Showing papers by "Marieke D. Spreeuwenberg published in 2007"

Prognostic value of right ventricular mass, volume, and function in idiopathic pulmonary arterial hypertension.

Abstract: Aims This study investigated the relationship between right ventricular (RV) structure and function and survival in idiopathic pulmonary arterial hypertension (IPAH). Methods and results In 64 patients, cardiac magnetic resonance, right heart catheterization, and the six-minute walk test (6MWT) were performed at baseline and after 1-year follow-up. RV structure and function were analysed as predictors of mortality. During a mean follow-up of 32 months, 19 patients died. A low stroke volume (SV), RV dilatation, and impaired left ventricular (LV) filling independently predicted mortality. In addition, a further decrease in SV, progressive RV dilatation, and further decrease in LV end-diastolic volume (LVEDV) at 1-year follow-up were the strongest predictors of mortality. According to Kaplan–Meier survival curves, survival was lower in patients with an inframedian SV index ≤ 25 mL/m2, a supramedian RV end-diastolic volume index ≥ 84 mL/m2, and an inframedian LVEDV≤40 mL/m2. Conclusions The RV contains prognostic information in IPAH. A large RV volume, low SV, and a reduced LV volume are strong independent predictors of mortality and treatment failure.

Right coronary artery flow impairment in patients with pulmonary hypertension

Abstract: Aims This study investigates whether increased right ventricular (RV) pressure in pulmonary hypertension (PH) impairs right coronary artery (RCA) flow and RV perfusion. Methods In 25 subjects, five patients with idiopathic pulmonary arterial hypertension, nine patients with chronic thromboembolic pulmonary arterial hypertension, and 11 healthy controls, flow of the RCA and left anterior descending (LAD) artery was measured with MR flow quantification. Results In PH, RCA peak systolic and mean systolic flow were lower, 1.02 ± 0.62 mL/s and 0.42 ± 0.30 mL/s, than peak and mean diastolic flow, 2.99 ± 1.97 mL/s ( P < 0.001) and 1.73 ± 0.97 mL/s ( P < 0.001); a pattern similar to the LAD. In contrast, in controls, RCA peak and mean flow in systole, 1.63 ± 0.58 mL/s and 0.72 ± 0.23 mL/s, were comparable to peak and mean flow in diastole, 1.72 ± 0.48 mL/s and 0.93 ± 0.28 mL/s (NS). The systolic-to-diastolic flow ratio in the RCA, and mean flow per gram RV tissue, were inversely related to RV mass, R = −0.61 ( P = 0.009), and R = −0.73 ( P < 0.001) and to RV pressure, R = −0.83 ( P < 0.001), and R = −0.57 ( P = 0.033). Conclusion Although in controls, RCA flow is similar in systole and diastole, in PH there is systolic flow impediment, which is proportional to RV pressure and mass. In patients with severe RV hypertrophy total mean flow is reduced.

Long-term follow-up of primary prophylactic implantable cardioverter-defibrillator therapy in Brugada syndrome.

Abstract: Aims To analyse the follow-up data of implantable cardioverter-defibrillator (ICD) therapy in Brugada syndrome (BS). Methods and results We conducted a retrospective, single centre study of 47 patients (mean age: 44.5 ± 15 years) with BS, who underwent primary prophylactic ICD implantation. All patients had baseline spontaneous (23 patients) or drug-induced (24 patients) coved type I ECG pattern. All patients were judged to be at high risk because of syncope (26 patients) and/or a positive family history of sudden death (26 patients). During a median follow-up of 47.5 months, seven patients had appropriate shocks. The presence of spontaneous type I ECG and non-sustained ventricular tachyarrhythmia in the ICD datalog suggested a trend towards shorter appropriate shock-free survival by Kaplan–Meier analysis ( P = 0.037 and P = 0.012, respectively). Seventeen patients received inappropriate shocks (IS); eight patients for sinus tachycardia; six patients for new onset atrial arrhythmias; and five patients for noise oversensing. In multivariable Cox-regression analysis, new onset atrial fibrillation (AF) and less than 50 years of age were independent predictors of significantly shorter IS-free survival ( P = 0.04 and P = 0.036, respectively). Conclusion In high-risk patients with BS, primary prophylactic ICD therapy is an effective treatment. In this, young and otherwise healthy patient population, the IS rate is high.

