{"generated":"2026-08-28T16:42:09Z","year":"2017","count":292,"licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","articles":[{"id":"fae6a9cbe90e","type":"article","url":"https://hartvaat.nl/2017/12/26/kwaliteit-van-leven-na-ees-of-cabg-bij-hoofdstamlijden-excel-qol/","title":"Kwaliteit van leven na EES of CABG bij hoofdstamlijden: EXCEL QoL","title_en":"Quality-of-Life After Everolimus-Eluting Stents or Bypass Surgery for Left-Main Disease: Results From the EXCEL Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.10.036","source_url":"https://doi.org/10.1016/j.jacc.2017.10.036","authors":["Suzanne J Baron","Khaja Chinnakondepalli","Elizabeth A Magnuson","David E Kandzari","John D Puskas","Ori Ben-Yehuda","Gerrit-Anne van Es","David P Taggart","Marie-Claude Morice","Nicholas J Lembo","W Morris Brown","Adrian Banning","Charles A Simonton","A Pieter Kappetein","Joseph F Sabik","Patrick W Serruys","Gregg W Stone","David J Cohen"],"significance":6,"published":"2017-12-26","source_date":"2017-12-26","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This EXCEL quality-of-life analysis compared patient-reported outcomes after PCI versus CABG for left main disease, showing that both strategies provide substantial symptom relief with differences in recovery trajectory.","created":"2026-07-03T10:27:04Z","updated":"2026-07-03T13:26:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EXCEL QoL-analyse die kwaliteit van leven vergeleek na PCI versus CABG bij linker-hoofdstamcoronairlijden. Patiëntperspectief naast harde eindpunten.","abstract_original":"BACKGROUND: The EXCEL (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization) trial compared outcomes in patients with unprotected left main coronary artery disease (LMCAD) treated with coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) using everolimus-eluting stents. Whereas rates of death, stroke, and myocardial infarction were similar at 36 months, event timing and repeat revascularization rates differed by treatment group. OBJECTIVES: To understand the effects of revascularization strategy from the patient's perspective, a prospective quality of life (QoL) substudy was performed alongside the EXCEL trial. METHODS: Between September 2010 and March 2014, 1,905 patients with LMCAD were randomized to undergo CABG or PCI, of whom 1,788 participated in the QoL substudy. QoL was assessed at baseline and 1, 12, and 36 months using the Seattle Angina Questionnaire, the 12-Item Short Form Health Survey, the Rose Dyspnea Scale, the Patient Health Questionnaire-8, and the EQ-5D. Differences between PCI and CABG were assessed using longitudinal random-effect growth curve models. RESULTS: Over 36 months, both PCI and CABG were associated with significant improvements in QoL compared with baseline. At 1 month, PCI was associated with better QoL than CABG. By 12 months though, these differences were largely attenuated, and by 36 months, there were no significant QoL differences between PCI and CABG. CONCLUSIONS: Among selected patients with LMCAD, both PCI and CABG result in similar QoL improvement through 36 months, although a greater early benefit is seen with PCI. Taken together with the 3-year clinical results of EXCEL, these findings suggest that PCI and CABG provide similar intermediate-term outcomes for patients with LMCAD. (Evaluation of Xience Versus Coronary Artery Bypass Surgery for Effectiveness of Left Main Revascularization [EXCEL]; NCT01205776)."},{"id":"d8104ed723ed","type":"article","url":"https://hartvaat.nl/2017/12/21/pci-strategieen-bij-acuut-mi-met-cardiogene-shock-nejm-culprit-shock/","title":"PCI-strategieën bij acuut MI met cardiogene shock: NEJM CULPRIT-SHOCK","title_en":"PCI Strategies in Patients with Acute Myocardial Infarction and Cardiogenic Shock.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock","percutane-coronaire-interventie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1710261","source_url":"https://doi.org/10.1056/NEJMoa1710261","authors":["Holger Thiele","Ibrahim Akin","Marcus Sandri","Georg Fuernau","Suzanne de Waha","Roza Meyer-Saraei","Peter Nordbeck","Tobias Geisler","Ulf Landmesser","Carsten Skurk","Andreas Fach","Harald Lapp","Jan J Piek","Marko Noc","Tomaž Goslar","Stephan B Felix","Lars S Maier","Janina Stepinska","Keith Oldroyd","Pranas Serpytis","Gilles Montalescot","Olivier Barthelemy","Kurt Huber","Stephan Windecker","Stefano Savonitto","Patrizia Torremante","Christiaan Vrints","Steffen Schneider","Steffen Desch","Uwe Zeymer"],"significance":10,"published":"2017-12-21","source_date":"2017-12-21","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/"],"congress":"","summary_en":"The CULPRIT-SHOCK trial demonstrated that culprit-lesion-only PCI was superior to immediate multivessel PCI in patients with acute MI and cardiogenic shock, reducing the composite of death and severe renal failure at 30 days. This finding reversed prevailing practice of routine complete revascularization in cardiogenic shock.","created":"2026-07-03T10:27:04Z","updated":"2026-07-03T13:26:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM CULPRIT-SHOCK-trial die aantoonde dat culprit-only PCI superieur is aan onmiddellijke multivaten-PCI bij MI met cardiogene shock. Veranderde de behandelstrategie voor de ziekste patiënten.","abstract_original":"BACKGROUND: In patients who have acute myocardial infarction with cardiogenic shock, early revascularization of the culprit artery by means of percutaneous coronary intervention (PCI) improves outcomes. However, the majority of patients with cardiogenic shock have multivessel disease, and whether PCI should be performed immediately for stenoses in nonculprit arteries is controversial. METHODS: In this multicenter trial, we randomly assigned 706 patients who had multivessel disease, acute myocardial infarction, and cardiogenic shock to one of two initial revascularization strategies: either PCI of the culprit lesion only, with the option of staged revascularization of nonculprit lesions, or immediate multivessel PCI. The primary end point was a composite of death or severe renal failure leading to renal-replacement therapy within 30 days after randomization. Safety end points included bleeding and stroke. RESULTS: At 30 days, the composite primary end point of death or renal-replacement therapy had occurred in 158 of the 344 patients (45.9%) in the culprit-lesion-only PCI group and in 189 of the 341 patients (55.4%) in the multivessel PCI group (relative risk, 0.83; 95% confidence interval [CI], 0.71 to 0.96; P=0.01). The relative risk of death in the culprit-lesion-only PCI group as compared with the multivessel PCI group was 0.84 (95% CI, 0.72 to 0.98; P=0.03), and the relative risk of renal-replacement therapy was 0.71 (95% CI, 0.49 to 1.03; P=0.07). The time to hemodynamic stabilization, the risk of catecholamine therapy and the duration of such therapy, the levels of troponin T and creatine kinase, and the rates of bleeding and stroke did not differ significantly between the two groups. CONCLUSIONS: Among patients who had multivessel coronary artery disease and acute myocardial infarction with cardiogenic shock, the 30-day risk of a composite of death or severe renal failure leading to renal-replacement therapy was lower among those who initially underwent PCI of the culprit lesion only than among those who underwent immediate multivessel PCI. (Funded by the European Union 7th Framework Program and others; CULPRIT-SHOCK ClinicalTrials.gov number, NCT01927549 .)."},{"id":"c57e9837025a","type":"article","url":"https://hartvaat.nl/2017/12/21/lilrb5-variant-geassocieerd-met-statine-intolerantie-en-myalgie/","title":"LILRB5-variant geassocieerd met statine-intolerantie en myalgie","title_en":"A common missense variant of LILRB5 is associated with statin intolerance and myalgia.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx467","source_url":"https://doi.org/10.1093/eurheartj/ehx467","authors":["Moneeza K Siddiqui","Cyrielle Maroteau","Abirami Veluchamy","Aleksi Tornio","Roger Tavendale","Fiona Carr","Ngu-Uma Abelega","Dan Carr","Katyrzyna Bloch","Par Hallberg","Qun-Ying Yue","Ewan R Pearson","Helen M Colhoun","Andrew D Morris","Eleanor Dow","Jacob George","Munir Pirmohamed","Paul M Ridker","Alex S F Doney","Ana Alfirevic","Mia Wadelius","Anke-Hilse Maitland-van der Zee","Daniel I Chasman","Colin N A Palmer"],"significance":6,"published":"2017-12-21","source_date":"2017-12-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This genetic study identified a common LILRB5 missense variant associated with statin intolerance and myalgia, advancing the pharmacogenomic understanding of statin-associated muscle symptoms.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Genetische studie die een missense-variant in LILRB5 identificeerde als risicofactor voor statine-intolerantie en myalgie. Farmacogenomische verklaring voor individuele statinebijwerkingen.","abstract_original":"AIMS: A genetic variant in LILRB5 (leukocyte immunoglobulin-like receptor subfamily-B) (rs12975366: T > C: Asp247Gly) has been reported to be associated with lower creatine phosphokinase (CK) and lactate dehydrogenase (LDH) levels. Both biomarkers are released from injured muscle tissue, making this variant a potential candidate for susceptibility to muscle-related symptoms. We examined the association of this variant with statin intolerance ascertained from electronic medical records in the GoDARTS study. METHODS AND RESULTS: In the GoDARTS cohort, the LILRB5 Asp247 variant was associated with statin intolerance (SI) phenotypes; one defined as having raised CK and being non-adherent to therapy [odds ratio (OR) 1.81; 95% confidence interval (CI): 1.34-2.45] and the other as being intolerant to the lowest approved dose of a statin before being switched to two or more other statins (OR 1.36; 95% CI: 1.07-1.73). Those homozygous for Asp247 had increased odds of developing both definitions of intolerance. Importantly the second definition did not rely on CK elevations. These results were replicated in adjudicated cases of statin-induced myopathy in the PREDICTION-ADR consortium (OR1.48; 95% CI: 1.05-2.10) and for the development of myalgia in the JUPITER randomized clinical trial of rosuvastatin (OR1.35, 95% CI: 1.10-1.68). A meta-analysis across the studies showed a consistent association between Asp247Gly and outcomes associated with SI (OR1.34; 95% CI: 1.16-1.54). CONCLUSION: This study presents a novel immunogenetic factor associated with statin intolerance, an important risk factor for cardiovascular outcomes. The results suggest that true statin-induced myalgia and non-specific myalgia are distinct, with a potential role for the immune system in their development. We identify a genetic group that is more likely to be intolerant to their statins."},{"id":"8dbd0e6294e8","type":"article","url":"https://hartvaat.nl/2017/12/19/chirurgische-versus-percutane-revascularisatie-bij-diabetes-met-acs/","title":"Chirurgische versus percutane revascularisatie bij diabetes met ACS","title_en":"Surgical Versus Percutaneous Coronary Revascularization in Patients With Diabetes and Acute Coronary Syndromes.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["coronaire-bypass"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.10.029","source_url":"https://doi.org/10.1016/j.jacc.2017.10.029","authors":["Krishnan Ramanathan","James G Abel","Julie E Park","Anthony Fung","Verghese Mathew","Carolyn M Taylor","G B John Mancini","Min Gao","Lillian Ding","Subodh Verma","Karin H Humphries","Michael E Farkouh"],"significance":6,"published":"2017-12-19","source_date":"2017-12-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This analysis compared CABG with PCI specifically in diabetic patients presenting with acute coronary syndromes, extending the FREEDOM-established surgical superiority to the acute setting.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van CABG versus PCI bij diabetespatiënten met acuut coronair syndroom. Diabetes als modificator van de revascularisatiekeuze.","abstract_original":"BACKGROUND: Randomized trial data support the superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention (PCI) in diabetic patients with multivessel coronary artery disease (MV-CAD). However, whether this benefit is seen in a real-world population among subjects with stable ischemic heart disease (SIHD) and acute coronary syndromes (ACS) is unknown. OBJECTIVES: The main objective of this study was to assess the generalizability of the FREEDOM (Future REvascularization Evaluation in Patients with Diabetes Mellitus: Optimal Management of Multi-vessel Disease) trial in real-world practice among patients with diabetes mellitus and MV-CAD in residents of British Columbia, Canada. Additionally, the study evaluated the impact of mode of revascularization (CABG vs. PCI with drug-eluting stents) in diabetic patients with ACS and MV-CAD. METHODS: In a large population-based database from British Columbia, this study evaluated major cardiovascular outcomes in all diabetic patients who underwent coronary revascularization between 2007 and 2014 (n = 4,661, 2,947 patients with ACS). The primary endpoint (major adverse cardiac or cerebrovascular events [MACCE]) was a composite of all-cause death, nonfatal myocardial infarction, and nonfatal stroke. The risk of MACCE with CABG or PCI was compared using multivariable adjustment and a propensity score model. RESULTS: At 30-days post-revascularization, for ACS patients the odds ratio for MACCE favored CABG 0.49 (95% confidence interval [CI]: 0.34 to 0.71), whereas among SIHD patients MACCE was not affected by revascularization strategy (odds ratio: 1.46; 95% CI: 0.71 to 3.01; pinteraction <0.01). With a median follow-up of 3.3 years, the late (31-day to 5-year) benefit of CABG over PCI no longer varied by acuity of presentation, with a hazard ratio for MACCE in ACS patients of 0.67 (95% CI: 0.55 to 0.81) and the hazard ratio for SIHD patients of 0.55 (95% CI: 0.40 to 0.74; pinteraction = 0.28). CONCLUSIONS: In diabetic patients with MV-CAD, CABG was associated with a lower rate of long-term MACCE relative to PCI for both ACS and SIHD. A well-powered randomized trial of CABG versus PCI in the ACS population is warranted because these patients have been largely excluded from prior trials."},{"id":"3c80f7e45009","type":"article","url":"https://hartvaat.nl/2017/12/19/5-jaarsuitkomsten-na-linker-hartoorsluiting-prevail-en-protect-af/","title":"5-jaarsuitkomsten na linker-hartoorsluiting: PREVAIL en PROTECT AF","title_en":"5-Year Outcomes After Left Atrial Appendage Closure: From the PREVAIL and PROTECT AF Trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.10.021","source_url":"https://doi.org/10.1016/j.jacc.2017.10.021","authors":["Vivek Y Reddy","Shephal K Doshi","Saibal Kar","Douglas N Gibson","Matthew J Price","Kenneth Huber","Rodney P Horton","Maurice Buchbinder","Petr Neuzil","Nicole T Gordon","David R Holmes"],"significance":8,"published":"2017-12-19","source_date":"2017-12-19","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/linkerhartoorkluiting/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/"],"congress":"","summary_en":"Combined 5-year results from PREVAIL and PROTECT AF showed that percutaneous left atrial appendage closure with the Watchman device was noninferior to warfarin for stroke prevention in atrial fibrillation, with lower rates of hemorrhagic stroke and cardiovascular mortality. The long-term data supported LAA closure as an alternative to lifelong anticoagulation.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:20Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gecombineerde 5-jaarsresultaten van PREVAIL en PROTECT AF-trials naar percutane linker-hartoorsluiting bij AF. Langetermijnbewijs voor deze alternatieve beroertepreventie.","abstract_original":"BACKGROUND: The PROTECT AF (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation) trial demonstrated that left atrial appendage closure (LAAC) with the Watchman device (Boston Scientific, St. Paul, Minnesota) was equivalent to warfarin for preventing stroke in atrial fibrillation, but had a high rate of complications. In a second randomized trial, PREVAIL (Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy), the complication rate was low. The warfarin cohort experienced an unexpectedly low ischemic stroke rate, rendering the efficacy endpoints inconclusive. However, these outcomes were based on relatively few patients followed for a relatively short time. OBJECTIVES: The final results of the PREVAIL trial, both alone and as part of a patient-level meta-analysis with the PROTECT AF trial, are reported with patients in both trials followed for 5 years. METHODS: PREVAIL and PROTECT AF are prospective randomized clinical trials with patients randomized 2:1 to LAAC or warfarin; together, they enrolled 1,114 patients for 4,343 patient-years. Analyses are by intention-to-treat, and rates are events per 100 patient-years. RESULTS: For the PREVAIL trial, the first composite coprimary endpoint of stroke, systemic embolism (SE), or cardiovascular/unexplained death did not achieve noninferiority (posterior probability for noninferiority = 88.4%), whereas the second coprimary endpoint of post-procedure ischemic stroke/SE did achieve noninferiority (posterior probability for noninferiority = 97.5%); the warfarin arm maintained an unusually low ischemic stroke rate (0.73%). In the meta-analysis, the composite endpoint was similar between groups (hazard ratio [HR]: 0.820; p = 0.27), as were all-stroke/SE (HR: 0.961; p = 0.87). The ischemic stroke/SE rate was numerically higher with LAAC, but this difference did not reach statistical significance (HR: 1.71; p = 0.080). However, differences in hemorrhagic stroke, disabling/fatal stroke, cardiovascular/unexplained death, all-cause death, and post-procedure bleeding favored LAAC (HR: 0.20; p = 0.0022; HR: 0.45; p = 0.03; HR: 0.59; p = 0.027; HR: 0.73; p = 0.035; HR: 0.48; p = 0.0003, respectively). CONCLUSIONS: These 5-year outcomes of the PREVAIL trial, combined with the 5-year outcomes of the PROTECT AF trial, demonstrate that LAAC with Watchman provides stroke prevention in nonvalvular atrial fibrillation comparable to warfarin, with additional reductions in major bleeding, particularly hemorrhagic stroke, and mortality. (WATCHMAN Left Atrial Appendage System for Embolic Protection in Patients With Atrial Fibrillation; NCT00129545; and Evaluation of the WATCHMAN LAA Closure Device in Patients With Atrial Fibrillation Versus Long Term Warfarin Therapy; NCT01182441)."},{"id":"2b322fca42d0","type":"article","url":"https://hartvaat.nl/2017/12/19/cva-preventie-met-ezetimibe-bij-acs-improve-it-analyse/","title":"CVA-preventie met ezetimibe bij ACS: IMPROVE-IT-analyse","title_en":"Prevention of Stroke with the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["cerebrovasculair","ezetimibe","farmaco-economie","hartrevalidatie","primaire-preventie","secundaire-preventie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.029095","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.029095","authors":["Erin A Bohula","Stephen D Wiviott","Robert P Giugliano","Michael A Blazing","Jeong-Gun Park","Sabina A Murphy","Jennifer A White","Francois Mach","Frans Van de Werf","Anthony J Dalby","Harvey D White","Andrew M Tershakovec","Christopher P Cannon","Eugene Braunwald"],"significance":7,"published":"2017-12-19","source_date":"2017-12-19","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This IMPROVE-IT subanalysis showed that adding ezetimibe to statin therapy after ACS reduces stroke risk proportionally to the LDL cholesterol reduction achieved, confirming that the stroke prevention benefit of lipid lowering extends to non-statin agents.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IMPROVE-IT subanalyse naar het effect van ezetimibe-toevoeging aan statines op CVA-preventie na ACS. Bevestigt dat LDL-verlaging ook cerebrovasculaire events vermindert.","abstract_original":"BACKGROUND: Patients who experience an acute coronary syndrome are at heightened risk of recurrent ischemic events, including stroke. Ezetimibe improved cardiovascular outcomes when added to statin therapy in patients stabilized after acute coronary syndrome. We investigated the efficacy of the addition of ezetimibe to simvastatin for the prevention of stroke and other adverse cardiovascular events in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial), with a focus on patients with a stroke before randomization. METHODS: Patients who experienced acute coronary syndrome were randomized to a placebo/simvastatin or ezetimibe/simvastatin regimen and followed for a median of 6 years. Treatment efficacy was assessed for the entire population and by subgroups for the first and total (first and subsequent) events for the end points of stroke of any etiology, stroke subtypes, and the primary trial end point at 7 years. RESULTS: Of 18 144 patients, 641 (3.5%) experienced at least 1 stroke; most were ischemic (527, 82%). Independent predictors of stroke included prior stroke, older age, atrial fibrillation, congestive heart failure, diabetes mellitus, myocardial infarction, and renal dysfunction. There was a nonsignificant reduction in the first event of stroke of any etiology (4.2% versus 4.8%; hazard ratio [HR], 0.86; 95% confidence interval [CI], 0.73-1.00; P=0.052) with ezetimibe/simvastatin versus placebo/simvastatin, driven by a significant 21% reduction in ischemic stroke (3.4% versus 4.1%; HR, 0.79; 95% CI, 0.67-0.94; P=0.008) and a nonsignificant increase in hemorrhagic stroke (0.8% versus 0.6%; HR, 1.38; 95% CI, 0.93-2.04; P=0.11). Evaluating total events, including the first and all recurrent strokes, ezetimibe/simvastatin reduced stroke of any etiology (HR, 0.83; 95% CI, 0.70-0.98; P=0.029) and ischemic stroke (HR, 0.76; 95% CI, 0.63-0.91; P=0.003). Patients who had experienced a stroke prior to randomization were at a higher risk of recurrence and demonstrated an absolute risk reduction of 8.6% for stroke of any etiology (10.2% versus 18.8%; number needed to treat=12; HR, 0.60; 95% CI, 0.38-0.95; P=0.030) and 7.6% for ischemic stroke (8.7% versus 16.3%; number needed to treat=13; HR, 0.52; 95% CI, 0.31-0.86; P=0.011) with ezetimibe added to simvastatin therapy. CONCLUSIONS: The addition of ezetimibe to simvastatin in patients stabilized after acute coronary syndrome reduces the frequency of ischemic stroke, with a particularly large effect seen in patients with a prior stroke. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00202878."},{"id":"0c8f513684dd","type":"article","url":"https://hartvaat.nl/2017/12/14/mechanische-ondersteuning-bij-cardiogene-shock-systematische-review-en-meta-anal/","title":"Mechanische ondersteuning bij cardiogene shock: systematische review en meta-analyse","title_en":"Percutaneous short-term active mechanical support devices in cardiogenic shock: a systematic review and collaborative meta-analysis of randomized trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","atleten","bradycardie","cardiogene-shock","hypertrofische-cardiomyopathie","klepprothese","laminopathie","myocardinfarct","obesitas","plotse-hartdood","slaapapneu","takotsubo"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx363","source_url":"https://doi.org/10.1093/eurheartj/ehx363","authors":["Holger Thiele","Alexander Jobs","Dagmar M Ouweneel","Jose P S Henriques","Melchior Seyfarth","Steffen Desch","Ingo Eitel","Janine Pöss","Georg Fuernau","Suzanne de Waha"],"significance":7,"published":"2017-12-14","source_date":"2017-12-14","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis of short-term active mechanical circulatory support devices in cardiogenic shock found limited evidence for mortality benefit but significant complications, highlighting the need for the large randomized trials that followed.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T18:38:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en collaboratieve meta-analyse van kortetermijn actieve mechanische ondersteuningsdevices bij cardiogene shock. Referentie voor het device-selectiebeleid.","abstract_original":"AIMS: Evidence on the impact on clinical outcome of active mechanical circulatory support (MCS) devices in cardiogenic shock (CS) is scarce. This collaborative meta-analysis of randomized trials thus aims to investigate the efficacy and safety of percutanzeous active MCS vs. control in CS. METHODS AND RESULTS: Randomized trials comparing percutaneous active MCS to control in patients with CS were identified through searches of medical literature databases. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated to analyse the primary endpoint of 30-day mortality and device-related complications including bleeding and leg ischaemia. Mean differences (MD) were calculated for mean arterial pressure (MAP), cardiac index (CI), pulmonary capillary wedge pressure (PCWP), and arterial lactate. Four trials randomizing 148 patients to either TandemHeart™ or Impella® MCS (n = 77) vs. control (n = 71) were identified. In all four trials intra-aortic balloon pumping (IABP) served as control. There was no difference in 30-day mortality (RR 1.01, 95% CI 0.70 to 1.44, P = 0.98, I2 = 0%) for active MCS compared with control. Active MCS significantly increased MAP (MD 11.85 mmHg, 95% CI 3.39 to 20.31, P = 0.02, I2 = 32.7%) and decreased arterial lactate (MD - 1.36 mmol/L, 95% CI - 2.52 to - 0.19, I2 = 0%, P = 0.02) at comparable CI (MD 0.32, 95% CI - 0.24 to 0.87, P = 0.14, I2 = 44.1%) and PCWP (MD - 5.59, 95% -15.59 to 4.40, P = 0.14, I2 = 81.1%). No significant difference was observed in the incidence of leg ischaemia (RR 2.64, 95% CI 0.83 to 8.39, P = 0.10, I2 = 0%), whereas the rate of bleeding was significantly increased in MCS compared to IABP (RR 2.50, 95% CI 1.55 to 4.04, P < 0.001, I2 = 0%). CONCLUSION: Results of this collaborative meta-analysis do not support the unselected use of active MCS in patients with CS complicating AMI."