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de Vos FH, Meuffels DE, Baart SJ, van Es EM, Reijman M. Externally validated treatment algorithm acceptably predicts nonoperative treatment success in patients with anterior cruciate ligament rupture. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38738823 DOI: 10.1002/ksa.12247] [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: 10/13/2023] [Revised: 04/15/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE This study aims to develop and externally validate a treatment algorithm to predict nonoperative treatment success or failure in patients with anterior cruciate ligament (ACL) rupture. METHODS Data were used from two completed studies of adult patients with ACL ruptures: the Conservative versus Operative Methods for Patients with ACL Rupture Evaluation study (development cohort) and the KNee osteoArthritis anterior cruciate Ligament Lesion study (validation cohort). The primary outcome variable is nonoperative treatment success or failure. Potential predictor variables were collected, entered into the univariable logistic regression model and then incorporated into the multivariable logistic regression model for constructing the treatment algorithm. Finally, predictive performance and goodness-of-fit were assessed and externally validated by discrimination and calibration measures. RESULTS In the univariable logistic regression model, a stable knee measured with the pivot shift test and a posttrauma International Knee Documentation Committee (IKDC) score <50 were predictive of needing an ACL reconstruction. Age >30 years and a body mass index > 30 kg/m2 were predictive for not needing an ACL reconstruction. Age, pretrauma Tegner score, the outcome of the pivot shift test and the posttrauma IKDC score are entered into the treatment algorithm. The predictability of needing an ACL reconstruction after nonoperative treatment (discrimination) is acceptable in both the development and the validation cohort: area under the curve = resp. 0.69 (95% confidence interval [CI]: 0.58-0.81) and 0.68 (95% CI: 0.58-0.78). CONCLUSION This study shows that the treatment algorithm can acceptably predict whether an ACL injury patient will have a(n) (un)successful nonoperative treatment (discrimination). Calibration of the treatment algorithm suggests a systematical underestimation of the need for ACL reconstruction. Given the limitations regarding the sample size of this study, larger data sets must be constructed to improve the treatment algorithm further. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Floris H de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Duncan E Meuffels
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eline M van Es
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Max Reijman
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Quaak CH, Kluivers ACM, Baart SJ, Smeele HTW, Neuman RI, Saleh L, Visser W, Danser AHJ, Dolhain RJEM. Tumor Necrosis Factor Inhibitor Use Increases Birthweight in Pregnant Women With Rheumatoid Arthritis Independently of the Soluble Fms-Like Tyrosine Kinase-1/Placental Growth Factor Ratio. J Am Heart Assoc 2024; 13:e032655. [PMID: 38533985 DOI: 10.1161/jaha.123.032655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/16/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND To study whether the use of TNF (tumor necrosis factor) inhibitors (TNFi) by pregnant women with rheumatoid arthritis affects sFlt-1 (soluble Fms-like tyrosine kinase-1), PlGF (placental growth factor), or their impact on birthweight. METHODS AND RESULTS sFlt-1 and PlGF were measured in all trimesters of pregnancy in the Preconception Counseling in Active Rheumatoid Arthritis study and were compared according to the use of TNFi. The association of sFlt-1 and PlGF with birthweight in relation to TNFi was determined. The study included 158 women, of whom 52.5% used TNFi during pregnancy. Both sFlt-1 and PlGF increased during pregnancy, whereas their ratio declined. Taking into consideration the trimester-related variation in levels of sFlt-1 and PlGF, after correction for relevant confounders, the sFlt-1/PlGF ratio was not significantly different between patients who did or did not use TNFi (sFlt-1/PlGF ratio in the second trimester compared with the first trimester: estimated change 8.17 [95% CI, 2.54-26.29], P=0.79; sFlt-1/PlGF ratio in the third trimester compared with the first trimester: estimated change 6.25 [95% CI, 1.73-22.50], P=0.25). In women who did not use TNFi, birthweight was significantly lower (3180 versus 3302 g; P=0.03), and sFlt-1 displayed a negative correlation with birthweight (r=-0.462, P<0.001) and birthweight percentile (r=-0.332, P=0.008). In TNFi users, these correlations were absent. CONCLUSIONS TNF inhibitor use increases birthweight in pregnant women with rheumatoid arthritis independently of the sFlt-1/PlGF ratio. REGISTRATION http://clinicaltrials.gov. Unique identifier: NCT01345071.
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Affiliation(s)
- Cornelia H Quaak
- Department of Rheumatology, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
- Department of Internal Medicine Division of Pharmacology and Vascular Medicine, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
| | - Anna C M Kluivers
- Department of Internal Medicine Division of Pharmacology and Vascular Medicine, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
- Department of Gynecology and Obstetrics, Erasmus Medical Center Rotterdam the Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus Medical Center Rotterdam the Netherlands
| | - Hieronymus T W Smeele
- Department of Rheumatology, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
| | - Rugina I Neuman
- Department of Internal Medicine Division of Pharmacology and Vascular Medicine, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
| | - Langeza Saleh
- Department of Gynecology and Obstetrics, Erasmus Medical Center Rotterdam the Netherlands
| | - Willy Visser
- Department of Internal Medicine Division of Pharmacology and Vascular Medicine, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
| | - A H Jan Danser
- Department of Internal Medicine Division of Pharmacology and Vascular Medicine, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
| | - Radboud J E M Dolhain
- Department of Rheumatology, Erasmus Medical Center Rotterdam Rotterdam the Netherlands
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van der Gaag SME, Frankema SPG, van der Ploeg ES, Baart SJ, Huygen FJMP. Evaluating Community-Based Intrathecal Baclofen Therapy: Effectiveness, Safety, and Feasibility. J Clin Med 2024; 13:1840. [PMID: 38610605 PMCID: PMC11012490 DOI: 10.3390/jcm13071840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/14/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Intrathecal baclofen (ITB) is used for the treatment of intractable spasticity. The burden of traveling for ITB screening and aftercare is problematic for nursing home residents with severe spasticity and seems to result in undertreatment of spasticity. The aim of this study is to evaluate the effectiveness, safety, and feasibility of ITB for nursing home residents treated in their home, describing the selection phase, the initial trial of ITB, and aftercare up to 3 months after implantation of an ITB pump. Methods: This retrospective database study included immobile, adult nursing home residents with severe spasticity, referred to an Ambulatory Care Clinic between 2016 and 2021. When eligible, an ITB trial was performed by ITB experts in the nursing home. If a permanent pump was implanted, dose titration and aftercare were performed on location. Results: A total of 102 patients were referred; 80 underwent an ITB trial on location, and 94% improved significantly on the Modified Ashworth Scale and clonus scale pre-ITB trial versus post-ITB trial, as well as at 3 months post-implantation. There was a low incidence of adverse events, mostly procedure- and drug-related. Conclusions: This study indicates that selection, testing, and aftercare for ITB on location is effective and safe.
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Affiliation(s)
- Simone M. E. van der Gaag
- Ambulatory Care Clinic, Care4homecare, Rond Deel 12, 5531 AH Bladel, The Netherlands;
- Center for Pain Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (S.P.G.F.); (S.J.B.); (F.J.M.P.H.)
| | - Sander P. G. Frankema
- Center for Pain Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (S.P.G.F.); (S.J.B.); (F.J.M.P.H.)
| | - Eva S. van der Ploeg
- Ambulatory Care Clinic, Care4homecare, Rond Deel 12, 5531 AH Bladel, The Netherlands;
| | - Sara J. Baart
- Center for Pain Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (S.P.G.F.); (S.J.B.); (F.J.M.P.H.)
| | - Frank J. M. P. Huygen
- Center for Pain Medicine, Erasmus University Medical Center, Doctor Molewaterplein 40, 3015 GD Rotterdam, The Netherlands; (S.P.G.F.); (S.J.B.); (F.J.M.P.H.)
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Kadhum A, Tan ETC, Fronius M, Baart SJ, Levi DM, Joosse MV, Simonsz HJ, Loudon SE. Supervised dichoptic gaming versus monitored occlusion therapy for childhood amblyopia: Effectiveness and efficiency. Acta Ophthalmol 2024; 102:38-48. [PMID: 37078540 DOI: 10.1111/aos.15674] [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] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/10/2023] [Accepted: 03/27/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE To compare the effectiveness and efficiency of supervised dichoptic action-videogame play to occlusion therapy in children with amblyopia. METHODS Newly diagnosed children with amblyopia aged 4-12 years were recruited, excluding strabismus >30PD. After 16 weeks of refractive adaptation children were randomized to gaming 1 h/week supervised by the researcher, or electronically monitored occlusion 2 h/day. The gaming group played a dichoptic action-videogame using virtual reality goggles, which included the task of catching a snowflake presented intermittently to the amblyopic eye. Contrast for the fellow eye was self-adjusted until 2 identical images were perceived. The primary outcome was visual acuity (VA) change from baseline to 24 weeks. RESULTS We recruited 96 children, 29 declined and 2 were excluded for language or legal issues. After refractive adaptation, 24 of the remaining 65 no longer met the inclusion criteria for amblyopia, and 8 dropped out. Of 16 children treated with gaming, 7 (6.7 years) completed treatment, whereas 9 younger children (5.3 years) did not. Of 17 treated with occlusion, 14 (5.1 years) completed treatment and 3 (4.5 years) did not. Of 5 children with small-angle strabismus, 3 treated with occlusion completed treatment and 2 treated with gaming did not. Median VA improved by 0.30 logMAR (IQR 0.20-0.40) after gaming, 0.20 logMAR (0.00-0.30) after occlusion (p = 0.823). Treatment efficiency was 1.25 logMAR/100 h (range 0.42-2.08) with gaming, 0.08 (-0.19-0.68) with occlusion (p < 0.001). CONCLUSION Dichoptic gaming seems a viable alternative for older children with refractive amblyopia after glasses adaptation. Treatment efficiency with gaming under continuous supervision was 15 times higher than with occlusion at home.
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Affiliation(s)
- Aveen Kadhum
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Emily T C Tan
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maria Fronius
- Department of Ophthalmology, Child Vision Research Unit, Goethe University, Frankfurt am Main, Germany
| | - S J Baart
- Department of Clinical Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Dennis M Levi
- Berkeley, Herbert Wertheim School of Optometry and Vision Science, and Helen Wills Neuroscience Institute, University of California, Berkeley, California, USA
| | - Maurits V Joosse
- Department of Ophthalmology, Haaglanden Medical Center (HMC), Westeinde Hospital, The Hague, The Netherlands
| | - Huibert J Simonsz
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Sjoukje E Loudon
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Janssen ML, Türk Y, Baart SJ, Hanselaar W, Aga Y, van der Steen-Dieperink M, van der Wal FJ, Versluijs VJ, Hoek RAS, Endeman H, Boer DP, Hoiting O, Hoelters J, Achterberg S, Stads S, Heller-Baan R, Dubois AVF, Elderman JH, Wils EJ. Safety and Outcome of High-Flow Nasal Oxygen Therapy Outside ICU Setting in Hypoxemic Patients With COVID-19. Crit Care Med 2024; 52:31-43. [PMID: 37855812 PMCID: PMC10715700 DOI: 10.1097/ccm.0000000000006068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE High-flow nasal oxygen (HFNO) therapy is frequently applied outside ICU setting in hypoxemic patients with COVID-19. However, safety concerns limit more widespread use. We aimed to assess the safety and clinical outcomes of initiation of HFNO therapy in COVID-19 on non-ICU wards. DESIGN Prospective observational multicenter pragmatic study. SETTING Respiratory wards and ICUs of 10 hospitals in The Netherlands. PATIENTS Adult patients treated with HFNO for COVID-19-associated hypoxemia between December 2020 and July 2021 were included. Patients with treatment limitations were excluded from this analysis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Outcomes included intubation and mortality rate, duration of hospital and ICU stay, severity of respiratory failure, and complications. Using propensity-matched analysis, we compared patients who initiated HFNO on the wards versus those in ICU. Six hundred eight patients were included, of whom 379 started HFNO on the ward and 229 in the ICU. The intubation rate in the matched cohort ( n = 214 patients) was 53% and 60% in ward and ICU starters, respectively ( p = 0.41). Mortality rates were comparable between groups (28-d [8% vs 13%], p = 0.28). ICU-free days were significantly higher in ward starters (21 vs 17 d, p < 0.001). No patient died before endotracheal intubation, and the severity of respiratory failure surrounding invasive ventilation and clinical outcomes did not differ between intubated ward and ICU starters (respiratory rate-oxygenation index 3.20 vs 3.38; Pa o2 :F io2 ratio 65 vs 64 mm Hg; prone positioning after intubation 81 vs 78%; mortality rate 17 vs 25% and ventilator-free days at 28 d 15 vs 13 d, all p values > 0.05). CONCLUSIONS In this large cohort of hypoxemic patients with COVID-19, initiation of HFNO outside the ICU was safe, and clinical outcomes were similar to initiation in the ICU. Furthermore, the initiation of HFNO on wards saved time in ICU without excess mortality or complicated course. Our results indicate that HFNO initiation outside ICU should be further explored in other hypoxemic diseases and clinical settings aiming to preserve ICU capacity and healthcare costs.
