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Feringa HHH, Bax JJ, Schouten O, Poldermans D. Protecting the Heart with Cardiac Medication in Patients with Left Ventricular Dysfunction Undergoing Major Noncardiac Vascular Surgery. Semin Cardiothorac Vasc Anesth 2016; 10:25-31. [PMID: 16703231 DOI: 10.1177/108925320601000106] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with left ventricular dysfunction who are undergoing major noncardiac vascular surgery are at increased risk of adverse postoperative events. We sought to evaluate whether perioperative medication use, including angiotensin-converting enzyme (ACE) inhibitors,b-blockers, statins, and aspirin, was associated with a reduced incidence of postoperative in-hospital mortality in these high-risk patients. The study enrolled 511 patients with left ventricular dysfunction (left ventricular ejection fraction <30%) who were undergoing major noncardiac vascular surgery. Cardiac risk factors and medication use were noted before surgery. Preoperative dobutamine stress echocardiography (DSE) was performed to identify patients with stress-induced myocardial ischemia. The end point was postoperative in-hospital mortality. Univariate and multivariate logistic regression analyses were performed to evaluate the relation between perioperative medication use and mortality. The mean age of the study population was 64 ± 11 years, and 75% were men. Perioperative use of ACE inhibitors, b-blockers, statins, and aspirin was recorded in 215 (48%), 139 (27%), 107 (21%), and 125 patients (24%), respectively. Stress-induced myocardial ischemia occurred in 82 patients (16%). Sixty-four patients (13%) died. Perioperative use of ACE inhibitors (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.12-0.91), b-blockers (OR, 0.03; 95% CI, 0.01-0.26), statins (OR, 0.06; 95% CI, 0.01-0.53), and aspirin (OR, 0.13; 95% CI, 0.03-0.55), was significantly associated with a reduced incidence of mortality, after adjusting for cardiac risk factors and DSE results. In conclusion, the present study showed that the perioperative use of ACE inhibitors,b-blockers, statins, and aspirin is independently associated with a reduced incidence of in-hospital mortality in patients with left ventricular dysfunction who are undergoing major noncardiac vascular surgery.
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Affiliation(s)
- Harm H H Feringa
- Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Flu WJ, van Kuijk JP, Winkel T, Hoeks S, Bax J, Poldermans D. Prevention of acute coronary events in noncardiac surgery: β-blocker therapy and coronary revascularization. Expert Rev Cardiovasc Ther 2014; 7:521-32. [DOI: 10.1586/erc.09.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Poldermans D. Don Poldermans MD PhD, replies to European heart journal editorial. Eur Heart J 2013; 34:1698. [PMID: 23926606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Tendera M, Aboyans V, Bartelink L, Baumgartner I, Clement D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FGR, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Rother J, Sievert H, van Sambeek M, Zeller T. [ESC guidelines for the treatment and diagnosis of peripheral artery disease. Guideline includes extracranial carotid artery, vertebral, mesenteric, renal, upper and lower extremity arteries]. Turk Kardiyol Dern Ars 2012; 40 Suppl 1:5-60. [PMID: 27305719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
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Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FGR, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Röther J, Sievert H, van Sambeek M, Zeller T. ESC Guidelines on the Diagnosis and Treatment of Peripheral Artery Diseases. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.rec.2011.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Grootenboer N, Hunink M, Hoeks S, Hendriks J, van Sambeek M, Poldermans D. The Impact of Gender on Prognosis After Non-cardiac Vascular Surgery. Eur J Vasc Endovasc Surg 2011; 42:510-6. [DOI: 10.1016/j.ejvs.2011.06.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 06/15/2011] [Indexed: 11/30/2022]
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Bakker EJ, Ravensbergen NJ, Poldermans D. Perioperative cardiac evaluation, monitoring, and risk reduction strategies in noncardiac surgery patients. Curr Opin Crit Care 2011; 17:409-15. [DOI: 10.1097/mcc.0b013e328348d40f] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Bakker E, Ravensbergen N, Voute M, Hoeks S, Chonchol M, Klimek M, Poldermans D. A Randomised Study of Perioperative Esmolol Infusion for Haemodynamic Stability during Major Vascular Surgery; Rationale and Design of DECREASE-XIII. Eur J Vasc Endovasc Surg 2011; 42:317-23. [DOI: 10.1016/j.ejvs.2011.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 05/03/2011] [Indexed: 10/18/2022]
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Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, Collet JP, Cremonesi A, De Carlo M, Erbel R, Fowkes FGR, Heras M, Kownator S, Minar E, Ostergren J, Poldermans D, Riambau V, Roffi M, Röther J, Sievert H, van Sambeek M, Zeller T. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:2851-906. [PMID: 21873417 DOI: 10.1093/eurheartj/ehr211] [Citation(s) in RCA: 1035] [Impact Index Per Article: 79.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
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- 3rd Division of Cardiology, Medical University of Silesia, Ziolowa 47, 40-635 Katowice, Poland.
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Flu WJ, Hoeks SE, van Kuijk JP, Bax JJ, Poldermans D. Treatment recommendations to prevent myocardial ischemia and infarction in patients undergoing vascular surgery. Curr Treat Options Cardiovasc Med 2011; 11:33-44. [PMID: 19141259 DOI: 10.1007/s11936-009-0004-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
During major vascular surgery (MVS), patients are at high risk for developing unrecognized myocardial infarction (MI) and myocardial ischemia. In reducing postoperative morbidity and mortality, preoperative cardiac risk stratification and adequate medical therapy play a pivotal role. Based on literature and current opinions, medical treatment should comprise at least a combination of beta-blockers, aspirin, and statins. beta-Blockers exert their beneficial effects predominantly through heart rate control, leading to reduced oxygen demand during surgery. A heart rate between 65 and 70 bpm should be achieved. Irrespective of their lipid-lowering effects, statins seem to improve postoperative cardiac outcome by stabilizing coronary artery plaques, thereby preventing atherosclerotic plaque rupture. Aspirin reduces platelet activation and vasoconstriction, thereby limiting ischemic events and reducing nonfatal MI by 34%. Adding clopidogrel to low-dose aspirin might be beneficial toward postoperative cardiac outcomes; however, the effect on the incidence of postoperative bleeding complications may be a problem for future studies to resolve. Whereas beta-blockers inhibit the effect of catecholamines, alpha(2)-agonists inhibit catecholamine release and may be used in the perioperative setting when beta-blockers are contraindicated. Despite the blood pressure-lowering effect and anti-inflammatory properties of angiotensin-converting enzyme inhibitors, the literature does not support their use in patients undergoing MVS. The possible use of calcium antagonists before MVS should be further evaluated in high-risk patients with contraindications to beta-blockers, such as asthma, conduction abnormalities, or a history of stroke. Although nitrates are widely used for treating angina pectoris, the beneficial effect of their use in patients undergoing MVS remains controversial. Therefore, nitrates are not routinely used in the perioperative setting. The current American College of Cardiology/American Heart Association guidelines do not recommend prophylactic coronary revascularization before noncardiac surgery in patients with stable coronary artery disease.