},{"id":"04b4ef1c8345","type":"article","url":"https://hartvaat.nl/2017/12/12/natriumreductie-en-dash-dieet-naar-uitgangs-bloeddruk/","title":"Natriumreductie en DASH-dieet naar uitgangs bloeddruk","title_en":"Effects of Sodium Reduction and the DASH Diet in Relation to Baseline Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.10.011","source_url":"https://doi.org/10.1016/j.jacc.2017.10.011","authors":["Stephen P Juraschek","Edgar R Miller","Connie M Weaver","Lawrence J Appel"],"significance":7,"published":"2017-12-12","source_date":"2017-12-12","image":"","kennis":[],"congress":"","summary_en":"This analysis from the original DASH trials showed that both sodium reduction and the DASH diet provide greater blood pressure lowering in patients with higher baseline blood pressure, supporting targeted dietary interventions for those who would benefit most.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het effect van natriumreductie en het DASH-dieet in relatie tot de uitgangs bloeddruk. Patiënten met hogere uitgangsdruk hebben meer voordeel.","abstract_original":"BACKGROUND: Both sodium reduction and the DASH (Dietary Approaches to Stop Hypertension) diet, a diet rich in fruits, vegetables, and low-fat dairy products, and reduced in saturated fat and cholesterol, lower blood pressure. The separate and combined effects of these dietary interventions by baseline blood pressure (BP) has not been reported. OBJECTIVES: The authors compared the effects of low versus high sodium, DASH versus control, and both (low sodium-DASH vs. high sodium-control diets) on systolic blood pressure (SBP) by baseline BP. METHODS: In the DASH-Sodium (Dietary Patterns, Sodium Intake and Blood Pressure) trial, adults with pre- or stage 1 hypertension and not using antihypertensive medications, were randomized to either DASH or a control diet. On either diet, participants were fed each of 3 sodium levels (50, 100, and 150 mmol/day at 2,100 kcal) in random order over 4 weeks separated by 5-day breaks. Strata of baseline SBP were <130, 130 to 139, 140 to 149, and ≥150 mm Hg. RESULTS: Of 412 participants, 57% were women, and 57% were black; mean age was 48 years, and mean SBP/diastolic BP was 135/86 mm Hg. In the context of the control diet, reducing sodium (from high to low) was associated with mean SBP differences of -3.20, -8.56, -8.99, and -7.04 mm Hg across the respective baseline SBP strata listed (p for trend = 0.004). In the context of high sodium, consuming the DASH compared with the control diet was associated with mean SBP differences of -4.5, -4.3, -4.7, and -10.6 mm Hg, respectively (p for trend = 0.66). The combined effects of the low sodium-DASH diet versus the high sodium-control diet on SBP were -5.3, -7.5, -9.7, and -20.8 mm Hg, respectively (p for trend <0.001). CONCLUSIONS: The combination of reduced sodium intake and the DASH diet lowered SBP throughout the range of pre- and stage 1 hypertension, with progressively greater reductions at higher levels of baseline SBP. SBP reductions in adults with the highest levels of SBP (≥150 mm Hg) were striking and reinforce the importance of both sodium reduction and the DASH diet in this high-risk group. Further research is needed to determine the effects of these interventions among adults with SBP ≥160 mm Hg. (Dietary Patterns, Sodium Intake and Blood Pressure [DASH-Sodium]; NCT00000608)."},{"id":"7c8c7d393343","type":"article","url":"https://hartvaat.nl/2017/12/12/implantatiechniek-en-uitkomsten-van-bioresorbeerbare-scaffolds-absorb-analyses/","title":"Implantatiechniek en uitkomsten van bioresorbeerbare scaffolds: ABSORB-analyses","title_en":"Effect of Technique on Outcomes Following Bioresorbable Vascular Scaffold Implantation: Analysis From the ABSORB Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.09.1106","source_url":"https://doi.org/10.1016/j.jacc.2017.09.1106","authors":["Gregg W Stone","Alexandre Abizaid","Yoshinobu Onuma","Ashok Seth","Runlin Gao","John Ormiston","Takeshi Kimura","Bernard Chevalier","Ori Ben-Yehuda","Ovidiu Dressler","Tom McAndrew","Stephen G Ellis","Dean J Kereiakes","Patrick W Serruys"],"significance":6,"published":"2017-12-12","source_date":"2017-12-12","image":"","kennis":[],"congress":"","summary_en":"This pooled ABSORB analysis showed that optimal implantation technique (proper sizing, high-pressure post-dilation) significantly improves bioresorbable scaffold outcomes, identifying operator-dependent factors that contributed to the device's clinical limitations.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse van ABSORB-trials naar het effect van implantatiechniek op BRS-uitkomsten. Correct sizing en hoge-druk nadilatatie waren cruciaal.","abstract_original":"BACKGROUND: Procedural technique may affect clinical outcomes after bioresorbable vascular scaffold (BVS) implantation. Prior studies suggesting such a relationship have not adjusted for baseline patient and lesion characteristics that may have influenced operator choice of technique and outcomes. OBJECTIVES: This study sought to determine whether target lesion failure (TLF) (cardiac death, target-vessel myocardial infarction, or ischemia-driven target lesion revascularization) and scaffold thrombosis (ScT) rates within 3 years of BVS implantation are affected by operator technique (vessel size selection and pre- and post-dilation parameters). METHODS: TLF and ScT rates were determined in 2,973 patients with 3,149 BVS-treated coronary artery lesions from 5 prospective studies (ABSORB II, ABSORB China, ABSORB Japan, ABSORB III, and ABSORB Extend). Outcomes through 3 years (and between 0 to 1 and 1 to 3 years) were assessed according to pre-specified definitions of optimal technique (pre-dilation, vessel sizing, and post-dilation). Multivariable analysis was used to adjust for differences in up to 18 patient and lesion characteristics. RESULTS: Optimal pre-dilation (balloon to core laboratory-derived reference vessel diameter ratio ≥1:1), vessel size selection (reference vessel diameter ≥2.25 mm and ≤3.75 mm), and post-dilation (with a noncompliant balloon at ≥18 atm and larger than the nominal scaffold diameter, but not by >0.5 mm larger) in all BVS-treated lesions were performed in 59.2%, 81.6%, and 12.4% of patients, respectively. BVS implantation in properly sized vessels was an independent predictor of freedom from TLF through 1 year (hazard ratio [HR]: 0.67; p = 0.01) and through 3 years (HR: 0.72; p = 0.01), and of freedom from ScT through 1 year (HR: 0.36; p = 0.004). Aggressive pre-dilation was an independent predictor of freedom from ScT between 1 and 3 years (HR: 0.44; p = 0.03), and optimal post-dilation was an independent predictor of freedom from TLF between 1 and 3 years (HR: 0.55; p = 0.05). CONCLUSIONS: In the present large-scale analysis from the major ABSORB studies, after multivariable adjustment for baseline patient and lesion characteristics, vessel sizing and operator technique were strongly associated with BVS-related outcomes during 3-year follow-up. (ABSORB II Randomized Controlled Trial [ABSORB II]; NCT01425281; ABSORB III Randomized Controlled Trial [RCT] [ABSORB-III]; NCT01751906; A Clinical Evaluation of Absorb Bioresorbable Vascular Scaffold [Absorb BVS] System in Chinese Population-ABSORB CHINA Randomized Controlled Trial [RCT] [ABSORB CHINA]; NCT01923740; ABSORB EXTEND Clinical Investigation [ABSORB EXTEND]; NCT01023789; AVJ-301 Clinical Trial: A Clinical Evaluation of AVJ-301 [Absorb BVS] in Japanese Population [ABSORB JAPAN]; NCT01844284)."},{"id":"2940c5adad49","type":"article","url":"https://hartvaat.nl/2017/12/12/3-jaarsresultaten-van-bioresorbeerbare-scaffolds-absorb-iii-trial/","title":"3-jaarsresultaten van bioresorbeerbare scaffolds: ABSORB III-trial","title_en":"3-Year Clinical Outcomes With Everolimus-Eluting Bioresorbable Coronary Scaffolds: The ABSORB III Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.10.010","source_url":"https://doi.org/10.1016/j.jacc.2017.10.010","authors":["Dean J Kereiakes","Stephen G Ellis","Christopher Metzger","Ronald P Caputo","David G Rizik","Paul S Teirstein","Marc R Litt","Annapoorna Kini","Ameer Kabour","Steven O Marx","Jeffrey J Popma","Robert McGreevy","Zhen Zhang","Charles Simonton","Gregg W Stone"],"significance":7,"published":"2017-12-12","source_date":"2017-12-12","image":"","kennis":[],"congress":"","summary_en":"The ABSORB III 3-year results showed increasing rates of scaffold thrombosis with the bioresorbable vascular scaffold compared with the Xience metallic stent. This late safety signal contributed to the commercial withdrawal of the Absorb device.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"3-jaarsresultaten van de ABSORB III-trial die toenemende scaffoldtrombose toonden. Droeg bij aan de beslissing om Absorb van de markt te halen.","abstract_original":"BACKGROUND: The Absorb everolimus-eluting poly-L-lactic acid-based bioresorbable vascular scaffold (BVS) provides early drug delivery and mechanical support functions similar to metallic drug-eluting stents (DES), followed by complete bioresorption in approximately 3 years with recovery of vascular structure and function. The ABSORB III trial demonstrated noninferior rates of target lesion failure (cardiac death, target vessel myocardial infarction [TVMI], or ischemia-driven target lesion revascularization) at 1 year in 2,008 patients with coronary artery disease randomized to BVS versus cobalt-chromium everolimus-eluting stents (EES). OBJECTIVES: This study sought to assess clinical outcomes through 3 years following BVS implantation. METHODS: Clinical outcomes from the ABSORB III trial were analyzed by randomized treatment assignment cumulative through 3 years, and between 1 and 3 years. RESULTS: The primary composite endpoint of target lesion failure through 3 years occurred in 13.4% of BVS patients and 10.4% of EES patients (p = 0.06), and between 1 and 3 years in 7.0% versus 6.0% of patients, respectively (p = 0.39). TVMI through 3 years was increased with BVS (8.6% vs. 5.9%; p = 0.03), as was device thrombosis (2.3% vs. 0.7%; p = 0.01). In BVS-assigned patients, treatment of very small vessels (those with quantitatively determined reference vessel diameter <2.25 mm) was an independent predictor of 3-year TLF and scaffold thrombosis. CONCLUSIONS: In the ABSORB III trial, 3-year adverse event rates were higher with BVS than EES, particularly TVMI and device thrombosis. Longer-term clinical follow-up is required to determine whether bioresorption of the polymeric scaffold will influence patient prognosis. (ABSORB III Randomized Controlled Trial [RCT] [ABSORB-III]; NCT01751906)."},{"id":"6a21097e2fb5","type":"article","url":"https://hartvaat.nl/2017/12/05/abdominale-obesitas-en-totale-mortaliteit-bij-hfpef/","title":"Abdominale obesitas en totale mortaliteit bij HFpEF","title_en":"Abdominal Obesity Is Associated With an Increased Risk of All-Cause Mortality in Patients With HFpEF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["obesitas","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.09.1111","source_url":"https://doi.org/10.1016/j.jacc.2017.09.1111","authors":["Tetsuro Tsujimoto","Hiroshi Kajio"],"significance":6,"published":"2017-12-05","source_date":"2017-12-05","image":"","kennis":[],"congress":"","summary_en":"This study demonstrated that abdominal obesity independently predicts all-cause mortality in HFpEF patients, supporting waist circumference as a risk assessment measure complementary to BMI in the obesity-HFpEF phenotype.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat abdominale obesitas geassocieerd is met verhoogde totale mortaliteit bij HFpEF-patiënten. Buikomvang als risicomarker naast BMI.","abstract_original":"BACKGROUND: There is a lack of studies that evaluate the association between abdominal obesity and subsequent outcomes in patients with heart failure with preserved ejection fraction (HFpEF). OBJECTIVES: The present study aimed to assess the association between abdominal obesity and risk of all-cause mortality in patients with HFpEF. METHODS: The present study used data from the TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist) trial. The primary outcome was all-cause mortality. We analyzed and compared the hazard ratios (HRs) in patients with abdominal obesity and those without abdominal obesity using multivariable Cox proportional hazard models. Abdominal obesity was defined as a waist circumference of ≥102 cm in men and ≥88 cm in women. RESULTS: The present study included 3,310 patients with HFpEF: 2,413 patients with abdominal obesity and 897 without abdominal obesity. The mean follow-up was 3.4 ± 1.7 years. During follow-up, 500 patients died. All-cause mortality rates in patients with and without abdominal obesity were 46.1 and 40.7 events per 1,000 person-years, respectively. After multivariable adjustment, the risk of all-cause mortality was significantly higher in patients with abdominal obesity than in those without abdominal obesity (adjusted HR: 1.52; 95% confidence interval [CI]: 1.16 to 1.99; p = 0.002). The risk of cardiovascular and noncardiovascular mortality was also significantly higher in patients with abdominal obesity than in those without abdominal obesity (adjusted HR: 1.50; 95% CI: 1.08 to 2.08; p = 0.01 and adjusted HR: 1.58; 95% CI: 1.00 to 2.51; p = 0.04, respectively). CONCLUSIONS: The risk of all-cause mortality was significantly higher in patients with HFpEF with abdominal obesity than in those without abdominal obesity."},{"id":"0beeff910870","type":"article","url":"https://hartvaat.nl/2017/12/05/j-curve-bij-gerandomiseerde-bloeddrukstreefwaarden-sprint-experimentele-analyse/","title":"J-curve bij gerandomiseerde bloeddrukstreefwaarden: SPRINT experimentele analyse","title_en":"J Curve in Patients Randomly Assigned to Different Systolic Blood Pressure Targets: An Experimental Approach to an Observational Paradigm.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030342","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030342","authors":["Deborah N Kalkman","Tom F Brouwer","Jim T Vehmeijer","Wouter R Berger","Reinoud E Knops","Robbert J de Winter","Ron J Peters","Bert-Jan H van den Born"],"significance":7,"published":"2017-12-05","source_date":"2017-12-05","image":"","kennis":[],"congress":"","summary_en":"This experimental SPRINT analysis addressed the J-curve concern by showing that low blood pressure achieved through randomization to intensive treatment was not associated with increased cardiovascular risk, distinguishing treatment-induced from disease-related hypotension.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Experimentele analyse van SPRINT die de J-curve onderzocht bij patiënten die gerandomiseerd waren naar verschillende bloeddrukstreefwaarden. Uniek ontwerp voor causale inferentie.","abstract_original":"BACKGROUND: Low systolic blood pressure (SBP) values are associated with an increased risk of cardiovascular events, giving rise to the so-called J-curve phenomenon. We assessed the association between on-treatment SBP levels, cardiovascular events, and all-cause mortality in patients randomized to different SBP targets. METHODS: Data from 2 large randomized trials that randomly allocated hypertensive patients at high risk for cardiovascular disease to intensive (SBP<120 mm Hg) or conventional (SBP<140 mm Hg) treatment were pooled and harmonized for outcomes and follow-up duration. Using natural cubic splines, we plotted the hazard ratio for all-cause mortality and cardiovascular events against the mean on-treatment SBP per treatment group. RESULTS: The pooled data consisted of 194 875 on-treatment SBP measurements in 13 946 patients (98.9%). During a median follow-up of 3.3 years, cardiovascular events occurred in 1014 patients (7.3%), and 502 patients died (3.7%). For both blood pressure targets, an identical shape of the J curve was present, with a nadir for cardiovascular events and all-cause mortality just below the SBP target. Patients in the lowest SBP stratum were older, had a higher body mass index, smoked more often, and had a higher frequency of diabetes mellitus and cardiovascular events. CONCLUSIONS: Low on-treatment SBP levels are associated with increased cardiovascular events and all-cause mortality. This association is independent of the attained blood pressure level because the J curve aligns with the SBP target. Our results suggest that the benefit or risk associated with intensive blood pressure-lowering treatment can be established only via randomized clinical trials. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifiers: NCT01206062 and NCT00000620."},{"id":"147e9497c5c3","type":"article","url":"https://hartvaat.nl/2017/12/01/evolocumab-bij-hoogrisicopatienten-met-laag-ldl-op-statine-fourier-subanalyse/","title":"Evolocumab bij hoogrisicopatiënten met laag LDL op statine: FOURIER-subanalyse","title_en":"Clinical Efficacy and Safety of Evolocumab in High-Risk Patients Receiving a Statin: Secondary Analysis of Patients With Low LDL Cholesterol Levels and in Those Already Receiving a Maximal-Potency Statin in a Randomized Clinical Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["bempedoïnezuur","ezetimibe","hdl-cholesterol","ldl-cholesterol","lipidenverlaging","lipoproteïne-a","niet-statine-therapie","ouderen","pcsk9-remmers","rosuvastatine","statines","yellow-iii"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.3944","source_url":"https://doi.org/10.1001/jamacardio.2017.3944","authors":["Robert P Giugliano","Anthony Keech","Sabina A Murphy","Kurt Huber","S Lale Tokgozoglu","Basil S Lewis","Jorge Ferreira","Armando Lira Pineda","Ransi Somaratne","Peter S Sever","Terje R Pedersen","Marc S Sabatine"],"significance":7,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This FOURIER subanalysis examined the incremental benefit of evolocumab in patients already achieving low LDL levels on statin therapy, showing continued cardiovascular risk reduction even when baseline LDL is below traditional targets.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology FOURIER-analyse bij patiënten die reeds lage LDL-niveaus bereikten op statines. Onderzoekt het incrementele voordeel van PCSK9-remming bij reeds goed behandelde patiënten.","abstract_original":"IMPORTANCE: Current guidelines for atherosclerotic cardiovascular disease focus on high-intensity statins and targeting or using a threshold low-density lipoprotein cholesterol (LDL-C) level of less than 70 mg/dL for the highest-risk patients. Whether further reduction of LDL-C beyond these boundaries would be beneficial is unknown. OBJECTIVE: To compare outcomes of evolocumab vs placebo in patients with stable atherosclerotic cardiovascular disease and a baseline LDL-C of less than 70 mg/dL and in those receiving background treatment with a maximal-potency statin. DESIGN, SETTING, AND PARTICIPANTS: This secondary ad hoc analysis of the Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk (FOURIER) trial compared randomized treatments in 2 subgroups of patients with stable atherosclerotic cardiovascular disease currently receiving statin. Patients were classified by a baseline LDL-C of less than 70 or at least 70 mg/dL and by statin intensity (maximal: atorvastatin calcium, 80 mg/d, or rosuvastatin, 40 mg/d; submaximal: all other dosages). Patients with baseline LDL of less than 70 mg/dL either had a final screening LDL-C of at least 70 mg/dL or a final screening non-high-density lipoprotein cholesterol level of at least 100 mg/dL. Data were retrieved from 2013 to 2016 and analyzed in 2017 based on intention to treat. MAIN OUTCOMES AND MEASURES: The primary efficacy endpoint was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The secondary efficacy endpoint was the composite of cardiovascular death, myocardial infarction, or stroke. Safety outcomes included adverse events and events of interest identified in the FOURIER trial. Interaction testing was used to assess the consistency of results in patients who did vs did not satisfy the above criteria. RESULTS: A total of 27 564 patients (75.4% men and 24.6% women; mean [SD] age, 62.5 [9.0] years) were included in the analysis. Of 2034 patients (7.4%) who had a baseline LDL-C of less than 70 mg/dL, evolocumab reduced the risk for the primary endpoint (hazard ratio [HR], 0.80; 95% CI, 0.60-1.07) to a similar degree as in the 25 529 patients who had baseline LDL-C of at least 70 mg/dL (HR 0.86; 95% CI, 0.79-0.92; P = .65 for interaction; 1 patient was missing baseline LDL-C data). Of 7533 patients (27.3%) receiving maximal-potency statins, evolocumab significantly reduced the primary endpoint (HR, 0.86; 95% CI, 0.75-0.98) to a similar degree as in the 20 031 patients not receiving a maximal-potency statin (HR, 0.85; 95% CI, 0.78-0.93; P = .88 for interaction). The key secondary endpoint was reduced to a similar degree in both analyses. No major safety concerns were identified. CONCLUSIONS AND RELEVANCE: Evolocumab was equally effective in reducing cardiovascular events in patients with stable atherosclerotic cardiovascular disease regardless of whether the baseline LDL-C was less than 70 or at least 70 mg/dL and whether the background statin was of maximal or submaximal potency."},{"id":"1c0869f9996f","type":"article","url":"https://hartvaat.nl/2017/12/01/kauwen-versus-slikken-van-ticagrelor-en-plaatjesremming-bij-stemi/","title":"Kauwen versus slikken van ticagrelor en plaatjesremming bij STEMI","title_en":"Effect of Chewing vs Swallowing Ticagrelor on Platelet Inhibition in Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.3868","source_url":"https://doi.org/10.1001/jamacardio.2017.3868","authors":["Elad Asher","Shir Tal","Israel Mazin","Arsalan Abu-Much","Avi Sabbag","Moshe Katz","Ehud Regev","Fernando Chernomordik","Victor Guetta","Amit Segev","Dan Elian","Israel Barbash","Paul Fefer","Michael Narodistky","Roy Beigel","Shlomi Matetzky"],"significance":6,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that chewing ticagrelor achieves faster and more complete platelet inhibition than swallowing intact tablets in STEMI patients, providing a practical pharmacological strategy for overcoming delayed drug absorption in acute MI.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial die het kauwen versus doorslikken van ticagrelor vergeleek op plaatjesremming bij STEMI. Praktisch relevant voor het versnellen van plaatjesremming in de acute fase.","abstract_original":"IMPORTANCE: Dual anti-platelet therapy represents standard care for treating patients with ST-segment elevation myocardial infarction (STEMI). Ticagrelor is a direct-acting P2Y12 inhibitor and, unlike clopidogrel and prasugrel, does not require metabolic activation. OBJECTIVE: To evaluate whether chewing a loading dose (LD) of ticagrelor, 180 mg, vs traditional oral administration of an equal dose enhances platelet inhibition at 30 minutes and 1 hour after LD administration in patients with STEMI. DESIGN, SETTING, AND PARTICIPANTS: A randomized clinical trial was conducted in adults aged 30 to 87 years from May to October 2016 in a large tertiary care center. Analyses were intention-to-treat. INTERVENTIONS: Fifty patients with STEMI were randomized to either chewing an LD of ticagrelor, 180 mg, or standard oral administration of an equal dose. MAIN OUTCOMES AND MEASURES: P2Y12 reaction units were evaluated using VerifyNow (Accumentrics) at baseline, 30 minutes, 1 hour, and 4 hours after LD. RESULTS: Baseline characteristics were similar in both groups. The mean (SD) of P2Y12 reaction units in the chewing group compared with the standard group at baseline, 30 minutes, 1 hour, and 4 hours after ticagrelor LD were 224 (33) vs 219 (44) (95% CI, -16.77 to 27.73; P = .26), 168 (78) vs 230 (69) (95% CI, -103.77 to -19.75; P = .003), 106 (90) vs 181 (89) (95% CI, -125.15 to -26.29; P = .005), and 43 (41) vs 51 (61) (95% CI, -36.34 to 21.14; P = .30), respectively. Platelet reactivity in the chewing group was significantly reduced by 24% at 30 minutes after LD (95% CI, 19.75 to 103.77; P = .001). The relative inhibition of platelet aggregation in the chewing vs the standard group were 51% vs 10% (95% CI, 13.69 to 67.67; P = .005) at 1 hour and 81% vs 76% (95% CI, -12.32 to 16.79; P = .24) at 4 hours, respectively. Major adverse cardiac and cardiovascular event rate at 30 days was low (4%) and occurred in 1 patient in each group (95% CI, 0.06 to 16.93; P > .99). CONCLUSIONS AND RELEVANCE: Chewing an LD of ticagrelor, 180 mg, in patients with STEMI is feasible and facilitates better early platelet inhibition compared with a standard oral LD. Larger studies are warranted to see if our preliminary findings translate into clinical outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02725099."