13993003.01454-2021. [PMID: 34764180 PMCID: PMC9218241 DOI: 10.1183/13993003.01454-2021] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 10/24/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness. This study assessed the impact of RV diastolic stiffness on RA-RV interaction. METHODS Low or high end-diastolic elastance (Eed) PAH patients (n=94) were compared to controls (n=31). Treatment response was evaluated in n=62 patients. RV and RA longitudinal strain, RA emptying and RV filling were determined and diastole was divided in a passive and active phase. Vena cava backflow was calculated as RV active filling-RA active emptying; RA stroke work as RA active emptying*RV end-diastolic pressure. RESULTS With increased Eed, RA and RV passive strain were reduced while active strain was preserved. In comparison to controls, patients had lower RV passive filling, but higher RA active emptying and RA stroke work. RV active filling was lower in high Eed patients, resulting in higher vena cava backflow. Upon treatment, Eed reduced in half of high Eedpatients, which coincided with larger reductions in afterload, RV mass and vena cava backflow and greater improvements in RV active filling and stroke volume in comparison to patients in whom Eed remained high. CONCLUSIONS In PAH, RA function is associated with changes in RV function. Despite increased RA stroke work, severe RV diastolic stiffness is associated with reduced RV active filling and increased vena cava backflow. In 50% of high baseline Eed patients, diastolic stiffness remains high, despite treatment. Eed reduction coincided with a large reduction in afterload, increased RV active filling and decreased vena cava backflow.
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Affiliation(s)
- Jeroen N Wessels
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sophia A Mouratoglou
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jessie van Wezenbeek
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M Louis Handoko
- Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J Tim Marcus
- Radiology and Nuclear medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Lilian J Meijboom
- Radiology and Nuclear medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Berend E Westerhof
- Cardiovascular and Respiratory Physiology, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Harm Jan Bogaard
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Gustav J Strijkers
- Dept of Biomedical Engineering and Physics, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Anton Vonk Noordegraaf
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frances S de Man
- Pulmonary Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Remmelzwaal S, Beulens JWJ, Elders PJM, Stehouwer CDA, Handoko ML, Appelman Y, van Empel V, Heymans SRB, van Ballegooijen AJ. Sex-specific associations of body composition measures with cardiac function and structure after 8 years of follow-up. Sci Rep 2021; 11:21046. [PMID: 34702868 PMCID: PMC8548503 DOI: 10.1038/s41598-021-00541-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 10/06/2021] [Indexed: 12/01/2022] Open
Abstract
We investigated the prospective associations of body composition with cardiac structure and function and explored effect modification by sex and whether inflammation was a mediator in these associations. Total body (BF), trunk (TF) and leg fat (LF), and total lean mass (LM) were measured at baseline by a whole body DXA scan. Inflammatory biomarkers and echocardiographic measures were determined both at baseline and follow-up in the Hoorn Study (n = 321). We performed linear regression analyses with body composition measures as determinant and left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI) or left atrial volume index (LAVI) at follow-up as outcome. Additionally, we performed mediation analysis using inflammation at follow-up as mediator. The study population was 67.7 ± 5.2 years and 50% were female. After adjustment, BF, TF and LF, and LM were associated with LVMI with regression coefficients of 2.9 (0.8; 5.1)g/m2.7, 2.3 (0.6; 4.0)g/m2.7, 2.0 (0.04; 4.0)g/m2.7 and − 2.9 (− 5.1; − 0.7)g/m2.7. Body composition measures were not associated with LVEF or LAVI. These associations were not modified by sex or mediated by inflammation. Body composition could play a role in the pathophysiology of LV hypertrophy. Future research should focus on sex differences in regional adiposity in relation with diastolic dysfunction.
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Affiliation(s)
- Sharon Remmelzwaal
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.
| | - Joline W J Beulens
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Yolande Appelman
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Vanessa van Empel
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University, CARIM School for Cardiovascular Diseases, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.,Centre for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, bus 911, 3000, Leuven, Belgium
| | - A Johanne van Ballegooijen
- Department of Epidemiology and Data Science, Amsterdam UMC, VU University Medical Center, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1089a, 1081 HV, Amsterdam, The Netherlands.,Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
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van de Bovenkamp AA, Enait V, de Man FS, Oosterveer FTP, Bogaard HJ, Vonk Noordegraaf A, van Rossum AC, Handoko ML. Validation of the 2016 ASE/EACVI Guideline for Diastolic Dysfunction in Patients With Unexplained Dyspnea and a Preserved Left Ventricular Ejection Fraction. J Am Heart Assoc 2021; 10:e021165. [PMID: 34476984 PMCID: PMC8649534 DOI: 10.1161/jaha.121.021165] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 12/11/2022]
Abstract
Background Echocardiography is considered the cornerstone of the diagnostic workup of heart failure with preserved ejection fraction. Thus far, validation of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) echo‐algorithm for evaluation of diastolic (dys)function in a patient suspected of heart failure with preserved ejection fraction has been limited. Methods and Results The diagnostic performance of the 2016 ASE/EACVI algorithm was assessed in 204 patients evaluated for unexplained dyspnea or pulmonary hypertension with echocardiogram and right heart catheterization. Invasively measured pulmonary capillary wedge pressure (PCWP) was used as the gold standard. In addition, the diagnostic performance of H2FPEF score and NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide) were evaluated. There was a poor correlation between indexed left atrial volume, E/e′ (septal and average) or early mitral inflow (E), and PCWP (r=0.25–0.30, P values all <0.01). No correlation was found in our cohort between e′ (septal or lateral) or tricuspid valve regurgitation and PCWP. The correlation between diastolic function grades of the ASE/EACVI algorithm and PCWP was poor (r=0.17, P<0.05). The ASE/EACVI algorithm had a sensitivity and specificity of 35% and 87%, respectively; an accuracy of 67% and an area under the curve of 0.56. Moreover, in 30% of cases the algorithm was not applicable or indeterminate. H2FPEF score had a modest correlation with PCWP (r=0.44, P<0.0001), and accuracy was 73%; NT‐proBNP correlated weakly with PCWP (r=0.24, P<0.001), and accuracy was 57%. Conclusions The 2016 ASE/EACVI algorithm for the assessment of diastolic function has a limited diagnostic accuracy in patients evaluated for unexplained dyspnea and/or pulmonary hypertension, and especially sensitivity to detect diastolic dysfunction was low.
