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Rinkel LA, Bouma BJ, Boekholdt SM, Beemsterboer CFP, Lobé NHJ, Beenen LFM, Marquering HA, Majoie CBLM, Roos YBWEM, van Randen A, Planken RN, Coutinho JM. Detection of patent foramen ovale in patients with ischemic stroke on prospective ECG-gated cardiac CT compared to transthoracic echocardiography. J Neurol 2023:10.1007/s00415-023-11688-0. [PMID: 37027020 DOI: 10.1007/s00415-023-11688-0] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/23/2023] [Accepted: 03/25/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Cardiac CT acquired during the acute stroke imaging protocol is an emerging alternative to transthoracic echocardiography (TTE) to screen for sources of cardioembolism. Currently, its diagnostic accuracy to detect patent foramen ovale (PFO) is unclear. METHODS This was a substudy of Mind the Heart, a prospective cohort in which consecutive adult patients with acute ischemic stroke underwent prospective ECG-gated cardiac CT during the initial stroke imaging protocol. Patients also underwent TTE. We included patients < 60 years who underwent TTE with agitated saline contrast (cTTE) and assessed sensitivity, specificity, negative and positive predictive value of cardiac CT for the detection of PFO using cTTE as the reference standard. RESULTS Of 452 patients in Mind the Heart, 92 were younger than 60 years. Of these, 59 (64%) patients underwent both cardiac CT and cTTE and were included. Median age was 54 (IQR 49-57) years and 41/59 (70%) were male. Cardiac CT detected a PFO in 5/59 (8%) patients, 3 of which were confirmed on cTTE. cTTE detected a PFO in 12/59 (20%) patients. Sensitivity and specificity of cardiac CT were 25% (95% CI 5-57%) and 96% (95% CI 85-99%), respectively. Positive and negative predictive values were 59% (95% CI 14-95) and 84% (95% CI 71-92). CONCLUSION Prospective ECG-gated cardiac CT acquired during the acute stroke imaging protocol does not appear to be a suitable screening method for PFO due to its low sensitivity. Our data suggest that if cardiac CT is used as a first-line screening method for cardioembolism, additional echocardiography remains indicated in young patients with cryptogenic stroke, in whom PFO detection would have therapeutic consequences. These results need to be confirmed in larger cohorts.
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Affiliation(s)
- L A Rinkel
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Location AMC, 1105 AZ, Amsterdam, The Netherlands
| | - B J Bouma
- Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - S M Boekholdt
- Department of Cardiology, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - C F P Beemsterboer
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Location AMC, 1105 AZ, Amsterdam, The Netherlands
| | - N H J Lobé
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - L F M Beenen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - H A Marquering
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - C B L M Majoie
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - Y B W E M Roos
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Location AMC, 1105 AZ, Amsterdam, The Netherlands
| | - A van Randen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, The Netherlands
| | - J M Coutinho
- Department of Neurology, Amsterdam University Medical Centres, University of Amsterdam, Location AMC, 1105 AZ, Amsterdam, The Netherlands.
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Peper J, Becker LM, Bruning TA, Budde RPJ, van Dockum WG, Frederix GWJ, Habets J, Henriques JPS, Houthuizen P, Mohamed Hoesein FAA, Planken RN, Voskuil M, Bots ML, Leiner T, Swaans MJ. Rationale and design of the iCORONARY trial: improving the cost-effectiveness of coronary artery disease diagnosis. Neth Heart J 2023; 31:150-156. [PMID: 36720801 PMCID: PMC10033793 DOI: 10.1007/s12471-023-01758-3] [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] [Accepted: 12/06/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND In patients with stable coronary artery disease (CAD), revascularisation decisions are based mainly on the visual grading of the severity of coronary stenosis on invasive coronary angiography (ICA). However, invasive fractional flow reserve (FFR) is the current standard to determine the haemodynamic significance of coronary stenosis. Non-invasive and less-invasive imaging techniques such as computed-tomography-derived FFR (FFR-CT) and angiography-derived FFR (QFR) combine both anatomical and functional information in complex algorithms to calculate FFR. TRIAL DESIGN The iCORONARY trial is a prospective, multicentre, non-inferiority randomised controlled trial (RCT) with a blinded endpoint evaluation. It investigates the costs, effects and outcomes of different diagnostic strategies to evaluate the presence of CAD and the need for revascularisation in patients with stable angina pectoris who undergo coronary computed tomography angiography. Those with a Coronary Artery Disease-Reporting and Data System (CAD-RADS) score between 0-2 and 5 will be included in a prospective registry, whereas patients with CAD-RADS 3 or 4A will be enrolled in the RCT. The RCT consists of three randomised groups: (1) FFR-CT-guided strategy, (2) QFR-guided strategy or (3) standard of care including ICA and invasive pressure measurements for all intermediate stenoses. The primary endpoint will be the occurrence of major adverse cardiac events (death, myocardial infarction and repeat revascularisation) at 1 year. CLINICALTRIALS gov-identifier: NCT04939207. CONCLUSION The iCORONARY trial will assess whether a strategy of FFR-CT or QFR is non-inferior to invasive angiography to guide the need for revascularisation in patients with stable CAD. Non-inferiority to the standard of care implies that these techniques are attractive, less-invasive alternatives to current diagnostic pathways.
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Affiliation(s)
- J Peper
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - L M Becker
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - T A Bruning
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - R P J Budde
- Department of Radiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - W G van Dockum
- Department of Cardiology, Maasstad Hospital, Rotterdam, The Netherlands
| | - G W J Frederix
- Department of Public Health, Healthcare Innovation and Evaluation and Medical Humanities, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J Habets
- Department of Radiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J P S Henriques
- Department of Cardiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - P Houthuizen
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - F A A Mohamed Hoesein
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R N Planken
- Department of Radiology, Amsterdam University Medical Centre, Amsterdam, The Netherlands
| | - M Voskuil
- Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M L Bots
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - T Leiner
- Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands
- Department of Radiology, Mayo Clinic Hospital, Rochester, United States of America
| | - M J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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3
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Moerdijk AS, Claessens NH, van Ooijen IM, van Ooij P, Alderliesten T, Grotenhuis HB, Benders MJNL, Bohte AE, Breur JMPJ, Charisopoulou D, Clur SA, Cornette JMJ, Fejzic Z, Franssen MTM, Frerich S, Geerdink LM, Go ATJI, Gommers S, Helbing WA, Hirsch A, Holtackers RJ, Klein WM, Krings GJ, Lamb HJ, Nijman M, Pajkrt E, Planken RN, Schrauben EM, Steenhuis TJ, ter Heide H, Vanagt WYR, van Beynum IM, van Gaalen MD, van Iperen GG, van Schuppen J, Willems TP, Witters I. Fetal MRI of the heart and brain in congenital heart disease. Lancet Child Adolesc Health 2023; 7:59-68. [PMID: 36343660 DOI: 10.1016/s2352-4642(22)00249-8] [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] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/06/2022]
Abstract
Antenatal assessment of congenital heart disease and associated anomalies by ultrasound has improved perinatal care. Fetal cardiovascular MRI and fetal brain MRI are rapidly evolving for fetal diagnostic testing of congenital heart disease. We give an overview on the use of fetal cardiovascular MRI and fetal brain MRI in congenital heart disease, focusing on the current applications and diagnostic yield of structural and functional imaging during pregnancy. Fetal cardiovascular MRI in congenital heart disease is a promising supplementary imaging method to echocardiography for the diagnosis of antenatal congenital heart disease in weeks 30-40 of pregnancy. Concomitant fetal brain MRI is superior to brain ultrasound to show the complex relationship between fetal haemodynamics in congenital heart disease and brain development.
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Affiliation(s)
- Anouk S Moerdijk
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Nathalie Hp Claessens
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Inge M van Ooijen
- Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Pim van Ooij
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Thomas Alderliesten
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands; Department of Neonatology, Division of Woman and Baby, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands
| | - Heynric B Grotenhuis
- Department of Pediatric Cardiology, Division of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, Netherlands.
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4
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Verwijs SM, Van Hattum JC, Daems JJN, Planken RN, Van Randen A, Boekholdt SM, Groenink M, Nederveen AJ, Prakken NHJ, Moen MH, Velthuis BK, Wilde AAM, Pinto YM, Jorstad HT. Redefining the upper limits of ventricular volumes in elite athletes. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Specific athlete reference values for cardiac volumes and function using cardiac magnetic resonance (CMR) parameters have been reported and are used in clinical practice. Elite athletes are conventionally thought to demonstrate the highest levels of physiological adaptation to sports and therefore dictate the upper limit of normal for biventricular size and function in the athlete population.
Purpose
To compare volumetric parameters in a cohort of both male and female elite-level athletes to previously published reference values.
Methods
We used data from the prospective ELITE-cohort, which collects pre-participation data of elite athletes (national-, international-, Olympic-, Paralympic-level), including CMR imaging. Athletes suspected of pathology based on comprehensively investigated electrocardiograph, exercise test, echocardiogram and late gadolinium enhancement were excluded. Biventricular volumes were derived from short-axis cine images using Cvi42 (v5.1.2.) and indexed for body surface area (BSA). Volumetric parameters were compared to the previously reported gender- and Mitchell sports classification specific cardiac 95th percentile (95%tile) reference values, as reported by Luijkx et al.: left-ventricle (LV) end-diastolic volume (EDV) / BSA for high-static and high-dynamic sports (HS/HD; ♀ 142 ♂ 158); low-static and high-dynamic (LS/HD; ♀ 127 ♂ 149); high-static and low-dynamic (HS/LD; ♀ 114 ♂ 140); right ventricle (RV) EDV / BSA HS/HD (♀ 154 ♂ 184), LS/HD (♀ 136 ♂ 163), and HS/LD (♀ 120 ♂ 157).
Results
We analysed a total of 221 athletes (38% female), with a median age (IQR) of 26.0 (22.5–29.8) years, and mean ±SD BSA of 1.96±0.22 m2. Athletes were classified according to the Mitchell sports classification: HS/HD 116 (54%); LS/HD 61 (29%); moderate-static and high-dynamic (MS/HD) 20 (9.4%); HS/LD 16 (7.5%) (Table). We found smaller mean ±SD (95%tile) RV EDV/BSA in athletes participating in HS/HD sports (♀: 117±20 (148) and ♂: 133±20 (160)) and LS/HD sports (♀: 109±11 (129) and ♂: 119±15 (142)) and smaller LV EDV/BSA in male athletes in LS/HD sports (116±15 (138)) compared to reference values, (Figure). When using conventional cut-offs in our population we found 10 (4.5%) and 2 (0.9%) athletes above 95%tile for LVEDV/BSA and RVEDV/BSA, respectively (Figure).
Conclusion
In a cohort consisting of healthy, elite athletes, volumetric adaptations were less outspoken as compared with current reference ranges, specifically in the RV. Only 1 percent of our athletes exceeded conventional 95%tile references for the RV. Potentially, current athlete reference values could overestimate healthy upper limits of cardiac volumes in elite athletes. Our study could indicate that a stricter definition of volumetric reference values, including 95%tile, might be of added value in the specific group of elite athletes to help differentiate between pathology and sports adaptation.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Amsterdam Movement Sciences (P1A210AMC2018)
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Affiliation(s)
- S M Verwijs
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - J C Van Hattum
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - J J N Daems
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - R N Planken
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine , Amsterdam , The Netherlands
| | - A Van Randen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine , Amsterdam , The Netherlands
| | - S M Boekholdt
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - M Groenink
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - A J Nederveen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine , Amsterdam , The Netherlands
| | - N H J Prakken
- University Medical Center Groningen, Department of Radiology , Groningen , The Netherlands
| | - M H Moen
- Nederlands Olympisch Committee*Nederlandse Sport Federatie, High Performance Team , Arnhem , The Netherlands
| | - B K Velthuis
- University Medical Center Utrecht, Department of Radiology , Utrecht , The Netherlands
| | - A A M Wilde
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - Y M Pinto
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - H T Jorstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
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5
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Hoeksema W, Van Der Ree MH, De Bruin-Bon HACM, Dieleman EMT, Visser J, Planken RN, Boekholdt SM, De Jong MAJ, Kemme MJB, Balt JC, Balgobind BV, Postema PG. Cardiac radioablation does not worsen cardiac function: preliminary safety results of the prospective STARNL-1 trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Cardiac radioablation for ventricular tachycardia (VT) appears to be highly effective and safe in patients with recurrent VT despite anti-arrhythmic therapy and catheter ablation(s), although global experience is currently very limited. Detailed echocardiographic strain analysis could provide important insights in (subclinical) functional safety. Importantly, current stereotactic cardiac radioablation techniques includes irradiation of the VT substrate but, inherently, also includes irradiation of the VT border zone and some healthy cardiac tissue. The latter particularly may result in detoriation of cardiac function after cardiac radioablation.