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Affiliation(s)
- Matthijs L Janssen
- Department of Intensive Care, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
- Department of Intensive Care, Martini Ziekenhuis, Groningen, The Netherlands
- Department of Respiratory Medicine, Martini Ziekenhuis, Groningen, The Netherlands
- Department of Intensive Care, Maasstad Ziekenhuis, Rotterdam, The Netherlands
- Department of Intensive Care, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
- Department of Respiratory Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
- Department of Intensive Care, Haaglanden Medisch Centrum, Den Haag, The Netherlands
- Department of Intensive Care, Ikazia Ziekenhuis, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Ikazia Ziekenhuis, Rotterdam, The Netherlands
- Department of Respiratory Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
- Department of Intensive Care, IJsselland Ziekenhuis, Capelle aan den Ijssel, The Netherlands
| | - Yasemin Türk
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Wessel Hanselaar
- Department of Respiratory Medicine, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
| | - Yaar Aga
- Department of Intensive Care, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
| | | | | | - Vera J Versluijs
- Department of Respiratory Medicine, Martini Ziekenhuis, Groningen, The Netherlands
| | - Rogier A S Hoek
- Department of Respiratory Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Henrik Endeman
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Dirk P Boer
- Department of Intensive Care, Maasstad Ziekenhuis, Rotterdam, The Netherlands
| | - Oscar Hoiting
- Department of Intensive Care, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Jürgen Hoelters
- Department of Respiratory Medicine, Canisius-Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
| | - Sefanja Achterberg
- Department of Intensive Care, Haaglanden Medisch Centrum, Den Haag, The Netherlands
| | - Susanne Stads
- Department of Intensive Care, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Roxane Heller-Baan
- Department of Respiratory Medicine, Ikazia Ziekenhuis, Rotterdam, The Netherlands
| | - Alain V F Dubois
- Department of Respiratory Medicine, Admiraal de Ruyter Ziekenhuis, Goes, The Netherlands
| | - Jan H Elderman
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
- Department of Intensive Care, IJsselland Ziekenhuis, Capelle aan den Ijssel, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis and Vlietland Ziekenhuis, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
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Mangnus TJP, Bharwani KD, Dik WA, Baart SJ, Dirckx M, Huygen FJPM. Is there an association between serum soluble interleukin-2 receptor levels and syndrome severity in persistent Complex Regional Pain Syndrome? Pain Med 2023; 24:1234-1243. [PMID: 37335874 PMCID: PMC10628980 DOI: 10.1093/pm/pnad081] [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] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/22/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023]
Abstract
OBJECTIVE A potentially useful biomarker for Complex Regional Pain Syndrome (CRPS) is the serum soluble interleukin-2 receptor (sIL-2R) level, which is a marker for T-cell activation. Elevated serum sIL-2R levels have been described in CRPS patients compared to healthy controls. In T-cell mediated inflammatory diseases such as sarcoidosis and rheumatoid arthritis, the serum sIL-2R levels correlate with disease severity. In this study, we investigate whether an association exists between serum sIL-2R levels in CRPS patients and CRPS severity. METHODS A cross-sectional cohort study was conducted in a tertiary pain referral center in the Netherlands. Adult CRPS patients diagnosed by the IASP criteria were included between October 2018 until October 2022. The main study parameters were serum sIL-2R levels and the CRPS severity score. RESULTS Fifty-three CRPS patients were included with a mean syndrome duration of 84 months (Q3 - Q1:180 - 48). The majority had persistent CRPS with a syndrome duration >1 year (n = 52, 98%). The median pain Numerical Rating Score (NRS) was 7 (Q3 - Q1: 8 - 5) and the mean CRPS severity score was 11 (SD ± 2.3). The median serum sIL-2R level was 330 U/mL (Q3 - Q1:451 - 256). No statistically significant correlation was observed between serum sIL-2R levels and the CRPS severity score (rs = 0.15, P = .28). CONCLUSIONS Our findings suggest that serum sIL-2R levels cannot be used as a biomarker for syndrome severity in persistent CRPS (syndrome duration >1 year). Serial measurements of serum sIL-2R from early CRPS to persistent CRPS are needed to investigate whether serum sIL-2R levels can be used to monitor T-cell mediated inflammatory syndrome activity.
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Affiliation(s)
- Thomas J P Mangnus
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Krishna D Bharwani
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Willem A Dik
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maaike Dirckx
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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Miedema JR, Janssen ML, von der Thüsen J, Endeman H, Langerak AW, Hellemons ME, van Nood E, Peeters BWA, Baart SJ, Schreurs MWJ. Antibodies against angiotensin II receptor type 1 and endothelin A receptor are increased in COVID-19 patients. Front Immunol 2023; 14:1204433. [PMID: 37622126 PMCID: PMC10446834 DOI: 10.3389/fimmu.2023.1204433] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/12/2023] [Indexed: 08/26/2023] Open
Abstract
Background Increased titers of autoantibodies targeting the G-protein-coupled receptors angiotensin II type 1 receptor (AT1R) and endotelin-1 type A receptor (ETAR) are associated with severe coronavirus disease 2019 (COVID-19) infection. The aim of this study was to determine whether 1) these antibodies are specifically related to COVID-19 disease pathogenesis or increased during any severe respiratory illness, 2) if they are formed during illness, and 3) if they correlate with inflammatory markers or long-term symptoms. Methods Antibodies against AT1R, ETAR, and antinuclear antibodies (ANAs) were measured in n=40 prospectively enrolled COVID-19 patients and n=207 COVID-19 patients included in a biobank. Clinical and laboratory findings were prospectively and retrospectively assessed in both cohorts, and results were combined for analysis. The presence of auto-antibodies against AT1R or ETAR in peripheral blood was compared between hospitalized patients with COVID-19 and controls (n=39). Additionally, AT1R and ETAR titers were compared between patients with an unfavorable disease course, defined as intensive care admission and/or death during hospital admission (n=121), to those with a favorable disease course (n=126). A subset of intubated patients with severe COVID-19 were compared to intubated patients with acute respiratory distress syndrome (ARDS) due to any other cause. Results Significantly increased AT1R and ETAR antibody titers were found in COVID-19 patients compared to controls, while titers were equal between favorable and unfavorable COVID-19 disease course groups. On ICU, intubated patients with COVID-19 had significantly increased AT1R and ETAR titers compared to patients with ARDS due to any other cause. The titers did not correlate with baseline inflammatory markers during admission or with diffusion capacity, cognitive impairment, or fatigue measured at 3 months follow-up. Conclusions In patients hospitalized for COVID-19, antibodies against AT1R and ETAR are increased compared to controls and patients with ARDS due to other causes than COVID-19. The baseline antibody titers do not correlate with inflammatory markers or long-term symptoms in this study.
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Affiliation(s)
- Jelle R. Miedema
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Matthijs L. Janssen
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, Netherlands
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Henrik Endeman
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, Netherlands
| | - Anton W. Langerak
- Department of Immunology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Merel E. Hellemons
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Els van Nood
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bas W. A. Peeters
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, Netherlands
| | - Sara J. Baart
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands
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Koper MC, Spek RWA, Reijman M, van Es EM, Baart SJ, Verhaar JAN, Bos PK. Are serum cobalt and chromium levels predictors for patient-reported outcome measures in the ASR hip resurfacing arthroplasty? Bone Joint J 2023; 105-B:775-782. [PMID: 37394959 DOI: 10.1302/0301-620x.105b7.bjj-2022-1359.r1] [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: 07/04/2023]
Abstract
Aims The aims of this study were to determine if an increasing serum cobalt (Co) and/or chromium (Cr) concentration is correlated with a decreasing Harris Hip Score (HHS) and Hip disability and Osteoarthritis Outcome Score (HOOS) in patients who received the Articular Surface Replacement (ASR) hip resurfacing arthroplasty (HRA), and to evaluate the ten-year revision rate and show if sex, inclination angle, and Co level influenced the revision rate. Methods A total of 62 patients with an ASR-HRA were included and monitored yearly postoperatively. At follow-up, serum Co and Cr levels were measured and the HHS and the HOOS were scored. In addition, preoperative patient and implant variables and the need for revision surgery were recorded. We used a linear mixed model to relate the serum Co and Cr levels to different patient-reported outcome measures (PROMs). For the survival analyses we used the Kaplan-Meier and Cox regression model. Results We found that an increase of one part per billion (ppb) in serum Co and Cr levels correlated significantly with worsening of the HHS in the following year. This significant correlation was also true for the HOOS-Pain and HOOS-quality of life sub scores. The overall ten-year survival rate in our cohort was 65% (95% confidence interval (CI) 52.5 to 77.6). Cox regression analysis showed a significant hazard ratio (HR) of 1.08 (95% CI 1.01 to 1.15; p = 0.028) for serum Co level. No significance was found with sex or inclination angle. Conclusion This study shows that increasing serum Co and Cr levels measured in patients with an ASR-HRA are predictive for deterioration in HHS and HOOS subscales in the following year. Increasing serum Co and Cr should forewarn both surgeon and patient that there is a heightened risk of failure. Continued and regular review of patients with an ASR-HRA implant by measurement of serum Co/Cr levels and PROMs remains essential.