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Affiliation(s)
- Arno A van de Bovenkamp
- Department of Cardiology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Vidya Enait
- Department of Cardiology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Frances S de Man
- Department of Pulmonology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Frank T P Oosterveer
- Department of Pulmonology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Anton Vonk Noordegraaf
- Department of Pulmonology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Albert C van Rossum
- Department of Cardiology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - M Louis Handoko
- Department of Cardiology Amsterdam Cardiovascular Sciences (ACS) Amsterdam UMC, Vrije Universiteit Amsterdam Amsterdam The Netherlands
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34
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Zwart K, Velthuis S, Polyukhovych YV, Mosterd A, Smidt L, Serné EH, van Raalte DH, Elders PJM, Handoko ML, Oldenburg-Ligtenberg PC. Sodium-glucose cotransporter 2 inhibitors: a practical guide for the Dutch cardiologist based on real-world experience. Neth Heart J 2021; 29:490-499. [PMID: 34132981 PMCID: PMC8455761 DOI: 10.1007/s12471-021-01580-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 01/01/2023] Open
Abstract
Sodium-glucose cotransporter 2 (SGLT2) inhibitors include a relatively new class of glucose-lowering drugs that reduce plasma glucose concentrations by inhibiting proximal tubular reabsorption of glucose in the kidney, while increasing its excretion in urine. Recent large randomised controlled trials have demonstrated that many of these agents reduce the occurrence of major adverse cardiovascular events, hospitalisation for heart failure, cardiovascular death and/or chronic kidney disease progression in patients with and without type 2 diabetes mellitus (DM2). Given their unique insulin-independent mode of action and favourable efficacy and adverse-event profile, SGLT2 inhibitors are promising and they offer an interesting therapeutic approach for the cardiologist to incorporate into routine practice. However, despite accumulating data supporting this class of therapy, cardiologists infrequently prescribe SGLT2 inhibitors, potentially due to a lack of familiarity with their use and the reticence to change DM medication. Here, we provide an up-to-date practical guide highlighting important elements of treatment initiation based on real-world evidence and expert opinion. We describe how to change DM medication, including insulin dosing when appropriate, and how to anticipate any adverse events based on real-world experience in patients with DM2 in the Meander Medical Centre in Amersfoort, the Netherlands. This includes a simple algorithm showing how to initiate SGLT2 inhibitor treatment safely, while considering the consequence of the glucosuric effects of these inhibitors for the individual patient.
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Affiliation(s)
- K Zwart
- Department of Internal Medicine/Endocrinology, Meander Medical Centre, Amersfoort, The Netherlands
| | - S Velthuis
- Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Y V Polyukhovych
- Department of Cardiology, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - A Mosterd
- Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| | - L Smidt
- Department of Internal Medicine/Endocrinology, Meander Medical Centre, Amersfoort, The Netherlands
| | - E H Serné
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - D H van Raalte
- Department of Internal Medicine/Endocrinology, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - P J M Elders
- Department of General Practice, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands
| | - M L Handoko
- Department of Cardiology, Amsterdam University Medical Centers, location VU University Medical Center, Amsterdam, The Netherlands.
| | - P C Oldenburg-Ligtenberg
- Department of Internal Medicine/Endocrinology, Meander Medical Centre, Amersfoort, The Netherlands
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35
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Conradi PM, van Loon RB, Handoko ML. Dynamic left ventricular outflow tract obstruction in Takotsubo cardiomyopathy resulting in cardiogenic shock. BMJ Case Rep 2021; 14:e240010. [PMID: 33762278 PMCID: PMC7993169 DOI: 10.1136/bcr-2020-240010] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 01/30/2023] Open
Abstract
We report a case of a 73-year-old female patient, who was admitted to the coronary care unit due to chest pain, malaise and near syncope. During physical examination, the patient was hypotensive and there were signs of left-sided heart failure and a loud systolic murmur. Echocardiogram showed apical ballooning with dynamic left ventricular outflow tract obstruction, based on systolic anterior motion of the mitral valve with important mitral valve regurgitation. In the acute setting, the cardiogenic shock was treated cautiously with fluid resuscitation and intravenous metoprolol, resulting in direct stabilisation of her haemodynamic condition. As a codiagnosis, there was a significant stenosis of left anterior descending artery, which was treated successfully by percutaneous coronary intervention with drug eluting stents. During follow-up, left ventricular function normalised, and the left ventricular outflow tract obstruction, systolic anterior motion of mitral valve and related mitral regurgitation all resolved.
