1
|
Helmink MAG, Peters SAE, Westerink J, Harris K, Tillmann T, Woodward M, van Sloten TT, van der Meer MG, Teraa M, Dorresteijn JAN, Ruigrok YM, Visseren FLJ, Hageman SHJ. Development and validation of a lifetime prediction model for incident type 2 diabetes in patients with established cardiovascular disease: the CVD2DM model. Eur J Prev Cardiol 2024:zwae096. [PMID: 38584392 DOI: 10.1093/eurjpc/zwae096] [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: 12/09/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/09/2024]
Abstract
AIMS Identifying patients with established cardiovascular disease (CVD) who are at high risk of type 2 diabetes (T2D) may allow for early interventions, reducing the development of T2D and associated morbidity. The aim of this study was to develop and externally validate the CVD2DM model to estimate the 10-year and lifetime risks of T2D in patients with established CVD. METHODS AND RESULTS Sex-specific, competing risk-adjusted Cox proportional hazard models were derived in 19 281 participants with established CVD and without diabetes at baseline from the UK Biobank. The core model's pre-specified predictors were age, current smoking, family history of diabetes mellitus, body mass index, systolic blood pressure, fasting plasma glucose, and HDL cholesterol. The extended model also included HbA1c. The model was externally validated in 3481 patients from the UCC-SMART study. During a median follow-up of 12.2 years (interquartile interval 11.3-13.1), 1628 participants with established CVD were diagnosed with T2D in the UK Biobank. External validation c-statistics were 0.79 [95% confidence interval (CI) 0.76-0.82] for the core model and 0.81 (95% CI 0.78-0.84) for the extended model. Calibration plots showed agreement between predicted and observed 10-year risk of T2D. CONCLUSION The 10-year and lifetime risks of T2D can be estimated with the CVD2DM model in patients with established CVD, using readily available clinical predictors. The model would benefit from further validation across diverse ethnic groups to enhance its applicability. Informing patients about their T2D risk could motivate them further to adhere to a healthy lifestyle.
Collapse
Affiliation(s)
- Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Sanne A E Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - Katie Harris
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Taavi Tillmann
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Mark Woodward
- The George Institute for Global Health, Imperial College London, London, UK
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| |
Collapse
|
2
|
Klaassen J, Hazenberg CEVB, Bloemert-Tuin T, Wulms SCA, Teraa M, van Herwaarden JA. Editor's Choice - Radiation Dose Reduction During Contralateral Limb Cannulation Using Fiber Optic RealShape Technology in Endovascular Aneurysm Repair. Eur J Vasc Endovasc Surg 2024; 67:594-600. [PMID: 37925100 DOI: 10.1016/j.ejvs.2023.10.041] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/13/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023]
Abstract
OBJECTIVE The increasing number of endovascular procedures has resulted in an increasing radiation burden, particularly for the treatment team. Fiber Optic RealShape (FORS) technology uses laser light instead of fluoroscopy to visualise the endovascular guidewire and catheters. These devices can be used during the navigational part of procedures, such as cannulation of the contralateral limb (CL) in endovascular aneurysm repair (EVAR). The aim of this study was to describe the effect of using FORS on radiation dose during CL cannulation in standard EVAR. METHODS This was a non-randomised, retrospective comparison study of prospectively collected, single centre data from FORS guided EVAR compared with a conventional fluoroscopy only guided EVAR cohort. A total of 27 FORS guided cases were matched 1:1 based on sex, age, and body mass index (BMI) with 27 regular (fluoroscopy only) EVARs. This study primarily focused on (1) technical success of FORS and (2) navigation time and radiation dose (cumulative air kerma [CAK], air kerma area product [KAP], and fluoroscopy time [FT]) during cannulation of the CL. In addition, overall procedure time and radiation dose of the complete EVAR procedure were studied. RESULTS In 22 (81%) of the 27 FORS guided cases the CL was successfully cannulated using FORS. All radiation dose parameters were significantly lower in the FORS group (CAK, p < .001; KAP, p = .009; and FT, p < .001) for an equal navigation time (p = .95). No significant differences were found when comparing outcomes of the complete procedure. CONCLUSION Use of FORS technology significantly reduces radiation doses during cannulation of the CL in standard EVAR.
Collapse
Affiliation(s)
- Jurre Klaassen
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | | | - Trijntje Bloemert-Tuin
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Suzan C A Wulms
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands; Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| |
Collapse
|
3
|
Teraa M, Resch TA. Thoracic Endovascular Repair in Acute Type B Aortic Intramural Haematoma: Is It Really Better To Fix What Is Broken? Eur J Vasc Endovasc Surg 2024; 67:593. [PMID: 38176450 DOI: 10.1016/j.ejvs.2023.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 12/29/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Timothy A Resch
- Department of Vascular Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
4
|
Teraa M, von Allmen RS. BioMimics 3D Stent Graft System in Chronic Limb Threatening Ischaemia and Complex Femoropopliteal Lesions: The New Dimension in Complex Endovascular Interventions? Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00261-2. [PMID: 38521187 DOI: 10.1016/j.ejvs.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 03/25/2024]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Regula S von Allmen
- Clinic for Vascular Surgery, Kantonsspital St Gallen, St Gallen, Switzerland
| |
Collapse
|
5
|
Castelijns MC, Hageman SHJ, Teraa M, van der Meer MG, Westerink J, Ten Berg J, Visseren FLJ. Generalisability of trials on antithrombotic treatment intensification in patients with cardiovascular disease. Heart 2024; 110:482-490. [PMID: 38182277 DOI: 10.1136/heartjnl-2023-323519] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/08/2023] [Indexed: 01/07/2024] Open
Abstract
OBJECTIVE Assessment of generalisability of guideline-informing trials on antithrombotic treatment intensification to real-world patients with cardiovascular disease (CVD). METHODS Inclusion and exclusion criteria of the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS), Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA), Prevention of Cardiovascular events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis in Myocardial Infarction (PEGASUS-TIMI) and Dual Antiplatelet Therapy (DAPT) study were applied to coronary artery disease (CAD) and/or peripheral artery disease (PAD) patients from Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) to determine real-world eligibility. Eligible and ineligible patients were compared on baseline characteristics, cardiovascular events, major bleeding and mortality. RESULTS Eligibility ranged from 11%-94% for CAD to 75%-90% for patients with PAD. Cardiovascular, bleeding and mortality risks were higher in COMPASS-eligible patients with CAD (rate ratios (RR) 1.98 (95% CI 1.74 to 2.26), 2.02 (95% CI 1.47 to 2.78) and 3.11 (95% CI 2.71 to 3.57), respectively) and CHARISMA-eligible patients (RR 1.51 (95% CI 1.12 to 2.06), 2.25 (95% CI 1.01 to 6.21) and 4.43 (95% CI 2.79 to 7.51), respectively), and lower in COMPASS-eligible patients with PAD (RR 0.45 (95% CI 0.36 to 0.56), 0.29 (95% CI 0.18 to 0.46) and 0.45 (95% CI 0.38 to 0.54), respectively) and DAPT-eligible patients with CAD (RR CVD 0.49 (95% CI 0.34 to 0.69) and mortality 0.67 (95% CI 0.48 to 0.94)) than ineligible patients. After adjustment for trial eligibility criteria, only higher cardiovascular and mortality risks in COMPASS-eligible patients with CAD and lower cardiovascular risks in CHARISMA-eligible and DAPT-eligible patients persisted with CAD. CONCLUSION A large proportion of contemporary CVD patients would be eligible for intensified antithrombotic treatment trials, with mostly similar adjusted event risks to ineligible patients. Trial-based guideline recommendations are largely applicable to real-world patients.
Collapse
Affiliation(s)
- Maria C Castelijns
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Internal Medicine, Isala Clinics Zwolle, Zwolle, The Netherlands
| | - Jurrien Ten Berg
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
6
|
Besseling PJ, Szymczyk W, Teraa M, Toorop RJ, Wu DJ, Driessen RCH, Lichauco AM, Janssen HM, van de Kaa M, den Ouden K, de Bree PM, Fledderus JO, Bouten CVC, de Borst GJ, Dankers PYW, Verhaar MC. Off-the-Shelf Synthetic Biodegradable Grafts Transform In Situ into a Living Arteriovenous Fistula in a Large Animal Model. Adv Healthc Mater 2024:e2303888. [PMID: 38451476 DOI: 10.1002/adhm.202303888] [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] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/31/2024] [Indexed: 03/08/2024]
Abstract
Current vascular access options require frequent interventions. In situ tissue engineering (TE) may overcome these limitations by combining the initial success of synthetic grafts with long-term advantages of autologous vessels by using biodegradable grafts that transform into autologous vascular tissue at the site of implantation. Scaffolds (6 mm-Ø) made of supramolecular polycarbonate-bisurea (PC-BU), with a polycaprolactone (PCL) anti-kinking-coil, are implanted between the carotid artery and jugular vein in goats. A subset is bio-functionalized using bisurea-modified-Stromal cell-derived factor-1α (SDF1α) derived peptides and ePTFE grafts as controls. Grafts are explanted after 1 and 3 months, and evaluated for material degradation, tissue formation, compliance, and patency. At 3 months, the scaffold is resorbed and replaced by vascular neo-tissue, including elastin, contractile markers, and endothelial lining. No dilations, ruptures, or aneurysms are observed and grafts are successfully cannulated at termination. SDF-1α-peptide-biofunctionalization does not influence outcomes. Patency is lower in TE grafts (50%) compared to controls (100% patency), predominantly caused by intimal hyperplasia. Rapid remodeling of a synthetic, biodegradable vascular scaffold into a living, compliant arteriovenous fistula is demonstrated in a large animal model. Despite lower patency compared to ePTFE, transformation into autologous and compliant living tissue with self-healing capacity may have long-term advantages.