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Affiliation(s)
- Maarten C Koper
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Reinier W A Spek
- Department of Trauma and Orthopedic Surgery, Flinders Medical Centre, Adelaide, Australia
| | - Max Reijman
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Eline M van Es
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - Jan A N Verhaar
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - P K Bos
- Department of Orthopedics and Sports Medicine, Erasmus MC, Rotterdam, the Netherlands
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9
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Thee EF, Acar İE, Colijn JM, Meester-Smoor MA, Verzijden T, Baart SJ, Jarboui MA, Fauser S, Hoyng CB, Ueffing M, den Hollander AI, Klaver CCW. Systemic Metabolomics in a Framework of Genetics and Lifestyle in Age-Related Macular Degeneration. Metabolites 2023; 13:701. [PMID: 37367859 DOI: 10.3390/metabo13060701] [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: 04/20/2023] [Revised: 05/20/2023] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Insights into the pathogenesis of age-related macular degeneration (AMD), a leading cause of blindness, point towards a complex interplay of genetic and lifestyle factors triggering various systemic pathways. This study aimed to characterize metabolomic profiles for AMD and to evaluate their position in the trias with genetics and lifestyle. This study included 5923 individuals from five European studies. Blood metabolomics were assessed using a nuclear magnetic resonance platform of 146 metabolites. Associations were studied using regression analyses. A genetic risk score (GRS) was calculated using β-values of 49 AMD variants, a lifestyle risk score (LRS) using smoking and diet data, and a metabolite risk score (MRS) using metabolite values. We identified 61 metabolites associated with early-intermediate AMD, of which 94% were lipid-related, with higher levels of HDL-subparticles and apolipoprotein-A1, and lower levels of VLDL-subparticles, triglycerides, and fatty acids (false discovery rate (FDR) p-value < 1.4 × 10-2). Late AMD was associated with lower levels of the amino acids histidine, leucine, valine, tyrosine, and phenylalanine, and higher levels of the ketone bodies acetoacetate and 3-hydroxybutyrate (FDR p-value < 1.5 × 10-3). A favorable lifestyle characterized by a healthy diet was associated with higher levels of amino acids and lower levels of ketone bodies, while an unfavorable lifestyle, including smoking, showed opposite effects (FDR p-value < 2.7 × 10-2). The MRS mediated 5% of the effect of the GRS and 20% of that of the LRS on late AMD. Our findings show that metabolomic profiles differ between AMD stages and show that blood metabolites mostly reflect lifestyle. The severity-specific profiles spur further interest into the systemic effects related to disease conversion.
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Affiliation(s)
- Eric F Thee
- Department of Ophthalmology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - İlhan E Acar
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Johanna M Colijn
- Department of Ophthalmology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Magda A Meester-Smoor
- Department of Ophthalmology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Timo Verzijden
- Department of Epidemiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Sara J Baart
- Department of Epidemiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Biostatistics, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
| | - Mohamed A Jarboui
- Department of Ophthalmology, Institute for Ophthalmic Research, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
- Department of Ophthalmology, University Eye Clinic, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | - Sascha Fauser
- Department of Ophthalmology, University Hospital Cologne, 50937 Cologne, Germany
- Hoffman-La Roche AG, 4070 Basel, Switzerland
| | - Carel B Hoyng
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Marius Ueffing
- Department of Ophthalmology, Institute for Ophthalmic Research, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
- Department of Ophthalmology, University Eye Clinic, Eberhard Karls University of Tübingen, 72076 Tübingen, Germany
| | | | - Caroline C W Klaver
- Department of Ophthalmology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus University Medical Center, 3015 GD Rotterdam, The Netherlands
- Department of Ophthalmology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Institute of Molecular and Clinical Ophthalmology, University of Basel, 4070 Basel, Switzerland
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10
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Mangnus TJP, Dirckx M, Bharwani KD, Baart SJ, Siepman TAM, Redekop K, Dik WA, de Vos CC, Huygen FJPM. Intermittent versus continuous esketamine infusions for long-term pain modulation in complex regional pain syndrome: protocol of a randomized controlled non-inferiority study (KetCRPS-2). BMC Musculoskelet Disord 2023; 24:239. [PMID: 36991381 DOI: 10.1186/s12891-023-06258-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/20/2023] [Indexed: 03/31/2023] Open
Abstract
BACKGROUND Complex regional pain syndrome (CRPS) is a chronic pain condition of an extremity. While achieving pain relief in CRPS is challenging, esketamine infusions can accomplish pain relief for several weeks post-infusion in a subgroup of CRPS patients. Unfortunately, CRPS esketamine protocols are very heterogeneous in advice on dosage, administration and treatment setting. Currently, no trials are available that study differences between intermittent and continuous esketamine infusions for CRPS. With the current situation of bed shortages, it is difficult to admit patients for several consecutive days for inpatient esketamine treatments. In this study, we investigate whether 6 intermittent outpatient esketamine treatments are not inferior to a continuous 6-day inpatient esketamine treatment in establishing pain relief. In addition, several secondary study parameters will be assessed in order to investigate mechanisms responsible for pain relief by esketamine infusions. Furthermore, the cost-effectiveness will be analyzed. METHODS In this RCT, the primary objective is to demonstrate that an intermittent esketamine dosing regimen is non-inferior to a continuous esketamine dosing regimen at 3 months follow-up. We will include 60 adult CRPS patients. The inpatient treatment group receives a continuous intravenous esketamine infusion for 6 consecutive days. The outpatient treatment group receives a 6-hour intravenous esketamine infusion every 2 weeks for 3 months. Esketamine dose will be individually tailored and is started at 0.05 mg/kg/h and can be increased to a maximum of 0.2 mg/kg/h. Each patient will be followed for 6 months. The primary study parameter is perceived pain intensity, measured by an 11-point Numerical Rating Scale. Secondary study parameters are conditioned pain modulation, quantitative sensory testing, adverse events, thermography, blood inflammatory parameter, questionnaires about functionality, quality of life and mood and costs per patient. DISCUSSION If our study reveals non-inferiority between intermittent and continuous esketamine infusions, these findings can be beneficial to increase the availability and flexibility of esketamine infusions through outpatient treatments. Furthermore, the costs of outpatient esketamine infusions could be lower than inpatient esketamine infusions. In addition, secondary parameters may predict response to esketamine treatment. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT05212571 , date of registration 01-28-2022. PROTOCOL VERSION Version 3, February 2022.
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Affiliation(s)
- Thomas J P Mangnus
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - Maaike Dirckx
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Krishna D Bharwani
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Theodora A M Siepman
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Ken Redekop
- Institute of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands
| | - Willem A Dik
- Laboratory Medical Immunology, Department of Immunology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Cecile C de Vos
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Frank J P M Huygen
- Department of Anesthesiology, Center for Pain Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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11
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Rijkse E, Roodnat JI, Baart SJ, Bijdevaate DC, Dijkshoorn ML, Kimenai HJAN, van de Wetering J, IJzermans JNM, Minnee RC. Ipsilateral Aorto-Iliac Calcification is Not Directly Associated With eGFR After Kidney Transplantation: A Prospective Cohort Study Analyzed Using a Linear Mixed Model. Transpl Int 2023; 36:10647. [PMID: 36756277 PMCID: PMC9901502 DOI: 10.3389/ti.2023.10647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/05/2023] [Indexed: 01/21/2023]
Abstract
Aorto-iliac calcification (AIC) is a well-studied risk factor for post-transplant cardiovascular events and mortality. Its effect on graft function remains unknown. The primary aim of this prospective cohort study was to assess the association between AIC and estimated glomerular filtration rate (eGFR) in the first year post-transplant. Eligibility criteria were: ≥50 years of age or ≥30 years with at least one risk factor for vascular disease. A non-contrast-enhanced CT-scan was performed with quantification of AIC using the modified Agatston score. The association between AIC and eGFR was investigated with a linear mixed model adjusted for predefined variables. One-hundred-and-forty patients were included with a median of 31 (interquartile range 26-39) eGFR measurements per patient. No direct association between AIC and eGFR was found. We observed a significant interaction between follow-up time and ipsilateral AIC, indicating that patients with higher AIC scores had lower eGFR trajectory over time starting 100 days after transplant (p = 0.014). To conclude, severe AIC is not directly associated with lower post-transplant eGFR. The significant interaction indicates that patients with more severe AIC have a lower eGFR trajectory after 100 days in the first year post-transplant.
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Affiliation(s)
- Elsaline Rijkse
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Joke I. Roodnat
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Sara J. Baart
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Marcel L. Dijkshoorn
- Department of Radiology, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Hendrikus J. A. N. Kimenai
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Robert C. Minnee
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, Erasmus MC University Medical Center, Rotterdam, Netherlands,*Correspondence: Robert C. Minnee,
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12
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Kriek N, de Vos CC, Groeneweg JG, Baart SJ, Huygen FJPM. Allodynia, Hyperalgesia, (Quantitative) Sensory Testing and Conditioned Pain Modulation in Patients With Complex Regional Pain Syndrome Before and After Spinal Cord Stimulation Therapy. Neuromodulation 2023; 26:78-86. [PMID: 36050204 DOI: 10.1016/j.neurom.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Revised: 05/14/2022] [Accepted: 06/07/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Complex regional pain syndrome (CRPS) is a chronic debilitating disease characterized by sensory abnormalities. Spinal cord stimulation (SCS) is an effective therapy for CRPS, but few studies have investigated the effects of SCS therapy on sensory characteristics. Therefore, this study investigated the effect of SCS on allodynia, hyperalgesia, electrical quantitative sensory testing (QST) parameters, and conditioned pain modulation (CPM) effect. MATERIALS AND METHODS This study is part of a multicenter randomized controlled trial (ISRCTN 36655259). Patients with CRPS in one extremity and eligible for SCS were included. The outcome parameters allodynia (symptom and sign), hyperalgesia (symptom), sensory thresholds with QST, CPM effect, and pain scores were tested before and after three months of SCS (40-Hz tonic SCS). Both the CRPS-affected extremity and the contralateral, clinically unaffected extremity were used to test three sensory thresholds with electrical QST: current perception threshold (CPT), pain perception threshold (PPT), and pain tolerance threshold (PTT). The PTT also was used as a test stimulus for the CPM paradigm both before and after the conditioning ice-water test. Nonparametric testing was used for all statistical analyses. RESULTS In total, 31 patients were included for analysis. Pain, allodynia (sign and symptom), and hyperalgesia (symptom) were all significantly reduced after SCS therapy. On the unaffected side, none of the QST thresholds (CPT, PPT, and PTT) was significantly altered after SCS therapy. However, the CPT on the CRPS-affected side was significantly increased after SCS therapy. A CPM effect was present both before and after SCS. CONCLUSIONS Standard 40-Hz tonic SCS significantly reduces pain, hyperalgesia, and allodynia in patients with CRPS. These findings suggest that SCS therapy should not be withheld from patients who suffer from allodynia and hyperalgesia, which contradicts previous findings derived from retrospective analysis and animal research. ISRCTN Registry: The ISRCTN registration number for the study is ISRCTN 36655259.
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Affiliation(s)
- Nadia Kriek
- Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Cecile C de Vos
- Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Johannes G Groeneweg
- Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank J P M Huygen
- Center for Pain Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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13
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Gürgöze MT, van Vark LC, Baart SJ, Kardys I, Akkerhuis KM, Manintveld OC, Postmus D, Hillege HL, Lesman-Leegte I, Asselbergs FW, Brunner-la-Rocca HP, van den Bos EJ, Orsel JG, de Ridder SP, Pinto YM, Boersma E. Multimarker Analysis of Serially Measured GDF-15, NT-proBNP, ST2, GAL-3, cTnI, Creatinine, and Prognosis in Acute Heart Failure. Circ Heart Fail 2022; 16:e009526. [PMID: 36408685 PMCID: PMC9833118 DOI: 10.1161/circheartfailure.122.009526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies on serially measured GDF-15 (growth differentiation factor 15) in acute heart failure (HF) are limited. Moreover, several pathophysiological pathways contribute to HF. Therefore, we aimed to explore the (additional) prognostic value of serially measured GDF-15 using a multi-marker approach to more accurately predict HF risk. METHODS TRIUMPH (Translational Initiative on Unique and Novel Strategies for Management of Patients With Heart Failure) is a prospective cohort of 496 patients with acute HF who were enrolled in 14 hospitals in the Netherlands between 2009 and 2014. Blood sampling was scheduled at 7 moments during 1-year follow-up. GDF-15, NT-proBNP (N-terminal pro-B-type natriuretic peptide), ST2 (suppression of tumorigenicity 2), galectin-3, troponin I, and creatinine were measured in a central laboratory. We associated repeated measurements of these biomarkers with the composite primary end point of all-cause mortality and HF rehospitalization, using multivariable joint modeling. RESULTS Median age was 74 years, and 37% were women. Median baseline GDF-15 was 4632 pg/mL. The primary end point was reached in 188 (40%) patients. The average estimated GDF-15 level increased weeks before the primary end point was reached. The hazard ratio per 1 SD difference in log-GDF-15 was 2.14 (95% CI, 1.78-2.57) unadjusted, 1.96 (1.49-2.53) after adjustment for clinical confounders and 1.44 (1.05-1.91) when jointly modeled with all biomarkers. The adjusted HRs for NT-proBNP were 2.38 (1.78-3.33) and 1.52 (1.15-2.08), respectively. The multimarker model combining GDF-15, NT-proBNP, and troponin I provided a favorable risk discrimination (area under the curve=0.785). CONCLUSIONS Sequentially measured GDF-15 independently and dynamically predicts risk of adverse outcomes during 1-year follow-up after index admission for acute HF. NT-proBNP remains a robust predictor among potential candidates. Multiple biomarkers should be considered for stratification in clinical practice. REGISTRATION URL: https://www.trialregister.nl/trial/1783; Unique Identifier: NTR1893. (The trial can be found temporarily at https://trialsearch.who.int/Trial2.aspx?TrialID=NTR1893.).
