Publications by authors named "Jan Verwerft"

10 Publications

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Iron Deficiency Is Associated With Impaired Biventricular Reserve and Reduced Exercise Capacity in Patients With Unexplained Dyspnea.

J Card Fail 2021 Apr 7. Epub 2021 Apr 7.

Department of Cardiology, Hartcentrum, Jessa Hospital, Hasselt, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.

Background: Iron deficiency (ID) is frequent and associated with diminished exercise capacity in heart failure (HF), but its contribution to unexplained dyspnea without a HF diagnosis at rest remains unclear.

Methods And Results: Consecutive patients with unexplained dyspnea and normal echocardiography and pulmonary function tests at rest underwent prospective standardized cardiopulmonary exercise testing with echocardiography in a tertiary care dyspnea clinic. ID was defined as ferritin of <300 µg/L and a transferrin saturation of <20% and its impact on peak oxygen uptake (peakVO), biventricular response to exercise, and peripheral oxygen extraction was assessed. Of 272 patients who underwent cardiopulmonary exercise testing with echocardiography, 63 (23%) had ID. For a similar respiratory exchange ratio, patients with ID had lower peakVO (14.6 ± 7.6 mL/kg/minvs 17.8 ± 8.8 mL/kg/min; P = .009) and maximal workload (89 ± 50 watt vs 108 ± 56 watt P = .047), even after adjustment for the presence of anemia. At rest, patients with ID had a similar left ventricular and right ventricular (RV) contractile function. During exercise, patients with ID had lower cardiac output reserve (P < .05) and depressed RV function by tricuspid s' (P = .004), tricuspid annular plane systolic excursion (P = .034), and RV end-systolic pressure-area ratio (P = .038), with more RV-pulmonary artery uncoupling measured by tricuspid annular plane systolic excursion/systolic pulmonary arterial pressure ratio (P = .023). RV end-systolic pressure-area ratio change from rest to peak exercise, as a load-insensitive metric of RV contractility, was lower in patients with ID (2.09 ± 0.72 mm Hg/cm vs 2.58 ± 1.14 mm Hg/cm; P < .001). ID was associated with impaired peripheral oxygen extraction (peakVO/peak cardiac output; P = .036). Cardiopulmonary exercise testing with echocardiography resulted in a diagnosis of HF with preserved ejection fraction in 71 patients (26%) based on an exercise E/e' ratio of >14, with equal distribution in patients with (28.6%) or without ID (25.4%, P = .611). None of these findings were influenced in a sensitivity analysis adjusted for a final diagnosis of HFpEF as etiology for the unexplained dyspnea.

Conclusions: In patients with unexplained dyspnea without clear HF at rest, ID is common and associated with decreased exercise capacity, diminished biventricular contractile reserve, and decreased peripheral oxygen extraction.
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http://dx.doi.org/10.1016/j.cardfail.2021.03.010DOI Listing
April 2021

Cardiac Function is Preserved in Adolescents With Well-Controlled Type 1 Diabetes and a Normal Physical Fitness: A Cross-sectional Study.

Can J Diabetes 2021 Jan 23. Epub 2021 Jan 23.

Faculty of Rehabilitation Sciences, Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium; Faculty of Medicine and Life Sciences, Biomedical Research Centre, Hasselt University, Diepenbeek, Belgium; Jessa Hospital, Heart Centre Hasselt, Hasselt, Belgium.

Objectives: Cardiovascular diseases and exercise intolerance elevate mortality in type 1 diabetes (T1D). Left ventricular systolic and diastolic function are already affected in T1DM adolescents, displaying poor glycemic control (glycated hemoglobin [A1C]>7.5%) and exercise intolerance. We investigated to the extent to which left ventricular function is affected by disease severity/duration and whether this is related to exercise capacity.

Methods: Transthoracic echocardiography was performed in 19 T1DM adolescents (14.8±1.9 years old, A1C 7.4±0.9%) and 19 controls (14.4±1.3 years old, A1C 5.3±0.2%), matched for age and Tanner stage. Diastolic and systolic (ejection fraction [EF]) function were assessed. Cardiopulmonary exercise testing was used to evaluate exercise capacity, as measured by peak oxygen uptake (VO).

Results: VO and left ventricular systolic and diastolic function were similar in both groups. Within the T1D group, EF was negatively associated with disease duration (r=-0.79 corrected for age, standardized body mass index, glucose variability and VO; p=0.011). Regression analyses revealed that 37.6% of the variance in EF could be attributed to disease duration.

Conclusions: Although left ventricular systolic and diastolic function are preserved in T1D with adequate exercise capacity, disease duration negatively affects EF. The detrimental effects of T1D seem to be driven by disease duration, rather than by disease severity, at least during adolescence. Young T1D patients may, therefore, benefit from cardiovascular evaluation in order to detect cardiovascular abnormalities early in the disease course, and therefore, improve long-term cardiovascular health.
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http://dx.doi.org/10.1016/j.jcjd.2021.01.010DOI Listing
January 2021

Immunoglobulin G4-related pseudotumour of the mitral valve.

Eur Heart J Case Rep 2020 Dec 5;4(6):1-2. Epub 2020 Nov 5.