Collapse
Affiliation(s)
- Paul J Besseling
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Wojciech Szymczyk
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Martin Teraa
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Raechel J Toorop
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Dan Jing Wu
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Rob C H Driessen
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
- Mechanobiology Services Eindhoven, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Arturo M Lichauco
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | | | - Melanie van de Kaa
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Krista den Ouden
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Petra M de Bree
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Joost O Fledderus
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| | - Carlijn V C Bouten
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, 3584 CX, the Netherlands
| | - Patricia Y W Dankers
- Department of Biomedical Engineering, and Institute for Complex Molecular Systems, Eindhoven University of Technology, Eindhoven, 5612 AZ, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, 3584 CX, the Netherlands
| |
Collapse
|
7
|
Teraa M, Bashir M. Iliac Branch Devices and Long Term Technical Success: A Synergetic Relationship. Eur J Vasc Endovasc Surg 2024:S1078-5884(24)00181-3. [PMID: 38382696 DOI: 10.1016/j.ejvs.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 02/14/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Mohamad Bashir
- Neurovascular Research Laboratory, Faculty of Life Sciences and Education, University of South Wales, UK
| |
Collapse
|
8
|
Bonekamp NE, Visseren FLJ, Cramer MJ, Dorresteijn JAN, van der Meer MG, Ruigrok YM, van Sloten TT, Teraa M, Geleijnse JM, Koopal C. Long-term lifestyle change and risk of mortality and Type 2 diabetes in patients with cardiovascular disease. Eur J Prev Cardiol 2024; 31:205-213. [PMID: 37774501 DOI: 10.1093/eurjpc/zwad316] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 05/31/2023] [Revised: 08/18/2023] [Accepted: 09/22/2023] [Indexed: 10/01/2023]
Abstract
AIMS To quantify the relationship between self-reported, long-term lifestyle changes (smoking, waist circumference, physical activity, and alcohol consumption) and clinical outcomes in patients with established cardiovascular disease (CVD). METHODS AND RESULTS Data were used from 2011 participants (78% male, age 57 ± 9 years) from the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease cohort who returned for a re-assessment visit (SMART2) after ∼10 years. Self-reported lifestyle change was classified as persistently healthy, improved, worsened, or persistently unhealthy. Cox proportional hazard models were used to quantify the relationship between lifestyle changes and the risk of (cardiovascular) mortality and incident Type 2 diabetes (T2D). Fifty-seven per cent of participants was persistently healthy, 17% improved their lifestyle, 8% worsened, and 17% was persistently unhealthy. During a median follow-up time of 6.1 (inter-quartile range 3.6-9.6) years after the SMART2 visit, 285 deaths occurred, and 99 new T2D diagnoses were made. Compared with a persistently unhealthy lifestyle, individuals who maintained a healthy lifestyle had a lower risk of all-cause mortality [hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.36-0.63], cardiovascular mortality (HR 0.57, 95% CI 0.38-0.87), and incident T2D (HR 0.46, 95% CI 0.28-0.73). Similarly, those who improved their lifestyle had a lower risk of all-cause mortality (HR 0.52, 95% CI 0.37-0.74), cardiovascular mortality (HR 0.46, 95% CI 0.26-0.81), and incident T2D (HR 0.50, 95% CI 0.27-0.92). CONCLUSION These findings suggest that maintaining or adopting a healthy lifestyle can significantly lower mortality and incident T2D risk in CVD patients. This study emphasizes the importance of ongoing lifestyle optimization in CVD patients, highlighting the potential for positive change regardless of previous lifestyle habits.
Collapse
Affiliation(s)
- Nadia E Bonekamp
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- UMC Utrecht Brain Center, Department of Neurology and Neurosurgery, Utrecht University, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Thomas T van Sloten
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Johanna M Geleijnse
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Charlotte Koopal
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Postbus 85500, 3508 GA, Utrecht, The Netherlands
| |
Collapse
|
9
|
Teraa M, Hazenberg CEVB. Retrograde Recanalisation in Complex Endovascular Interventions: Being More Than Just an Alternative Way to Rome. Eur J Vasc Endovasc Surg 2024:S1078-5884(23)01054-7. [PMID: 38185374 DOI: 10.1016/j.ejvs.2023.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/29/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | | |
Collapse
|
10
|
Teraa M, Hazenberg CEVB. Long Term Outcomes After Fenestrated Endovascular Aneurysm Repair in Search for the Guiding COMPASS. Eur J Vasc Endovasc Surg 2024; 67:130-131. [PMID: 37541319 DOI: 10.1016/j.ejvs.2023.07.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 07/28/2023] [Indexed: 08/06/2023]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | | |
Collapse
|
11
|
Burger PM, Dorresteijn JAN, Fiolet ATL, Koudstaal S, Eikelboom JW, Nidorf SM, Thompson PL, Cornel JH, Budgeon CA, Westendorp ICD, Beelen DPW, Martens FMAC, Steg PG, Asselbergs FW, Cramer MJ, Teraa M, Bhatt DL, Visseren FLJ, Mosterd A. Individual lifetime benefit from low-dose colchicine in patients with chronic coronary artery disease. Eur J Prev Cardiol 2023; 30:1950-1962. [PMID: 37409348 DOI: 10.1093/eurjpc/zwad221] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 05/30/2023] [Accepted: 07/04/2023] [Indexed: 07/07/2023]
Abstract
AIMS Low-dose colchicine reduces cardiovascular risk in patients with coronary artery disease (CAD), but absolute benefits may vary between individuals. This study aimed to assess the range of individual absolute benefits from low-dose colchicine according to patient risk profile. METHODS AND RESULTS The European Society of Cardiology (ESC) guideline-recommended SMART-REACH model was combined with the relative treatment effect of low-dose colchicine and applied to patients with CAD from the Low-Dose Colchicine 2 (LoDoCo2) trial and the Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease (UCC-SMART) study (n = 10 830). Individual treatment benefits were expressed as 10-year absolute risk reductions (ARRs) for myocardial infarction, stroke, or cardiovascular death (MACE), and MACE-free life-years gained. Predictions were also performed for MACE plus coronary revascularization (MACE+), using a new lifetime model derived in the REduction of Atherothrombosis for Continued Health (REACH) registry. Colchicine was compared with other ESC guideline-recommended intensified (Step 2) prevention strategies, i.e. LDL cholesterol (LDL-c) reduction to 1.4 mmol/L and systolic blood pressure (SBP) reduction to 130 mmHg. The generalizability to other populations was assessed in patients with CAD from REACH North America and Western Europe (n = 25 812). The median 10-year ARR from low-dose colchicine was 4.6% [interquartile range (IQR) 3.6-6.0%] for MACE and 8.6% (IQR 7.6-9.8%) for MACE+. Lifetime benefit was 2.0 (IQR 1.6-2.5) MACE-free years, and 3.4 (IQR 2.6-4.2) MACE+-free life-years gained. For LDL-c and SBP reduction, respectively, the median 10-year ARR for MACE was 3.0% (IQR 1.5-5.1%) and 1.7% (IQR 0.0-5.7%), and the lifetime benefit was 1.2 (IQR 0.6-2.1) and 0.7 (IQR 0.0-2.3) MACE-free life-years gained. Similar results were obtained for MACE+ and in American and European patients from REACH. CONCLUSION The absolute benefits of low-dose colchicine vary between individual patients with chronic CAD. They may be expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in a majority of patients already on conventional lipid-lowering and blood pressure-lowering therapy.
Collapse
Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Aernoud T L Fiolet
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
| | - Stefan Koudstaal
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Green Heart Hospital, Gouda, The Netherlands
| | | | - Stefan M Nidorf
- Department of Cardiology, GenesisCare Western Australia, Perth, Australia
- Heart Research Institute of Western Australia, Perth, Australia
| | - Peter L Thompson
- Department of Cardiology, GenesisCare Western Australia, Perth, Australia
- Heart Research Institute of Western Australia, Perth, Australia
| | - Jan H Cornel
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Charley A Budgeon
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | | | - Driek P W Beelen
- Department of Cardiology, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Fabrice M A C Martens
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | - Philippe Gabriel Steg
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Université de Paris, Paris, France
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, USA
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arend Mosterd
- Dutch Cardiovascular Research Network (WCN), Moreelsepark 1, 3511 EP Utrecht, The Netherlands
- Department of Cardiology, Meander Medical Centre, Maatweg 3, 3813 TZ Amersfoort, The Netherlands
| |
Collapse
|
12
|
Jansen S, de Borst GJ, Hinchliffe R, Teraa M. Peripheral Artery Disease: Underappreciated Impact and Residual Cardiovascular Risk Despite Revascularization. Clin Ther 2023; 45:1019-1022. [PMID: 37940497 DOI: 10.1016/j.clinthera.2023.09.021] [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: 05/01/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 11/10/2023]
Abstract
This Commentary highlights the under-recognized prevalence and heavy burden of peripheral artery disease (PAD) and its important role as a harbinger of complications of atherosclerotic cardiovascular disease. Although increasing in prevalence globally, PAD is being further accelerated with diabetes, and patients with advanced PAD are at high risk for chronic limb-threatening ischemia. The need for (repeated) revascularization and amputation places a heavy social burden on patients and family, and a heavy financial burden on the health care system, exceeding the cost of coronary artery and cerebrovascular diseases. Clinical trial research in PAD will be enhanced by widely agreed-upon definitions of major adverse cardiovascular events and major adverse limb events. Antithrombotic and lipid-lowering therapies are recommended but underutilized, while the optimal peri-interventional antithrombotic regimen is still under debate. Additional antiinflammatory treatment is currently an unaddressed strategy in the management of patients with PAD, and there is a strong case for the evaluation of widely available antiinflammatory agents such as colchicine.
Collapse
Affiliation(s)
- Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital; Harry Perkins Institute of Medical Research; Curtin University Medical School; and the; Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia.
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Robert Hinchliffe
- Bristol Centre for Surgical Research, Bristol NIHR Biomedical Research Centre, University of Bristol, Bristol, United Kingdom
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
13
|
Jansen S, Teraa M, Chan N, Bosch J, de Borst GJ, Hinchliffe R. Assessing Limb Outcomes in Drug Trials in Peripheral Artery Disease: The Need for a Universal and Pragmatic Definition. Eur J Vasc Endovasc Surg 2023; 66:442-443. [PMID: 37327967 DOI: 10.1016/j.ejvs.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/15/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Shirley Jansen
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Noel Chan
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Jackie Bosch
- Population Health Research Institute, Hamilton, Ontario, Canada
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Robert Hinchliffe
- Bristol Centre for Surgical Research, Bristol NIHR Biomedical Research Centre, University of Bristol, United Kingdom
| |
Collapse
|
14
|
Lareyre F, Chaudhuri A, Behrendt CA, Pouhin A, Teraa M, Boyle JR, Tulamo R, Raffort J. Artificial intelligence-based predictive models in vascular diseases. Semin Vasc Surg 2023; 36:440-447. [PMID: 37863618 DOI: 10.1053/j.semvascsurg.2023.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/24/2023] [Accepted: 05/24/2023] [Indexed: 10/22/2023]
Abstract
Cardiovascular disease represents a source of major health problems worldwide, and although medical and technical advances have been achieved, they are still associated with high morbidity and mortality rates. Personalized medicine would benefit from novel tools to better predict individual prognosis and outcomes after intervention. Artificial intelligence (AI) has brought new insights to cardiovascular medicine, especially with the use of machine learning techniques that allow the identification of hidden patterns and complex associations in health data without any a priori assumptions. This review provides an overview on the use of artificial intelligence-based prediction models in vascular diseases, specifically focusing on aortic aneurysm, lower extremity arterial disease, and carotid stenosis. Potential benefits include the development of precision medicine in patients with vascular diseases. In addition, the main challenges that remain to be overcome to integrate artificial intelligence-based predictive models in clinical practice are discussed.