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Affiliation(s)
- Muhammed T. Gürgöze
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Laura C. van Vark
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Sara J. Baart
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, the Netherlands (S.J.B.)
| | - Isabella Kardys
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - K. Martijn Akkerhuis
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Olivier C. Manintveld
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
| | - Douwe Postmus
- Department of Epidemiology (D.P., H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Hans L. Hillege
- Department of Epidemiology (D.P., H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands,Department of Cardiology (H.L.H.), University Medical Center Groningen, University of Groningen, the Netherlands,University Medical Center Groningen, University of Groningen, the Netherlands (H.L.H.)
| | - Ivonne Lesman-Leegte
- Department of General Practice and Elderly Care Medicine (I.L.-L.), University Medical Center Groningen, University of Groningen, the Netherlands
| | - Folkert W. Asselbergs
- Department of Cardiology, Division of Heart and Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands (F.W.A.).,Institute of Cardiovascular Science, Faculty of Population Health Sciences (F.W.A.), University College London, United Kingdom.,Health Data Research UK and Institute of Health Informatics (F.W.A.), University College London, United Kingdom
| | | | - Ewout J. van den Bos
- Department of Cardiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands (E.J.v.d.B.)
| | - Joke G. Orsel
- Philips Healthcare, Eindhoven, the Netherlands (J.G.O.)
| | - Stijn P.J. de Ridder
- Department of Cardiology, St. Anna Hospital, Geldrop, the Netherlands (S.P.J.d.R.)
| | - Yigal M. Pinto
- Department of Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands (Y.M.P.)
| | - Eric Boersma
- Department of Cardiology, Thorax Center, Erasmus MC, University Medical Center Rotterdam, the Netherlands (MT.G., L.C.v.V., I.K., K.M.A., O.C.M., E.B.)
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14
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Dumoulin DW, Cantini L, Cornelissen R, Vink M, Klaase L, Sloof K, Tebayna N, Mankor JM, Baart SJ, Hendriks R, Dingemans AMC, Willemsen M, Aerts JGJV. Lurbinectedin shows clinical activity and immune-modulatory functions in patients with pre-treated small cell lung cancer and malignant pleural mesothelioma. Eur J Cancer 2022; 172:357-366. [PMID: 35834843 DOI: 10.1016/j.ejca.2022.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/03/2022] [Accepted: 06/09/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Lurbinectedin is a promising new drug being investigated in pre-treated patients with small cell lung cancer (SCLC) or malignant pleural mesothelioma (MPM). Its clinical activity in the real-world setting has not been investigated yet. PATIENTS AND METHODS Clinical data of patients with SCLC and MPM who were treated with lurbinectedin were prospectively collected. Comprehensive immune cell profiling by flow cytometry was performed on screening and treating peripheral blood samples. RESULTS A total of 95 patients (43 SCLC and 52 MPM) were treated, mostly as ≥3-line of therapy. In the SCLC cohort, a median progression-free survival (mPFS) was 1.5 months (95% CI: 1.4-3.0), and median overall survival was 7.0 months (95% CI: 4.7-not reached). Objective radiological response and disease control rate after 12 weeks were 16% and 28%, respectively. In the MPM cohort, median progression-free survival was 2.8 months (95% CI: 1.4-4.2), and median overall survival was 7.2 months (95% CI: 5.9-not reached). Disease control rate after 12 weeks was 29%, whereas no partial responses were registered. No new safety signals were observed. Lurbinectedin treatment was significantly associated with the depletion of circulating classical monocytes, which correlated with a better PFS in patients with SCLC. Lurbinectedin increased the proliferation of CD4+ and CD8+ T cells (SCLC) and natural killer and natural killer T cells (SCLC and MPM) and altered co-stimulatory and co-inhibitory receptor expression on circulating lymphocytes. CONCLUSION Lurbinectedin has a manageable safety profile and shows clinical activity in pre-treated patients with SCLC and MPM. Its immune-modulatory functions make lurbinectedin a potential platform for immunotherapy combinations.
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Affiliation(s)
- Daphne W Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Luca Cantini
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands; Clinical Oncology, Università Politecnica Delle Marche, AOU Ospedali Riuniti Ancona, Italy
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Madelief Vink
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Larissa Klaase
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Kick Sloof
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Nura Tebayna
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Joanne M Mankor
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Sara J Baart
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands; Department of Biostatistics, Erasmus MC, Rotterdam, the Netherlands
| | - Rudi Hendriks
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Anne-Marie C Dingemans
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Marcella Willemsen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands.
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15
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van Driel MEC, van Dijk JFM, Baart SJ, Meissner W, Huygen FJPM, Rijsdijk M. Development and validation of a multivariable prediction model for early prediction of chronic postsurgical pain in adults: a prospective cohort study. Br J Anaesth 2022; 129:407-415. [PMID: 35732539 DOI: 10.1016/j.bja.2022.04.030] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [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: 12/09/2021] [Revised: 03/31/2022] [Accepted: 04/20/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Early identification of patients at risk of developing chronic postsurgical pain (CPSP) is an essential step in reducing pain chronification in postsurgical patients. We aimed to develop and validate a prognostic model for the early prediction of CPSP including pain characteristics indicating altered pain processing within 2 weeks after surgery. METHODS A prospective cohort study was conducted in adult patients undergoing orthopaedic, vascular, trauma, or general surgery between 2018 and 2019. Multivariable logistic regression models for CPSP were developed using data from the University Medical Centre (UMC) Utrecht and validated in data from the Erasmus UMC Rotterdam, The Netherlands. RESULTS In the development (n=344) and the validation (n=150) cohorts, 28.8% and 21.3% of patients reported CPSP. The best performing model (area under the curve=0.82; 95% confidence interval [CI], 0.76-0.87) included preoperative treatment with opioids (odds ratio [OR]=4.04; 95% CI, 2.13-7.70), bone surgery (OR=2.01; 95% CI, 1.10-3.67), numerical rating scale pain score on postoperative day 14 (OR=1.57; 95% CI, 1.34-1.83), and the presence of painful cold within the painful area 2 weeks after surgery (OR=4.85; 95% CI, 1.85-12.68). Predictive performance was confirmed by external validation. CONCLUSIONS As only four easily obtainable predictors are necessary for reliable CPSP prediction, the models are useful for the clinician to be alerted to further assess and treat individual patients at risk. Identification of the presence of painful cold within 2 weeks after surgery as a strong predictor supports altered pain processing as an important contributor to CPSP development.
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Affiliation(s)
- Marjelle E C van Driel
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jacqueline F M van Dijk
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sara J Baart
- Department of Anaesthesiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Winfried Meissner
- Department of Anaesthesiology and Intensive Care, University Hospital Jena, Jena, Germany
| | - Frank J P M Huygen
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Mienke Rijsdijk
- Pain Clinic, Department of Anaesthesiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
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Hullegie-Peelen DM, van der Zwan M, Clahsen-van Groningen MC, Mustafa DAM, Baart SJ, Reinders MEJ, Baan CC, Hesselink DA. Clinical and Molecular Profiling to Develop a Potential Prediction Model for the Response to Alemtuzumab Therapy for Acute Kidney Transplant Rejection. Clin Pharmacol Ther 2022; 111:1155-1164. [PMID: 35202481 PMCID: PMC9314084 DOI: 10.1002/cpt.2566] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023]
Abstract
Alemtuzumab, a monoclonal antibody that depletes CD52‐bearing immune cells, is an effective drug for the treatment of severe or glucocorticoid‐resistant acute kidney transplant rejection (AR). Patient‐specific predictions on treatment response are, however, urgently needed, given the severe side effects of alemtuzumab. This study developed a multidimensional prediction model with the aim of generating clinically useful prognostic scores for the response to alemtuzumab. Clinical and histological characteristics were collected retrospectively from patients who were treated with alemtuzumab for AR. In addition, targeted gene expression profiling of AR biopsy tissues was performed. Least absolute shrinkage and selection operator (LASSO) logistic regression modeling was used to construct the ALEMtuzumab for Acute Rejection (ALEMAR) prognostic score. Response to alemtuzumab was defined as patient and allograft survival and at least once an estimated glomerular filtration rate (eGFR) > 30 mL/min/1.73 m2 during the first 6 months after treatment. One hundred fifteen patients were included, of which 84 (73%) had a response to alemtuzumab. The ALEMAR‐score accurately predicted the chance of response. Gene expression analysis identified 13 differentially expressed genes between responders and nonresponders. The combination of the ALEMAR‐score and selected genes resulted in improved predictions of treatment response. The present preliminary prediction model is potentially helpful for the development of stratified alemtuzumab treatment for acute kidney transplant rejection but requires validation.
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Affiliation(s)
- Daphne M Hullegie-Peelen
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Marieke van der Zwan
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marian C Clahsen-van Groningen
- Erasmus MC Transplant Institute, Rotterdam, The Netherlands.,Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dana A M Mustafa
- Department of Pathology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,The Tumor Immuno-Pathology Laboratory, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marlies E J Reinders
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Carla C Baan
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Dennis A Hesselink
- Department of Internal Medicine, Division of Nephrology & Transplantation, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands.,Erasmus MC Transplant Institute, Rotterdam, The Netherlands
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17
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Nakshbandi G, Moor CC, Nossent EJ, Geelhoed JJM, Baart SJ, Boerrigter BG, Aerts JGJV, Nijman SFM, Santema HY, Hellemons ME, Wijsenbeek MS. Home monitoring of lung function, symptoms and quality of life after admission with COVID-19 infection: The HOMECOMIN' study. Respirology 2022; 27:501-509. [PMID: 35441433 PMCID: PMC9115460 DOI: 10.1111/resp.14262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/15/2022] [Accepted: 03/28/2022] [Indexed: 01/20/2023]
Abstract
Background and objective To develop targeted and efficient follow‐up programmes for patients hospitalized with coronavirus disease 2019 (COVID‐19), structured and detailed insights in recovery trajectory are required. We aimed to gain detailed insights in long‐term recovery after COVID‐19 infection, using an online home monitoring programme including home spirometry. Moreover, we evaluated patient experiences with the home monitoring programme. Methods In this prospective multicentre study, we included adults hospitalized due to COVID‐19 with radiological abnormalities. For 6 months after discharge, patients collected weekly home spirometry and pulse oximetry measurements, and reported visual analogue scales on cough, dyspnoea and fatigue. Patients completed the fatigue assessment scale (FAS), global rating of change (GRC), EuroQol‐5D‐5L (EQ‐5D‐5L) and online tool for the assessment of burden of COVID‐19 (ABCoV tool). Mixed models were used to analyse the results. Results A total of 133 patients were included in this study (70.1% male, mean age 60 years [SD 10.54]). Patients had a mean baseline forced vital capacity of 3.25 L (95% CI: 2.99–3.44 L), which increased linearly in 6 months with 19.1% (Δ0.62 L, p < 0.005). Patients reported substantial fatigue with no improvement over time. Nevertheless, health status improved significantly. After 6 months, patients scored their general well‐being almost similar as before COVID‐19. Overall, patients considered home spirometry useful and not burdensome. Conclusion Six months after hospital admission for COVID‐19, patients' lung function and quality of life were still improving, although fatigue persisted. Home monitoring enables detailed follow‐up for patients with COVID‐19 at low burden for patients and for the healthcare system.