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Affiliation(s)
- Willem-Jan Flu
- Don Poldermans, MD, PhD Department of Anesthesiology, Erasmus Medical Center, Room H805, 's-Gravendijkwal 230, 3015 GD Rotterdam, The Netherlands.
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Hackam DG, Shojania KG, Spence JD, Alter DA, Beanlands RS, Dresser GK, Goela A, Davies AH, Badano LP, Poldermans D, Boersma E, Njike VY. Influence of Noninvasive Cardiovascular Imaging in Primary Prevention. ACTA ACUST UNITED AC 2011; 171:977-82. [DOI: 10.1001/archinternmed.2011.69] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Voûte MT, Bastos Gonçalves FM, Klein Nulent CG, van Kuijk JP, Hoeks SE, van de Luijtgaarden KM, Ravensbergen NJ, Verhagen HJ, Poldermans D. RR31. Endograft Composition Plays a Material Role in Post-Implantation Syndrome. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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van de Luijtgaarden KM, Hoeks SE, Bakker EJ, Voute MT, Ravensbergen NJ, Verhagen HJ, Krakauer DM, Poldermans D. RR11. Familial AAA: High Prevalence and Decreased Cardiac Risk Factors. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Schouten O, Hoeks SE, Voute MT, Boersma E, Verhagen HJ, Poldermans D. SS9. Long-term Benefit of Perioperative Statin Use in Patients Undergoing Vascular Surgery: Results from the DECREASE III Trial. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hoeks SE, Bouw E, Poldermans D. Quality assurance in perioperative care. Best Pract Res Clin Gastroenterol 2011; 25:435-41. [PMID: 21764011 DOI: 10.1016/j.bpg.2011.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2011] [Revised: 05/06/2011] [Accepted: 05/07/2011] [Indexed: 01/31/2023]
Abstract
Nowadays more and more clinical guidelines are developed. Clinical guidelines aim to assist practitioner and patient decision making about appropriate care for specific clinical conditions. Furthermore, guidelines can play a crucial role in the quality cycle form guidelines to clinical practice. However, this does not necessarily mean that these guidelines are actually implemented and the ultimately goal, improved patient outcome, is achieved. Care gaps exist between guidelines and daily clinical practice in perioperative care. Research should be focused on identification of barriers to adherence and subsequent effect implementation strategies to achieve higher standards of quality of care. A multifactorial approach to improving use of guidelines in clinical practice may improve the treatment of patients with peripheral arterial disease.
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Affiliation(s)
- Sanne E Hoeks
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Ravensbergen NJ, Mastenbroek MH, Voûte MT, Hoeks SE, Poldermans D. PS26. Long Term Quality of Life after Endovascular Aneurysm Repair, Compared to Open Repair in Patients with Abdominal Aortic Aneurysms. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Bastos Gonçalves FM, van Herwaarden JA, van Keulen JW, Poldermans D, Moll FL, de Vries JPM, Verhagen HJ. PS36. Severe Proximal Aneurysm Neck Angulation: Mid-Term Results and Morphological Changes after EVAR Using Latest Stent Graft Technology. J Vasc Surg 2011. [DOI: 10.1016/j.jvs.2011.03.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Affiliation(s)
- Michiel T Voûte
- Department of Vascular Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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van Loon JE, Leebeek FWG, Deckers JW, Dippel DWJ, Poldermans D, Strachan DP, Tang W, O'Donnell CJ, Smith NL, de Maat MPM. Effect of genetic variations in syntaxin-binding protein-5 and syntaxin-2 on von Willebrand factor concentration and cardiovascular risk. ACTA ACUST UNITED AC 2011; 3:507-12. [PMID: 21156930 DOI: 10.1161/circgenetics.110.957407] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elevated von Willebrand factor (VWF) plasma levels are associated with an increased risk of cardiovascular disease. A meta-analysis of genomewide association studies on VWF identified novel candidate genes, that is, syntaxin-binding protein 5 (STXBP5) and syntaxin 2 (STX2), which are possibly involved in the secretion of VWF. We investigated whether VWF antigen levels (VWF:Ag), VWF collagen-binding activity (VWF:CB) and the risk of arterial thrombosis are affected by common genetic variations in these genes. METHODS AND RESULTS In 463 young white subjects (men ≤45 years of age and women ≤55 years of age), who were included 1 to 3 months after a first event of arterial thrombosis, and 406 control subjects, we measured VWF:Ag and VWF:CB. Nine haplotype tagging single-nucleotide polymorphisms of STXBP5 and STX2 were selected and subsequently analyzed using linear regression with additive genetic models adjusted for age, sex, and ABO blood group. The minor alleles of rs9399599 and rs1039084 in STXBP5 were associated with lower VWF plasma levels and activity, whereas the minor allele of rs7978987 in STX2 was associated with higher VWF plasma levels and activity. The minor alleles of the single-nucleotide polymorphisms in STX2 were associated with a reduced risk of arterial thrombosis (rs1236: odds ratio, 0.73 [95% confidence interval, 0.59, 0.89]; rs7978987: odds ratio, 0.81 [95% confidence interval, 0.65, 1.00]; rs11061158: odds ratio, 0.69 [95% confidence interval, 0.55, 0.88]). CONCLUSIONS Genetic variability in STXBP5 and STX2 affects both VWF concentration and activity in young individuals with premature arterial thrombosis. Furthermore, in our study, genetic variability in STX2 is associated with the risk of arterial thrombosis. However, at this point, the underlying mechanism remains unclear.