Collapse
Affiliation(s)
- Fabien Lareyre
- Department of Vascular Surgery, Hospital of Antibes Juan-les-Pins, France; Université Côte d'Azur, INSERM U1065, C3M, Nice, France
| | - Arindam Chaudhuri
- Bedfordshire-Milton Keynes Vascular Centre, Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK
| | - Christian-Alexander Behrendt
- Brandenburg Medical School Theodor-Fontane, Neuruppin, Germany; Department of Vascular and Endovascular Surgery, Asklepios Medical School Hamburg, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Alexandre Pouhin
- Division of Vascular Surgery, Dijon University Hospital, Dijon, France
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Trust and Department of Surgery, University of Cambridge, Cambridge, UK
| | - Riikka Tulamo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Juliette Raffort
- Université Côte d'Azur, INSERM U1065, C3M, Nice, France; Institute 3IA Côte d'Azur, Université Côte d'Azur, France; Clinical Chemistry Laboratory, University Hospital of Nice, France.
| |
Collapse
|
15
|
Helmink MAG, Westerink J, Hageman SHJ, Koopman M, van der Meer MG, Teraa M, Ruigrok YM, Visseren FLJ. Effect of adipose tissue quantity and dysfunction on the risk of cancer in individuals with and without type 2 diabetes. Obes Res Clin Pract 2023; 17:383-389. [PMID: 37777400 DOI: 10.1016/j.orcp.2023.09.004] [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: 04/26/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE To determine the role of waist circumference and metabolic dysfunction in the risk of cancer in individuals with type 2 diabetes (T2D) and to compare this to individuals without T2D. METHODS Individuals with (n = 1925) and without T2D (n = 10,204) were included from the UCC-SMART cohort. Incident cancer diagnoses were obtained by linkage with the Netherlands Cancer Registry. Metabolic dysfunction was defined as ≥ 3 adapted NCEP ATP-III metabolic syndrome criteria. The effects of waist circumference and metabolic dysfunction on cancer were assessed using Cox proportional hazards models, adjusted for confounders. RESULTS During a median follow-up of 8.3 years (IQR 4.2-13.1), 1740 individuals were diagnosed with cancer. Incidence rates of total cancer were 19.3 and 15.5/1000 person-years for individuals with and without T2D, respectively. In individuals without T2D, a higher waist circumference was associated with an increased risk of colorectal (per standard deviation: HR 1.23; 95%CI 1.03-1.46), urinary tract (HR 1.28; 95%CI 1.05-1.56) and total cancer (HR 1.06; 95%CI 1.02-1.13). Metabolic dysfunction was related to an increased risk of colorectal (HR 1.35; 95%CI 1.01-1.82), lung (HR 1.37; 95%CI 1.07-1.75) and total cancer (HR 1.13; 95%CI 1.01-1.25) in individuals without T2D. In individuals with T2D, no significant associations were found. CONCLUSION Incidence rates of cancer are higher among individuals with T2D. However, higher waist circumference and metabolic dysfunction are only associated with an increased cancer risk in patients without T2D. These findings provide novel insights into the role of metabolic dysfunction in the occurrence of cancer.
Collapse
Affiliation(s)
- Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands; Department of Internal Medicine, Isala Clinics Zwolle, PO Box 10400, 8000 GK Zwolle, the Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Miriam Koopman
- Department of Medical Oncology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | | | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| |
Collapse
|
16
|
Burger PM, Koudstaal S, Mosterd A, Fiolet ATL, Teraa M, van der Meer MG, Cramer MJ, Visseren FLJ, Ridker PM, Dorresteijn JAN. C-Reactive Protein and Risk of Incident Heart Failure in Patients With Cardiovascular Disease. J Am Coll Cardiol 2023; 82:414-426. [PMID: 37495278 DOI: 10.1016/j.jacc.2023.05.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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: 02/16/2023] [Revised: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Patients with established cardiovascular disease (CVD) are at high risk of incident heart failure (HF), which may in part reflect the impact of systemic inflammation. OBJECTIVES The goal of this study was to determine the association between C-reactive protein (CRP) and incident HF in patients with established CVD. METHODS Patients from the prospective UCC-SMART (Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease) cohort with established CVD, but without prevalent HF were included (n = 8,089). Incident HF was defined as a first hospitalization for HF. The association between baseline CRP and incident HF was assessed using Cox proportional hazards models adjusted for established risk factors (ie, age, sex, myocardial infarction, smoking, diabetes mellitus, body mass index, blood pressure, cholesterol, and kidney function). RESULTS During a median follow-up of 9.7 years (IQR 5.4-14.1 years), 810 incident HF cases were observed (incidence rate 1.01/100 person-years). Higher CRP was independently associated with an increased risk of incident HF: HR per 1 mg/L: 1.10 (95% CI: 1.07-1.13), and for last vs first CRP quartile: 2.22 (95% CI: 1.76-2.79). The association was significant for both HF with reduced (HR: 1.09; 95% CI: 1.04-1.14) and preserved ejection fraction (HR: 1.12; 95% CI: 1.07-1.18) (P for difference = 0.137). Additional adjustment for medication use and interim myocardial infarction did not attenuate the association, and the association remained consistent beyond 15 years after the CRP measurement. CONCLUSIONS In patients with established CVD, CRP is an independent risk marker of incident HF. These data support ongoing trial efforts to assess whether anti-inflammatory agents can reduce the burden of HF.
Collapse
Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Stefan Koudstaal
- Department of Cardiology, Green Heart Hospital, Gouda, the Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Center, Amersfoort, the Netherlands
| | - Aernoud T L Fiolet
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul M Ridker
- Center for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
17
|
Burger PM, Pradhan AD, Dorresteijn JAN, Koudstaal S, Teraa M, de Borst GJ, van der Meer MG, Mosterd A, Ridker PM, Visseren FLJ. C-Reactive Protein and Risk of Cardiovascular Events and Mortality in Patients with Various Cardiovascular Disease Locations. Am J Cardiol 2023; 197:13-23. [PMID: 37218417 DOI: 10.1016/j.amjcard.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/10/2023] [Accepted: 03/26/2023] [Indexed: 05/24/2023]
Abstract
Anti-inflammatory drugs reduce the risk of cardiovascular events in patients with coronary artery disease (CAD), but less is known about the relation between inflammation and outcomes in patients with cerebrovascular disease (CeVD), peripheral artery disease (PAD), and abdominal aortic aneurysm (AAA). This study assessed the association between C-reactive protein (CRP) and clinical outcomes in patients with CAD (n = 4,517), CeVD (n = 2,154), PAD (n = 1,154), and AAA (n = 424) from the prospective Utrecht Cardiovascular Cohort-Second Manifestations of ARTerial disease study. The primary outcome was recurrent cardiovascular disease (CVD), defined as myocardial infarction, ischemic stroke, or cardiovascular death. Secondary outcomes were major adverse limb events and all-cause mortality. Associations between baseline CRP and outcomes were assessed using Cox proportional hazards models adjusted for age, sex, smoking, diabetes mellitus, body mass index, systolic blood pressure, non-high-density lipoprotein cholesterol, and glomerular filtration rate. Results were stratified by CVD location. During a median follow-up of 9.5 years, 1,877 recurrent CVD events, 887 major adverse limb events, and 2,341 deaths were observed. CRP was independently associated with recurrent CVD (hazard ratio [HR] per 1 mg/L 1.08, 95% confidence interval [CI] 1.05 to 1.10), and all secondary outcomes. Compared with the first quintile of CRP, HRs for recurrent CVD were 1.60 (95% CI 1.35 to 1.89) for the last quintile ≤10 mg/L and 1.90 (95% CI 1.58 to 2.29) for the subgroup with CRP >10 mg/L. CRP was associated with recurrent CVD in patients with CAD (HR per 1 mg/L 1.08, 95% CI 1.04 to 1.11), CeVD (HR 1.05, 95% CI 1.01 to 1.10), PAD (HR 1.08, 95% CI 1.03 to 1.13), and AAA (HR 1.08, 95% CI 1.01 to 1.15). The association between CRP and all-cause mortality was stronger for patients with CAD (HR 1.13, 95% CI 1.09 to 1.16) than for patients with other CVD locations (HRs 1.06 to 1.08; p = 0.002). Associations remained consistent beyond 15 years after the CRP measurement. In conclusion, greater CRP is independently associated with an increased risk of recurrent CVD and mortality, irrespective of previous CVD location.
Collapse
Affiliation(s)
- Pascal M Burger
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Aruna D Pradhan
- Centre for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Stefan Koudstaal
- Department of Cardiology, Green Heart Hospital, Gouda, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Arend Mosterd
- Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Paul M Ridker
- Centre for Cardiovascular Disease Prevention, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
18
|
Besseling PJ, Krebber MM, Fledderus JO, Teraa M, den Ouden K, van de Kaa M, de Bree PM, Serrero A, Bouten CVC, Dankers PYW, Cox MAJ, Verhaar MC. The effect of chronic kidney disease on tissue formation of in situ tissue-engineered vascular grafts. APL Bioeng 2023; 7:026107. [PMID: 37234843 PMCID: PMC10208679 DOI: 10.1063/5.0138808] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
Vascular in situ tissue engineering encompasses a single-step approach with a wide adaptive potential and true off-the-shelf availability for vascular grafts. However, a synchronized balance between breakdown of the scaffold material and neo-tissue formation is essential. Chronic kidney disease (CKD) may influence this balance, lowering the usability of these grafts for vascular access in end-stage CKD patients on dialysis. We aimed to investigate the effects of CKD on in vivo scaffold breakdown and tissue formation in grafts made of electrospun, modular, supramolecular polycarbonate with ureido-pyrimidinone moieties (PC-UPy). We implanted PC-UPy aortic interposition grafts (n = 40) in a rat 5/6th nephrectomy model that mimics systemic conditions in human CKD patients. We studied patency, mechanical stability, extracellular matrix (ECM) components, total cellularity, vascular tissue formation, and vascular calcification in CKD and healthy rats at 2, 4, 8, and 12 weeks post-implantation. Our study shows successful in vivo application of a slow-degrading small-diameter vascular graft that supports adequate in situ vascular tissue formation. Despite systemic inflammation associated with CKD, no influence of CKD on patency (Sham: 95% vs CKD: 100%), mechanical stability, ECM formation (Sirius red+, Sham 16.5% vs CKD 25.0%-p:0.83), tissue composition, and immune cell infiltration was found. We did find a limited increase in vascular calcification at 12 weeks (Sham 0.08% vs CKD 0.80%-p:0.02) in grafts implanted in CKD animals. However, this was not associated with increased stiffness in the explants. Our findings suggest that disease-specific graft design may not be necessary for use in CKD patients on dialysis.