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Affiliation(s)
- Paulina M Conradi
- Cardiology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - Ramon B van Loon
- Cardiology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
| | - M Louis Handoko
- Cardiology, Amsterdam UMC, Amsterdam, Noord-Holland, The Netherlands
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36
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von Bartheld MB, Duffels MGJ, Handoko ML. Too much of a good thing: a case report of traumatic drop attacks and syncope due to orthostatic hypertension. Eur Heart J Case Rep 2021; 5:ytaa479. [PMID: 33554018 PMCID: PMC7850609 DOI: 10.1093/ehjcr/ytaa479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/04/2020] [Accepted: 11/02/2020] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Orthostatic hypertension (OHT) is the clinical opposite to orthostatic hypotension and is an under-recognized and poorly understood clinical phenomenon. Patients may experience disabling symptoms such as dizziness, chest pain, and shortness of breath. In addition, OHT is associated with important clinical outcomes such as silent cerebral infarcts and cognitive decline.
Case summary
We present the case of a 67-year-old female who experienced frequent drop attacks with and without transient loss of consciousness causing various injuries. A range of standard diagnostic procedures did not yield an explanation for her symptoms but head-up tilt (HUT) testing showed OHT and induced most of her symptoms. Upon initiation of doxazosin, an alpha-blocking drug, she was free of symptoms and blood pressure response was normal on the repeat HUT test.
Discussion
To our knowledge, this is the first report of syncope due to OHT. Orthostatic hypertension is a heterogeneous condition and may occur in young, otherwise healthy individuals but also in older patients with cardiovascular comorbidities. It is thought that symptoms occur because of excessive venous pooling (causing a drop in cardiac output) or adrenergic hypersensitivity (resulting in cerebral vasoconstriction or acute rise in cardiac afterload). Since our patient had a marked response to an alpha-blocking agent, we think baroreflex hypersensitivity is the most likely cause of her complaints. Though syncope is probably rare, OHT should be regarded as a possible explanation of orthostatic symptoms.
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Affiliation(s)
- Martin B von Bartheld
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Post Office Box 7057, 1007 MB Amsterdam, the Netherlands
| | - Mariëlle G J Duffels
- Department of Cardiology, Noord West Ziekenhuis Groep, Post Office Box 501, 1800 AM Alkmaar, the Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Post Office Box 7057, 1007 MB Amsterdam, the Netherlands
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37
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Baniaamam M, Voskuyl AE, Nurmohamed MT, Handoko ML. Clinical improvement of cardiac function in a patient with systemic lupus erythematosus and heart failure with preserved ejection fraction treated with belimumab. BMJ Case Rep 2021; 14:14/1/e237549. [PMID: 33452071 PMCID: PMC7813343 DOI: 10.1136/bcr-2020-237549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
We present a 51-year-old Caucasian woman, with a medical history of systemic lupus erythematosus (SLE) who had dyspnoea at exertion. The SLE was clinically quiescent but serologically active. Echocardiography showed preserved left ventricular (LV) systolic function, pseudonormal mitral inflow pattern (diastolic dysfunction grade III), absence of wall motion abnormalities and elevated E/e' at exercise. An exercise right heart catheterisation was performed, confirming the diagnosis of heart failure with preserved ejection fraction (HFpEF). In the absence of other possible causes, we assumed that HFpEF was mediated by systemic inflammation secondary to SLE. Based on the Paulus' paradigm, that systemic inflammation may lead to diastolic dysfunction, we decided to add belimumab (a biological agent against soluble B-lymphocyte stimulator protein). After 16 weeks of treatment, patient reported an improved condition. Also, cardiopulmonary exercise test and echocardiography results improved, confirming resolution of the underlying LV diastolic dysfunction. This case supports the idea that targeting inflammation has therapeutic potential in a subset of HFpEF-patients.
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Affiliation(s)
- Milad Baniaamam
- Rheumatology, VU University Medical Center, Amsterdam, The Netherlands,Rheumatology, Reade, Amsterdam, The Netherlands
| | | | - Michael T Nurmohamed
- Rheumatology, VU University Medical Center, Amsterdam, The Netherlands,Rheumatology, Reade, Amsterdam, The Netherlands
| | - M Louis Handoko
- Cardiology, VU University Medical Center, Amsterdam, The Netherlands
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38
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Remmelzwaal S, van Ballegooijen AJ, Schoonmade LJ, Dal Canto E, Handoko ML, Henkens MTHM, van Empel V, Heymans SRB, Beulens JWJ. Natriuretic peptides for the detection of diastolic dysfunction and heart failure with preserved ejection fraction-a systematic review and meta-analysis. BMC Med 2020; 18:290. [PMID: 33121502 PMCID: PMC7599104 DOI: 10.1186/s12916-020-01764-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 04/21/2020] [Accepted: 08/25/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND An overview of the diagnostic performance of natriuretic peptides (NPs) for the detection of diastolic dysfunction (DD) and heart failure with preserved ejection fraction (HFpEF), in a non-acute setting, is currently lacking. METHODS We performed a systematic literature search in PubMed and Embase.com (May 13, 2019). Studies were included when they (1) reported diagnostic performance measures, (2) are for the detection of DD or HFpEF in a non-acute setting, (3) are compared with a control group without DD or HFpEF or with patients with heart failure with reduced ejection fraction, (4) are in a cross-sectional design. Two investigators independently assessed risk of bias of the included studies according to the QUADAS-2 checklist. Results were meta-analysed when three or more studies reported a similar diagnostic measure. RESULTS From 11,728 titles/abstracts, we included 51 studies. The meta-analysis indicated a reasonable diagnostic performance for both NPs for the detection of DD and HFpEF based on AUC values of approximately 0.80 (0.73-0.87; I2 = 86%). For both NPs, sensitivity was lower than specificity for the detection of DD and HFpEF: approximately 65% (51-85%; I2 = 95%) versus 80% (70-90%; I2 = 97%), respectively. Both NPs have adequate ability to rule out DD: negative predictive value of approximately 85% (78-93%; I2 = 95%). The ability of both NPs to prove DD is lower: positive predictive value of approximately 60% (30-90%; I2 = 99%). CONCLUSION The diagnostic performance of NPs for the detection of DD and HFpEF is reasonable. However, they may be used to rule out DD or HFpEF, and not for the diagnosis of DD or HFpEF.