Purpose
To evaluate functional echocardiographic safety of cardiac radioablation.
Methods
The STARNL-1 trial is a prospective, monocenter, single-arm, pre-post intervention study. Six patients with recurrent VT despite high dose anti-arrhythmic drugs, after (single or multiple) conventional catheter ablation and deemed unsuited for repeat catheter ablation, were treated with a single fraction 25 Gy radiotherapy dose. Per protocol, patients underwent echocardiograms at baseline, 24 hours after treatment, and 3 months after treatment. Echocardiograms were analysed using 2D-speckle tracking. Mean radiotherapy dose per segment was calculated according to the AHA 17-segment model. Echocardiographic parameters were compared between baseline, 24 hours and 3 months, and correlated to radiotherapy dose.
Results
Patients were all male (age 55–83 years), all suffered from ischaemic cardiomyopathy, and all completed 3 month follow-up. At baseline, median left ventricle ejection fraction (LVEF) was 38% [30; 47] and median global longitudinal strain (GLS) −8% [−12; −5]. Interestingly, LVEF significantly improved 24 hours after treatment (42% [36; 49], p=0.046) but GLS did not change (−7% [−12; −5], p=0.833). At 3 months, both LVEF and GLS were unchanged compared to baseline (LVEF 39% [33; 49%], p=0.463; GLS −6% [−12; −5], p=0.893). The difference in longitudinal strain per segment before and after treatment did not correlate with the mean radiotherapy dose per segment, both 24 hours after treatment (Pearson coefficient −0.082, p=0.410) and 3 months after treatment (Pearson coefficient −0.005, p=0.957). In Figure 1 an illustrative case is presented.
Conclusion(s)
Cardiac radioablation for VT does not worsen (subclinical) cardiac function within the first 3 months after treatment.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Dutch Heart Foundation
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Affiliation(s)
- W Hoeksema
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology , Amsterdam , The Netherlands
| | - M H Van Der Ree
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology , Amsterdam , The Netherlands
| | - H A C M De Bruin-Bon
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology , Amsterdam , The Netherlands
| | - E M T Dieleman
- Amsterdam UMC, University of Amsterdam, Department of Radiation Oncology , Amsterdam , The Netherlands
| | - J Visser
- Amsterdam UMC, University of Amsterdam, Department of Radiation Oncology , Amsterdam , The Netherlands
| | - R N Planken
- Amsterdam UMC, University of Amsterdam, Department of Radiology , Amsterdam , The Netherlands
| | - S M Boekholdt
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology , Amsterdam , The Netherlands
| | - M A J De Jong
- Amsterdam UMC, University of Amsterdam, Department of Radiation Oncology , Amsterdam , The Netherlands
| | - M J B Kemme
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Cardiology , Amsterdam , The Netherlands
| | - J C Balt
- St Antonius Hospital, Department of Cardiology , Nieuwegein , The Netherlands
| | - B V Balgobind
- Amsterdam UMC, University of Amsterdam, Department of Radiation Oncology , Amsterdam , The Netherlands
| | - P G Postema
- Amsterdam UMC, University of Amsterdam, Department of Clinical and Experimental Cardiology , Amsterdam , The Netherlands
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6
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Jukema R, Maaniitty T, Van Diemen P, Berkhof H, Raijmakers P, Sprengers R, Planken R, Knaapen P, Saraste A, Danad I, Knuuti J. Warranty period of normal CCTA and [15O]H2O PET in chest pain patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Normal coronary computed tomography angiography (CTA) and positron emission tomography (PET) are associated with an excellent prognosis. Hitherto, data on the warranty period of normal coronary CTA and normal myocardial blood flow (MBF) by PET are scarce.
Purpose
To determine the event-free period after normal coronary CTA and PET results. In addition, to determine whether PET MBF imaging confers additional prognostic value beyond coronary anatomy in symptomatic patients.
Methods
Patients with suspected but not previously diagnosed coronary artery disease (CAD) who underwent coronary CTA or [15O]H2O PET were categorized based upon coronary CTA as no CAD, non-obstructive CAD or obstructive CAD. A hyperemic MBF <2.3 ml/min/g was considered abnormal and indicative for ischemia. A cumulative risk below 5% against death and myocardial infarction (MI) was used to define the warranty period.
Results
Of 2575 included patients (mean age 61.4±9.9 years, 41% male) 1319 (51.2%) underwent coronary CTA only, 1237 (48.0%) underwent both coronary CTA and PET and 19 (0.74%) patients underwent PET imaging only. During a median follow-up of 7.0 years 163 deaths and 68 MIs occurred. The warranty period for patients without any CAD was >10 years. Patients with non-obstructive CAD had a 5 year warranty period. In patients with no, non-obstructive or obstructive CAD on CTA, normal PET extended the warranty period with ≥2 years. The warranty period of patients with non-obstructive CAD or normal perfusion varied between 2.5 and >10 years for patients with or without clinical risk factors.
Conclusions
As standalone imaging, the warranty period for a normal coronary CTA is >10 years, whereas patients with non-obstructive CAD have a warranty period of 5 years. Independent of coronary anatomy normal perfusion imaging has additional prognostic value and extends the warranty period by ≥2 years.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Jukema
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | | | - P Van Diemen
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | - H Berkhof
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | - P Raijmakers
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | - R Sprengers
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | - R Planken
- Amsterdam UMC - Location Academic Medical Center , Amsterdam , The Netherlands
| | - P Knaapen
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | | | - I Danad
- Amsterdam UMC - Location VUmc , Amsterdam , The Netherlands
| | - J Knuuti
- Turku PET Centre , Turku , Finland
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7
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Van Hattum J, Verwijs SM, Daems JJN, Boekholdt SM, Groenink M, Planken RN, Van Luijk-Snoeks RD, Van Der Randen A, Moen MH, Wijne CACM, Nederveen AJ, Pinto YM, Wilde AAM, Jorstad HT. No deterioration in function or volumetric parameters in elite athletes after SARS-CoV-2 infections compared to non-infected athletes: results from the ELITE cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
SARS-CoV-2 (subclinical) myocarditis has been demonstrated in up to 5% in athletes, and is currently a topic being intensively investigated. However, more subtle changes in function and volumetric parameters have been less well documented, especially in elite athletes, who perform at the highest levels of sports, with potentially the most outspoken adaptation.
Purpose
To determine differences in cardiac function and volumetric parameters using cardiac magnetic resonance imaging (CMR) in elite athletes recovered from a SARS-CoV-2 infection as compared to non-infected elite athletes (controls).
Methods
We included elite athletes from the ELITE (Evaluation of Lifetime Intensive Top-level sports and Exercise) cohort, who voluntary undergo cardiovascular pre-participation screenings, which includes cardiac magnetic resonance imaging (CMR). SARS-CoV-2 infection was diagnosed with a positive-PCR or antibody test (if unvaccinated). The primary outcome was the incidence of structural cardiac changes on CMR, defined as LV/RV BSA indexed-EDV (EDVi), LV/RV BSA indexed-ESV (ESVi), LV/RV EF, presence of pathological late gadolinium enhancement (LGE) (excluding hinge point fibrosis), and T1 times.
Results
We included 234 elite athletes, mean age 27 (±7), 39% female, with main athletic disciplines (≥10 hours/week) of cycling (24%), field hockey (13%), and water polo (12%). In total 69 elite athletes had documented SARS-CoV-2 infection, and 165 were documented as not exposed to SARS-CoV-2. The majority reported mild symptoms 61/69 (88%), 1/69 (1%) severe symptoms, and 7/69 (11%) no symptoms. Mean time between infection and CMR was 2.8 (±2) months. CMR showed no significant difference between elite athletes with SARS-CoV-2 and without (Table) in mean LVEDVi (117±19 vs 120±19 ml/m2, p=0.29), LVESVi (50.6±11 vs 53.2±11 ml/m2, p=0.12), LVEF (56.9% ±5 vs 55.8% ±5, p=0.14), RVEDVi (120±20 vs 122±19 ml/m2, p=0.56), RVESVi (54.5±11 vs 56.2±11 ml/m2, p=0.29), and RVEF (54.6% ±4 vs 53.9% ±5, p=0.23). In 4/69 (4.7%) vs 1/165 (1.3%) pathological non-ischemic pattern of myocardial LGE was present (≤20% of total LV mass), of which one athlete (1.2%) showed increased T1 time, all with no deterioration in right and left ventricle function and volumetric parameters (Figure) after SARS-CoV-2 infection. All athletes made a full recovery and returned to elite competitive sports.
Conclusion(s)
This cross-sectional study of elite athletes demonstrates that infection with SARS-CoV-2 is not associated with deterioration in cardiac function and volumetric parameters on CMR compared with non-infected athletes, also in the small subset of athletes with pathological LGE patterns after SARS-CoV-2 infection. Prospective studies with long-term follow-up are needed to establish whether intensive sports is associated with long-term cardiac deleterious effects in elite athletes exposed to SARS-CoV-2.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Dutch Heart FoundationDutch National Olympic Committee & National Sports Federation (NOC*NSF)
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Affiliation(s)
- J Van Hattum
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
| | - S M Verwijs
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
| | - J J N Daems
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
| | - S M Boekholdt
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
| | - M Groenink
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
| | - R N Planken
- Amsterdam UMC, University of Amsterdam, Radiology , Amsterdam , The Netherlands
| | | | - A Van Der Randen
- Amsterdam UMC, University of Amsterdam, Radiology , Amsterdam , The Netherlands
| | - M H Moen
- Dutch National Olympic Committee & National Sports Federation, High Performance Team , Arnhem , The Netherlands
| | - C A C M Wijne
- Hospital Onze Lieve Vrouwe Gasthuis, Sports Medicine , Amsterdam , The Netherlands
| | - A J Nederveen
- Amsterdam UMC, University of Amsterdam, Radiology , Amsterdam , The Netherlands
| | - Y M Pinto
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
| | - A A M Wilde
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
| | - H T Jorstad
- Amsterdam UMC, University of Amsterdam, Cardiology , Amsterdam , The Netherlands
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8
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Daems JJN, Verwijs SM, Van Luijk-Snoeks RD, Van Hattum JC, Ercan A, Moen MH, Nederveen AJ, Planken RN, Van Randen A, Pinto YM, Groenink M, Jorstad HT. Athlete status and gender strongly influence CMR T1 mapping times: an athlete-control study. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
In the general population, cardiac magnetic resonance imaging (CMR) T1 mapping is an established tool used for cardiac tissue characterisation. Such characterisation is of particular interest in athletes, as differentiation of the “grey zone” between physiological adaptation to sports and myocardial pathology can be highly challenging. To correctly interpret individual T1 times, T1 times are conventionally compared with normal values derived from healthy controls. However, whether these normative T1 values can be applied to elite athletes, who commonly demonstrate the most extreme cardiac adaptation, is unknown.
Purpose
To determine whether there are gender-specific differences in normative T1 times between elite athletes and healthy controls.
Methods
This study is a cross-sectional assessment of healthy athletes included the ELITE-cohort. ELITE includes athletes at national, international, and Olympic level in the Netherlands, aged sixteen years or older and without a history of cardiovascular disease. All athletes undergo standard periodic preparticipation screening with cardiovascular magnetic resonance imaging (Phillips 1.5 Tesla), including native T1 mapping. For the current study, we compared athletes to healthy controls per gender group. T1 inversion times were calculated in Circle Cardiovascular software (v5.12); means for global and segmented myocardium, according to the AHA 16-segment model, were determined using R (v4.1.4).