Collapse
Affiliation(s)
| | - Merle M. Krebber
- Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joost O. Fledderus
- Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Krista den Ouden
- Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Melanie van de Kaa
- Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Petra M. de Bree
- Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Carlijn V. C. Bouten
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, TU/e, Eindhoven, The Netherlands
| | - Patricia Y. W. Dankers
- Department of Biomedical Engineering and Institute for Complex Molecular Systems, TU/e, Eindhoven, The Netherlands
| | | | - Marianne C. Verhaar
- Department of Nephrology and Hypertension, Regenerative Medicine Center, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
19
|
Teraa M, van Herwaarden JA. Complex Endovascular or Open Repair in Juxtarenal and Pararenal Aneurysms: The Best of Both Worlds. Eur J Vasc Endovasc Surg 2023; 65:837-838. [PMID: 36931551 DOI: 10.1016/j.ejvs.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| |
Collapse
|
20
|
Castelijns MC, Hageman SHJ, Teraa M, van der Meer MG, Westerink J, Costa F, Ten Berg JM, Visseren FLJ. External validation of bleeding risk models for the prediction of long-term bleeding risk in patients with established cardiovascular disease. Am Heart J 2023; 260:72-81. [PMID: 36841319 DOI: 10.1016/j.ahj.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE The long-term predictive performance of existing bleeding risk models in patients with various manifestations of cardiovascular disease (CVD) is not well known. This study aims to assess and compare the performance of relevant existing bleeding risk models in estimating the long-term risk of major bleeding in a cohort of patients with established CVD. METHODS Seven existing bleeding risk models (PRECISE-DAPT, DAPT, Ducrocq et al, de Vries et al, S2TOP-BLEED, Intracranial B2LEED3S and HAS-BLED) were identified and externally validated in 7,249 patients with established CVD included in the Utrecht Cardiovascular Cohort-second manifestations of arterial disease study. Predictive performance was assessed in terms of discrimination and calibration, both at 10 years and the original prediction horizon of the models. Major bleeding was defined as Bleeding Academic Research Consortium type 3 or 5. RESULTS After a median follow-up of 8.4 years (interquartile range 4.5-12.5), a total of 233 (3.2%) major bleeding events occurred. C-statistics for discrimination at 10 years ranged from 0.53 (95%CI 0.49-0.57) to 0.64 (95%CI 0.60-0.68). Calibration plots after recalibration to 10 years showed best agreement between predicted and observed bleeding risk for De Vries et al, S2TOP-BLEED, DAPT and PRECISE-DAPT. CONCLUSIONS The performance of existing bleeding risk models to predict long-term bleeding in patients with CVD varied. Discrimination and calibration were best for the models of de Vries et al, S2TOP-BLEED, DAPT and PRECISE-DAPT. Of these, recalibrated models requiring the least predictors may be preferred for use to personalize prevention with antithrombotic therapy.
Collapse
Affiliation(s)
- Maria C Castelijns
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Isala Clinics Zwolle, Zwolle, The Netherlands
| | - Francesco Costa
- Department of Cardiology, G. Martino University Hospital Messina, Messina, Italy
| | - Jurriën M Ten Berg
- Department of Cardiology and Platelet Function Research, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands; Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
21
|
Teraa M. Contemporary Cardiovascular Epidemiological Data: A Message from the Heart of Hamburgers. Eur J Vasc Endovasc Surg 2023; 65:599. [PMID: 36657706 DOI: 10.1016/j.ejvs.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 01/18/2023]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
22
|
Castelijns MC, Helmink MAG, Hageman SHJ, Asselbergs FW, de Borst GJ, Bots ML, Cramer MJ, Dorresteijn JAN, Emmelot-Vonk MH, Geerlings MI, de Jong PA, van der Kaaij NP, Kappelle LJ, Lely AT, van der Meer MG, Mol BM, Nathoe HM, Onland-Moret NC, van Petersen RB, Ruigrok YM, van Smeden M, Teraa M, Vandersteen A, Verhaar MC, Westerink J, Visseren FLJ. Cohort profile: the Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) Study-an ongoing prospective cohort study of patients at high cardiovascular risk in the Netherlands. BMJ Open 2023; 13:e066952. [PMID: 36806141 PMCID: PMC9944278 DOI: 10.1136/bmjopen-2022-066952] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [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: 02/22/2023] Open
Abstract
PURPOSE The Utrecht Cardiovascular Cohort-Second Manifestations of Arterial Disease (UCC-SMART) Study is an ongoing prospective single-centre cohort study with the aim to assess important determinants and the prognosis of cardiovascular disease progression. This article provides an update of the rationale, design, included patients, measurements and findings from the start in 1996 to date. PARTICIPANTS The UCC-SMART Study includes patients aged 18-90 years referred to the University Medical Center Utrecht, the Netherlands, for management of cardiovascular disease (CVD) or severe cardiovascular risk factors. Since September 1996, a total of 14 830 patients have been included. Upon inclusion, patients undergo a standardised screening programme, including questionnaires, vital signs, laboratory measurements, an ECG, vascular ultrasound of carotid arteries and aorta, ankle-brachial index and ultrasound measurements of adipose tissue, kidney size and intima-media thickness. Outcomes of interest are collected through annual questionnaires and adjudicated by an endpoint committee. FINDINGS TO DATE By May 2022, the included patients contributed to a total follow-up time of over 134 000 person-years. During follow-up, 2259 patients suffered a vascular endpoint (including non-fatal myocardial infarction, non-fatal stroke and vascular death) and 2794 all-cause deaths, 943 incident cases of diabetes and 2139 incident cases of cancer were observed up until January 2020. The UCC-SMART cohort contributed to over 350 articles published in peer-reviewed journals, including prediction models recommended by the 2021 European Society of Cardiology CVD prevention guidelines. FUTURE PLANS The UCC-SMART Study guarantees an infrastructure for research in patients at high cardiovascular risk. The cohort will continue to include about 600 patients yearly and follow-up will be ongoing to ensure an up-to-date cohort in accordance with current healthcare and scientific knowledge. In the near future, UCC-SMART will be enriched by echocardiography, and a food frequency questionnaire at baseline enabling the assessment of associations between nutrition and CVD and diabetes.
Collapse
Affiliation(s)
- Maria C Castelijns
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marga A G Helmink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Mirjam I Geerlings
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Pim A de Jong
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Niels P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Titia Lely
- Department of Gynaecology and Obstetrics, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Manon G van der Meer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Barend M Mol
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hendrik M Nathoe
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N Charlotte Onland-Moret
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rutger B van Petersen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maarten van Smeden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Angela Vandersteen
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
23
|
Castelijns MC, Hageman SHJ, Ruigrok YM, van der Meer MG, Teraa M, Westerink J, Visseren FLJ. Visceral adipose tissue quantity and dysfunction and the occurrence of major bleeding in patients with established cardiovascular disease. Obes Res Clin Pract 2023; 17:40-46. [PMID: 36464615 DOI: 10.1016/j.orcp.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 11/07/2022] [Accepted: 11/20/2022] [Indexed: 12/04/2022]
Abstract
OBJECTIVES To determine the association between both visceral fat quantity and adipose tissue dysfunction, and major bleeding in patients with established cardiovascular disease. METHODS Patients from the Second Manifestations of ARTerial disease study with established cardiovascular disease were included. Visceral fat was measured using ultrasound and adipose tissue dysfunction was depicted using metabolic syndrome criteria (revised National Cholesterol Education Program). Cox regression models were fitted to study the relation with major bleeding defined as Bleeding Academic Research Consortium (BARC) type 3 or 5, or International Society on Thrombosis and Haemostasis (ISTH) major bleeding. Sensitivity analyses were performed using C-reactive protein levels to reflect adipose tissue dysfunction. RESULTS In 6927 patients during a median follow up of 9.2 years, a total of 237 BARC type 3 or 5 bleedings and 224 ISTH major bleedings were observed. Visceral fat quantity was not related to major bleeding (HR 1.01, 95%CI 0.88-1.16 for BARC type 3 or 5 bleeding and HR 1.00, 95%CI 0.87-1.15 for ISTH major bleeding), nor was metabolic syndrome (HR 0.97, 95%CI 0.75-1.26 for BARC type 3 or 5 bleeding and HR 0.98, 95%CI 0.75-1.28 for ISTH major bleeding). Sensitivity analyses using C-reactive protein levels showed similar results. No effect modification was observed by sex, antithrombotic therapy, presence of metabolic syndrome or diabetes. CONCLUSION In patients with cardiovascular disease, no association was found between visceral fat quantity measured with ultrasound or measures of adipose tissue dysfunction and the risk of major bleeding, irrespective of antithrombotic agent use.
Collapse
Affiliation(s)
- Maria C Castelijns
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Ynte M Ruigrok
- Department of Neurology, University Medical Center Utrecht, the Netherlands
| | | | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, the Netherlands.
| | | |
Collapse
|
24
|
Khashram M, Teraa M. Safety of Paclitaxel Coated Devices: Is the Quest Completed? Eur J Vasc Endovasc Surg 2023; 65:141. [PMID: 36057368 DOI: 10.1016/j.ejvs.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 01/17/2023]
Affiliation(s)
- Manar Khashram
- Department of Vascular Surgery, Waikato Hospital Department, Hamilton, New Zealand
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| |
Collapse
|
25
|
Teraa M, Hazenberg CEVB. The Current Era of Endovascular Aortic Interventions and What the Future Holds. J Clin Med 2022; 11:jcm11195900. [PMID: 36233768 PMCID: PMC9573386 DOI: 10.3390/jcm11195900] [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] [Received: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Martin Teraa
- Correspondence: ; Tel.: +31-887556965; Fax: +31-887555017
| | | |
Collapse
|
26
|
Burger P, Dorresteijn J, Fiolet A, Koudstaal S, Eikelboom J, Nidorf S, Thompson P, Cornel J, Budgeon C, Steg P, Cramer M, Teraa M, Bhatt D, Visseren F, Mosterd A. Individual lifetime benefit from low-dose colchicine in chronic coronary artery disease patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1222] [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
Low-dose colchicine reduces the risk of cardiovascular events in patients with chronic coronary artery disease (CAD), but the absolute benefit may vary between patients. Individual benefit from preventive therapies can be estimated using the guideline-recommended SMART-REACH model.