Department of Cardiology, Jessa Hospital, Hasselt, Belgium.

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http://dx.doi.org/10.1093/ehjcr/ytaa340DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891235PMC
December 2020

Exercise capacity is related to attenuated responses in oxygen extraction and left ventricular longitudinal strain in asymptomatic type 2 diabetes patients.

Eur J Prev Cardiol 2020 Nov 20. Epub 2020 Nov 20.

Department of REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Belgium.

Aims: Type 2 diabetes mellitus (T2DM) is associated with reduced exercise capacity and cardiovascular diseases, both increasing morbidity and risk for premature death. As exercise intolerance often relates to cardiac dysfunction, it remains to be elucidated to what extent such an interplay occurs in T2DM patients without overt cardiovascular diseases. Design: Cross-sectional study, NCT03299790.

Methods And Results: Fifty-three T2DM patients underwent exercise echocardiography (semi-supine bicycle) with combined ergospirometry. Cardiac output (CO), left ventricular longitudinal strain (LS), oxygen uptake (O2), and oxygen (O2) extraction were assessed simultaneously at rest, low-intensity exercise, and high-intensity exercise. Glycaemic control and lipid profile were assessed in the fasted state. Participants were assigned according to their exercise capacity being adequate or impaired (EXadequate: O2peak <80% and EXimpaired: O2peak ≥80% of predicted O2peak) to compare O2 extraction, CO, and LS at all stages. Thirty-eight participants (EXimpaired: n = 20 and EXadequate: n = 18) were included in the analyses. Groups were similar regarding HbA1c, age, and sex (P > 0.05). At rest, CO was similar in the EXimpaired group vs. EXadequate group (5.1 ± 1 L/min vs. 4.6 ± 1.4 L/min, P > 0.05) and increased equally during exercise. EXimpaired patients displayed a 30.7% smaller increase in O2 extraction during exercise compared to the EXadequate group (P = 0.016) which resulted in a lower O2 extraction at high-intensity exercise (12.5 ± 2.8 mL/dL vs. 15.3 ± 3.9 mL/dL, P = 0.012). Left ventricular longitudinal strain was similar at rest but increased significantly less in the EXimpaired vs. EXadequate patients (1.9 ± 2.5% vs. 5.9 ± 4.1%, P = 0.004).

Conclusions: In asymptomatic T2DM patients, an impaired exercise capacity is associated with an impaired response in oxygen extraction and myocardial deformation (LS).

Trial Registry: Effect of High-intensity Interval Training on Cardiac Function and Regulation of Glycemic Control in Diabetic Cardiomyopathy (https://clinicaltrials.gov/ct2/show/NCT03299790).
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http://dx.doi.org/10.1093/eurjpc/zwaa007DOI Listing
November 2020

Comparison of versus upgrade cardiac resynchronisation therapy on clinical effect and long-term outcome.

Acta Cardiol 2021 Jan 12:1-9. Epub 2021 Jan 12.

Heart Centre, Jessa Hospital Hasselt, Hasselt, Belgium.

Background: The benefit of cardiac resynchronisation therapy (CRT) implantation in selected patients with heart failure is well known. The number of upgrade procedures is increasing but data on clinical response and outcome are less well documented as compared to implantation.

Objectives: To investigate the efficacy and outcome of CRT upgrade procedures in patients with existing cardiac implantable electronic devices (CIEDs).

Methods: Baseline characteristics, change in New York Heart Association (NYHA) functional class, echocardiographic parameters, life-threatening ventricular tachyarrhythmias, all-cause mortality and mode of death were evaluated in CRT patients with the comparison between and upgrade CRT procedures.

Results: About 410 patients (CRT upgrade/ CRT,  = 97/313) were followed for 63.5 ± 38.1 months. Upgrade patients were older (75.5 ± 8.1 vs 69.9 ± 10.7 years;  < 0.001), had more often an ischaemic cause of heart failure (58.8% vs 45.4%;  = 0.021), a higher NYHA functional class ( = 0.004) and a higher comorbidity burden. Improvement in left ventricular ejection fraction (LVEF) was higher in the CRT group (8.4 ± 9.9 vs 11.0 ± 10.3%;  = 0.035). Clinical response was similar between both groups (60.5 vs 62.5%;  = 0.793), as was mortality at 1 year (8.2 vs 5.8%;  = 0.351) and at last follow-up (33.0 vs 28.8%;  = 0.447). The proportion of cardiovascular related deaths was similar between both groups (46.9% vs 38.9%;  = 0.531).

Conclusions: Patients with CRT upgrade procedures have similar symptomatic improvements, as well as 1 year and long-term outcome as compared to patients with CRT implantation.
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http://dx.doi.org/10.1080/00015385.2020.1867387DOI Listing
January 2021

Asymptomatic type 2 diabetes mellitus display a reduced myocardial deformation but adequate response during exercise.

Eur J Appl Physiol 2021 Mar 8;121(3):929-940. Epub 2021 Jan 8.

REVAL-Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium.