Results
A total of 81 elite athletes (35 women, 43.2%) with a median (IQR) age of 26 (22.0–29.55) years and 55 healthy controls (27 women, 49.1%), with a mean age of 38.4±15 years were included (Table 1). Overall, mean global T1 times were markedly shorter in athletes compared with controls (959±21.1ms vs. 984±26.6ms, P<0.001). This difference was also present in both women (athletes 968±18.5ms vs controls 999±26.5ms, P<0.001) and men (athletes 952±20.3ms vs controls 970±18.0ms, P<0.001). We observed gender differences in T1 times within both the athlete (men 952±20.3ms vs women 968±18.5ms, P<0.001) and the control group (men 984±26.6ms vs women 999±26.5ms, P<0.001). Gender specific differences in T1 times were consistent between athletes and controls in the basal-, mid- and apical slices, as well as across all 16 segments (Figure panels A and B).
Conclusion(s)
Athletes demonstrate markedly shorter T1 times as compared with healthy controls, both in women and men. Sex-specific, athlete-normative T1 times should be taken into account when interpreting T1 times in athletes undergoing cardiac evaluation.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Amsterdam Movement Sciences and the Dutch Olympic Committee*Dutch Sports Federation
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Affiliation(s)
- J J N Daems
- Amsterdam UMC, Cardiology , Amsterdam , The Netherlands
| | - S M Verwijs
- Amsterdam UMC, Cardiology , Amsterdam , The Netherlands
| | | | | | - A Ercan
- Amsterdam UMC, Cardiology , Amsterdam , The Netherlands
| | - M H Moen
- Dutch Olympic Committee*Dutch Sports Federation – NOC*NSF , Arnhem , The Netherlands
| | - A J Nederveen
- Amsterdam UMC, Radiology , Amsterdam , The Netherlands
| | - R N Planken
- Amsterdam UMC, Radiology , Amsterdam , The Netherlands
| | - A Van Randen
- Amsterdam UMC, Radiology , Amsterdam , The Netherlands
| | - Y M Pinto
- Amsterdam UMC, Cardiology , Amsterdam , The Netherlands
| | - M Groenink
- Amsterdam UMC, Cardiology , Amsterdam , The Netherlands
| | - H T Jorstad
- Amsterdam UMC, Cardiology , Amsterdam , The Netherlands
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9
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Talebian Yazdi M, Robbers-Visser D, van der Bilt IAC, Boekholdt SM, Koolbergen DR, Planken RN, Groenink M. Anomalous coronary artery from the pulmonary artery diagnosed in adulthood: a case series on variations of coronary anatomy and the diagnostic value of cardiac magnetic resonance imaging. Eur Heart J Case Rep 2022; 6:ytac345. [PMID: 36045648 PMCID: PMC9425847 DOI: 10.1093/ehjcr/ytac345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/08/2022] [Accepted: 08/10/2022] [Indexed: 11/14/2022]
Abstract
Background Anomalous coronary artery from the pulmonary artery is a rare congenital disorder with high mortality rates in infancy. Adult cases can present with life-threatening arrhythmias and sudden cardiac death. Case summary We report three cases of adults with anomalous pulmonary origin of each of the main coronary branches. The first patient with an anomalous left coronary artery from the pulmonary artery presented with an out-of-hospital cardiac arrest. The second patient with an anomalous circumflex artery from the pulmonary artery was evaluated for a bicuspid aortic valve and a suspected coronary fistula but was otherwise asymptomatic. The third patient with an anomalous right coronary artery from the pulmonary artery presented with anginal symptoms. In all cases, the diagnosis was made by cardiac computed tomography or coronary angiography. Cardiac magnetic resonance imaging was performed in all patients to guide clinical decision making on surgical or non-invasive management. All patients underwent surgical repair. In two patients, a dual coronary artery system was restored by aortic reimplantation of the anomalous coronary artery. In one patient, aortic reimplantation was unsuccessful due to poor vessel quality and the anomalous coronary artery was ligated. Clinical follow-up during 1.8–9.7 years did not show any cardiovascular complications and all patients are currently alive and asymptomatic. Discussion Anomalous coronary artery from the pulmonary artery can have various clinical presentations in adulthood. Cardiac magnetic resonance imaging is a useful modality to guide selection of patients who might have symptomatic or prognostic benefit from surgical repair.
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Affiliation(s)
- Mehrdad Talebian Yazdi
- Department of Cardiology, Alrijne Hospital , Simon Smitweg 1, 2353 GA Leiderdorp , The Netherlands
| | - D Robbers-Visser
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
| | - I A C van der Bilt
- Department of Cardiology, Haga Teaching Hospital , 2545 AA the Hague , The Netherlands
| | - S M Boekholdt
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
| | - D R Koolbergen
- Department of Cardiothoracic Surgery, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Academic Medical Center, Amsterdam Cardiovascular Sciences, University of Amsterdam , 1105 AZ Amsterdam , The Netherlands
| | - M Groenink
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam , Meibergdreef 9, 1105 BK Amsterdam , The Netherlands
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10
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Lopes RR, van den Boogert TPW, Lobe NHJ, Verwest TA, Henriques JPS, Marquering HA, Planken RN. Machine learning-based prediction of insufficient contrast enhancement in coronary computed tomography angiography. Eur Radiol 2022; 32:7136-7145. [PMID: 35708840 PMCID: PMC9474338 DOI: 10.1007/s00330-022-08901-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/29/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Patient-tailored contrast delivery protocols strongly reduce the total iodine load and in general improve image quality in CT coronary angiography (CTCA). We aim to use machine learning to predict cases with insufficient contrast enhancement and to identify parameters with the highest predictive value. METHODS Machine learning models were developed using data from 1,447 CTs. We included patient features, imaging settings, and test bolus features. The models were trained to predict CTCA images with a mean attenuation value in the ascending aorta below 400 HU. The accuracy was assessed by the area under the receiver operating characteristic (AUROC) and precision-recall curves (AUPRC). Shapley Additive exPlanations was used to assess the impact of features on the prediction of insufficient contrast enhancement. RESULTS A total of 399 out of 1,447 scans revealed attenuation values in the ascending aorta below 400 HU. The best model trained using only patient features and CT settings achieved an AUROC of 0.78 (95% CI: 0.73-0.83) and AUPRC of 0.65 (95% CI: 0.58-0.71). With the inclusion of the test bolus features, it achieved an AUROC of 0.84 (95% CI: 0.81-0.87), an AUPRC of 0.71 (95% CI: 0.66-0.76), and a sensitivity of 0.66 and specificity of 0.88. The test bolus' peak height was the feature that impacted low attenuation prediction most. CONCLUSION Prediction of insufficient contrast enhancement in CT coronary angiography scans can be achieved using machine learning models. Our experiments suggest that test bolus features are strongly predictive of low attenuation values and can be used to further improve patient-specific contrast delivery protocols. KEY POINTS • Prediction of insufficient contrast enhancement in CT coronary angiography scans can be achieved using machine learning models. • The peak height of the test bolus curve is the most impacting feature for the best performing model.
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Affiliation(s)
- R R Lopes
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ, Amsterdam, The Netherlands
| | - T P W van den Boogert
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - N H J Lobe
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ, Amsterdam, The Netherlands
| | | | - J P S Henriques
- Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands
| | - H A Marquering
- Department of Biomedical Engineering and Physics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, 1105, AZ, Amsterdam, The Netherlands.
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11
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Van Der Ree MH, Visser J, Planken RN, Dieleman EMT, Boekholdt SM, Balgobind BV, Postema PG. Standardizing the cardiac radioablation targeting workflow: enabling semi-automated angulation and segmentation of the heart according to the American Heart Association segmented model. Europace 2022. [DOI: 10.1093/europace/euac053.357] [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: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Dutch Heart Foundation
Purpose
Cardiac radioablation has evolved as a potential treatment modality for therapy-refractory ventricular tachycardia. To standardize cardiac radioablation treatments, promote accurate communication and target identification, and to assess toxicity, robust and reproducible methods for angulation and cardiac segmentation are paramount. In this study, we developed and evaluated a workflow for semi-automated angulation and segmentation according to the American Heart Association (AHA) 17-segment model.
Methods and materials
The workflow for semi-automated angulation and segmentation of the planning-CT was based on an in-house developed tool requiring placement of only 4 point-markers and a rotation matrix. For angulation, 2 markers defining the cardiac long-axis were placed: at the cardiac apex and at the center of the mitral valve (figure A). A rotation matrix was derived that angulates the CT-volume, resulting in the cardiac short axis (figure B). Segmentation was subsequently performed based on marking the two left ventricular hinge points (figure BC). To evaluate reproducibility, 5 observers independently placed markers in planning-CTs of 6 patients.
Results
The Root-Mean-Square of the standard deviation for the angulation and segmentation marker positions were all below 0.52cm. The 17-segments were subsequently generated and compared between the observers resulting in a median dice coefficient of 0.8 [0.70;0.87] and a median of the mean Hausdorff distance of 0.09cm [0.05;0.17]. Figure D shows the heat maps of two illustrative segments indicating the percentage agreement per voxel between the 5 observers. The interquartile ranges of Euler angles α and β, determined by the angulation markers, was less than 30 for all patients except one. For the γ angle, determined by the hinge point markers, the interquartile range was up to 120.
Conclusion
In this study, a workflow for cardiac radioablation is presented that enables reproducible semi-automatic cardiac angulation and segmentation of the planning-CT according to the AHA 17-segment model. This workflow can be easily implemented and be used to promote communication between radiation oncology and cardiology, enables cardiology-oriented targeting and permits focused toxicity evaluations.
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Affiliation(s)
- MH Van Der Ree
- Amsterdam UMC - Location Academic Medical Center, Heart Center; department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands (The)
| | - J Visser
- Amsterdam UMC - Location Academic Medical Center, Radiation Oncology, Amsterdam, Netherlands (The)
| | - RN Planken
- Amsterdam UMC - Location Academic Medical Center, Radiology, Amsterdam, Netherlands (The)
| | - EMT Dieleman
- Amsterdam UMC - Location Academic Medical Center, Radiation Oncology, Amsterdam, Netherlands (The)
| | - SM Boekholdt
- Amsterdam UMC - Location Academic Medical Center, Heart Center; department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands (The)
| | - BV Balgobind
- Amsterdam UMC - Location Academic Medical Center, Radiation Oncology, Amsterdam, Netherlands (The)
| | - PG Postema
- Amsterdam UMC - Location Academic Medical Center, Heart Center; department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands (The)
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12
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Verwijs SM, Van Hattum JC, Spies JL, Boekholdt SM, Planken RN, Groenink M, Van Randen A, Van Luijk RD, Van Den Berg-Faaij AM, Bakermans AJ, Nederveen AJ, Moen MH, Pinto YM, Wilde AAM, Jorstad HT. Late gadolinium enhancement of the hinge point is a common finding in asymptomatic ELITE athletes. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Late gadolinium enhancement (LGE) demonstrates regional differences in myocardial extracellular volume, such as seen in myocardial fibrosis, and is associated with diverse cardiac diseases and is a predictive factor for sudden cardiac death. Earlier findings suggest an LGE prevalence of 7% in endurance athletes of varying age and exercise exposure. However, findings for (potentially benign) LGE indices in athletes performing at elite-level are lacking.
Purpose
To establish a specific baseline for LGE findings on CMR in apparently healthy, elite-level athletes.
Methods
We performed a cross-sectional assessment of hinge point late gadolinium enhancement (HP-LGE) in elite athletes (national-, international-, Olympic-, Paralympic-level or comparable).
All athletes were asymptomatic and examined during pre-participation cardiovascular screening. Each underwent CMR using 3 Tesla- (Philips) or 1½ Tesla- (Siemens) MRI-scanners including short-axis cine imaging, LGE, and T1-mapping. CMR data were analysed using cvi42, statistical analyses using R. Athletes with HP-LGE were compared to athletes without HP-LGE.
Results
We screened 210 athletes, 34% female, with a mean age (±SD) of 28±7 and body surface area (BSA) of 2.0±0.2 m2 participating in road cycling (n=38), field hockey (n=28), water polo (n=27), soccer (n=21), rowing (n=18), swimming (n=13), track cycling (n=12), tennis (n=10), sailing (n=10), para-cycling (n=7), and miscellaneous (n=26) sports. We observed indexed end-diastolic volumes (EDVi) of 119±20 and 123±20 ml/m2, stroke volumes 131±33 and 127±37 ml, and ejection fractions of 56±5 and 54±6 %, in the left- (LV) and right ventricle (RV), respectively.