Purpose
This study aimed to assess the range of individual absolute 10-year and lifetime benefit from low-dose colchicine according to patient risk profile.
Methods
The SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to all participants from the LoDoCo2 trial (n=5,522), and patients with chronic CAD from the UCC-SMART cohort (n=5,308). Individual treatment benefit was expressed as (i) 10-year absolute risk reductions (ARRs) for myocardial infarction, ischemic stroke, or cardiovascular death (MACE), and (ii) life-years gained free of MACE. Predictions were also performed for MACE plus ischemia-driven coronary revascularization (MACE+), through development of a new competing risk-adjusted lifetime prediction model in data from the REACH registry (n=14,522). Low-dose colchicine was compared to alternative intensive prevention goals, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to <1.4 mmol/L, and systolic blood pressure (SBP) reduction to <130 mmHg.
Results
Median individual 10-year ARR for MACE from low-dose colchicine therapy was 4.6% (interquartile range [IQR] 3.6–6.0%), and median gain in life expectancy free of MACE was 2.0 (IQR 1.6–2.5) years. Median 10-year ARR for MACE+ was 8.6% (IQR 7.6–9.8%), and median gain in MACE+-free life expectancy was 3.4 (IQR 2.6–4.2) years. For intensified LDL-c and SBP reduction respectively, median 10-year ARRs were 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%) for MACE, and 5.2% (IQR 2.5–8.7%) and 2.9% (IQR 0.0–9.5%) for MACE+. Median life-years gained from LDL-c and SBP reduction were 1.2 (IQR 0.6–2.1) and 0.7 (IQR 0.0–2.3) years free of MACE, and 1.8 (IQR 0.8–3.3) and 0.9 (IQR 0.0–3.4) years free of MACE+.
Conclusion
The individual absolute benefit from low-dose colchicine varies between patients. In an era where lipid- and blood pressure-lowering therapies are already routinely used, the benefits of low-dose colchicine are expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in patients with chronic CAD.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- P Burger
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - J Dorresteijn
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - A Fiolet
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - S Koudstaal
- Green Heart Hospital , Gouda , The Netherlands
| | | | - S Nidorf
- Sir Charles Gairdner Hospital , Perth , Australia
| | - P Thompson
- Sir Charles Gairdner Hospital , Perth , Australia
| | - J Cornel
- Radboud University Medical Centre , Nijmegen , The Netherlands
| | - C Budgeon
- University of Western Australia , Perth , Australia
| | - P Steg
- University Paris Diderot , Paris , France
| | - M Cramer
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - M Teraa
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - D Bhatt
- Brigham and Women's Hospital , Boston , United States of America
| | - F Visseren
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - A Mosterd
- Meander Medical Center , Amersfoort , The Netherlands
| |
Collapse
|
27
|
Porras C, Bots M, Teraa M, van Doorn S, Vernooij R. Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.03.027] [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] [Indexed: 11/30/2022]
|
28
|
van Rhijn-Brouwer FCCC, Gremmels H, den Ouden K, Teraa M, Fledderus JO, Verhaar MC. Human bone marrow mononuclear cells do not improve limb perfusion in the hindlimb ischemia model. Stem Cells Dev 2022; 31:176-180. [PMID: 35152731 PMCID: PMC9057881 DOI: 10.1089/scd.2021.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Hendrik Gremmels
- University Medical Center Utrecht, Department of Nephrology & Hypertension, Regenerative Medicine Center Utrecht, Utrecht, Netherlands
| | - Krista den Ouden
- University Medical Center Utrecht, Department of Nephrology & Hypertension, Regenerative Medicine Center Utrecht, Utrecht, Netherlands
| | - Martin Teraa
- University Medical Center Utrecht, Department of Nephrology & Hypertension, Regenerative Medicine Center Utrecht, Utrecht, Netherlands
- University Medical Center Utrecht, Department of Vascular Surgery, Utrecht, Netherlands
| | - Joost Ougust Fledderus
- University Medical Center Utrecht, Department of Nephrology & Hypertension, Regenerative Medicine Center Utrecht, Utrecht, Netherlands
| | - Marianne Christina Verhaar
- University Medical Center Utrecht, Department of Nephrology & Hypertension, Regenerative Medicine Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
29
|
Verwer MC, Teraa M, Van Eijk L, Hazenberg CEVBS, De Borst GJ. [Peripheral artery disease and diabetes: complex multidisciplinary care for an increasing number of patients]. Ned Tijdschr Geneeskd 2021; 165:D5560. [PMID: 34854584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The forthcoming increase in the number of people with diabetes mellitus (DM) is likely to lead to an absolute and relative increase in the number of people with a combination of DM and peripheral artery disease (PAD). Due to different pathophysiological processes and presentation, diagnosis and treatment in these patients are more complicated compared to non-DM related PAD. Understanding the differences, pitfalls and concerns in patients with combined DM-PAD would result in better care for these patients, who are at high risk of cardiovascular comorbidities, mortality and amputation. Introduced by two case reports, we provide an overview of current guidelines, recent literature and innovations to address these critical issues.
Collapse
Affiliation(s)
- Maarten C Verwer
- Universitair Medisch Centrum Utrecht, Utrecht, Afd. Vaatchirurgie
| | - Martin Teraa
- Universitair Medisch Centrum Utrecht, Utrecht, Afd. Vaatchirurgie
| | - Luuk Van Eijk
- Universitair Medisch Centrum Utrecht, Utrecht, Afd. Vaatchirurgie
| | | | - Gert J De Borst
- Universitair Medisch Centrum Utrecht, Utrecht, Afd. Vaatchirurgie
- Contact: Gert J. De Borst
| |
Collapse
|
30
|
Wijnand JGJ, Zarkowsky D, Wu B, van Haelst STW, Vonken EJPA, Sorrentino TA, Pallister Z, Chung J, Mills JL, Teraa M, Verhaar MC, de Borst GJ, Conte MS. The Global Limb Anatomic Staging System (GLASS) for CLTI: Improving Inter-Observer Agreement. J Clin Med 2021; 10:jcm10163454. [PMID: 34441757 PMCID: PMC8396876 DOI: 10.3390/jcm10163454] [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] [Received: 07/04/2021] [Revised: 07/29/2021] [Accepted: 08/01/2021] [Indexed: 11/23/2022] Open
Abstract
Objective: The 2020 Global Vascular Guidelines aim at improving decision making in Chronic Limb-Threatening Ischemia (CLTI) by providing a framework for evidence-based revascularization. Herein, the Global Limb Anatomic Staging System (GLASS) serves to estimate the chance of success and patency of arterial pathway revascularization based on the extent and distribution of the atherosclerotic lesions. We report the preliminary feasibility results and observer variability of the GLASS. GLASS is a part of the new global guideline and posed as a promising additional tool for EBR strategies to predict the success of lower extremity arterial revascularization. This study reports on the consistency of GLASS scoring to maximize inter-observer agreement and facilitate its application. Methods: GLASS separately scores the femoropopliteal (FP) and infrapopliteal (IP) segment based on stenosis severity, lesion length and the extent of calcification within the target artery pathway (TAP). In our stepwise approach, we used two angiographic datasets. Each following step was based on the lessons learned from the previous step. The primary outcome was inter-observer agreement measured as Cohen’s Kappa, scored by two (step 1 + 2) and four (step 3) blinded and experienced observers, respectively. Steps 1 (n = 139) and 2 (n = 50) were executed within a dataset of a Dutch interventional RCT in CLTI. Step 3 (n = 100) was performed in randomly selected all-comer CLTI patients from two vascular centers in the United States. Results: In step 1, kappa values were 0.346 (FP) and 0.180 (IP). In step 2, applied in the same dataset, the use of other experienced observers and a provided TAP, resulted in similar low kappa values 0.406 (FP) and 0.089 (IP). Subsequently, in step 3, the formation of an altered stepwise approach using component scoring, such as separate scoring of calcification and adding a ruler to the images resulted in kappa values increasing to 0.796 (FP) and 0.730 (IP). Conclusion: This retrospective GLASS validation study revealed low inter-observer agreement for unconditioned scoring. A stepwise component scoring provides acceptable agreement and a solid base for further prospective validation studies to investigate how GLASS relates to treatment outcomes.
Collapse
Affiliation(s)
- Joep G. J. Wijnand
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
- Correspondence: ; Tel.: +1-415-353-4366
| | - Devin Zarkowsky
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
| | - Bian Wu
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
| | - Steven T. W. van Haelst
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
| | - Evert-Jan P. A. Vonken
- Department of Radiology, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Thomas A. Sorrentino
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
| | - Zachary Pallister
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (Z.P.); (J.C.); (J.L.M.)
| | - Jayer Chung
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (Z.P.); (J.C.); (J.L.M.)
| | - Joseph L. Mills
- Department of Vascular Surgery, Baylor College of Medicine, Houston, TX 77030, USA; (Z.P.); (J.C.); (J.L.M.)
