Publications by authors named "Robert K Riezebos"

28 Publications

  • Page 1 of 1

One-year mortality in NSTEMI patients is unaffected by timing of PCI within the first week of admission: Results of a real-world cohort analysis.

Catheter Cardiovasc Interv 2021 Jul 15. Epub 2021 Jul 15.

Heart Center, OLVG Hospital, Amsterdam, Netherlands.

Objectives: We aimed to explore the impact of time to percutaneous coronary intervention (PCI) (T2P) on 1-year mortality in non-ST-elevation myocardial infarction (NSTEMI) patients.

Background: The current guidelines recommend an early invasive strategy for NSTEMI patients. However, impact of an early invasive strategy on mortality is a matter of debate. For that reason, real world data are of great value to determine the optimal treatment window.

Methods: This retrospective single center cohort study was performed in a high-volume PCI center in Amsterdam, The Netherlands. Intermediate- and high-risk NSTEMI patients undergoing PCI were included. The main discriminant was timing of PCI after admission (T2P), stratified according to different time windows (<24 h, 24-72 h, 72 h-7 days or >7 days). We analyzed 1-year mortality and the time distribution of overall survival.

Results: In total, 848 patients treated between January 1, 2016 and January 1, 2018 were included in the analysis. T2P was <24 h in 145 patients, 24-72 h in 192 patients, 72 h-7 days in 275 patients, and >7 days in 236 patients. The mean GRACE-risk score was 127.1 (SD 28.7), 130.0 (33.1), 133.8 (32.1), and 148.7 (34.6) respectively, p = <0.001. After adjusting for confounders, 1-year mortality in patients with T2P <24 h did not significantly differ when compared with T2P 24-72 h (OR = 1.08; 95% CI = 0.33-3.51) and T2P 72 h-7 days (OR 1.72; 95% CI = 0.57-5.21) but was significantly higher in T2P >7 days (OR = 3.20; 95% CI = 1.06-9.68).

Conclusions: In an unselected cohort of patients with NSTEMI, treatment by PCI <24 h did not lead to improved survival as compared to aT2P <7 days strategy. Delay in PCI >7 days after admission resulted in worse outcome.
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http://dx.doi.org/10.1002/ccd.29873DOI Listing
July 2021

Non-bacterial thrombotic endocarditis manifested by ventricular fibrillation in a patient with low grade ovarian carcinoma: case report and literature review.

Eur Heart J Case Rep 2021 Apr 21;5(4):ytab120. Epub 2021 Apr 21.

Department of cardiology, Heart Centre OLVG, Oosterparkstraat 9, 1091 AC Amsterdam, the Netherlands.

Background: Non-bacterial thrombotic endocarditis (NBTE) is a rare form of endocarditis notably described in patients with advanced malignancy and auto-immune diseases. It is characterized by the formation of sterile, fibrin-containing vegetations on cardiac endothelium, in the absence of positive blood cultures. It is predominantly located on the mitral- and aortic valve (AV). Vegetations in NBTE are prone to embolize. Trousseau syndrome (TS) is defined as unexplained thrombotic events that precede the diagnosis of malignancy.

Case Summary: A 49-year-old pre-menopausal woman with a history of visual disturbances, recurrent deep vein thrombosis (DVT) with concurrent pulmonary emboli (PE), and uterine myomas with dysfunctional uterine bleeding was resuscitated for ventricular fibrillation. While echocardiography revealed vegetations on the AV, blood cultures remained negative. Additional work-up for the aetiology of sterile vegetations revealed a low-grade ovarian carcinoma. Cardiac analysis showed evidence of myocardial infarction in the absence of coronary atherosclerosis as a cause for ventricular fibrillation.

Discussion: Unexplained thrombotic events (venous, arterial, or both) warrant further investigation, e.g., with regard to TS. NBTE is a potential source of thromboembolism in TS and a rare ante-mortem finding, which prompts additional investigation of the underlying cause. In our patient, a triad of (suspected) (i) arterial/systemic embolization (i.e. visual disturbances, splenic infarction, coronary embolism), (ii) peripheral thrombophlebitis/hypercoagulability (i.e. DVT and PE), and (iii) malignancy (i.e. gynaecological abnormalities) raised suspicion of NBTE in the setting of TS. Early diagnosis and treatment of NBTE is of importance due to the high incidence of embolization, with possible fatal outcome.
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http://dx.doi.org/10.1093/ehjcr/ytab120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183660PMC
April 2021

[Thromboembolisms due to recreational use of nitrous oxide].