Eighty-four (40%) athletes had HP-LGE. Proportionally, fewer female athletes had HP-LGE as compared with men (24 vs 41 %, p=0.014). Athletes with HP-LGE had greater LV- and RV EDVi (123±20 and 127±20 ml/m2 vs. 117±19 and 120±19 ml/m2, p=0.02 and p=0.01; for LV and RV, respectively), lower RV ejection fractions (53±5 vs. 55±6, p-value 0.04), smaller estimated global extra cellular volumes of the LV (24 vs 25 %, p=0.01).
There were no differences in indexed LV- and RV end-systolic volumes, LV- and RV stroke volumes, LV ejection fraction and indexed wall mass, global native-, or contrast-enhanced T1 times in athletes with and without HP-LGE.
Conclusion
Late gadolinium enhancement in the hinge point is present in 40% of asymptomatic elite athletes. Athletes with HP-LGE were more frequently men, had higher LV- and RV EDVi, suggesting an association with ventricular volumes. Our findings in asymptomatic, elite athletes, with normal ventricular function and T1 times, suggest that HP-LGE could be a sign of physiological sports adaptation instead of an early sign of pathology. Further studies are warranted to investigate if HP-LGE is associated with long-term cardiac changes or the development of cardiac pathology.
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Affiliation(s)
- SM Verwijs
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - JC Van Hattum
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - JL Spies
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - SM Boekholdt
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - RN Planken
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - M Groenink
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - A Van Randen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - RD Van Luijk
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - AM Van Den Berg-Faaij
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - AJ Bakermans
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - AJ Nederveen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - MH Moen
- Nederlands Olympisch Committee*Nederlandse Sport Federatie, High Performance Team, Arnhem, Netherlands (The)
| | - YM Pinto
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - AAM Wilde
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - HT Jorstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
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13
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Verwijs SM, Van Hattum JC, Stomilovic N, Daems JJN, Boekholdt SM, Planken RN, Groenink M, Van Randen A, Bakermans AJ, Nederveen AJ, Moen MH, Pinto YM, Wilde AAM, Jorstad HT. Aortic dilatation using cardiac magnetic resonance in asymptomatic ELITE athletes. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Purpose
Aortic dilatation is associated with acute aortic pathology. Cardiac magnetic resonance (CMR) data in asymptomatic elite athletes is lacking. Therefore, we investigated the prevalence of aortic dilatation in a cohort of elite-level athletes using CMR.
Methods
We performed a cross-sectional study of aortic dimensions among elite-level (national-, international-, Olympic-, Paralympic-level or comparable) athletes.
All athletes were asymptomatic and examined during pre-participation screening. Each underwent CMR with 3D whole heart in diastole (1.5 mm voxel) for aortic measurements, next to cine imaging, late gadolinium enhancement (LGE), and T1-mapping. We defined dilatation as 38 and 40 mm at the aortic root (sinus of Valsalva cusp-cusp), 27 and 31 mm at the sinotubular junction, and 23 and 26 mm at the level of the diaphragm, in male- and female athletes, respectively. Athletes were grouped for having 0- (normal), 1-, 2- or 3 measurements above cut-off values.
Results
We screened 156 athletes, 41% female, with a mean age (±SD) of 28±7 and body surface area (BSA) of 2.0±0.2 m2. Mean aortic dimensions were 33±4 mm for the sinus of Valsalva, 28±3 mm for the sinotubular junction, 20±3 mm for the aorta at diaphragm. We observed indexed end-diastolic volumes (EDVi) of 122±20 and 123±20 ml/m2, indexed end-systolic volumes (ESVi) of 53±13 and 54±16 ml/m2, stroke volumes (SV) of 129±36 and 126±39 ml, and ejection fractions (EF) of 56±5 and 55±6 %, in the left- (LV) and right ventricle (RV), respectively
Fifty-three (34%) athletes, of which 45% female, had 1 or 2 aortic measurements above conventional cut-off values (Table 1). Eleven (7%), 18% female, had 2 aortic measurements above cut-off values. No athlete had all 3 measurements above cut-offs values. Athletes with 2 dilated measurements compared to athletes with 1 or 0 dilated measurements, had greater LV EDVi (145±19 vs. 119±18 vs. 120±19 ml/m2, p<0.001), greater RV EDVi (142±18 vs. 119±17 vs. and 122±20 ml/m2, p=0.002), greater LV ESVi (66±10 vs. 51±13 vs. 52±13 ml/m2, p=0.002), greater RV ESVi (66±10 vs. 53±13 vs. 53±17 ml/m2, p=0.039), greater LV SV (156±26 vs. 132±35 vs. 125±36 ml, p=0.020), and greater RV SV (152±25 vs. 130±34 vs. 121±41 ml, p=0.031), 2- vs, 1- vs. 0 dilated segments, respectively (Table 1, Figure 1).
Athletes with dilated measurements had no LGE (excluding the hinge point), no difference in T1-mapping times, or LV- and RV EF, compared to athletes without dilated measurements.
Conclusion
One in three elite-athletes has dilatation in one or more aortic segments, including the sinus of Valsalva, sinotubular junction, or the aorta at diaphragm. Athletes with 2 dilated measurements (7%) had greater LV- and RV EDVi, ESVi, and SV, suggesting an association with ventricular volumes. Our findings in asymptomatic elite athletes, with normal EF and no LGE and comparable T1-mapping times, could be a sign of an outspoken physiological sports adaptation, instead of pathology.
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Affiliation(s)
- SM Verwijs
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - JC Van Hattum
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - N Stomilovic
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - JJN Daems
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - SM Boekholdt
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - RN Planken
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - M Groenink
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - A Van Randen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - AJ Bakermans
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - AJ Nederveen
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - MH Moen
- Nederlands Olympisch Committee*Nederlandse Sport Federatie, High Performance Team, Arnhem, Netherlands (The)
| | - YM Pinto
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - AAM Wilde
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - HT Jorstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
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14
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Van Hattum J, Verwijs SM, Davelaar SE, Daems JJN, Boekholdt SM, Groenink M, Planken RN, Van Luijk-Snoeks RD, Van Den Berg-Faay AM, Moen MH, Wijne CACM, Nederveen AJ, Pinto YM, Wilde AAM, Jorstad HT. SARS-CoV-2 associated cardiac abnormalities in elite athletes: results from the prospective, longitudinal COMMIT cohort. Eur J Prev Cardiol 2022. [PMCID: PMC9384057 DOI: 10.1093/eurjpc/zwac056.283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Dutch National Olympic Committee & National Sports Federation (NOC*NSF) Dutch Heart Foundation Background/Introduction Active myocarditis is regarded as an absolute contra-indication to competitive sports. Subclinical SARS-CoV-2 myocarditis/myocardial damage has been demonstrated 2-5% in athletes. However, the prognosis in elite athletes after SARS-CoV-2 cardiac involvement, with potentially detrimental effects on recovery, is currently unknown. Purpose We aimed to investigate the prevalence and clinical course of cardiac abnormalities in elite athletes after SARS-CoV-2 infection. Methods We retrospectively and prospectively included elite athletes in the COMMIT (COvid-19 Myocardial Manifestations in Intensive Top-level sports) cohort. Outcomes of interest were 1) incidence and clinical course of cardiac abnormalities on CMR, defined as reduced EF, increased EDV, presence of late gadolinium enhancement (LGE) (excluding hinge point fibrosis), increased T1 and/or T2 time); 2) clinically important arrhythmias defined as premature ventricular complex, (non-)sustained ventricular tachycardia on exercise ECG or 4-8 days Holter monitoring; 3) cardiac- symptoms/ events. SARS-CoV-2 infection was diagnosed with a positive- PCR or antibody test if unvaccinated. Results We included 85 elite SARS-CoV-2 recovered athletes (34% women), mean age 26.5 (±7) years, with main athletic disciplines (≥10 hours/week) football (27%), cycling (12%), water polo (9%), field hockey (9%), and rowing (8%). Mean time between infection and CMR was 2.6 months (±3). Mean CMR LVEDV/BSA was 120.6 ml/m2 (±21), LVEF 57.3% (±5), RVEDV/BSA 126.2 ml/m2 (±22), RVEF 54% (±4), and 1/85 (1.2%) showed increased T1 time after infection. In 4/85 (4.7%) myocardial LGE was present (Figure 1 and 2). In cases with LGE, after 11 (±2) months of follow-up, one demonstrated complete resolution (i.e. no LGE present) after 3 months. One case showed persistent inflammation on three sequential CMRs (1, 3, 6 months post-COVID-19); at 9 months CMR demonstrated no inflammation, but persistent LGE. Two elite athletes had unchanged LGE, one at 3 months, and one at 5 and 9 months. No clinically important arrhythmias were found in athletes with LGE. At a mean follow-up of 7.8 (±3.3) months, no symptoms/events were reported, and all had returned to sports. Pre-/post-SARS-CoV-2 infection CMR was available in 13/85 athletes; in this subgroup, no pathologic LGE or clinically important changes in ventricular volumes/function were found. Conclusion This longitudinal cohort of elite athletes demonstrates that infection with SARS-CoV-2 is associated with 4.7% of myocardial abnormalities, with varying clinical courses. There were no important arrhythmias, and we found no evidence of deleterious effects of sports after COVID-19. Prospective studies with comprehensive arrhythmia monitoring and long-term follow-up are needed to establish whether intensive sports is associated with long-term deleterious cardiac effects.
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Affiliation(s)
- J Van Hattum
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - SM Verwijs
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - SE Davelaar
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - JJN Daems
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - SM Boekholdt
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - M Groenink
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - RN Planken
- Amsterdam UMC, University of Amsterdam, Radiology, Amsterdam, Netherlands (The)
| | - RD Van Luijk-Snoeks
- Amsterdam UMC, University of Amsterdam, Radiology, Amsterdam, Netherlands (The)
| | | | - MH Moen
- Dutch National Olympic Committee & National Sports Federation, High Performance Team, Arnhem, Netherlands (The)
| | - CACM Wijne
- Hospital Onze Lieve Vrouwe Gasthuis, Sports Medicine, Amsterdam, Netherlands (The)
| | - AJ Nederveen
- Amsterdam UMC, University of Amsterdam, Radiology, Amsterdam, Netherlands (The)
| | - YM Pinto
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - AAM Wilde
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - HT Jorstad
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
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15
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Bourfiss M, Prakken NHJ, James CA, Planken RN, Boekholdt SM, Ahmetagic D, van den Berg MP, Tichnell C, Van der Heijden JF, Loh P, Murray B, Tandri H, Kamel I, Calkins H, Asselbergs FW, Zimmerman SL, Velthuis BK, Te Riele ASJM. Prognostic value of strain by feature-tracking cardiac magnetic resonance in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J Cardiovasc Imaging 2022; 24:98-107. [PMID: 35152298 PMCID: PMC9762936 DOI: 10.1093/ehjci/jeac030] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by ventricular dysfunction and ventricular arrhythmias (VA). Adequate arrhythmic risk assessment is important to prevent sudden cardiac death. We aimed to study the incremental value of strain by feature-tracking cardiac magnetic resonance imaging (FT-CMR) in predicting sustained VA in ARVC patients. METHODS AND RESULTS CMR images of 132 ARVC patients (43% male, 40.6 ± 16.0 years) without prior VA were analysed for global and regional right and left ventricular (RV, LV) strain. Primary outcome was sustained VA during follow-up. We performed multivariable regression assessing strain, in combination with (i) RV ejection fraction (EF); (ii) LVEF; and (iii) the ARVC risk calculator. False discovery rate adjusted P-values were given to correct for multiple comparisons and c-statistics were calculated for each model. During 4.3 (2.0-7.9) years of follow-up, 19% of patients experienced sustained VA. Compared to patients without VA, those with VA had significantly reduced RV longitudinal (P ≤ 0.03) and LV circumferential (P ≤ 0.04) strain. In addition, patients with VA had significantly reduced biventricular EF (P ≤ 0.02). After correcting for RVEF, LVEF, and the ARVC risk calculator separately in multivariable analysis, both RV and LV strain lost their significance [hazard ratio 1.03-1.18, P > 0.05]. Likewise, while strain improved the c-statistic in combination with RVEF, LVEF, and the ARVC risk calculator separately, this did not reach statistical significance (P ≥ 0.18). CONCLUSION Both RV longitudinal and LV circumferential strain are reduced in ARVC patients with sustained VA during follow-up. However, strain does not have incremental value over RVEF, LVEF, and the ARVC VA risk calculator.