},{"id":"668eaf492989","type":"article","url":"https://hartvaat.nl/2017/12/01/enkelvoudige-versus-tweekamer-pacing-bij-sick-sinus-syndroom-danpace-langetermij/","title":"Enkelvoudige versus tweekamer pacing bij sick sinus syndroom: DANPACE langetermijnfollow-up","title_en":"Single lead atrial vs. dual chamber pacing in sick sinus syndrome: extended register-based follow-up in the DANPACE trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw364","source_url":"https://doi.org/10.1093/europace/euw364","authors":["Niels H Brandt","Rikke Esberg Kirkfeldt","Jens Cosedis Nielsen","Leif Spange Mortensen","Gunnar Vagn Hagemann Jensen","Jens Brock Johansen","Ketil Haugan"],"significance":6,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":[],"congress":"","summary_en":"This extended DANPACE follow-up compared single-lead atrial with dual-chamber pacing in sick sinus syndrome, providing long-term data on the optimal pacing mode for this common bradycardia indication.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnfollow-up van de DANPACE-trial naar enkelvoudige atriale versus tweekamer pacing bij sick sinus syndroom. Onderzoekt het effect op AF-incidentie en mortaliteit.","abstract_original":"AIMS: The DANPACE trial randomized patients with sick sinus syndrome (SSS) to single lead atrial (AAIR) or dual chamber (DDDR) pacemaker (PM). After 5 years follow-up, no difference in overall survival, stroke or heart failure (HF) was observed, whereas risk of atrial fibrillation (AF) and PM reoperation were increased in the AAIR group. The present study aimed to investigate very long term risk of death, AF hospitalization, stroke, HF and rate of change in pacing mode using national register-based data. METHODS AND RESULTS: The study population consisted of all 1384 patients included at Danish PM centres in the DANPACE trial randomized to AAIR (n = 696) or DDDR (n = 688). Long-term follow-up data was obtained from Danish national registers. Analysis was intention-to-treat. results: During mean follow-up of 8.9 years, 413 patients (59.3%) died in the AAIR-group compared to 367 (53.3%) in the DDDR-group (adjusted hazard ratio 1.03; 95% confidence interval 0.90-1.19; P = 0.65). We observed no difference in risk of AF hospitalization, stroke or HF. During extended follow-up, annual rate of pacing mode change to DDDR in the AAIR group was 4.5%, and higher than the 2.3% observed during trial conduct. CONCLUSION: This register-based long-term follow-up study indicates that there is no difference in mortality among patients with SSS randomized to AAIR or DDDR pacing, even with very long follow-up. Nor is there any difference in risk of AF hospitalization, stroke or HF. The higher rate of pacing mode-change to DDDR in the AAIR group suggests a different management of patients with an AAIR PM after the DANPACE trial."},{"id":"a6017e738eed","type":"article","url":"https://hartvaat.nl/2017/12/01/voorkeur-voor-pikant-eten-versterkt-zoutwaarneming-en-vermindert-zoutinname-en-b/","title":"Voorkeur voor pikant eten versterkt zoutwaarneming en vermindert zoutinname en bloeddruk","title_en":"Enjoyment of Spicy Flavor Enhances Central Salty-Taste Perception and Reduces Salt Intake and Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09950","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09950","authors":["Qiang Li","Yuanting Cui","Rongbing Jin","Hongmei Lang","Hao Yu","Fang Sun","Chengkang He","Tianyi Ma","Yingsha Li","Xunmei Zhou","Daoyan Liu","Hongbo Jia","Xiaowei Chen","Zhiming Zhu"],"significance":6,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":[],"congress":"","summary_en":"This innovative study showed that enjoyment of spicy flavors enhances central salty-taste perception and leads to reduced salt intake and lower blood pressure, identifying a dietary strategy for population-level sodium reduction.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat voorkeur voor pittig eten de centrale zoutwaarneming versterkt, waardoor de zoutinname en bloeddruk dalen. Innovatieve niet-farmacologische benadering.","abstract_original":"High salt intake is a major risk factor for hypertension and is associated with cardiovascular events. Most countries exhibit a traditionally high salt intake; thus, identification of an optimal strategy for salt reduction at the population level may have a major impact on public health. In this multicenter, random-order, double-blind observational and interventional study, subjects with a high spice preference had a lower salt intake and blood pressure than subjects who disliked spicy food. The enjoyment of spicy flavor enhanced salt sensitivity and reduced salt preference. Salt intake and salt preference were related to the regional metabolic activity in the insula and orbitofrontal cortex (OFC) of participants. Administration of capsaicin-the major spicy component of chili pepper-enhanced the insula and OFC metabolic activity in response to high-salt stimuli, which reversed the salt intensity-dependent differences in the metabolism of the insula and OFC. In animal study, OFC activity was closely associated with salt preference, and salty-taste information processed in the OFC was affected in the presence of capsaicin. Thus, interventions related to this region may alter the salt preference in mice through fiber fluorometry and optogenetic techniques. In conclusion, enjoyment of spicy foods may significantly reduce individual salt preference, daily salt intake, and blood pressure by modifying the neural processing of salty taste in the brain. Application of spicy flavor may be a promising behavioral intervention for reducing high salt intake and blood pressure."},{"id":"6f7765cce427","type":"article","url":"https://hartvaat.nl/2017/12/01/placental-growth-factor-als-prognostisch-instrument-bij-hypertensieve-zwangersch/","title":"Placental growth factor als prognostisch instrument bij hypertensieve zwangerschapscomplicaties","title_en":"Placental Growth Factor as a Prognostic Tool in Women With Hypertensive Disorders of Pregnancy: A Systematic Review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["zwangerschap-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10150","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10150","authors":["U Vivian Ukah","Jennifer A Hutcheon","Beth Payne","Matthew D Haslam","Manu Vatish","J Mark Ansermino","Helen Brown","Laura A Magee","Peter von Dadelszen"],"significance":6,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"This systematic review evaluated placental growth factor (PlGF) as a prognostic biomarker in hypertensive disorders of pregnancy, supporting its clinical utility for predicting adverse outcomes beyond the diagnostic setting.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review naar placental growth factor (PlGF) als prognostische biomarker bij hypertensieve zwangerschapsaandoeningen. Onderbouwt het gebruik van PlGF in de verloskunde.","abstract_original":"The PlGF (placental growth factor) has been largely demonstrated to be associated with the diagnosis of the hypertensive disorders of pregnancy (HDPs); however, it is unclear how useful it is for the prognosis of the condition. Our objective was to provide a summary of important findings of its prognostic ability by systematically reviewing studies that examined the ability of the PlGF, either independently or combined with other factors, to predict maternal and fetal complications resulting from the HDPs. We included studies published before January 30, 2017, reporting on the use of the PlGF as a prognostic test for women with confirmed HDPs or suspected preeclampsia. Of the 220 abstracts identified through MEDLINE, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), 17 studies were eligible for our review. Prognostic performance was evaluated by sensitivity, specificity, likelihood ratios, and area under the receiver operating characteristic curve. PlGF showed moderate-to-high evidence (likelihood ratios of ≥5 or ≤0.2 or area under the receiver operating characteristic curves ≥0.70) for identifying women at the highest risk of preterm delivery or neonatal outcomes (10/12 studies) but showed no clinically useful performance for the prediction of adverse maternal outcomes. PlGF may aid in the management of women with HDPs to avert fetal complications. Future studies should determine an optimum threshold for the marker to guide delivery and should examine whether its use for predicting adverse maternal outcomes in women with HDPs can be improved."},{"id":"016b009ba4bc","type":"article","url":"https://hartvaat.nl/2017/12/01/centrale-iliacale-av-anastomose-bij-ongecontroleerde-hypertensie-rox-control-htn/","title":"Centrale iliacale AV-anastomose bij ongecontroleerde hypertensie: ROX CONTROL HTN 1-jaarsresultaten","title_en":"Central Iliac Arteriovenous Anastomosis for Uncontrolled Hypertension: One-Year Results From the ROX CONTROL HTN Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10142","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10142","authors":["Melvin D Lobo","Christian Ott","Paul A Sobotka","Manish Saxena","Alice Stanton","John R Cockcroft","Neil Sulke","Eamon Dolan","Markus van der Giet","Joachim Hoyer","Stephen S Furniss","John P Foran","Adam Witkowski","Andrzej Januszewicz","Danny Schoors","Konstantinos Tsioufis","Benno J Rensing","Benjamin Scott","G André Ng","Roland E Schmieder"],"significance":6,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"One-year results of the ROX CONTROL HTN trial showed sustained blood pressure reduction with a central iliac arteriovenous anastomose device for resistant hypertension, testing a novel device-based approach targeting central hemodynamics.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"1-jaarsresultaten van de ROX CONTROL HTN-trial naar een centrale iliacale arterioveneuze anastomose voor behandelresistente hypertensie. Innovatieve devicetherapie.","abstract_original":"UNLABELLED: Creation of a central iliac arteriovenous anastomosis using a novel nitinol coupler device results in an immediate, significant reduction of blood pressure (BP). We present efficacy and safety findings at 12 months post-coupler insertion. This open-label, multicenter, prospective, randomized trial enrolled patients with a baseline office systolic BP ≥140 mm Hg and average daytime ambulatory BP ≥135/85 mm Hg. Subjects were randomly allocated to coupler implantation and continuing previous pharmacotherapy or to maintain previous treatment alone. At 12 months, 39 patients who had coupler therapy were included in the intention-to-treat analysis. Office-based systolic BP reduced by 25.1±23.3 mm Hg (baseline, 174±18 mm Hg; P<0.0001) post-coupler placement, and office diastolic BP reduced by 20.8±13.3 mm Hg (baseline, 100±13 mm Hg; P<0.0001). Mean 24-hour ambulatory BP reduced by 12.6±17.4/15.3±9.7 mm Hg (P<0.0001 for both). In a prespecified subset of patients who failed to respond adequately to prior renal denervation, coupler therapy led to highly significant reduction in office systolic/diastolic BP (30.7/24.1 mm Hg) and significant reduction in 24-hour ambulatory systolic/diastolic BP (12.4/14.4 mm Hg) at 12 months (n=9). After coupler therapy, 14 patients (33%) developed ipsilateral venous stenosis; all were treated successfully with venous stenting. These findings confirm the importance of arterial mechanics in the pathophysiology of hypertension and support the clinical use of a central iliac arteriovenous anastomosis. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01642498."},{"id":"134cb0eac3b7","type":"article","url":"https://hartvaat.nl/2017/12/01/revascularisatie-versus-medicamenteus-beleid-bij-nste-acs-bij-ouderen-meta-analy/","title":"Revascularisatie versus medicamenteus beleid bij NSTE-ACS bij ouderen: meta-analyse","title_en":"Revascularisation compared with initial medical therapy for non-ST-elevation acute coronary syndromes in the elderly: a meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311233","source_url":"https://doi.org/10.1136/heartjnl-2017-311233","authors":["Sonali R Gnanenthiran","Leonard Kritharides","Mario D'Souza","Harry C Lowe","David B Brieger"],"significance":7,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This meta-analysis comparing revascularization with initial medical therapy in elderly patients with NSTE-ACS found a survival benefit with invasive management, providing evidence for active intervention in older acute coronary syndrome patients.","created":"2026-07-03T10:27:02Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die revascularisatie vergeleek met initiële medicamenteuze therapie bij oudere patiënten met NSTE-ACS. Relevant voor de behandelbeslissing bij de toenemende oudere populatie.","abstract_original":"OBJECTIVE: Whether revascularisation is superior to medical therapy in older populations presenting with non-ST-elevation acute coronary syndromes (NSTEACS) remains contentious, with inconclusive evidence from randomised trials. We aimed to compare routine invasive therapy with initial medical management in the elderly presenting with NSTEACS. METHODS: MEDLINE, EMBASE and Cochrane Controlled Trial Register were searched for studies comparing routine invasive therapy with initial medical management in patients ≥75 years old presenting with NSTEACS. Endpoints included long-term mortality, myocardial infarction (MI), revascularisation, rehospitalisation, stroke and major bleeding reported as ORs. RESULTS: Four randomised trials and three observational studies met inclusion criteria, enrolling a total of 20 540 patients followed up from 6 months to 5 years. Routine invasive therapy reduced mortality (OR 0.67, CI 0.61 to 0.74), MI (OR 0.56, CI 0.45 to 0.70) and stroke (OR 0.53, CI 0.30 to 0.95). Analyses restricted to randomised controlled trials (RCTs) confirmed a reduction in MI (OR 0.51, CI 0.40 to 0.66), revascularisation (OR 0.27, CI 0.13 to 0.56) and a trend to reduced mortality (OR 0.84, CI 0.66 to 1.06) at the expense of major bleeding (OR 2.19, CI 1.12 to 4.28). Differences in major bleeding were unapparent in more recent studies. CONCLUSION: Routine invasive therapy reduces MI and repeat revascularisation and may reduce mortality at the expense of major bleeding in elderly patients with NSTEACS. Our findings highlight the need for further RCTs to better determine the effect on mortality and contemporary bleeding risk."},{"id":"dafccc0c0d3c","type":"article","url":"https://hartvaat.nl/2017/12/01/geintegreerde-zorg-bij-atriumfibrilleren-systematische-review-en-meta-analyse/","title":"Geïntegreerde zorg bij atriumfibrilleren: systematische review en meta-analyse","title_en":"Integrated care in atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","farmaco-economie","ouderen","pathfinder-trial","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310952","source_url":"https://doi.org/10.1136/heartjnl-2016-310952","authors":["Celine Gallagher","Adrian D Elliott","Christopher X Wong","Geetanjali Rangnekar","Melissa E Middeldorp","Rajiv Mahajan","Dennis H Lau","Prashanthan Sanders","Jeroen M L Hendriks"],"significance":7,"published":"2017-12-01","source_date":"2017-12-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis demonstrated that integrated, multidisciplinary AF care models improve clinical outcomes including mortality and hospitalization compared with usual care, supporting the structured approach to AF management endorsed by contemporary guidelines.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T18:38:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die aantoont dat geïntegreerde AF-zorg (multidisciplinair, patiëntgericht) de uitkomsten verbetert. Onderbouwt het AF-CARE-model van de ESC.","abstract_original":"OBJECTIVE: Atrial fibrillation (AF) is an emerging global epidemic associated with significant morbidity and mortality. Whilst other chronic cardiovascular conditions have demonstrated enhanced patient outcomes from coordinated systems of care, the use of this approach in AF is a comparatively new concept. Recent evidence has suggested that the integrated care approach may be of benefit in the AF population, yet has not been widely implemented in routine clinical practice. We sought to undertake a systematic review and meta-analysis to evaluate the impact of integrated care approaches to care delivery in the AF population on outcomes including mortality, hospitalisations, emergency department visits, cerebrovascular events and patient-reported outcomes. METHODS: PubMed, Embase and CINAHL databases were searched until February 2016 to identify papers addressing the impact of integrated care in the AF population. Three studies, with a total study population of 1383, were identified that compared integrated care approaches with usual care in AF populations. RESULTS: Use of this approach was associated with a reduction in all-cause mortality (OR 0.51, 95% CI 0.32 to 0.80, p=0.003) and cardiovascular hospitalisations (OR 0.58, 95% CI 0.44 to 0.77, p=0.0002) but did not significantly impact on AF-related hospitalisations (OR 0.82, 95% CI 0.56 to 1.19, p=0.29) or cerebrovascular events (OR 1.00, 95% CI 0.48 to 2.09, p=1.00). CONCLUSIONS: The use of the integrated care approach in AF is associated with reduced cardiovascular hospitalisations and all-cause mortality. Further research is needed to identify optimal settings, methods and components of delivering integrated care to the burgeoning AF population."},{"id":"bb11ae72cb17","type":"article","url":"https://hartvaat.nl/2017/11/30/restrictieve-versus-liberale-bloedtransfusie-bij-hartchirurgie-nejm-trics-iii/","title":"Restrictieve versus liberale bloedtransfusie bij hartchirurgie: NEJM TRICS III","title_en":"Restrictive or Liberal Red-Cell Transfusion for Cardiac Surgery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1711818","source_url":"https://doi.org/10.1056/NEJMoa1711818","authors":["C David Mazer","Richard P Whitlock","Dean A Fergusson","Judith Hall","Emilie Belley-Cote","Katherine Connolly","Boris Khanykin","Alexander J Gregory","Étienne de Médicis","Shay McGuinness","Alistair Royse","François M Carrier","Paul J Young","Juan C Villar","Hilary P Grocott","Manfred D Seeberger","Stephen Fremes","François Lellouche","Summer Syed","Kelly Byrne","Sean M Bagshaw","Nian C Hwang","Chirag Mehta","Thomas W Painter","Colin Royse","Subodh Verma","Gregory M T Hare","Ashley Cohen","Kevin E Thorpe","Peter Jüni","Nadine Shehata"],"significance":9,"published":"2017-11-30","source_date":"2017-11-30","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The TRICS III trial demonstrated that a restrictive red-cell transfusion strategy (hemoglobin threshold <7.5 g/dL) was noninferior to a liberal strategy (<9.5 g/dL) for the composite of death, MI, stroke, or renal failure in patients undergoing cardiac surgery. The findings support restrictive transfusion thresholds in cardiac surgical patients.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM TRICS III-trial die restrictief versus liberaal transfusiebeleid vergeleek bij hartchirurgiepatiënten. Definitieve trial voor transfusiedrempels in de cardiale setting.","abstract_original":"BACKGROUND: The effect of a restrictive versus liberal red-cell transfusion strategy on clinical outcomes in patients undergoing cardiac surgery remains unclear. METHODS: In this multicenter, open-label, noninferiority trial, we randomly assigned 5243 adults undergoing cardiac surgery who had a European System for Cardiac Operative Risk Evaluation (EuroSCORE) I of 6 or more (on a scale from 0 to 47, with higher scores indicating a higher risk of death after cardiac surgery) to a restrictive red-cell transfusion threshold (transfuse if hemoglobin level was <7.5 g per deciliter, starting from induction of anesthesia) or a liberal red-cell transfusion threshold (transfuse if hemoglobin level was <9.5 g per deciliter in the operating room or intensive care unit [ICU] or was <8.5 g per deciliter in the non-ICU ward). The primary composite outcome was death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis by hospital discharge or by day 28, whichever came first. Secondary outcomes included red-cell transfusion and other clinical outcomes. RESULTS: The primary outcome occurred in 11.4% of the patients in the restrictive-threshold group, as compared with 12.5% of those in the liberal-threshold group (absolute risk difference, -1.11 percentage points; 95% confidence interval [CI], -2.93 to 0.72; odds ratio, 0.90; 95% CI, 0.76 to 1.07; P<0.001 for noninferiority). Mortality was 3.0% in the restrictive-threshold group and 3.6% in the liberal-threshold group (odds ratio, 0.85; 95% CI, 0.62 to 1.16). Red-cell transfusion occurred in 52.3% of the patients in the restrictive-threshold group, as compared with 72.6% of those in the liberal-threshold group (odds ratio, 0.41; 95% CI, 0.37 to 0.47). There were no significant between-group differences with regard to the other secondary outcomes. CONCLUSIONS: In patients undergoing cardiac surgery who were at moderate-to-high risk for death, a restrictive strategy regarding red-cell transfusion was noninferior to a liberal strategy with respect to the composite outcome of death from any cause, myocardial infarction, stroke, or new-onset renal failure with dialysis, with less blood transfused. (Funded by the Canadian Institutes of Health Research and others; TRICS III ClinicalTrials.gov number, NCT02042898 .)."},{"id":"33001b92dc10","type":"article","url":"https://hartvaat.nl/2017/11/28/ct-coronairangiografie-en-initiatie-van-cardioprotectieve-medicatie/","title":"CT-coronairangiografie en initiatie van cardioprotectieve medicatie","title_en":"Impact of Coronary Computed Tomography Angiography Findings on Initiation of Cardioprotective Medications.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["coronaire-ct-angiografie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.029994","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.029994","authors":["Anna Marie Chang","Harold I Litt","Bradley S Snyder","Constantine Gatsonis","Erin M Greco","Chadwick D Miller","Harjit Singh","Katie J O'Conor","Judd E Hollander"],"significance":6,"published":"2017-11-28","source_date":"2017-11-28","image":"","kennis":[],"congress":"","summary_en":"This study showed that coronary CT angiography findings significantly influence the initiation of cardioprotective medications, with CCTA serving as a catalyst for evidence-based preventive therapy in patients with subclinical coronary disease.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de impact van CT-coronairangiografiebevindingen op het starten van cardioprotectieve medicatie. CCTA als katalysator voor preventieve behandeling.","abstract_original":""},{"id":"ddcfb8e9efa6","type":"article","url":"https://hartvaat.nl/2017/11/28/xenon-inhalatie-vermindert-myocardschade-bij-overlevenden-van-hartstilstand-xe-h/","title":"Xenon-inhalatie vermindert myocardschade bij overlevenden van hartstilstand: Xe-Hypotheca","title_en":"Inhaled Xenon Attenuates Myocardial Damage in Comatose Survivors of Out-of-Hospital Cardiac Arrest: The Xe-Hypotheca Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.09.1088","source_url":"https://doi.org/10.1016/j.jacc.2017.09.1088","authors":["Olli Arola","Antti Saraste","Ruut Laitio","Juhani Airaksinen","Marja Hynninen","Minna Bäcklund","Emmi Ylikoski","Johanna Wennervirta","Mikko Pietilä","Risto O Roine","Veli-Pekka Harjola","Jussi Niiranen","Kirsi Korpi","Marjut Varpula","Harry Scheinin","Mervyn Maze","Tero Vahlberg","Timo Laitio"],"significance":6,"published":"2017-11-28","source_date":"2017-11-28","image":"","kennis":[],"congress":"","summary_en":"The Xe-Hypotheca trial tested whether inhaled xenon combined with hypothermia provides additional neuroprotection in comatose survivors of out-of-hospital cardiac arrest, exploring noble gas therapy for post-resuscitation brain injury.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Xe-Hypotheca-trial die inhalatie van xenon onderzocht als neuroprotectieve strategie bij comateuze overlevenden van buitenziekenhuishartstilstand.","abstract_original":"BACKGROUND: The authors previously reported that inhaled xenon combined with hypothermia attenuates brain white matter injury in comatose survivors of out-of-hospital cardiac arrest (OHCA). OBJECTIVES: A pre-defined secondary objective was to assess the effect of inhaled xenon on myocardial ischemic damage in the same study population. METHODS: A total of 110 comatose patients who had experienced OHCA from a cardiac cause were randomized to receive either inhaled xenon (40% end-tidal concentration) combined with hypothermia (33°C) for 24 h (n = 55; xenon group) or hypothermia treatment alone (n = 55; control group). Troponin-T levels were measured at hospital admission, and at 24 h, 48 h, and 72 h post-cardiac arrest. All available cases were analyzed for troponin-T release. RESULTS: Troponin-T measurements were available from 54 xenon patients and 54 control patients. The baseline characteristics did not differ significantly between the groups. After adjustments for age, sex, study site, primary coronary percutaneous intervention (PCI), and norepinephrine dose, the mean ± SD post-arrival incremental change of the ln-transformed troponin-T at 72 h was 0.79 ± 1.54 in the xenon group and 1.56 ± 1.38 in the control group (adjusted mean difference -0.66; 95% confidence interval: -1.16 to -0.16; p = 0.01). The effect of xenon on the change in the troponin-T values did not differ in patients with or without PCI or in those with a diagnosis of ST-segment elevation myocardial infarction (group by PCI or ST-segment elevation myocardial infarction interaction effect; p = 0.86 and p = 0.71, respectively). CONCLUSIONS: Among comatose survivors of OHCA, in comparison with hypothermia alone, inhaled xenon combined with hypothermia suggested a less severe myocardial injury as demonstrated by the significantly reduced release of troponin-T."