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Affiliation(s)
- Sharon Remmelzwaal
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, VU University Medical Centre, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.
| | - Adriana J van Ballegooijen
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, VU University Medical Centre, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Department of Nephrology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | | | - Elisa Dal Canto
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, VU University Medical Centre, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michiel T H M Henkens
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Vanessa van Empel
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology & Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, VU University Medical Centre, De Boelelaan 1089a, 1081HV, Amsterdam, The Netherlands.,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
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Baniaamam M, Handoko ML, Agca R, Heslinga SC, Konings TC, van Halm VP, Nurmohamed MT. The Effect of Anti-TNF Therapy on Cardiac Function in Rheumatoid Arthritis: An Observational Study. J Clin Med 2020; 9:jcm9103145. [PMID: 33003318 PMCID: PMC7600361 DOI: 10.3390/jcm9103145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/23/2020] [Accepted: 09/25/2020] [Indexed: 01/08/2023] Open
Abstract
Congestive heart failure (CHF) is the second most prevalent cause of death in rheumatoid arthritis (RA). The systemic inflammatory state in RA patients is deemed responsible for this finding. Anti-inflammatory treatment with anti-tumor necrosis factor (anti-TNF) therapy decreases CV risk and subsequently might improve the cardiac function by lowering the overall inflammatory state. This study investigated the effect of anti-TNF on the cardiac function in RA patients. Fifty one RA patients were included, of which thirty three completed follow-up. Included patients were >18 years, had moderate-high disease activity and no history of cardiac disease. Patients were assessed at baseline and after six months of anti-TNF treatment. Patients underwent conventional Speckle tracking and tissue Doppler echocardiography in combination with clinical and laboratory assessments at baseline and follow-up. The left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS) showed no changes during follow-up, LVEF 63% (±9) to 62% (±8) p = 0.097 and GLS -20 (±4) to -20 (±3) p = 0.79, respectively. Furthermore, E/e' nor E/A changed significantly between baseline and follow-up, respectively 8 (7-9) and 8 (7-9) p = 0.17 and 1.1 (±0.4) and 1.1 (±0.4) p = 0.94. Follow-up NT-proBNP decreased with 23%, from 89 ng/L (47-142) to 69 ng/L (42-155), p = 0.10. Regression analysis revealed no association between change in inflammatory variables and cardiac function. Echocardiography showed no effect of anti-TNF treatment on the cardiac function in RA patients with low prevalence of cardiac dysfunction. Moreover, NT-proBNP decreased, possibly indicating (subtle) improvement of the cardiac function.
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Affiliation(s)
- Milad Baniaamam
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Amsterdam Cardiovascular Sciences, Vrije Universiteit, 1081 HZ Amsterdam, The Netherlands
- Correspondence: ; Tel.: +31-20-242-1808
| | - M. Louis Handoko
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.L.H.); (T.C.K.); (V.P.v.H.)
| | - Rabia Agca
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Sjoerd C. Heslinga
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
| | - Thelma C. Konings
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.L.H.); (T.C.K.); (V.P.v.H.)
| | - Vokko P. van Halm
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (M.L.H.); (T.C.K.); (V.P.v.H.)
| | - Mike T. Nurmohamed
- Amsterdam Rheumatology Immunology Center, Location Reade, 1056 AB Amsterdam, The Netherlands; (R.A.); (S.C.H.); (M.T.N.)
- Amsterdam Cardiovascular Sciences, Vrije Universiteit, 1081 HZ Amsterdam, The Netherlands
- Department of Rheumatology, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands
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van Oort S, Beulens JW, van Ballegooijen AJ, Handoko ML, Larsson SC. Modifiable lifestyle factors and heart failure: A Mendelian randomization study. Am Heart J 2020; 227:64-73. [PMID: 32682105 DOI: 10.1016/j.ahj.2020.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 06/07/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Lifestyle factors may be important targets in the prevention of heart failure. The current knowledge on the relationship between lifestyle factors and heart failure originates mostly from observational studies. The objective of this study was to investigate causal associations of multiple lifestyle factors with heart failure risk by using Mendelian randomization. METHODS We obtained summary statistics data for single nucleotide polymorphisms associated with the following 5 lifestyle factors at genome-wide significance in genome-wide association studies of European-descent individuals: smoking, alcohol consumption, coffee consumption, physical activity, and sleep duration. The corresponding data for heart failure were acquired from a genome-wide association study comprising 47,309 cases and 930,014 controls of European ancestry. For the primary analyses, we used the inverse-variance weighted method. RESULTS Genetic predisposition to smoking initiation (ever smoked regularly) was robustly associated with a higher odds of heart failure (odds ratio: 1.28; 99% CI: 1.21-1.35). Genetically predicted longer sleep duration was associated with a lower odds of heart failure (odds ratio per hour/day: 0.73; 99% CI: 0.60-0.89). We found no associations of alcohol consumption, coffee consumption, and physical activity with heart failure. CONCLUSIONS This Mendelian randomization study showed that smoking initiation increases heart failure risk, whereas longer sleep duration decreases the risk of heart failure. Sleep duration should be regarded as novel risk factor in heart failure prevention guidelines. The potential causal role of alcohol and coffee consumption and physical activity for heart failure warrants further investigation in future larger Mendelian randomization analyses.