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Affiliation(s)
- Gizal Nakshbandi
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Catharina C Moor
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Esther J Nossent
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - J J Miranda Geelhoed
- Department of Respiratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Sara J Baart
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Bart G Boerrigter
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Joachim G J V Aerts
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Suzan F M Nijman
- Department of Pulmonary Medicine, Amsterdam UMC, VU University Medical Centre, Amsterdam, The Netherlands
| | - Helger Y Santema
- Department of Respiratory Medicine, Leiden University Medical Centre, Leiden, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Marlies S Wijsenbeek
- Department of Respiratory Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands
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18
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Baart SJ, van der Palen RLF, Putter H, Tsonaka R, Blom NA, Rizopoulos D, van Geloven N. Joint Modeling of Longitudinal Markers and Time-to-Event Outcomes: An Application and Tutorial in Patients After Surgical Repair of Transposition of the Great Arteries. Circ Cardiovasc Qual Outcomes 2021; 14:e007593. [PMID: 34674542 PMCID: PMC8598112 DOI: 10.1161/circoutcomes.120.007593] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text. Most patients with congenital heart disease survive into adulthood; however, residual abnormalities remain and management of the patients is life-long and personalized. Patients with surgical repair of transposition of the great arteries, for example, face the risk to develop neoaortic valve regurgitation. Cardiologists update the prognosis of the patient intuitively with updated information of the cardiovascular status of the patient, for instance from echocardiographic imaging.
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Affiliation(s)
- Sara J Baart
- Department of Biostatistics (S.J.B., D.R.), Erasmus MC, Rotterdam, the Netherlands.,Department of Epidemiology (S.J.B., D.R.), Erasmus MC, Rotterdam, the Netherlands
| | - Roel L F van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics (R.L.F.v.d.P., N.A.B.), Leiden University Medical Center, the Netherlands
| | - Hein Putter
- Department of Biomedical Data Sciences, Section Medical Statistics (H.P., R.T., N.v.G.), Leiden University Medical Center, the Netherlands
| | - Roula Tsonaka
- Department of Biomedical Data Sciences, Section Medical Statistics (H.P., R.T., N.v.G.), Leiden University Medical Center, the Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics (R.L.F.v.d.P., N.A.B.), Leiden University Medical Center, the Netherlands.,Division of Pediatric Cardiology, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, the Netherlands (N.A.B.)
| | - Dimitris Rizopoulos
- Department of Biostatistics (S.J.B., D.R.), Erasmus MC, Rotterdam, the Netherlands.,Department of Epidemiology (S.J.B., D.R.), Erasmus MC, Rotterdam, the Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics (H.P., R.T., N.v.G.), Leiden University Medical Center, the Netherlands
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19
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Badwy M, Baart SJ, Thio HB, Huygen FJPM, de Vos CC. Electrical neurostimulation for the treatment of chronic pruritus: A systematic review. Exp Dermatol 2021; 31:280-289. [PMID: 34637585 PMCID: PMC9299998 DOI: 10.1111/exd.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 07/06/2021] [Accepted: 09/30/2021] [Indexed: 11/30/2022]
Abstract
Approximately one fifth of the world population experiences continuous itch for 6 weeks or more during their life, that is chronic itch. It is diverse in its aetiologies, and it is notoriously hard to treat. Because itch and pain have largely overlapping pathophysiology and the demonstrated efficacy of neurostimulation in treatment of selected chronic pain conditions, we conducted a systematic review to investigate whether neurostimulation could be an effective treatment for chronic itch. We identified two randomized controlled trials and 17 open label studies or case reports investigating various neurostimulation modalities for the treatment of refractory itch of various aetiologies. Transcutaneous electrical nerve stimulation (TENS) was the most investigated modality (n = 17), and in the largest number of conditions. Other modalities were cutaneous field stimulation (n = 2), painscrambler (n = 1), transcranial direct current stimulation (n = 1) and peripheral nerve field stimulation (n = 1). Atopic dermatitis was the most studied condition (n = 5). Despite the large heterogeneity in used stimulation paradigms and outcome parameters, all studies reported a positive effect of at least one neurostimulation modality. Our review indicates that electrical neurostimulation could be considered for the treatment of refractory chronic itch of selected aetiologies, such as atopic dermatitis or burn pruritus. However, better understanding of the mechanisms of action of the neurostimulation modalities and regimens in various pruritic conditions is necessary.
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Affiliation(s)
- Moustafa Badwy
- Center for pain Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sara J Baart
- Center for pain Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hok B Thio
- Department of Dermatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Center for pain Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cecile C de Vos
- Center for pain Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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20
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Belderbos RA, Maat APWM, Baart SJ, Madsen EVE, Bogers AJJC, Cornelissen R, Aerts JGJV, Mahtab EAF, von der Thüsen JH. Ki67 (MIB-1) as a Prognostic Marker for Clinical Decision Making Before Extended Pleurectomy Decortication in Malignant Pleural Mesothelioma. JTO Clin Res Rep 2021; 2:100155. [PMID: 34590009 PMCID: PMC8474452 DOI: 10.1016/j.jtocrr.2021.100155] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/28/2020] [Accepted: 01/24/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction The role of surgery for early stage malignant pleural mesothelioma (MPM) remains controversial. Current expert opinion is only to treat patients surgically as part of multimodality therapy. It is still challenging to identify patients who will not benefit from surgery. We specifically evaluated tumor-related parameters in combination with clinical parameters to identify prognostic markers for survival. Methods Clinical data of 27 consecutive patients with MPM treated with extended pleurectomy and decortication within a multimodality approach were collected and analyzed. Several tumor (immuno-)histopathologic characteristics were determined on resected tumor material, among which MTAP and Ki67 (MIB-1). Univariable and multivariable analyses served to correlate clinical and tumor-related parameters to overall survival (OS) and progression-free survival (PFS). Results The median PFS (mPFS) was 15.3, and the median OS (mOS) was 26.5 months. Patients with a Ki67 score greater than 10% had a significantly shorter PFS (mPFS = 8.81 versus 25.35 mo, p = 0.001) and OS (mOS 19.7 versus 44.5 mo, p = 0.002) than those with a Ki67 score less than or equal to 10. Receiver operating characteristic curve analysis for Ki67 revealed an area under the curve of 0.756 with a sensitivity of 90% and specificity of 71% for a cutoff of 10% for Ki67. Patients with loss of MTAP had a significantly shorter mPFS (9 versus 21.1 mo, p = 0.014) and mOS (19.7 versus 42.6 mo, p = 0.047) than those without MTAP loss. Conclusions In our study, Ki67 was prognostic for OS and PFS in patients with MPM treated with extended pleurectomy/decortication in a multimodality approach. Determination of Ki67 before surgery combined with specific clinical parameters could assist in clinical decision making by identifying patients, with high Ki67, who are unlikely to benefit from surgery.
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Affiliation(s)
- Robert A Belderbos
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Alexander P W M Maat
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Eva V E Madsen
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Joachim G J V Aerts
- Department of Pulmonary Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.,Erasmus MC Cancer Institute, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Edris A F Mahtab
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
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21
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Eikelboom WS, van den Berg E, Singleton EH, Baart SJ, Coesmans M, Leeuwis AE, Teunissen CE, van Berckel BNM, Pijnenburg YAL, Scheltens P, van der Flier WM, Ossenkoppele R, Papma JM. Neuropsychiatric and Cognitive Symptoms Across the Alzheimer Disease Clinical Spectrum: Cross-sectional and Longitudinal Associations. Neurology 2021; 97:e1276-e1287. [PMID: 34413181 PMCID: PMC8480405 DOI: 10.1212/wnl.0000000000012598] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [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: 02/24/2021] [Accepted: 06/29/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives To investigate the prevalence and trajectories of neuropsychiatric symptoms (NPS) in relation to cognitive functioning in a cohort of β-amyloid–positive (A+) individuals across the Alzheimer disease (AD) clinical spectrum. Methods In this single-center observational study, we included all individuals who visited the Alzheimer Center Amsterdam and had a clinical diagnosis of subjective cognitive decline (SCD), mild cognitive impairment (MCI), or probable AD dementia and were A+. We measured NPS with the Neuropsychiatric Inventory (NPI), examining total scores and the presence of specific NPI domains. Cognition was assessed across 5 cognitive domains and with the Mini-Mental State Examination (MMSE). We examined trajectories including model-based trends for NPS and cognitive functioning over time. We used linear mixed models to relate baseline NPI scores to cognitive functioning at baseline (whole-sample) and longitudinal time points (subsample n = 520, mean 1.8 [SD 0.7] years follow-up). Results We included 1,524 A+ individuals from the Amsterdam Dementia Cohort with A+ SCD (n = 113), A+ MCI (n = 321), or A+ AD dementia (n = 1,090). NPS were prevalent across all clinical AD stages (≥1 NPS 81.4% in SCD, 81.2% in MCI, 88.7% in dementia; ≥1 clinically relevant NPS 54.0% in SCD, 50.5% in MCI, 66.0% in dementia). Cognitive functioning showed a uniform gradual decline; while in contrast, large intraindividual heterogeneity of NPS was observed over time across all AD groups. At baseline, we found associations between NPS and cognition in dementia that were most pronounced for NPI total scores and MMSE (range β = −0.18 to −0.11, false discovery rate [FDR]–adjusted p < 0.05), while there were no cross-sectional relationships in SCD and MCI (range β = −0.32 to 0.36, all FDR-adjusted p > 0.05). There were no associations between baseline NPS and cognitive functioning over time in any clinical stage (range β = −0.13 to 0.44, all FDR-adjusted p > 0.05). Discussion NPS and cognitive symptoms are both prevalent across the AD clinical spectrum, but show a different evolution during the course of the disease.
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Affiliation(s)
- Willem S Eikelboom
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Esther van den Berg
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Ellen H Singleton
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Sara J Baart
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Michiel Coesmans
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Annebet E Leeuwis
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Charlotte E Teunissen
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Bart N M van Berckel
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Yolande A L Pijnenburg
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Philip Scheltens
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Wiesje M van der Flier
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Rik Ossenkoppele
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden
| | - Janne M Papma
- From the Departments of Neurology (W.S.E., E.v.d.B., J.M.P.), Biostatistics (S.J.B.), and Psychiatry (M.C.), Erasmus MC, University Medical Center, Rotterdam; Department of Neurology, Alzheimer Center Amsterdam (E.H.S., A.E.L., Y.A.L.P., P.S., W.M.v.d.F., R.O.), Neurochemistry Laboratory, Department of Clinical Chemistry (C.E.T.), and Department of Radiology and Nuclear Medicine (B.N.M.v.B.), Amsterdam University Medical Centers, the Netherlands; and Clinical Memory Research Unit (R.O.), Lund University, Malmö, Sweden.