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Affiliation(s)
- M Bourfiss
- Corresponding author. Tel: +31 88 77570240; Fax: +31 88 7555660. E-mail:
| | - N H J Prakken
- Department of Radiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - C A James
- Department of Cardiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21218, USA
| | - R N Planken
- Department of Radiology and nuclear medicine, Amsterdam University Medical Center, Amsterdam, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - S M Boekholdt
- Department of Cardiology, Amsterdam University Medical Center, Amsterdam, Location AMC, Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - D Ahmetagic
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - M P van den Berg
- Department of Cardiology, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - C Tichnell
- Department of Cardiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21218, USA
| | - J F Van der Heijden
- Division of Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - P Loh
- Division of Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - B Murray
- Department of Cardiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21218, USA
| | - H Tandri
- Department of Cardiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21218, USA
| | - I Kamel
- Department of Radiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21218, USA
| | - H Calkins
- Department of Cardiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21218, USA
| | - F W Asselbergs
- Division of Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Health Data Research UK and Institute of Health Informatics, University College London, Gower St, London WC1E 6BT, UK
| | - S L Zimmerman
- Department of Radiology, Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD 21218, USA
| | - B K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - A S J M Te Riele
- Division of Cardiology, Department of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands,Netherlands Heart Institute, Moreelsepark 1, 3511 EP Utrecht, The Netherlands
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16
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Bruin De- Bon H, Verwijs SM, Hattum Van JC, Blomjous AGA, Planken RN, Boekholdt SM, Groenink M, Hoogenband Van Den CR, Moen MH, Wilde AAM, Pinto YM, Bouma BJ, Jorstad HT. Normalization of global longitudinal strain after 20 squats in elite athletes. Eur Heart J Cardiovasc Imaging 2022. [DOI: 10.1093/ehjci/jeab289.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background/Introduction: Transthoracic echocardiography (TTE) is often the first diagnostic imaging modality of choice in athlete care to differentiate between physiological adaptation to sports and pathology. Left ventricular (LV) global longitudinal strain (GLS) has been suggested as a tool to detect early signs of myocardial diseases in athletes. However, low rates of myocardial deformation can also be associated with cardiac adaptation to sports. We hypothesized that observing decreased cardiac deformation in elite athletes may be a sign of an outspoken relaxed cardiac state, rather than pathology. Therefore, we investigated whether a short exercise bout can normalize strain values in elite athletes with abnormal resting GLS.
Methods
We prospectively enrolled elite athletes who participated in the ELITE (Evaluation of Lifetime Participation in Intensive Top-level Sports and Exercise) cohort. In short, ELITE is a prospective athlete cohort, which collects medical history, ECG, TTE and cardiac magnetic resonance (CMR) data in elite athletes (Olympic/Paralympic level or comparable). For this analysis, we analysed TTEs of asymptomatic athletes without cardiovascular disease and with a structurally normal heart on CMR. TTE (Vivid, GE) was performed in each athlete according to guidelines at rest.
After a short exercise bout, consisting of 20 squats, additional GLS, LV ejection fraction (EF), and LV stroke volume (SV) measurements were assessed when heart-rate (HR) was comparable to HR during pre-exercise measurements. TTE data was assessed using EchoPAC (GE). GLS delta (pre- to post-exercise) for each athlete was calculated were plotted, using R. GLS ≥ -16% was considered decreased and -16% ≥ GLS > -18% borderline.
Results
Our population comprised 73 athletes (26% women), mean age (±SD) of 25.6 ± 6.5 years, BSA of 2 ± 0.2m2, and athletic disciplines road cycling (n = 28), soccer (n = 12), hockey (n = 8), swimming (n = 5), tennis (n = 5) and 8 miscellaneous sports (n = 15). Mean pre- and post-exercise GLS were -18.2 ± 2.1% vs -20.5 ± 2.0% (P < 0.001; Figure 1), EF 57 ± 4% vs 59 ± 6% (P = 0.006; Figure 1), SV 89 ± 20ml vs 99 ± 24ml (P = 0.008), and HR 56 ± 12bpm vs 56 ± 13bpm (P = 0.875). We observed an increase of myocardial deformation after a short bout of exercise: mean GLS delta of -2.3 ± 1.9%. Finally, we found a decreased strain in 14 athletes (19%), in which pre- and post-exercise GLS were -15.1 ± 0.8% and -18.6 ± 2.3%, P= <0.001, Figure 1). Only 1 athlete (1%, no other signs of cardiac pathology: MRI, biomarkers, complaints) had post-exercise decreased GLS. We found 9 athletes with a deteriorated cardiac deformation (delta GLS ≤ 0%), pre- and post-exercise GLS were -20.4 ± 1.4% and -19.9 ± 1.5% (maximal GLS post-exercise was -17.7%, Figure 1).
Conclusion
GLS normalizes in 99% of healthy (elite) athletes. In athletes with decreased GLS at rest, performing a short exercise bout is a pragmatic method to separate decreased GLS due to pathology from sport adaptation Abstract figure 1
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Affiliation(s)
| | - SM Verwijs
- Academic medical center, Amsterdam, Netherlands (The)
| | - JC Hattum Van
- Academic medical center, Amsterdam, Netherlands (The)
| | - AGA Blomjous
- Academic medical center, Amsterdam, Netherlands (The)
| | - RN Planken
- Academic medical center, Amsterdam, Netherlands (The)
| | - SM Boekholdt
- Academic medical center, Amsterdam, Netherlands (The)
| | - M Groenink
- Academic medical center, Amsterdam, Netherlands (The)
| | | | - MH Moen
- Dutch Olympic Commitee*Dutch Sports Federation -NOC*NSF, arnhem, Netherlands (The)
| | - AAM Wilde
- Academic medical center, Amsterdam, Netherlands (The)
| | - YM Pinto
- Academic medical center, Amsterdam, Netherlands (The)
| | - BJ Bouma
- Academic medical center, Amsterdam, Netherlands (The)
| | - HT Jorstad
- Academic medical center, Amsterdam, Netherlands (The)
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17
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van den Boogert TPW, Claessen BEPM, Boekholdt SM, Leiner T, Vliegenthart R, Schuiling SF, Timmer JR, Bekkers SCAM, Voskuil M, Siebelink HJ, van Es W, Lamb HJ, Prokop M, Damman P, Stoker J, Willems HC, Henriques JP, Planken RN. The impact and challenges of implementing CTCA according to the 2019 ESC guidelines on chronic coronary syndromes: a survey and projection of CTCA services in the Netherlands. Insights Imaging 2021; 12:186. [PMID: 34921633 PMCID: PMC8684565 DOI: 10.1186/s13244-021-01122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
Background The 2019 ESC-guidelines on chronic coronary syndromes (ESC-CCS) recommend computed tomographic coronary angiography (CTCA) or non-invasive functional imaging instead of exercise ECG as initial test to diagnose obstructive coronary artery disease. Since impact and challenges of these guidelines are unknown, we studied the current utilisation of CTCA-services, status of CTCA-protocols and modeled the expected impact of these guidelines in the Netherlands. Methods and results A survey on current practice and CTCA utilisation was disseminated to every Dutch hospital organisation providing outpatient cardiology care and modeled the required CTCA capacity for implementation of the ESC guideline, based on these national figures and expert consensus. Survey response rate was 100% (68/68 hospital organisations). In 2019, 63 hospital organisations provided CTCA-services (93%), CTCA was performed on 99 CTCA-capable CT-scanners, and 37,283 CTCA-examinations were performed. Between the hospital organisations, we found substantial variation considering CTCA indications, CTCA equipment and acquisition and reporting standards. To fully implement the new ESC guideline, our model suggests that 70,000 additional CTCA-examinations would have to be performed in the Netherlands. Conclusions Despite high national CTCA-services coverage in the Netherlands, a substantial increase in CTCA capacity is expected to be able to implement the 2019 ESC-CCS recommendations on the use of CTCA. Furthermore, the results of this survey highlight the importance to address variations in image acquisition and to standardise the interpretation and reporting of CTCA, as well as to establish interdisciplinary collaboration and organisational alignment.
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Affiliation(s)
- T P W van den Boogert
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - B E P M Claessen
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Cardiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - S M Boekholdt
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - T Leiner
- Department of Radiology, Utrecht University Medical centre, Utrecht, The Netherlands
| | - R Vliegenthart
- Department of Radiology, University Medical centre Groningen, Groningen, The Netherlands
| | - S F Schuiling
- Zorgevaluatie en Gepast Gebruik, Diemen, The Netherlands
| | - J R Timmer
- Departments of Cardiology, Isala, Zwolle, The Netherlands
| | - S C A M Bekkers
- Department of Cardiology, Maastricht University Medical centre, Maastricht, The Netherlands
| | - M Voskuil
- Department of Cardiology, Utrecht University Medical centre, Utrecht, The Netherlands
| | - H J Siebelink
- Department of Cardiology, Leiden University Medical centre, Leiden, The Netherlands
| | - W van Es
- Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - H J Lamb
- Department of Radiology, Leiden University Medical centre, Leiden, The Netherlands
| | - M Prokop
- Department of Radiology, Nuclear Medicine, and Anatomy, Radboud University Medical centre, Nijmegen, The Netherlands
| | - P Damman
- Department of Cardiology, Radboud University Medical centre, Nijmegen, The Netherlands
| | - J Stoker
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - H C Willems
- Division of Geriatrics, Department of Internal Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - J P Henriques
- Heart centre, Department of Clinical and Experimental Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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18
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van Schuppen J, van der Hulst AE, Kuipers IM, Straver B, Boekholdt SM, Planken RN, Oostra RJ. Midline crossing pulmonary vein: right upper lobe dual venous drainage, with partial anomalous venous return of the right lung into a persistent left superior vena cava. Surg Radiol Anat 2021; 44:99-103. [PMID: 34709422 PMCID: PMC8758614 DOI: 10.1007/s00276-021-02849-9] [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: 06/14/2021] [Accepted: 10/08/2021] [Indexed: 11/29/2022]
Abstract
Introduction We present a case of dual drainage of the right upper lobe of the lung into the left atrium and via partial anomalous venous pulmonary return (PAPVR) into a persistent left superior vena cava (SVC). Discussion It is only in the minority of PAPVR cases where the anomalous pulmonary veins cross the midline. We provide a review of current literature on this topic and an explanatory embryological model. Knowledge of embryonic development and possible anatomic variations, including the concept of dual venous drainage of the lung, leads to better interpretation of imaging, with more accurate description of the morphology at hand. High-resolution multidetector computed tomography (MDCT) helps to delineate the exact vascular anatomy. This will enhance a better understanding of and anticipation on the patient’s disease status, with more accurate planning of intervention, and possibly less complications.
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Affiliation(s)
- J van Schuppen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Suite C1-234, 1105 AZ, Amsterdam, The Netherlands.
| | - A E van der Hulst
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - I M Kuipers
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - B Straver
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - S M Boekholdt
- Department of Cardiology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Center, Location AMC, Meibergdreef 9, Suite C1-234, 1105 AZ, Amsterdam, The Netherlands
| | - R J Oostra
- Department of Medical Biology, Section Clinical Anatomy and Embryology, Amsterdam University Medical Center, Location Meibergdreef, Amsterdam, The Netherlands
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19
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Verwijs SM, De Bruin-Bon HACM, Van Hattum JC, Spies JL, Planken RN, Boekholdt SM, Groenink M, Van Den Hoogenband CR, Moen MH, Wilde AAM, Pinto YM, Jorstad HT. Normalization of global longitudinal strain after a 30-seconds exercise bout in elite athletes. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Transthoracic echocardiography (TTE) is often the first diagnostic imaging modality of choice in athlete care to differentiate between physiological adaptation to sports and pathology. Mechanical strain as outcome measure, i.e. left ventricular (LV) global longitudinal strain (GLS), has been suggested as a tool to detect early signs of myocardial diseases in athletes. However, low or very low rates of myocardial deformation can also be associated with cardiac adaptation to sports. We hypothesize that observing decreased cardiac deformation in elite athletes may be a sign of an outspoken relaxed cardiac state, rather than pathology. Therefore, we investigated whether a short exercise bout can normalize strain values in elite athletes with abnormal resting GLS.