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Henkens MTHM, Remmelzwaal S, Robinson EL, van Ballegooijen AJ, Barandiarán Aizpurua A, Verdonschot JAJ, Raafs AG, Weerts J, Hazebroek MR, Sanders-van Wijk S, Handoko ML, den Ruijter HM, Lam CSP, de Boer RA, Paulus WJ, van Empel VPM, Vos R, Brunner-La Rocca HP, Beulens JWJ, Heymans SRB. Risk of bias in studies investigating novel diagnostic biomarkers for heart failure with preserved ejection fraction. A systematic review. Eur J Heart Fail 2020; 22:1586-1597. [PMID: 32592317 PMCID: PMC7689920 DOI: 10.1002/ejhf.1944] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 03/20/2020] [Revised: 06/19/2020] [Accepted: 06/20/2020] [Indexed: 12/28/2022] Open
Abstract
Aim Diagnosing heart failure with preserved ejection fraction (HFpEF) in the non‐acute setting remains challenging. Natriuretic peptides have limited value for this purpose, and a multitude of studies investigating novel diagnostic circulating biomarkers have not resulted in their implementation. This review aims to provide an overview of studies investigating novel circulating biomarkers for the diagnosis of HFpEF and determine their risk of bias (ROB). Methods and results A systematic literature search for studies investigating novel diagnostic HFpEF circulating biomarkers in humans was performed up until 21 April 2020. Those without diagnostic performance measures reported, or performed in an acute heart failure population were excluded, leading to a total of 28 studies. For each study, four reviewers determined the ROB within the QUADAS‐2 domains: patient selection, index test, reference standard, and flow and timing. At least one domain with a high ROB was present in all studies. Use of case‐control/two‐gated designs, exclusion of difficult‐to‐diagnose patients, absence of a pre‐specified cut‐off value for the index test without the performance of external validation, the use of inappropriate reference standards and unclear timing of the index test and/or reference standard were the main bias determinants. Due to the high ROB and different patient populations, no meta‐analysis was performed. Conclusion The majority of current diagnostic HFpEF biomarker studies have a high ROB, reducing the reproducibility and the potential for clinical care. Methodological well‐designed studies with a uniform reference diagnosis are urgently needed to determine the incremental value of circulating biomarkers for the diagnosis of HFpEF.
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Affiliation(s)
- Michiel T H M Henkens
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Sharon Remmelzwaal
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Emma L Robinson
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Adriana J van Ballegooijen
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Arantxa Barandiarán Aizpurua
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Job A J Verdonschot
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anne G Raafs
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Jerremy Weerts
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Mark R Hazebroek
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Sandra Sanders-van Wijk
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Carolyn S P Lam
- National Heart Centre Singapore, Singapore, Singapore.,Duke-National University of Singapore, Singapore, Singapore.,Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Walter J Paulus
- Department of Physiology, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands
| | - Vanessa P M van Empel
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands
| | - Joline W J Beulens
- Department of Epidemiology and Biostatistics, Amsterdam Cardiovascular Sciences Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stephane R B Heymans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Netherlands Heart Institute (ICIN), Utrecht, The Netherlands.,Department of Cardiovascular Research, University of Leuven, Leuven, Belgium
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Jansen SMA, Huis In 't Veld AE, Jacobs W, Grotjohan HP, Waskowsky M, van der Maten J, van der Weerdt A, Hoekstra R, Overbeek MJ, Mollema SA, Tolen PHCG, Hassan El Bouazzaoui LH, Vriend JWJ, Roorda JMM, de Nooijer R, van der Lee I, Voogel BAJ, Peels K, Macken T, Aerts JM, Vonk Noordegraaf A, Handoko ML, de Man FS, Bogaard HJ. Noninvasive Prediction of Elevated Wedge Pressure in Pulmonary Hypertension Patients Without Clear Signs of Left-Sided Heart Disease: External Validation of the OPTICS Risk Score. J Am Heart Assoc 2020; 9:e015992. [PMID: 32750312 PMCID: PMC7792270 DOI: 10.1161/jaha.119.015992] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Although most newly presenting patients with pulmonary hypertension (PH) have elevated pulmonary artery wedge pressure, identification of so‐called postcapillary PH can be challenging. A noninvasive tool predicting elevated pulmonary artery wedge pressure in patients with incident PH may help avoid unnecessary invasive diagnostic procedures. Methods and Results A combination of clinical data, ECG, and echocardiographic parameters was used to refine a previously developed left heart failure risk score in a retrospective cohort of pre‐ and postcapillary PH patients. This updated score (renamed the OPTICS risk score) was externally validated in a prospective cohort of patients from 12 Dutch nonreferral centers the OPTICS network. Using the updated OPTICS risk score, the presence of postcapillary PH could be predicted on the basis of body mass index ≥30, diabetes mellitus, atrial fibrillation, dyslipidemia, history of valvular surgery, sum of SV1 (deflection in V1 in millimeters) and RV6 (deflection in V6 in millimeters) on ECG, and left atrial dilation. The external validation cohort included 81 postcapillary PH patients and 66 precapillary PH patients. Using a predefined cutoff of >104, the OPTICS score had 100% specificity for postcapillary PH (sensitivity, 22%). In addition, we investigated whether a high probability of heart failure with preserved ejection fraction, assessed by the H2FPEF score (obesity, atrial fibrillation, age >60 yrs, ≥2 antihypertensives, E/e' >9, and pulmonary artery systolic pressure by echo >35 mmHg), similarly predicted the presence of elevated pulmonary artery wedge pressure. High probability of heart failure with preserved ejection fraction (H2FPEF score ≥6) was less specific for postcapillary PH. Conclusions In a community setting, the OPTICS risk score can predict elevated pulmonary artery wedge pressure in PH patients without clear signs of left‐sided heart disease. The OPTICS risk score may be used to tailor the decision to perform invasive diagnostic testing.