Ned Tijdschr Geneeskd 2021 04 26;165. Epub 2021 Apr 26.

OLVG, Amsterdam: Afd. Hartcentrum.

Nitrous oxide (N2O) is increasingly used as a recreational drug, and is presumed relatively safe and innocent. The risks for neurological complications are often known, however the risks of serious thromboembolic events are not. We describe three cases of acute thromboembolic events resulting in serious cardiovascular complications after N2O abuse: one case of myocardial infarction that resulted in a reduced ejection fraction, one case of peripheral arterial occlusion that led to limb amputation and one case of pulmonary embolism that resulted in hemodynamic instability requiring extracorporeal membrane oxygenation (ECMO) and surgical removal. All patients were young adults with a low cardiovascular risk profile. N2O inactivates vitamin B12, leading to vitamin B12 deficiency and subsequent to hyperhomocysteinemia, which is associated with the formation of fibrinolysis-resistant blood thrombi. In conclusion, we contest the safety and innocence of recreational N2O (ab)use. Our three cases illustrate that, next to previously described neurological complications, the use of nitrous oxide is associated with thromboembolic cardiovascular complications, presumably mediated by hyperhomocysteinemia.
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April 2021

Case report of an acute myocardial infarction after high-dose recreational nitrous oxide use: a consequence of hyperhomocysteinaemia?

Eur Heart J Case Rep 2021 Feb 12;5(2):ytaa557. Epub 2021 Jan 12.

Department of Cardiology, OLVG, Oosterpark 9, 1091 AC Amsterdam, The Netherlands.

Background: Nitrous oxide (NO, laughing gas) is increasingly used as a recreational drug and is presumed relatively safe and innocent. It is often being used in combination with other substances, such as cannabis.

Case Summary: A young adult attended the emergency room because of chest pain after recreational use of very high-dose nitrous oxide in combination with cannabis. Electrocardiography demonstrated ST-elevation in the anterior leads. Coronary angiography showed thrombus in the proximal and thrombotic occlusion of the distal left anterior descending coronary artery for which primary percutaneous coronary intervention was attempted. Thrombus aspiration was unsuccessful and the patient was further treated with a glycoprotein IIb/IIIa in addition to dual platelet therapy. Blood results showed low vitamin B12 and folic acid status with concomitant hyperhomocysteinaemia, a known cause of hypercoagulation. Transthoracic echocardiogram showed a moderately reduced left ventricular ejection fraction (LVEF). Three months later, an improvement in LVEF and no recurrent angina or symptoms of heart failure were noticed.

Discussion: We report a case of acute myocardial infarction secondary to very high-dose nitrous oxide abuse in combination with cannabis and possible hypoxia. We propose that severe hyperhomocysteinaemia secondary to nitrous oxide-induced vitamin B12 deficiency together with the vasoconstrictive effects of cannabis might pose a seriously increased risk for intracoronary, among others, thrombus formation. In conclusion, we contest the safety and innocence of recreational nitrous oxide (ab)use, notably in the context of other factors increasing the risk of coagulation.
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http://dx.doi.org/10.1093/ehjcr/ytaa557DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7873791PMC
February 2021

An immediate or early invasive strategy in non-ST-elevation acute coronary syndrome: The OPTIMA-2 randomized controlled trial.

Am Heart J 2021 04 7;234:42-50. Epub 2021 Jan 7.

Heart Center, OLVG Hospital, Amsterdam, the Netherlands.

Background: In intermediate- and high-risk non-ST elevated acute coronary syndrome (NSTE-ACS) patients, a routine invasive approach is recommended. The timing of coronary angiography remains controversial. To assess whether an immediate (<3 hours) invasive treatment strategy would reduce infarct size and is safe, compared with an early strategy (12-24 hours), for patients admitted with NSTE-ACS while preferably treated with ticagrelor.

Methods: In this single-center, prospective, randomized trial an immediate or early invasive strategy was randomly assigned to patients with NSTE-ACS. At admission, the patients were preferably treated with a combination of aspirin, ticagrelor and fondaparinux. The primary endpoint was the infarct size as measured by area under the curve (AUC) of CK-MB in 48 hours. Secondary endpoints were bleeding outcomes and major adverse cardiac events (MACE): composite of all-cause death, MI and unplanned revascularization. Interim analysis showed futility regarding the primary endpoint and trial inclusion was terminated.

Results: In total 249 patients (71% of planned) were included. The primary endpoint of in-hospital infarct size was a median AUC of CK-MB 186.2 ng/mL in the immediate group (IQR 112-618) and 201.3 ng/mL in the early group (IQR 119-479). Clinical follow-up was 1-year. The MACE-rate was 10% in the immediate and 10% in the early group (hazard ratio [HR] 1.13, 95% CI: 0.52-2.49).