},{"id":"9a15b55cc2ce","type":"article","url":"https://hartvaat.nl/2017/11/28/double-kissing-crush-versus-provisional-stenting-bij-hoofdstambifurcatie-dkcrush/","title":"Double kissing crush versus provisional stenting bij hoofdstambifurcatie: DKCRUSH-V","title_en":"Double Kissing Crush Versus Provisional Stenting for Left Main Distal Bifurcation Lesions: DKCRUSH-V Randomized Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.09.1066","source_url":"https://doi.org/10.1016/j.jacc.2017.09.1066","authors":["Shao-Liang Chen","Jue-Jie Zhang","Yaling Han","Jing Kan","Lianglong Chen","Chunguang Qiu","Tiemin Jiang","Ling Tao","Hesong Zeng","Li Li","Yong Xia","Chuanyu Gao","Teguh Santoso","Chootopol Paiboon","Yan Wang","Tak W Kwan","Fei Ye","Nailiang Tian","Zhizhong Liu","Song Lin","Chengzhi Lu","Shangyu Wen","Lang Hong","Qi Zhang","Imad Sheiban","Yawei Xu","Lefeng Wang","Tanveer S Rab","Zhanquan Li","Guanchang Cheng","Lianqun Cui","Martin B Leon","Gregg W Stone"],"significance":8,"published":"2017-11-28","source_date":"2017-11-28","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/esc-richtlijn-diabetes-cvd-cardiometabool/"],"congress":"","summary_en":"The DKCRUSH-V trial demonstrated that the double kissing crush stenting technique was superior to provisional stenting for distal left main bifurcation lesions, reducing target lesion failure at 1 year. The results changed the recommended bifurcation approach for left main PCI.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T13:26:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DKCRUSH-V-trial die de double kissing crush techniek vergeleek met provisional stenting bij distale linker-hoofdstambifurcatielaesies. Veranderde de bifurcatie-aanpak bij hoofdstamziekte.","abstract_original":"BACKGROUND: Provisional stenting (PS) is the most common technique used to treat distal left main (LM) bifurcation lesions in patients with unprotected LM coronary artery disease undergoing percutaneous coronary intervention. The double kissing (DK) crush planned 2-stent technique has been shown to improve clinical outcomes in non-LM bifurcations compared with PS, and in LM bifurcations compared with culotte stenting, but has never been compared with PS in LM bifurcation lesions. OBJECTIVES: The authors sought to determine whether a planned DK crush 2-stent technique is superior to PS for patients with true distal LM bifurcation lesions. METHODS: The authors randomized 482 patients from 26 centers in 5 countries with true distal LM bifurcation lesions (Medina 1,1,1 or 0,1,1) to PS (n = 242) or DK crush stenting (n = 240). The primary endpoint was the 1-year composite rate of target lesion failure (TLF): cardiac death, target vessel myocardial infarction, or clinically driven target lesion revascularization. Routine 13-month angiographic follow-up was scheduled after ascertainment of the primary endpoint. RESULTS: TLF within 1 year occurred in 26 patients (10.7%) assigned to PS, and in 12 patients (5.0%) assigned to DK crush (hazard ratio: 0.42; 95% confidence interval: 0.21 to 0.85; p = 0.02). Compared with PS, DK crush also resulted in lower rates of target vessel myocardial infarction I (2.9% vs. 0.4%; p = 0.03) and definite or probable stent thrombosis (3.3% vs. 0.4%; p = 0.02). Clinically driven target lesion revascularization (7.9% vs. 3.8%; p = 0.06) and angiographic restenosis within the LM complex (14.6% vs. 7.1%; p = 0.10) also tended to be less frequent with DK crush compared with PS. There was no significant difference in cardiac death between the groups. CONCLUSIONS: In the present multicenter randomized trial, percutaneous coronary intervention of true distal LM bifurcation lesions using a planned DK crush 2-stent strategy resulted in a lower rate of TLF at 1 year than a PS strategy. (Double Kissing and Double Crush Versus Provisional T Stenting Technique for the Treatment of Unprotected Distal Left Main True Bifurcation Lesions: A Randomized, International, Multi-Center Clinical Trial [DKCRUSH-V]; ChiCTR-TRC-11001213)."},{"id":"4c185e64c5b6","type":"article","url":"https://hartvaat.nl/2017/11/28/schildklierfunctie-en-risico-op-af-subclinische-hypothyreoidie/","title":"Schildklierfunctie en risico op AF: subclinische hypothyreoïdie","title_en":"Thyroid Function Within the Normal Range, Subclinical Hypothyroidism, and the Risk of Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028753","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028753","authors":["Christine Baumgartner","Bruno R da Costa","Tinh-Hai Collet","Martin Feller","Carmen Floriani","Douglas C Bauer","Anne R Cappola","Susan R Heckbert","Graziano Ceresini","Jacobijn Gussekloo","Wendy P J den Elzen","Robin P Peeters","Robert Luben","Henry Völzke","Marcus Dörr","John P Walsh","Alexandra Bremner","Massimo Iacoviello","Peter Macfarlane","Jan Heeringa","David J Stott","Rudi G J Westendorp","Kay-Tee Khaw","Jared W Magnani","Drahomir Aujesky","Nicolas Rodondi"],"significance":6,"published":"2017-11-28","source_date":"2017-11-28","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"This study demonstrated that thyroid function variation within the normal range and subclinical hypothyroidism are associated with increased risk of atrial fibrillation, identifying thyroid status as a modifiable risk factor for AF.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het verband tussen schildklierfunctie (inclusief subclinische hypothyreoïdie) en het risico op atriumfibrilleren. Schildklierdisfunctie als modificeerbare AF-risicofactor.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) is a highly prevalent disorder leading to heart failure, stroke, and death. Enhanced understanding of modifiable risk factors may yield opportunities for prevention. The risk of AF is increased in subclinical hyperthyroidism, but it is uncertain whether variations in thyroid function within the normal range or subclinical hypothyroidism are also associated with AF. METHODS: We conducted a systematic review and obtained individual participant data from prospective cohort studies that measured thyroid function at baseline and assessed incident AF. Studies were identified from MEDLINE and EMBASE databases from inception to July 27, 2016. The euthyroid state was defined as thyroid-stimulating hormone (TSH) 0.45 to 4.49 mIU/L, and subclinical hypothyroidism as TSH 4.5 to 19.9 mIU/L with free thyroxine (fT4) levels within reference range. The association of TSH levels in the euthyroid and subclinical hypothyroid range with incident AF was examined by using Cox proportional hazards models. In euthyroid participants, we additionally examined the association between fT4 levels and incident AF. RESULTS: Of 30 085 participants from 11 cohorts (278 955 person-years of follow-up), 1958 (6.5%) had subclinical hypothyroidism and 2574 individuals (8.6%) developed AF during follow-up. TSH at baseline was not significantly associated with incident AF in euthyroid participants or those with subclinical hypothyroidism. Higher fT4 levels at baseline in euthyroid individuals were associated with increased AF risk in age- and sex-adjusted analyses (hazard ratio, 1.45; 95% confidence interval, 1.26-1.66, for the highest quartile versus the lowest quartile of fT4; P for trend ≤0.001 across quartiles). Estimates did not substantially differ after further adjustment for preexisting cardiovascular disease. CONCLUSIONS: In euthyroid individuals, higher circulating fT4 levels, but not TSH levels, are associated with increased risk of incident AF."},{"id":"02026898eea3","type":"article","url":"https://hartvaat.nl/2017/11/21/hoog-sensitief-troponine-i-en-uitkomsten-bij-verdenking-acs-jama-studie/","title":"Hoog-sensitief troponine I en uitkomsten bij verdenking ACS: JAMA-studie","title_en":"Association of High-Sensitivity Cardiac Troponin I Concentration With Cardiac Outcomes in Patients With Suspected Acute Coronary Syndrome.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["hs-crp","slaapapneu","troponine"],"journal":"JAMA","doi":"10.1001/jama.2017.17488","source_url":"https://doi.org/10.1001/jama.2017.17488","authors":["Andrew R Chapman","Kuan Ken Lee","David A McAllister","Louise Cullen","Jaimi H Greenslade","William Parsonage","Andrew Worster","Peter A Kavsak","Stefan Blankenberg","Johannes Neumann","Nils A Sörensen","Dirk Westermann","Madelon M Buijs","Gerard J E Verdel","John W Pickering","Martin P Than","Raphael Twerenbold","Patrick Badertscher","Zaid Sabti","Christian Mueller","Atul Anand","Philip Adamson","Fiona E Strachan","Amy Ferry","Dennis Sandeman","Alasdair Gray","Richard Body","Brian Keevil","Edward Carlton","Kim Greaves","Frederick K Korley","Thomas S Metkus","Yader Sandoval","Fred S Apple","David E Newby","Anoop S V Shah","Nicholas L Mills"],"significance":7,"published":"2017-11-21","source_date":"2017-11-21","image":"","kennis":[],"congress":"","summary_en":"This JAMA study examined the prognostic value of high-sensitivity cardiac troponin I at concentrations below conventional MI thresholds, demonstrating a continuous relationship between troponin level and cardiac risk in patients with suspected ACS.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA-studie naar de associatie van hoog-sensitief troponine I met cardiale uitkomsten bij patiënten met verdenking op ACS. Verfijnt de diagnostische drempelwaarden.","abstract_original":"IMPORTANCE: High-sensitivity cardiac troponin I testing is widely used to evaluate patients with suspected acute coronary syndrome. A cardiac troponin concentration of less than 5 ng/L identifies patients at presentation as low risk, but the optimal threshold is uncertain. OBJECTIVE: To evaluate the performance of a cardiac troponin I threshold of 5 ng/L at presentation as a risk stratification tool in patients with suspected acute coronary syndrome. DATA SOURCES: Systematic search of MEDLINE, EMBASE, Cochrane, and Web of Science databases from January 1, 2006, to March 18, 2017. STUDY SELECTION: Prospective studies measuring high-sensitivity cardiac troponin I concentrations in patients with suspected acute coronary syndrome in which the diagnosis was adjudicated according to the universal definition of myocardial infarction. DATA EXTRACTION AND SYNTHESIS: The systematic review identified 19 cohorts. Individual patient-level data were obtained from the corresponding authors of 17 cohorts, with aggregate data from 2 cohorts. Meta-estimates for primary and secondary outcomes were derived using a binomial-normal random-effects model. MAIN OUTCOMES AND MEASURES: The primary outcome was myocardial infarction or cardiac death at 30 days. Performance was evaluated in subgroups and across a range of troponin concentrations (2-16 ng/L) using individual patient data. RESULTS: Of 11 845 articles identified, 104 underwent full-text review, and 19 cohorts from 9 countries were included. Among 22 457 patients included in the meta-analysis (mean age, 62 [SD, 15.5] years; n = 9329 women [41.5%]), the primary outcome occurred in 2786 (12.4%). Cardiac troponin I concentrations were less than 5 ng/L at presentation in 11 012 patients (49%), in whom there were 60 missed index or 30-day events (59 index myocardial infarctions, 1 myocardial infarction at 30 days, and no cardiac deaths at 30 days). This resulted in a negative predictive value of 99.5% (95% CI, 99.3%-99.6%) for the primary outcome. There were no cardiac deaths at 30 days and 7 (0.1%) at 1 year, with a negative predictive value of 99.9% (95% CI, 99.7%-99.9%) for cardiac death. CONCLUSIONS AND RELEVANCE: Among patients with suspected acute coronary syndrome, a high-sensitivity cardiac troponin I concentration of less than 5 ng/L identified those at low risk of myocardial infarction or cardiac death within 30 days. Further research is needed to understand the clinical utility and cost-effectiveness of this approach to risk stratification."},{"id":"492f42cb9df5","type":"article","url":"https://hartvaat.nl/2017/11/21/sacubitril-valsartan-versus-olmesartan-en-cardiovasculaire-remodellering-bij-hyp/","title":"Sacubitril/valsartan versus olmesartan en cardiovasculaire remodellering bij hypertensie: PARAMETER-2","title_en":"The effect of sacubitril/valsartan compared to olmesartan on cardiovascular remodelling in subjects with essential hypertension: the results of a randomized, double-blind, active-controlled study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","bloeddrukbehandeling","sacubitril-valsartan"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx525","source_url":"https://doi.org/10.1093/eurheartj/ehx525","authors":["Roland E Schmieder","Frank Wagner","Michael Mayr","Christian Delles","Christian Ott","Christian Keicher","Maja Hrabak-Paar","Tobias Heye","Solveig Aichner","Yasser Khder","Denise Yates","Diego Albrecht","Thomas Langenickel","Patrick Freyhardt","Rolf Janka","Jens Bremerich"],"significance":7,"published":"2017-11-21","source_date":"2017-11-21","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/"],"congress":"","summary_en":"This PARAMETER follow-up analysis showed that sacubitril-valsartan improved cardiovascular remodeling parameters (aortic stiffness, left ventricular mass) compared with olmesartan in essential hypertension, suggesting structural cardiovascular benefits of combined neprilysin-RAAS inhibition.","created":"2026-07-03T10:27:01Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PARAMETER follow-upanalyse naar het effect van sacubitril/valsartan op cardiovasculaire remodellering bij essentiële hypertensie. ARNI als antihypertensivum met orgaanprotectief potentieel.","abstract_original":"AIMS: Progressive aortic stiffening eventually leads to left ventricular (LV) hypertrophy and heart failure if left untreated. Anti-hypertensive agents have been shown to reverse this to some extent. The effects of sacubitril/valsartan (LCZ696), a dual-action angiotensin receptor blocker (ARB), and neprilysin inhibitor, on arterial stiffness and LV remodelling have not been investigated. METHODS AND RESULTS: This was a randomized, multi-centre, double-blind, double-dummy, active-controlled, parallel group, study to compare the effects on cardiovascular remodelling of sacubitril/valsartan with those of olmesartan in patients with hypertension and elevated pulse pressure. Magnetic resonance imaging scans were used to assess LV mass and local aortic distensibility, at baseline and at 12 and 52 weeks after initiation of treatment. Central pulse and systolic pressure were determined using a SphymoCor® XCEL device at each time point. A total of 114 patients were included, with 57 in each treatment group. The mean age was 59.8 years, and 67.5% were male. Demographic characteristics did not vary between the two sets of patients. Left ventricular mass index decreased to a greater extent in the sacubitril/valsartan group compared to the olmesartan group from baseline to 12 weeks (-6.36 vs. -2.32 g/m2; P = 0.039) and from baseline to 52 weeks (-6.83 vs. -3.55 g/m2; P = 0.029). These differences remained significant after adjustment for systolic blood pressure (SBP) at follow-up (P = 0.036 and 0.019 at 12 and 52 weeks, respectively) and similar signals (though formally non-significant) were observed after adjusting for changes in SBP (P = 0.0612 and P = 0.0529, respectively). There were no significant differences in local distensibility changes from baseline to 12 or 52 weeks between the two groups; however, there was a larger reduction in central pulse pressure for the sacubitril/valsartan group compared to the olmesartan group (P = 0.010). CONCLUSION: Since LV mass change correlates with cardiovascular prognosis, the greater reductions in LV mass indicate valuable advantages of sacubitril/valsartan compared to olmesartan. The finding that LV mass index decrease might be to some extent independent of SBP suggests that the effect of the dual-acting agent may go beyond those due to its BP-lowering ability."},{"id":"65f37afae4e3","type":"article","url":"https://hartvaat.nl/2017/11/21/bloeddrukeffecten-van-ibuprofen-naproxen-en-celecoxib-bij-artritis-precision-abp/","title":"Bloeddrukeffecten van ibuprofen, naproxen en celecoxib bij artritis: PRECISION-ABPM","title_en":"Differential blood pressure effects of ibuprofen, naproxen, and celecoxib in patients with arthritis: the PRECISION-ABPM (Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen Ambulatory Blood Pressure Measurement) Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx508","source_url":"https://doi.org/10.1093/eurheartj/ehx508","authors":["Frank Ruschitzka","Jeffrey S Borer","Henry Krum","Andreas J Flammer","Neville D Yeomans","Peter Libby","Thomas F Lüscher","Daniel H Solomon","M Elaine Husni","David Y Graham","Deborah A Davey","Lisa M Wisniewski","Venu Menon","Rana Fayyad","Bruce Beckerman","Dinu Iorga","A Michael Lincoff","Steven E Nissen"],"significance":8,"published":"2017-11-21","source_date":"2017-11-21","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/nierziekte/nsaids-en-nierziekte/"],"congress":"","summary_en":"The PRECISION-ABPM substudy showed differential blood pressure effects among NSAIDs, with celecoxib having the most favorable profile (minimal BP increase) compared with ibuprofen (significant increase) and naproxen. The 24-hour ambulatory data informed NSAID selection in hypertensive patients.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PRECISION-ABPM substudie die de bloeddrukeffecten van drie NSAID's vergeleek bij artritispatiënten met 24-uurs ambulante meting. Celecoxib had het gunstigste profiel.","abstract_original":"AIMS: Non-steroidal anti-inflammatory drugs (NSAIDs), both non-selective and selective cyclooxygenase-2 (COX-2) inhibitors, are among the most widely prescribed drugs worldwide, but associate with increased blood pressure (BP) and adverse cardiovascular (CV) events. PRECISION-ABPM, a substudy of PRECISION was conducted at 60 sites, to determine BP effects of the selective COX-2 inhibitor celecoxib vs. the non-selective NSAIDs naproxen and ibuprofen. METHODS AND RESULTS: In this double-blind, randomized, multicentre non-inferiority CV-safety trial, 444 patients (mean age 62 ± 10 years, 54% female) with osteoarthritis (92%) or rheumatoid arthritis (8%) and evidence of or at increased risk for coronary artery disease received celecoxib (100-200 mg bid), ibuprofen (600-800 mg tid), or naproxen (375-500 mg bid) with matching placebos in a 1: 1: 1 allocation, to assess the effect on 24-h ambulatory BP after 4 months. The change in mean 24-h systolic BP (SBP) in celecoxib, ibuprofen and naproxen-treated patients was -0.3 mmHg [95% confidence interval (CI), -2.25, 1.74], 3.7 (95% CI, 1.72, 5.58) and 1.6 mmHg (95% CI, -0.40, 3.57), respectively. These changes resulted in a difference of - 3.9 mmHg (P = 0.0009) between celecoxib and ibuprofen, of - 1.8 mmHg (P = 0.12) between celecoxib and naproxen, and of - 2.1 mmHg (P = 0.08) between naproxen and ibuprofen. The percentage of patients with normal baseline BP who developed hypertension (mean 24-h SBP ≥ 130 and/or diastolic BP ≥ 80 mmHg) was 23.2% for ibuprofen, 19.0% for naproxen, and 10.3% for celecoxib (odds ratio 0.39, P = 0.004 and odds ratio 0.49, P = 0.03 vs. ibuprofen and naproxen, respectively). CONCLUSIONS: In PRECISION-ABPM, allocation to the non-selective NSAID ibuprofen, compared with the COX-2 selective inhibitor celecoxib was associated with a significant increase of SBP, and a higher incidence of new-onset hypertension. CLINICALTRIALS: gov number NCT00346216."},{"id":"d44232018f5f","type":"article","url":"https://hartvaat.nl/2017/11/21/coronair-calcium-en-prognostische-waarde-bij-pijn-op-de-borst-promise-studie/","title":"Coronair calcium en prognostische waarde bij pijn op de borst: PROMISE-studie","title_en":"Prognostic Value of Coronary Artery Calcium in the PROMISE Study (Prospective Multicenter Imaging Study for Evaluation of Chest Pain).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030578","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030578","authors":["Matthew J Budoff","Thomas Mayrhofer","Maros Ferencik","Daniel Bittner","Kerry L Lee","Michael T Lu","Adrian Coles","James Jang","Mayil Krishnam","Pamela S Douglas","Udo Hoffmann"],"significance":7,"published":"2017-11-21","source_date":"2017-11-21","image":"","kennis":[],"congress":"","summary_en":"This PROMISE analysis confirmed the prognostic value of coronary artery calcium scoring in patients evaluated for stable chest pain, showing that CAC adds incremental prediction beyond clinical risk factors and functional testing.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PROMISE-analyse naar de prognostische waarde van coronair calciumscore bij patiënten met verdenking op stabiel coronairlijden.","abstract_original":"BACKGROUND: Coronary artery calcium (CAC) is an established predictor of future major adverse atherosclerotic cardiovascular events in asymptomatic individuals. However, limited data exist as to how CAC compares with functional testing (FT) in estimating prognosis in symptomatic patients. METHODS: In the PROMISE trial (Prospective Multicenter Imaging Study for Evaluation of Chest Pain), patients with stable chest pain (or dyspnea) and intermediate pretest probability for obstructive coronary artery disease were randomized to FT (exercise electrocardiography, nuclear stress, or stress echocardiography) or anatomic testing. We evaluated those who underwent CAC testing as part of the anatomic evaluation (n=4209) and compared that with results of FT (n=4602). We stratified CAC and FT results as normal or mildly, moderately, or severely abnormal (for CAC: 0, 1-99 Agatston score [AS], 100-400 AS, and >400 AS, respectively; for FT: normal, mild=late positive treadmill, moderate=early positive treadmill or single-vessel ischemia, and severe=large ischemic region abnormality). The primary end point was all-cause death, myocardial infarction, or unstable angina hospitalization over a median follow-up of 26.1 months. Cox regression models were used to calculate hazard ratios (HRs) and C statistics to determine predictive and discriminatory values. RESULTS: Overall, the distribution of normal or mildly, moderately, or severely abnormal test results was significantly different between FT and CAC (FT: normal, n=3588 [78.0%]; mild, n=432 [9.4%]; moderate, n=217 [4.7%]; severe, n=365 [7.9%]; CAC: normal, n=1457 [34.6%]; mild, n=1340 [31.8%]; moderate, n=772 [18.3%]; severe, n=640 [15.2%]; P<0.0001). Moderate and severe abnormalities in both arms robustly predicted events (moderate: CAC: HR, 3.14; 95% confidence interval, 1.81-5.44; and FT: HR, 2.65; 95% confidence interval, 1.46-4.83; severe: CAC: HR, 3.56; 95% confidence interval, 1.99-6.36; and FT: HR, 3.88; 95% confidence interval, 2.58-5.85). In the CAC arm, the majority of events (n=112 of 133, 84%) occurred in patients with any positive CAC test (score >0), whereas fewer than half of events occurred in patients with mildly, moderately, or severely abnormal FT (n=57 of 132, 43%; P<0.001). In contrast, any abnormality on FT was significantly more specific for predicting events (78.6% for FT versus 35.2% for CAC; P<0.001). Overall discriminatory ability in predicting the primary end point of mortality, nonfatal myocardial infarction, and unstable angina hospitalization was similar and fair for both CAC and FT (C statistic, 0.67 versus 0.64). Coronary computed tomographic angiography provided significantly better prognostic information compared with FT and CAC testing (C index, 0.72). CONCLUSIONS: Among stable outpatients presenting with suspected coronary artery disease, most patients experiencing clinical events have measurable CAC at baseline, and fewer than half have any abnormalities on FT. However, an abnormal FT was more specific for cardiovascular events, leading to overall similarly modest discriminatory abilities of both tests. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01174550."},{"id":"bf054afc6c17","type":"article","url":"https://hartvaat.nl/2017/11/14/af-type-en-uitkomsten-bij-hfref/","title":"AF-type en uitkomsten bij HFrEF","title_en":"Type of Atrial Fibrillation and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.09.027","source_url":"https://doi.org/10.1016/j.jacc.2017.09.027","authors":["Ulrik M Mogensen","Pardeep S Jhund","William T Abraham","Akshay S Desai","Kenneth Dickstein","Milton Packer","Jean L Rouleau","Scott D Solomon","Karl Swedberg","Michael R Zile","Lars Køber","John J V McMurray"],"significance":6,"published":"2017-11-14","source_date":"2017-11-14","image":"","kennis":[],"congress":"","summary_en":"This study investigated how the type of AF (paroxysmal vs persistent vs permanent) affects outcomes in patients with heart failure and reduced ejection fraction, finding that AF type independently influences prognosis in the HF population.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van het type atriumfibrilleren (paroxysmaal vs persisterend vs permanent) op uitkomsten bij patiënten met HFrEF.