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22
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van Beek JGM, van Rij CM, Baart SJ, Yavuzyigitoglu S, Bergmann MJ, Paridaens D, Naus NC, Kiliç E. Fractionated stereotactic radiotherapy for uveal melanoma: Long-term outcome and control rates. Acta Ophthalmol 2021; 100:511-519. [PMID: 34529346 PMCID: PMC9544756 DOI: 10.1111/aos.15029] [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: 05/07/2021] [Revised: 08/07/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
Purpose The aim of our study is to evaluate local tumour control rates, radiation side‐effects, visual preservation and disease‐free survival (DFS) of uveal melanoma (UM) patients treated with fractionated stereotactic radiotherapy (fSRT). Methods A retrospective study of UM patients, who were treated with fSRT (N = 189), was performed by the Rotterdam Ocular Melanoma Study group (ROMS), the Netherlands, between 1999 and 2014 with a follow‐up of at least 5 years. Results The 1‐, 3‐, 5‐, 10‐ and 15‐year local tumour control rates were as follows: 99.4%, 92.8%, 92.2%, 89.3% and 89.3%, respectively. Cataract (67.8%) was the most common side‐effect of fSRT followed by retinopathy (35.1%), maculopathy (23.8%), vitreous haemorrhage (20.1%), neovascular glaucoma (NVG) (20.0%) and optic neuropathy (12.4%). Patients with anterior located UMs developed cataract more frequently (p = 0.047, multivariable analysis). By multivariable analysis, significant factors for secondary enucleation were tumour recurrence (p < 0.001) and NVG (p < 0.001). In multivariable analysis, risk factors for a worse DFS were larger UM (p = 0.024) and tumours with subretinal fluid (SRF) at baseline (p = 0.038). The 5‐year DFS was 77.0% and the best corrected visual acuity decreased significantly after treatment. After 5 years, 22.0% of patients and after 10 years 17.6% of patients had a visual acuity of ≤0.3 logMAR. Conclusion Fractionated stereotactic radiotherapy is a good treatment option for small‐, medium‐ and large‐sized tumours with 5‐year local tumour control of 92.2%. After 5 years, 22.0% of the patients had a good vision. Independently of tumour location, the visual acuity decreased significantly after treatment. Overall, the 5‐year DFS was 77.0%.
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Affiliation(s)
- Jackelien G. M. van Beek
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
- Department of Ophthalmology Ikazia Hospital Rotterdam The Netherlands
- ‘Oog op Zuid’ Eye Clinic Rotterdam The Netherlands
| | - Caroline M. van Rij
- Department of Radiotherapy Erasmus University Medical Centre Rotterdam The Netherlands
| | - Sara J. Baart
- Department of Biostatistics Erasmus University Medical Centre Rotterdam The Netherlands
| | - Serdar Yavuzyigitoglu
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
| | - Michael J. Bergmann
- Department of Ophthalmology Albert Schweitzer Hospital Dordrecht The Netherlands
| | - Dion Paridaens
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
- Oculoplastic and Orbital surgery Rotterdam Eye Hospital Rotterdam The Netherlands
| | - Nicole C. Naus
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
| | - Emine Kiliç
- Department of Ophthalmology Erasmus University Medical Centre Rotterdam The Netherlands
- Department of Clinical Genetics Erasmus University Medical Centre Rotterdam The Netherlands
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23
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Dumoulin DW, Cornelissen R, Bezemer K, Baart SJ, Aerts JGJV. Long-Term Follow-Up of Mesothelioma Patients Treated with Dendritic Cell Therapy in Three Phase I/II Trials. Vaccines (Basel) 2021; 9:vaccines9050525. [PMID: 34069348 PMCID: PMC8158710 DOI: 10.3390/vaccines9050525] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/08/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Malignant pleural mesothelioma (MPM) is a fatal neoplasm with, if untreated, poor survival of approximately nine months from diagnosis. Until recently, phase II–III immunotherapy trials did not show any significant benefit. The lack of immunotherapy efficacy can be explained by the fact that mesothelioma is a tumor with an “immune desert” phenotype, meaning a non-inflamed tumor characterized by low T-cell infiltration. By administration of DCs, which were ex-vivo cultured, exposed to (tumor-associated) antigens, and subsequently activated, this “immune desert” phenotype might be turned into an “inflamed” phenotype. Three phase I/II studies have been performed and published using activated DCs, which support this concept. We here report on the long-term survival of patients treated with DCs in three phase I/II studies. Methods: Survival data of the phase I/II trials using DC therapy in MPM patients were obtained and subsequently analyzed. In the first two trials, DCs were loaded with autologous tumor lysate. In the third trial, DCs were loaded with allogeneic mesothelioma tumor cell line lysate. Results: In the three studies combined, 29 patients with MPM were treated with DC vaccination between 2006 and 2015. At data cut-off, the median OS was 27 months (95% CI: 21–47 months). OS at 2 years was 55.2% (95% CI: 39.7–76.6%), and OS at 5 years was 20.7% (95% CI: 10.1–42.2%). Conclusions: The long-term survival of DC therapy in MPM in these three trials is promising, which is the basis for the randomized phase II/III DENIM study. This DENIM study is currently enrolling, and the results of which have to be awaited for definite conclusions.
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Affiliation(s)
- Daphne W. Dumoulin
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (R.C.); (K.B.); (J.G.J.V.A.)
- Correspondence:
| | - Robin Cornelissen
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (R.C.); (K.B.); (J.G.J.V.A.)
| | - Koen Bezemer
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (R.C.); (K.B.); (J.G.J.V.A.)
| | - Sara J. Baart
- Department of Biostatistics, Erasmus MC, 3015 GD Rotterdam, The Netherlands;
| | - Joachim G. J. V. Aerts
- Department of Pulmonary Medicine, Erasmus MC Cancer Institute, 3015 GD Rotterdam, The Netherlands; (R.C.); (K.B.); (J.G.J.V.A.)
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Talman S, Uzun S, Djamin RS, Baart SJ, Grootenboers MJJH, Aerts J, van der Eerden M. Long-Term Azithromycin Maintenance Treatment in Patients with Frequent Exacerbations of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis 2021; 16:495-498. [PMID: 33688175 PMCID: PMC7935328 DOI: 10.2147/copd.s284397] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/07/2021] [Indexed: 12/31/2022] Open
Abstract
Macrolides are effective in reducing the number of exacerbations in COPD patients with the frequent exacerbator phenotype. Our study did not show a persistent effect of azithromycin on exacerbation frequencies after more than one year of usage.
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Affiliation(s)
- Sander Talman
- Amphia Hospital Breda, Department of Pulmonary Medicine, Breda, 4800RK, the Netherlands
| | - Sevim Uzun
- Erasmus Medical Centre Rotterdam, Department of Pulmonary Medicine, Rotterdam, 3015 CE, the Netherlands
| | - Remco S Djamin
- Amphia Hospital Breda, Department of Pulmonary Medicine, Breda, 4800RK, the Netherlands
| | - Sara J Baart
- Erasmuc Medical Centre Rotterdam, Department of Biostatistics, Rotterdam, 3015 CE, the Netherlands
| | | | - Joachim Aerts
- Erasmus Medical Centre Rotterdam, Department of Pulmonary Medicine, Rotterdam, 3015 CE, the Netherlands
| | - Menno van der Eerden
- Erasmus Medical Centre Rotterdam, Department of Pulmonary Medicine, Rotterdam, 3015 CE, the Netherlands
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25
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Baart SJ, van den Berge JC, Akkerhuis KM, Deckers JW, van Domburg RT, Boersma E, Kardys I. Relative conditional survival analysis provides additional insights into the prognosis of heart failure patients. Eur J Prev Cardiol 2021; 29:e72-e73. [PMID: 34038528 DOI: 10.1093/eurjpc/zwab003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/10/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Sara J Baart
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands.,Department of Biostatistics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jan C van den Berge
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Jaap W Deckers
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, the Netherlands
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26
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den Ottelander BK, de Goederen R, de Planque CA, Baart SJ, van Veelen MLC, Corel LJA, Joosten KFM, Mathijssen IMJ, Dremmen MHG. Cervical Spinal Cord Compression and Sleep-Disordered Breathing in Syndromic Craniosynostosis. AJNR Am J Neuroradiol 2020; 42:201-205. [PMID: 33272949 DOI: 10.3174/ajnr.a6881] [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] [Received: 05/29/2020] [Accepted: 08/19/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Cerebellar tonsillar herniation arises frequently in syndromic craniosynostosis and causes central and obstructive apneas in other diseases through spinal cord compression. The purposes of this study were the following: 1) to determine the prevalence of cervical spinal cord compression in syndromic craniosynostosis, and 2) to evaluate its connection with sleep-disordered breathing. MATERIALS AND METHODS This was a cross-sectional study including patients with syndromic craniosynostosis who underwent MR imaging and polysomnography. Measures encompassed the compression ratio at the level of the odontoid process and foramen magnum and the cervicomedullary angle. MR imaging studies of controls were included. Linear mixed models were developed to compare patients with syndromic craniosynostosis with controls and to evaluate the association between obstructive and central sleep apneas and MR imaging parameters. RESULTS One hundred twenty-two MR imaging scans and polysomnographies in 89 patients were paired; 131 MR imaging scans in controls were included. The mean age at polysomnography was 5.7 years (range, 0.02-18.9 years). The compression ratio at the level of the odontoid process was comparable with that in controls; the compression ratio at the level of the foramen magnum was significantly higher in patients with Crouzon syndrome (+27.1, P < .001). The cervicomedullary angle was significantly smaller in Apert, Crouzon, and Saethre-Chotzen syndromes (-4.4°, P = .01; -10.2°, P < .001; -5.2°, P = .049). The compression ratios at the level of the odontoid process and the foramen magnum, the cervicomedullary angle, and age were not associated with obstructive apneas (P > .05). Only age was associated with central apneas (P = .02). CONCLUSIONS The prevalence of cervical spinal cord compression in syndromic craniosynostosis is low and is not correlated to sleep disturbances. However, considering the high prevalence of obstructive sleep apnea in syndromic craniosynostosis and the low prevalence of compression and central sleep apnea in our study, we would, nevertheless, recommend a polysomnography in case of compression on MR imaging studies.