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
| | - Marianne C. Verhaar
- Department of Nephrology & Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Gert J. de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands; (S.T.W.v.H.); (M.T.); (G.J.d.B.)
| | - Michael S. Conte
- Department of Vascular Surgery, UCSF Medical Center, San Francisco, CA 94143, USA; (D.Z.); (B.W.); (T.A.S.); (M.S.C.)
| |
Collapse
|
31
|
Teraa M, Boyle JR. Abdominal Compartment Syndrome; Can Big Data Provide the Answers? Eur J Vasc Endovasc Surg 2021; 62:408. [PMID: 34301461 DOI: 10.1016/j.ejvs.2021.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - Jonathan R Boyle
- Cambridge Vascular Unit, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| |
Collapse
|
32
|
Verwer MC, Wijnand JGJ, Teraa M, Verhaar MC, de Borst GJ. Long Term Survival and Limb Salvage in Patients With Non-Revascularisable Chronic Limb Threatening Ischaemia. Eur J Vasc Endovasc Surg 2021; 62:225-232. [PMID: 34090781 DOI: 10.1016/j.ejvs.2021.04.003] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/17/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study was to provide long term survival and limb salvage rates for patients with non-revascularisable (NR) chronic limb threatening ischaemia (CLTI). METHODS This was a retrospective review of prospectively collected data, derived from a randomised controlled trial (JUVENTAS) investigating the use of a regenerative cell therapy. Survival and limb salvage of the index limb in CLTI patients without viable options for revascularisation at inclusion were analysed retrospectively. The primary outcome was amputation free survival, a composite of survival and limb salvage, at five years after inclusion in the original trial. RESULTS In 150 patients with NR-CLTI, amputation free survival was 43% five years after inclusion. This outcome was driven by an equal rate of all cause mortality (35%) and amputation (33%). Amputation occurred predominantly in the first year. Furthermore, 33% of those with amputation subsequently died within the investigated period, with a median interval of 291 days. CONCLUSION Five years after the initial need for revascularisation, about half of the CLTI patients who were deemed non-revascularisable survived with salvage of the index limb. Although the prospects for these high risk patients are still poor, under optimal medical care, amputation free survival seems comparable with that of revascularisable CLTI patients, while the major amputation rate within one year, especially among NR-CLTI patients with ischaemic tissue loss, is very high.
Collapse
Affiliation(s)
- Maarten C Verwer
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Joep G J Wijnand
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology & Hypertension, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
33
|
Besseling PJ, Mes T, Bosman AW, Peeters JW, Janssen HM, Bakker MH, Fledderus JO, Teraa M, Verhaar MC, Gremmels H, Dankers PYW. The in‐vitro biocompatibility of ureido‐pyrimidinone compounds and polymer degradation products. Journal of Polymer Science 2021. [DOI: 10.1002/pol.20210072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Paul J. Besseling
- Department of Nephrology and Hypertension University Medical Center Utrecht Utrecht The Netherlands
| | | | | | | | - Henk M. Janssen
- SyMO‐Chem BV Den Dolech 2 Eindhoven The Netherlands
- Department of Biomedical Engineering, Laboratory of Chemical Biology Eindhoven University of Technology Eindhoven The Netherlands
| | - Maarten H. Bakker
- Institute for Complex Molecular Systems Eindhoven University of Technology Eindhoven The Netherlands
| | - Joost O. Fledderus
- Department of Nephrology and Hypertension University Medical Center Utrecht Utrecht The Netherlands
| | - Martin Teraa
- Department of Nephrology and Hypertension University Medical Center Utrecht Utrecht The Netherlands
| | - Marianne C. Verhaar
- Department of Nephrology and Hypertension University Medical Center Utrecht Utrecht The Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension University Medical Center Utrecht Utrecht The Netherlands
| | - Patricia Y. W. Dankers
- Department of Biomedical Engineering, Laboratory of Chemical Biology Eindhoven University of Technology Eindhoven The Netherlands
- Institute for Complex Molecular Systems Eindhoven University of Technology Eindhoven The Netherlands
| |
Collapse
|
34
|
Hanssen NMJ, Teraa M, Scheijen JLJM, Van de Waarenburg M, Gremmels H, Stehouwer CDA, Verhaar MC, Schalkwijk CG. Plasma Methylglyoxal Levels Are Associated With Amputations and Mortality in Severe Limb Ischemia Patients With and Without Diabetes. Diabetes Care 2021; 44:157-163. [PMID: 33144352 DOI: 10.2337/dc20-0581] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes is a risk factor for severe limb ischemia (SLI), a condition associated with high mortality, morbidity, and limb loss. The reactive glucose-derived dicarbonyl methylglyoxal (MGO) is a major precursor for advanced glycation end products (AGEs) and a potential driver of cardiovascular disease. We investigated whether plasma MGO levels are associated with poor outcomes in SLI. RESEARCH DESIGN AND METHODS We measured plasma levels of MGO, free AGEs, and d-lactate, the detoxification end product of MGO, with ultraperformance liquid chromatography-tandem mass spectrometry at baseline in 160 patients (64.8 ± 13.3 years, 67.5% male, 37.5% with diabetes) with no-option SLI and recorded major adverse outcomes (n = 86, comprising n = 53 deaths and n = 49 amputations [first event counted]) over the 5-year follow-up. Data were analyzed with linear or Cox regression, after Ln-transformation of the independent variables, adjusted for sex, age, trial arm, diabetes, estimated glomerular filtration rate, systolic blood pressure, cholesterol levels, and BMI. Associations are reported per 1 SD plasma marker. RESULTS Higher plasma MGO levels were associated with more adverse outcomes (relative risk 1.44; 95% CI 1.11-1.86) and amputations separately (1.55; 1.13-2.21). We observed a similar but weaker trend for mortality (1.28; 0.93-1.77). The MGO-derived AGE Nε-(carboxyethyl)lysine was also associated with more adverse outcomes (1.46; 1.00-2.15) and amputations (1.71; 1.04-2.79). d-Lactate was not associated with adverse incident outcomes. Higher plasma MGO levels were also associated with more inflammation and white blood cells and fewer progenitor cells. CONCLUSIONS Plasma MGO levels are associated with adverse outcomes in SLI. Future studies should investigate whether MGO-targeting therapies improve outcomes in SLI.
Collapse
Affiliation(s)
- Nordin M J Hanssen
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands .,Diabetes Center, Department of Vascular and Internal Medicine, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jean L J M Scheijen
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Marjo Van de Waarenburg
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Coen D A Stehouwer
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Casper G Schalkwijk
- Department of Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM) School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
35
|
Teraa M, Hazenberg CE, Houben IB, Trimarchi S, van Herwaarden JA. Important issues regarding planning and sizing for emergent TEVAR. J Cardiovasc Surg (Torino) 2020; 61:708-712. [PMID: 32964898 DOI: 10.23736/s0021-9509.20.11571-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In the past decades, treatment of acute thoracic aortic syndrome underwent drastic changes with a central role for thoracic endovascular aortic repair (TEVAR). One of the essential factors in the success of TEVAR is accurate sizing of the endograft, as both under- and oversizing can lead to suboptimal results and disastrous complications. The aim of this review was to give an overview of issues regarding endograft sizing in emergent TEVAR. Sizing of the endograft can be complicated by specific factors related to the underlying disease. For instance, different types of the acute thoracic aortic syndrome, i.e. blunt thoracic injury, thoracic aortic aneurysm or dissection with concomitant rupture are associated with hemorrhagic shock and the need for resuscitation, which leads to profound changes in diameter of the thoracic aorta. These diameter changes should be taken into account during endograft sizing. Measuring the thoracic aorta based on the admission CTA can lead to inaccurate sizing, even if proper centerline-based measurements are performed. The use of real-time imaging, in particular intravascular ultrasound (IVUS), has been shown to provide more accurate endograft sizing in acute thoracic aortic syndromes, especially if associated with hypovolemia. Future research should provide additional data on the exact role of different intra-operative imaging modalities (e.g. IVUS, transesophageal echocardiography [TEE], three dimensional CTA) on endograft sizing and long-term outcomes to ultimately improve patient outcome.
Collapse
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands -
| | | | - Ignas B Houben
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Santi Trimarchi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical and Community Sciences, University of Milan, Milan, Italy
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| |
Collapse
|
36
|
Teraa M, van Herwaarden JA. Now We Know What Happens after Landing, but Do We Know When and How to Fly? Eur J Vasc Endovasc Surg 2020; 59:946. [PMID: 32081530 DOI: 10.1016/j.ejvs.2020.01.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| |
Collapse
|
37
|
Wijnand JGJ, van Koeverden ID, Teraa M, Spreen MI, Mali WPTM, van Overhagen H, Pasterkamp G, de Borst GJ, Conte MS, Gremmels H, Verhaar MC. Validation of randomized controlled trial-derived models for the prediction of postintervention outcomes in chronic limb-threatening ischemia. J Vasc Surg 2019; 71:869-879. [PMID: 31564582 DOI: 10.1016/j.jvs.2019.06.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 06/13/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease and has a large impact on quality of life, morbidity, and mortality. Interventions are aimed at improving tissue perfusion and averting amputation and secondary cardiovascular complications with an optimal risk-benefit ratio. Several prediction models regarding postprocedural outcomes in CLTI patients have been developed on the basis of randomized controlled trials to improve clinical decision-making. We aimed to determine model performance in predicting clinical outcomes in selected CLTI cohorts. METHODS This study validated the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL), Finland National Vascular registry (FINNVASC), and Prevention of Infrainguinal Vein Graft Failure (PREVENT III) models in data sets from a peripheral artery disease registry study (Athero-Express) and two randomized controlled trials of CLTI in The Netherlands, Rejuvenating Endothelial Progenitor Cells via Transcutaneous Intra-arterial Supplementation (JUVENTAS) and Percutaneous Transluminal Angioplasty and Drug-eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia (PADI). Receiver operating characteristic (ROC) curve analysis was used to calculate their predictive capacity. The primary outcome was amputation-free survival (AFS); secondary outcomes were all-cause mortality and amputation at 12 months after intervention. RESULTS The BASIL and PREVENT III models showed predictive values regarding postintervention mortality in the JUVENTAS cohort with an area under the ROC curve (AUC) of 81% and 70%, respectively. Prediction of AFS was poor to fair (AUC, 0.60-0.71) for all models in each population, with the highest predictive value of 71% for the BASIL model in the JUVENTAS population. The FINNVASC model showed the highest predictive value regarding amputation risk in the PADI population with AUC of 78% at 12 months. CONCLUSIONS In general, all models performed poor to fair in predicting mortality and amputation. Because the BASIL model performed best in predicting AFS, we propose use of the BASIL model to aid in the clinical decision-making process in CLTI. However, improvements in performance have to be made for any of these models to be of real additional value in clinical practice.