Methods
We prospectively enrolled elite athletes who participated in the ELITE (Evaluation of Lifetime Participation in Intensive Top-level Sports and Exercise) cohort. In short, ELITE is a prospective athlete cohort, which collects medical history, ECG, TTE and cardiac magnetic resonance (CMR) data in elite athletes (Olympic/Paralympic level or comparable). For this analysis, we analysed TTEs of asymptomatic athletes without cardiovascular disease and with a structurally normal heart on CMR. TTE (Vivid, GE) was performed in each athlete according to guidelines at rest. After a short exercise bout, consisting of 20 squats, additional measurements were performed when heart-rate (HR) was comparable to HR during pre-exercise measurements. TTE data was assessed using EchoPAC (GE). Paired t-tests were calculated for functional parameters; boxplots for pre- and post-exercise measurements; and GLS delta (pre- to post-exercise) for each athlete was calculated were plotted; using R. GLS ≥−16% was considered decreased and −16% ≥ GLS >−18% borderline.
Results
Our population comprised 51 athletes (35% women), with a mean age (±SD) of 26.4±5.2 years, and mean BSA of 2±0.3m2. Athletic disciplines consisted of road cycling (n=25), hockey (n=7), swimming (n=5), and 7 miscellaneous sports (n=14). We observed an increase of myocardial deformation after a short bout of exercise: mean GLS delta of 2.6±2% (pre- vs post-exercise GLS: −18.2±2.1% vs −20.8±1.9%; P≤0.001; Figure, A). Furthermore, mean LV stroke volumes were 94±19ml vs 103±23ml (P=0.020), ejection fractions (EF) 57±4% vs 60±4% (P≤0.001), and HR 55±10bpm vs 54±13bpm (P=0.8). Finally, we found a decreased strain in 8 athletes (16%), in 7 of which increased to normal values. Mean delta GLS was 4.5±2.2 (pre- vs post-exercise GLS: −14.9±1.1% vs −19.4±2.7%, P=0.002, Figure, B). The athlete who did not show an increase to normal GLS levels had a decreased LV EF (42%), but showed no other signs of cardiac pathology (MRI, biomarkers, complaints).
Conclusion
In athletes with abnormal GLS at rest, performing a short exercise bout may provide a pragmatic method to separate decreased GLS due to true pathology from sports adaptation.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Amsterdam Movement Sciences
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Affiliation(s)
- S M Verwijs
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - H A C M De Bruin-Bon
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - J C Van Hattum
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - J L Spies
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - R N Planken
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, Netherlands (The)
| | - S M Boekholdt
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - M Groenink
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - C R Van Den Hoogenband
- Nederlands Olympisch Committee*Nederlandse Sport Federatie, High Performance Team, Arnhem, Netherlands (The)
| | - M H Moen
- Nederlands Olympisch Committee*Nederlandse Sport Federatie, High Performance Team, Arnhem, Netherlands (The)
| | - A A M Wilde
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - Y M Pinto
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
| | - H T Jorstad
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, Netherlands (The)
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20
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Meijerink F, Wolsink I, Holierook M, Chekanova EV, Planken RN, Van Randen A, De Winter RJ, Beijk MAM, Koch KT, Robbers-Visser D, Boekholdt SM, Bouma BJ, Baan J. Cardiac CT derived 3D reconstruction discriminates for complexity and hemodynamic effect of transcatheter mitral valve repair. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Transcatheter mitral valve repair (TMVR) is increasingly used to treat mitral regurgitation (MR) in high risk patients. Optimal transseptal access and guiding catheter position are essential to perform adequate repair. Anatomy of the inter-atrial septum (IAS) and mitral annulus (MA) are often complex and difficult to determine from echocardiography.
Purpose
The aim of the current study was to evaluate whether pre-TMVR cardiac CT and 3D reconstruction of the IAS and MA could discriminate for complexity and hemodynamic effect of TMVR.
Methods
Patients planned for TMVR, underwent cardiac CT scan (if eligible). Post-processing software was used to segment and reconstruct the aortic root, IAS, fossa ovalis (FO) and MA, resulting in a 3D model. The following parameters were measured in each model: (1) IAS angle (°) (2) Posterior-FO angle (°) (3) FO-perpendicularity angle (°) (4) MA area (cm2). Patient specific anatomy was categorized in 4 groups as either (1) Posterior-perpendicular (PP) FO + limited IAS angle, (2) PP FO + wide IAS angle, (3) non-PP FO + limited IAS angle or (4) non-PP FO + wide IAS angle. PP FO was defined as posterior-FO angle >65° and FO-perpendicularity angle >135°. IAS angle was considered limited if <110°. Device implantation time (min) was used to assess complexity of the procedure and was compared between the different groups. MR reduction (grades), number of clips used and mitral valve (MV) gradient (mmHg) were compared for patients with MA area <14 cm2 vs. ≥14 cm2.
Results
46 patients (mean age 75 years, 41% male) were included. Anatomy was classified (1) PP FO + limited IAS angle in 13, (2) PP FO + wide IAS angle in 13, (3) Non-PP FO + limited IAS angle in 8 and (4) Non-PP FO + wide IAS angle in 12. Median device implantation time was 20 min in group 1, compared to 39 min in group 2 (p=0.02), 33 min in group 3 (p=0.03) and 29 min in group 4 (p=0.08). In patients with MA area <14 cm2, MR reduction was greater (2.22 vs. 1.68, p=0.02), number of clips used was lower (1.44 vs. 1.79, p=0.05) and MV gradient was higher, though not significant (3.15 vs. 2.58, p=0.26)
Conclusion
The current study showed that TMVR seemed less complex in patients with an optimal anatomy. In patients with limited mitral annulus area a more favorable hemodynamic effect was achieved. Cardiac CT and 3D reconstruction could therefore be of strong aid for procedural planning of TMVR.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Abbott Vascular Anatomy and device implantation timeHemodynamic effect of annulus area
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Affiliation(s)
- F Meijerink
- Amsterdam UMC - Location Academic Medical Center, Amsterdam, Netherlands (The)
| | - I Wolsink
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - M Holierook
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - E V Chekanova
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - R N Planken
- Amsterdam UMC - Location Academic Medical Center, Radiology, Amsterdam, Netherlands (The)
| | - A Van Randen
- Amsterdam UMC - Location Academic Medical Center, Radiology, Amsterdam, Netherlands (The)
| | - R J De Winter
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - M A M Beijk
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - K T Koch
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - D Robbers-Visser
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - S M Boekholdt
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - B J Bouma
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
| | - J Baan
- Amsterdam UMC - Location Academic Medical Center, Cardiology, Amsterdam, Netherlands (The)
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21
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Van Hattum J, Spies JL, Verwijs SM, Verwoert GC, Planken RN, Boekholdt SM, Groenink M, Malekzadeh A, Pinto YM, Wilde AAM, Jorstad HT. Post-COVID-19 peri- and myocardial manifestations are less common in athletes than in healthy non-athletes: findings from a systematic review. Eur Heart J 2021. [PMCID: PMC8767600 DOI: 10.1093/eurheartj/ehab724.2718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/Introduction The prognosis of peri- and myocarditis can be negatively influenced by intensive exercise and sports. Therefore sustained cardiac involvement after recovery from COVID-19 in athletes is of particular relevance for the prevention of sudden cardiac arrest/sudden cardiac death (SCA/SCD). To date, only small sample-size studies are available, or studies predominantly focusing on hospitalized and severely ill patients. We aimed to address this knowledge gap in a comprehensive, systematic review of peri-/myocardial involvement after SARS-CoV-2 infection in athletes versus healthy non-athletes. Purpose Quantification of peri-/myocardial involvement and risks of SCA/SCD after SARS-CoV-2 infection in athletes as compared with healthy non-athletes. Methods We performed a systematic search with a combination of key terms in Medline (Ovid), Embase (Ovid) and Scopus (through March 8th 2021). To capture potential non- peer-reviewed COVID-19 SCA/SCD reports we performed monthly scoping internet searches. Inclusion criteria: athletes/non-athletes, with cardiovascular magnetic resonance (CMR) or echocardiography after recovery from SARS-CoV-2 infection, including arrhythmia outcomes. Exclusion criteria: study population ≥1 individual comorbidity and mean age <18/>64 years. Results We included 16 manuscripts (933 papers reviewed) comprising 1129 athletes (284 college/student-, 807 professional- and 38 elite athletes) and 382 healthy non-athletes. Athletes vs non-athletes reported myocarditis on echocardiography and/or CMR in 0–15% vs 45–60%, LGE in 0–46% vs 0–74% (Figure 1), and pericardial effusion in 8–58% vs 0–47% (Figure 2). Weighted means of diagnosed myocarditis were 3% in athletes (3.5% college/student-, and 0% elite athletes) and 56.6% in non-athletes. No important arrhythmias were reported. Systematic internet query identified 2 collapsed post-COVID-19 athletes during exercise, 1 lethal. Ten studies (n=1301) reporting post-recovery troponin T/I found no clear relationship with cardiac abnormalities. Summary/Conclusions Rates of peri-/myocardial abnormalities in athletes/healthy non-athletes after SARS-CoV-2 infection are variable, ranging from 0–74%, and predominantly seen on CMR. Athletes have a lower risk of peri-/myocardial involvement, and myocarditis (0–3.5% vs 56.5%) than non-athletes after SARS-CoV-2 infection. Risks of SCA/SCD appear low, but data are lacking. Troponin screenings seems unreliable to identify athletes at risk for myocardial involvement. Prospective studies, with pre-COVID-19 imaging (CMR), in athletes, including follow-up and arrhythmia monitoring, are urgently needed. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): Dutch Olympic Committee*Dutch Sports Federation (NOC*NSF)Amsterdam Movement Sciences (AMS)
Figure 1. Total peri-/myocardial LGE (%) ![]() Figure 2. Total pericardial effusion (%) ![]()
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Affiliation(s)
- J Van Hattum
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - J L Spies
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - S M Verwijs
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - G C Verwoert
- Erasmus University Medical Centre, Cardiology, Rotterdam, Netherlands (The)
| | - R N Planken
- Amsterdam UMC, University of Amsterdam, Radiology, Amsterdam, Netherlands (The)
| | - S M Boekholdt
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - M Groenink
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - A Malekzadeh
- Amsterdam UMC, University of Amsterdam, Medical library, Amsterdam, Netherlands (The)
| | - Y M Pinto
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - A A M Wilde
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
| | - H T Jorstad
- Amsterdam UMC, University of Amsterdam, Cardiology, Amsterdam, Netherlands (The)
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Indrakusuma R, Jalalzadeh H, van der Laan M, Koelemay M, Nederveen A, Planken R, van Ooij P, Balm R. 4D Flow MRI in Patients with Asymptomatic Abdominal Aortic Aneurysms: Reproducibility and Clinical Analysis. Eur J Vasc Endovasc Surg 2019. [DOI: 10.1016/j.ejvs.2019.09.157] [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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van den Boogert TPW, Vendrik J, Claessen BEPM, Baan J, Beijk MA, Limpens J, Boekholdt SAM, Hoek R, Planken RN, Henriques JP. CTCA for detection of significant coronary artery disease in routine TAVI work-up : A systematic review and meta-analysis. Neth Heart J 2018; 26:591-599. [PMID: 30178209 PMCID: PMC6288031 DOI: 10.1007/s12471-018-1149-6] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [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] [Indexed: 01/08/2023] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has evolved to standard treatment of severe aortic stenosis in patients with an intermediate to high surgical risk. Computed tomography coronary angiography (CTCA) could partially replace invasive coronary angiography to diagnose significant coronary artery disease in the work-up for TAVI. A literature search was performed in MEDLINE and EMBASE for papers comparing CTCA and coronary angiography in TAVI candidates. The primary endpoint was the diagnostic accuracy of CTCA, compared to coronary angiography, for detection of significant (>50% diameter stenosis) coronary artery disease, measured as sensitivity, specificity, positive—(PPV) and negative predictive value (NPV). Seven studies were included, with a cumulative sample size of 1,275 patients. The patient-based pooled sensitivity, specificity, PPV and NPV were 95, 65, 71 and 94% respectively. Quality assessment revealed excellent and good quality in terms of applicability and risk of bias respectively, with the main concern being patient selection. In conclusion, on the basis of a significance cut-off value of 50% diameter stenosis, CTCA provides acceptable diagnostic accuracy for the exclusion of coronary artery disease in patients referred for TAVI. Using the routinely performed preoperative computed tomography scans as a gatekeeper for coronary angiography could decrease additional coronary angiographies by 37% in this high-risk and fragile population.