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Affiliation(s)
- Samara M A Jansen
- Department of Pulmonology VU University Medical Center Amsterdam The Netherlands
| | | | - Wouter Jacobs
- Department of Pulmonology of the Martini Ziekenhuis Groningen Groningen The Netherlands
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kathinka Peels
- Catharina Ziekenhuis Eindhoven Eindhoven The Netherlands
| | - Thomas Macken
- Jeroen Bosch ziekenhuis Den Bosch Hertogenbosch The Netherlands
| | | | | | - M Louis Handoko
- Department of Cardiology VU University Medical Center Amsterdam The Netherlands
| | - Frances S de Man
- Department of Pulmonology VU University Medical Center Amsterdam The Netherlands
| | - Harm Jan Bogaard
- Department of Pulmonology VU University Medical Center Amsterdam The Netherlands
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43
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Affiliation(s)
| | | | - M Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
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44
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Kleipool EEF, Wiersinga JHI, Trappenburg MC, van Rossum AC, van Dam CS, Liem SS, Peters MJL, Handoko ML, Muller M. The relevance of a multidomain geriatric assessment in older patients with heart failure. ESC Heart Fail 2020; 7:1264-1272. [PMID: 32125785 PMCID: PMC7261545 DOI: 10.1002/ehf2.12651] [Citation(s) in RCA: 11] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 01/03/2023] Open
Abstract
Aims Physical frailty screening is more commonly performed at outpatient heart failure (HF) clinics. However, this does not incorporate other common geriatric domains. This study assesses whether a multidomain geriatric assessment, in comparison with HF severity or physical frailty, is associated with short‐term adverse outcomes. Methods and results This is a prospective cohort study of 197 patients with HF (mean age 78, 44% female) attending outpatient HF clinics. HF severity was assessed with New York Heart Association class (I‐II versus III‐IV) and N‐terminal pro b‐type natriuretic peptide levels. Physical frailty was assessed with the Fried frailty criteria (not frail, pre‐frail, and frail). The following geriatric domains were assessed: physical function, nutrition, polypharmacy, cognition, and dependency in activities of daily living. Logistic regression analyses adjusted for age, sex, diabetes and kidney function assessed 3 month risk of adverse health outcomes (emergency department visits, hospital admissions, and/or death) according to HF severity, physical frailty, and number of affected domains. Number (%) of patients with HF with no, 1, 2, and ≥3 domains affected were 36 (18%), 61 (31%), 58 (29%), and 42 (21%). Seventy‐four adverse outcomes were experienced in 50 patients at follow‐up. Severity of HF and physical frailty were not significantly associated with an increased risk of adverse health outcomes. However, increasing number of affected domains were significantly associated with an increased risk of adverse outcomes. Compared with no domains affected, odds ratios (95% confidence interval) for 1, 2, and ≥3 domains were 1.8 (0.5–6.5), 4.5 (1.3–15.4), and 7.2 (2.0–26.3) (P‐trend <0.01). Further adjustment for HF severity and frailty status slightly attenuated the effect estimates (P‐trend 0.02). Conclusions Having limitations in multiple domains appears more strongly associated with short‐term adverse outcomes than HF severity and physical frailty. This may illustrate the potential added value of a multidomain geriatric assessment in the evaluation and treatment of patients with HF with respect to relevant short‐term health outcomes.
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Affiliation(s)
- Emma E F Kleipool
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Julia H I Wiersinga
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Marijke C Trappenburg
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Department of Internal Medicine, Amstelland Hospital, Amstelveen, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Carmen S van Dam
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - Su-San Liem
- Department of Cardiology, Amstelland Hospital, Amstelveen, The Netherlands
| | - Mike J L Peters
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - M Louis Handoko
- Department of Cardiology, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Majon Muller
- Department of Internal Medicine and Geriatrics, Amsterdam UMC, location VUmc, Amsterdam Cardiovascular Sciences, Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
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Huis in’t Veld AE, Oosterveer FP, De man FS, Marcus JTIM, Nossent EJ, Boonstra A, Van rossum A(B, Vonk Noordegraaf A, Bogaard HJ, Handoko ML. Hemodynamic Effects of Pulmonary Arterial Hypertension-Specific Therapy in Patients With Heart Failure With Preserved Ejection Fraction and With Combined Post- and Precapillay Pulmonary Hypertension. J Card Fail 2020; 26:26-34. [DOI: 10.1016/j.cardfail.2019.07.547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 07/21/2019] [Accepted: 07/26/2019] [Indexed: 12/22/2022]
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Handoko ML, van de Bovenkamp AA. CardioMEMS: the next revolution in heart failure management? Neth Heart J 2019; 28:14-15. [PMID: 31811555 PMCID: PMC6940399 DOI: 10.1007/s12471-019-01356-2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- M L Handoko
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, The Netherlands.