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Affiliation(s)
- Janine E van Loon
- Department of Hematology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Ng AC, Delgado V, Bertini M, Antoni ML, van Bommel RJ, van Rijnsoever EP, van der Kley F, Ewe SH, Witkowski T, Auger D, Nucifora G, Schuijf JD, Poldermans D, Leung DY, Schalij MJ, Bax JJ. Alterations in multidirectional myocardial functions in patients with aortic stenosis and preserved ejection fraction: a two-dimensional speckle tracking analysis. Eur Heart J 2011; 32:1542-50. [DOI: 10.1093/eurheartj/ehr084] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Winkel T, Rouwet E, van Kuijk JP, Voute M, de Melis M, Verhagen H, Poldermans D. Aortic Surgery Complications Evaluated by an Implanted Continuous Electrocardiography Device: A Case Report. Eur J Vasc Endovasc Surg 2011; 41:334-6. [DOI: 10.1016/j.ejvs.2010.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/03/2010] [Indexed: 10/18/2022]
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Shanks M, Delgado V, Ng ACT, Auger D, Mooyaart EAQ, Bertini M, Marsan NA, van Bommel RJ, Holman ER, Poldermans D, Schalij MJ, Bax JJ. Clinical and echocardiographic predictors of nonresponse to cardiac resynchronization therapy. Am Heart J 2011; 161:552-7. [PMID: 21392611 DOI: 10.1016/j.ahj.2010.11.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Accepted: 11/13/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Lack of response to cardiac resynchronization therapy (CRT) ranges between 30% to 40% of heart failure (HF) patients. The present study aimed to evaluate the clinical and echocardiographic determinants of nonresponse to CRT. METHODS A total of 581 patients (66.4 ± 10.0 years, 77.9% male) with advanced HF scheduled for CRT implantation were included. Clinical and echocardiographic evaluations were performed at baseline and 6 months of follow-up. Nonresponse was defined as no improvement in the New York Heart Association functional class, death from worsening HF or heart transplantation, and <15% reduction in left ventricular (LV) end-systolic volume. RESULTS At 6 months of follow-up, 254 patients (44%) did not respond to CRT. The nonresponders were more frequently male (81.9% vs 74.3%, P = .030) and had ischemic cardiomyopathy (69.7% vs 53.2%, P < .001), shorter QRS duration (150.6 ± 29.9 milliseconds vs 156.0 ± 32.5 milliseconds, P = .041), worse New York Heart Association functional class (2.8 ± 0.6 vs 2.7 ± 0.6, P = .008) and shorter 6-minute walk distance (297.9 ± 110.7 m vs 331.8 ± 112.6 m, P = .001), larger left atrial volumes (44.9 ± 16.9 mL/m(2) vs 40.9 ± 17.6 mL/m(2), P = .006), less baseline LV dyssynchrony (56.2 ± 41.3 milliseconds vs 69.1 ± 39.9 milliseconds, P < .001), and, more frequently, anterior LV lead position (12.4% vs 4.0%, P = .007). At multivariate analysis, only the ischemic etiology of HF (odds ratio [OR] 2.264, P = .005), shorter 6-minute walk distance at baseline (OR 0.998, P = .030), less baseline LV dyssynchrony (OR 0.989, P < .001), and anterior LV lead position (OR 3.713, P < .010) remained independent predictors of nonresponse to CRT. CONCLUSIONS Ischemic etiology of HF, shorter baseline 6-minute walk distance, less baseline LV dyssynchrony, and anterior LV lead position are independent determinants of nonresponse to CRT.
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Affiliation(s)
- Miriam Shanks
- Department of Cardiology, Leiden University Medical Center, The Netherlands
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de Liefde II, Verhagen HJM, Stolker RJ, van Domburg RT, Poldermans D. The value of treadmill exercise test parameters together in patients with known or suspected peripheral arterial disease. Eur J Prev Cardiol 2011; 19:192-8. [PMID: 21450584 DOI: 10.1177/1741826711399986] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [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: 11/16/2022]
Abstract
BACKGROUND Exercise test parameters (exercise ankle brachial index (ABI), walking distance and blood pressure response) separately are associated with long-term outcome in patients with known or suspected peripheral arterial disease (PAD). However, the clinical value of the combination of these parameters together is unknown. METHODS 2165 patients performed a treadmill exercise test to diagnose or to evaluate their PAD. Resting ABI, exercise ABI, abnormal blood pressure response (hypotensive and hypertensive) and walking distance (impairment <150 m) were measured. The study population was divided into patients with a resting ABI ≥ 0.90 and patients with PAD (resting ABI < 0.90). RESULTS The mean follow-up period was 5 years (0.5-14 years). Long-term mortality rate and risks increases when more exercise parameters became abnormal (p-value = 0.001). Patients with a normal resting ABI but with an abnormal exercise test had a higher mortality risk--HR 1.90 (1.32-2.73)--than patients with a normal exercise test. The highest mortality risk and cardiac death was observed in PAD patients with a walking impairment together with an abnormal blood pressure response--HR 3.48 (2.22-5.46). CONCLUSION Exercise tests give multiple parameters, which together provide important prognostic information on long-term outcome in both patients with normal resting ABI and PAD.
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Affiliation(s)
- Inge I de Liefde
- Department of Anaesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Cacoub PP, Zeymer U, Limbourg T, Baumgartner I, Poldermans D, Rother J, Bhatt DL, Steg PG. Effects of adherence to guidelines for the control of major cardiovascular risk factors on outcomes in the REduction of Atherothrombosis for Continued Health (REACH) Registry Europe. Heart 2011; 97:660-7. [DOI: 10.1136/hrt.2010.213710] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [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
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de Liefde II, Klein J, Bax JJ, Verhagen HJM, van Domburg RT, Poldermans D. Exercise ankle brachial index adds important prognostic information on long-term out-come only in patients with a normal resting ankle brachial index. Atherosclerosis 2011; 216:365-9. [PMID: 21397231 DOI: 10.1016/j.atherosclerosis.2010.10.051] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/06/2010] [Accepted: 10/06/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The clinical value of exercise ankle brachial index (ABI) is still unclear, especially in patients with normal resting ABI. METHOD 2164 patients performed a single-stage treadmill exercise test to diagnose or evaluate PAD. The population was divided into two groups: a normal resting ABI (resting ABI≥0.90) and PAD (resting ABI<0.90). Patients with a normal resting ABI were divided into 4 exercise ABI groups: exercise ABI<0.90, 0.90-0.99, 1.00-1.09 and 1.10-1.29 (reference). RESULTS Mean follow-up was 5 years. Exercise ABI added significant prognostic information on all cause long-term mortality only in patients with normal resting ABI (p-value 0.014, HR 0.99 95% CI (0.98-0.99)), not in patients with PAD. Fifty years or older (OR 2.93 95% CI (1.65-5.20)) and resting systolic blood pressure>140 mmHg (OR 2.18 95% CI (1.35-3.55)) were associated with an abnormal exercise ABI in patients with a normal resting ABI. Mortality rate increased when the exercise ABI became worse (p trend 0.0001) with a 2.5-fold increase mortality risk in patients with a normal resting ABI but exercise ABI <0.90 (HR 2.56, 95% CI (1.11-5.91)). CONCLUSION In patients with a normal resting ABI, treadmill exercise ABI added important prognostic information on long-term mortality. Based on our results we recommend that at least all patients suspected for PAD, with a resting ABI≥0.90, who are 50 years or older and having hypertension should undergo treadmill exercise testing.
