1
|
Woudstra O, Skoric-Milosavljevic D, Post MC, Meijboom FJ, Jongbloed MRM, Van Dijk APJ, Konings TC, Bezzina CR, Mulder BJM, Bouma BJ, Tanck MWT. Common genetic variants improve risk stratification after atrial switch operation for transposition of the great arteries. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Current clinical risk scores are able to predict late complication risk in adults after atrial switch operation (AtrSO) for transposition of the great arteries (TGA), but a large heterogeneity in clinical course remains.
Purpose
To study whether common genetic factors are predictive of outcome and provide added value to an existing clinical risk score in TGA-AtrSO patients.
Methods
This multicenter study examined the association of genome-wide single-nucleotide polymorphisms (SNPs) in TGA-AtrSO patients with a combined clinical endpoint: time to symptomatic ventricular arrhythmia, heart failure hospitalization, ventricular assist device implantation, heart transplantation, or mortality. Furthermore, we evaluated whether a polygenic risk score (PRS) constructed of independent single-nucleotide polymorphisms (SNPs) with a p<1x10–5 could be of added value to a recently published clinical risk score (included clinical factors: age >30 years, prior ventricular arrhythmia, age >1 year at repair, ≥moderate right ventricular dysfunction, severe tricuspid regurgitation, and ≥mild left ventricular dysfunction).
Results
We followed 133 patients (age at inclusion 28 [IQR 24–35] years, 59% male) for 13 [IQR 8–16] years. Thirty-two patients (24%) reached the endpoint. The genome-wide association study yielded one locus that reached genome-wide significance (p<1x10–8) and 18 loci marked by 20 SNPs that reached the suggestive threshold (p<1x10–5). The constructed PRS remained an independent predictor after correction for the clinical score (HR=1.21/point increase [95% CI 1.13–1.29], p=3x10–10). While the clinical risk score indicated intermediate (5–20%) 5-year risk of events in 52 patients (39%), the combined risk score (clinical score + PRS) reclassified 35 patients to low (<5%) and 6 to high (>20%) risk. Observed 5-year event-free survival based on the combined score remained 100% for low-risk patients, compared to 23% and 64% in intermediate and high-risk patients, respectively. This resulted in improved risk stratification with the combined risk score vs the clinical risk score alone (p=2x10–16, C-statistic 0.95 vs 0.85).
Conclusions
Genetic factors explain some of the variation in clinical course of TGA-AtrSO patients and improve risk stratification. In the heterogeneous group of patients with a clinical score indicating intermediate risk, the combined model could classify 67% of patients more accurately to <5% or >20% risk. These data argue for more research into the impact of genetics on clinical outcome in adult congenital heart disease.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation Figure 1. Risk stratification of predicted 5-year risk of events based on the clinical model versus the combined model (clinical risk score + polygenic risk score).
Collapse
Affiliation(s)
- O Woudstra
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (The)
| | | | - M C Post
- St Antonius Hospital, Nieuwegein, Netherlands (The)
| | - F J Meijboom
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | | | - A P J Van Dijk
- University Medical Center St Radboud (UMCN), Nijmegen, Netherlands (The)
| | - T C Konings
- Amsterdam UMC - Location VUmc, Amsterdam, Netherlands (The)
| | - C R Bezzina
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (The)
| | - B J M Mulder
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (The)
| | - B J Bouma
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (The)
| | - M W T Tanck
- Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands (The)
| |
Collapse
|
2
|
