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1.
Dewilde, W.J.M.
Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation in coronary stenting.
Degree: 2014, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/298551 
► Chronic oral anticoagulation (OAC) is necessary in patients with mechanical heart valves and in most patients with atrial fibrillation (AF). A large subgroup of these…
(more)
▼ Chronic oral anticoagulation (OAC) is necessary in patients with mechanical heart valves and in most patients with atrial fibrillation (AF). A large subgroup of these patients has concomitant coronary artery disease (CAD). When these patients have to undergo percutaneous coronary intervention (PCI), additional dual antiplatelet treatment (DAPT) with aspirin and a P2Y12 inhibitor becomes indicated to prevent stent thrombosis. In a rapidly ageing community, the number of patients suffering both AF and CAD is steadily increasing. Up to 2012 these patients were treated with the so-called triple therapy that is the combination of aspirin, clopidogrel and a vitamin K antagonist (VKA). However, this triple therapy also has its downsides. There is an association with an annual bleeding risk of up to 45% and bleeding is the Achilles-heel of triple therapy because it is the associated with an increased mortality risk. This thesis is based upon the clinical problem in this high-risk patient group (AF & PCI) that we encountered in 2007-2008 when patients had a high bleeding tendency when treated with triple therapy. We set out to decrease the bleeding risk without increasing the risk of stent thrombosis. Although triple therapy is still recommend by the guidelines, these recommendations are based on expert opinion and not on randomised trials. In this thesis we provide evidence that suggests that the increased bleeding risk outweighs the efficacy (preventing stent thrombosis, myocardial infarction (MI), stroke and thromboembolism) benefit of triple therapy in these patients and we present a possible new strategy of VKA and a P2Y12 inhibitor alone. The results of this randomised WOEST trial were presented in the hot line session of the 2012 annual meeting of the European Society of Cardiology in Munich and published in the Lancet. Second, we focus on the possible pitfall of VKA as it may modify the clopidogrel drug responsiveness and efficacy. However, the clinical impact of this finding on the risk of atherothrombotic events in patients on long term OAC undergoing PCI is unclear. Further investigation on this topic is needed. Third, the optimal peri-procedural PCI strategy in patients on OAC is highlighted. In a sub-analysis of the WOEST study, uninterrupted oral anticoagulation was not associated with an increase of bleeding or MACCE compared to bridging therapy. This study supports the current guidelines to adopt a peri-procedural uninterrupted oral anticoagulation strategy in patients on long term OAC who undergo PCI. Finally, we focus on stent choice in patients on OAC who undergo PCI. For patients on OAC who need to undergo PCI, guidelines (based on expert opinion) recommend the use of bare metal stents (BMS) but a sub-analysis of the WOEST trial showed that in patients treated with OAC who undergo PCI the implantation of DES was not associated with an increase of bleeding or ischemic events compared to BMS. The use of DES was associated with a significantly lower rate of TVR and therefore the use of DES seems a reasonable…
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Verheugt, C.L.,
M.%22%29&pagesize-30">ten Berg, J.M..
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APA (6th Edition):
Dewilde, W. J. M. (2014). Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation in coronary stenting. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/298551
Chicago Manual of Style (16th Edition):
Dewilde, W J M. “Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation in coronary stenting.” 2014. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/298551.
MLA Handbook (7th Edition):
Dewilde, W J M. “Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation in coronary stenting.” 2014. Web. 14 Apr 2021.
Vancouver:
Dewilde WJM. Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation in coronary stenting. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2014. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/298551.
Council of Science Editors:
Dewilde WJM. Optimal antiplatelet and anticoagulant therapy in patients with oral anticoagulation in coronary stenting. [Doctoral Dissertation]. Universiteit Utrecht; 2014. Available from: http://dspace.library.uu.nl:8080/handle/1874/298551
Universiteit Utrecht
2.
Vliet, Patrick van.
Progenitor cells from the heart - Cellulae Progenitores Cordis.
Degree: 2009, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/33258
► Myocardial infarction is a leading cause of high mortality rates in Western countries. After ischemia, lost cardiomyocytes are replaced by fibrotic tissue, while remaining cardiomyocytes…
(more)
▼ Myocardial infarction is a leading cause of high mortality rates in Western countries. After ischemia, lost cardiomyocytes are replaced by fibrotic tissue, while remaining cardiomyocytes hypertrophy, both further impairing ventricular function. Current therapies consist of restoration of reperfusion and drug administration to attenuate chronic symptoms and prevent the development of heart failure. In recent years, the possibility of using stem cells to replace lost tissue has become a hot topic in the cardiovascular scientific community. We have recently isolated cardiomyocyte progenitor cells (CMPCs) from fetal and adult human cardiac tissue (Goumans MJ et al. Stem Cell Res 2008; Van Vliet
P et al. Neth Heart J 2008; Smits AM et al. Nature Prot 2009). Upon isolation, CMPCs can be easily expanded and express several stem cell markers and cardiac transcription factors. Stimulation with specific chemicals and growth factors induces differentiation of CMPCs into smooth muscle cells and endothelial cells. We also found that while fetal CMPCs can form spontaneously beating cardiomyocytes, adult CMPCs appear to differentiate into more mature, quiescent cardiomyocytes in vitro. The adult CMPC-derived cardiomyocytes may therefore be more suitable for clinical application than their fetal counterparts. In contrast, the potential of fetal CMPCs to form additional mesodermal cell types indicates that these cells are an interesting population for studies on progenitor cell development. Several signaling pathways that are known to affect skeletal myogenesis are also involved in cardiomyogenesis. In this thesis we report our results on two of these mechanisms. First, we investigated the role of microRNAs (miRs). MiRs are non-coding, small RNA molecules that affect translation of messenger RNA towards protein and have been reported to regulate many developmental processes. We identified several interesting candidates that were differentially expressed between undifferentiated and differentiated CMPCs. These miRs could subsequently be used to improve CMPC differentiation efficiency. Second, we previously reported that stimulation of CMPCs with TGFbeta enhanced cardiomyogenic differentiation (Goumans MJ et al. Stem Cell Res 2008). We show here that TGFbeta induces hyperpolarization in undifferentiated CMPCs, leading to the formation of spontaneously beating cardiomyocytes. These results suggest a novel mechanism for cardiomyogenic differentiation. Transplantation of CMPCs or CMPC-derived cardiomyocytes in infarcted mouse hearts prevented cardiac dilatation and deterioration of cardiac function (Smits AM, submitted; Van Laake LW, Cardiac recovery by stem and progenitor cells, Thesis 2008). In addition, CMPCs differentiated in vivo into cardiomyocytes, smooth muscle cells and endothelial cells. However, the effect of hypoxia on CMPCs remained uninvestigated. Therefore, we exposed the cells to low oxygen levels in vitro and found that hypoxia results in increased proliferation. This was mediated by a pro-survival gene that, when…
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Goumans, M.J.,
P.G.%22%29&pagesize-30">Sluijter, J.P.G..