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) is common in heart failure (HF), but the outcome by type of AF is largely unknown. OBJECTIVES: This study investigated outcomes related to type of AF (paroxysmal, persistent or permanent, or new onset) in 2 recent large trials in patients with HF with reduced ejection fraction. METHODS: The study analyzed patients in the PARADIGM-HF (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and morbidity in Heart Failure) and ATMOSPHERE (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure) trials. Multivariable Cox regression models were used to estimate hazard ratios (HRs) for outcomes related to AF type. RESULTS: Of 15,415 patients, 5,481 (35.6%) had a history of AF at randomization, and of these, 1,645 (30.0%) had paroxysmal AF. Compared with patients without AF, patients with paroxysmal AF at randomization had a higher risk of the primary composite endpoint of cardiovascular death or HF hospitalization (HR: 1.20; 95% confidence interval [CI]: 1.09 to 1.32; p < 0.001), HF hospitalization (HR: 1.34; 95% CI: 1.19 to 1.51; p < 0.001), and stroke (HR: 1.34; 95% CI: 1.02 to 1.76; p = 0.037), whereas the corresponding risks in patients with persistent or permanent AF were not elevated. Neither type of AF was associated with higher mortality. New onset AF was associated with the greatest risk of adverse outcomes: primary endpoint (HR: 2.21; 95% CI: 1.80 to 2.71), HF hospitalization (HR: 2.11; 95% CI: 1.58 to 2.81), stroke (HR: 2.20; 95% CI: 1.25 to 3.88), and all-cause mortality (HR: 2.26; 95% CI: 1.86 to 2.74), all p values < 0.001, compared with patients without AF. Anticoagulants were used less often in patients with paroxysmal (53%) and new onset (16%) AF than in patients with persistent or permanent AF (71%). CONCLUSIONS: Among HF patients with a history of AF, those with paroxysmal AF were at greater risk of HF hospitalization and stroke than were patients with persistent or permanent AF, underlining the importance of anticoagulant therapy. New onset AF was associated with increased risk of all outcomes. (Prospective comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255) (Aliskiren Trial to Minimize Outcomes in Patients with Heart Failure [ATMOSPHERE]; NCT00853658)."},{"id":"50d2118265e2","type":"article","url":"https://hartvaat.nl/2017/11/14/timing-van-angiografie-bij-hoogrisico-nstemi-acuity-analyse/","title":"Timing van angiografie bij hoogrisico-NSTEMI: ACUITY-analyse","title_en":"Timing of Angiography and Outcomes in High-Risk Patients With Non-ST-Segment-Elevation Myocardial Infarction Managed Invasively: Insights From the TAO Trial (Treatment of Acute Coronary Syndrome With Otamixaban).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.029779","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.029779","authors":["Pierre Deharo","Gregory Ducrocq","Christoph Bode","Marc Cohen","Thomas Cuisset","Shamir R Mehta","Charles Pollack","Stephen D Wiviott","Yedid Elbez","Marc S Sabatine","Philippe Gabriel Steg"],"significance":6,"published":"2017-11-14","source_date":"2017-11-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This ACUITY analysis examined the optimal timing of coronary angiography in high-risk NSTEMI patients (GRACE score >140), providing data on whether earlier intervention improves outcomes in the highest-acuity ACS population.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACUITY-analyse naar de optimale timing van angiografie bij hoogrisico-NSTEMI die invasief wordt behandeld. Relevant voor het tijdsvenster-debat.","abstract_original":"BACKGROUND: In patients with non-ST-segment-elevation myocardial infarction (NSTEMI) and GRACE (Global Registry of Acute Coronary Events) score >140, coronary angiography (CAG) is recommended by European and American guidelines within 24 hours. We sought to study the association of very early (ie, ≤12 hours), early (12-24 hours), and delayed (>24 hours) CAG in patients with NSTEMI with GRACE score >140 with ischemic outcomes. METHODS: The TAO trial (Treatment of Acute Coronary Syndrome With Otamixaban) randomized patients with NSTEMI and CAG scheduled within 72 hours to heparin plus eptifibatide versus otamixaban. In this post hoc analysis, patients with a GRACE score >140 were categorized into 3 groups according to timing of CAG from admission (<12, ≥12-<24, and ≥24 hours). The primary ischemic outcome was the composite of all-cause death and myocardial infarction within 180 days of randomization. RESULTS: CAG was performed in 4071 patients (<12 hours, n=1648 [40.5%]; 12-24 hours, n=1420 [34.9%]; ≥24 hours, n=1003 [24.6%]). With CAG ≥24 hours as a reference, CAG from 12 to 24 hours was not associated with a lower risk of primary ischemic outcome at 180 days (odds ratio, 0.96; 95% confidence interval, 0.75-1.23), whereas CAG <12 hours was associated with a lower risk of death and myocardial infarction (odds ratio, 0.71; 95% confidence interval, 0.55-0.91). Performing CAG <12 hours was also associated with a lower risk of death and myocardial infarction (odds ratio, 0.76; 95% confidence interval, 0.61-0.94; P=0.01) compared with CAG performed at 12 to 24 hours. No difference was observed in bleeding complications. CONCLUSIONS: In patients with high-risk NSTEMI, undergoing CAG within the initial 12 hours after admission (as opposed to later, either 12-24 or ≥24 hours) was associated with lower risk of ischemic outcomes at 180 days."},{"id":"0d16c6e4c409","type":"article","url":"https://hartvaat.nl/2017/11/14/ldl-verlaging-voor-primaire-preventie-bij-mannen-met-primaire-ldl-verhoging/","title":"LDL-verlaging voor primaire preventie bij mannen met primaire LDL-verhoging","title_en":"Low-Density Lipoprotein Cholesterol Lowering for the Primary Prevention of Cardiovascular Disease Among Men With Primary Elevations of Low-Density Lipoprotein Cholesterol Levels of 190 mg/dL or Above: Analyses From the WOSCOPS (West of Scotland Coronary Prevention Study) 5-Year Randomized Trial and 20-Year Observational Follow-Up.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging","primaire-preventie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.027966","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.027966","authors":["Antonio J Vallejo-Vaz","Michele Robertson","Alberico L Catapano","Gerald F Watts","John J Kastelein","Chris J Packard","Ian Ford","Kausik K Ray"],"significance":6,"published":"2017-11-14","source_date":"2017-11-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This study evaluated LDL cholesterol lowering for primary cardiovascular prevention in men with primary LDL elevations ≥190 mg/dL, showing significant cardiovascular risk reduction with statin therapy in this genetically high-risk population.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de effectiviteit van LDL-cholesterolverlaging voor primaire preventie specifiek bij mannen met primaire LDL-verhoging als enige risicofactor.","abstract_original":"BACKGROUND: Patients with primary elevations of low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dL are at a higher risk of atherosclerotic cardiovascular disease as a result of long-term exposure to markedly elevated LDL-C levels. Therefore, initiation of statin therapy is recommended for these individuals. However, there is a lack of randomized trial evidence supporting these recommendations in primary prevention. In the present analysis, we provide hitherto unpublished data on the cardiovascular effects of LDL-C lowering among a primary prevention population with LDL-C ≥190 mg/dL. METHODS: We aimed to assess the benefits of LDL-C lowering on cardiovascular outcomes among individuals with primary elevations of LDL-C ≥190 mg/dL without preexisting vascular disease at baseline. We performed post hoc analyses from the WOSCOPS (West of Scotland Coronary Prevention Study) randomized, placebo-controlled trial, and observational posttrial long-term follow-up, after excluding individuals with evidence of vascular disease at baseline. WOSCOPS enrolled 6595 men aged 45 to 64 years, who were randomly assigned to pravastatin 40 mg/d or placebo. In the present analyses, 5529 participants without evidence of vascular disease were included, stratified by LDL-C levels into those with LDL-C <190 mg/dL (n=2969; mean LDL-C 178±6 mg/dL) and those with LDL-C ≥190 mg/dL (n=2560; mean LDL-C 206±12 mg/dL). The effect of pravastatin versus placebo on coronary heart disease and major adverse cardiovascular events were assessed over the 4.9-year randomized controlled trial phase and on mortality outcomes over a total of 20 years of follow-up. RESULTS: Among 5529 individuals without vascular disease, pravastatin reduced the risk of coronary heart disease by 27% (P=0.002) and major adverse cardiovascular events by 25% (P=0.004) consistently among those with and without LDL-C ≥190 mg/dL (P-interaction >0.9). Among individuals with LDL-C ≥190 mg/dL, pravastatin reduced the risk of coronary heart disease by 27% (P=0.033) and major adverse cardiovascular events by 25% (P=0.037) during the initial trial phase and the risk of coronary heart disease death, cardiovascular death, and all-cause mortality by 28% (P=0.020), 25% (P=0.009), and 18% (P=0.004), respectively, over a total of 20 years of follow-up. CONCLUSIONS: The present analyses provide robust novel evidence for the short- and long-term benefits of lowering LDL-C for the primary prevention of cardiovascular disease among individuals with primary elevations of LDL-C ≥190 mg/dL."},{"id":"9f0edddd7418","type":"article","url":"https://hartvaat.nl/2017/11/11/renale-denervatie-zonder-antihypertensiva-lancet-spyral-htn-off-med/","title":"Renale denervatie zonder antihypertensiva: Lancet SPYRAL HTN-OFF MED","title_en":"Catheter-based renal denervation in patients with uncontrolled hypertension in the absence of antihypertensive medications (SPYRAL HTN-OFF MED): a randomised, sham-controlled, proof-of-concept trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["radiance-htn","renale-denervatie"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32281-X","source_url":"https://doi.org/10.1016/S0140-6736(17)32281-X","authors":["Raymond R Townsend","Felix Mahfoud","David E Kandzari","Kazuomi Kario","Stuart Pocock","Michael A Weber","Sebastian Ewen","Konstantinos Tsioufis","Dimitrios Tousoulis","Andrew S P Sharp","Anthony F Watkinson","Roland E Schmieder","Axel Schmid","James W Choi","Cara East","Anthony Walton","Ingrid Hopper","Debbie L Cohen","Robert Wilensky","David P Lee","Adrian Ma","Chandan M Devireddy","Janice P Lea","Philipp C Lurz","Karl Fengler","Justin Davies","Neil Chapman","Sidney A Cohen","Vanessa DeBruin","Martin Fahy","Denise E Jones","Martin Rothman","Michael Böhm"],"significance":9,"published":"2017-11-11","source_date":"2017-11-11","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/"],"congress":"","summary_en":"The SPYRAL HTN-OFF MED trial demonstrated that catheter-based renal denervation significantly reduced blood pressure compared with sham control in patients with hypertension who were not taking antihypertensive medications. This proof-of-concept study revived renal denervation research after the negative SYMPLICITY HTN-3 results.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark Lancet SPYRAL HTN-OFF MED-trial die renale denervatie onderzocht bij ongecontroleerde hypertensie zonder antihypertensieve medicatie. Bewijst het bloeddrukverlagend effect van RDN in een zuiver ontwerp.","abstract_original":"BACKGROUND: Previous randomised renal denervation studies did not show consistent efficacy in reducing blood pressure. The objective of our study was to evaluate the effect of renal denervation on blood pressure in the absence of antihypertensive medications. METHODS: SPYRAL HTN-OFF MED was a multicentre, international, single-blind, randomised, sham-controlled, proof-of-concept trial. Patients were enrolled at 21 centres in the USA, Europe, Japan, and Australia. Eligible patients were drug-naive or discontinued their antihypertensive medications. Patients with an office systolic blood pressure (SBP) of 150 mm Hg or greater and less than 180 mm Hg, office diastolic blood pressure (DBP) of 90 mm Hg or greater, and a mean 24-h ambulatory SBP of 140 mm Hg or greater and less than 170 mm Hg at second screening underwent renal angiography and were randomly assigned to renal denervation or sham control. Patients, caregivers, and those assessing blood pressure were blinded to randomisation assignments. The primary endpoint, change in 24-h blood pressure at 3 months, was compared between groups. Drug surveillance was done to ensure patient compliance with absence of antihypertensive medication. The primary analysis was done in the intention-to-treat population. Safety events were assessed at 3 months. This study is registered with ClinicalTrials.gov, number NCT02439749. FINDINGS: Between June 25, 2015, and Jan 30, 2017, 353 patients were screened. 80 patients were randomly assigned to renal denervation (n=38) or sham control (n=42) and followed up for 3 months. Office and 24-h ambulatory blood pressure decreased significantly from baseline to 3 months in the renal denervation group: 24-h SBP -5·5 mm Hg (95% CI -9·1 to -2·0; p=0·0031), 24-h DBP -4·8 mm Hg (-7·0 to -2·6; p<0·0001), office SBP -10·0 mm Hg (-15·1 to -4·9; p=0·0004), and office DBP -5·3 mm Hg (-7·8 to -2·7; p=0·0002). No significant changes were seen in the sham-control group: 24-h SBP -0·5 mm Hg (95% CI -3·9 to 2·9; p=0·7644), 24-h DBP -0·4 mm Hg (-2·2 to 1·4; p=0·6448), office SBP -2·3 mm Hg (-6·1 to 1·6; p=0·2381), and office DBP -0·3 mm Hg (-2·9 to 2·2; p=0·8052). The mean difference between the groups favoured renal denervation for 3-month change in both office and 24-h blood pressure from baseline: 24-h SBP -5·0 mm Hg (95% CI -9·9 to -0·2; p=0·0414), 24-h DBP -4·4 mm Hg (-7·2 to -1·6; p=0·0024), office SBP -7·7 mm Hg (-14·0 to -1·5; p=0·0155), and office DBP -4·9 mm Hg (-8·5 to -1·4; p=0·0077). Baseline-adjusted analyses showed similar findings. There were no major adverse events in either group. INTERPRETATION: Results from SPYRAL HTN-OFF MED provide biological proof of principle for the blood-pressure-lowering efficacy of renal denervation. FUNDING: Medtronic."},{"id":"889e4dd9f07f","type":"article","url":"https://hartvaat.nl/2017/11/07/optische-frequentiedomeinbeeldvorming-versus-ivus-bij-pci-opinion-trial/","title":"Optische frequentiedomeinbeeldvorming versus IVUS bij PCI: OPINION-trial","title_en":"Optical frequency domain imaging vs. intravascular ultrasound in percutaneous coronary intervention (OPINION trial): one-year angiographic and clinical results.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["intracoronaire-beeldvorming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx351","source_url":"https://doi.org/10.1093/eurheartj/ehx351","authors":["Takashi Kubo","Toshiro Shinke","Takayuki Okamura","Kiyoshi Hibi","Gaku Nakazawa","Yoshihiro Morino","Junya Shite","Tetsuya Fusazaki","Hiromasa Otake","Ken Kozuma","Tetsuya Ioji","Hideaki Kaneda","Takeshi Serikawa","Toru Kataoka","Hisayuki Okada","Takashi Akasaka"],"significance":6,"published":"2017-11-07","source_date":"2017-11-07","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/intravasculaire-echografie-ivus-oct/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The OPINION trial compared optical frequency domain imaging (OFDI) with IVUS for guiding PCI, demonstrating that these two intravascular imaging modalities produce comparable clinical outcomes and can be used interchangeably.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"OPINION-trial die OFDI vergeleek met IVUS voor het sturen van PCI. Vergelijking van twee intracoronaire beeldvormingsmodaliteiten.","abstract_original":"AIMS: Optical frequency domain imaging (OFDI) is a recently developed, light-based, high-resolution intravascular imaging technique. Intravascular ultrasound (IVUS) is a widely used, conventional imaging technique for guiding percutaneous coronary intervention (PCI). We aimed to demonstrate the non-inferiority of OFDI-guided PCI compared with IVUS-guided PCI in terms of clinical outcomes. METHODS AND RESULTS: We did a prospective, multicentre, randomized (ratio 1:1), active-controlled, non-inferiority study to compare head-to-head OFDI vs. IVUS in patients undergoing PCI with a second generation drug-eluting stent. The primary endpoint was target vessel failure defined as a composite of cardiac death, target-vessel related myocardial infarction, and ischaemia-driven target vessel revascularization until 12 months after the PCI. The major secondary endpoint was angiographic binary restenosis at 8 months. We randomly allocated 829 patients to receive OFDI-guided PCI (n = 414) or IVUS-guided PCI (n = 415). Target vessel failure occurred in 21 (5.2%) of 401 patients undergoing OFDI-guided PCI, and 19 (4.9%) of 390 patients undergoing IVUS-guided PCI, demonstrating non-inferiority of OFDI-guided PCI to IVUS-guided PCI (hazard ratio 1.07, upper limit of one-sided 95% confidence interval 1.80; Pnon-inferiority = 0.042). With 89.8% angiographic follow-up, the rate of binary restenosis was comparable between OFDI-guided PCI and IVUS-guided PCI (in-stent: 1.6% vs. 1.6%, P = 1.00; and in-segment: 6.2% vs. 6.0%, P = 1.00). CONCLUSION: The 12-month clinical outcome in patients undergoing OFDI-guided PCI was non-inferior to that of patients undergoing IVUS-guided PCI. Both OFDI-guided and IVUS-guided PCI yielded excellent angiographic and clinical results, with very low rates of 8-month angiographic binary restenosis and 12-month target vessel failure. CLINICAL REGISTRATION: ClinicalTrials.gov, number NCT01873027."},{"id":"812db3817001","type":"article","url":"https://hartvaat.nl/2017/11/07/stentontwerp-en-dapt-duur-effect-op-ischemie-en-bloedingen-netwerkmeta-analyse/","title":"Stentontwerp en DAPT-duur: effect op ischemie en bloedingen — netwerkmeta-analyse","title_en":"Impact of design of coronary stents and length of dual antiplatelet therapies on ischaemic and bleeding events: a network meta-analysis of 64 randomized controlled trials and 102 735 patients.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx437","source_url":"https://doi.org/10.1093/eurheartj/ehx437","authors":["Fabrizio D'Ascenzo","Mario Iannaccone","Gaelle Saint-Hilary","Maurizio Bertaina","Stefanie Schulz-Schüpke","Cheol Wahn Lee","Alaide Chieffo","Gerard Helft","Sebastiano Gili","Umberto Barbero","Giuseppe Biondi Zoccai","Claudio Moretti","Fabrizio Ugo","Maurizio D'Amico","Roberto Garbo","Gregg Stone","Sara Rettegno","Pierluigi Omedè","Federico Conrotto","Christian Templin","Antonio Colombo","Seung-Jung Park","Adnan Kastrati","David Hildick-Smith","Mauro Gasparini","Fiorenzo Gaita"],"significance":7,"published":"2017-11-07","source_date":"2017-11-07","image":"","kennis":[],"congress":"","summary_en":"This network meta-analysis examined the interaction between coronary stent design (durable vs biodegradable polymer) and DAPT duration on ischemic and bleeding outcomes, exploring whether stent technology influences the optimal antiplatelet duration.","created":"2026-07-03T10:27:00Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerkmeta-analyse die de interactie onderzocht tussen coronair stentontwerp en DAPT-duur op ischemische en bloedingsuitkomsten.","abstract_original":"AIMS: The differential impact on ischaemic and bleeding events of the type of drug-eluting stent [durable polymer stents [DES] vs. biodegradable polymer stents vs. bioresorbable scaffolds (BRS)] and length of dual antiplatelet therapy (DAPT) remains to be defined. METHODS AND RESULTS: Randomized controlled trials comparing different types of DES and/or DAPT durations were selected. The primary endpoint was Major Adverse Cardiovascular Events (MACE) [a composite of death, myocardial infarction (MI), and target vessel revascularization]. Definite stent thrombosis (ST) and single components of MACE were secondary endpoints. The arms of interest were: BRS with 12 months of DAPT (12mDAPT), biodegradable polymer stent with 12mDAPT, durable polymer stent [everolimus-eluting (EES), zotarolimus-eluting (ZES)] with 12mDAPT, EES/ZES with <12 months of DAPT, and EES/ZES with >12 months of DAPT (DAPT > 12 m). Sixty-four studies with 150 arms and 102 735 patients were included. After a median follow-up of 20 months, MACE rates were similar in the different arms of interest. EES/ZES with DAPT > 12 m reported a lower incidence of MI than the other groups, while BRS showed a higher rate of ST when compared to EES/ZES, irrespective of DAPT length. A higher risk of major bleedings was observed for DAPT > 12 m as compared to shorter DAPT. CONCLUSION: Durable and biodegradable polymer stents along with BRS report a similar rate of MACE irrespective of DAPT length. Fewer MI are observed with EES/ZES with DAPT > 12 m, while a higher rate of ST is reported for BRS when compared to EES/ZES, independently from DAPT length. Stent type may partially affect the outcome together with DAPT length."},{"id":"242721917fcc","type":"article","url":"https://hartvaat.nl/2017/11/07/leeftijd-en-uitkomsten-van-primaire-preventie-icd-bij-niet-ischemisch-hartfalen-/","title":"Leeftijd en uitkomsten van primaire preventie-ICD bij niet-ischemisch hartfalen: DANISH","title_en":"Age and Outcomes of Primary Prevention Implantable Cardioverter-Defibrillators in Patients With Nonischemic Systolic Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["primaire-preventie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028829","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028829","authors":["Marie Bayer Elming","Jens C Nielsen","Jens Haarbo","Lars Videbæk","Eva Korup","James Signorovitch","Line Lisbeth Olesen","Per Hildebrandt","Flemming H Steffensen","Niels E Bruun","Hans Eiskjær","Axel Brandes","Anna M Thøgersen","Finn Gustafsson","Kenneth Egstrup","Regitze Videbæk","Christian Hassager","Jesper Hastrup Svendsen","Dan E Høfsten","Christian Torp-Pedersen","Steen Pehrson","Lars Køber","Jens Jakob Thune"],"significance":7,"published":"2017-11-07","source_date":"2017-11-07","image":"","kennis":[],"congress":"","summary_en":"This DANISH subanalysis showed that the benefit of primary prevention ICDs in nonischemic heart failure is modified by age, with younger patients (<68 years) deriving significant mortality benefit while older patients did not. The finding supports age-based ICD selection criteria.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"DANISH-analyse die het effect van leeftijd onderzocht op het voordeel van primaire preventie-ICD bij niet-ischemisch systolisch hartfalen. Jongere patiënten hadden meer voordeel.","abstract_original":"BACKGROUND: The DANISH study (Danish Study to Assess the Efficacy of ICDs [Implantable Cardioverter Defibrillators] in Patients With Non-Ischemic Systolic Heart Failure on Mortality) did not demonstrate an overall effect on all-cause mortality with ICD implantation. However, the prespecified subgroup analysis suggested a possible age-dependent association between ICD implantation and mortality with survival benefit seen only in the youngest patients. The nature of this relationship between age and outcome of a primary prevention ICD in patients with nonischemic systolic heart failure warrants further investigation. METHODS: All 1116 patients from the DANISH study were included in this prespecified subgroup analysis. We assessed the relationship between ICD implantation and mortality by age, and an optimal age cutoff was estimated nonparametrically with selection impact curves. Modes of death were divided into sudden cardiac death and nonsudden death and compared between patients younger and older than this age cutoff with the use of χ2 analysis. RESULTS: Median age of the study population was 63 years (range, 21-84 years). There was a linearly decreasing relationship between ICD and mortality with age (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.003-1.06; P=0.03). An optimal age cutoff for ICD implantation was present at ≤70 years. There was an association between reduced all-cause mortality and ICD in patients ≤70 years of age (HR, 0.70; 95% CI, 0.51-0.96; P=0.03) but not in patients >70 years of age (HR, 1.05; 95% CI, 0.68-1.62; P=0.84). For patients ≤70 years old, the sudden cardiac death rate was 1.8 (95% CI, 1.3-2.5) and nonsudden death rate was 2.7 (95% CI, 2.1-3.5) events per 100 patient-years, whereas for patients >70 years old, the sudden cardiac death rate was 1.6 (95% CI, 0.8-3.2) and nonsudden death rate was 5.4 (95% CI, 3.7-7.8) events per 100 patient-years. This difference in modes of death between the 2 age groups was statistically significant (P=0.01). CONCLUSIONS: In patients with systolic heart failure not caused by ischemic heart disease, the association between the ICD and survival decreased linearly with increasing age. In this study population, an age cutoff for ICD implantation at ≤70 years yielded the highest survival for the population as a whole. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00542945."},{"id":"a1a68cbf0072","type":"article","url":"https://hartvaat.nl/2017/11/07/alivecor-kardia-voor-af-screening-de-rehearse-af-studie/","title":"AliveCor Kardia voor AF-screening: de REHEARSE-AF-studie","title_en":"Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation: The REHEARSE-AF Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030583","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030583","authors":["Julian P J Halcox","Kathie Wareham","Antonia Cardew","Mark Gilmore","James P Barry","Ceri Phillips","Michael B Gravenor"],"significance":7,"published":"2017-11-07","source_date":"2017-11-07","image":"","kennis":[],"congress":"","summary_en":"The REHEARSE-AF study demonstrated that remote heart rhythm monitoring using the AliveCor Kardia device increases AF detection compared with routine care, pioneering the use of consumer-grade ECG technology for population-level AF screening.