Baniaamam M, Heslinga SC, Handoko ML, Boekel L, Konings TC, Kamp O, Van Halm VP, Van Denderen JC, Van der Horst-Bruinsma I, Nurmohamed M. FRI0308 ANKYLOSING SPONDYLITIS PATIENTS AT RISK OF DEVELOPING AORTIC VALVE REGURGITATION, NEED FOR MANDATORY ECHOCARDIOGRAPHY? Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.5299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:The overall mortality rate in ankylosing spondylitis (AS) patients is increased by 60–90% compared with the general population. This higher mortality rate is predominately caused by cardiovascular disease (CVD) comprising an increased prevalence of cardiac diseases such as valvular heart disease, conduction disturbances and cardiomyopathies as well as atherosclerotic diseases such as myocardial infarctions. However, there is a lack of contemporary studies. Therefore, we investigated current prevalences of cardiac disorders in a well characterized cohort of Dutch patients with AS compared to osteoarthritis (OA) controls.Objectives:To assess the prevalence of CVD in AS patients in comparison to OA controls in a Dutch population.Methods:We performed a cross-sectional study in AS and OA patients between 50-75 years. Subjects were recruited from a large rheumatology outpatient clinic (Reade) in Amsterdam, the Netherlands. Patients underwent echocardiography with 2D, spectral and Color Doppler imaging. The echocardiogram was evaluated by an experienced and certified cardiologist. Diastolic dysfunction was assessed according to the ASE/EACVI 2016 guideline. Furthermore, blood sample, surveys and physical examination were done. Disease activity and function were measured with the BASFI, BASDAI and the ASDAS-CRP.Results:A total of 193 consecutive AS patients were included with a median age of 60 (±7) years of which 72% men (138). The control group consisted of 70 OA patients (table 1). In the AS cohort the disease activity measures, BASDAI, ASDAS-CRP and BASFI, indicated moderate disease activity and were, respectively 3.1 (1.6-5.0), 2.1 (±1.0) and 3.5 (1.7-5.7). Anti-TNF was used by 43% of the AS patients. History of cardiovascular disease (CVD), i.e. angina pectoris, myocardial infarction, stroke and/or peripheral ischemia was comparable between the AS and OA cohort, respectively 9% (17) and 10% (7), p=0.81. Antihypertensives were significantly more often used in AS patients, 85 (44%) vs 19 (27%), p=0.02. Prevalences of systolic dysfunction and diastolic dysfunction did not differ significantly in AS and OA patients, respectively 6 (5%) vs 2 (5%), p=0.96 in systolic dysfunction and 7 (3%) vs 2 (3%), p=0.86 in diastolic dysfunction. Prevalence of aortic valve (AV) regurgitation was significantly higher in AS patients compared to OA patients, respectively 41 (22%) and 7 (10%), mostly with mild severity. The prevalence of mitral valve (MV) regurgitation did not differ between the AS and OA patients, respectively 68 (36%) vs 21 (33%), p=0.59. When corrected for age, gender and cardiovascular risk factors in a regression analysis, AS patients still had a substantially increased risk for AV regurgitation, odds ratio (OR) 2.8 95%CI 1.1-7.2, p=0.038.Table 1.Patient characteristicsASOApN19370Men (n, %)138 (72)40 (57)0.028*Age (years)60 ±763 ±70.004*Disease activityBASDAI3.1 (1.6-5.0)-ASDAS-CRP2.1 ±1.0-BASFI3.5 (1.7-5.7)-CVDHistory of CVD* (n, %)17 (9)7 (10)0.81Antihypertensives (n, %)85 (44)19 (27)0.02Aortic valve regurgitation (n, %)41 (22)7 (10)0.04* Trace (n, %)16 (9)6 (9) Mild (n, %)23 (12)6 (9) Moderate (n, %)1 (1)0 Severe (n, %)1 (1)0 Prosthesis (n, %)1(1)0Mitral valve regurgitation (n, %)68 (36)21 (33)0.59Diastolic dysfunction (n, %)7 (3)2 (3)0.86*Angina pectoris, myocardial infarction, stroke and/or peripheral ischemiaConclusion:This study demonstrates an almost tripled risk for developing AV regurgitation in Dutch AS patients. Although mostly mild in this age, due to the progressive nature of AV regurgitation in AS, echocardiographic screening should be considered in elderly AS patients.Disclosure of Interests:Milad Baniaamam: None declared, Sjoerd C. Heslinga: None declared, M.L. Handoko: None declared, Laura Boekel: None declared, Thelma C. Konings: None declared, Otto Kamp: None declared, Vokko P. van Halm: None declared, J.C. van Denderen: None declared, Irene van der Horst-Bruinsma Grant/research support from: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Consultant of: AbbVie, Novartis, Eli Lilly, Bristol-Myers Squibb, MSD, Pfizer, UCB Pharma, Michael Nurmohamed Grant/research support from: Not related to this research, Consultant of: Not related to this research, Speakers bureau: Not related to this research
Collapse
|
3
|