Pulmonary embolism causes endomyocarditis in the human heart

Abstract: Objectives Pulmonary embolism (PE) is a significant cause of morbidity and mortality. In a recent study in patients with PE, an increased amount of macrophages in the right ventricle was found. In the present study the presence of inflammatory cells, myocytolysis and intracavitary thrombi in the left and right ventricle of patients who died because of PE was evaluated as a putative new source of heart failure. Design 22 PE patients were studied. For comparison, 8 controls and 11 patients who died of chronic pulmonary hypertension (PHT) were used. Slides of the left and right ventricle were stained with antibodies, identifying neutrophilic granulocytes, lymphocytes and macrophages, which were subsequently quantified. Myocytolysis was visualised using complement staining. Thrombi were identified using conventional staining. Results Compared to controls, in patients with PE a significant increase in extravascular localization of all three inflammatory cells was found both in the right and left ventricle, coinciding with myocytolysis, indicative for myocarditis. No increase in inflammatory cells was found in PHT patients. Also endocardial cellular infiltration was found, partly coinciding with the presence of ventricular thrombi. Conclusions In PE patients endomyocarditis and intracavitary thrombi in the left and right ventricle were found. These abnormalities could form an additional and novel explanation for the observed cardiac enzyme release and functional abnormalities of the heart in these patients and may contribute to the morbidity and mortality of the disease.

Late gadolinium-enhanced cardiovascular magnetic resonance evaluation of infarct size and microvascular obstruction in optimally treated patients after acute myocardial infarction

Abstract: Purpose: Cardiovascular magnetic resonance (CMR) is considered the standard imaging modality in clinical trials to monitor patients after acute myocardial infarction (AMI). However, limited data is available with respect to infarct size, presence, and extent of microvascular injury (MVO), and changes over time, in relation to cardiac function in these optimally treated patients. In this study, we prospectively investigate the change of infarct size over time, and the incidence and significance of MVO in a uniform, optimally treated patient group after AMI. Methods: Forty patients underwent cine and late gadolinium-enhanced CMR within 9 days and at 4 months after primary stenting. Left ventricular ejection fraction (LVEF), infarct size (IS) and MVO size were calculated. Results: IS decreased with 19.0% at follow-up (p < 0.01). The 23 (57.5%) patients with MVO had larger infarct size, higher left ventricular volumes and lower LVEF and more involution of IS at follow-up. Overall, LVEF improved from 42.3 ± 9.8% to 44.0 ± 9.8% (p = 0.06), irrespective of presence or size of MVO. Conclusion: Infarct size reduces over time by 19.0% in optimally treated patients after AMI. Despite optimal reperfusion, MVO was found in the majority of patients. Although patients with MVO had larger infarcts and worse indices of left ventricular remodelling, functional change at follow-up was comparable to patients without MVO.

Effect of Corticosteroid Therapy on Low-Molecular–Weight Protein Markers of Kidney Function

Abstract: Serum cystatin C, β2-microglobulin, and β-trace protein are endogenous markers of glomerular filtration rate (GFR). Cystatin C, in particular, is a promising alternative to creatinine for the detection of incipient renal failure. However, corticosteroids affect the extrarenal metabolism of cystatin C, which limits the use of cystatin C as a marker of GFR in a variety of clinical settings. Low-molecular–weight (LMW) β-trace protein might be a useful alternative in this respect. The present study set out to compare the effect of corticosteroid therapy on the serum concentrations of cystatin C, β2-microglobulin, and β-trace protein. We studied a group of 108 children being treated or followed for malignancy (n = 41) or renal disease (n = 67). In the former group 14 patients (34%) were treated with glucocorticoids, in the latter 18 (27%). We compared single-injection inulin clearance studies in 76 patients not receiving steroids with 32 in patients receiving corticosteroid treatment (median dose 33.0 mg prednisone-equivalent per m2 body surface area per day, range 1.2–70.4). Mean (SD) age was 9.7 (5.8) years, mean (SD) GFR 92.8 (34.6) mL · min−1 · (1.73 m2)−1. Patients included in the …