Subjects/Keywords: Geneeskunde; Cardiomyocyte; progenitor cell; proliferation; differentiation; multipotency; electrophysiology; microRNA; Survivin
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APA (6th Edition):
Vliet, P. v. (2009). Progenitor cells from the heart - Cellulae Progenitores Cordis. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/33258
Chicago Manual of Style (16th Edition):
Vliet, Patrick van. “Progenitor cells from the heart - Cellulae Progenitores Cordis.” 2009. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/33258.
MLA Handbook (7th Edition):
Vliet, Patrick van. “Progenitor cells from the heart - Cellulae Progenitores Cordis.” 2009. Web. 14 Apr 2021.
Vancouver:
Vliet Pv. Progenitor cells from the heart - Cellulae Progenitores Cordis. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2009. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/33258.
Council of Science Editors:
Vliet Pv. Progenitor cells from the heart - Cellulae Progenitores Cordis. [Doctoral Dissertation]. Universiteit Utrecht; 2009. Available from: http://dspace.library.uu.nl:8080/handle/1874/33258
Universiteit Utrecht
3.
Putten, K. van der.
Anemia and response to erythropoietin in the cardiorenal syndrome.
Degree: 2011, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/204685
► Chronic kidney disease (CKD) is associated with a high risk of cardiovascular disease and death. Whereas cardiovascular disease is common in CKD, patients with cardiac…
(more)
▼ Chronic kidney disease (CKD) is associated with a high risk of cardiovascular disease and death. Whereas cardiovascular disease is common in CKD, patients with cardiac failure often have renal dysfunction. The combination of kidney disease and heart failure is currently known as the cardiorenal syndrome (CRS). Anemia is common in CRS and is associated with increased mortality risk. A main causative factor is an inadequate bone marrow response to endogenous and/or exogenous EPO has (EPO resistance). The role of treatment of anemia with recombinant human EPO has been the subject of many studies recently. Large-scale trials failed to demonstrate a beneficial effect of EPO when targeting normalization of Hb in CKD patients. This could be related to the Hb levels attained, or alternatively to unwanted nonhematopoietic effects of (high dosages of) EPO. Also patient-related factors may play a role, since it is known that EPO resistance in itself is associated with worse outcomes. In this thesis, we investigate mechanisms of EPO resistance and the role of hepcidin herein. Furthermore, we study various aspects of hemoglobin variability in four different patient groups: hemodialysis and peritoneal patients treated with EPO, predialysis patients treated with EPO and predialysis patients not treated with EPO. Lastly, the role of circadian (mis)alignment of melatonin, EPO, IGF-1 and pro-inflammatory cytokines in the pathophysiology of anemia in CKD is investigated. The overall conclusion of this thesis is that EPO treatment should be tailored to the individual patient. However, no evidence is available as to which patients will encounter benefits or complications from EPO.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
M.%22%29&pagesize-30">Gaillard, C.A.J.M.,
Braam, B..
Subjects/Keywords: Geneeskunde; erytrhopoietin; CHF; CKD; anemia; cardiorenal
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APA (6th Edition):
Putten, K. v. d. (2011). Anemia and response to erythropoietin in the cardiorenal syndrome. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/204685
Chicago Manual of Style (16th Edition):
Putten, K van der. “Anemia and response to erythropoietin in the cardiorenal syndrome.” 2011. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/204685.
MLA Handbook (7th Edition):
Putten, K van der. “Anemia and response to erythropoietin in the cardiorenal syndrome.” 2011. Web. 14 Apr 2021.
Vancouver:
Putten Kvd. Anemia and response to erythropoietin in the cardiorenal syndrome. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2011. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/204685.
Council of Science Editors:
Putten Kvd. Anemia and response to erythropoietin in the cardiorenal syndrome. [Doctoral Dissertation]. Universiteit Utrecht; 2011. Available from: http://dspace.library.uu.nl:8080/handle/1874/204685
Universiteit Utrecht
4.
Van der Heyden, J.A.S.
Carotid Artery Stenting prior to Cardiac Surgery.
Degree: 2012, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/238520
► This thesis describes the strategy of the management and treatment of patients with concomitant significant carotid and coronary artery disease. The short and long term…
(more)
▼ This thesis describes the strategy of the management and treatment of patients with concomitant significant carotid and coronary artery disease. The short and long term outcome of a single centre experience is reported and compared with general common practise. The author conducted different observational trials in order to provide more information to justify the institutional policy. More particularly, the use of embolic protection devices in asymptomatic patients is questioned, the optimal antiplatelet therapy is investigated and the use of CT perfusion to better understand individual cerebral hemodynamics is examined.
Patients with asymptomatic carotid stenosis undergoing CAS-CABG have a decreased stroke and death rate compared to those undergoing isolated CABG or CEA-CABG. CAS may be a safer carotid revascularization option for patients with asymptomatic carotid stenosis requiring CABG in terms of postoperative stroke prevention.
In patients with symptomatic carotid stenosis available data are confounding, therefore the preferred strategy remains unclear, however carotid revascularization will result incontestably in higher periprocedural complication rates. Although level I evidence would be ideal to determine the best treatment strategy for patients who require combined treatment of carotid and coronary arterial disease, the design and implementation of a multicenter randomised clinical trial has been proven impractical and unrealistic. The heterogeneity of patients with varying degrees of coronary and carotid artery disease and the preference of carotid intervention are the main limitations for such a trial. Nevertheless, when conceived, such a trial should compare isolated CABG (including on and off pump surgery) with CAS-CABG and CEA-CABG in symptomatic and asymptomatic patients separately.
Optimal treatment of patients with concurrent carotid and coronary artery disease remains unresolved despite extensive publications during the last 30 years. Although only 40% to 50% of strokes after CABG are ipsilateral to an existing carotid lesion, carotid revascularization is one of the few available options to reduce the excessive stroke and death rates in patients with combined disease.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Suttorp, M.J.,
M.%22%29&pagesize-30">Plokker, H.W.M..
Subjects/Keywords: Geneeskunde; carotid stenting; cardiac surgery; stroke; myocardial infarction
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APA (6th Edition):
Van der Heyden, J. A. S. (2012). Carotid Artery Stenting prior to Cardiac Surgery. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/238520
Chicago Manual of Style (16th Edition):
Van der Heyden, J A S. “Carotid Artery Stenting prior to Cardiac Surgery.” 2012. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/238520.
MLA Handbook (7th Edition):
Van der Heyden, J A S. “Carotid Artery Stenting prior to Cardiac Surgery.” 2012. Web. 14 Apr 2021.