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"REHEARSE-AF-studie die remote hartritme-monitoring met de AliveCor Kardia evalueerde voor AF-screening. Pionierswerk in consumer-technologie voor aritmiedetectie.","abstract_original":"BACKGROUND: Asymptomatic atrial fibrillation (AF) is increasingly common in the aging population and implicated in many ischemic strokes. Earlier identification of AF with appropriate anticoagulation may decrease stroke morbidity and mortality. METHODS: We conducted a randomized controlled trial of AF screening using an AliveCor Kardia monitor attached to a WiFi-enabled iPod to obtain ECGs (iECGs) in ambulatory patients. Patients ≥65 years of age with a CHADS-VASc score ≥2 free from AF were randomized to the iECG arm or routine care (RC). iECG participants acquired iECGs twice weekly over 12 months (plus additional iECGs if symptomatic) onto a secure study server with overread by an automated AF detection algorithm and by a cardiac physiologist and/or consultant cardiologist. Time to diagnosis of AF was the primary outcome measure. The overall cost of the devices, ECG interpretation, and patient management were captured and used to generate the cost per AF diagnosis in iECG patients. Clinical events and patient attitudes/experience were also evaluated. RESULTS: We studied 1001 patients (500 iECG, 501 RC) who were 72.6±5.4 years of age; 534 were female. Mean CHADS-VASc score was 3.0 (heart failure, 1.4%; hypertension, 54%; diabetes mellitus, 30%; prior stroke/transient ischemic attack, 6.5%; arterial disease, 15.9%; all CHADS-VASc risk factors were evenly distributed between groups). Nineteen patients in the iECG group were diagnosed with AF over the 12-month study period versus 5 in the RC arm (hazard ratio, 3.9; 95% confidence interval=1.4-10.4; P=0.007) at a cost per AF diagnosis of $10 780 (£8255). There was a similar number of stroke/transient ischemic attack/systemic embolic events (6 versus 10, iECG versus RC; hazard ratio=0.61; 95% confidence interval=0.22-1.69; P=0.34). The majority of iECG patients were satisfied with the device, finding it easy to use without restricting activities or causing anxiety. CONCLUSIONS: Screening with twice-weekly single-lead iECG with remote interpretation in ambulatory patients ≥65 years of age at increased risk of stroke is significantly more likely to identify incident AF than RC over a 12-month period. This approach is also highly acceptable to this group of patients, supporting further evaluation in an appropriately powered, event-driven clinical trial. CLINICAL TRIAL REGISTRATION: URL: https://www.isrctn.com. Unique identifier: ISRCTN10709813."},{"id":"764956db8b7b","type":"article","url":"https://hartvaat.nl/2017/11/01/totale-occlusie-van-de-culprit-arterie-bij-nstemi-meta-analyse/","title":"Totale occlusie van de culprit arterie bij NSTEMI: meta-analyse","title_en":"Impact of total occlusion of culprit artery in acute non-ST elevation myocardial infarction: a systematic review and meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx418","source_url":"https://doi.org/10.1093/eurheartj/ehx418","authors":["Abdur R Khan","Harsh Golwala","Avnish Tripathi","Aref A Bin Abdulhak","Chirag Bavishi","Haris Riaz","Vishnu Mallipedi","Ambarish Pandey","Deepak L Bhatt"],"significance":6,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This meta-analysis showed that total occlusion of the culprit artery in acute NSTEMI is more common than previously recognized and is associated with worse outcomes, supporting the consideration of earlier invasive management in this subgroup.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar de impact van totale occlusie van de culprit arterie bij acuut NSTEMI. Occlusie is frequenter dan verwacht en geassocieerd met slechtere uitkomsten.","abstract_original":"AIMS: Total occlusion (TO) of the culprit artery usually presents with ST-elevation myocardial infarction. A subset of patients with TO present as non-ST segment elevation myocardial infarction (NSTEMI) without classic ST-elevation on the electrocardiogram. This may lead to delay in identification of these patients and further management. We performed a meta-analysis to estimate the difference in outcomes between totally occluded and non-occluded culprit arteries in patients with NSTEMI. METHODS AND RESULTS: Our literature search yielded seven studies with 40 777 patients. The outcomes assessed were clinical presentation (Killip class), left ventricular ejection fraction, time to angiography, major cardiac adverse events (MACE) and all-cause mortality. The generic inverse or Mantel-Haenszel method was used to pool relevant outcomes and the mean difference (MD) or relative risk (RR) was calculated. A total of 10 415 (25.5%) patients had an occluded culprit artery with a predominant infero-lateral distribution (40% right coronary and 33% left circumflex artery). There was an increased risk of both MACE (short-term RR: 1.41; CI: 1.17, 1.70; P = 0.0003; I2 = 26%; medium- to long-term RR: 1.32; CI: 1.11, 1.56; P = 0.001; I2 = 25%) and all-cause mortality (short-term RR: 1.67; CI: 1.31, 2.13; P < 0.0001; I2 = 41%; medium to long-term RR: 1.42; CI: 1.08, 1.86; P = 0.01; I2 = 32%) with TO of the culprit artery. CONCLUSION: Our meta-analysis suggests that patients with NSTEMI who demonstrate a totally occluded culprit vessel on coronary angiography are at higher risk of mortality and major adverse cardiac events. Better risk stratification tools are needed to identify such high-risk acute coronary syndrome patients to facilitate earlier revascularization and potentially to improve outcomes."},{"id":"3e06875cc6ea","type":"article","url":"https://hartvaat.nl/2017/11/01/switchen-van-dapt-na-acs-de-topic-trial/","title":"Switchen van DAPT na ACS: de TOPIC-trial","title_en":"Benefit of switching dual antiplatelet therapy after acute coronary syndrome: the TOPIC (timing of platelet inhibition after acute coronary syndrome) randomized study.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx175","source_url":"https://doi.org/10.1093/eurheartj/ehx175","authors":["Thomas Cuisset","Pierre Deharo","Jacques Quilici","Thomas W Johnson","Stéphanie Deffarges","Clémence Bassez","Guillaume Bonnet","Laurent Fourcade","Jean Philippe Mouret","Marc Lambert","Valentine Verdier","Pierre Emmanuel Morange","Marie Christine Alessi","Jean Louis Bonnet"],"significance":8,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":[],"congress":"","summary_en":"The TOPIC trial demonstrated that switching from potent P2Y12 inhibitors to clopidogrel one month after ACS reduced bleeding complications without increasing ischemic events. The study provided early evidence supporting a de-escalation strategy in the post-acute ACS phase.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TOPIC-trial die aantoonde dat het switchen van potente P2Y12-remming naar clopidogrel na de acute fase van ACS de bloedingscomplicaties vermindert zonder meer ischemische events.","abstract_original":"AIMS: Newer P2Y12 blockers (prasugrel and ticagrelor) demonstrated significant ischaemic benefit over clopidogrel after acute coronary syndrome (ACS). However, both drugs are associated with an increase in bleeding complications. The objective of the present study was to evaluate the benefit of switching dual antiplatelet therapy (DAPT) from aspirin plus a newer P2Y12 blocker to aspirin plus clopidogrel 1 month after ACS. METHODS AND RESULTS: We performed an open-label, monocentric, and randomized trial. From March 2014 to April 2016, patients admitted with ACS requiring coronary intervention, on aspirin and a newer P2Y12 blocker and without adverse event at 1 month, were assigned to switch to aspirin and clopidogrel (switched DAPT) or continuation of their drug regimen (unchanged DAPT). The primary outcome was a composite of cardiovascular death, urgent revascularization, stroke and bleeding as defined by the Bleeding Academic Research Consortium (BARC) classification ≥2 at 1 year post ACS. Six hundred and forty six patients were randomized and 645 analysed, corresponding to 322 patients in the switched DAPT and 323 in the unchanged DAPT group. The primary endpoint occurred in 43 (13.4%) patients in the switched DAPT group and in 85 (26.3%) patients in the unchanged DAPT (HR 95%CI 0.48 (0.34-0.68), P < 0.01). No significant differences were reported on ischaemic endpoints, while BARC ≥ 2 bleeding occurred in 13 (4.0%) patients in the switched DAPT and in 48 (14.9%) in the unchanged DAPT group (HR 95%CI 0.30 (0.18-0.50), P < 0.01). CONCLUSION: A switched DAPT is superior to an unchanged DAPT strategy to prevent bleeding complications without increase in ischaemic events following ACS."},{"id":"19377963580f","type":"article","url":"https://hartvaat.nl/2017/11/01/defibrillatie-drempelwaarden-bij-rechtspectorale-icd-en-golfvorm-tuning/","title":"Defibrillatie-drempelwaarden bij rechtspectorale ICD en golfvorm-tuning","title_en":"Defibrillation thresholds with right pectoral implantable cardioverter defibrillators and impact of waveform tuning (the Tilt and Tune trial).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["icd-implantatie","ventrikelfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw306","source_url":"https://doi.org/10.1093/europace/euw306","authors":["Niraj Varma","Raymond Schaerf","Steven Kalbfleisch","Rhea Pimentel","Mark W Kroll","Ashish Oza"],"significance":4,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":[],"congress":"","summary_en":"This randomised study assessed defibrillation thresholds with right pectoral ICD implantation and evaluated whether waveform tuning optimisation improves defibrillation efficacy in this configuration.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar defibrillatie-drempelwaarden bij rechtspectoraal geïmplanteerde ICD's en het effect van golfvorm-optimalisatie.","abstract_original":"AIMS: Assess defibrillation thresholds (DFTs) with right active pectoral implantable cardioverter defibrillator (RICDs). Defibrillation thresholds in patients receiving RICDs are regarded as 'high' and potentially improved by waveform optimization (tuning). However, this has not been systematically tested. METHODS AND RESULTS: Patients receiving RICDs [Single chamber (VVI) = 16, DDD = 32, cardiac resynchronization therapy (CRT) = 43] were randomized to either 50/50% fixed tilt (FT) or tuned waveform (3.5 ms time constant based). Defibrillation threshold was tested with a binary search protocol in single coil anodal configuration. Then RICDs were compared with left-sided placements. Baseline patient characteristics in FT (n = 54) and tuned (n = 37) were similar (65 ± 14 years, 71% male, Left ventricular ejection fraction 31 ± 13%; and proportions VVI/DDD/Cardiac resynchronization therapy defibrillator). Tuning reduced Phase 1 by 15% and Phase 2 by 45%. For FT vs. tuned: high voltage impedance was 61.9 ± 13.2 vs. 64.5 ± 12.7 Ω (P = 0.33) and mean DFT 14.2 ± 8.8 vs. 14.9 ± 9.2 J (P = 0.8). When high voltage impedance was >62 Ω (mean 73.6 ± 8.6 Ω), DFT was identical [FT 13.0 ± 7.9 J vs. tuned 12.0 ± 5.9 J (P= 0.7)]. Defibrillation thresholds exceeded 20 J (600 V) in >20% of patients [FT 11/54 (20.4%) vs. tuned 12/37 (32%) patients]. Defibrillation threshold with RICD was greater and exhibited wider dispersion compared with left ICDs (n = 54) under similar conditions. CONCLUSION: This first randomized trial investigating DFTs with right ICDs confirms relatively higher DFTs with RICDs than reported for left pectoral ICDs. However, DFTs were generally unaffected by 3.5 ms time constant-based waveform tuning compared with a 50% tilt waveform. Implant testing may be preferred with RICDs. CLINICAL TRIAL NUMBER: NCT00873691."},{"id":"06b2bcab4d5a","type":"article","url":"https://hartvaat.nl/2017/11/01/tijdsverloop-van-bloeddrukverandering-door-zoutreductie-en-dash-dieet/","title":"Tijdsverloop van bloeddrukverandering door zoutreductie en DASH-dieet","title_en":"Time Course of Change in Blood Pressure From Sodium Reduction and the DASH Diet.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10017","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10017","authors":["Stephen P Juraschek","Mark Woodward","Frank M Sacks","Vincent J Carey","Edgar R Miller","Lawrence J Appel"],"significance":6,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":[],"congress":"","summary_en":"This study quantified the time course of blood pressure change following sodium reduction and the DASH diet, showing that most of the benefit occurs within the first week, supporting rapid dietary interventions for blood pressure management.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:16Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het tijdsverloop van bloeddrukverandering na natriumreductie en het DASH-dieet. Kwantificeert hoe snel dieetinterventies effect hebben op de bloeddruk.","abstract_original":"UNLABELLED: Both sodium reduction and the Dietary Approaches to Stop Hypertension (DASH) diet lower blood pressure (BP); however, the patterns of their effects on BP over time are unknown. In the DASH-Sodium trial, adults with pre-/stage 1 hypertension, not using antihypertensive medications, were randomly assigned to either a typical American diet (control) or DASH. Within their assigned diet, participants randomly ate each of 3 sodium levels (50, 100, and 150 mmol/d, at 2100 kcal) over 4-week periods. BP was measured weekly for 12 weeks; 412 participants enrolled (57% women; 57% black; mean age, 48 years; mean systolic BP [SBP]/diastolic BP [DBP], 135/86 mm Hg). For those assigned control, there was no change in SBP/DBP between weeks 1 and 4 on the high-sodium diet (weekly change, -0.04/0.06 mm Hg/week) versus a progressive decline in BP on the low-sodium diet (-0.94/-0.70 mm Hg/week; P interactions between time and sodium <0.001 for SBP and DBP). For those assigned DASH, SBP/DBP changed -0.60/-0.16 mm Hg/week on the high- versus -0.42/-0.54 mm Hg/week on the low-sodium diet (P interactions between time and sodium=0.56 for SBP and 0.10 for DBP). When comparing DASH to control, DASH changed SBP/DBP by -4.36/-1.07 mm Hg after 1 week, which accounted for most of the effect observed, with no significant difference in weekly rates of change for either SBP (P interaction=0.97) or DBP (P interaction=0.70). In the context of a typical American diet, a low-sodium diet reduced BP without plateau, suggesting that the full effects of sodium reduction are not completely achieved by 4 weeks. In contrast, compared with control, DASH lowers BP within a week without further effect thereafter. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000608."},{"id":"7b894bda903a","type":"article","url":"https://hartvaat.nl/2017/11/01/iv-lisdiuretica-bij-acuut-hartfalen-diur-ahf-studieontwerp/","title":"IV lisdiuretica bij acuut hartfalen: DIUR-AHF studieontwerp","title_en":"Rationale and study design of intravenous loop diuretic administration in acute heart failure: DIUR-AHF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hfpef","hfref","ijzersuppletie"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12226","source_url":"https://doi.org/10.1002/ehf2.12226","authors":["Alberto Palazzuoli","Gaetano Ruocco","Giorgio Vescovo","Roberto Valle","Salvatore Di Somma","Ranuccio Nuti"],"significance":4,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/diuretica-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The DIUR-AHF study protocol describes a randomised trial comparing continuous infusion versus intermittent bolus administration of intravenous loop diuretics in acute heart failure, assessing decongestion efficacy, diuretic efficiency, and long-term prognosis.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studieprotocol van DIUR-AHF naar de optimale toedieningswijze van intraveneuze lisdiuretica bij acuut hartfalen.","abstract_original":"AIMS: Although loop diuretics are the most commonly used drugs in acute heart failure (AHF) treatment, their short-term and long-term effects are relatively unknown. The significance of worsening renal function occurrence during intravenous treatment is not clear enough. This trial aims to clarify all these features and contemplate whether continuous infusion is better than an intermittent strategy in terms of decongestion efficacy, diuretic efficiency, renal function, and long-term prognosis. METHODS AND RESULTS: This is a prospective, multicentre, randomized study that compares continuous infusion to intermittent infusion and a low vs. high diuretic dose of furosemide in patients with a diagnosis of acute heart failure, BNP ≥ 100 pg/mL, and specific chest X-ray signs. Randomization criteria have been established at a 1:1 ratio using a computer-generated scheme of either twice-daily bolus injection or continuous infusion for a time period ranging from 72 to 120 h. The initial dose will be 80 mg/day of intravenous furosemide and, in the case of poor response, will be doubled using an escalation algorithm. A high diuretic dose is defined as a furosemide daily amount >120 mg/day respectively. CONCLUSIONS: Continuous and high dose groups could reveal a more intensive diuresis and a greater decongestion with respect to intermittent and low dose groups; high dose and poor loop diuretic efficiency should be related to increased diuretic resistance, renal dysfunction occurrence, and greater congestion status. Poor diuretic response will be associated with less decongestion and an adverse prognosis."},{"id":"a86419a917e6","type":"article","url":"https://hartvaat.nl/2017/11/01/zoutbuffering-in-de-huid-bij-mensen-een-nieuw-mechanisme/","title":"Zoutbuffering in de huid bij mensen: een nieuw mechanisme","title_en":"Novel Mechanism for Buffering Dietary Salt in Humans: Effects of Salt Loading on Skin Sodium, Vascular Endothelial Growth Factor C, and Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10003","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10003","authors":["Viknesh Selvarajah","Kaisa M Mäki-Petäjä","Liliana Pedro","Sylvaine F A Bruggraber","Keith Burling","Anna K Goodhart","Morris J Brown","Carmel M McEniery","Ian B Wilkinson"],"significance":6,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This study described a novel mechanism for dietary salt buffering in human skin, showing that sodium is stored in skin tissue and triggers VEGF-C-mediated lymphangiogenesis, fundamentally changing the understanding of sodium homeostasis.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T13:26:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die een nieuw mechanisme beschrijft voor zoutbuffering in de menselijke huid via natrium-opslag en VEGF-C. Verandert het begrip van zoutbalans en bloeddrukregulatie.","abstract_original":"High dietary sodium intake triggers increased blood pressure (BP). Animal studies show that dietary salt loading results in dermal Na+ accumulation and lymphangiogenesis mediated by VEGF-C (vascular endothelial growth factor C), both attenuating the rise in BP. Our objective was to determine whether these mechanisms function in humans. We assessed skin electrolytes, BP, and plasma VEGF-C in 48 healthy participants randomized to placebo (70 mmol sodium/d) and slow sodium (200 mmol/d) for 7 days. Skin Na+ and K+ concentrations were measured in mg/g of wet tissue and expressed as the ratio Na+:K+ to correct for variability in sample hydration. Skin Na+:K+ increased between placebo and slow sodium phases (2.91±0.08 versus 3.12±0.09; P=0.01). In post hoc analysis, there was a suggestion of a sex-specific effect, with a significant increase in skin Na+:K+ in men (2.59±0.09 versus 2.88±0.12; P=0.008) but not women (3.23±0.10 versus 3.36±0.12; P=0.31). Women showed a significant increase in 24-hour mean BP with salt loading (93±1 versus 91±1 mm Hg; P<0.001) while men did not (96±2 versus 96±2 mm Hg; P=0.91). Skin Na+:K+ correlated with BP, stroke volume, and peripheral vascular resistance in men but not in women. No change was noted in plasma VEGF-C. These findings suggest that the skin may buffer dietary Na+, reducing the hemodynamic consequences of increased salt, and this may be influenced by sex."},{"id":"89eaa7fef850","type":"article","url":"https://hartvaat.nl/2017/11/01/bloeddrukvariabiliteit-en-uitkomsten-bij-af-affirm-studie/","title":"Bloeddrukvariabiliteit en uitkomsten bij AF: AFFIRM-studie","title_en":"Systolic Blood Pressure Visit-to-Visit Variability and Major Adverse Outcomes in Atrial Fibrillation: The AFFIRM Study (Atrial Fibrillation Follow-Up Investigation of Rhythm Management).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.10106","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.10106","authors":["Marco Proietti","Giulio Francesco Romiti","Brian Olshansky","Gregory Y H Lip"],"significance":6,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/","https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"This AFFIRM analysis showed that systolic blood pressure visit-to-visit variability independently predicts major adverse events in AF patients, identifying a novel risk factor in the anticoagulated AF population.","created":"2026-07-03T10:26:59Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"AFFIRM-analyse naar systolische bloeddrukvariabiliteit en cardiovasculaire uitkomsten bij AF. Variabiliteit als onafhankelijke risicofactor bij atriumfibrilleren.","abstract_original":"UNLABELLED: Hypertension and atrial fibrillation predict major adverse events independently. Visit-to-visit variability (VVV) in systolic blood pressure (SBP) predicts outcomes beyond SBP itself, but risk associated with SBP-VVV in atrial fibrillation remains uncertain. We evaluated relationships between SBP-VVV, quality of oral anticoagulation control, and outcomes in patients with atrial fibrillation. Data from the AFFIRM trial (atrial fibrillation follow-up investigation of rhythm management) were analyzed. SBP-VVV was defined according to SD of SBP (SBP-SD) during follow-up. SBP-VVV was categorized by quartiles (1st, <10.09; 2nd, 10.09-13.85; 3rd, 13.86-17.33; and 4th, ≥17.34 mm Hg) and as a continuous variable. Among the original cohort, 3843 (94.7%) patients were eligible. Time in therapeutic range and percentage of international normalized ratio in range were progressively lower by quartiles (both P<0.001). An inverse linear association existed between SBP-SD and time in therapeutic range/percentage of international normalized ratio in range (P<0.001). After a median (interquartile range) follow-up of 3.6 (2.7-4.6) years, stroke and major bleeding rates progressively increased by SBP-VVV quartile (both P<0.001). Patients in the 4th quartile had the highest rate of cardiovascular and all-cause death (P=0.005 and P<0.001). A Cox multivariate analysis confirmed that 3rd and 4th quartiles were associated independently with a higher risk for stroke (P=0.042 and P=0.004) and major bleeding (P=0.009 and P<0.001). Patients in 4th quartile had also a higher risk for all-cause death (P=0.048). SBP-SD as a continuous variable was associated with increased risk for all outcomes. In conclusion, SBP-VVV is inversely associated with quality of anticoagulation control and independently predicts major adverse outcomes. Management of blood pressure variability may improve outcomes in atrial fibrillation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00000556."},{"id":"d84282dfc0c9","type":"article","url":"https://hartvaat.nl/2017/11/01/gemiddelde-bloeddruk-en-visit-to-visit-variabiliteit-als-gecombineerde-voorspell/","title":"Gemiddelde bloeddruk en visit-to-visit variabiliteit als gecombineerde voorspellers: ONTARGET/TRANSCEND","title_en":"Relative and Combined Prognostic Importance of On-Treatment Mean and Visit-to-Visit Blood Pressure Variability in ONTARGET and TRANSCEND Patients.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09714","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09714","authors":["Giuseppe Mancia","Helmut Schumacher","Michael Böhm","Josep Redon","Roland E Schmieder","Paolo Verdecchia","Peter Sleight","Koon Teo","Salim Yusuf"],"significance":6,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":[],"congress":"","summary_en":"This ONTARGET/TRANSCEND analysis demonstrated that both mean blood pressure and visit-to-visit variability independently predict cardiovascular outcomes, supporting assessment of both parameters for comprehensive blood pressure risk evaluation.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T13:26:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ONTARGET/TRANSCEND-analyse naar de relatieve en gecombineerde prognostische waarde van on-treatment gemiddelde bloeddruk en bloeddrukvariabiliteit.","abstract_original":"UNLABELLED: In 28 790 patients recruited for the ONTARGET (Ongoing Treatment Alone and in Combination With Ramipril Global End Point Trials) and TRANSCEND (Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease) trials, we investigated the prognostic value for cardiovascular events (primary outcome) of (1)on-treatment visit-to-visit systolic blood pressure (SBP) variability versus mean SBP and (2) the 2 measures together. SBP variability was measured by the coefficient of variation (CV) of mean SBP to which it was unrelated. Confounders such as variable time and number of visits from which to calculate SBP-CV were avoided by using the same number of visits at identical times in all patients. The covariate-adjusted risk of the primary outcome (Cox models) increased as SBP-CV or mean on-treatment quintile SBP increased, but only for mean on-treatment SBP, the relationship achieved statistical significance: global test for trend, P=0.12 versus P<0.0001. SBP-CV showed a relationship with fatal events, but it was unrelated to the risk of myocardial infarction and stroke, which were predicted by on-treatment mean SBP. Prediction of the primary outcome improved by the combined use of both measures: global test for trend, P<0.0001; hazard ratio for combined fifth versus first quintile, 1.42 (1.20-1.68) compared with 1.13 (1.01-1.27) for SBP-CV and 1.24 (1.11-1.40) for mean SBP. Thus, in the present study, on-treatment mean SBP provided an overall better prediction of cardiovascular risk than visit-to-visit SBP-CV. Prediction improved by their combined use, which may thus offer a more precise estimate of the protective effect of treatment. CLINICAL TRIAL REGISTRATION: URL: http//www.clinicaltrial.gov. Unique identifier: NCT00153101"},{"id":"5c6c140a79a6","type":"article","url":"https://hartvaat.nl/2017/11/01/klinische-presentatie-bij-eerste-hartfalenhospitalisatie-voorspelt-geen-heropnam/","title":"Klinische presentatie bij eerste hartfalenhospitalisatie voorspelt geen heropname","title_en":"Clinical presentation at first heart failure hospitalization does not predict recurrent heart failure admission.