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Affiliation(s)
- B K den Ottelander
- From the Dutch Craniofacial Center (B.K.d.O., R.D.G., C.A.d.P., I.M.J.M.), Department of Plastic and Reconstructive Surgery and Hand Surgery
| | - R de Goederen
- From the Dutch Craniofacial Center (B.K.d.O., R.D.G., C.A.d.P., I.M.J.M.), Department of Plastic and Reconstructive Surgery and Hand Surgery
| | - C A de Planque
- From the Dutch Craniofacial Center (B.K.d.O., R.D.G., C.A.d.P., I.M.J.M.), Department of Plastic and Reconstructive Surgery and Hand Surgery
| | - S J Baart
- Department of Biostatistics (S.J.B.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | | | - L J A Corel
- Pediatric Intensive Care Unit (L.J.A.C., K.F.M.J.)
| | | | - I M J Mathijssen
- From the Dutch Craniofacial Center (B.K.d.O., R.D.G., C.A.d.P., I.M.J.M.), Department of Plastic and Reconstructive Surgery and Hand Surgery
| | - M H G Dremmen
- Department of Radiology (M.H.G.D.), Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, Rotterdam, the Netherlands
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27
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van der Palen RL, Baart SJ, van Geloven N, Hazekamp MG, Blom NA. Neoaortic growth rate and diameter as risk factors for neoaortic valve regurgitation after arterial switch operation. Heart 2020; 106:1950. [PMID: 33020229 DOI: 10.1136/heartjnl-2020-318142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Roel Lf van der Palen
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sara J Baart
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Section Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - Mark G Hazekamp
- Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Nico A Blom
- Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
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28
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Bouwens E, Schuurman AS, Akkerhuis KM, Baart SJ, Caliskan K, Brugts JJ, van Ramshorst J, Germans T, Umans VAWM, Boersma E, Kardys I. Serially Measured Cytokines and Cytokine Receptors in Relation to Clinical Outcome in Patients With Stable Heart Failure. Can J Cardiol 2020; 36:1587-1591. [PMID: 32827637 DOI: 10.1016/j.cjca.2020.08.010] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 08/04/2020] [Accepted: 08/10/2020] [Indexed: 11/19/2022] Open
Abstract
In this prospective cohort study of 250 stable heart failure patients with trimonthly blood sampling, we investigated associations of 17 repeatedly measured cytokines and cytokine receptors with clinical outcome during a median follow-up of 2.2 (25th-75th percentile, 1.4-2.5) years. Sixty-six patients reached the primary end point (composite of cardiovascular mortality, heart failure hospitalization, heart transplantation, left ventricular assist device implantation). Repeatedly measured levels of 8 biomarkers correlated with clinical outcomes independent of clinical characteristics. Rates of change over time (slopes of biomarker evolutions) remained independently associated with outcome for 15 biomarkers. Thus, temporal patterns of cytokines and cytokine receptors, in particular tumour necrosis factor ligand superfamily member 13B and interleukin-1 receptor type 1, might contribute to personalized risk assessment.
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Affiliation(s)
- Elke Bouwens
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Sara J Baart
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Kadir Caliskan
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jasper J Brugts
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Jan van Ramshorst
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Tjeerd Germans
- Department of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Isabella Kardys
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
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29
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van den Hoven AT, Bons LR, Baart SJ, Moelker A, van de Laar IMBH, van den Bosch AE, Bekkers JA, Verhagen HJM, van der Linde D, Roos-Hesselink JW. Aortic Dimensions and Clinical Outcome in Patients With SMAD3 Mutations. Circ Genom Precis Med 2019; 11:e002329. [PMID: 30571188 DOI: 10.1161/circgen.118.002329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A T van den Hoven
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (A.T.v.d.H., L.R.B., A.E.v.d.B., D.v.d.L., J.W.R.-H.)
| | - Lidia R Bons
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (A.T.v.d.H., L.R.B., A.E.v.d.B., D.v.d.L., J.W.R.-H.)
| | - Sara J Baart
- Department of Clinical Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B.)
| | - Adriaan Moelker
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands (A.M.)
| | - Ingrid M B H van de Laar
- Department of Clinical Genetics, Erasmus Medical Center, Rotterdam, The Netherlands (I.M.B.H.v.d.L.)
| | - Annemien E van den Bosch
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (A.T.v.d.H., L.R.B., A.E.v.d.B., D.v.d.L., J.W.R.-H.)
| | - Jos A Bekkers
- Department of Cardio-Thoracic Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (J.A.B.)
| | - Hence J M Verhagen
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands (H.J.M.V.)
| | - Denise van der Linde
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (A.T.v.d.H., L.R.B., A.E.v.d.B., D.v.d.L., J.W.R.-H.)
| | - Jolien W Roos-Hesselink
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (A.T.v.d.H., L.R.B., A.E.v.d.B., D.v.d.L., J.W.R.-H.)
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30
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van Grootel RW, van den Bosch AE, Baggen VJ, Menting ME, Baart SJ, Cuypers JA, Witsenburg M, Roos-Hesselink JW. The Prognostic Value of Myocardial Deformation in Adult Patients With Corrected Tetralogy of Fallot. J Am Soc Echocardiogr 2019; 32:866-875.e2. [DOI: 10.1016/j.echo.2019.03.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/19/2019] [Accepted: 03/20/2019] [Indexed: 11/25/2022]
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31
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Baart SJ, Boersma E, Rizopoulos D. Joint models for longitudinal and time-to-event data in a case-cohort design. Stat Med 2019; 38:2269-2281. [PMID: 30706536 PMCID: PMC6590325 DOI: 10.1002/sim.8113] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/10/2022]
Abstract
Studies with longitudinal measurements are common in clinical research. Particular interest lies in studies where the repeated measurements are used to predict a time‐to‐event outcome, such as mortality, in a dynamic manner. If event rates in a study are low, however, and most information is to be expected from the patients experiencing the study endpoint, it may be more cost efficient to only use a subset of the data. One way of achieving this is by applying a case‐cohort design, which selects all cases and only a random samples of the noncases. In the standard way of analyzing data in a case‐cohort design, the noncases who were not selected are completely excluded from analysis; however, the overrepresentation of the cases will lead to bias. We propose to include survival information of all patients from the cohort in the analysis. We approach the fact that we do not have longitudinal information for a subset of the patients as a missing data problem and argue that the missingness mechanism is missing at random. Hence, results obtained from an appropriate model, such as a joint model, should remain valid. Simulations indicate that our method performs similar to fitting the model on a full cohort, both in terms of parameters estimates and predictions of survival probabilities. Estimating the model on the classical version of the case‐cohort design shows clear bias and worse performance of the predictions. The procedure is further illustrated in data from a biomarker study on acute coronary syndrome patients, BIOMArCS.
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Affiliation(s)
- Sara J Baart
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.,Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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32
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Baart SJ, Dam V, Scheres LJJ, Damen JAAG, Spijker R, Schuit E, Debray TPA, Fauser BCJM, Boersma E, Moons KGM, van der Schouw YT. Cardiovascular risk prediction models for women in the general population: A systematic review. PLoS One 2019; 14:e0210329. [PMID: 30620772 PMCID: PMC6324808 DOI: 10.1371/journal.pone.0210329] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 12/20/2018] [Indexed: 12/17/2022] Open
Abstract
AIM To provide a comprehensive overview of cardiovascular disease (CVD) risk prediction models for women and models that include female-specific predictors. METHODS We performed a systematic review of CVD risk prediction models for women in the general population by updating a previous review. We searched Medline and Embase up to July 2017 and included studies in which; (a) a new model was developed, (b) an existing model was validated, or (c) a predictor was added to an existing model. RESULTS A total of 285 prediction models for women have been developed, of these 160 (56%) were female-specific models, in which a separate model was developed solely in women and 125 (44%) were sex-predictor models. Out of the 160 female-specific models, 2 (1.3%) included one or more female-specific predictors (mostly reproductive risk factors). A total of 591 validations of sex-predictor or female-specific models were identified in 206 papers. Of these, 333 (56%) validations concerned nine models (five versions of Framingham, SCORE, Pooled Cohort Equations and QRISK). The median and pooled C statistics were comparable for sex-predictor and female-specific models. In 260 articles the added value of new predictors to an existing model was described, however in only 3 of these female-specific predictors (reproductive risk factors) were added. CONCLUSIONS There is an abundance of models for women in the general population. Female-specific and sex-predictor models have similar predictors and performance. Female-specific predictors are rarely included. Further research is needed to assess the added value of female-specific predictors to CVD models for women and provide physicians with a well-performing prediction model for women.
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Affiliation(s)
- Sara J. Baart
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
- Netherlands Heart Institute, Utrecht, the Netherlands
| | - Veerle Dam
- Netherlands Heart Institute, Utrecht, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Luuk J. J. Scheres
- Netherlands Heart Institute, Utrecht, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - Johanna A. A. G. Damen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - René Spijker
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, the Netherlands
- Clinical Library, Academic Medical Center, Amsterdam, the Netherlands
| | - Ewoud Schuit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Thomas P. A. Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Bart C. J. M. Fauser
- Department of Reproductive Medicine & Gynaecology, University Medical Center, Utrecht University, the Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Karel G. M. Moons
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
- Cochrane Netherlands, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Yvonne T. van der Schouw
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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33
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van Velzen HG, Schinkel AF, Baart SJ, Huurman R, van Slegtenhorst MA, Kardys I, Michels M. Effect of Gender and Genetic Mutations on Outcomes in Patients With Hypertrophic Cardiomyopathy. Am J Cardiol 2018; 122:1947-1954. [PMID: 30292335 DOI: 10.1016/j.amjcard.2018.08.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/15/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022]
Abstract
Gender has been proposed to impact the phenotype and prognosis of hypertrophic cardiomyopathy (HC). Our aims were to study gender differences in the clinical presentation, phenotype, genotype, and outcome of HC. This retrospective single-center cohort study included 1,007 patients with HC (62% male, 80% genotyped) evaluated between 1977 and 2017. Hazard ratios (HR) were calculated using multivariable Cox proportional hazard regression models. At first evaluation, female patients presented more often with symptoms (43% vs 35%, p = 0.01), were older than male patients (56 ± 16 vs 49 ± 15 years, p <0.001), and more frequently had hypertension (38% vs 27%, p <0.001), left ventricular outflow tract obstruction (37% vs 27%, p <0.001), and impaired left ventricular systolic (17% vs 11%, p = 0.01) and diastolic (77% vs 62%, p <0.001) function. Overall, the genetic yield was similar between genders (54% vs 51%, p = 0.4); however, in patients ≥70 years, the genetic yield was less in women (15% vs 36%, p = 0.03). During 6.8-year follow-up (interquartile range 3.2 to 10.9), female gender was not independently associated with all-cause mortality (HR 1.25 [0.91 to 1.73]), cardiovascular mortality (HR 1.22 [0.83 to 1.79]), heart failure-related mortality (HR 1.77 [0.95 to 3.27]), or sudden cardiac death (SCD) and/or aborted SCD (HR 0.75 [0.44 to 1.30]). Interventions and nonfatal clinical events did not differ between the genders. In conclusion, female patients with HC present at a more advanced age with a different clinical, phenotypic, and genetic status. There is no independent association between female gender and all-cause mortality, cardiovascular mortality, heart failure-related mortality, or SCD.
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van Velzen HG, Schinkel AF, Baart SJ, Oldenburg RA, Frohn-Mulder IM, van Slegtenhorst MA, Michels M. Outcomes of Contemporary Family Screening in Hypertrophic Cardiomyopathy. Circ: Genomic and Precision Medicine 2018; 11:e001896. [DOI: 10.1161/circgen.117.001896] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/25/2018] [Indexed: 01/16/2023]
Abstract
Background:
Contemporary hypertrophic cardiomyopathy (HCM) family screening includes clinical evaluation and genetic testing (GT). This screening strategy requires the identification of a pathogenic mutation in the proband. Our aim was to examine the results of this HCM screening strategy.
Methods:
Between 1985 and 2016, 777 relatives of 209 probands were assessed in the context of HCM screening. Genotype-positive (G+) relatives and relatives without genetic testing (GT) underwent repeated clinical evaluations. In genotype-negative (G-) relatives mortality was assessed during follow-up.
Results:
A pathogenic mutation was identified in 72% of probands. After counseling, GT was performed in 620 (80%) relatives: 264 (43%) were G+ (age 41±18 y) and 356 (57%) were G- (age 48±17 y). At first screening, HCM was diagnosed in 98 (37%) G+ relatives and 28 (17%) relatives without GT (
p
<0.001). During 9 years follow-up of relatives diagnosed with HCM, 8 (6%) underwent septal reduction therapy, 16 (16%) received primary prevention ICDs, and cardiac mortality was 0.3%/year. During 7 years follow-up of relatives without HCM, 29 (16%) developed HCM. Survival at 5/10 years was 99%/95% in G+ relatives, 97%/94% in G- relatives (
p
=0.8), and 100%/100% in relatives without GT.