Vancouver:
Van der Heyden JAS. Carotid Artery Stenting prior to Cardiac Surgery. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2012. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/238520.
Council of Science Editors:
Van der Heyden JAS. Carotid Artery Stenting prior to Cardiac Surgery. [Doctoral Dissertation]. Universiteit Utrecht; 2012. Available from: http://dspace.library.uu.nl:8080/handle/1874/238520
Universiteit Utrecht
5.
Van den Branden, B.J.L.
Innovation in intervention : new devices in interventional cardiology.
Degree: 2011, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/215185
► This thesis reports on the application of several new devices for percutaneous treatment of structural heart disease. A patent foramen ovale (PFO) is a tunnellike…
(more)
▼ This thesis reports on the application of several new devices for percutaneous treatment of structural heart disease. A patent foramen ovale (PFO) is a tunnellike communication between the right and the left atrium and has been associated with the occurrence of cryptogenic stroke. PFO closure has proven its efficacy in preventing recurrent TIA or stroke. An atrial septal defect (ASD) occurs when a part of the interatrial septum is missing and is characterized by a left-to-right shunt, resulting in volume overload of the right heart. Percutaneous closure has become common practice. New devices for PFO and ASD closure are being constructed to facilitate the procedure and to lower the complication rate. Mitral valve regurgitation (MR) is an important clinical issue. Less invasive transcatheter techniques are proposed as an alternative treatment option in highsurgical- risk patients. The aims of this thesis were to study the safety and the efficacy if this new devices and techniques. The general discussion describes the different treatment options for PFO, ASD, and MR. We provide an overview of the literature with implementation of our study results, highlighting new techniques with recommendations for further investigation.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Budts, W.I.H.L.,
Suttorp, M.J.,
Post, M.C..
Subjects/Keywords: Geneeskunde
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APA (6th Edition):
Van den Branden, B. J. L. (2011). Innovation in intervention : new devices in interventional cardiology. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/215185
Chicago Manual of Style (16th Edition):
Van den Branden, B J L. “Innovation in intervention : new devices in interventional cardiology.” 2011. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/215185.
MLA Handbook (7th Edition):
Van den Branden, B J L. “Innovation in intervention : new devices in interventional cardiology.” 2011. Web. 14 Apr 2021.
Vancouver:
Van den Branden BJL. Innovation in intervention : new devices in interventional cardiology. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2011. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/215185.
Council of Science Editors:
Van den Branden BJL. Innovation in intervention : new devices in interventional cardiology. [Doctoral Dissertation]. Universiteit Utrecht; 2011. Available from: http://dspace.library.uu.nl:8080/handle/1874/215185
Universiteit Utrecht
6.
Swaans, M.J.
Transcatheter cardiac interventions and the role of interventional echocardiography.
Degree: 2014, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/301928
► This thesis concerns the application of three new procedures in the field of structural heart disease. Firstly, we investigate the mineral invasive transcatheter tgechnique to…
(more)
▼ This thesis concerns the application of three new procedures in the field of structural heart disease. Firstly, we investigate the mineral invasive transcatheter tgechnique to treat high-surgicval risk patients with severe symptomatic MR using edge-to-edge technique with the MitraClip system. Secondly, we describe a percutaneous device (Watchman) for exclusion of the LAA from the systemic circulation and hereby reducin gthe risk of stroke and abolishing the need for VKA and associated bleeding risk. Thirdly, we focus on a minimal invasive treatment of symptomatic peri-prosthetic leaks using a transapicla access in patients with a high operative mortality risk of who are denied for surgery. Finally, the additional value of 3DTEE for patient selection and guidance of these transcatheter cardiac interventions throughout this thesis is shown.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Post, M.C.,
M.%22%29&pagesize-30">Rensing, B.J.W.M..
Subjects/Keywords: Geneeskunde
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APA ·
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APA (6th Edition):
Swaans, M. J. (2014). Transcatheter cardiac interventions and the role of interventional echocardiography. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/301928
Chicago Manual of Style (16th Edition):
Swaans, M J. “Transcatheter cardiac interventions and the role of interventional echocardiography.” 2014. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/301928.
MLA Handbook (7th Edition):
Swaans, M J. “Transcatheter cardiac interventions and the role of interventional echocardiography.” 2014. Web. 14 Apr 2021.
Vancouver:
Swaans MJ. Transcatheter cardiac interventions and the role of interventional echocardiography. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2014. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/301928.
Council of Science Editors:
Swaans MJ. Transcatheter cardiac interventions and the role of interventional echocardiography. [Doctoral Dissertation]. Universiteit Utrecht; 2014. Available from: http://dspace.library.uu.nl:8080/handle/1874/301928
Universiteit Utrecht
7.
Leenders, G.E.H.
Physiologic Insights and Clinical Consequences of Mechanical Discoordination in Left Bundle Brranch Block.
Degree: 2016, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/327917
► Conduction disturbances are present in a large number of heart failure patients. In particular left bundle branch block has subsequent deleterious effects on cardiac structure,…
(more)
▼ Conduction disturbances are present in a large number of heart failure patients. In particular left bundle branch block has subsequent deleterious effects on cardiac structure, function, and efficiency. Cardiac resynchronization therapy is a device based therapy that aims to improve cardiac mechanics by restoring electrical activation. The response in individual patients is highly variable and one of the reasons is the variability in amenable mechanical substrate. How to define, assess and quantify this mechanical substrate however remains unclear. The thesis aims to extend the physiologic insights into the mechanical consequences of left bundle branch block in heart failure patients to improve the diagnostic approaches and to optimize therapy delivery in clinical practice.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Prinzen, F.W.,
M.%22%29&pagesize-30">Cramer, M.J.M.,
De Boeck, B.W.L..
Subjects/Keywords: Left Bundle Branch Block; Echocardiography; Cardiac Pacing; Medicine; Heart Failure
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APA (6th Edition):
Leenders, G. E. H. (2016). Physiologic Insights and Clinical Consequences of Mechanical Discoordination in Left Bundle Brranch Block. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/327917
Chicago Manual of Style (16th Edition):
Leenders, G E H. “Physiologic Insights and Clinical Consequences of Mechanical Discoordination in Left Bundle Brranch Block.” 2016. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/327917.
MLA Handbook (7th Edition):
Leenders, G E H. “Physiologic Insights and Clinical Consequences of Mechanical Discoordination in Left Bundle Brranch Block.” 2016. Web. 14 Apr 2021.
Vancouver:
Leenders GEH. Physiologic Insights and Clinical Consequences of Mechanical Discoordination in Left Bundle Brranch Block. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2016. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/327917.