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"ESC heart failure","doi":"10.1002/ehf2.12157","source_url":"https://doi.org/10.1002/ehf2.12157","authors":["Annamaria Kosztin","Jason Costa","Arthur J Moss","Yitschak Biton","Vivien Klaudia Nagy","Scott D Solomon","Laszlo Geller","Scott McNitt","Bronislava Polonsky","Bela Merkely","Valentina Kutyifa"],"significance":5,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/acuut-hartfalen/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This study showed that the clinical presentation pattern at first heart failure hospitalization does not predict the nature of future readmissions, challenging the assumption that HF phenotype is stable over time.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T13:26:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat de klinische presentatie bij de eerste hartfalenhospitalisatie niet voorspellend is voor de aard van toekomstige heropnames. Implicaties voor ontslagbeleid.","abstract_original":"AIMS: There are limited data on whether clinical presentation at first heart failure (HF) hospitalization predicts recurrent HF events. We aimed to assess predictors of recurrent HF hospitalizations in mild HF patients with an implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator. METHODS AND RESULTS: Data on HF hospitalizations were prospectively collected for patients enrolled in MADIT-CRT. Predictors of recurrent HF hospitalization (HF2) after the first HF hospitalization were assessed using Cox proportional hazards regression models including baseline covariates and clinical presentation or management at first HF hospitalization. There were 193 patients with first HF hospitalization, and 156 patients with recurrent HF events. Recurrent HF rate after the first HF hospitalization was 43% at 1 year, 52% at 2 years, and 55% at 2.5 years. Clinical signs and symptoms, medical treatment, or clinical management of HF at first HF admission was not predictive for HF2. Baseline covariates predicting recurrent HF hospitalization included prior HF hospitalization (HR = 1.59, 95% CI: 1.15-2.20, P = 0.005), digitalis therapy (HR = 1.58, 95% CI: 1.13-2.20, P = 0.008), and left ventricular end-diastolic volume >240 mL (HR = 1.62, 95% CI: 1.17-2.25, P = 0.004). CONCLUSIONS: Recurrent HF events are frequent following the first HF hospitalization in patients with implanted implantable cardioverter defibrillator or cardiac resynchronization therapy with defibrillator. Neither clinical presentation nor clinical management during first HF admission was predictive of recurrent HF. Prior HF hospitalization, digitalis therapy, and left ventricular end-diastolic volume at enrolment predicted recurrent HF hospitalization, and these covariates could be used as surrogate markers for identifying a high-risk cohort."},{"id":"ddc4f35228dc","type":"article","url":"https://hartvaat.nl/2017/11/01/labetalol-versus-nifedipine-bij-chronische-hypertensie-in-de-zwangerschap-gerand/","title":"Labetalol versus nifedipine bij chronische hypertensie in de zwangerschap: gerandomiseerde trial","title_en":"Labetalol Versus Nifedipine as Antihypertensive Treatment for Chronic Hypertension in Pregnancy: A Randomized Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09972","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09972","authors":["Louise M Webster","Jenny E Myers","Catherine Nelson-Piercy","Kate Harding","J Kennedy Cruickshank","Ingrid Watt-Coote","Asma Khalil","Cornelia Wiesender","Paul T Seed","Lucy C Chappell"],"significance":7,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-zwangerschap/","https://hartvaat.nl/kennis/hypertensie/centrale-middelen-hypertensie/"],"congress":"","summary_en":"This randomized trial comparing labetalol with nifedipine for chronic hypertension in pregnancy provided head-to-head comparative data on the two most commonly used antihypertensive agents in this population, informing drug selection during pregnancy.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T13:26:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die labetalol vergeleek met nifedipine bij chronische hypertensie in de zwangerschap. Head-to-head vergelijking van de twee meest gebruikte middelen.","abstract_original":"UNLABELLED: Data from randomized controlled trials to guide antihypertensive agent choice for chronic hypertension in pregnancy are limited; this study aimed to compare labetalol and nifedipine, additionally assessing the impact of ethnicity on treatment efficacy. Pregnant women with chronic hypertension (12+0-27+6 weeks' gestation) were enrolled at 4 UK centers (August 2014 to October 2015). Open-label first-line antihypertensive treatment was randomly assigned: labetalol- (200-1800 mg/d) or nifedipine-modified release (20-80 mg/d). Analysis included 112 women (98%) who completed the study (labetalol n=55, nifedipine n=57). Maximum blood pressure after randomization was 161/101 mm Hg with labetalol versus 163/105 mm Hg with nifedipine (mean difference systolic: 1.2 mm Hg [-4.9 to 7.2 mm Hg], diastolic: 3.3 mm Hg [-0.6 to 7.3 mm Hg]). Mean blood pressure was 134/84 mm Hg with labetalol and 134/85 mm Hg with nifedipine (mean difference systolic: 0.3 mm Hg [-2.8 to 3.4 mm Hg], and diastolic: -1.9 mm Hg [-4.1 to 0.3 mm Hg]). Nifedipine use was associated with a 7.4-mm Hg reduction (-14.4 to -0.4 mm Hg) in central aortic pressure, measured by pulse wave analysis. No difference in treatment effect was observed in black women (n=63), but a mean 4 mm Hg reduction (-6.6 to -0.8 mm Hg; P=0.015) in brachial diastolic blood pressure was observed with labetalol compared with nifedipine in non-black women (n=49). Labetalol and nifedipine control mean blood pressure to target in pregnant women with chronic hypertension. This study provides support for a larger definitive trial scrutinizing the benefits and side effects of first-line antihypertensive treatment. CLINICAL TRIAL REGISTRATION: URL: https://www.isrctn.com. Unique identifier: ISRCTN40973936."},{"id":"6efcb5b0f4a5","type":"article","url":"https://hartvaat.nl/2017/11/01/sildenafil-tijdens-de-zwangerschap-preklinische-meta-analyse-over-foetale-groei-/","title":"Sildenafil tijdens de zwangerschap: preklinische meta-analyse over foetale groei en bloeddruk","title_en":"Sildenafil During Pregnancy: A Preclinical Meta-Analysis on Fetal Growth and Maternal Blood Pressure.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09690","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09690","authors":["Nina D Paauw","Fieke Terstappen","Wessel Ganzevoort","Jaap A Joles","Hendrik Gremmels","A Titia Lely"],"significance":5,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":[],"congress":"","summary_en":"This preclinical meta-analysis evaluated the effects of sildenafil on fetal growth and maternal blood pressure during pregnancy, providing safety data relevant to the ongoing clinical investigation of PDE5 inhibitors for fetal growth restriction.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T13:26:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Preklinische meta-analyse van sildenafil tijdens de zwangerschap met focus op foetale groei en maternale bloeddruk. Veiligheidsdata voorafgaand aan klinische trials.","abstract_original":"Sildenafil is a new approach to treat fetal growth restriction (FGR) and preeclampsia. We performed a systematic meta-analysis to evaluate effects of sildenafil. Our search identified 22 animal studies (mouse, rat, rabbit, sheep, and guinea pigs) and 2 human randomized controlled trials. Data were pooled using ratio of means and mean differences with 95% confidence intervals for fetal growth and maternal blood pressure, respectively. Meta-regression analyses were performed for study-related factors that might affect efficacy of sildenafil, including the model used (healthy pregnancy versus FGR/preeclampsia) and route of administration. Dose-response curves with dose per metabolic weight (mg/kg0.75 per 24 hours) were fitted using splines. Our analyses show that sildenafil increases fetal growth during FGR/preeclampsia pregnancy compared with healthy pregnancy (1.10 [1.06-1.13] versus 1.03 [0.99-1.06]; P=0.006). There was no significant effect on fetal growth in the absence of FGR/preeclampsia. Effects were similar among different species and largest after oral and continuous administration. There was a positive relation between dose and fetal growth up to a human equivalent dose of ≈450 mg/d. A significant blood pressure-lowering effect of sildenafil is present during FGR/preeclampsia pregnancy only (-19 [-25 to -13] mm Hg; P<0.01), with the effect size being highly dependent on baseline blood pressure and without effect in the absence of hypertension. This meta-analysis supports that sildenafil improves fetal growth and maternal blood pressure regulation during FGR and preeclampsia pregnancy. The greatest beneficial effects on fetal growth are with dosages greater than those currently used in human studies."},{"id":"605c86415d0f","type":"article","url":"https://hartvaat.nl/2017/11/01/raas-blokkade-bij-hfpef-systematische-review-en-meta-analyse/","title":"RAAS-blokkade bij HFpEF: systematische review en meta-analyse","title_en":"Renin-angiotensin blockade in heart failure with preserved ejection fraction: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bloeddrukbehandeling","hfref","ras-remmers","sacubitril-valsartan","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12204","source_url":"https://doi.org/10.1002/ehf2.12204","authors":["Muhammad Shahzeb Khan","Gregg C Fonarow","Hassan Khan","Stephen J Greene","Stefan D Anker","Mihai Gheorghiade","Javed Butler"],"significance":7,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This meta-analysis of renin-angiotensin blockade in HFpEF found modest reductions in heart failure hospitalization but no mortality benefit with ACE inhibitors or ARBs. The analysis highlighted the limited efficacy of conventional neurohormonal therapy in preserved ejection fraction.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse naar het effect van renine-angiotensine blokkade bij hartfalen met behouden ejectiefractie. Ondanks breed gebruik is het bewijs beperkt.","abstract_original":"Studies with angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) in patients with heart failure with preserved ejection fraction (HFpEF) have yielded inconsistent results. To conduct a systematic review and meta-analysis of all evidence for ACE-I and ARBs in patients with HFpEF, we searched PubMed, Ovid SP, Embase, and Cochrane database to identify randomized trials and observational studies that compared ACE-I or ARBs against placebo or standard therapy in HFpEF patients. Random-effect models were used to pool the data, and I2 testing was performed to assess the heterogeneity of the included studies. A total of 13 studies (treatment arm = 8676 and control arm = 8608) were analysed. Pooled analysis of randomized trials for ACE-I and ARBs (n = 6) did not show any effect on all-cause mortality [relative risk (RR) = 1.02, 95% confidence interval (CI) = 0.93-1.11, P = 0.68, I2  = 0%], while results from observational studies showed a significant improvement (RR = 0.91, 95% CI = 0.87-0.95, P = 0.005, I2  = 81.5%). In pooled analyses of all studies, ACE-I showed a reduction of all-cause mortality (RR = 0.91, 95% CI = 0.87-0.95, P = 0.01). There was no reduction in cardiovascular mortality seen, but in pooled analysis of randomized trials, there was a trend towards reduced HF hospitalization risk (RR = 0.91, 95% CI = 0.83-1.01, I2  = 0%, P = 0.074). These data suggest that ACE-I and ARBs may have a role in improving outcomes of patients with HFpEF, underscoring the need for future research with careful patient selection, and trial design and conduct."},{"id":"1980d7744cda","type":"article","url":"https://hartvaat.nl/2017/11/01/hypertensiecontrole-bij-diabetes-met-recidiverende-cv-events-tecos-globale-resul/","title":"Hypertensiecontrole bij diabetes met recidiverende CV-events: TECOS globale resultaten","title_en":"Hypertension Control in Adults With Diabetes Mellitus and Recurrent Cardiovascular Events: Global Results From the Trial Evaluating Cardiovascular Outcomes With Sitagliptin.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","diabetes-en-hart","diabetes-type-1","diabetes-type-2","select-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09482","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09482","authors":["Ann Marie Navar","Dianne S Gallup","Yuliya Lokhnygina","Jennifer B Green","Darren K McGuire","Paul W Armstrong","John B Buse","Samuel S Engel","John M Lachin","Eberhard Standl","Frans Van de Werf","Rury R Holman","Eric D Peterson"],"significance":6,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/"],"congress":"","summary_en":"This TECOS global analysis of hypertension control in diabetic patients with recurrent cardiovascular events showed that blood pressure remains suboptimally controlled in a substantial proportion despite the increased risk, identifying treatment gaps.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TECOS globale analyse naar hypertensiecontrole bij diabetespatiënten met recidiverende cardiovasculaire events. Identificeert hiaten in bloeddrukmanagement.","abstract_original":"Systolic blood pressure (SBP) treatment targets for adults with diabetes mellitus remain unclear. SBP levels among 12 275 adults with diabetes mellitus, prior cardiovascular disease, and treated hypertension were evaluated in the TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin) randomized trial of sitagliptin versus placebo. The association between baseline SBP and recurrent cardiovascular disease was evaluated using multivariable Cox proportional hazards modeling with restricted cubic splines, adjusting for clinical characteristics. Kaplan-Meier curves by baseline SBP were created to assess time to cardiovascular disease and 2 potential hypotension-related adverse events: worsening kidney function and fractures. The association between time-updated SBP and outcomes was examined using multivariable Cox proportional hazards models. Overall, 42.2% of adults with diabetes mellitus, cardiovascular disease, and hypertension had an SBP ≥140 mm Hg. The association between SBP and cardiovascular disease risk was U shaped, with a nadir ≈130 mm Hg. When the analysis was restricted to those with baseline SBP of 110 to 150 mm Hg, the adjusted association between SBP and cardiovascular disease risk was flat (hazard ratio per 10-mm Hg increase, 0.96; 95% confidence interval, 0.91-1.02). There was no association between SBP and risk of fracture. Above 150 mm Hg, higher SBP was associated with increasing risk of worsening kidney function (hazard ratio per 10-mm Hg increase, 1.10; 95% confidence interval, 1.02-1.18). Many patients with diabetes mellitus have uncontrolled hypertension. The U-shaped association between SBP and cardiovascular disease events was largely driven by those with very high or low SBP, with no difference in cardiovascular disease risk between 110 and 150 mm Hg. Lower SBP was not associated with higher risks of fractures or worsening kidney function."},{"id":"d0459dea435b","type":"article","url":"https://hartvaat.nl/2017/11/01/rehospitalisatie-na-intermitterend-levosimendan-bij-gevorderd-hartfalen-meta-ana/","title":"Rehospitalisatie na intermitterend levosimendan bij gevorderd hartfalen: meta-analyse","title_en":"Rehospitalization after intermittent levosimendan treatment in advanced heart failure patients: a meta-analysis of randomized trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","pathfinder-trial","step-hfpef"],"journal":"ESC heart failure","doi":"10.1002/ehf2.12177","source_url":"https://doi.org/10.1002/ehf2.12177","authors":["Simona Silvetti","Alessandro Belletti","Antonella Fontana","Piero Pollesello"],"significance":6,"published":"2017-11-01","source_date":"2017-11-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis evaluated intermittent levosimendan administration in advanced heart failure, assessing whether repeated infusions improve quality of life and reduce rehospitalization in patients with refractory disease.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van gerandomiseerde trials naar intermitterend levosimendan bij gevorderd hartfalen. Onderzoekt of herhaalde toediening ziekenhuisopnames vermindert.","abstract_original":"AIMS: Intermittent levosimendan administration has been suggested to improve survival in patients with advanced heart failure (AdHF). Quality of life is a key issue for AdHF patients and is negatively affected by frequent hospitalizations. METHODS AND RESULTS: CENTRAL, Google Scholar, MEDLINE/PubMed, Scopus, and the Cochrane Central Register of clinical trials (updated 15/1/2017) were searched for randomized controlled trials investigating the effect of intermittent levosimendan administration in patients with AdHF. The primary outcome was the number of patients requiring rehospitalization 3 months after the end of treatment. A total of 319 patients from six trials were included. Overall pooled analysis showed that the use of levosimendan was associated with a significant reduction in the number of rehospitalizations at 3 months: 33/207 (16%) vs. 39/113 (35%), risk ratio 0.40, 95% confidence interval 0.27-0.59, P < 0.001, I2  = 0%. This result was confirmed by sensitivity analyses. CONCLUSIONS: Within the limitations of this meta-analysis including also studies in which endpoints were not independently adjudicated and not clearly specified, repetitive or intermittent administration of levosimendan for patients with AdHF was associated with a reduction in the rehospitalization rate at 3 months. Large, high-quality randomized controlled trials are needed to confirm this finding."},{"id":"ba27becdbde0","type":"article","url":"https://hartvaat.nl/2017/10/31/laesiecomplexiteit-en-uitkomsten-van-verlengde-dapt-na-pci/","title":"Laesiecomplexiteit en uitkomsten van verlengde DAPT na PCI","title_en":"Lesion Complexity and Outcomes of Extended Dual Antiplatelet Therapy After Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.09.011","source_url":"https://doi.org/10.1016/j.jacc.2017.09.011","authors":["Robert W Yeh","Dean J Kereiakes","P Gabriel Steg","Donald E Cutlip","Kevin J Croce","Joseph M Massaro","Laura Mauri"],"significance":6,"published":"2017-10-31","source_date":"2017-10-31","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that patients with complex coronary lesion anatomy derive greater relative benefit from extended DAPT, supporting lesion complexity as a factor in personalizing antiplatelet therapy duration.","created":"2026-07-03T10:26:58Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de interactie tussen laesiecomplexiteit en het voordeel van verlengde DAPT na PCI. Complexere laesies hebben meer baat bij langere behandelduur.","abstract_original":"BACKGROUND: Subjects undergoing coronary stenting with complex lesion anatomy may experience different risks and benefits with prolonged dual antiplatelet therapy. OBJECTIVES: The authors assessed the effect of 30 months versus 12 months of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) based on the presence or absence of anatomically-complex target lesions. METHODS: In the DAPT Study, combined myocardial infarction (MI) or stent thrombosis and moderate/severe bleeding were assessed in enrolled (n = 25,416) and randomized (n = 11,554) subjects. Complex lesions had any of the following characteristics: unprotected left main, >2 lesions/vessel, length ≥30 mm, bifurcation with side branch ≥2.5 mm, vein bypass graft, or thrombus-containing lesion. Events were evaluated according to increasing number of complexity characteristics and compared according to DAPT score. RESULTS: Enrolled subjects with more complex target lesions had higher rates of MI or stent thrombosis in the first 12 months after PCI (3.9% vs. 2.4%; p < 0.001). Among those who were event-free at 12 months, rates of MI or stent thrombosis between 12 and 30 months were similar between those with versus without complex anatomy (3.5% vs. 2.9%; p = 0.07). Reduction of MI or stent thrombosis with continued thienopyridine beyond 12 months versus placebo was similar for subjects with (2.5% vs. 4.5%; hazard ratio: 0.55; 95% confidence interval: 0.38 to 0.79; p = 0.001) and without (2.0% vs. 3.8%; hazard ratio: 0.52; 95% confidence interval: 0.39 to 0.69; p < 0.001) anatomic complexity (pinteraction = 0.81), as was increase in moderate/severe bleeding (pinteraction = 0.44). Among subjects with anatomic complexity, those with DAPT scores ≥2 randomized to continued thienopyridine had greater reductions in MI or stent thrombosis (3.0% vs. 6.1%; p < 0.001) compared with subjects with scores <2 (1.7% vs. 2.3%; p = 0.42; p value comparing risk differences = 0.03). CONCLUSIONS: Complex target-lesion anatomy is associated with increased ischemic events, particularly within the first year after PCI. Among those without events in the first 12 months, the benefits of extending DAPT were similar in subjects with and without complex lesions. A high DAPT score identified those experiencing the most benefit from extended treatment among patients with and without complex anatomy. (The Dual Antiplatelet Therapy Study [DAPT Study]; NCT00977938)."},{"id":"a17aa21fd96b","type":"article","url":"https://hartvaat.nl/2017/10/28/zeer-lage-ldl-concentraties-met-evolocumab-lancet-fourier-subanalyse/","title":"Zeer lage LDL-concentraties met evolocumab: Lancet FOURIER-subanalyse","title_en":"Clinical efficacy and safety of achieving very low LDL-cholesterol concentrations with the PCSK9 inhibitor evolocumab: a prespecified secondary analysis of the FOURIER trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["bempedoïnezuur","ezetimibe","ldl-cholesterol"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32290-0","source_url":"https://doi.org/10.1016/S0140-6736(17)32290-0","authors":["Robert P Giugliano","Terje R Pedersen","Jeong-Gun Park","Gaetano M De Ferrari","Zbigniew A Gaciong","Richard Ceska","Kalman Toth","Ioanna Gouni-Berthold","Jose Lopez-Miranda","François Schiele","François Mach","Brian R Ott","Estella Kanevsky","Armando Lira Pineda","Ransi Somaratne","Scott M Wasserman","Anthony C Keech","Peter S Sever","Marc S Sabatine"],"significance":9,"published":"2017-10-28","source_date":"2017-10-28","image":"","kennis":[],"congress":"","summary_en":"This prespecified FOURIER analysis confirmed the 'lower is better' principle for LDL cholesterol, showing that patients achieving LDL levels below 0.5 mmol/L with evolocumab had the greatest cardiovascular risk reduction without safety concerns. The findings supported setting very low LDL targets in high-risk patients.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet FOURIER-subanalyse naar de werkzaamheid en veiligheid van het bereiken van zeer lage LDL-concentraties met evolocumab. Bevestigt 'lower is better' tot zeer lage niveaus.","abstract_original":"BACKGROUND: LDL cholesterol is a well established risk factor for atherosclerotic cardiovascular disease. How much one should or safely can lower this risk factor remains debated. We aimed to explore the relationship between progressively lower LDL-cholesterol concentrations achieved at 4 weeks and clinical efficacy and safety in the FOURIER trial of evolocumab, a monoclonal antibody to proprotein convertase subtilisin-kexin type 9 (PCSK9). METHODS: In this prespecified secondary analysis of 25 982 patients from the randomised FOURIER trial, the relationship between achieved LDL-cholesterol concentration at 4 weeks and subsequent cardiovascular outcomes (primary endpoint was the composite of cardiovascular death, myocardial infarction, stroke, coronary revascularisation, or unstable angina; key secondary endpoint was the composite of cardiovascular death, myocardial infarction, or stroke) and ten prespecified safety events of interest was examined over a median of 2·2 years of follow-up. We used multivariable modelling to adjust for baseline factors associated with achieved LDL cholesterol. This trial is registered with ClinicalTrials.gov, number NCT01764633. FINDINGS: Between Feb 8, 2013, and June 5, 2015, 27 564 patients were randomly assigned a treatment in the FOURIER study. 1025 (4%) patients did not have an LDL cholesterol measured at 4 weeks and 557 (2%) had already had a primary endpoint event or one of the ten prespecified safety events before the week-4 visit. From the remaining 25 982 patients (94% of those randomly assigned) 13 013 were assigned evolocumab and 12 969 were assigned placebo. 