Showing papers by "Jaap W. Deckers published in 2013"
TL;DR: Right bundle branch block was associated with increased cardiovascular risk and all-cause mortality, whereas IRBBB was not, and RBBB in asymptomatic individuals should alert clinicians to cardiovascular risk.
Abstract: Aims To determine the prevalence, predictors of newly acquired, and the prognostic value of right bundle branch block (RBBB) and incomplete RBBB (IRBBB) on a resting 12-lead electrocardiogram in men and women from the general population.
Methods and results We followed 18 441 participants included in the Copenhagen City Heart Study examined in 1976–2003 free from previous myocardial infarction (MI), chronic heart failure, and left bundle branch block through registry linkage until 2009 for all-cause mortality and cardiovascular outcomes. The prevalence of RBBB/IRBBB was higher in men (1.4%/4.7% in men vs. 0.5%/2.3% in women, P < 0.001). Significant predictors of newly acquired RBBB were male gender, increasing age, high systolic blood pressure, and presence of IRBBB, whereas predictors of newly acquired IRBBB were male gender, increasing age, and low BMI. Right bundle branch block was associated with significantly increased all-cause and cardiovascular mortality in both genders with age-adjusted hazard ratios (HR) of 1.31 [95% confidence interval (CI), 1.11–1.54] and 1.87 (95% CI, 1.48–2.36) in the gender pooled analysis with little attenuation after multiple adjustment. Right bundle branch block was associated with increased risk of MI with an HR of 1.67 (95% CI, 1.16–2.42) and pacemaker insertion with an HR of 2.17 (95% CI, 1.22–3.86), but not with chronic heart failure (HR 1.37; 95% CI, 0.96–1.94), atrial fibrillation (HR 1.10; 95% CI, 0.73–1.67), or chronic obstructive pulmonary disease (HR 0.99; 95% CI, 0.60–1.62). The presence of IRBBB was not associated with any adverse outcome.
Conclusion In this cohort study, RBBB and IRBBB were two to three times more common among men than women. Right bundle branch block was associated with increased cardiovascular risk and all-cause mortality, whereas IRBBB was not. Contrary to common perception, RBBB in asymptomatic individuals should alert clinicians to cardiovascular risk.
192 citations
TL;DR: In this article, an elevated resting heart rate is associated with rehospitalization for heart failure and is a modifiable risk factor in heart failure patients, and the authors aimed to examine the association of elevated heart rate with heart failure.
Abstract: Background—An elevated resting heart rate is associated with rehospitalization for heart failure and is a modifiable risk factor in heart failure patients. We aimed to examine the association betwe...
62 citations
TL;DR: Elevated admission glucose levels are common in patients with myocardial infarction and are strongly associated with increased mortality, particularly in patients without diabetes.
Abstract: We examined temporal trends in mortality after myocardial infarction from 1985 to 2008 depending on admission glucose levels. We included 11,324 consecutive patients admitted to our intensive coronary care unit for myocardial infarction from 1985 to 2008. Patients were categorized into normal, mild, and severe hyperglycemia groups (admission glucose levels <140, 140 to 200, and ≥200 mg/dl, respectively). Temporal trends were determined using 3 groups: 1985 to 1990, 1990 to 2000, and 2000 to 2008. The prevalence of hyperglycemia increased from 26% in the 1980s to 49% in the 2000s. The prevalence of hyperglycemia primarily increased in patients without diabetes. Kaplan-Meier mortality was 4%, 8%, and 17% at 30 days and 64%, 71%, and 82% at 20 years in patients with normal, mild, and severe hyperglycemia, respectively. Compared with normal admission glucose level, adjusted 30-day mortality was 3.6-fold greater (95% confidence interval 2.9 to 4.3) in patients with severe hyperglycemia. This association was not dependent on diabetic status (p for interaction = 0.43) but was dependent on the decade of hospitalization with a stronger association from 2000 to 2008 (adjusted odds ratio 7.7, 95% confidence interval 5.4 to 11, p for interaction <0.001). Compared with diabetes, hyperglycemia was a better discriminator for 30-day mortality. Mortality at 30 days decreased from 1985 to 2008, however, it decreased less in patients with hyperglycemia compared with those with normoglycemia. In conclusion, elevated admission glucose levels are common in patients with myocardial infarction and are strongly associated with increased mortality. Mortality decreased less from 1985 to 2008 in patients with hyperglycemia compared with those with normoglycemia. Efforts that establish optimal treatment for these patients remain warranted.
38 citations
TL;DR: It is concluded that in familial TAAD/PDA with an MYH11 variant in the index case caution should be exercised upon counseling family members, and that segregation analysis remains very important in clinical genetics.