Council of Science Editors:
Leenders GEH. Physiologic Insights and Clinical Consequences of Mechanical Discoordination in Left Bundle Brranch Block. [Doctoral Dissertation]. Universiteit Utrecht; 2016. Available from: http://dspace.library.uu.nl:8080/handle/1874/327917
Universiteit Utrecht
8.
Mastenbroek, M.H.
How to improve implantable cardioverter defibrillator therapy: Focus on patient-reported outcomes and enhanced programming.
Degree: 2016, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/328490
► Cardiovascular implantable electronic devices (CIEDs), such as pacemakers, implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices, have become the treatment of choice for…
(more)
▼ Cardiovascular implantable electronic devices (CIEDs), such as pacemakers, implantable cardioverter defibrillators (ICDs) or cardiac resynchronization therapy (CRT) devices, have become the treatment of choice for cardiac rhythm disorders in subgroups of patients with heart disease. Due to the expanding indications for CIEDs and the availability of data supporting the clinical effectiveness of these devices, the number of CIED implants has increased significantly over the past decades. While in the past mortality reduction was the primary goal of CIED therapy, in recent years increasing attention has been paid towards assessing the impact of these life-saving devices on patients’ lives. Despite increased focus on the patient perspective, there are still several knowledge gaps that need to be filled in order to optimize the management and care for patients with a CIED. In the first two parts of the current dissertation, the course and determinants of patient-reported health status following CIED implantation and the impact of patient-reported outcomes (PROs) on prognosis in ICD and heart failure patients was explored. Findings indicate that levels of (disease-specific) health status vary considerably across subgroups of patients receiving an ICD or CRT-defibrillator device. Depending on the health status component that was measured, 4-7 different outcome trajectories were identified in the first 12-14 months after implantation. The different health status trajectories generally showed an initial small to large improvement between device implantation and short-term follow-up, followed by stabilization between short- and long-term follow-up. Overall, poorer health status was particularly associated with patients’ psychological profile (i.e., negative affectivity, anxiety, depression, use of psychotropic medication and Type D personality) and less with their clinical status (except for NYHA classification), which is consistent with earlier research. Furthermore, this dissertationcorroborates that PROs not only compromise the well-being of patients but also increase their risk of adverse clinical outcomes including premature death. In the third part of this dissertation, current and previous research on the effects of optimization of ICD programming on (unnecessary) ICD therapy and PROs was reviewed. In recent years, a series of important clinical trials have led to a shift in ICD programming towards less early and aggressive arrhythmia termination using in-device detection algorithms, prolonged detection duration, and no therapy delivery for slower and stable ventricular tachyarrhythmias, allowing them to terminate spontaneously. These efforts have significantly reduced the incidence of inappropriate ICD shocks (i.e., approximately 2% at 1-year). However, with respect to reducing appropriate but unnecessary antitachycardia pacing and shocks, there are still gains to be made. The ENHANCED Implantable Cardioverter Defibrillator programming to reduce therapies and improve quality of life study (ENHANCED-ICD study), a…
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Pedersen, S.S.,
Meine, M.,
Versteeg, H..
Subjects/Keywords: Patient-reported outcomes; health status; prognosis; implantable cardioverter defibrillator; ICD programming
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APA ·
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MLA ·
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to Zotero / EndNote / Reference
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APA (6th Edition):
Mastenbroek, M. H. (2016). How to improve implantable cardioverter defibrillator therapy: Focus on patient-reported outcomes and enhanced programming. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/328490
Chicago Manual of Style (16th Edition):
Mastenbroek, M H. “How to improve implantable cardioverter defibrillator therapy: Focus on patient-reported outcomes and enhanced programming.” 2016. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/328490.
MLA Handbook (7th Edition):
Mastenbroek, M H. “How to improve implantable cardioverter defibrillator therapy: Focus on patient-reported outcomes and enhanced programming.” 2016. Web. 14 Apr 2021.
Vancouver:
Mastenbroek MH. How to improve implantable cardioverter defibrillator therapy: Focus on patient-reported outcomes and enhanced programming. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2016. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/328490.
Council of Science Editors:
Mastenbroek MH. How to improve implantable cardioverter defibrillator therapy: Focus on patient-reported outcomes and enhanced programming. [Doctoral Dissertation]. Universiteit Utrecht; 2016. Available from: http://dspace.library.uu.nl:8080/handle/1874/328490
9.
Sant, J. van 't.
Clinical aspects of cardiac resynchronization therapy.
Degree: 2016, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/330510
► This thesis addresses clinical aspects of cardiac resynchronization therapy (CRT). Prediction and assessment of (volumetric) response were investigated as well as clinical outcome. We analyzed…
(more)
▼ This thesis addresses clinical aspects of cardiac resynchronization therapy (CRT). Prediction and assessment of (volumetric) response were investigated as well as clinical outcome. We analyzed the additional value of echocardiographic parameters of mechanical dyssynchrony as predictors of CRT response besides the generally used electrocardiographic parameters like left bundle branch block (LBBB) and QRS duration and assessed whether latest electrically activated segments also start contracting the latest. Furthermore, we evaluated whether echocardiographic response is accompanied by improved health status and exercise capacity. We also explored whether echocardiographic volumetric response differs at different points in time (i.e. after six and 14 months), and which parameter is best to use as a surrogate outcome marker. Furthermore, it was investigated whether these predictors and surrogate outcome measures are equally applicable for patients with ischemic and non-ischemic cardiomyopathy (ICM and NICM, respectively). Chapter 3 describes the additional value of echocardiographic parameters of mechanical dyssynchrony concerning the prediction of reverse remodeling. Two models, with and without echocardiographic parameters of mechanical dyssynchrony, were tested in a CRT population on their capacity to predict reverse remodeling 6 months after device implantation. In addition, model performance was tested separately for patients with non-ischemic cardiomyopathy and ischemic cardiomyopathy. In chapter 4 we evaluate whether electrically latest activated regions of the LV are also latest mechanically activated as both electrical delays and mechanical delays have been used in previous studies to guide LV lead positioning. To assess electrical activation delays electrical mappings were performed in the coronary sinus and its large side branches. Mechanical activation delays were evaluated by 2D speckle tracking analyses and time to peak strain was assessed. Definition of response is still under debate. In chapter 5 several surrogate markers of CRT response, among them change in LVESV, are investigated and their relationship to long-term outcome is assessed. In addition, we evaluate whether these surrogate outcome measures are equally appropriate for patients with ischemic and non-ischemic cardiomyopathy. In chapter 6 we evaluate whether echocardiographic responders also show significant improved exercise capacity six months after CRT implantation. All included patients performed an exercise test pre- and 6 months post implantation and echocardiographic studies were performed at the same time points. In chapter 7 we investigate whether echocardiographic responders are also health status responders after 6 months of CRT. We defined health status response by the Kansas City Cardiomyopathy Questionnaire (KCCQ), which is a self-report questionnaire that has been validated and shown to be sensitive to clinical change in HF patients. [52] Echocardiographic response was defined as LVESV decrease of at least 15 %. In chapter 8 we…
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Cramer, M.J.,
Meine, M..