Background And Purpose: The development of myocardial fibrosis is a major complication of Type 2 diabetes mellitus (T2DM), impairing myocardial deformation and, therefore, cardiac performance. It remains to be established whether abnormalities in longitudinal strain (LS) exaggerate or only occur in well-controlled T2DM, when exposed to exercise and, therefore, cardiac stress. We therefore studied left ventricular LS at rest and during exercise in T2DM patients vs. healthy controls.

Methods And Results: Exercise echocardiography was applied with combined breath-by-breath gas exchange analyses in asymptomatic, well-controlled (HbA1c: 6.9 ± 0.7%) T2DM patients (n = 36) and healthy controls (HC, n = 23). Left ventricular LS was assessed at rest and at peak exercise. Peak oxygen uptake (V̇O) and workload (W) were similar between groups (p > 0.05). Diastolic (E, e', E/e') and systolic function (left ventricular ejection fraction) were similar at rest and during exercise between groups (p > 0.05). LS (absolute values) was significantly lower at rest and during exercise in T2DM vs. HC (17.0 ± 2.9% vs. 19.8 ± 2% and 20.8 ± 4.0% vs. 23.3 ± 3.3%, respectively, p < 0.05). The response in myocardial deformation (the change in LS from rest up to peak exercise) was similar between groups (+ 3.8 ± 0.6% vs. + 3.6 ± 0.6%, in T2DM vs. HC, respectively, p > 0.05). Multiple regression revealed that HDL-cholesterol, fasted insulin levels and exercise tolerance accounted for 30.5% of the variance in response of myocardial deformation in the T2DM group (p = 0.002).

Conclusion: Myocardial deformation is reduced in well-controlled T2DM and despite adequate responses, such differences persist during exercise.

Trial Registration: NCT03299790, initially released 09/12/2017.
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http://dx.doi.org/10.1007/s00421-020-04557-5DOI Listing
March 2021

An uncommon cause of iatrogenic tricuspid valve regurgitation.

Eur Heart J Cardiovasc Imaging 2020 10;21(11):1215

Department of Cardiology, Jessa Hospital, Hasselt, 3500 Hasselt, Belgium.

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http://dx.doi.org/10.1093/ehjci/jeaa125DOI Listing
October 2020

Rationale and design of the IRON-CRT trial: effect of intravenous ferric carboxymaltose on reverse remodelling following cardiac resynchronization therapy.

ESC Heart Fail 2019 12 28;6(6):1208-1215. Epub 2019 Sep 28.

Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.

Aims: Iron deficiency is common in heart failure with reduced ejection fraction (HFrEF). In patients with cardiac resynchronization therapy (CRT), it is associated with a diminished reverse remodelling response and poor functional improvement. The latter is partially related to a loss in contractile force at higher heart rates (negative force-frequency relationship).

Methods And Results: The effect of intravenous ferric carboxymaltose on reverse remodelling following cardiac resynchronization therapy (IRON-CRT) trial is a multicentre, prospective, randomized, double-blind controlled trial in HFrEF patients who experienced incomplete reverse remodelling (defined as a left ventricular ejection fraction below <45%) at least 6 months after CRT. Additionally, patients need to have iron deficiency defined as a ferritin below 100 μg/L irrespective of transferrin saturation or a ferritin between 100 and 300 μg/L with a transferrin saturation <20%. Patients will be randomized to either intravenous ferric carboxymaltose (dose based according to Summary of Product Characteristics) or intravenous placebo. The primary objective is to evaluate the effect of ferric carboxymaltose on metrics of cardiac reverse remodelling and contractility, measured by the primary endpoint, change in left ventricular ejection fraction assessed by three-dimensional (3D) echo from baseline to 3 month follow-up and the secondary endpoints change in left ventricular end-systolic and end-diastolic volume. The secondary objective is to determine if ferric carboxymaltose is capable of improving cardiac contractility in vivo, by assessing the force-frequency relationship through incremental biventricular pacing. A total of 100 patients will be randomized in a 1:1 fashion.

Conclusions: The IRON-CRT trial will determine the effect of ferric carboxymaltose on cardiac reverse remodelling and rate-dependent cardiac contractility in HFrEF patients.
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http://dx.doi.org/10.1002/ehf2.12503DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6989286PMC
December 2019

Complicated Infective Endocarditis of a Mechanical Aortic Valve due to Propionibacterium acnes.

J Heart Valve Dis 2016 05;25(3):364-368

Department of Cardiology, Jessa Hospitals, Hasselt, Belgium.

Propionibacterium acnes is known to be a causative microorganism in low-grade and late prosthetic valve endocarditis. Here, the case is reported of a late, apparently culture-negative endocarditis of an aortic mechanical prosthesis, diagnosed to be caused by P. acnes after pan-bacterial polymerase chain reaction (PCR) on the explanted mechanical prosthetic valve. This endocarditis was complicated by an aortic root abscess; after surgical resection a ventricular septal defect (VSD) with overt right ventricular and multiple organ failure occurred. Low suspicion, the failure of routine blood culture to grow P. acnes and erroneous interpretation of P. acnes as contamination, frequently delay the correct diagnosis and treatment of this condition. Hence, although infection with P. acnes is usually indolent, abscess formation and a need for surgery are common.
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May 2016