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Affiliation(s)
- Inge I de Liefde
- Department of Anesthesiology, Erasmus MC, Rotterdam, The Netherlands
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Goei D, van Kuijk JP, Flu WJ, Hoeks SE, Chonchol M, Verhagen HJ, Bax JJ, Poldermans D. Usefulness of Repeated N-Terminal Pro-B-Type Natriuretic Peptide Measurements as Incremental Predictor for Long-Term Cardiovascular Outcome After Vascular Surgery. Am J Cardiol 2011; 107:609-14. [DOI: 10.1016/j.amjcard.2010.10.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 10/05/2010] [Accepted: 10/05/2010] [Indexed: 11/15/2022]
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Abstract
IMPORTANCE OF THE FIELD In patients undergoing vascular surgery there is a high incidence of adverse cardiac events, due to sudden coronary plaque rupture. The non-lipid lowering or pleiotropic effects of statins can help reduce adverse cardiovascular events associated with vascular surgery. AREAS COVERED IN THIS REVIEW The evidence for perioperative use of fluvastatin, as well as other statins, in high-risk surgery patients is summarized in this review. Data on pharmacokinetics and metabolism is presented, together with considerations on possible drug interactions in the perioperative period. WHAT THE READER WILL GAIN The reader will gain a comprehensive understanding of the existing safety and efficacy data for fluvastatin and other statins in the perioperative period. The practical considerations of perioperative fluvastatin therapy will be presented, including potential side-effects and management of the early non-oral phase immediately post surgery. Finally, advice on when to initiate therapy and safety recommendations are offered. TAKE HOME MESSAGE In patients scheduled for high-risk vascular surgery, fluvastatin improves postoperative outcome, reducing the incidence of myocardial damage by approximately 50% in the first 30 days following vascular surgery. In comparison with placebo, fluvastatin was not associated with a rise in liver enzymes or creatine kinase levels. To bridge the non-oral phase, an extended-release formula is recommended.
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Affiliation(s)
- Michiel T Voûte
- Department of Vascular Surgery, Suite Z-838, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Ravensbergen NJC, Voute MT, Poldermans D. Safety of perioperative β-blocker use: how do β-blockers compare in terms of side effects? Expert Opin Drug Saf 2011; 10:545-58. [PMID: 21247365 DOI: 10.1517/14740338.2011.552500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION In the perioperative setting, there is still a high incidence of adverse cardiac events due to sudden coronary plaque rupture or oxygen supply-demand imbalance. β-Blockers play an important role in preventing these cardiac events. Discussion, however, remains on the side effects accompanying this therapy. AREAS COVERED The evidence for perioperative use of β-blockers is summarized in this review in terms of risk reduction, perioperative safety and current clinical use. Furthermore, data on pharmacokinetics, pharmacodynamics and pharmacogenetics are presented. EXPERT OPINION In perioperative care, β-blockers are recommended and can be given safely when started early in a low dose, titrated to heart rate. In the future, there could be a place for added perioperative short-acting β-blockers to further optimize heart rate control.
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van de Laar IMBH, Oldenburg RA, Pals G, Roos-Hesselink JW, de Graaf BM, Verhagen JMA, Hoedemaekers YM, Willemsen R, Severijnen LA, Venselaar H, Vriend G, Pattynama PM, Collée M, Majoor-Krakauer D, Poldermans D, Frohn-Mulder IME, Micha D, Timmermans J, Hilhorst-Hofstee Y, Bierma-Zeinstra SM, Willems PJ, Kros JM, Oei EHG, Oostra BA, Wessels MW, Bertoli-Avella AM. Mutations in SMAD3 cause a syndromic form of aortic aneurysms and dissections with early-onset osteoarthritis. Nat Genet 2011; 43:121-6. [PMID: 21217753 DOI: 10.1038/ng.744] [Citation(s) in RCA: 465] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Accepted: 11/24/2010] [Indexed: 11/09/2022]
Abstract
Thoracic aortic aneurysms and dissections are a main feature of connective tissue disorders, such as Marfan syndrome and Loeys-Dietz syndrome. We delineated a new syndrome presenting with aneurysms, dissections and tortuosity throughout the arterial tree in association with mild craniofacial features and skeletal and cutaneous anomalies. In contrast with other aneurysm syndromes, most of these affected individuals presented with early-onset osteoarthritis. We mapped the genetic locus to chromosome 15q22.2-24.2 and show that the disease is caused by mutations in SMAD3. This gene encodes a member of the TGF-β pathway that is essential for TGF-β signal transmission. SMAD3 mutations lead to increased aortic expression of several key players in the TGF-β pathway, including SMAD3. Molecular diagnosis will allow early and reliable identification of cases and relatives at risk for major cardiovascular complications. Our findings endorse the TGF-β pathway as the primary pharmacological target for the development of new treatments for aortic aneurysms and osteoarthritis.