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APA (6th Edition):
Sant, J. v. '. (2016). Clinical aspects of cardiac resynchronization therapy. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/330510
Chicago Manual of Style (16th Edition):
Sant, J van 't. “Clinical aspects of cardiac resynchronization therapy.” 2016. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/330510.
MLA Handbook (7th Edition):
Sant, J van 't. “Clinical aspects of cardiac resynchronization therapy.” 2016. Web. 14 Apr 2021.
Vancouver:
Sant Jv'. Clinical aspects of cardiac resynchronization therapy. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2016. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/330510.
Council of Science Editors:
Sant Jv'. Clinical aspects of cardiac resynchronization therapy. [Doctoral Dissertation]. Universiteit Utrecht; 2016. Available from: http://dspace.library.uu.nl:8080/handle/1874/330510
Universiteit Utrecht
10.
Verloop, W.L.
The dreams of renal denervation: a translational approach.
Degree: 2015, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/310674
► In the body, many processes are carried out without raising conscious sensations. The activities of these processes are controlled by a special system of nerve…
(more)
▼ In the body, many processes are carried out without raising conscious sensations. The activities of these processes are controlled by a special system of nerve cells and nerve fibers: the sympathetic nervous system (SNS) and the parasympathetic nervous system (PSNS).
In addition to the beneficial effects of the SNS, the sympathetic nervous system also plays a role in the etiology of a number of cardiovascular diseases such as primary hypertension, heart failure, chronic kidney disease, diabetes, and obesity. Renal denervation (RDN) has been developed as a new treatment option to lower the activity of the SNS and may therefore be an alternative treatment for patients with resistant hypertension. Next to the blood pressure reduction induced by renal denervation, some small studies have reported that RDN can positively affect other conditions characterized by sympathetic overactivity. These conditions include heart failure and insulin resistance.
The purposes of this thesis were to understand the working mechanism behind renal denervation (RDN), to determine which patients benefit most from treatment, and to study the effects of RDN. The first focus is on the pathophysiologic studies of the working mechanism behind RDN and possible markers of successful therapy. The second focus is on the selection of eligible patients for RDN. The third focus is on the effects of RDN in hypertensive patients. The fourth focus is on the effects of RDN beyond resistant hypertension.
The conclusions of this thesis are:
1. Renal denervation may induce hemodynamic changes in the kidneys itself, resulting in a lower resistance in the kidneys. It may be expected that this lower resistance leads to an improved renal blood flow and therefore a lower blood pressure. It may even be that hemodynamic measurements may be used as a per-procedural marker of successful RDN.
2. This thesis showed that a multidisciplinary team improves the selection of eligible patients for RDN. Since a relevant number of patients referred for RDN is not eligible for treatment, all patients should be screened systematically. Moreover we demonstrated that patients with an impaired renal function benefit more from treatment.
3. In the third part of this thesis it is concluded that the effects of RDN have a wide variety and that a relevant number of patients is a non-responder after RDN.
4. Finally it was investigated what the effects of renal denervation was on disease-states other than (resistant) hypertension. It was concluded that renal denervation does not have a significant effect on insulin resistance in a metabolic population.
In conclusion, renal denervation still seems a very promising therapy. However, we should not be blinded by the first, very encouraging, studies. It is likely that a blood pressure reduction can be established, however not to such an extent as suggested in the first clinical studies.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Voskuil, M.,
Spiering, W..
Subjects/Keywords: Geneeskunde; Renal denervation; Hypertension; Metabolic syndrome; Sympathetic nervous system; Blood pressure
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APA (6th Edition):
Verloop, W. L. (2015). The dreams of renal denervation: a translational approach. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/310674
Chicago Manual of Style (16th Edition):
Verloop, W L. “The dreams of renal denervation: a translational approach.” 2015. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/310674.
MLA Handbook (7th Edition):
Verloop, W L. “The dreams of renal denervation: a translational approach.” 2015. Web. 14 Apr 2021.
Vancouver:
Verloop WL. The dreams of renal denervation: a translational approach. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2015. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/310674.
Council of Science Editors:
Verloop WL. The dreams of renal denervation: a translational approach. [Doctoral Dissertation]. Universiteit Utrecht; 2015. Available from: http://dspace.library.uu.nl:8080/handle/1874/310674
Universiteit Utrecht
11.
Gho, J.M.I.H.
Opportunities in the failing heart.
Degree: 2015, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/321645
► Heart failure (HF) is a syndrome with typical signs and symptoms that can result from abnormal cardiac structure or function. It can lead to impaired…
(more)
▼ Heart failure (HF) is a syndrome with typical signs and symptoms that can result from abnormal cardiac structure or function. It can lead to impaired quality of life, decreased functional capacity, hospital admissions and mortality. Heart failure has been associated with focal and diffuse myocardial fibrosis and arrhythmias. The aim of this thesis was to provide opportunities from bench-to-bedside to elucidate pathways associated with the failing heart and ultimately to improve clinical outcome for patients. In the first part of this thesis, we observed that in the current era a substantial amount of patients develop HF after a first myocardial infarction (MI) and identified several important risk factors for HF following MI. In the second part of this thesis, we developed a novel systematic digital histological quantification method to compare histology with imaging techniques. For late gadolinium enhancement (LGE) imaging, we found that the full width at half maximum (FWHM) technique is preferred for the detection of fibrosis. While LGE cardiovascular magnetic resonance imaging (CMR) provides an accurate qualitative measure of replacement fibrosis, it has potential adverse effects and does not provide a quantitative or direct measurement of cardiac collagen. Therefore, we reviewed endogenous contrast methods to assess fibrosis with CMR including non-contrast T1 and T1rho mapping and although these methods seem promising, more research is required before a large-scale application for clinical decision-making can be recommended. Phospholamban (PLN) is a crucial regulator of cardiac contractility. Within the Netherlands a relatively large population of patients exists with the PLN R14del mutation causing HF. In a systematic histological analysis of PLN R14del patients heart slices, fibrosis was mainly observed in the posterolateral wall of the left ventricle, whilst adipose tissue was more pronounced in the outer myocardium of the right ventricle. We also found a characteristic distribution of fibrosis in genetic cardiomyopathies related to the mutation group. In the third and final part of this thesis, epigenetic and therapeutic pathways in HF are investigated. In an epigenetic study we found multiple PLN R14del mutation specific regulated genes, which could be used in future as a biomarker for risk stratification. Regarding the translational axis of cell therapy, we found that the results of cell therapy for dilated cardiomyopathy seem promising, but we have methodological recommendations for future studies before implementation in clinical practice. Finally, we performed a randomized, placebo controlled study with intracoronary infusion of cardiomyocyte progenitor cells (CMPCs) in a large preclinical model of ischaemic HF. While this method seems feasible and safe, we did not find significant positive effects on left ventricular performance or infarct size. Therefore translation of the current CMPCs towards a first-in-man trial is presently not justified. In summary, in this thesis we have shed light on…
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Asselbergs, F.W.,
Chamuleau, S.A.J.,
Vink, A..