Homocysteine affects cardiomyocyte viability: concentration-dependent effects on reversible flip-flop, apoptosis and necrosis

Abstract: Background Hyperhomocysteinaemia (HHC) is thought to be a risk factor for cardiovascular disease including heart failure. While numerous studies have analyzed the role of homocysteine (Hcy) in the vasculature, only a few studies investigated the role of Hcy in the heart. Therefore we have analyzed the effects of Hcy on isolated cardiomyocytes.

Effects of aging on left atrioventricular coupling and left ventricular filling assessed using cardiac magnetic resonance imaging in healthy subjects.

Abstract: Left ventricular (LV) filling results from diastolic suction of the left ventricle and passive left atrial (LA) emptying at early diastole and LA contraction at end-diastole. Effects of aging on LA and LV geometric characteristics and function and its consequences for LV filling are incompletely understood. Insight into these effects may increase the understanding of diastolic function. Cardiac magnetic resonance imaging was used to study effects of aging on left atrioventricular coupling and LV filling. Forty healthy volunteers underwent cardiac magnetic resonance imaging and were subdivided into 2 age groups of 20 to 40 (younger group) and 40 to 65 years (older group). For the older group, LA volumes were larger (p 2 ; p 2 ; p

Evaluation of global left ventricular function and mechanical dyssynchrony in patients with an asymptomatic left bundle branch block: a real-time 3D echocardiography study

Abstract: Background A left bundle branch block (LBBB) affects both global left ventricular (LV) function and mechanical dyssynchrony. The aim was to evaluate global LV function and mechanical dyssynchrony with real-time 3D echocardiography (RT3DE), in asymptomatic LBBB patients, healthy volunteers and patients with symptomatic heart failure (HF) and a LBBB. Furthermore, the relation between presence or absence of symptoms of HF and mechanical dyssynchrony was investigated. Methods RT3DE was performed in 61 consecutive patients: 16 healthy volunteers, 22 patients with an asymptomatic LBBB and 23 patients with symptomatic HF and a LBBB. Global LV function and the systolic dyssynchrony index (SDI) were measured. Results In healthy volunteers, mean LV ejection fraction was 54 ± 5%, in asymptomatic LBBB patients 50 ± 9%, and in HF patients 29 ± 9%. SDI was 5.6 ± 3.6%, 7.3 ± 3.2% and 12.8 ± 4.8% for healthy volunteers, asymptomatic LBBB patients and HF patients respectively. SDI differed significantly between HF patients and both other groups. A cut-off value for SDI for presence of symptoms of HF was 10.8%. Conclusion Asymptomatic LBBB patients have more depressed global LV function than healthy volunteers have; patients with symptoms of HF and a LBBB have severe global LV dysfunction. Asymptomatic LBBB patients have an intermediate mechanical dyssynchrony; HF patients with a LBBB have the most severe mechanical dyssynchrony. A substantial amount of mechanical dyssynchrony might be accompanied by the presence of symptoms of HF.

Reproducibility of 3-dimensional sonographic measurements of fetal and placental volume at gestational ages of 11-18 weeks.