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Vidaković R, Poldermans D, Nesković AN. Preoperative cardiac risk management. Acta Chir Iugosl 2011; 58:9-18. [PMID: 21879645 DOI: 10.2298/aci1102009v] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Approximately 100 million people undergo noncardiac surgery annually worldwide. It is estimated that around 3% of patients undergoing noncardiac surgery experience a major adverse cardiac event. Although cardiac events, like myocardial infarction, are major cause of perioperative morbidity or mortality, its true incidence is difficult to assess. The risk of perioperative cardiac complications depends mainly on two conditions: (1) identified risk factors, and (2) the type of the surgical procedure. On that basis, different scoring systems have been developed in order to accurately assess the perioperative cardiac risk and to improve the patient management. Importantly, patients with estimated high risk should be tested preoperatively by non-invasive cardiac imaging modalities. According to test results, they can proceed directly to planed surgery with the use of cardioprotective drugs (beta-blockers, statins, aspirin), or to myocardial revascularization prior to non-cardiac surgery. In this review, we discuss the role of clinical cardiac risk factors, laboratory measurements, additional non-invasive cardiac testing, and consequent strategies in perioperative management of patients undergoing noncardiac surgery.
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Affiliation(s)
- Radosav Vidaković
- Department of Cardiology, Clinical Hospital Zemun, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Flu WJ, Van Kuijk JP, Chonchol M, Winkel TA, Verhagen H, Bax JJ, Poldermans D. TIMING OF PRE-OPERATIVE BETA-BLOCKER TREATMENT IN VASCULAR SURGERY PATIENTS: INFLUENCE ON POST-OPERATIVE OUTCOME. Racionalʹnaâ farmakoterapiâ v kardiologii 2011. [DOI: 10.20996/1819-6446-2011-7-1-94-102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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de Bruijne ELE, Gils A, Rijken DC, de Maat MPM, Guimarães AHC, Poldermans D, Declerck PJ, Leebeek FWG. High thrombin activatable fibrinolysis inhibitor levels are associated with an increased risk of premature peripheral arterial disease. Thromb Res 2010; 127:254-8. [PMID: 21195459 DOI: 10.1016/j.thromres.2010.11.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 09/08/2010] [Revised: 11/18/2010] [Accepted: 11/26/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND Previous studies suggested that hypofibrinolysis is associated with increased risk of peripheral arterial disease. Thrombin activatable fibrinolysis inhibitor (TAFI) has been identified as an important inhibitor of fibrinolysis. The aim of our study was to assess the role of TAFI in young patients with peripheral arterial disease. METHODS In a single-center case-control study we measured plasma TAFI antigen levels and functional TAFI in consecutive young patients (men 18-45 years and women 18-55 years) with a first manifestation of peripheral arterial disease and compared these with a population-based control group. RESULTS A total of 47 peripheral arterial disease patients and 141 controls (mean age 43) were included. Intact TAFI antigen levels were significantly higher in patients with peripheral arterial disease (112.4±21.1%) than in controls (104.9±19.9%, p=0.03). The risk of peripheral arterial disease increased with 18% (OR 1.18; CI 1.01-1.34) per 10% increase of TAFI antigen. Functional TAFI levels were slightly higher in patients compared to controls, however this difference was not significant. For individuals with the highest functional TAFI levels, above the 90th percentile, the increased risk for peripheral arterial disease was most pronounced (OR 3.1; CI 1.02-9.41). CONCLUSION High TAFI levels are associated with increased risk of premature peripheral arterial disease.
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Affiliation(s)
- Emile L E de Bruijne
- Dept of Hematology, Erasmus University Medical Center Rotterdam, The Netherlands.
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Cacoub P, Zeymer U, Limbourg T, Baumgartner I, Poldermans D, Röther J, Bhatt DL, Steg PG. Prise en charge des facteurs de risque cardiovasculaires : impact à trois ans sur les évènements cardiovasculaires et la mortalité dans le registre REACH Europe. Rev Med Interne 2010. [DOI: 10.1016/j.revmed.2010.10.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Winkel TA, Voute MT, de Melis M, Hoeks SE, Schouten O, Kessels R, Verhagen HJM, Poldermans D. Sudden death during follow-up after new-onset ventricular tachycardia in vascular surgery patients. J Vasc Surg 2010; 53:732-7; discussion 737. [PMID: 21106322 DOI: 10.1016/j.jvs.2010.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 09/02/2010] [Accepted: 09/02/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Vascular surgery patients are at increased risk for late sudden cardiac death. Identification of patients at risk during surgery offers the opportunity for focused therapy. METHODS We monitored 483 vascular surgery patients who had no documented history of arrhythmias to identify perioperative new-onset ventricular tachyarrhythmia (VT) and myocardial ischemia using a continuous electrocardiographic (ECG) device for 72 hours. Cardiac risk factors, left ventricular ejection fraction (LVEF), medical therapy, inflammation status, and perioperative ischemia in relation to arrhythmia were noted in all patients. During follow-up, event-based outcomes analysis was used to describe survival. RESULTS New-onset perioperative VT was detected in 33 patients (6.8%). A higher percentage of patients experiencing perioperative VT had reduced LVEF preoperatively than those without VT (24% vs 12%; P = .04). Additionally, fewer patients experiencing VT were receiving statins than those without (70% vs 85%; P = .02). Patients experiencing VT had a higher incidence of myocardial ischemia (30% vs 18%; P = .10). Perioperative VT was preceded by ischemia in only 60% of the cases. The overall cohort survival was 83% at 24-month follow-up (interquartile range [IQR], 1.1-1.3). Sudden cardiac death free survival among patients experiencing VT was less than in those without (79% vs 92%; P = .02). After adjusting for gender, cardiac risk factors, and type of surgery, new-onset perioperative VT was associated with sudden cardiac death (hazard ratio [HR], 2.6; 95% confidence interval [CI], 1.1-5.8). CONCLUSION Perioperative VT is likely to be associated with late sudden cardiac death and decreased survival. Continuous perioperative ECG is an effective method to identify VT and may allow improved management of these patients.