Subjects/Keywords: heart failure; incidence; fibrosis; magnetic resonance imaging; histology; genetics; cell therapy
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APA (6th Edition):
Gho, J. M. I. H. (2015). Opportunities in the failing heart. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/321645
Chicago Manual of Style (16th Edition):
Gho, J M I H. “Opportunities in the failing heart.” 2015. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/321645.
MLA Handbook (7th Edition):
Gho, J M I H. “Opportunities in the failing heart.” 2015. Web. 14 Apr 2021.
Vancouver:
Gho JMIH. Opportunities in the failing heart. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2015. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/321645.
Council of Science Editors:
Gho JMIH. Opportunities in the failing heart. [Doctoral Dissertation]. Universiteit Utrecht; 2015. Available from: http://dspace.library.uu.nl:8080/handle/1874/321645
Universiteit Utrecht
12.
Nijhoff, F.
Evolving Concepts in Transcatheter Aortic Valve Implantation.
Degree: 2015, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/326862
► Part I of the present thesis is dedicated to implantation technique and the clinical performance of new valve prostheses. A satisfactory TAVI result not solely…
(more)
▼ Part I of the present thesis is dedicated to implantation technique and the clinical performance
of new valve prostheses. A satisfactory TAVI result not solely depends on patient characteristics,
but also relies on proper valve positioning and final placement. Moreover, prosthetic design is an
important determinant of implantation feasibility, efficacy and safety.
In Chapter 2 we report on our two-step inflation technique for balloon-expandable valve
implantation, which was introduced to enhance the precision of prosthesis placement. In Chapter 3
the feasibility, efficacy and safety of TAVI with a new self-expanding prosthesis for large aortic annuli
is evaluated in an international multicenter study design. In Chapter 4 the clinical performance of
the newest iteration of a balloon-expandable valve system, designed to reduce post-implantation
aortic regurgitation, is compared to its predecessor by means of propensity-score matching.
Part II of this thesis focuses on procedural outcomes. Institutional and operator experience
have been shown to impact the outcome of many interventions. Improved procedural outcomes are
further expected from technological advances and refined patient selection. In TAVI, results may
additionally be influenced by anesthetic technique and the use of intraoperative adjunctive imaging.
Mainly comprising elderly with multiple comorbidities, patients who undergo TAVI may well be at
increased of postoperative delirium.
In Chapter 5 we assess the value of adjunctive intracardiac echocardiography during fluoroscopy
guided transfemoral TAVI under local anesthesia and conscious sedation, and report the outcomes
achieved with this strategy. In Chapter 6 temporal trends in procedural outcomes are investigated
in our single-center seven year TAVI experience, illustrating the impact of the learning curve and
technological advances. In Chapter 7 we report on the incidence, predictive factors and impact of
postoperative delirium after TAVI, a complication largely ignored by the interventional cardiology
community so far.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Stella, P.R.,
Agostoni, P..
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APA ·
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MLA ·
Vancouver ·
CSE |
Export
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Manager
APA (6th Edition):
Nijhoff, F. (2015). Evolving Concepts in Transcatheter Aortic Valve Implantation. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/326862
Chicago Manual of Style (16th Edition):
Nijhoff, F. “Evolving Concepts in Transcatheter Aortic Valve Implantation.” 2015. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/326862.
MLA Handbook (7th Edition):
Nijhoff, F. “Evolving Concepts in Transcatheter Aortic Valve Implantation.” 2015. Web. 14 Apr 2021.
Vancouver:
Nijhoff F. Evolving Concepts in Transcatheter Aortic Valve Implantation. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2015. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/326862.
Council of Science Editors:
Nijhoff F. Evolving Concepts in Transcatheter Aortic Valve Implantation. [Doctoral Dissertation]. Universiteit Utrecht; 2015. Available from: http://dspace.library.uu.nl:8080/handle/1874/326862
13.
Schölzel, B.E.
Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension.
Degree: 2015, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/306315
► Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a raised mean pulmonary artery pressure (of at least 25 mmHg at rest) caused by persistent obstruction…
(more)
▼ Chronic thromboembolic pulmonary hypertension (CTEPH) is defined as a raised mean pulmonary artery pressure (of at least 25 mmHg at rest) caused by persistent obstruction of pulmonary arteries after pulmonary embolism that has not resolved despite at least 3 months of therapeutic anticoagulation.
Non-resolving acute pulmonary embolism is the most common cause of CTEPH, and can occur after one or multiple episodes. CTEPH might occasionally develop owing to in-situ pulmonary artery thrombosis, which could be associated with inflammation of the vessel walls. The estimated prevalence of CTEPH two years after acute pulmonary embolism is 0.1-4.0%. Pulmonary endarterectomy (PEA) is the treatment of choice, offering immediate hemodynamic benefits and providing a potential cure for many patients. However, PEA is not possible for about 50% of patients (inoperable CTEPH), due to either distal pulmonary vascular obstruction that is surgically inaccessible or significant comorbidities thought to be associated with unacceptably high risk. Furthermore, in CTEPH patients with disease amenable to surgery, approximately 10% to 15% of patients have residual pulmonary hypertenion (PH, mean pulmonary arterial pressure [mPAP] > 25 mmHg) after PEA (persistent/recurrent post-operative PH). In these situations, medical treatment might be useful.
Recently, clinical worsening (CW) has been used as a composite endpoint in pulmonary arterial hypertension (PAH) trials, as described by McLaughlin. It is a combination of mortality and different morbidity parameters described after the initiation of specific PH therapy. The definition most frequently used is a combination of all-cause mortality, non-elective hospital stay for PH to initiate intravenous prostanoid or lung transplantation, and disease progression defined as a reduction from baseline in six-minutes walking distance (6-MWD) by 15%.
This thesis concerns the outcome of patients with operable and inoperable chronic thromboembolic pulmonary hypertension (CTEPH).