Conclusions: In NSTE-ACS patients randomized to either an immediate or an early-invasive strategy the observed median difference in the primary endpoint was about half the magnitude of the expected difference. The trial was terminated early for futility after 71% of the projected enrollment had been randomized into the trial.
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http://dx.doi.org/10.1016/j.ahj.2021.01.001DOI Listing
April 2021

The current practice for cocaine-associated chest pain in the Netherlands.

Toxicol Rep 2021 18;8:23-27. Epub 2020 Dec 18.

Department of Cardiology, OLVG Hospital, Amsterdam, the Netherlands.

Introduction: Cocaine is considered a cardiovascular risk factor, yet it is not included in the frequently used risk stratification scores. Moreover, many guidelines provide limited advice on how to diagnose and treat cocaine-associated chest pain (CACP). This study aimed to determine the current practice for CACP patients in emergency departments and coronary care units throughout the Netherlands.

Methods: An anonymous online questionnaire-based survey was conducted among Dutch emergency physicians and cardiologists between July 2015 and February 2016. The questionnaire was based on the American Heart Association CACP treatment algorithm.

Results: A total of 214 subjects were enrolled and completed the questionnaire. All responders considered cocaine use a risk factor for developing acute coronary syndrome (ACS), nevertheless 74.4 % of emergency physicians and 81.1 % of cardiologists do not always question chest pain patients about drug use. Of all responders, 73.6 % never perform toxicology screening. Most responders (60 %) observe patients with CACP according to the European Society of Cardiology ACS guideline, and 24.3 % give these patients ß-blockers.

Conclusion: The current practice for CACP patients in most emergency departments and coronary care units in the Netherlands is not in line with the AHA scientific statement. Emergency physicians and cardiologists should be advised to routinely question all chest pain patients on drug history and be aware that the risk stratifications scores are not validated for CACP. Despite the AHA scientific statement of 2008, many respondents utilize ß-blockers for CACP patients, which is supported by published evidence since the statement appeared.
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http://dx.doi.org/10.1016/j.toxrep.2020.12.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7770504PMC
December 2020

A Perforated Mitral Valve Aneurysm: A Rare but Serious Complication of Aortic Valve Endocarditis Resulting From a Regurgitant Jet Lesion.

Cureus 2020 Nov 23;12(11):e11644. Epub 2020 Nov 23.

Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, NLD.

Infective endocarditis has high morbidity and mortality rates. The aortic valve is most often affected in native valve endocarditis. Complications of aortic valve endocarditis range from local abscess and fistula formation, systemic complications secondary to thromboembolism and septic embolization, to congestive heart failure resulting from conduction system involvement and valve damage. A rare complication of aortic valve endocarditis is the occurrence of a 'jet lesion' on the mitral valve. Such a lesion, caused by an impinging regurgitant jet stream from a damaged aortic valve, can become directly and indirectly inoculated and evolve into a local infected aneurysm which might eventually rupture causing acute severe congestive heart failure and/or peripheral thromboembolism. We present the case of a 63-year-old man who presented with aortic valve endocarditis complicated by a perforated mitral valve aneurysm, congestive heart failure, and peripheral thromboembolism.
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http://dx.doi.org/10.7759/cureus.11644DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755663PMC
November 2020

Myocardial Infarction in the ISCHEMIA Trial: Impact of Different Definitions on Incidence, Prognosis, and Treatment Comparisons.

Circulation 2021 Feb 3;143(8):790-804. Epub 2020 Dec 3.

New York University Grossman School of Medicine, New York (J.S.B., H.R.R., S.B., J.S.H.).

Background: In the ISCHEMIA trial (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches), an initial invasive strategy did not significantly reduce rates of cardiovascular events or all-cause mortality in comparison with a conservative strategy in patients with stable ischemic heart disease and moderate/severe myocardial ischemia. The most frequent component of composite cardiovascular end points was myocardial infarction (MI).

Methods: ISCHEMIA prespecified that the primary and major secondary composite end points of the trial be analyzed using 2 MI definitions. For procedural MI, the primary MI definition used creatine kinase-MB as the preferred biomarker, whereas the secondary definition used cardiac troponin. Procedural thresholds were >5 times the upper reference level for percutaneous coronary intervention and >10 times for coronary artery bypass grafting. Procedural MI definitions included (1) a category of elevated biomarker only events with much higher biomarker thresholds, (2) new ST-segment depression of ≥1 mm for the primary and ≥0.5 mm for the secondary definition, and (3) new coronary dissections National Heart, Lung, and Blood Institute grade 3. We compared MI type, frequency, and prognosis by treatment assignment using both MI definitions.