Abstract: Thoracic aortic aneurysms and dissections (TAAD) is a serious condition with high morbidity and mortality. It is estimated that 20% of non-syndromic TAAD cases are inherited in an autosomal-dominant pattern with variable expression and reduced penetrance. Mutations in myosin heavy chain 11 (MYH11), one of several identified TAAD genes, were shown to simultaneously cause TAAD and patent ductus arteriosus (PDA). We identified two large Dutch families with TAAD/PDA and detected two different novel heterozygote MYH11 variants in the probands. These variants, a heterozygote missense variant and a heterozygote in-frame deletion, were predicted to have damaging effects on protein structure and function. However, these novel alterations did not segregate with the TAAD/PDA in 3 out of 11 cases in family TAAD01 and in 2 out of 6 cases of family TAAD02. No mutation was detected in other known TAAD genes. Thus, it is expected that within these families other genetic factors contribute to the disease either by themselves or by interacting with the MYH11 variants. Such an oligogenic model for TAAD would explain the variable onset and progression of the disorder and its reduced penetrance in general. We conclude that in familial TAAD/PDA with an MYH11 variant in the index case caution should be exercised upon counseling family members. Specialized surveillance should still be offered to the non-carriers to prevent catastrophic aortic dissections or ruptures. Furthermore, our study underscores that segregation analysis remains very important in clinical genetics. Prediction programs and mutation evaluation algorithms need to be interpreted with caution.
36 citations
TL;DR: During the past 25 years, treatment of patients with a MI improved substantially with a concomitant decline in mortality, and although the findings were similar for all stages of kidney function, the prognosis remains poor for patients with stage 4-5 CKD.
36 citations
TL;DR: The mortality follow-up of the EUROASPIRE I and II CHD patients emphasize the continuing risk from elevated glucose and total cholesterol levels and underline the importance of smoking cessation in secondary prevention, and the ERC risk tool that is developed may prove helpful to obtain these goals in the setting of secondary prevention.
33 citations
TL;DR: In patients with established coronary artery disease, the risk of cardiovascular mortality during longer term follow-up can be adequately predicted using the clinical characteristics available at baseline, however, the prediction of nonfatal outcomes, both separately and combined with fatal outcomes, poses major challenges for clinicians and model developers.
Abstract: Appropriate risk stratification of patients with established, stable coronary artery disease could contribute to the prevention of recurrent cardiovascular events. The purpose of the present study was to develop and validate risk prediction models for various cardiovascular end points in the EURopean trial On reduction of cardiac events with Perindopril in stable coronary Artery disease (EUROPA) database, consisting of 12,218 patients with established coronary artery disease, with a median follow-up of 4.1 years. Cox proportional hazards models were used for model development. The end points examined were cardiovascular mortality, noncardiovascular mortality, nonfatal myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, resuscitated cardiac arrest, and combinations of these end points. The performance measures included Nagelkerke's R 2 , time-dependent area under the receiver operating characteristic curves, and calibration plots. Backward selection resulted in a prediction model for cardiovascular mortality (464 events) containing age, current smoking, diabetes mellitus, total cholesterol, body mass index, previous myocardial infarction, history of congestive heart failure, peripheral vessel disease, previous revascularization, and previous stroke. The model performance was adequate for this end point, with a Nagelkerke R 2 of 12%, and an area under the receiver operating characteristic curve of 0.73. However, the performance of models constructed for nonfatal and combined end points was considerably worse, with an area under the receiver operating characteristic curve of about 0.6. In conclusion, in patients with established coronary artery disease, the risk of cardiovascular mortality during longer term follow-up can be adequately predicted using the clinical characteristics available at baseline. However, the prediction of nonfatal outcomes, both separately and combined with fatal outcomes, poses major challenges for clinicians and model developers.
32 citations
TL;DR: This paper re-examines the position of "unstable angina" within the ACS context and concludes that the seminal 1989 clinical definition of unstable angina remains the most appropriate description of that ACS entity.
28 citations
TL;DR: Older patients with an MI remained less likely to receive evidence-based care during 24 years of observation and the change in mortality over the 24-year study period is similar among the spectrum of ages.
24 citations
11 citations
TL;DR: Microsimulation takes into account the dynamic nature of coronary artery disease by estimating most likely outcomes regarding a broad range of clinical events and can be used to evaluate treatment effects by estimating the event-free life expectancy with and without treatment.