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Affiliation(s)
- Tamara A Winkel
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Bastos Gonçalves F, Metz R, Hendriks JM, Rouwet EV, Muhs BE, Poldermans D, Verhagen HJM. Decision-making in type-B dissection: current evidence and future perspectives. J Cardiovasc Surg (Torino) 2010; 51:657-667. [PMID: 20924327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Aortic dissection is a devastating cardiovascular condition with an incidence of 3,5:100 000. It is classified according to anatomic extent, mechanism of lesion, duration from index event and course (uncomplicated vs. complicated). Intramural hematoma and penetrating aortic ulcers share many of the features of classic dissections, but tend to occur in older patients with advanced atherosclerosis. In uncomplicated type-B dissection, conservative treatment with tight blood pressure and heart rate control is safe and effective. Early stent-graft implantation may, however, result in more favorable aortic remodeling and reduced late complications. For acute complicated cases intervention is usually required. Stent-graft coverage of the entry tear frequently resolves malperfusion, but the role of the false lumen in organ perfusion must be assessed and endovascular revascularization performed if necessary. In chronic type-B dissections, coverage of the entry tear likely results in continued pressurization of the false lumen due to rigidity of the dissecting membrane and distal fenestrations. Better understanding of the different disease mechanisms involved, imaging advances and introduction of dedicated stent-grafts are expected to further improve patient outcomes in the future. Primary and secondary pharmacological prevention, stricter follow-up protocols and screening of family members may also prove valuable. Better patient selection will allow preventive treatment with low morbidity for those at higher risk of complications.
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Affiliation(s)
- F Bastos Gonçalves
- Department of Vascular Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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Auger D, van Bommel RJ, Bertini M, Delgado V, Ng AC, Ewe SH, Shanks M, Marsan NA, Mooyaart EA, Witkowski T, Poldermans D, Schalij MJ, Bax JJ. Prevalence and characteristics of patients with clinical improvement but not significant left ventricular reverse remodeling after cardiac resynchronization therapy. Am Heart J 2010; 160:737-43. [PMID: 20934569 DOI: 10.1016/j.ahj.2010.07.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 07/13/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although most patients who improve in clinical status after cardiac resynchronization therapy (CRT) also show a significant left ventricular (LV) reverse remodeling, some patients do not show echocardiographic improvement. The aim of the present study was to evaluate the degree of agreement between clinical and echocardiographic response to CRT in a large cohort of heart failure patients, and to evaluate the characteristics of patients with clinical response but without echocardiographic response. METHODS In 440 consecutive heart failure patients (mean age 66 ± 11 years, 81% men) treated with CRT, agreement between clinical and echocardiographic responses at 6 months of follow-up were evaluated. The combined clinical response was defined as: ≥1-point New York Heart Association functional class improvement or ≥15% increase in 6-minute walk test. Echocardiographic response was defined by a reduction in LV end-systolic volume (LVESV) ≥15%. RESULTS At 6 months of follow-up, clinical response was observed in 84% (n = 370) of the patients. Significant reduction in LVESV was noted in 63% (n = 276). The majority of patients who improved clinically did show LV reverse remodeling (72%, n = 268). Importantly, 28% (n = 102) of patients who improved clinically did not show significant LV reverse remodeling. The patients with clinical response but without echocardiographic response had more often ischemic heart failure as compared to patients with positive clinical and echocardiographic response (69.6% vs 57.5%; P = .021). Moreover, patients with such discordant responses had more narrow QRS complex (148 ± 31 vs 159 ± 31 milliseconds; P = .004), and showed less LV dyssynchrony than patients with concordant positive responses (90 ± 77 vs 171 ± 105 milliseconds; P < .001). CONCLUSIONS Although there is a good concordance between echocardiographic and clinical response to CRT, up to 28% of the population experienced clinical response without significant LV reverse remodeling. Subjects with such discrepant responses have more frequently ischemic heart failure and show more narrow QRS complex and less LV dyssynchrony than patients with both clinical and echocardiographic response.
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Winkel TA, Schouten O, Hoeks SE, Voûte MT, Chonchol M, Goei D, Flu WJ, van Kuijk JP, Lindemans J, Verhagen HJM, Bax JJ, Poldermans D. Prognosis of vascular surgery patients using a quantitative assessment of troponin T release: is the crystal ball still clear? Eur J Vasc Endovasc Surg 2010; 40:739-46. [PMID: 20884259 DOI: 10.1016/j.ejvs.2010.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2010] [Accepted: 08/14/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cardiac troponin T (cTnT) assays with increased sensitivity might increase the number of positive tests. Using the area under the curve (AUC) with serial sampling of cTnT an exact quantification of the myocardial damage size can be made. We compared the prognosis of vascular surgery patients with integrated cTnT-AUC values to continuous and standard 12-lead electrocardiography (ECG) changes. METHODS 513 Patients were monitored. cTnT sampling was performed on postoperative days 1, 3, 7, 30 and/or at discharge or whenever clinically indicated. If cTnT release occurred, daily measurements of cTnT were performed, until baseline was achieved. CTnT-AUC was quantified and divided in tertiles. All-cause mortality and cardiovascular events (cardiac death and myocardial infarction) were noted during follow-up. RESULTS 81/513 (16%) Patients had cTnT release. After adjustment for gender, cardiac risk factors, and site and type of surgery, those in the highest cTnT-AUC tertile were associated with a significantly worse cardiovascular outcome and long-term mortality (HR 20.2; 95% CI 10.2-40.0 and HR 4.0; 95% CI 2.0-7.8 respectively). Receiver operator analysis showed that the best cut-off value for cTnT-AUC was <0.01 days*ng m for predicting long-term cardiovascular events and all-cause mortality. CONCLUSION In vascular surgery patients quantitative assessment of cTnT strongly predicts long-term outcome.