Results: Procedural MIs accounted for 20.1% of all MI events with the primary definition and 40.6% of all MI events with the secondary definition. Four-year MI rates in patients undergoing revascularization were more frequent with the invasive versus conservative strategy using the primary (2.7% versus 1.1%; adjusted hazard ratio [HR], 2.98 [95% CI, 1.87-4.73]) and secondary (8.2% versus 2.0%; adjusted HR, 5.04 [95% CI, 3.64-6.97]) MI definitions. Type 1 MIs were less frequent with the invasive versus conservative strategy using the primary (3.40% versus 6.89%; adjusted HR, 0.53 [95% CI, 0.41-0.69]; <0.0001) and secondary (3.48% versus 6.89%; adjusted HR, 0.53 [95% CI, 0.41-0.69]; <0.0001) definitions. The risk of subsequent cardiovascular death was higher after a type 1 MI than after no MI using the primary (adjusted HR, 3.38 [95% CI, 2.03-5.61]; <0.001) or secondary MI definition (adjusted HR, 3.52 [2.11-5.88]; <0.001).

Conclusions: In ISCHEMIA, type 1 MI events using the primary and secondary definitions during 5-year follow-up were more frequent with an initial conservative strategy and associated with subsequent cardiovascular death. Procedural MI rates were greater in the invasive strategy and with the use of the secondary MI definition. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01471522.
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http://dx.doi.org/10.1161/CIRCULATIONAHA.120.047987DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902479PMC
February 2021

The HYSTER study: the effect of intracervically administered terlipressin versus placebo on the number of gaseous emboli and fluid intravasation during hysteroscopic surgery: study protocol for a randomized controlled clinical trial.

Trials 2018 Feb 14;19(1):107. Epub 2018 Feb 14.

University of Amsterdam/AMC Hospital, Meibergdreef 9, 1105 AZ, Amsterdam, Netherlands.

Background: Transcervical resection of myoma or endometrium is a safe, hysteroscopic, minimally invasive procedure. However, intravasation of distension fluid is a common phenomenon during these procedures. In a previous study we observed venous gas emboli in almost every patient. The severity of hysteroscopic-derived embolization has been shown to be correlated to the amount of intravasation. In addition, paradoxical gas embolism, which is potentially dangerous, was observed in several patients. Studies have shown a reduction of intravasation by using intracervically administered vasopressin during hysteroscopy. We think that its analog, terlipressin, should have the same effect. In our previous research we observed more gaseous emboli as intravasation increased. Whether or not the insertion of intracervically administered terlipressin leads to a lower incidence and severity of gas embolism is unknown. We hypothesize that intracervically administered terlipressin leads to a reduction of intravasation with a lower incidence and severity of gas embolism. Terlipressin may be of benefit during hysteroscopic surgery.

Methods/design: Forty-eight patients (ASA 1 or 2) scheduled for transcervical resection of large, types 1-2 myoma or extensive endometrium resection will be included. In a double-blind fashion patients will be randomized 1:1 according to surgical treatment using either intracervically administered terlipressin or placebo. Transesophageal echocardiography will be used to observe and record embolic events. A pre- and post-procedure venous blood sample will be taken to calculate intravasation based on hemodilution. Our primary endpoint will be how terlipressin influences the severity of embolic events. Secondary endpoints include the effect of terlipressin on the amount of intravasation and on hemodynamic parameters.

Discussion: If terlipressin does indeed reduce the number of gaseous emboli and intravasation occurring during hysteroscopic surgery, it would be a simple method to minimize potential adverse events. It also allows for prolonged operating time before the threshold of intravasation is reached, thereby reducing the need for a second operation.

Trial Registration: Nederlands Trial Register (Dutch Trial Register), ID: NTR5577 . Registered retrospectively on 18 December 2015.
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http://dx.doi.org/10.1186/s13063-018-2442-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5813421PMC
February 2018

The tissue Doppler imaging derived post-systolic velocity notch originates at the aortic annulus.

J Cardiovasc Ultrasound 2014 Mar 31;22(1):23-7. Epub 2014 Mar 31.

Department of Cardiology, Onze Lieve Vrouwe Gasthuis Hospital, Amsterdam, the Netherlands.