Collapse
Affiliation(s)
- Joep G J Wijnand
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ian D van Koeverden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Experimental Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marlon I Spreen
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Willem P T M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hans van Overhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Gerard Pasterkamp
- Laboratory of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael S Conte
- Department of Vascular Surgery, University of California San Francisco Medical Center, San Francisco, Calif
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
| |
Collapse
|
38
|
Teraa M, Hazenberg CEVB. A Paclitaxel Free Alternative in the War Against Drugs? Eur J Vasc Endovasc Surg 2019; 58:728. [PMID: 31383584 DOI: 10.1016/j.ejvs.2019.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | | |
Collapse
|
39
|
Leenstra B, Wijnand J, Verhoeven B, Koning O, Teraa M, Verhaar MC, de Borst GJ. Applicability of Transcutaneous Oxygen Tension Measurement in the Assessment of Chronic Limb-Threatening Ischemia. Angiology 2019; 71:208-216. [PMID: 31387360 PMCID: PMC6987479 DOI: 10.1177/0003319719866958] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Transcutaneous oxygen tension measurement (TcPO2) is widely applied for the
evaluation of chronic limb-threatening ischemia (CLTI). Nevertheless, studies that focused
on the clinical value of TcPO2 have shown varying results. We identified
factors that potentially play a role in TcPO2 measurement variation such as
probe placement, probe temperature, and the use of a reference probe. In this review of
the current literature, we assessed the application of these factors. A systematic search
was conducted. Parameters that were assessed were probe placement, probe temperature, and
mentioning and/or use of a reference probe. In total, 36 articles were eligible for
analysis. In 24 (67%) studies, probes were placed on specific anatomical locations. Seven
(19%) studies placed probes, regardless of the location of the ulcer, adjacent to an
ischemic lesion or ulcer (perilesion). Selected temperature setting of the probe differed;
in 18 (50%), a default probe temperature of 44°C was selected, and in 13 (36%), a
different temperature was selected. In 31 (84%) studies, the use of a reference probe was
not reported. Transcutaneous oxygen tension measurement is applied diversely in patients
with CLTI. Homogeneity in TcPO2 protocols is warranted for reliable clinical
application and to compare future TcPO2 research.
Collapse
Affiliation(s)
- Bernard Leenstra
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the Netherlands
| | - Joep Wijnand
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the Netherlands
| | - Bart Verhoeven
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat, GZ 's-Hertogenbosch, the Netherlands
| | - Olivier Koning
- Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat, GZ 's-Hertogenbosch, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the Netherlands.,Department of Vascular Surgery, Jeroen Bosch Ziekenhuis, Henri Dunantstraat, GZ 's-Hertogenbosch, the Netherlands.,Department of Nephrology and Hypertension, UMC Utrecht, Heidelberglaan, CX Utrecht, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, UMC Utrecht, Heidelberglaan, CX Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, UMC Utrecht, CX Utrecht, the Netherlands
| |
Collapse
|
40
|
Gremmels H, van Rhijn-Brouwer FCC, Papazova DA, Fledderus JO, Teraa M, Verhaar MC. Exhaustion of the bone marrow progenitor cell reserve is associated with major events in severe limb ischemia. Angiogenesis 2019; 22:411-420. [PMID: 30929097 PMCID: PMC6652783 DOI: 10.1007/s10456-019-09666-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/25/2019] [Indexed: 12/25/2022]
Abstract
Lower numbers of progenitor cells (PCs) in peripheral blood (PB) have been associated with cardiovascular events in high-risk populations. Therapies aiming to increase the numbers of PCs in circulation have been developed, but clinical trials did not result in better outcomes. It is currently unknown what causes the reduction in PB PC numbers: whether it is primary depletion of the progenitor cell reserve, or a reduced mobilization of PCs from the bone marrow (BM). In this study, we examine if PB and BM PC numbers predict Amputation-Free Survival (AFS) in patients with Severe Limb Ischemia (SLI). We obtained PB and BM from 160 patients enrolled in a clinical trial investigating BM cell therapy for SLI. Samples were incubated with antibodies against CD34, KDR, CD133, CD184, CD14, CD105, CD140b, and CD31; PC populations were enumerated by flow cytometry. Higher PB CD34+ and CD133+ PC numbers were related to AFS (Both Hazard Ratio [HRevent] = 0.56, p = 0.003 and p = 0.0007, respectively). AFS was not associated with the other cell populations in PB. BM PC numbers correlated with PB PC numbers and showed similar HRs for AFS. A further subdivision based on relative BM and PB PC numbers showed that BM PC numbers, rather than mobilization, associated with AFS. Both PB and BM PC numbers are associated with AFS independently from traditional risk factor and show very similar risk profiles. Our data suggest that depletion of the progenitor cell reserve, rather than decreased PC mobilization, underlies the association between PB PC numbers and cardiovascular risk.
Collapse
Affiliation(s)
- Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Postal Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Femke C C van Rhijn-Brouwer
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Postal Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Diana A Papazova
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Postal Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Joost O Fledderus
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Postal Box 85500, 3508 GA, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Postal Box 85500, 3508 GA, Utrecht, The Netherlands.
| |
Collapse
|
41
|
Teraa M, de Vries M. Substent Anchor Technique for Recanalisation of a Full Metal Jacket Femoropopliteal Occlusion: An Unconventional Road to Rome. EJVES Short Rep 2018; 41:24. [PMID: 30582022 PMCID: PMC6300431 DOI: 10.1016/j.ejvssr.2018.10.004] [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] [Received: 10/15/2018] [Accepted: 10/15/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Mattijs de Vries
- Department of Vascular Surgery, Diakonessenhuis, Utrecht, the Netherlands
| |
Collapse
|
42
|
van Haelst ST, Teraa M, Moll FL, de Borst GJ, Verhaar MC, Conte MS. Prognostic value of the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification in patients with no-option chronic limb-threatening ischemia. J Vasc Surg 2018; 68:1104-1113.e1. [DOI: 10.1016/j.jvs.2018.02.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/11/2018] [Indexed: 01/26/2023]
|
43
|
Teraa M, Gremmels H, Wijnand JGJ, Verhaar MC. Cell Therapy for Chronic Limb-Threatening Ischemia: Current Evidence and Future Directions. Stem Cells Transl Med 2018; 7:842-846. [PMID: 30070050 PMCID: PMC6265636 DOI: 10.1002/sctm.18-0025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 02/03/2018] [Revised: 06/16/2018] [Accepted: 07/03/2018] [Indexed: 12/19/2022] Open
Abstract
Cell‐based therapies have gained interest as a potential treatment method in cardiovascular disease in the past two decades, peripheral artery disease amongst others. Initial pre‐clinical and small pilot clinical studies showed promising effects of cell therapy in peripheral artery disease and chronic limb‐threatening ischemia in particular. However, these promising results were not corroborated in larger high quality blinded randomized trials. This has led to a shift of the field towards more sophisticated cell products, especially mesenchymal stromal cells. Mesenchymal stromal cells have some important benefits, making these cells ideal for regenerative medicine, e.g., potential for allogeneic application, loss of disease‐mediated cell dysfunction, reduced production costs, off‐the‐shelf availability. Future high quality and large clinical studies have to prove the efficacy of mesenchymal stromal cells in the treatment of peripheral artery disease. Stem Cells Translational Medicine2018;7:842–846
Collapse
Affiliation(s)
- Martin Teraa
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joep G J Wijnand
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
44
|
Spreen MI, Gremmels H, Teraa M, Sprengers RW, Martens JM, Verhaar MC, Wever JJ, de Borst GJ, Vos JA, Mali WP, van Overhagen H. High and immeasurable ankle-brachial index as predictor of poor amputation-free survival in critical limb ischemia. J Vasc Surg 2018; 67:1864-1871.e3. [DOI: 10.1016/j.jvs.2017.10.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Accepted: 10/03/2017] [Indexed: 01/26/2023]
|
45
|
van Rhijn-Brouwer FC, Gremmels H, van Koeverden ID, Teraa M, Pasterkamp G, de Borst GJ, Fledderus JO, Verhaar MC. Abstract 728: The Neutrophil-to-lymphocyte Ratio is Associated With Amputation Free Survival in Critical Limb Ischemia. Arterioscler Thromb Vasc Biol 2018. [DOI: 10.1161/atvb.38.suppl_1.728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Inflammation plays a key role in ischemic cardiovascular disease. The neutrophil-to-lymphocyte ratio (NLR) is an inexpensive marker for inflammation and correlates with outcomes in critical limb ischemia (CLI). Previous studies have suffered from low power due to low event rates, and show only limited adjustment for confounders. We examined in a prospective cohort whether the peripheral blood (PB) NLR predicts amputation-free-survival (AFS) and has additional predictive power over established risk factors. We also studied bone-marrow (BM) composition and plasma cytokines to elucidate the etiology of NLR alterations.
Methods and Results:
Data from CLI patients in the JUVENTAS Trial and ATHERO-EXPRESS registry were pooled (N=351). Median follow-up was 3.16 years during which 128 events (amputation or death) occurred. In patients that experienced an event, the PB NLR was elevated (Event: 4.2 (SD 2.8) vs No event: 3.0 (SD 1.9) p=<0.001), the neutrophil count was higher (6.3 (SD 2.5) vs 5.5 (SD2.3) p=0.0003), and the lymphocyte count was lower (1.7 (SD 0.8) vs 2.1 (SD 0.8) p<0.001). Cox regression showed that the hazard ratio (HR) for AFS was 1.6 (CI: 1.4-1.9), p=2*10
-8
. In a model adjusting for age, sex, diabetes mellitus, BMI, smoking, and GFR the NLR significantly predicted AFS, HR 1.4 (CI 1.2-1.7) p=0.0003. In a sub study in the JUVENTAS cohort, the PB NLR correlated with the BM NLR, but the BM NLR did not correlate with AFS. Additionally, the NLR correlated strongly with the inflammatory cytokines IL-6, IL-8, and CRP.
Discussion and Conclusion:
These results show that the NLR is an independent predictor of AFS in CLI. While most studies analyzed the NLR as a binary value, here we show a continuous correlation between the NLR and AFS, even when corrected for major confounders. We show that blood NLR is reflected in BM and correlates with inflammatory cytokines, indicating that our incidental measurements may reflect chronic inflammation-driven alterations in BM.