Heslinga SC, Konings TC, van der Horst-Bruinsma IE, Kamp O, van Halm VP, de Bruin-Bon H, Peters MJ, Nurmohamed MT. The effects of golimumab treatment on systolic and diastolic left ventricular function in ankylosing spondylitis. Biologics 2018; 12:143-149. [PMID: 30510398 PMCID: PMC6231442 DOI: 10.2147/btt.s176806] [Citation(s) in RCA: 2] [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] [Indexed: 12/27/2022]
Abstract
Background Diastolic left ventricular (LV) dysfunction appears more prevalent in ankylosing spondylitis (AS). The effects of tumor necrosis factor alpha (TNF-α) blocking therapy, a strong and effective anti-inflammatory drug, on diastolic LV function in AS are unknown. The objective of the study was to find the effects of 1-year treatment with golimumab 50 mg subcutaneously once per month on systolic and diastolic LV dysfunction in AS patients. Methods Forty consecutive AS patients were treated with TNF-α blocking therapy for 1 year. Transthoracic echocardiography was performed in all patients at baseline and after 1 year of treatment. Results Diastolic LV function improved after treatment in four out of six (67%) AS patients who completed follow-up (P=0.125), and did not develop or worsen in any of the other patients. Treatment with TNF-α blocking therapy had no effect on systolic LV function. Conclusion These findings give support to the hypothesis that diastolic LV dysfunction improves during treatment with TNF-α blocking therapy.
Collapse
Affiliation(s)
- S C Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands, .,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands,
| | - T C Konings
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - I E van der Horst-Bruinsma
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands, .,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands,
| | - O Kamp
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - V P van Halm
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Hacm de Bruin-Bon
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - M J Peters
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - M T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands, .,Department of Rheumatology, Amsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, The Netherlands,
| |
Collapse
|
4
|
Yang H, Heidendael JF, de Groot JR, Konings TC, Veen G, van Dijk APJ, Meijboom FJ, Sieswerda GT, Post MC, Winter MM, Mulder BJM, Bouma BJ. Oral anticoagulant therapy in adults with congenital heart disease and atrial arrhythmias: Implementation of guidelines. Int J Cardiol 2018; 257:67-74. [PMID: 29506740 DOI: 10.1016/j.ijcard.2017.12.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/15/2017] [Accepted: 12/12/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Current guidelines on oral anticoagulation (OAC) in adults with congenital heart disease (ACHD) and atrial arrhythmias (AA) consist of heterogeneous and divergent recommendations with limited level of evidence, possibly leading to diverse OAC management and different outcomes. Therefore, we aimed to evaluate real-world implementation and outcome of three guidelines on OAC management in ACHD patients with AA. METHODS The ESC GUCH 2010, PACES/HRS 2014 and ESC atrial fibrillation (AF) 2016 guidelines were assessed for implementation. ACHD patients with recurrent or sustained non-valvular AA from 5 tertiary centers were identified using a national ACHD registry. After two years of prospective follow-up, thromboembolism, major bleeding and death were assessed. RESULTS In total, 225 adults (mean age 54±15years, 55% male) with various defects (simple 43%; moderate 37%; complex 20%) and AA were included. Following the most strict indication (OAC is recommended in all three guidelines), one should treat a mere 37% of ACHD patients with AA, whereas following the least strict indication (OAC is recommended in any one of the three guidelines), one should treat 98% of patients. The various guidelines were implemented in 54-80% of patients. From all recommendations, Fontan circulation, CHA2DS2-VASc≥1 and AF were independently associated with OAC prescription. Superiority of any guideline in identifying outcome (n=15) could not be demonstrated. CONCLUSIONS The implementation of current guidelines on OAC management in ACHD patients with AA is low, probably due to substantial heterogeneity among guidelines. OAC prescription in daily practice was most consistent in patients with AF and CHA2DS2-VASc≥1 or Fontan circulation.