Background: A distinct velocity pattern represented by a "notch" is observed during the time interval between the end of the systolic and the onset of the early diastolic velocity wave on longitudinal myocardial velocity curve. The origin of the post-systolic velocity notch (PSN) has not been resolved.

Methods: The high frame rate color tissue Doppler imaging of the apical longitudinal axis was performed in 32 healthy subjects.

Results: The time delays of the PSN onset at the posterior aortic wall (AW), the mid anteroseptal wall (MAS) and the posterior mitral annulus (MA) relatively to the anterior aortic annulus (AA) were found to be significantly longer than zero (5.1 ± 2.2, 6.0 ± 2.3, 6.8 ± 2.8 ms; p < 0.001). The amplitude was the highest at the AA when compared to the AW, the MAS and the MA (4.77 ± 1.28 vs. 2.88 ± 1.11, 2.15 ± 0.73, 2.44 ± 1.17 cm/s; p < 0.001). A second PSN spike was identifiable in 10/32 (31%) of the studied subjects at the AA. Of these, 9 (28%) exhibited a second PSN spike at the AW, 3 (9%) at the MAS and no one at the MA.

Conclusion: The AA represents the site of the earliest onset and maximal amplitude of the PSN on the longitudinal velocity curve suggesting its mechanism to be that of an energy release at the instant of the aortic valve closure causing an apically directed acceleration of the myocardium. A substantial number of healthy subjects exhibit a second PSN spike predominantly at the level of the AA. Its mechanism remains to be elucidated.
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http://dx.doi.org/10.4250/jcu.2014.22.1.23DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3992344PMC
March 2014

Timing of angiography in non-ST elevation myocardial infarction.

Heart 2013 Dec 20;99(24):1867-73. Epub 2013 Apr 20.

Department of Cardiology, Heart Center, Onze Lieve Vrouwe Gasthuis (OLVG), , Amsterdam, The Netherlands.

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http://dx.doi.org/10.1136/heartjnl-2012-302034DOI Listing
December 2013

The biochemical aspects of a non-ST-segment elevation acute coronary syndrome.

Rev Cardiovasc Med 2012 ;13(2-3):e70-6

Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

The clinical course of an acute coronary syndrome can vary from relatively benign to potentially fatal. The biomarkers of myocardial necrosis relate to the amount of myocardial damage and are closely linked to a patient's prognosis. They are measured to help guide management decisions. Recent interest in myocardial neurohumoral mechanisms has identified the natriuretic peptides as strong prognostic biomarkers following an ischemic event. During an acute event they provide information regarding the area of myocardium at risk. The biomarkers of inflammation, such as C-reactive protein, are related to both the development of atherosclerosis and the risk of acute ischemic events. The mechanism characterizing the pathophysiology of the syndrome is represented by these cardiac biomarkers. Assessing combinations of pathobiologically diverse biomarkers may provide a better risk evaluation method and further dictate subsequent therapy.
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March 2013

Gas embolism during hysteroscopic surgery using bipolar or monopolar diathermia: a randomized controlled trial.

Am J Obstet Gynecol 2012 Oct 26;207(4):271.e1-6. Epub 2012 Jul 26.

Department of Anesthesiology, Academic Medical Center, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Objective: The objective of the study was to determine the incidence and amount of gas embolism during hysteroscopic surgery using either monopolar or bipolar diathermia and to investigate the relationship between the severity of gas embolism and the amount of intravasation of distension fluid.

Study Design: This was a randomized, observer-blinded trial. Fifty patients, scheduled for hysteroscopic surgery, were assigned to either monopolar or bipolar diathermia. Transesophageal echocardiography was used to detect and classify gas embolism (grade 0-IV). Intravasation of distension fluid was measured.

Results: Venous gas embolism was observed in all but 1 patient. A higher incidence of more extensive (grade IV) was seen during bipolar diathermia (42% vs 13%; P = .031). Paradoxical embolism was observed in 2 patients. When intravasation exceeded 1000 mL, significantly more grade IV venous gas embolism was seen (P = .049).

Conclusion: During hysteroscopic surgery, gas embolism was equally observed irrespective of the type of diathermia. However, more extensive embolism was observed when intravasation of distension fluid exceeded 1 L. These results question the acceptance of up to 2500 mL intravasation of distension fluid if bipolar diathermia is used.
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http://dx.doi.org/10.1016/j.ajog.2012.07.027DOI Listing
October 2012

Ramus circumflexissimus--a rare coronary anomaly detected by coronary computed tomography angiography.

Congenit Heart Dis 2013 Nov-Dec;8(6):576-8. Epub 2011 Jul 1.