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Affiliation(s)
- T P W van den Boogert
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Vendrik
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - B E P M Claessen
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - M A Beijk
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - J Limpens
- Medical Library, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - S A M Boekholdt
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R Hoek
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P Henriques
- Heart Centre, Academic Medical Centre, part of the Amsterdam Cardiovascular Sciences, University of Amsterdam, Amsterdam, The Netherlands.
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van Mourik MS, van Kesteren F, Planken RN, Stoker J, Wiegerinck EMA, Piek JJ, Tijssen JG, Koopman MG, Henriques JPS, Baan J, Vis MM. Short versus conventional hydration for prevention of kidney injury during pre-TAVI computed tomography angiography. Neth Heart J 2018; 26:425-432. [PMID: 30039383 PMCID: PMC6115307 DOI: 10.1007/s12471-018-1133-1] [Citation(s) in RCA: 5] [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] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Computed tomography angiography (CTA) is required in the work-up for transcatheter aortic valve implantation (TAVI). However, CTA may cause contrast-induced acute kidney injury (CI-AKI). We hypothesised that a short (1 h, 3 ml/kg/h sodium bicarbonate) hydration protocol is not inferior to conventional (24 h, 1 ml/kg/h saline) hydration in avoiding a decline in renal function in patients with impaired renal function. METHODS AND RESULTS Single-centre randomised non-inferiority trial in patients with impaired renal function who underwent pre-TAVI CTA. Patients were randomised on a 1:1 ratio to short hydration (SHORT; 1 h sodium bicarbonate, 3 ml/kg/h) or conventional hydration (CONV; 24 h saline, 1 ml/kg/h). Outcomes included percentage change in serum creatinine until 2-6 days after CTA with a non-inferiority margin of 10% and an increase on the Borg dyspnoea scale ≥1 point. Seventy-four patients were included. Increase in creatinine was 6 µmol/l (95% CI 2.5-9.3) in the SHORT versus 2 µmol/l (95% CI-1.4 to 6.3) in the CONV arm (p = 0.167). The percentage change was 4.6% (95% CI 2.0-7.3%) in the SHORT arm versus 2.5% (95% CI: 0.8 to 5.8%) in the CONV arm. The difference in percentage increase in creatinine between the two arms was 2.1% (95% CI: 2.0-6.2%; p-value non-inferiority: <0.001). CI-AKI and a need for dialysis were not observed. An increase of ≥1 point on the Borg scale (dyspnoea scale ranging from 1 (lowest) to 10 (highest)) was seen in 1 patient in the SHORT arm versus 5 patients in the CONV arm (2.9% vs 16.1%, p = 0.091). CONCLUSION For patients with impaired renal function undergoing pre-TAVI CTA, a short 1‑h, low-volume hydration protocol with sodium bicarbonate is not inferior to conventional 24-h, high-volume saline hydration.
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Affiliation(s)
- M S van Mourik
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - F van Kesteren
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Stoker
- Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Wiegerinck
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Tijssen
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M G Koopman
- Department of Nephrology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Vis
- Heart Centre, Amsterdam Cardiovascular Sciences, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Farag ES, Vendrik J, van Ooij P, Poortvliet QL, van Kesteren F, Wollersheim LW, Kaya A, Driessen AHG, Piek JJ, Koch KT, Baan J, Planken RN, Kluin J, Nederveen AJ, de Mol BAJM. Transcatheter aortic valve replacement alters ascending aortic blood flow and wall shear stress patterns: A 4D flow MRI comparison with age-matched, elderly controls. Eur Radiol 2018; 29:1444-1451. [PMID: 30132105 PMCID: PMC6510864 DOI: 10.1007/s00330-018-5672-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/06/2018] [Accepted: 07/16/2018] [Indexed: 11/01/2022]
Abstract
BACKGROUND With the implementation of transcatheter aortic valve replacement (TAVR) in lower-risk patients, evaluation of blood flow characteristics and the effect of TAVR on aortic dilatation becomes of considerable interest. We employed 4D flow MRI in the ascending aorta of patients after TAVR to assess wall shear stress (WSS) and compare blood flow patterns with surgical aortic valve replacement (SAVR) and age- and gender-matched controls. METHODS Fourteen post-TAVR patients and ten age- and gender-matched controls underwent kt-PCA accelerated 4D flow MRI of the thoracic aorta at 3.0 Tesla. Velocity and wall shear stress was compared between the two groups. In addition, aortic flow eccentricity and displacement was assessed and compared between TAVR patients, controls and 14 SAVR patients recruited as part of an earlier study. RESULTS Compared to controls, abnormally elevated WSS was present in 30±10% of the ascending aortic wall in TAVR patients. Increased WSS was present along the posterior mid-ascending aorta and the anterior distal-ascending aorta in all TAVR patients. TAVR results in eccentric and displaced flow in the mid- and distal-ascending aorta, whereas blood flow displacement in SAVR patients occurs only in the distal-ascending aorta. CONCLUSION This study shows that TAVR results in increased blood flow velocity and WSS in the ascending aorta compared to age- and gender-matched elderly controls. This finding warrants longitudinal assessment of aortic dilatation after TAVR in the era of potential TAVR in lower-risk patients. Additionally, TAVR results in altered blood flow eccentricity and displacement in the mid- and distal-ascending aorta, whereas SAVR only results in altered blood flow eccentricity and displacement in the distal-ascending aorta. KEY POINTS • TAVR results in increased blood flow velocity and WSS in the ascending aorta. • Longitudinal assessment of aortic dilatation after TAVR is warranted in the era of potential TAVR in lower-risk patients. • Both TAVR and SAVR result in altered blood flow patterns in the ascending aorta when compared to age-matched controls.
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Affiliation(s)
- E S Farag
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - J Vendrik
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - P van Ooij
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - Q L Poortvliet
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - F van Kesteren
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - L W Wollersheim
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A Kaya
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A H G Driessen
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J J Piek
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - K T Koch
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - J Baan
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - J Kluin
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - A J Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - B A J M de Mol
- Departments of Cardiology and Cardiothoracic Surgery, Heart Centre, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD, Amsterdam, The Netherlands
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Van Den Boogert TPW, Vendrik J, Claessen BEPM, Baan J, Beijk MA, Limpens J, Boekholdt SAM, Hoek R, Planken RN, Henriques JPS. P6051CTCA for detection of significant CAD in routine TAVI work-up, a systematic review and meta-analysis. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6051] [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: 11/15/2022] Open
Affiliation(s)
| | - J Vendrik
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - B E P M Claessen
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J Baan
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - M A Beijk
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J Limpens
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - S A M Boekholdt
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - R Hoek
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - R N Planken
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
| | - J P S Henriques
- Academic Medical Center of Amsterdam, Cardiology, Amsterdam, Netherlands
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van Kesteren F, van Mourik MS, Wiegerinck EMA, Vendrik J, Piek JJ, Tijssen JG, Koch KT, Henriques JPS, Wykrzykowska JJ, de Winter RJ, Driessen AHG, Kaya A, Planken RN, Vis MM, Baan J. Trends in patient characteristics and clinical outcome over 8 years of transcatheter aortic valve implantation. Neth Heart J 2018; 26:445-453. [PMID: 29943117 PMCID: PMC6115311 DOI: 10.1007/s12471-018-1129-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 12/04/2022] Open
Abstract
Aim In the evolving field of transcatheter aortic valve implantations (TAVI) we aimed to gain insight into trends in patient and procedural characteristics as well as clinical outcome over an 8‑year period in a real-world TAVI population. Methods We performed a single-centre retrospective analysis of 1,011 consecutive patients in a prospectively acquired database. We divided the cohort into tertiles of 337 patients; first interval: January 2009–March 2013, second interval: March 2013–March 2015, third interval: March 2015–October 2016. Results Over time, a clear shift in patient selection was noticeable towards lower surgical risks including Society of Thoracic Surgeons predicted risk of mortality score and comorbidity. The frequency of transfemoral TAVI increased (from 66.5 to 77.4%, p = 0.0015). Device success improved (from 62.0 to 91.5%, p < 0.0001) as did the frequency of symptomatic relief (≥1 New York Heart Association class difference) (from 73.8 to 87.1%, p = 0.00025). Complication rates decreased, including in-hospital stroke (from 5.0 to 2.1%, p = 0.033) and pacemaker implantations (from 10.1 to 5.9%, p = 0.033). Thirty-day mortality decreased (from 11.0 to 2.4%, p < 0.0001); after adjustment for patient characteristics, a mortality-risk reduction of 72% was observed (adjusted hazard ratio [HR]: 0.28, 95% confidence interval [CI]: 0.13–0.62). One-year mortality rates decreased (from 23.4 to 11.4%), but this was no longer significant after a landmark point was set at 30 days (mortality from 31 days until 1 year) (adjusted HR: 0.69, 95% CI: 0.41–1.16, p = 0.16). Conclusion A clear shift towards a lower-risk TAVI population and improved clinical outcome was observed over an 8‑year period. Survival after TAVI improved impressively, mainly as a consequence of decreased 30-day mortality. Electronic supplementary material The online version of this article (10.1007/s12471-018-1129-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- F van Kesteren
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
| | - M S van Mourik
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E M A Wiegerinck
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Vendrik
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Piek
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J G Tijssen
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - K T Koch
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J P S Henriques
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J J Wykrzykowska
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R J de Winter
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A H G Driessen
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - A Kaya
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M M Vis
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J Baan
- Heart Centre, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Indrakusuma R, Jalalzadeh H, Planken RN, Marquering HA, Legemate DA, Koelemay MJW, Balm R. Biomechanical Imaging Markers as Predictors of Abdominal Aortic Aneurysm Growth or Rupture: A Systematic Review. Eur J Vasc Endovasc Surg 2016; 52:475-486. [PMID: 27558090 DOI: 10.1016/j.ejvs.2016.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/01/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Biomechanical characteristics, such as wall stress, are important in the pathogenesis of abdominal aortic aneurysms (AAA) and can be visualised and quantified using imaging techniques. This systematic review aims to present an overview of all biomechanical imaging markers that have been studied in relation to AAA growth and rupture. METHODS This systematic review followed the PRISMA guidelines. A search in Medline, Embase, and the Cochrane Library identified 1503 potentially relevant articles. Studies were included if they assessed biomechanical imaging markers and their potential association with growth or rupture. RESULTS Twenty-seven articles comprising 1730 patients met the inclusion criteria. Eighteen studies performed wall stress analysis using finite element analysis (FEA), 13 of which used peak wall stress (PWS) to quantify wall stress. Ten of 13 case control FEA studies reported a significantly higher PWS for symptomatic or ruptured AAAs than for intact AAAs. However, in some studies there was confounding bias because of baseline differences in aneurysm diameter between groups. Clinical heterogeneity in methodology obstructed a meaningful meta-analysis of PWS. Three of five FEA studies reported a significant positive association between several wall stress markers, such as PWS and 99th percentile stress, and growth. One study reported a significant negative association and one other study reported no significant association. Studies assessing wall compliance, the augmentation index and wall stress analysis using Laplace's law, computational fluid dynamics and fluid structure interaction were also included in this systematic review. CONCLUSIONS Although PWS is significantly higher in symptomatic or ruptured AAAs in most FEA studies, confounding bias, clinical heterogeneity, and lack of standardisation limit the interpretation and generalisability of the results. Also, there is conflicting evidence on whether increased wall stress is associated with growth.