| | - A A van de Bovenkamp
- Department of Cardiology, Amsterdam University Medical Centres, Amsterdam Cardiovascular Sciences, Vrije Universiteit, Amsterdam, The Netherlands
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Hoeper MM, Lam CSP, Vachiery JL, Bauersachs J, Gerges C, Lang IM, Bonderman D, Olsson KM, Gibbs JSR, Dorfmuller P, Guazzi M, Galiè N, Manes A, Handoko ML, Vonk-Noordegraaf A, Lankeit M, Konstantinides S, Wachter R, Opitz C, Rosenkranz S. Pulmonary hypertension in heart failure with preserved ejection fraction: a plea for proper phenotyping and further research. Eur Heart J 2019; 38:2869-2873. [PMID: 28011705 DOI: 10.1093/eurheartj/ehw597] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [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: 05/28/2016] [Accepted: 11/22/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
- Marius M Hoeper
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Carolyn S P Lam
- National Centre Singapore and Duke-National University of Singapore, 5 Hospital Dr, Singapore 16960
| | - Jean-Luc Vachiery
- Pulmonary Vascular Disease and Heart Failure Clinic, CUB Hopital Erasme, Route de Lennik 808, 1070 Brussels, Belgium
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Christian Gerges
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Irene M Lang
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Diana Bonderman
- Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Spitalgasse 23, 1090 Vienna, Austria
| | - Karen M Olsson
- Department of Respiratory Medicine and German Centre of Lung Research (DZL), Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - J Simon R Gibbs
- National Heart and Lung Institute, Imperial College, Sydney St, Chelsea, London SW3 6NP and National Pulmonary Hypertension Service, Hammersmith Hospital, Du Cane Rd, White City, London W12 0HS, United Kingdom
| | - Peter Dorfmuller
- Department of Pathology and INSERM UMR-S 999, Paris-South University, Marie Lannelongue Hospital, Le Plessis Robinson, 15 Rue Georges Clemenceau, 91400 Orsay, France
| | - Marco Guazzi
- Department of Cardiology, University of Milano, IRCCS Policlinico San Donato, Piazza Edmondo Malan, 1, 20097 San Donato Milanese, Milano, Italy
| | - Nazzareno Galiè
- Department of Experimental, Diagnostic and Speciality Medicine, Bologna University Hospital, Via Zamboni, 33, 40126 Bologna, Italy
| | - Alessandra Manes
- Department of Experimental, Diagnostic and Speciality Medicine, Bologna University Hospital, Via Zamboni, 33, 40126 Bologna, Italy
| | - M Louis Handoko
- Department of Cardiology, VU University Medical Center, De Boelelaan 1117, 1081 Amsterdam, The Netherlands
| | - Anton Vonk-Noordegraaf
- Department of Pneumology, VU University Medical Center, De Boelelaan 1117, 1081 Amsterdam, The Netherlands
| | - Mareike Lankeit
- Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Stavros Konstantinides
- Centre for Thrombosis and Haemostasis, University Medical Centre Mainz, Langenbeckstraße 1, 55131 Mainz, Germany; and Department of Cardiology, Democritus University of Thrace, University Campus, 69100 Komotini, Alexandroupolis, Greece
| | - Rolf Wachter
- Department of Cardiology, University of Göttingen, and German Cardiovascular Research Center (DZHK), Robert-Koch-Str. 40, 37099 Göttingen, Germany
| | - Christian Opitz
- Department of Cardiology, DRK-Kliniken Berlin, Spandauer Damm 130, 14050 Berlin Germany
| | - Stephan Rosenkranz
- Department of Cardiology and Cologne Cardiovascular Research Centre (CCRC), University of Cologne, Kerpener Strasse 62, 50937 Köln, Germany
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Kleipool EEF, Handoko ML, Van Rossum AC, Hornstra JM, Peters MJL, Liem SS, Muller M. P4515The aging heart failure patient: frailty and cognitive impairment more common than you would expect - baseline data of the heart-brain clinic. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0908] [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: 11/13/2022] Open
Abstract
Abstract
Background
Heart failure (HF) is a cardiovascular disease that is increasing by epidemic proportions, largely due to an aging society and therapeutic advances in disease management. Because heart failure is largely a cardiogeriatric syndrome, age-related syndromes such as frailty and cognitive impairment are common in heart failure patients.
Purpose
To assess the prevalence and determinants of frailty and cognitive impairment in a HF population ≥60 years of age.
Methods
Data from n=236 patients with HF (77±9 years; 43% female) visiting the heart-brain clinic in Amsterdam in 2018–2019. HF severity was evaluated by NT-proBNP and NYHA-classification. Frailty was assessed using Fried's frailty criteria, cognition using the Montreal cognitive assessment (MoCa). Logistic regression analyses were performed to evaluate which variables were associated with frailty and cognitive impairment.
Results
Median (IQR) NT-proBNP was 2000 (876–3469) pmol/L, 38% of patients had NYHA III-IV. 51% of patients were pre-frail and 28% frail. 77% of the patients were (mildly) cognitive impaired. Age, NYHA-classification III-IV, NT-proBNP>2000 pmol/L and use of ≥10 drugs were associated with frailty; HR (95% CI): 2.0 (1.4–3.0) per 10 years, 3.4 (1.9–6.2), 1.8 (1.0–3.2) and 1.8 (1.4–3.3) respectively. Age was associated with cognitive impairment; HR (95% CI) 2.2 (1.4–3.6) per 10 years.