Department of Cardiology, Hofpoort Ziekenhuis, Woerden Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

We present a case of L-1 type solitary (left) coronary artery that was detected with coronary computed tomography angiography and confirmed by invasive coronary angiography in a female patient with atypical chest pain. Solitary coronary artery anomalies are rare. The L-1 subtype is thought to be a benign type.
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http://dx.doi.org/10.1111/j.1747-0803.2011.00545.xDOI Listing
July 2014

The value of N-terminal proB-type natriuretic peptide for early identification of myocardial infarction in patients with high-risk non-ST-elevation acute coronary syndromes.

Clin Chem Lab Med 2011 Aug 22;49(8):1359-65. Epub 2011 Jun 22.

Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Background: N-terminal proB-type natriuretic peptide (NT-proBNP) is a marker of biomechanical strain, secreted by cardiomyocytes in response to ischemia. As necrosis occurs after prolonged ischemia, a rise in NT-proBNP concentration could precede a rise in markers of necrosis.

Methods: The aim of the study was to evaluate whether NT-proBNP is able to identify those patients with an evolving myocardial infarction (MI) with high-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). Data were analyzed from a prospective cohort of 103 high-risk NSTE-ACS patients admitted within 6 h after onset of pain and treated with an early invasive strategy. NT-proBNP samples, obtained immediately upon admission, were related to the presence of an in hospital MI. The optimal cut-off value for NT-proBNP was determined using receiver-operating characteristics (ROC) curve analysis.

Results: Analyses was performed separately for creatinine kinase MB-mass (CKMB) and troponin T (TnT) based MI definitions. In both cases, a NT-proBNP concentration above 40 pmol/L (339 ng/L) at admission proved to be independently associated with the presence of MI. The diagnostic odds ratio (OR) for CKMB-MI was 4.9 (confidence interval 2.0-11.9, p<0.001). The diagnostic OR for TnT-MI was 4.9 (1.8-14.4, p=0.003). Adjusting for differences in baseline variables did not weaken the diagnostic OR. In addition, elevated NT-proBNP concentrations were related to unfavour-able demographic, physical and biochemical parameters.

Conclusions: With a dichotomous cut-off value, a single elevated NT-proBNP (>40 pmol/L) at admission provides independent information about the presence of MI in high-risk NSTE-ACS patients.
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http://dx.doi.org/10.1515/CCLM.2011.213DOI Listing
August 2011

ACP Journal Club. Telemonitoring did not reduce readmissions or mortality in patients recently hospitalized for heart failure.

Ann Intern Med 2011 Mar;154(6):JC3-8

Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

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http://dx.doi.org/10.7326/0003-4819-154-6-201103150-02008DOI Listing
March 2011

Percutaneous coronary intervention for non ST-elevation acute coronary syndromes: which, when and how?

Am J Cardiol 2011 Feb 22;107(4):509-15. Epub 2010 Dec 22.

Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

The presentation of patients with suspected non ST-elevation acute coronary syndromes is quite diverse. Therefore, the diagnostic workup and choice of treatment may vary accordingly. Major issues regarding the evaluation are the likelihood of the diagnosis and the risk for adverse events. These factors should guide the choice of diagnostic test. Patients with increased risk for ischemic events and patients with recurrent ischemia are most likely to benefit from revascularization. In addition, when percutaneous coronary intervention is considered, evidence suggests that sufficient time should be allowed for pharmacologic stabilization, reducing the possibility of periprocedurally inflicted myocardial infarction. However, postponement of intervention may lead to an increase of new spontaneous events, and high-risk patients should apply for revascularization soon after pharmacologic stabilization. The extent of revascularization performed by percutaneous coronary intervention depends predominantly on patient characteristics and anatomy but should be limited to flow-obstructive lesions. In conclusion, patients presenting with non-ST elevation acute coronary syndromes constitute a very diverse population; diagnostic workup, treatment, and the timing of a possible intervention should be tailored individually.
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http://dx.doi.org/10.1016/j.amjcard.2010.10.016DOI Listing
February 2011

Intervention timing and acute coronary syndromes.

JAMA 2010 Jan;303(2):131-2; author reply 132

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http://dx.doi.org/10.1001/jama.2009.1968DOI Listing
January 2010

The association of depressive symptoms with survival in a Dutch cohort of patients with end-stage renal disease.

Nephrol Dial Transplant 2010 Jan 4;25(1):231-6. Epub 2009 Aug 4.

Department of Nephrology, Sint Lucas Andreas Hospital, The Netherlands.