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Affiliation(s)
- T A Winkel
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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van Kuijk JP, Flu WJ, Valentijn TM, Chonchol M, Kuiper RJ, Verhagen HJM, Bax JJ, Poldermans D. Influence of left ventricular dysfunction (diastolic versus systolic) on long-term prognosis in patients with versus without diabetes mellitus having elective peripheral arterial surgery. Am J Cardiol 2010; 106:860-4. [PMID: 20816129 DOI: 10.1016/j.amjcard.2010.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 05/03/2010] [Accepted: 05/03/2010] [Indexed: 11/28/2022]
Abstract
Diabetes mellitus (DM) and left ventricular dysfunction (LVD) are often coexistent and invariably associated with increased mortality. Data on long-term prognosis of "isolated" diastolic LVD in diabetics are lacking; therefore, we evaluated these prognostic implications in patients with peripheral arterial disease (PAD) and DM. Using echocardiography, 1321 patients were screened for diastolic, systolic (ejection fraction <50%) or combined LVD. Diastolic LVD was diagnosed based on the ratio of early rapid filling to late filling due to atrial contraction, pulmonary vein flow, and deceleration time. Patients using glucose-lowering drugs or insulin or with a fasting glucose level >6.1 mmol/L were diagnosed with DM. The primary end point was occurrence of cardiovascular death during a mean follow-up of 2.5 +/- 1.9 years. In the total population, DM was diagnosed in 518 patients (39%), and diastolic, systolic, or combined LVD was present in 356 patients (27%), 102 patients (8%), or 156 patients (12%), respectively. In diabetic patients, diastolic and systolic LVDs were associated with increased cardiovascular mortality (hazard ratio 1.8, 95% confidence interval 1.03 to 3.03; hazard ratio 3.1, 95% confidence interval 1.46 to 6.38). In nondiabetic patients, the same association between diastolic or systolic LVD and outcome was observed (hazard ratio 2.2, 95% confidence interval 1.30 to 3.74; hazard ratio 3.9, 95% confidence interval 2.00 to 7.52). Combined systolic and diastolic LVD had the worst prognosis. In conclusion, diabetic patients with PAD have an increased prevalence of isolated systolic and combined LVD. In patients with PAD the presence of isolated diastolic, systolic, or combined LVD was independently and equally associated with increased cardiovascular mortality, irrespective of the concomitant presence of DM.
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Affiliation(s)
- Jan-Peter van Kuijk
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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Hoogwegt M, Hoeks S, Pedersen S, Scholte op Reimer W, van Gestel Y, Verhagen H, Poldermans D. Smoking Cessation has no Influence on Quality of Life in Patients with Peripheral Arterial Disease 5 Years Post-vascular Surgery. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.07.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Goei D, Poldermans D. Screening value of N-terminal pro-B-type natriuretic peptide as a predictor of perioperative cardiac events after noncardiac surgery. Future Cardiol 2010; 6:603-9. [DOI: 10.2217/fca.10.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Preoperative cardiac risk assessment is the cornerstone of rationale perioperative management that guides invasive surgical interventions. In addition to clinical risk factors, a simple screening biomarker would be useful for identifying those surgical patients who might benefit from additional cardiac testing or therapeutic interventions. Preoperative plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) are predictors of cardiac events after noncardiac surgery. NT–proBNP is synthesized in the ventricular myocardium in response to ventricular wall stress. To further increase the diagnostic accuracy of NT-proBNP for preoperative screening, it is important to identify confounding factors that influence NT-proBNP levels and their interaction with identifying risks for adverse cardiac events. Moreover, until now the available data from previous studies has been unable to consistently recognize the optimal discriminatory threshold for NT-proBNP. Currently, the ongoing DECREASE-VI study is conducted to evaluate whether current preoperative risk stratification can be improved by incorporating NT-proBNP measurements.
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Affiliation(s)
- Dustin Goei
- Department of Vascular Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Don Poldermans
- Department of Anaesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Erasmus Medical Center Rotterdam’s-Gravendijkwal, 2303015 CE, Rotterdam, The Netherlands
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van Kuijk JP, Voute MT, Flu WJ, Schouten O, Chonchol M, Hoeks SE, Boersma EE, Verhagen HJ, Bax JJ, Poldermans D. The efficacy and safety of clopidogrel in vascular surgery patients with immediate postoperative asymptomatic troponin T release for the prevention of late cardiac events: Rationale and design of the Dutch Echocardiographic Cardiac Risk Evaluation Applying Stress Echo-VII (DECREASE-VII) trial. Am Heart J 2010; 160:387-93. [PMID: 20826244 DOI: 10.1016/j.ahj.2010.06.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 06/24/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Major vascular surgery patients are at high risk for developing asymptomatic perioperative myocardial ischemia reflected by a postoperative troponin release without the presence of chest pain or electrocardiographic abnormalities. Long-term prognosis is severely compromised and characterized by an increased risk of long-term mortality and cardiovascular events. Current guidelines on perioperative care recommend single antiplatelet therapy with aspirin as prophylaxis for cardiovascular events. However, as perioperative surgical stress results in a prolonged hypercoagulable state, the postoperative addition of clopidogrel to aspirin within 7 days after perioperative asymptomatic cardiac ischemia could provide improved effective prevention for cardiovascular events. STUDY DESIGN DECREASE-VII is a phase III, randomized, double-blind, placebo-controlled, multicenter clinical trial designed to evaluate the efficacy and safety of early postoperative dual antiplatelet therapy (aspirin and clopidogrel) for the prevention of cardiovascular events after major vascular surgery. Eligible patients undergoing a major vascular surgery (abdominal aorta or lower extremity vascular surgery) who developed perioperative asymptomatic troponin release are randomized 1:1 to clopidogrel or placebo (300-mg loading dose, followed by 75 mg daily) in addition to standard medical treatment with aspirin. The primary efficacy end point is the composite of cardiovascular death, stroke, or severe ischemia of the coronary or peripheral arterial circulation leading to an intervention. The evaluation of long-term safety includes bleeding defined by TIMI criteria. Recruitment began early 2010. The trial will continue until 750 patients are included and followed for at least 12 months. SUMMARY DECREASE-VII is evaluating whether early postoperative dual antiplatelet therapy for patients developing asymptomatic cardiac ischemia after vascular surgery reduces cardiovascular events with a favorable safety profile.
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Suárez C, Zeymer U, Limbourg T, Baumgartner I, Cacoub P, Poldermans D, Röther J, Bhatt DL, Steg PG. Influence of polyvascular disease on cardiovascular event rates. Insights from the REACH Registry. Vasc Med 2010; 15:259-65. [DOI: 10.1177/1358863x10373299] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Cardiovascular event rates have been shown to increase substantially with the number of symptomatic disease locations. We sought to assess the risk profile, management and subsequent event rates of polyvascular disease patients. Consecutive outpatients were assessed for atherosclerotic risk factors and medications in the REACH Registry. A total of 19,117 symptomatic patients in Europe completed a 2-year follow-up: 77.2% with single arterial bed disease (coronary artery or cerebrovascular or peripheral arterial disease) and 22.8% with polyvascular disease (≥ 1 disease location). Polyvascular disease patients were older (68.5 ± 9.4 vs 66.3 ± 9.9 years, p < 0.0001), more often current or former smokers (64.9% vs 58.7%, p < 0.0001), and more often suffered from hypertension (59.5% vs 46.6%, p < 0.0001) and diabetes (34.5% vs 25.9%, p < 0.0001) than single arterial bed disease patients. Despite more intense medical therapy, risk factors (smoking, hypertension, low fasting glucose, and low fasting total cholesterol) were less often controlled in polyvascular disease patients. This was associated with substantially more events over 2 years compared with single arterial bed disease patients (cMACCE [cardiovascular death/non-fatal stroke/non-fatal MI] odds ratio, 1.63 [95% CI, 1.45—1.83], p < 0.0001). In conclusion, polyvascular disease patients have more cardiovascular risk factors, and the prognosis for these patients is significantly worse than for patients with single arterial bed disease. This suggests a need to improve detection and consequent medical treatment of polyvascular disease.