Collapse
Affiliation(s)
- H Yang
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - J F Heidendael
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - J R de Groot
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - T C Konings
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - G Veen
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | - A P J van Dijk
- Department of Cardiology, RADBOUD University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - F J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G Tj Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - M M Winter
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - B J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
5
|
Woudstra OI, Kuijpers JM, Meijboom FJ, Post MC, Jongbloed MRM, Van Dijk APJ, Van Melle JP, Konings TC, Zwinderman AH, Mulder BJM, Bouma BJ. 6013Drug therapy in adult congenital heart disease: the burden of polypharmacy. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- O I Woudstra
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - J M Kuijpers
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - F J Meijboom
- University Medical Center Utrecht, Utrecht, Netherlands
| | - M C Post
- St Antonius Hospital, Nieuwegein, Netherlands
| | | | - A P J Van Dijk
- Radboud University Medical Centre, Nijmegen, Netherlands
| | - J P Van Melle
- University Medical Center Groningen, Groningen, Netherlands
| | - T C Konings
- VU University Medical Center, Amsterdam, Netherlands
| | - A H Zwinderman
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - B J M Mulder
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| | - B J Bouma
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands
| |
Collapse
|
6
|
Yang H, Kuijpers JM, de Groot JR, Konings TC, van Dijk A, Sieswerda GT, Post MC, Mulder BJM, Bouma BJ. Impact of atrial arrhythmias on outcome in adults with congenital heart disease. Int J Cardiol 2018; 248:152-154. [PMID: 28942870 DOI: 10.1016/j.ijcard.2017.06.073] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/22/2017] [Accepted: 06/19/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adults with congenital heart disease (ACHD) are affected by atrial arrhythmias (AA). To elucidate the impact of AA on prognosis, we aimed to determine the impact of AA on death, heart failure and stroke in ACHD patients in a prospective nationwide clinical registry. METHODS All patients aged ≥18years included in the CONCOR registry per October 1st 2015 were analysed. Prior AA was defined as atrial fibrillation, atrial flutter or unspecified AA before inclusion in CONCOR and new-onset AA as a first documented AA during follow-up. The outcomes were death, first stroke and first admission for heart failure (HF). RESULTS The study cohort comprised 14,224 patients (baseline median age 33.6 [IQR 23-47], male 49.5%, AA n=1501, complex defect 10.3%, repaired defect 58.9%). Median follow-up was 6.5years [IQR 3-10]. Adjusting for age, sex, repair status and defect severity, patients with prior AA had higher mortality and more HF admissions, but no increased risk of stroke compared to those without AA (HR=2.11; 95% CI=1.79-2.49; p<0.001, HR=4.06; 95% CI=2.66-6.19; p<0.001 and HR=1.09; 95% CI=0.71-1.68; p=0.698, respectively). New-onset AA during follow-up was significantly associated with stroke (HR=2.04; 95% CI=1.05-3.96; p=0.036). CONCLUSIONS ACHD patients with prior AA have a 2-fold increased risk of death and a 4-fold increased risk of heart failure, but no increased risk for stroke compared to those without AA. Defect severity and age appear to be more important risk factors for stroke than prior AA. Stroke risk is increased only after conversion of new onset AA.
Collapse
Affiliation(s)
- H Yang
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - J M Kuijpers
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - J R de Groot
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - T C Konings
- Department of Cardiology, VU University Medical Centre, Amsterdam, The Netherlands
| | - A van Dijk
- Department of Cardiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - G Tj Sieswerda
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - B J M Mulder
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands; Netherlands Heart Institute, Utrecht, The Netherlands
| | - B J Bouma
- Department of Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
| |
Collapse
|
7
|
Van Der Bom T, Van Der Palen RLF, Bouma BJ, Konings TC, Zwinderman AH, Blom NA, Hazekamp MG, Mulder BJM. Persistent neo-aortic growth during adulthood in patients after an arterial switch operation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
8
|
Winter MM, Bouma BJ, Groenink M, Konings TC, Tijssen JGP, van Veldhuisen DJ, Mulder BJM. Latest insights in therapeutic options for systemic right ventricular failure: a comparison with left ventricular failure. Heart 2008; 95:960-3. [DOI: 10.1136/hrt.2008.156265] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Konings TC, van der Wouw PA, Bloemendaal K. Separation of coronary ostium caused by pseudoaneurysm formation after composite valve graft replacement for acute dissection of the ascending aorta. Heart 2002; 88:265. [PMID: 12181219 PMCID: PMC1767319 DOI: 10.1136/heart.88.3.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|