Aim: To evaluate the prevalence and the influence on survival of depressive symptoms in a European cohort of end-stage renal disease (ESRD) patients on renal replacement therapy (RRT).

Methods: In a prospective fashion, symptoms of depression were evaluated in ESRD patients on RRT using the depression subscore of the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal clinical events were determined during a 1-year follow-up.

Results: Of 101 patients with ESRD, 42% showed manifest depressive symptoms, defined as a HADS-D score > or =7. No association was found between depressive symptoms and severity of somatic disease. During follow-up, all-cause mortality was significantly higher in patients with depressive symptoms above threshold (n = 42, mortality: 26%) compared to patients with depressive symptoms below threshold (n = 59, mortality 8%), (crude HR 3.3, CI 1.2-9.6, P = 0.02). The excess in mortality was mainly caused by a higher incidence of septicaemia (0 versus 12%, P = 0.01). After adjustment for clinical parameters, this association between depressive symptoms and mortality became even stronger. There was no significant difference observed in the incidence of cardiovascular events.

Conclusions: Patients with ESRD treated with dialysis show a high level of depressive symptoms that is independently associated with poor survival. Future research should address appropriate therapeutic regimens.
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http://dx.doi.org/10.1093/ndt/gfp383DOI Listing
January 2010

Twiddler's syndrome: an unusual cause of pacemaker dysfunction.

Am J Geriatr Cardiol 2008 Jan-Feb;17(1):53-4

Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.

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http://dx.doi.org/10.1111/j.1076-7460.2007.05830.xDOI Listing
March 2008

A bridge to Brugada.

Europace 2007 Jun 13;9(6):398-400. Epub 2007 Apr 13.

Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091AC Amsterdam, the Netherlands.

In acute cardiac care, prompt diagnosis and management is mandatory. The electrocardiogram (ECG) remains a crucial investigation in the management of ischemic heart disease and arrhythmias. A case is discussed, where the ECG changes caused by the Brugada syndrome and those caused by ischemia, aggravated by myocardial bridging, intertwine.
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http://dx.doi.org/10.1093/europace/eum052DOI Listing
June 2007

Oral administration of glycine in the prevention of restenosis after coronary angioplasty. A double blind placebo controlled randomized feasibility trial evaluating safety and efficacy of glycine in the prevention of restenosis after angioplasty.

Acute Card Care 2006 ;8(1):58-64

Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Objectives: Evaluation of safety, feasibility, and efficacy of oral administered glycine in prevention of angiographic restenosis six months after percutaneous coronary intervention (PCI).

Background: The amino acid glycine modulates immunological response and enhances the production of endothelial derived nitric oxide (EDNO) factor. This factor has been shown to possess anti-atherosclerotic properties, actions of which are thought to reduce neo-intimal hyperplasia. Furthermore, glycine significantly elevates arginine serum levels. This amino acid has been extensively studied for its effects on the endothelium, nitric oxide (NO) metabolism and effects on several biochemical pathways interfering with the process of restenosis after PCI.

Methods: A prospective double blind placebo controlled randomized study evaluated safety and feasibility of chronic oral administration of glycine. In addition, the efficacy was determined by evaluation of six months angiographic restenosis rates.

Results: 214 patients scheduled for elective PCI were randomized to receive glycine or placebo. At follow-up, there was no significant difference in side effects and in major adverse cardiac events (MACE) between both groups. Six-month angiograms revealed similar restenosis rates for the glycine group (17.5%) and for the placebo group (20.2%) (P = 0.82).

Conclusion: Chronic oral administration of glycine was safe and feasible and had similar side effects compared to placebo. However, chronic oral administration of glycine did not lead to a significant reduction in restenosis rates at six months after elective PCI.
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http://dx.doi.org/10.1080/14628840600643383DOI Listing
September 2006

NT-ProBNP serum levels reflect severity and extent of ischemia in patients admitted with non-ST-elevation acute coronary syndrome.

Acute Card Care 2006 ;8(1):51-7

Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Objective: To explore the relationship between NT-proBNP elevation and prognosis in patients with NSTEACS.

Background: High NT-proBNP levels are related to a worse prognosis in patients with ACS. The precise mechanism by which is not clear.

Methods: Serial sampling of NT-proBNP, Troponin T and CK-MB was performed in 23 patients admitted with NSTEACS. Using coronary angiography in each patient a culprit lesion was identified. Proximal lesions were located before or at the first major branch of the parent artery. All other lesions localizations were considered distal. To evaluate the influence of left ventricular systolic function on NT-proBNP levels WMSI was measured by echocardiography.