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Affiliation(s)
- Carmen Suárez
- Department of Internal Medicine, Hopital Universitario de la Princesa, Madrid, Spain,
| | - Uwe Zeymer
- Institut für Herzinfarktforschung Ludwigshafen, an der Universität Heidelberg, Ludwigshafen, Germany
| | - Tobias Limbourg
- Institut für Herzinfarktforschung Ludwigshafen, an der Universität Heidelberg, Ludwigshafen, Germany
| | - Iris Baumgartner
- Swiss Cardiovascular Centre, Division of Clinical and Interventional Angiology, Inselspital, University Hospital, Berne, Switzerland
| | - Patrice Cacoub
- Pierre and Marie Curie University, Paris 6, AP-HP, Hospital La Pitié-Salpêtrière, Paris, France
| | | | - Joachim Röther
- Johannes Wesling Klinikum Minden, Hannover Medical School, Hannover, Germany
| | - Deepak L Bhatt
- VA Boston Healthcare System and Brigham and Women's Hospital, Boston, MA, USA
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Flu WJ, Schouten O, van Kuijk JP, Poldermans D. Perioperative Cardiac Damage in Vascular Surgery Patients. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.05.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Helderman F, Manoch I, Breeuwer M, Kose U, Boersma H, van Sambeek M, Pattynama P, Schouten O, Poldermans D, Wisselink W, van der Steen A, Krams R. Predicting Patient-Specific Expansion of Abdominal Aortic Aneurysms. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2010.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hoeks SE, Poldermans D. European Society of Cardiology 2009 guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery. Key messages for clinical practice. Pol Arch Intern Med 2010. [DOI: 10.20452/pamw.951] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hoeks SE, Poldermans D. European Society of Cardiology 2009 guidelines for preoperative cardiac risk assessment and perioperative cardiac management in noncardiac surgery: key messages for clinical practice. Pol Arch Med Wewn 2010; 120:294-299. [PMID: 20693961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Patients undergoing noncardiac surgery are at risk of adverse perioperative and long-term outcome. When considering a patient for noncardiac surgery, a careful preoperative clinical risk evaluation and subsequent risk-reduction strategies are essential to reduce postoperative complications. To assist physicians with decision making, clinical guidelines are developed. The aim of clinical guidelines is to improve patient care by providing recommendations about appropriate healthcare in specific circumstances. Development of clinical guidelines is an important component in improving the quality of care. By translating the best available scientific evidence into specific recommendations, guidelines can serve as a useful tool to achieve effective and efficient patient care. In 2009, the first European Society of Cardiology guidelines on perioperative care were developed. This decisionmaking process integrates clinical markers, early coronary evaluation, functional capacity, and the type of surgery involved.
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Flu WJ, van Kuijk JP, Hoeks SE, Kuiper R, Schouten O, Goei D, Elhendy A, Verhagen HJM, Thomson IR, Bax JJ, Fleisher LA, Poldermans D. Prognostic implications of asymptomatic left ventricular dysfunction in patients undergoing vascular surgery. Anesthesiology 2010. [PMID: 20502115 DOI: 10.1097/aln.0b013e 3181da89ca] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND The prognostic value of heart failure symptoms on postoperative outcome is well acknowledged in perioperative guidelines. The prognostic value of asymptomatic left ventricular (LV) dysfunction remains unknown. This study evaluated the prognostic implications of asymptomatic LV dysfunction in vascular surgery patients assessed with routine echocardiography. METHODS Echocardiography was performed preoperatively in 1,005 consecutive vascular surgery patients. Systolic LV dysfunction was defined as LV ejection fraction less than 50%. Ratio of mitral-peak velocity during early and late filling, pulmonary vein flow, and deceleration time was used to diagnose diastolic LV dysfunction. Troponin-T measurements and electrocardiograms were performed routinely perioperatively. Multivariate regression analyses evaluated the relation between LV function and the study endpoints, 30-day cardiovascular events, and long-term cardiovascular mortality. RESULTS Left ventricular dysfunction was diagnosed in 506 (50%) patients of which 80% were asymptomatic. In open vascular surgery (n = 649), both asymptomatic systolic and isolated diastolic LV dysfunctions were associated with 30-day cardiovascular events (odds ratios 2.3, 95% confidence interval [CI] 1.4-3.6 and 1.8, 95% CI 1.1-2.9, respectively) and long-term cardiovascular mortality (hazard ratios 4.6, 95% CI 2.4-8.5 and 3.0, 95% CI 1.5-6.0, respectively). In endovascular surgery (n = 356), only symptomatic heart failure was associated with 30-day cardiovascular events (odds ratio 1.8, 95% CI 1.1-2.9) and long-term cardiovascular mortality (hazard ratio 10.3, 95% CI 5.4-19.3). CONCLUSIONS This study demonstrated that asymptomatic LV dysfunction is predictive for 30-day and long-term cardiovascular outcome in open vascular surgery patients. These data suggest that preoperative risk stratification should include not only solely heart failure symptoms but also routine preoperative echocardiography to risk stratify open vascular surgery patients.
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Affiliation(s)
- Willem-Jan Flu
- Department of Anesthesiology, Erasmus Medical Center, Rotterdam, The Netherlands
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van Kuijk JP, Flu WJ, Chonchol M, Bax JJ, Verhagen HJ, Poldermans D. Metabolic syndrome is an independent predictor of cardiovascular events in high-risk patients with occlusive and aneurysmatic peripheral arterial disease. Atherosclerosis 2010; 210:596-601. [DOI: 10.1016/j.atherosclerosis.2009.12.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 12/07/2009] [Accepted: 12/10/2009] [Indexed: 10/20/2022]
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