Chapter 2 concerns the incidence of clinical worsening in patients with inoperable CTEPH in a single center population and in chapter 3 we describe the occurrence of clinical worsening in patients with CTEPH who underwent pulmonary endarterectomy (PEA). Chapter 4 and chapter 5 provide us the important role of cardiovascular imaging modalities like echocardiography and computed tomography in the pre-operative prediction of outcome after PEA. Finally, in chapter 7 the upstream pulmonary artery resistance measured by the pulmonary artery occlusion technique is evaluated as a predictor of outcome after PEA.
Advisors/Committee Members: F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Delcroix, M.C.,
Post, M.C.,
Reesink, H.J..
Subjects/Keywords: Chronic thromboembolic pulmonary hypertension; Pulmonary endarterectomy; Outcome; Clinical worsening; Echocardiography; Computed tomography
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APA ·
Chicago ·
MLA ·
Vancouver ·
CSE |
Export
to Zotero / EndNote / Reference
Manager
APA (6th Edition):
Schölzel, B. E. (2015). Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/306315
Chicago Manual of Style (16th Edition):
Schölzel, B E. “Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension.” 2015. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/306315.
MLA Handbook (7th Edition):
Schölzel, B E. “Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension.” 2015. Web. 14 Apr 2021.
Vancouver:
Schölzel BE. Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2015. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/306315.
Council of Science Editors:
Schölzel BE. Clinical worsening in Chronic Thromboembolic Pulmonary Hypertension. [Doctoral Dissertation]. Universiteit Utrecht; 2015. Available from: http://dspace.library.uu.nl:8080/handle/1874/306315
14.
Velthuis, S.
Clinical implications of pulmonary shunting on contrast echocardiography.
Degree: 2014, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/301528
► Pulmonary right-to-left shunting can be encountered using transthoracic contrast echocardiography (TTCE) with agitated saline. Diseases associated with prevalence of pulmonary shunting on saline TTCE include…
(more)
▼ Pulmonary right-to-left shunting can be encountered using transthoracic contrast echocardiography (TTCE) with agitated saline. Diseases associated with prevalence of pulmonary shunting on saline TTCE include hereditary haemorrhagic telangiectasia (HHT), hepatopulmonary syndrome and some congenital heart defects after partial or complete cavopulmonary anastomosis. Furthermore, small pulmonary shunts on saline TTCE are also documented in a proportion of healthy individuals.
Pulmonary shunting carries the risk for severe neurological complications due to paradoxical embolisation. In HHT, additional chest CT is recommended in case of any pulmonary shunt detected on saline TTCE, in order to evaluate the feasibility for transcatheter embolotherapy of pulmonary arteriovenous malformations (PAVMs). Furthermore, antibiotic prophylaxis is advised in case of any pulmonary shunt on saline TTCE to prevent brain abscesses after procedures with risk of bacteremia.
The present thesis provides an overview of important aspects of pulmonary shunting and its detection using saline TTCE. Furthermore, advances in understanding the clinical implications of different pulmonary shunt grades on saline TTCE are described. It appears that small pulmonary shunts on saline TTCE lack any clinical implication, as these shunts cannot be used as a diagnostic criterion for HHT, are not associated with an increased risk for neurological complications and represent PAVMs too small for subsequent endovascular treatment. This implies that additional chest CT could be safely withheld in all persons with only a small pulmonary shunt on saline TTCE and sets the stage for further discussion about the need for antibiotic prophylaxis in these subjects. Besides further optimization of the current screening algorithm for the detection of PAVMs in HHT, these observations can be of additional clinical importance in other diseases associated with pulmonary shunting and in those healthy individuals with a documented small pulmonary shunt on saline TTCE.
Advisors/Committee Members: Grutters, J.C., F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Post, M.C.,
Mager, J.J..
Subjects/Keywords: Geneeskunde; pulmonary right-to-left shunt; pulmonary arteriovenous malformation; transthoracic contrast echocardiography; hereditary haemorrhagic telangiectasia
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Export
to Zotero / EndNote / Reference
Manager
APA (6th Edition):
Velthuis, S. (2014). Clinical implications of pulmonary shunting on contrast echocardiography. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/301528
Chicago Manual of Style (16th Edition):
Velthuis, S. “Clinical implications of pulmonary shunting on contrast echocardiography.” 2014. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/301528.
MLA Handbook (7th Edition):
Velthuis, S. “Clinical implications of pulmonary shunting on contrast echocardiography.” 2014. Web. 14 Apr 2021.
Vancouver:
Velthuis S. Clinical implications of pulmonary shunting on contrast echocardiography. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2014. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/301528.
Council of Science Editors:
Velthuis S. Clinical implications of pulmonary shunting on contrast echocardiography. [Doctoral Dissertation]. Universiteit Utrecht; 2014. Available from: http://dspace.library.uu.nl:8080/handle/1874/301528
Universiteit Utrecht
15.
Groeneweg, J.A.
Arrhythmogenic Cardiomyopathy. Impact of Genotype, Clinical Course, and Long-Term Outcome.
Degree: 2014, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/300756
► Background: Arrhythmogenic Cardiomyopathy (AC) is characterized by ventricular arrhythmias and structural and functional ventricular abnormalities. The genetic substrate is mostly found in genes encoding desmosomal…
(more)
▼ Background: Arrhythmogenic Cardiomyopathy (AC) is characterized by ventricular arrhythmias and structural and functional ventricular abnormalities. The genetic substrate is mostly found in genes encoding desmosomal proteins. However, pathogenic desmosomal genes mutations are identified in 60% of patients. In the remaining 40%, unclassified genetic variants or no genetic variation at all can be found. Moreover, the impact of the genotype on clinical course remains to be defined. The increased ventricular arrhythmia susceptibility is presumably due to activation delay. Therefore, detection of activation delay, preferably by non-invasive techniques, may improve risk management. Although AC is considered a progressive cardiomyopathy, information on outcomes during long-term follow-up is limited.
Objectives: 1) to evaluate the desmosomal and non-desmosomal genetic contribution, facilitate interpretation of genetic screening results, and to define the impact of genotype on disease course and 2) to evaluate invasive and non-invasive measurements of arrhythmic substrate and to define the long-term outcome of AC. The ultimate goal of this thesis was to support and improve early diagnosis and patient management in AC.