Results: Proximal culprit lesion localization was associated with significant higher baseline (mean 506 ng/l, SD 440 ng/l) and peak NT-proBNP levels (mean 1055 ng/l; SD 236 ng/l), as compared to patients with a distal lesion localization. (Baseline: 139 ng/l, SD 140 ng/l, peak: 381 ng/l; SD 64 ng/l). (P = 0.01) NT-proBNP levels were highly correlated to Troponin T and CK-MB peak serum levels. Adjustments for left ventricular dysfunction did not alter these associations.

Conclusions: High peak NT-proBNP levels are independently associated with both proximal culprit localization and elevated biochemical markers of myocardial damage. These findings suggest that NT-proBNP levels reflect the amount of jeopardized myocardium and could signify the integral of the extent and severity of an ischemic event.
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http://dx.doi.org/10.1080/14628840600627972DOI Listing
September 2006

Dynamics in N-terminal pro-brain natriuretic peptide concentration in patients with non-ST-elevation acute coronary syndrome.

Am Heart J 2005 Dec;150(6):1255-9

Amsterdam Department of Interventional Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Background: Although there is growing evidence that N-terminal pro-brain natriuretic peptide (NT-proBNP) can be used as a powerful tool in risk prediction in patients with non-ST-elevation acute coronary syndrome (NSTEACS), the dynamic variation of serum concentrations in time is poorly understood. To gain insight into the dynamics of NT-proBNP, a study was performed using serial serum samples in patients admitted with NSTEACS.

Methods: A total of 24 patients admitted with NSTEACS was included in this study. Serial samples were taken at baseline, 8 hours, 16 hours, 24 hours, and 36 hours after admittance.

Results: A highly dynamic pattern in serial measurements of NT-proBNP was observed. Although an increase in NT-proBNP serum levels already existed 8 hours after admittance, it did not reach significance as compared with baseline. The samples obtained 16, 24, and 36 hours after admission were all significantly increased as compared with the values at admission (P < .01), generally leading to a > 2-fold increase with peak values at 16 to 24 hours after admittance. Furthermore, considerable differences in NT-proBNP concentrations between patients were observed.

Conclusions: It was shown that NT-proBNP is a highly dynamic cardiac peptide. Strategic sampling at 16 to 24 hours after admittance could prove representative regarding the assessment of risk prediction and subsequent clinical decision making.
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http://dx.doi.org/10.1016/j.ahj.2005.02.003DOI Listing
December 2005

Lack of efficacy of clopidogrel pre-treatment in the prevention of myocardial damage after elective stent implantation.

J Am Coll Cardiol 2004 Jul;44(1):20-4

Amsterdam Department for Intervention Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.

Objectives: The object of this study was to determine the effect of pre-treatment with clopidogrel in patients undergoing elective stent implantation.

Background: The treatment of patients with adenosine diphosphate receptor blockers after percutaneous coronary intervention (PCI) with stent implantation has been shown to decrease the incidence of subacute stent thrombosis. Furthermore, non-randomized studies on pre-treatment with clopidogrel among patients undergoing stent implantation have suggested a reduction in myocardial damage and clinical events. The effect of pre-treatment with clopidogrel has been studied in only a few randomized trials.

Methods: In a randomized trial, three days of pre-treatment with clopidogrel was compared with standard post-procedural treatment in 203 patients undergoing elective stent implantation. The primary end point was a rise in troponin I or creatine kinase-MB fraction (CK-MB) serum levels at 6 to 8 and 16 to 24 h after PCI. Secondary end points were death, stroke, myocardial infarction, coronary bypass grafting, repeated PCI, and subacute stent thrombosis at one and six months after PCI.

Results: No difference was found between non-pre-treated and pre-treated patients in the post-procedural elevation of troponin I (42 [43.3%] vs. 48 [51.1%], respectively, p = 0.31) or CK-MB (6 [6.3%] vs. 7 [7.4%], respectively, p = 0.78). Adjustment for possible confounding factors did not change these findings. Patient follow-up at one and six months showed no significant difference between the treatment groups in death, stroke, myocardial infarction, coronary artery bypass grafting, repeated PCI, or subacute stent thrombosis.

Conclusions: In this randomized study, no beneficial effect of pre-treatment with clopidogrel on post-procedural elevation of troponin I and CK-MB or on clinical events after one and sixth months could be demonstrated. The study suggests that among patients with stable coronary syndromes in whom coronary stent implantation is planned, pre-treatment may not be beneficial in reducing early myocardial damage.
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http://dx.doi.org/10.1016/j.jacc.2004.02.056DOI Listing
July 2004
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