Conclusions:
HCM was identified in 30% of relatives at first screening, and 16% developed HCM during 7 years of repeated evaluation. GT led to a discharge from clinical follow-up in 46% of the study population. Survival in the relatives was good.
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Affiliation(s)
- Hannah G. van Velzen
- Department of Cardiology, Thoraxcenter (H.G.v.V., A.F.L.S., S.J.B., M.M.), Department of Clinical Genetics (R.A.O., M.A.v.S.), and Department of Pediatrics (I.M.E.F.-M.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Arend F.L. Schinkel
- Department of Cardiology, Thoraxcenter (H.G.v.V., A.F.L.S., S.J.B., M.M.), Department of Clinical Genetics (R.A.O., M.A.v.S.), and Department of Pediatrics (I.M.E.F.-M.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sara J. Baart
- Department of Cardiology, Thoraxcenter (H.G.v.V., A.F.L.S., S.J.B., M.M.), Department of Clinical Genetics (R.A.O., M.A.v.S.), and Department of Pediatrics (I.M.E.F.-M.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Rogier A. Oldenburg
- Department of Cardiology, Thoraxcenter (H.G.v.V., A.F.L.S., S.J.B., M.M.), Department of Clinical Genetics (R.A.O., M.A.v.S.), and Department of Pediatrics (I.M.E.F.-M.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ingrid M.E. Frohn-Mulder
- Department of Cardiology, Thoraxcenter (H.G.v.V., A.F.L.S., S.J.B., M.M.), Department of Clinical Genetics (R.A.O., M.A.v.S.), and Department of Pediatrics (I.M.E.F.-M.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjon A. van Slegtenhorst
- Department of Cardiology, Thoraxcenter (H.G.v.V., A.F.L.S., S.J.B., M.M.), Department of Clinical Genetics (R.A.O., M.A.v.S.), and Department of Pediatrics (I.M.E.F.-M.), Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter (H.G.v.V., A.F.L.S., S.J.B., M.M.), Department of Clinical Genetics (R.A.O., M.A.v.S.), and Department of Pediatrics (I.M.E.F.-M.), Erasmus Medical Center, Rotterdam, The Netherlands
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Baggen VJM, Baart SJ, van den Bosch AE, Eindhoven JA, Witsenburg M, Cuypers JAAE, Roos-Hesselink JW, Boersma E. Prognostic Value of Serial N-Terminal Pro-B-Type Natriuretic Peptide Measurements in Adults With Congenital Heart Disease. J Am Heart Assoc 2018; 7:e008349. [PMID: 29581225 PMCID: PMC5907602 DOI: 10.1161/jaha.117.008349] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/14/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND A single NT-proBNP (N-terminal pro-B-type natriuretic peptide) measurement is a strong prognostic factor in adult congenital heart disease. This study investigates NT-proBNP profiles within patients with adult congenital heart disease and relates these to cardiovascular events. METHODS AND RESULTS In this prospective cohort, 602 patients with adult congenital heart disease were enrolled at the outpatient clinic (years 2011-2013). NT-proBNP was measured at study inclusion in 595 patients (median age 33 [IQR 25-41] years, 58% male, 90% NYHA I) and at subsequent annual visits. The primary end point was defined as death, heart failure, hospitalization, arrhythmia, thromboembolic event, or cardiac intervention; the secondary end point as death or heart failure. Repeated measurements were analyzed using linear mixed models and joint models. During a median follow-up of 4.4 [IQR 3.8-4.8] years, a total of 2424 repeated measurements were collected. Average NT-proBNP increase was 2.9 pmol/L the year before the primary end point (n=199, 34%) and 18.2 pmol/L before the secondary end point (n=58, 10%), compared with 0.3 pmol/L in patients who remained end point-free (P-value for difference in slope 0.006 and <0.001, respectively). In patients with elevated baseline NT-proBNP (>14 pmol/L, n=315, 53%), repeated measurements were associated with the primary end point (HR per 2-fold higher value 2.08; 95% CI 1.31-3.87; P<0.001) and secondary end point (HR 2.47; 95% CI 1.13-5.70; P=0.017), when adjusted for the baseline measurement. CONCLUSIONS NT-proBNP increased before the occurrence of events, especially in patients who died or developed heart failure. Serial NT-proBNP measurements could be of additional prognostic value in the annual follow-up of patients with adult congenitive heart disease with an elevated NT-proBNP.
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Affiliation(s)
- Vivan J M Baggen
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Cardiovascular Research School COEUR, Rotterdam, The Netherlands
| | - Sara J Baart
- Department of Clinical Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Cardiovascular Research School COEUR, Rotterdam, The Netherlands
| | | | - Jannet A Eindhoven
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Maarten Witsenburg
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | | | - Eric Boersma
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Clinical Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Cardiovascular Research School COEUR, Rotterdam, The Netherlands
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36
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van Vark LC, Lesman-Leegte I, Baart SJ, Postmus D, Pinto YM, de Boer RA, Asselbergs FW, Wajon EMCJ, Orsel JG, Boersma E, Hillege HL, Akkerhuis KM. Prognostic Value of Serial Galectin-3 Measurements in Patients With Acute Heart Failure. J Am Heart Assoc 2017; 6:JAHA.116.003700. [PMID: 29187387 PMCID: PMC5778986 DOI: 10.1161/jaha.116.003700] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several clinical studies have evaluated the association between galectin-3 levels and outcome in patients with heart failure (HF). However, little is known about the predictive value of repeated galectin-3 measurements. This study evaluates the prognostic value of repeated time-dependent galectin-3 measurements in acute HF patients. METHODS AND RESULTS In the TRIUMPH (Translational Initiative on Unique and Novel Strategies for Management of Patients with Heart Failure) clinical cohort study, 496 acute HF patients were enrolled in 14 hospitals in The Netherlands, between 2009 and 2014. Repeated blood samples (7) were drawn during 1-year follow-up. Associations between repeated biomarker measurements and the primary end point were assessed using a joint model. Median age was 74 years and 37% were women. The primary end point, composite of all-cause mortality and HF rehospitalization, was reached in 188 patients (40%), during a median follow-up of 325 days (interquartile range 85-401). The median baseline galectin-3 level was 24 ng/mL (interquartile range 18-34). The mean number of galectin-3 measurements available per patient was 4.3. After adjustment for clinical factors and N-terminal pro-brain natriuretic peptide, there was a weak association between baseline galectin-3 and risk of the primary end point. When repeated measurements were taken into account, the adjusted hazard ratio per 1 SD increase of the galectin-3 level (on the log2 scale) at any time point increased to 1.67 (95% confidence interval, 1.24-2.23, P<0.001). After additional adjustment for repeated N-terminal pro-brain natriuretic peptide measurements, the association remained statistically significant. CONCLUSIONS Repeated galectin-3 measurements appeared to be a strong predictor of outcome in acute HF patients, independent of N-terminal pro-brain natriuretic peptide. Hence, galectin-3 may be helpful in clinical practice for prognostication and treatment monitoring.
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Affiliation(s)
- Laura C van Vark
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands .,Cardiovascular Research School Erasmus MC (COEUR), Rotterdam, The Netherlands
| | - Ivonne Lesman-Leegte
- Department of Epidemiology, University Medical Center Groningen University of Groningen, The Netherlands
| | - Sara J Baart
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.,Cardiovascular Research School Erasmus MC (COEUR), Rotterdam, The Netherlands
| | - Douwe Postmus
- Department of Epidemiology, University Medical Center Groningen University of Groningen, The Netherlands
| | - Yigal M Pinto
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherland
| | - Rudolf A de Boer
- Department of Cardiology, University Medical Center Groningen University of Groningen, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart & Lungs, UMC Utrecht, Utrecht, The Netherlands.,Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Elly M C J Wajon
- Department of Cardiology, Medical Spectrum Twente, Enschede, The Netherlands
| | - Joke G Orsel
- Department of Precision and Decentralized Diagnostics, Philips Research, Eindhoven, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.,Cardiovascular Research School Erasmus MC (COEUR), Rotterdam, The Netherlands
| | - Hans L Hillege
- Department of Epidemiology, University Medical Center Groningen University of Groningen, The Netherlands
| | - K Martijn Akkerhuis
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.,Cardiovascular Research School Erasmus MC (COEUR), Rotterdam, The Netherlands
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37
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Baart SJ, van Domburg RT, Janssen-Heijnen ML, Deckers JW, Akkerhuis KM, Daemen J, van Geuns RJ, Boersma E, Kardys I. Impact of Relative Conditional Survival Estimates on Patient Prognosis After Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.116.003344. [DOI: 10.1161/circoutcomes.116.003344] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 04/21/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Sara J. Baart
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Ron T. van Domburg
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Maryska L.G. Janssen-Heijnen
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Jaap W. Deckers
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - K. Martijn Akkerhuis
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Joost Daemen
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Robert-Jan van Geuns
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Eric Boersma
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
| | - Isabella Kardys
- From the Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands (S.J.B., R.T.v.D., J.W.D., K.M.A., J.D., R.-J.v.G., E.B., I.K.); and Department of Clinical Epidemiology, VieCuri Medical Centre, Venlo, The Netherlands (M.L.G.J.-H.)
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38
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Cuypers JAA, Menting ME, Opić P, Utens EMW, Helbing WA, Witsenburg M, van den Bosch AE, van Domburg RT, Baart SJ, Boersma E, Meijboom FJ, Bogers AJJ, Roos-Hesselink JW. The unnatural history of pulmonary stenosis up to 40 years after surgical repair. Heart 2016; 103:273-279. [PMID: 27515953 DOI: 10.1136/heartjnl-2015-309159] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 12/23/2015] [Revised: 06/29/2016] [Accepted: 07/13/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To provide prospective information on long-term outcome after surgical correction of valvular pulmonary stenosis (PS). METHODS Fifty-three consecutive patients operated for PS during childhood between 1968 and 1980 in one centre are followed longitudinally for 37±3.4 years, including extensive in-hospital examination every 10 years. RESULTS Survival information was available in 100% of the original 53 patients. Cumulative survival was 94% at 20 years and 91% at 40 years. Excluding perioperative mortality (<30 days), survival was 94% at 40 years. Of 46 eligible survivors, 29 participated in the in-hospital examination and 15 gave permission to use their hospital records (96% participation). Cumulative event-free survival was 68% after 40 years: 25% needed a reintervention, 12% underwent pacemaker implantation and 9% had supraventricular arrhythmias. Early reinterventions were mainly for residual PS, late reinterventions for pulmonary regurgitation. Subjective health status was good. Exercise capacity was normal in 74% (median 96 (82-107)% of expected workload). Right ventricular and left ventricular (LV) dysfunction was found in 13% and 41%, respectively. The use of a transannular patch and younger age at surgery were predictive for late events (HR 3.02 (95% CI 1.09 to 8.37) and HR 0.81/year (95% CI 0.66 to 0.98), respectively). Use of inflow occlusion compared with cardiopulmonary bypass showed a trend towards more reinterventions (HR 3.19 (95% CI 0.97 to 10.47)). CONCLUSIONS Survival up to 40 years after successful PS repair is nearly normal. Subjective health status is good and there is a low incidence of arrhythmias. Reinterventions, however, are necessary in one-quarter and 40 years postoperatively several patients show LV dysfunction.
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Affiliation(s)
| | - Myrthe E Menting
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Petra Opić
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Elisabeth M Wj Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Willem A Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | | | | | - Sara J Baart
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Eric Boersma
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ad J Jc Bogers
- Department of Cardio-thoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
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