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Affiliation(s)
- R Indrakusuma
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - H Jalalzadeh
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - H A Marquering
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands; Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - D A Legemate
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M J W Koelemay
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R Balm
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Jalalzadeh H, Indrakusuma R, Planken RN, Legemate DA, Koelemay MJW, Balm R. Inflammation as a Predictor of Abdominal Aortic Aneurysm Growth and Rupture: A Systematic Review of Imaging Biomarkers. Eur J Vasc Endovasc Surg 2016; 52:333-42. [PMID: 27283346 DOI: 10.1016/j.ejvs.2016.05.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [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: 02/01/2016] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Methods are required to identify abdominal aortic aneurysms (AAAs) at increased risk of rupture. Inflammatory characteristics of AAA can be visualised using advanced imaging techniques and have been proposed as potential predictors of aneurysm progression. The objective of this review was to determine which inflammatory imaging biomarkers are associated with AAA growth and rupture. METHODS A systematic review was carried out in accordance with the PRISMA guidelines. The electronic databases of Medline (PubMed), Embase, and the Cochrane Library were searched up to January 1, 2016 for studies to determine the potential association between inflammatory imaging biomarkers and AAA growth or rupture. RESULTS Seven studies were included, comprising 202 AAA patients. (18)F-fluoro-deoxy-glucose positron emission tomography ((18)F-FDG PET-CT) was evaluated in six studies. Magnetic resonance imaging with ultrasmall superparamagnetic particles of iron oxide (USPIO-MRI) was evaluated in one study. Two of six (18)F-FDG PET-CT studies reported a significant negative correlation (r=.383, p = .015) or a significant negative association (p = .04). Four of six (18)F-FDG PET-CT studies reported no significant association between (18)F-FDG uptake and AAA growth. The single study investigating USPIO-MRI demonstrated that AAA growth was three times higher in patients with focal USPIO uptake in the AAA wall compared to patients with diffuse or no USPIO uptake in the wall (0.66 vs. 0.24 vs. 0.22 cm/y, p = .020). In the single study relating (18)F-FDG uptake results to AAA rupture, the association was not significant. CONCLUSIONS Current evidence shows contradictory associations between (18)F-FDG uptake and AAA growth. Data on the association with rupture are insufficient. Based on the currently available evidence, neither (18)F-FDG PET-CT nor USPIO-MRI can be implemented as growth or rupture prediction tools in daily practice. The heterogeneous results reflect the complex and partially unclear relationship between inflammatory processes and AAA progression.
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Affiliation(s)
- H Jalalzadeh
- Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R Indrakusuma
- Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R N Planken
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - D A Legemate
- Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - M J W Koelemay
- Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - R Balm
- Department of Vascular Surgery, Academic Medical Center, Amsterdam, The Netherlands.
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Pérez Matos AJ, Planken RN, Bouma BJ, Groenink M, Backx APCM, de Winter RJ, Koolbergen DR, Mulder BJM, Boekholdt SM. Unroofed coronary sinus newly diagnosed in adult patients after corrected congenital heart disease. Neth Heart J 2014; 22:240-5. [PMID: 24590769 PMCID: PMC4016326 DOI: 10.1007/s12471-014-0533-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Patients with congenital heart disease corrected in early childhood may later in life present with cardiac symptoms caused by other associated congenital anomalies that were initially not diagnosed. Nowadays, several noninvasive imaging modalities are available for the visualisation of cardiac anatomy in great detail. We describe two patients with an unroofed coronary sinus, a rare congenital anomaly which could be diagnosed using a combination of modalities including echocardiography, cardiac CT and cardiac MRI.
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Affiliation(s)
- A J Pérez Matos
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM, Nieuwegein, the Netherlands
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Wiegerinck EMA, Marquering HA, Oldenburger NY, Elattar MA, Planken RN, De Mol BAJM, Piek JJ, Baan J. Imaging for approach selection of TAVI: assessment of the aorto-iliac tract diameter by computed tomography-angiography versus projection angiography. Int J Cardiovasc Imaging 2013; 30:399-405. [PMID: 24326399 DOI: 10.1007/s10554-013-0343-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 05/13/2013] [Accepted: 11/29/2013] [Indexed: 12/19/2022]
Abstract
The choice of preferred access route for transcatheter aortic valve implantation (TAVI) is mainly guided by the minimal aorto-femoral tract diameter. Currently, projection angiography (XA) and CT-angiography (CTA) are used interchangeably to assess this diameter in the TAVI work-up. We aimed to assess the agreement of XA and CTA diameter measurements in TAVI candidates. Diameters of 700 aorta-iliac segments of 102 TAVI candidates were analyzed on both XA and CTA. The diameters on XA were measured manually, for the CTA-based analysis semi-automated segmentation software was used. Paired sample T test was used to evaluate differences in diameter measurements between the modalities. Disagreement on the suitability for a transfemoral (TF)-TAVI approach was identified. The interobserver agreement for both measurements was assessed by calculating the intraclass correlation coefficient (ICC). The average diameters were 10.1 ± 1.8 mm and 8.4 ± 1.7 for XA and CTA respectively. The mean paired difference was 1.73 mm (p < 0.001). For 18 patients (17.6 %) diameters measured on CTA images, were bilaterally less than 6 mm, whilst XA indicated a minimum diameter exceeding 6 mm. For both modalities, the interobserver agreement was excellent (ICC 0.95). Diameters measured semi-automatically on CTA were statistically significantly smaller compared to XA. This should be acknowledged in the work-up for selecting the most appropriate approach for TAVI. In our population 17.6 % of patients would have been denied a transfemoral TAVI based on CTA measurements, whilst XA suggested diameters sufficient for a TF approach.
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Affiliation(s)
- E M A Wiegerinck
- Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands,
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Bode AS, Planken RN, Merkx MAG, van der Sande FM, Geerts L, Tordoir JHM, Leiner T. Feasibility of non-contrast-enhanced magnetic resonance angiography for imaging upper extremity vasculature prior to vascular access creation. Eur J Vasc Endovasc Surg 2011; 43:88-94. [PMID: 22070856 DOI: 10.1016/j.ejvs.2011.09.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 09/12/2011] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Preoperative mapping of arterial and venous anatomy helps to prevent postoperative complications after vascular access creation. The use of gadolinium in contrast-enhanced (CE) magnetic resonance angiography (MRA) has been linked to nephrogenic systemic fibrosis in patients with end-stage renal disease (ESRD). The purpose of this study was to evaluate non-contrast-enhanced (NCE) MRA for assessment of upper extremity and central vasculature and to compare it with CE-MRA. METHODS NCE and CE-MRA images were acquired in 10 healthy volunteers and 15 patients with ESRD. In each data set, two observers analysed 11 arterial and 16 venous segments with regard to image quality (0-4), presence of artefacts (0-2) and vessel-to-background ratio. RESULTS More arterial segments were depicted using CE-MRA compared to NCE-MRA (99% vs. 96%, p = 0.001) with mean image quality of 3.80 vs. 2.68, (p < 0.001) and mean vessel-to-background ratio of 6.47 vs. 4.14 (p < 0.001). Ninety-one percent of the venous segments were portrayed using NCE-MRA vs. 80% using CE-MRA (p < 0.001). Mean image quality and vessel-to-background ratio were 2.41 vs. 2.21 (p = 0.140) and 5.13 vs. 3.88 (p < 0.001), respectively. CONCLUSIONS Although arterial image quality and vessel-to-background ratios were lower, NCE-MRA is considered a feasible alternative to CE-MRA in patients with ESRD who need imaging of the upper extremity and central vasculature prior to dialysis access creation.
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Affiliation(s)
- A S Bode
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6202 AZ Maastricht, The Netherlands
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Planken RN, Leiner T, Nijenhuis RJ, Duijm LE, Cuypers PW, Douwes-Draaijer P, Van Der Sande FM, Kessels AG, Tordoir JHM. Contrast-enhanced magnetic resonance angiography findings prior to hemodialysis vascular access creation: a prospective analysis. J Vasc Access 2008; 9:269-277. [PMID: 19085897] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
PURPOSE To determine prospectively the clinical value of contrast-enhanced magnetic resonance angiography (CE-MRA) for assessment of the arterial inflow and venous outflow prior to vascular access (VA) creation. METHODS Seventy-three patients underwent duplex ultrasonography (DUS) and CE-MRA prior to VA creation for detection of stenoses and occlusions. Two observers read the CE-MRA images for determination of inter-observer agreement. A VA was considered functional if it could be used for successful two-needle hemodialysis therapy within 2 months after creation. RESULTS CE-MRA detected 6 stenosed, 8 occluded arterial vessel segments and 12 stenosed and 41 occluded venous vessel segments in 70 patients. Inter-observer agreement for detection of upper extremity arterial and venous stenoses and occlusions with CE-MRA was substantial to almost perfect (kappa values 0.76-0.96). CE-MRA detected lesions, not detected by DUS, that were associated with VA early failure and non-maturation in 33% of patients (7/21). Accessory veins detected preoperatively were the cause of VA non-maturation in a substantial group of patients (47%: 7/15). CONCLUSION CE-MRA enables accurate detection of upper extremity arterial and venous stenosis and occlusions prior to VA creation. Preoperative CE-MRA identified arterial and venous stenoses, not detected by DUS that were associated with VA early failure and non-maturation. However, the use of gadolinium containing contrast media is currently contraindicated due the reported incidence of nephrogenic systemic fibrosis.
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Affiliation(s)
- R N Planken
- Department of Vascular Surgery, Maastricht University Hospital, Maastricht University Medical School, Maastricht, The Netherlands.
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Planken RN, Duijm LE, Kessels AG, Leiner T, Kooman JP, Van Der Sande FM, Tordoir JHM. Accessory veins and radial-cephalic arteriovenous fistula non-maturation: a prospective analysis using contrast-enhanced magnetic resonance angiography. J Vasc Access 2007; 8:281-286. [PMID: 18161675] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
PURPOSE To determine if large caliber accessory veins are associated with radial-cephalic arteriovenous fistula (RC-AVF) non-maturation. METHODS RC-AVFs were created in 15 consecutive patients (radial artery and cephalic vein diameter > 2 mm, in the absence of arterial inflow or venous outflow stenoses or occlusions). Contrast-enhanced magnetic resonance angiography (CE-MRA) was performed preoperatively for the determination of vessel diameters, stenoses and occlusions. The location and caliber of accessory veins was determined. Vascular access (VA) function was monitored and all interventions required to obtain a functioning VA were recorded. Non-maturation was defined as a nonfunctional VA at 2 months after creation. The predictive value of accessory vein caliber for prediction of RC-AVF non-maturation was evaluated using receiver operating characteristic (ROC) analysis. RESULTS Non-maturation occurred in 10 (67%) out of 15 RC-AVFs. Large caliber accessory veins (n = 4), venous stenosis (n = 3) or both (n = 2) were associated with RC-AVF non-maturation. The presence of large caliber accessory veins was the only significant predictor for RC-AVF non-maturation (p = 0.01). Preoperatively detected accessory veins with a diameter > 70% of the cephalic vein diameter, had a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 80, 100, 100 and 91% for prediction of RC-AVF non-maturation on patient level. Accessory vein ligation and dilatation of venous stenosis resulted in an overall salvage success rate of 89% (8/9). CONCLUSION Large caliber accessory veins are associated with RC-AVF non-maturation. Ligation of large caliber accessory veins is a successful salvage procedure in a substantial group of patients. Furthermore, ligation of these accessory veins during initial RC-AVF creation can potentially reduce non-maturation rates; and therefore, preoperative assessment of accessory veins is recommended.
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Affiliation(s)
- R N Planken
- Department of Vascular Surgery, Maastricht University, Maastricht, The Netherlands.
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Planken RN, Tordoir JHM, Duijm LEM, de Haan MW, Leiner T. Current techniques for assessment of upper extremity vasculature prior to hemodialysis vascular access creation. Eur Radiol 2007; 17:3001-11. [PMID: 17486345 DOI: 10.1007/s00330-007-0662-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [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: 09/26/2006] [Revised: 04/04/2007] [Accepted: 04/05/2007] [Indexed: 10/23/2022]
Abstract
Vascular access problems lead to increased patient morbidity and mortality and place a large burden on care facilities, manpower and costs. Autogenous arteriovenous fistulas (AVF) are preferred over arteriovenous grafts (AVG) because of a lower incidence of vascular access related complications. An aggressive increase in the utilization of AVF, however, results in an increased incidence of AVF early failure and non-maturation. Increasing evidence suggests that routine preoperative assessment results in an increased utilization of functioning AVF by better selection of adequate vessels. To date, the reproducibility and standardization of assessment protocols are lacking and assessment of a single morphological parameter has not enabled adequate prediction of postoperative AVF function for individual patients. In this paper, we provide an overview of available diagnostic modalities and parameters that potentially enable better selection of adequate vessels for successful AVF creation.
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Affiliation(s)
- R N Planken
- Department of Vascular Surgery, Maastricht University Hospital, Peter Debijelaan 25, 6202 AZ, Maastricht, The Netherlands.
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