Figure 1
Conclusion(s)
Frailty affects almost a third of the patients with HF and is more prevalent in older patients and those with more severe HF. Screening for frailty and cognitive impairment should be part of the standard workup in older HF patients as frail and/or cognitively impaired HF patients are less likely to adhere to their HF treatment and more likely to be (re)admitted to hospital for HF.
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Affiliation(s)
- E E F Kleipool
- VU University Medical Center, Internal/Geriatric medicine, Amsterdam, Netherlands (The)
| | - M L Handoko
- VU University Medical Center, Internal/Geriatric medicine, Amsterdam, Netherlands (The)
| | - A C Van Rossum
- VU University Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | | | - M J L Peters
- VU University Medical Center, Internal/Geriatric medicine, Amsterdam, Netherlands (The)
| | - S S Liem
- Amstelland hospital, Amstelveen, Netherlands (The)
| | - M Muller
- VU University Medical Center, Internal/Geriatric medicine, Amsterdam, Netherlands (The)
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49
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Himmelreich JCL, Karregat EPM, Lucassen WAM, van Weert HCPM, de Groot JR, Handoko ML, Nijveldt R, Harskamp RE. Diagnostic Accuracy of a Smartphone-Operated, Single-Lead Electrocardiography Device for Detection of Rhythm and Conduction Abnormalities in Primary Care. Ann Fam Med 2019; 17:403-411. [PMID: 31501201 PMCID: PMC7032908 DOI: 10.1370/afm.2438] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 04/03/2019] [Accepted: 04/12/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To validate a smartphone-operated, single-lead electrocardiography (1L-ECG) device (AliveCor KardiaMobile) with an integrated algorithm for atrial fibrillation (AF) against 12-lead ECG (12L-ECG) in a primary care population. METHODS We recruited consecutive patients who underwent 12L-ECG for any nonacute indication. Patients held a smartphone with connected 1L-ECG while local personnel simultaneously performed 12L-ECG. All 1L-ECG recordings were assessed by blinded cardiologists as well as by the smartphone-integrated algorithm. The study cardiologists also assessed all 12L-recordings in random order as the reference standard. We determined the diagnostic accuracy of the 1L-ECG in detecting AF or atrial flutter (AFL) as well as any rhythm abnormality and any conduction abnormality with the simultaneously performed 12L-ECG as the reference standard. RESULTS We included 214 patients from 10 Dutch general practices. Mean ± SD age was 64.1 ± 14.7 years, and 53.7% of the patients were male. The 12L-ECG diagnosed AF/AFL, any rhythm abnormality, and any conduction abnormality in 23, 44, and 28 patients, respectively. The 1L-ECG as assessed by cardiologists had a sensitivity and specificity for AF/AFL of 100% (95% CI, 85.2%-100%) and 100% (95% CI, 98.1%-100%). The AF detection algorithm had a sensitivity and specificity of 87.0% (95% CI, 66.4%-97.2%) and 97.9% (95% CI, 94.7%-99.4%). The 1L-ECG as assessed by cardiologists had a sensitivity and specificity for any rhythm abnormality of 90.9% (95% CI, 78.3%-97.5%) and 93.5% (95% CI, 88.7%-96.7%) and for any conduction abnormality of 46.4% (95% CI, 27.5%-66.1%) and 100% (95% CI, 98.0%-100%). CONCLUSIONS In a primary care population, a smartphone-operated, 1L-ECG device showed excellent diagnostic accuracy for AF/AFL and good diagnostic accuracy for other rhythm abnormalities. The 1L-ECG device was less sensitive for conduction abnormalities.
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Affiliation(s)
- Jelle C L Himmelreich
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Evert P M Karregat
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Wim A M Lucassen
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Henk C P M van Weert
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Joris R de Groot
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - M Louis Handoko
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Robin Nijveldt
- Radboud University Medical Center, Department of Cardiology, Nijmegen, The Netherlands
| | - Ralf E Harskamp
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam Public Health, Amsterdam, The Netherlands
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Abstract
Chronotropic incompetence (CI) is generally defined as the inability to increase the heart rate (HR) adequately during exercise to match cardiac output to metabolic demands. In patients with heart failure (HF), however, this definition is unsuitable because metabolic demands are unmatched to cardiac output in both conditions. Moreover, HR dynamics in patients with HF differ from those in healthy subjects and may be affected by β-blocking medication. Nevertheless, it has been demonstrated that CI in HF is associated with reduced functional capacity and poor survival. During exercise, the normal heart increases both stroke volume and HR, whereas in the failing heart, contractility reserve is lost, thus rendering increases in cardiac output primarily dependent on cardioacceleration. Consequently, insufficient cardioacceleration because of CI may be considered a major limiting factor in the exercise capacity of patients with HF. Despite the profound effects of CI in this specific population, the issue has drawn limited attention during the past years and is often overlooked in clinical practice. This might partly be caused by a lack of standardized approach to diagnose the disease, further complicated by changes in HR dynamics in the HF population, which render reference values derived from a normal population invalid. Cardiac implantable electronic devices (implantable cardioverter defibrillator; cardiac resynchronization therapy) now offer a unique opportunity to study HR dynamics and provide treatment options for CI by rate-adaptive pacing using an incorporated sensor that measures physical activity. This review provides an overview of disease mechanisms, diagnostic strategies, clinical consequences, and state-of-the-art device therapy for CI in HF.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | | | - M Louis Handoko
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
| | - Cornelis P Allaart
- Department of Cardiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, the Netherlands
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