Abstract: Background: In cardiovascular disease, numerous evidence-based prognostic models have been created, usually based on regression analyses of isolated patient datasets. They tend to focus on one outcome event, based on just one baseline evaluation of the patient, and fail to take the disease process in its dynamic nature into account. We present so-called microsimulation as an attractive alternative for clinical decision-making in individual patients. We aim to further familiarize clinicians with the concept of microsimulation and to inform them about the modeling process. Methods and Results: We describe the modeling process, advantages and disadvantages of microsimulation. We illustrate the concept using a hypothetical 60-year-old patient, with several cardiac risk factors, who is hospitalized for myocardial infarction. By using microsimulation, we calculate this patient's probability of death. In our example, this particular patient's estimated life expectancy turns out to be 8.9 years. While calculating this life expectancy, we were able to account for multiple outcome events and changing patient characteristics. Conclusions: Microsimulation takes into account the dynamic nature of coronary artery disease by estimating most likely outcomes regarding a broad range of clinical events. Moreover, microsimulation can be used to evaluate treatment effects by estimating the event-free life expectancy with and without treatment. Hence, microsimulation has several advantages compared to modeling techniques such as regression. (Circ J 2013; 77: 717-724)
TL;DR: Unexpectedly, latent heart failure and unrecognized diabetes are observed in a large proportion of the patients, as well as elevated inflammatory markers.
Abstract: Objective: Implantable cardioverter-defibrillators (ICDs) prevent arrhythmic death, but do not modify disease progression. The prevalence of persistent cardiovascular risk factors in patients receiving an ICD and their adherence to optimal pharmacological therapy at late follow-up is unknown. The aim of this study was to assess the prevalence of cardiovascular and specific sudden cardiac arrest (SCA) risk factors, and the pharmacological treatment in ICD recipients who survived SCA caused by ventricular fibrillation (VF).Design: Cross-sectional study. A total of 100 consecutive ICD patients who survived SCA due to documented VF, not due to a transient or reversible cause or an arrhythmogenic disease, were interviewed and examined at the routine outpatient clinic.Results: The mean age of the patients was 60 ± 11 years, and they were analysed at a median interval of 1092 days after SCA. The majority of patients had coronary artery disease. The New York Heart Association class at the time of implantation was...
TL;DR: It is agreed that it is too early to implement such a screening programme in the elderly in the absence of randomized evidence, and a note of caution on screening for failing hearts in the disabled and oldest of the old is placed.
Abstract: Heart failure is a disease of old age and casts a dark shadow over the last phase of life in many elderly people. This is confirmed by the striking prevalence of heart failure in elderly UK nursing home residents reported by Dr Hancock and colleagues in this journal. The authors emphasized the feasibility of potential screening for heart failure in this specific population. In the concomitant editorial, Dr Hoes elegantly assessed the validity of a hypothetical heart failure screening programme in the elderly. While many of the World Health Organization (WHO) screening criteria appear to be met, we agree with Dr Hoes that it is too early to implement such a screening programme in the absence of randomized evidence. In addition, we would like to place a note of caution on screening for failing hearts in the disabled and oldest of the old. Only few diseases in the elderly match the burden of morbidity and poor survival associated with heart failure. Therefore, timely diagnosis and initiation of treatment could potentially prevent substantial numbers of hospitalizations and deaths related to heart failure in the elderly. However, in contrast to younger patient groups, approximately half of the elderly diagnosed with heart failure in the general population will not die from cardiovascular causes. Moreover we must realize that due to the frailty and compression of co-morbitiy that accompanies heart failure in these older persons (and especially in nursing home residents), other competing non-cardiac causes of death are expected to take over rapidly and thereby reduce the benefit of screening in the elderly. These phenomena constitute some of the main arguments against screening for cancer in elderly persons and determine the upper age limits in most such screening guidelines. With the ageing of the population and the ever improving prognosis of acute cardiac conditions, increasing numbers of heart failure patients in the future will be a harsh reality. Joint efforts of cardiologists, primary care physicians, and cardiovascular researchers are warranted to halt this oncoming tide. However, one may argue whether the most desirable way to achieve this would be through screening for the late stages of the disease itself. Focusing on more effective preventive measures for major risk factors throughout the life course may well be a more logical option. More research on both determinants and outcomes of heart failure, specifically in the elderly, is needed to fuel this discussion.
01 Jan 2013
TL;DR: Hart-and vaatziekten vormen nog altijd de belangrijkste oorzaak van ziekte en sterfte in Nederland en de westerse wereld as discussed by the authors.
Abstract: Hart- en vaatziekten vormen nog altijd de belangrijkste oorzaak van ziekte en sterfte in Nederland en de westerse wereld. De dalende tendens in het sterftecijfer is onder andere het gevolg van sterke verbeteringen in de preventieve en curatieve zorg. Preventie van hart- en vaatziekten wordt in toenemende mate volgens de richtlijnen uitgevoerd, ook al is nog veel voor verbetering vatbaar. Tevens zijn er verbeterde medicijnen en behandelingstechnieken beschikbaar gekomen. In Nederland is bijvoorbeeld de organisatie erop gericht om bij patienten met een acuut hartinfarct het betrokken bloedvat zo snel mogelijk doorgankelijk te maken door middel van transport naar een centrum waar een dotterbehandeling kan worden uitgevoerd.