Abstract: Purpose. Determine the reproducibility of 3D ultrasound (3DUS) measurements of fetal and placental volumes. Methods. We included 34 pregnant women between gestational weeks (GW) 11–18. Two operators independently acquired fetal and placental volumes using 3DUS. Each volume was acquired twice and stored on disk for off-line analysis. Intra- and interobserver reproducibility was expressed in the intra- and interclass correlation coefficient (intra-CC and inter-CC). In addition, the 3DUS volumes acquired by the first operator were calculated by the second and vice-versa to evaluate the effect of volume acquisition and caliper placement. A value >0.75 was considered a good agreement. Results. Fetal and placental volume measurements were successful in 97% of all cases. Between GW 11–14 and 14–18 the median fetal volume was 20.8 (5.0–35.1) and 51.7 (37.9–132.8) ml, the median placental volume was 71.3 (40.9–111.9) and 120.7 (94.2– 273.7) ml. Bland-Altman plots were used for statistical analysis. The intraobserver reproducibility was good for fetus (intra-CC: 0.99; 0.99) and placenta (intra-CC: 0.99; 0.98). Also, interobserver reproducibility was good for fetus (inter-CC 0.98) and placenta (inter-CC 0.98). In addition, regardless of the operator who acquired the volumes, the inter-CC remained good for both fetus (inter-CC: 0.99; 0.99) and placenta (inter-CC: 0.97; 0.99). Conclusion. The reproducibility of fetal and placental volume measurements by 3DUS between GW 11–18 is good. In addition, individually chosen caliper placement and volume acquisition has no effect on the calculation of either volumes. © 2007 Wiley Periodicals, Inc. J Clin Ultrasound, 2007

The effect of left bundle branch block on left ventricular remodeling, dyssynchrony and deformation of the mitral valve apparatus: an observational cardiovascular magnetic resonance imaging study.

Abstract: The effect of a left bundle branch block (LBBB) on cardiac function and remodeling in patients at different stages of heart failure (HF) is unknown. We used cardiac magnetic resonance imaging (CMR) to evaluate the effect of LBBB on left ventricular (LV) remodeling, mechanical dyssynchrony, functional mitral regurgitation (FMR) and deformation of the mitral valve apparatus (MVA) in LBBB patients at different stages of HF. In 12 LBBB patients with HF, 4 patients with isolated LBBB, and 4 controls, cine CMR was performed to measure LV remodeling, FMR grade and deformation of the MVA. CMR tagging was used to measure septal-to-lateral onset of shortening delay and coefficient of circumferential strain variation (CV) to quantify dyssynchrony. LV end-diastolic volume (LVEDV) and end-systolic volume (LVESV) were largest in LBBB patients with HF. Patients with isolated LBBB tended to have a larger LVESV and smaller LV ejection fraction compared to controls, (56 ± 22 ml/m2 versus 45 ± 9 ml/m2, P = ns, 42 ± 9% versus 53 ± 4 %, P = ns). QRS duration and septal-to-lateral-onset-of-shortening delay were comparable between LBBB patients with HF and isolated LBBB patients, CV was larger (98 ± 45 versus 40 ± 4, P < 0.05). MVA tenting and FMR were present both in LBBB patients with HF and patients with isolated LBBB and were not observed in controls. The presence of a LBBB in asymptomatic patients is related to mechanical dyssynchrony and deformation of the MVA and may be associated with LV remodeling. If confirmed, close monitoring or even timely initiation of therapy may be warranted in patients with isolated LBBB. This advocates to conduct a longitudinal CMR follow-up study on the clinical course in patients with isolated LBBB.

Color Doppler ultrasound of spiral artery blood flow for prediction of hypertensive disorders and intra uterine growth restriction: a longitudinal study

Abstract: Objective To construct reference ranges for spiral artery (SA) flow velocities and examine the possibility to predict intra uterine growth restricted (IUGR) fetuses, pregnancy-induced hypertension (PIH) and/or preeclampsia. Methods Spiral artery flow velocity measurements were performed using Color Doppler between 11 to 13 + 6, between 14 to 17 + 6 and between 18 to 24 weeks of gestation, each measurement was performed twice. Spiral artery flow velocities were analyzed with multilevel modeling: individual regression curves were estimated and combined to obtain the reference intervals for SA flow velocities in normal pregnancies. Mann–Whitney U tests was used to compare the deviation from expected flow velocity between normal and complicated pregnancies. Results One hundred and eight pregnancies were included; 4 pregnancies were complicated with preeclampsia, 10 pregnancies with IUGR fetuses (