Results: The studies in this thesis showed that in 58% of Dutch AC index patients, a pathogenic desmosomal mutation was found. A non-desmosomal phospholamban (PLN) mutation was identified in 13% of patients, explaining 32% of the up-till-then genetically unexplained cases. PLN mutation carriers more often had low voltages and negative T waves in left precordial leads on their ECG and additional left ventricular abnormalities compared to desmosomal mutation carriers. An algorithm composed of in silico prediction program scores combined with the variant minor allele frequency and the in vitro mRNA analysis improved the prediction of pathogenicity of unclassified variants and facilitated interpretation of genetic screening results in AC. Genotype-phenotype correlation analysis showed that the genotype impacted the phenotype and clinical course. With invasive evaluation of arrhythmogenic substrate in AC patients, electrical abnormalities were mostly shown in the subtricuspid and RV outflow tract area. ECG criteria for non-invasive detection of activation delay mostly in the RV outflow tract already exist in the 2010 diagnostic Task Force Criteria. ECG criteria reflecting electrical abnormalities and activation delay mostly in the subtricuspid area might be: 1) late isolated potentials in inferior leads, 2) negative T waves in inferior leads, and 3) left axis deviation. Assessment of the clinical, genetic, and long-term follow-up data of 1001 individuals showed that long-term outcomes were favorable in diagnosed and appropriately treated index patients and family members. In index-patients, long-term outcome was determined by ICD implantation but remarkably not by mutation status and familial background of disease. In family members, long-term outcome was determined by symptoms at presentation and the presence…
Advisors/Committee Members: Hauer, R.N.W., F.
M.%22%29&pagesize-30">
Doevendans,
P.A.
F.
M.,
Veen, A.A.B. van,
P.%20van%22%29&pagesize-30">Tintelen, J.P. van.
Subjects/Keywords: Geneeskunde; Arrhythmogenic Cardiomyopathy; Arrhythmogenic Right Ventricular Dysplasia/Cardiomyopathy; Genetics; Ventricular Arrhythmias
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APA ·
Chicago ·
MLA ·
Vancouver ·
CSE |
Export
to Zotero / EndNote / Reference
Manager
APA (6th Edition):
Groeneweg, J. A. (2014). Arrhythmogenic Cardiomyopathy. Impact of Genotype, Clinical Course, and Long-Term Outcome. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/300756
Chicago Manual of Style (16th Edition):
Groeneweg, J A. “Arrhythmogenic Cardiomyopathy. Impact of Genotype, Clinical Course, and Long-Term Outcome.” 2014. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/300756.
MLA Handbook (7th Edition):
Groeneweg, J A. “Arrhythmogenic Cardiomyopathy. Impact of Genotype, Clinical Course, and Long-Term Outcome.” 2014. Web. 14 Apr 2021.
Vancouver:
Groeneweg JA. Arrhythmogenic Cardiomyopathy. Impact of Genotype, Clinical Course, and Long-Term Outcome. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2014. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/300756.
Council of Science Editors:
Groeneweg JA. Arrhythmogenic Cardiomyopathy. Impact of Genotype, Clinical Course, and Long-Term Outcome. [Doctoral Dissertation]. Universiteit Utrecht; 2014. Available from: http://dspace.library.uu.nl:8080/handle/1874/300756
Universiteit Utrecht
16.
Meer, M.G. van der.
Gender differences in diagnosis and prognosis of coronary artery disease.
Degree: 2015, Universiteit Utrecht
URL: http://dspace.library.uu.nl:8080/handle/1874/318542
► The first aim of this thesis was to evaluate the diagnostic value of clinical symptoms for the diagnosis of CAD in women and men presenting…
(more)
▼ The first aim of this thesis was to evaluate the diagnostic value of clinical symptoms for the diagnosis of CAD in women and men presenting with chest pain in the general practice and the emergency department. The second aim of this thesis was to investigate the influence of gender on treatment success and (long-term) prognosis. The treatment of CVD in general has improved enormously over the last decades resulting in a better prognosis of women and men. In the Netherlands, the mortality rates of CVD have decreased between 1980 and 2011 with 64% in men and 59% in women. The largest decline was the mortality of acute myocardial infarctions: 84% in men and 79% in women. This improvement in treatment includes better prevention (primary and secondary) for CVD, new medical options, the rise and improvement in (primary) percutaneous coronary interventions (PCI) and a decline in peri- and postoperative mortality after coronary artery bypass grafting (CABG). It remains uncertain whether women receive the same treatment as men, if they respond as good to treatment as men and if there are differences in the prognosis of CVD between sexes. To illustrate: the treatment of a STEMI has improved mainly due to the shift from thrombolysis to primary PCI. Therefore primary PCI is now the recommended treatment for STEMI in Europe and the United States. Many studies have looked for differences in outcome between women and men with a STEMI treated with primary PCI but the results remain conflicting. This is partly due to the fact that data are often difficult to compare as inclusion criteria frequently differ, and there is variation in outcome measures and duration of follow-up. In this thesis we focused on the treatment and prognosis of women and men with a STEMI treated with primary PCI, gender differences in long-term outcome after CABG and in patients with known CVD. Early recognition of high-risk individuals to prevent clinically manifest disease through lifestyle modifications or drug treatment is essential to prevent symptomatic cardiovascular disease. In an attempt to identify people at risk of CVD several prediction models have been developed throughout the years. The Framingham Risk Score, SCORE, and the Pooled Cohort Equations are examples of such frequently used algorithms that aim to predict 10-year absolute risk of CVD for individuals without CVD. Even though these prediction rules are sex-specific, they include the same combination of traditional risk factors for women and men. Female-specific risk factors are known to affect CVD risk but it is however unknown whether female-specific risk factors have any added value on top of the traditional risk factors to predict future risk of CVD in women. The third aim of this thesis was to investigate the added value of female-specific risk factors on top of the traditional risk factors for the prediction of CVD in healthy women.
Advisors/Committee Members: F.
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Doevendans,
P.A.
F.
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Graaf, Y. van der,
Appelman, J.E.A.,
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APA (6th Edition):
Meer, M. G. v. d. (2015). Gender differences in diagnosis and prognosis of coronary artery disease. (Doctoral Dissertation). Universiteit Utrecht. Retrieved from http://dspace.library.uu.nl:8080/handle/1874/318542
Chicago Manual of Style (16th Edition):
Meer, M G van der. “Gender differences in diagnosis and prognosis of coronary artery disease.” 2015. Doctoral Dissertation, Universiteit Utrecht. Accessed April 14, 2021.
http://dspace.library.uu.nl:8080/handle/1874/318542.
MLA Handbook (7th Edition):
Meer, M G van der. “Gender differences in diagnosis and prognosis of coronary artery disease.” 2015. Web. 14 Apr 2021.
Vancouver:
Meer MGvd. Gender differences in diagnosis and prognosis of coronary artery disease. [Internet] [Doctoral dissertation]. Universiteit Utrecht; 2015. [cited 2021 Apr 14].
Available from: http://dspace.library.uu.nl:8080/handle/1874/318542.
Council of Science Editors:
Meer MGvd. Gender differences in diagnosis and prognosis of coronary artery disease. [Doctoral Dissertation]. Universiteit Utrecht; 2015. Available from: http://dspace.library.uu.nl:8080/handle/1874/318542
. 
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