Collapse
|
46
|
Wijnand JGJ, Teraa M, Gremmels H, van Rhijn-Brouwer FCC, de Borst GJ, Verhaar MC. Rationale and design of the SAIL trial for intramuscular injection of allogeneic mesenchymal stromal cells in no-option critical limb ischemia. J Vasc Surg 2017; 67:656-661. [PMID: 29242062 DOI: 10.1016/j.jvs.2017.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 09/30/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and has an immense impact on quality of life, morbidity, and mortality. A considerable proportion of CLI patients are ineligible for revascularization, leaving amputation as the only option. Mesenchymal stromal cells (MSCs), because of their vasculoregenerative and immunomodulatory characteristics, have emerged as a potential new treatment. METHODS The primary objective of this trial is to investigate whether intramuscular administration of allogeneic bone marrow (BM)-derived MSCs is safe and potentially effective. The SAIL (allogeneic mesenchymal Stromal cells for Angiogenesis and neovascularization in no-option Ischemic Limbs) trial is a double-blind, placebo-controlled randomized clinical trial to investigate the effect of allogeneic BM-MSCs in patients with CLI who are not eligible for conventional revascularization. A total of 66 patients will be included and randomized (1:1) to undergo 30 intramuscular injections with either BM-MSCs (5 × 106 MSCs per injection) or placebo in the ischemic lower extremity. Primary outcome, that is, therapy success, a composite outcome consisting of mortality, limb status, clinical status, and changes in pain score, will be assessed at 6 months. All study-related procedures will take place in the University Medical Center Utrecht in The Netherlands. CONCLUSIONS If our results indicate that intramuscular allogeneic BM-MSC therapy for CLI is safe and potentially effective, this will have important consequences for treatment of patients with CLI. A large multicenter clinical trial with longer follow-up focusing on hard end points should then be initiated to confirm these findings.
Collapse
Affiliation(s)
- Joep G J Wijnand
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martin Teraa
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | |
Collapse
|
47
|
De Haan JJ, Haitjema S, den Ruijter HM, Pasterkamp G, de Borst GJ, Teraa M, Verhaar MC, Gremmels H, de Jager SCA. Growth Differentiation Factor 15 Is Associated With Major Amputation and Mortality in Patients With Peripheral Artery Disease. J Am Heart Assoc 2017; 6:JAHA.117.006225. [PMID: 28855167 PMCID: PMC5634279 DOI: 10.1161/jaha.117.006225] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 12/16/2022]
Abstract
Background Peripheral artery disease (PAD) is one of the most common clinical presentations of atherosclerosis, and its prevalence is still increasing. Despite improvement of health care, morbidity and mortality risks remain high, including the risk of amputation. GDF15 (growth differentiation factor 15) is a member of the transforming growth factor family that is involved in apoptosis and inflammation; therefore, GDF15 is a potential biomarker to identify patients at high risk of adverse clinical outcomes. Methods and Results Circulating GDF15 levels were measured using a multiplex immunoassay in patients with critical limb ischemia and PAD from 2 different patient cohorts that included patients with clinically manifest PAD: the JUVENTAS (Rejuvenating Endothelial Progenitor Cells via Transcutaneous Intra‐Arterial Supplementation) trial (n=160, 67 major events; critical limb ischemia) and the Athero‐Express Biobank (n=386, 64 major events; PAD). Kaplan–Meier curves demonstrated that high levels of GDF15 were associated with increased risk of major events, defined as major amputation (at or above the ankle joint) and all‐cause mortality, in both cohorts (highest versus lowest, JUVENTAS: hazard ratio: 4.01 [95% confidence interval, 2.05–7.84; P<0.0001]; Athero‐Express: hazard ratio: 3.27 [95% confidence interval, 1.64–6.54; P=0.0008]). In the JUVENTAS trial, this was more pronounced in women. Cox proportional multivariable regression models with median follow‐up of 3 years, corrected for common confounders, showed hazard ratios of 1.70 (95% confidence interval, 1.18–2.69; P=0.0053) and 1.57 (95% confidence interval, 1.02–2.41; P=0.041) per 2.78‐fold increase of GDF15 in JUVENTAS and Athero‐Express, respectively. Conclusions High GDF15 levels are associated with increased risk of major amputation and/or death in PAD patients. GDF15 levels could be of additive value to identify patients who are at high risk of amputation or death and could help guide treatment choices.
Collapse
Affiliation(s)
- Judith J De Haan
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, the Netherlands
| | - Saskia Haitjema
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, the Netherlands
| | - Hester M den Ruijter
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, the Netherlands
| | - Gerard Pasterkamp
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, the Netherlands.,Laboratory for Clinical Chemistry and Haematology, University Medical Center Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology and Hypertension, University Medical Center Utrecht, the Netherlands
| | - Hendrik Gremmels
- Department of Nephrology and Hypertension, University Medical Center Utrecht, the Netherlands
| | - Saskia C A de Jager
- Laboratory for Experimental Cardiology, University Medical Center Utrecht, the Netherlands .,Laboratory of Translational Immunology, University Medical Center Utrecht, the Netherlands
| |
Collapse
|
48
|
Leunissen TC, Wisman PP, van Holten TC, de Groot PG, Korporaal SJ, Koekman AC, Moll FL, Teraa M, Verhaar MC, de Borst GJ, Urbanus RT, Roest M. The effect of P2Y12 inhibition on platelet activation assessed with aggregation- and flow cytometry-based assays. Platelets 2016; 28:567-575. [PMID: 27885904 DOI: 10.1080/09537104.2016.1246713] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients on P2Y12 inhibitors may still develop thrombosis or bleeding complications. Tailored antiplatelet therapy, based on platelet reactivity testing, might reduce these complications. Several tests have been used, but failed to show a benefit of tailored antiplatelet therapy. This could be due to the narrowness of current platelet reactivity tests, which are limited to analysis of platelet aggregation after stimulation of the adenosine diphosphate (ADP)-pathway. However, the response to ADP does not necessarily reflect the effect of P2Y12 inhibition on platelet function in vivo. Therefore, we investigated whether measuring platelet reactivity toward other physiologically relevant agonists could provide more insight in the efficacy of P2Y12 inhibitors. The effect of in vitro and in vivo P2Y12 inhibition on αIIbβ3-activation, P-selectin and CD63-expression, aggregate formation, release of alpha, and dense granules content was assessed after stimulation of different platelet activation pathways. Platelet reactivity measured with flow cytometry in 72 patients on P2Y12 inhibitors was compared to VerifyNow results. P2Y12 inhibitors caused strongly attenuated platelet fibrinogen binding after stimulation with peptide agonists for protease activated receptor (PAR)-1 and -4, or glycoprotein VI ligand crosslinked collagen-related peptide (CRP-xl), while aggregation was normal at high agonist concentration. P2Y12 inhibitors decreased PAR-agonist and CRP-induced dense granule secretion, but not alpha granule secretion. A proportion of P2Y12-inhibitor responsive patients according to VerifyNow, displayed normal fibrinogen binding assessed with flow cytometry after stimulation with PAR-agonists or CRP despite full inhibition of the response to ADP, indicating suboptimal platelet inhibition. Concluding, measurement of platelet fibrinogen binding with flow cytometry after stimulation of thrombin- or collagen receptors in addition to ADP response identifies different patients as nonresponders to P2Y12 inhibitors, compared to only ADP-induced aggregation-based assays. Future studies should investigate the value of both assays for monitoring on-treatment platelet reactivity.
Collapse
Affiliation(s)
- Tesse C Leunissen
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands.,b Department of Vascular Surgery , University Medical Center Utrecht , The Netherlands
| | - Peter Paul Wisman
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands.,b Department of Vascular Surgery , University Medical Center Utrecht , The Netherlands
| | - Thijs C van Holten
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands
| | - Philip G de Groot
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands
| | - Suzanne J Korporaal
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands
| | - Arnold C Koekman
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands
| | - Frans L Moll
- b Department of Vascular Surgery , University Medical Center Utrecht , The Netherlands
| | - Martin Teraa
- b Department of Vascular Surgery , University Medical Center Utrecht , The Netherlands.,c Department of Nephrology and Hypertension , University Medical Center Utrecht , The Netherlands
| | - Marianne C Verhaar
- c Department of Nephrology and Hypertension , University Medical Center Utrecht , The Netherlands
| | - Gert Jan de Borst
- b Department of Vascular Surgery , University Medical Center Utrecht , The Netherlands
| | - Rolf T Urbanus
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands
| | - Mark Roest
- a Department of Clinical Chemistry and Hematology , University Medical Center Utrecht , The Netherlands
| |
Collapse
|
49
|
Spreen MI, Gremmels H, Teraa M, Sprengers RW, Verhaar MC, Statius van Eps RG, de Vries JPPM, Mali WPTM, van Overhagen H. Diabetes Is Associated With Decreased Limb Survival in Patients With Critical Limb Ischemia: Pooled Data From Two Randomized Controlled Trials. Diabetes Care 2016; 39:2058-2064. [PMID: 27612499 DOI: 10.2337/dc16-0850] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 08/05/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Although never assessed prospectively, diabetes mellitus (DM) is assumed to negatively affect the outcomes of critical limb ischemia (CLI). DM was highly prevalent in two recently conducted randomized controlled trials in CLI patients, the PADI (Percutaneous Transluminal Balloon Angioplasty [PTA] and Drug Eluting Stents for Infrapopliteal Lesions in Critical Limb Ischemia) and JUVENTAS (Rejuvenating Endothelial Progenitor Cells via Transcutaneous Intra-Arterial Supplementation) trials. To determine the implications of DM in a population of patients with infrapopliteal CLI, clinical outcomes were compared in patients with and without DM. RESEARCH DESIGN AND METHODS Individual data from patients with CLI (Rutherford category ≥4) were pooled. Patients were considered to have DM when this diagnosis was reported in the hospital electronic medical records. Rates of major amputation (above ankle level) and major events (major amputation or death) were compared between CLI patients with and without DM. Hazard ratios (HRs) were calculated. RESULTS Of a total of 281 patients, DM was present in 49.1%. The major amputation rate at 5 years of follow-up was higher in patients with DM than in patients without DM (34.1% vs. 20.4%, P = 0.015). The major event and death rate did not differ. The unadjusted HR of DM for the major amputation risk was 1.87 (95% CI 1.12-3.12). Model factors with significant HRs in the multivariate analysis were baseline Rutherford category (HR 1.95; 95% CI 1.24-3.06) and ankle-brachial index (ABI) >1.4 (HR 2.78; 95% CI 1.37-5.64). CONCLUSIONS CLI patients with DM are at a significantly higher risk of major amputation than CLI patients without DM. This increased risk is associated with a higher prevalence of baseline ABI >1.4 and more severe ischemia at initial presentation in patients with DM.
Collapse
Affiliation(s)
- Marlon I Spreen
- Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands
| | - Hendrik Gremmels
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ralf W Sprengers
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marianne C Verhaar
- Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | | | - Willem P Th M Mali
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hans van Overhagen
- Department of Radiology, Haga Teaching Hospital, The Hague, the Netherlands
| | | |
Collapse
|
50
|
Affiliation(s)
- Martin Teraa
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael S Conte
- Division of Vascular and Endovascular Surgery, University of California, San Francisco, San Francisco, CA
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marianne C Verhaar
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|