2669 (10%) of 25 982 patients achieved LDL-cholesterol concentrations of less than 0·5 mmol/L, 8003 (31%) patients achieved concentrations between 0·5 and less than 1·3 mmol/L, 3444 (13%) patients achieved concentrations between 1·3 and less than 1·8 mmol/L, 7471 (29%) patients achieved concentrations between 1·8 to less than 2·6 mmol/L, and 4395 (17%) patients achieved concentrations of 2·6 mmol/L or higher. There was a highly significant monotonic relationship between low LDL-cholesterol concentrations and lower risk of the primary and secondary efficacy composite endpoints extending to the bottom first percentile (LDL-cholesterol concentrations of less than 0·2 mmol/L; p=0·0012 for the primary endpoint, p=0·0001 for the secondary endpoint). Conversely, no significant association was observed between achieved LDL cholesterol and safety outcomes, either for all serious adverse events or any of the other nine prespecified safety events. INTERPRETATION: There was a monotonic relationship between achieved LDL cholesterol and major cardiovascular outcomes down to LDL-cholesterol concentrations of less than 0·2 mmol/L. Conversely, there were no safety concerns with very low LDL-cholesterol concentrations over a median of 2·2 years. These data support further LDL-cholesterol lowering in patients with cardiovascular disease to well below current recommendations. FUNDING: Amgen."},{"id":"80cd53dc2349","type":"article","url":"https://hartvaat.nl/2017/10/21/canakinumab-en-longkankerincidentie-bij-atherosclerose-lancet-cantos-exploratief/","title":"Canakinumab en longkankerincidentie bij atherosclerose: Lancet CANTOS exploratief","title_en":"Effect of interleukin-1β inhibition with canakinumab on incident lung cancer in patients with atherosclerosis: exploratory results from a randomised, double-blind, placebo-controlled trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["atherosclerose","ezetimibe"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32247-X","source_url":"https://doi.org/10.1016/S0140-6736(17)32247-X","authors":["Paul M Ridker","Jean G MacFadyen","Tom Thuren","Brendan M Everett","Peter Libby","Robert J Glynn"],"significance":8,"published":"2017-10-21","source_date":"2017-10-21","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This exploratory CANTOS analysis unexpectedly revealed that canakinumab significantly reduced incident lung cancer in post-MI patients, suggesting that IL-1β-mediated inflammation plays a role in cancer progression. The finding opened a new line of investigation into anti-inflammatory cancer prevention.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Exploratieve Lancet-analyse van CANTOS die onverwacht een reductie in longkankerincidentie aantoonde met canakinumab. Verrassende link tussen inflammatieremming en kankerpreventie.","abstract_original":"BACKGROUND: Inflammation in the tumour microenvironment mediated by interleukin 1β is hypothesised to have a major role in cancer invasiveness, progression, and metastases. We did an additional analysis in the Canakinumab Anti-inflammatory Thrombosis Outcomes Study (CANTOS), a randomised trial of the role of interleukin-1β inhibition in atherosclerosis, with the aim of establishing whether inhibition of a major product of the Nod-like receptor protein 3 (NLRP3) inflammasome with canakinumab might alter cancer incidence. METHODS: We did a randomised, double-blind, placebo-controlled trial of canakinumab in 10 061 patients with atherosclerosis who had had a myocardial infarction, were free of previously diagnosed cancer, and had concentrations of high-sensitivity C-reactive protein (hsCRP) of 2 mg/L or greater. To assess dose-response effects, patients were randomly assigned by computer-generated codes to three canakinumab doses (50 mg, 150 mg, and 300 mg, subcutaneously every 3 months) or placebo. Participants were followed up for incident cancer diagnoses, which were adjudicated by an oncology endpoint committee masked to drug or dose allocation. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, NCT01327846. The trial is closed (the last patient visit was in June, 2017). FINDINGS: Baseline concentrations of hsCRP (median 6·0 mg/L vs 4·2 mg/L; p<0·0001) and interleukin 6 (3·2 vs 2·6 ng/L; p<0·0001) were significantly higher among participants subsequently diagnosed with lung cancer than among those not diagnosed with cancer. During median follow-up of 3·7 years, compared with placebo, canakinumab was associated with dose-dependent reductions in concentrations of hsCRP of 26-41% and of interleukin 6 of 25-43% (p<0·0001 for all comparisons). Total cancer mortality (n=196) was significantly lower in the pooled canakinumab group than in the placebo group (p=0·0007 for trend across groups), but was significantly lower than placebo only in the 300 mg group individually (hazard ratio [HR] 0·49 [95% CI 0·31-0·75]; p=0·0009). Incident lung cancer (n=129) was significantly less frequent in the 150 mg (HR 0·61 [95% CI 0·39-0·97]; p=0·034) and 300 mg groups (HR 0·33 [95% CI 0·18-0·59]; p<0·0001; p<0·0001 for trend across groups). Lung cancer mortality was significantly less common in the canakinumab 300 mg group than in the placebo group (HR 0·23 [95% CI 0·10-0·54]; p=0·0002) and in the pooled canakinumab population than in the placebo group (p=0·0002 for trend across groups). Fatal infections or sepsis were significantly more common in the canakinumab groups than in the placebo group. All-cause mortality did not differ significantly between the canakinumab and placebo groups (HR 0·94 [95% CI 0·83-1·06]; p=0·31). INTERPRETATION: Our hypothesis-generating data suggest the possibility that anti-inflammatory therapy with canakinumab targeting the interleukin-1β innate immunity pathway could significantly reduce incident lung cancer and lung cancer mortality. Replication of these data in formal settings of cancer screening and treatment is required. FUNDING: Novartis Pharmaceuticals."},{"id":"31a51d173b22","type":"article","url":"https://hartvaat.nl/2017/10/21/ultradunne-bioresorbeerbare-versus-dunne-duurzame-polymer-stents-lancet-bioscien/","title":"Ultradunne bioresorbeerbare versus dunne duurzame polymer stents: Lancet BIOSCIENCE","title_en":"Ultrathin, bioresorbable polymer sirolimus-eluting stents versus thin, durable polymer everolimus-eluting stents in patients undergoing coronary revascularisation (BIOFLOW V): a randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32249-3","source_url":"https://doi.org/10.1016/S0140-6736(17)32249-3","authors":["David E Kandzari","Laura Mauri","Jacques J Koolen","Joseph M Massaro","Gheorghe Doros","Hector M Garcia-Garcia","Johan Bennett","Ariel Roguin","Elie G Gharib","Donald E Cutlip","Ron Waksman"],"significance":7,"published":"2017-10-21","source_date":"2017-10-21","image":"","kennis":[],"congress":"","summary_en":"This Lancet trial compared ultra-thin bioresorbable polymer sirolimus-eluting stents with thin durable polymer everolimus-eluting metallic stents, evaluating whether newer stent designs with degradable coatings improve long-term outcomes.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde trial van ultradunne bioresorbeerbare polymer sirolimus-eluting stents versus everolimus-eluting metallic stents.","abstract_original":"BACKGROUND: The development of coronary drug-eluting stents has included use of new metal alloys, changes in stent architecture, and use of bioresorbable polymers. Whether these advancements improve clinical safety and efficacy has not been shown in previous randomised trials. We aimed to examine the clinical outcomes of a bioresorbable polymer sirolimus-eluting stent compared with a durable polymer everolimus-eluting stent in a broad patient population undergoing percutaneous coronary intervention. METHODS: BIOFLOW V was an international, randomised trial done in patients undergoing elective and urgent percutaneous coronary intervention in 90 hospitals in 13 countries (Australia, Belgium, Canada, Denmark, Germany, Hungary, Israel, the Netherlands, New Zealand, South Korea, Spain, Switzerland, and the USA). Eligible patients were those aged 18 years or older with ischaemic heart disease undergoing planned stent implantation in de-novo, native coronary lesions. Patients were randomly assigned (2:1) to either an ultrathin strut (60 μm) bioresorbable polymer sirolimus-eluting stent or to a durable polymer everolimus-eluting stent. Randomisation was via a central web-based data capture system (mixed blocks of 3 and 6), and stratified by study site. The primary endpoint was 12-month target lesion failure. The primary non-inferiority comparison combined these data from two additional randomised trials of bioresorbable polymer sirolimus-eluting stent and durable polymer everolimus-eluting stent with Bayesian methods. Analysis was by intention to treat. The trial is registered with ClinicalTrials.gov, number NCT02389946. FINDINGS: Between May 8, 2015, and March 31, 2016, 4772 patients were recruited into the study. 1334 patients met inclusion criteria and were randomly assigned to treatment with bioresorbable polymer sirolimus-eluting stents (n=884) or durable polymer everolimus-eluting stents (n=450). 52 (6%) of 883 patients in the bioresorbable polymer sirolimus-eluting stent group and 41 (10%) of 427 patients in the durable polymer everolimus-eluting stent group met the 12-month primary endpoint of target lesion failure (95% CI -6·84 to -0·29, p=0·0399), with differences in target vessel myocardial infarction (39 [5%] of 831 patients vs 35 [8%] of 424 patients, p=0·0155). The posterior probability that the bioresorbable polymer sirolimus-eluting stent is non-inferior to the durable polymer everolimus-eluting stent was 100% (Bayesian analysis, difference in target lesion failure frequency -2·6% [95% credible interval -5·5 to 0·1], non-inferiority margin 3·85%, n=2208). INTERPRETATION: The outperformance of the ultrathin, bioresorbable polymer sirolimus-eluting stent over the durable polymer everolimus-eluting stent in a complex patient population undergoing percutaneous coronary intervention suggests a new direction in improving next generation drug-eluting stent technology. FUNDING: BIOTRONIK."},{"id":"e55f57466779","type":"article","url":"https://hartvaat.nl/2017/10/19/dubbele-antitrombotische-therapie-met-dabigatran-na-pci-bij-af-nejm-re-dual-pci/","title":"Dubbele antitrombotische therapie met dabigatran na PCI bij AF: NEJM RE-DUAL PCI","title_en":"Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1708454","source_url":"https://doi.org/10.1056/NEJMoa1708454","authors":["Christopher P Cannon","Deepak L Bhatt","Jonas Oldgren","Gregory Y H Lip","Stephen G Ellis","Takeshi Kimura","Michael Maeng","Bela Merkely","Uwe Zeymer","Savion Gropper","Matias Nordaby","Eva Kleine","Ruth Harper","Jenny Manassie","James L Januzzi","Jurrien M Ten Berg","P Gabriel Steg","Stefan H Hohnloser"],"significance":10,"published":"2017-10-19","source_date":"2017-10-19","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The RE-DUAL PCI trial showed that dual antithrombotic therapy with dabigatran plus a P2Y12 inhibitor (without aspirin) significantly reduced bleeding compared with triple therapy in patients with atrial fibrillation who underwent PCI. Together with PIONEER AF-PCI, this trial established the paradigm shift toward dropping aspirin in this population.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM RE-DUAL PCI-trial die dubbele antitrombotische therapie (dabigatran + P2Y12) vergeleek met triple therapie bij AF-patiënten na PCI. Samen met PIONEER AF-PCI bepalend voor het nieuwe paradigma.","abstract_original":"BACKGROUND: Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding. METHODS: In this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups). Outside the United States, elderly patients (≥80 years of age; ≥70 years of age in Japan) were randomly assigned to the 110-mg dual-therapy group or the triple-therapy group. The primary end point was a major or clinically relevant nonmajor bleeding event during follow-up (mean follow-up, 14 months). The trial also tested for the noninferiority of dual therapy with dabigatran (both doses combined) to triple therapy with warfarin with respect to the incidence of a composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization. RESULTS: The incidence of the primary end point was 15.4% in the 110-mg dual-therapy group as compared with 26.9% in the triple-therapy group (hazard ratio, 0.52; 95% confidence interval [CI], 0.42 to 0.63; P<0.001 for noninferiority; P<0.001 for superiority) and 20.2% in the 150-mg dual-therapy group as compared with 25.7% in the corresponding triple-therapy group, which did not include elderly patients outside the United States (hazard ratio, 0.72; 95% CI, 0.58 to 0.88; P<0.001 for noninferiority). The incidence of the composite efficacy end point was 13.7% in the two dual-therapy groups combined as compared with 13.4% in the triple-therapy group (hazard ratio, 1.04; 95% CI, 0.84 to 1.29; P=0.005 for noninferiority). The rate of serious adverse events did not differ significantly among the groups. CONCLUSIONS: Among patients with atrial fibrillation who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with dabigatran and a P2Y12 inhibitor than among those who received triple therapy with warfarin, a P2Y12 inhibitor, and aspirin. Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events. (Funded by Boehringer Ingelheim; RE-DUAL PCI ClinicalTrials.gov number, NCT02164864 .)."},{"id":"1495de65a0b6","type":"article","url":"https://hartvaat.nl/2017/10/17/laaggedoseerd-ticagrelor-versus-clopidogrel-na-eerder-mi/","title":"Laaggedoseerd ticagrelor versus clopidogrel na eerder MI","title_en":"Low-Dose Ticagrelor Versus Clopidogrel in Patients With Prior Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["trombocytenaggregatieremmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.08.031","source_url":"https://doi.org/10.1016/j.jacc.2017.08.031","authors":["Dimitrios Alexopoulos","Stefanos Despotopoulos","Ioanna Xanthopoulou","Periklis Davlouros"],"significance":6,"published":"2017-10-17","source_date":"2017-10-17","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This comparison of low-dose ticagrelor with clopidogrel in patients with prior MI explored a dose-reduction strategy that may provide the antiplatelet benefit of newer agents with a side-effect profile closer to clopidogrel.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van laaggedoseerd ticagrelor met clopidogrel bij patiënten met eerder myocardinfarct. Onderzoekt een dosisreductiestrategie voor langetermijn P2Y12-remming.","abstract_original":""},{"id":"e600ba5cacf2","type":"article","url":"https://hartvaat.nl/2017/10/17/katheterablatie-versus-frequentiecontrole-bij-af-met-systolische-disfunctie-came/","title":"Katheterablatie versus frequentiecontrole bij AF met systolische disfunctie: CAMERA-MRI","title_en":"Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction: The CAMERA-MRI Study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.08.041","source_url":"https://doi.org/10.1016/j.jacc.2017.08.041","authors":["Sandeep Prabhu","Andrew J Taylor","Ben T Costello","David M Kaye","Alex J A McLellan","Aleksandr Voskoboinik","Hariharan Sugumar","Siobhan M Lockwood","Michael B Stokes","Bhupesh Pathik","Chrishan J Nalliah","Geoff R Wong","Sonia M Azzopardi","Sarah J Gutman","Geoffrey Lee","Jamie Layland","Justin A Mariani","Liang-Han Ling","Jonathan M Kalman","Peter M Kistler"],"significance":7,"published":"2017-10-17","source_date":"2017-10-17","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The CAMERA-MRI study showed that catheter ablation improved left ventricular function compared with rate control in AF patients with systolic dysfunction, assessed by cardiac MRI. The results supported ablation as a therapeutic strategy for AF-related cardiomyopathy.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"CAMERA-MRI-studie die katheterablatie vergeleek met medicamenteuze frequentiecontrole bij AF-patiënten met systolische disfunctie. MRI-eindpunten voor objectieve evaluatie.","abstract_original":"BACKGROUND: Atrial fibrillation (AF) and left ventricular systolic dysfunction (LVSD) frequently co-exist despite adequate rate control. Existing randomized studies of AF and LVSD of varying etiologies have reported modest benefits with a rhythm control strategy. OBJECTIVES: The goal of this study was to determine whether catheter ablation (CA) for AF could improve LVSD compared with medical rate control (MRC) where the etiology of the LVSD was unexplained, apart from the presence of AF. METHODS: This multicenter, randomized clinical trial enrolled patients with persistent AF and idiopathic cardiomyopathy (left ventricular ejection fraction [LVEF] ≤45%). After optimization of rate control, patients underwent cardiac magnetic resonance (CMR) to assess LVEF and late gadolinium enhancement, indicative of ventricular fibrosis, before randomization to either CA or ongoing MRC. CA included pulmonary vein isolation and posterior wall isolation. AF burden post-CA was assessed by using an implanted loop recorder, and adequacy of MRC was assessed by using serial Holter monitoring. The primary endpoint was change in LVEF on repeat CMR at 6 months. RESULTS: A total of 301 patients were screened; 68 patients were enrolled between November 2013 and October 2016 and randomized with 33 in each arm (accounting for 2 dropouts). The average AF burden post-CA was 1.6 ± 5.0% at 6 months. In the intention-to-treat analysis, absolute LVEF improved by 18 ± 13% in the CA group compared with 4.4 ± 13% in the MRC group (p < 0.0001) and normalized (LVEF ≥50%) in 58% versus 9% (p = 0.0002). In those undergoing CA, the absence of late gadolinium enhancement predicted greater improvements in absolute LVEF (10.7%; p = 0.0069) and normalization at 6 months (73% vs. 29%; p = 0.0093). CONCLUSIONS: AF is an underappreciated reversible cause of LVSD in this population despite adequate rate control. The restoration of sinus rhythm with CA results in significant improvements in ventricular function, particularly in the absence of ventricular fibrosis on CMR. This outcome challenges the current treatment paradigm that rate control is the appropriate strategy in patients with AF and LVSD. (Catheter Ablation Versus Medical Rate Control in Atrial Fibrillation and Systolic Dysfunction [CAMERA-MRI]; ACTRN12613000880741)."},{"id":"5ff2f69be5d4","type":"article","url":"https://hartvaat.nl/2017/10/17/farmaco-invasieve-strategie-met-halve-dosis-alteplase-versus-primaire-pci-bij-st/","title":"Farmaco-invasieve strategie met halve dosis alteplase versus primaire PCI bij STEMI","title_en":"Efficacy and Safety of a Pharmaco-Invasive Strategy With Half-Dose Alteplase Versus Primary Angioplasty in ST-Segment-Elevation Myocardial Infarction: EARLY-MYO Trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.030582","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.030582","authors":["Jun Pu","Song Ding","Heng Ge","Yaling Han","Jinchen Guo","Rong Lin","Xi Su","Heng Zhang","Lianglong Chen","Ben He"],"significance":7,"published":"2017-10-17","source_date":"2017-10-17","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"This study evaluated a pharmaco-invasive strategy using half-dose alteplase versus primary angioplasty for STEMI, testing whether a fibrinolytic-facilitated approach can serve as an alternative when timely primary PCI is not available.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de werkzaamheid van een farmaco-invasieve strategie met halve dosis alteplase versus primaire angioplastiek bij STEMI. Relevant voor setting waar directe PCI niet beschikbaar is.","abstract_original":"BACKGROUND: Timely primary percutaneous coronary intervention (PPCI) cannot be offered to all patients with ST-segment-elevation myocardial infarction (STEMI). Pharmaco-invasive (PhI) strategy has been proposed as a valuable alternative for eligible patients with STEMI. We conducted a randomized study to compare the efficacy and safety of a PhI strategy with half-dose fibrinolytic regimen versus PPCI in patients with STEMI. METHODS: The EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction) was an investigator-initiated, prospective, multicenter, randomized, noninferiority trial comparing a PhI strategy with half-dose alteplase versus PPCI in patients with STEMI 18 to 75 years of age presenting ≤6 hours after symptom onset but with an expected PCI-related delay. The primary end point of the study was complete epicardial and myocardial reperfusion after PCI, defined as thrombolysis in myocardial infarction flow grade 3, thrombolysis in myocardial infarction myocardial perfusion grade 3, and ST-segment resolution ≥70%. We also measured infarct size and left ventricular ejection fraction with cardiac magnetic resonance and recorded 30-day clinical and safety outcomes. RESULTS: A total of 344 patients from 7 centers were randomized to PhI (n=171) or PPCI (n=173). PhI was noninferior (and even superior) to PPCI for the primary end point (34.2% versus 22.8%, Pnoninferiority<0.05, Psuperiority=0.022), with no significant differences in the frequency of the individual components of the combined end point: thrombolysis in myocardial infarction flow 3 (91.3% versus 89.2%, P=0.580), thrombolysis in myocardial infarction myocardial perfusion grade 3 (65.8% versus 62.9%, P=0.730), and ST-segment resolution ≥70% (50.9% versus 45.5%, P=0.377). Infarct size (23.3%±11.3% versus 25.8%±13.7%, P=0.101) and left ventricular ejection fraction (52.2%±11.0% versus 51.4%±12.0%, P=0.562) were similar in both groups. No significant differences occurred in 30-day rates of total death (0.6% versus 1.2%, P=1.0), reinfarction (0.6% versus 0.6%, P=1.0), heart failure (13.5% versus 16.2%, P=0.545), major bleeding events (0.6% versus 0%, P=0.497), or intracranial hemorrhage (0% versus 0%), but minor bleeding (26.9% versus 11.0%, P<0.001) was observed more often in the PhI group. CONCLUSIONS: For patients with STEMI presenting ≤6 hours after symptom onset and with an expected PCI-related delay, a PhI strategy with half-dose alteplase and timely PCI offers more complete epicardial and myocardial reperfusion when compared with PPCI. Adequately powered trials with this reperfusion strategy to assess clinical and safety outcomes are warranted. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01930682."},{"id":"c3b329b7fb2f","type":"article","url":"https://hartvaat.nl/2017/10/14/tmao-als-cardiovasculaire-risicobiomarker-systematische-review-en-meta-analyse/","title":"TMAO als cardiovasculaire risicobiomarker: systematische review en meta-analyse","title_en":"Gut microbe-generated metabolite trimethylamine-N-oxide as cardiovascular risk biomarker: a systematic review and dose-response meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["microbioom"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx342","source_url":"https://doi.org/10.1093/eurheartj/ehx342","authors":["Gabriele Giacomo Schiattarella","Anna Sannino","Evelina Toscano","Giuseppe Giugliano","Giuseppe Gargiulo","Anna Franzone","Bruno Trimarco","Giovanni Esposito","Cinzia Perrino"],"significance":7,"published":"2017-10-14","source_date":"2017-10-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This systematic review and dose-response meta-analysis established trimethylamine-N-oxide (TMAO), a gut microbiome-derived metabolite, as an emerging cardiovascular risk biomarker with a graded relationship between circulating levels and cardiovascular events.","created":"2026-07-03T10:26:57Z","updated":"2026-07-03T13:26:14Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en dosis-responsmeta-analyse van TMAO (trimethylamine-N-oxide, darmmicrobioommetaboliet) als cardiovasculaire risicobiomarker. Ondersteunt de darm-hart-as.","abstract_original":"AIMS: Gut microbiota-derived metabolite trimethylamine-N-oxide (TMAO) is emerging as a new potentially important cause of increased cardiovascular risk. The purpose of this meta-analysis was to systematically estimate and quantify the association between TMAO plasma levels, mortality, and major adverse cardio and cerebrovascular events (MACCE). METHODS AND RESULTS: MEDLINE, ISI Web of Science, and SCOPUS databases were searched for ad hoc studies published up to April 2017. Associations between TMAO plasma levels, all-cause mortality (primary outcome) and MACCE (secondary outcome) were systematically addressed. A total of 17 clinical studies were included in the analytic synthesis, enrolling 26 167 subjects. The mean follow-up in our study population was 4.3 ± 1.5 years. High TMAO plasma levels were associated with increased incidence of all-cause mortality [14 studies for 16 cohorts enrolling 15 662 subjects, hazard ratio (HR): 1.91; 95% confidence interval (CI): 1.40-2.61, P < 0.0001, I2 = 94%] and MACCE (5 studies for 6 cohorts enrolling 13 944 subjects, HR: 1.67, 95% CI: 1.33-2.11, P < 0.00001, I2 = 46%,). Dose-response meta-analysis revealed that the relative risk (RR) for all-cause mortality increased by 7.6% per each 10 μmol/L increment of TMAO [summary RR: 1.07, 95% CI (1.04-1.11), P < 0.0001; based on seven studies]. Association of TMAO and mortality persisted in all examined subgroups and across all subject populations. CONCLUSIONS: This is the first systematic review and meta-analysis demonstrating the positive dose-dependent association between TMAO plasma levels and increased cardiovascular risk and mortality."},{"id":"3cfcd7717f72","type":"article","url":"https://hartvaat.nl/2017/10/14/multifacet-interventie-voor-oac-gebruik-bij-af-lancet-impact-af/","title":"Multifacet-interventie voor OAC-gebruik bij AF: Lancet IMPACT-AF","title_en":"A multifaceted intervention to improve treatment with oral anticoagulants in atrial fibrillation (IMPACT-AF): an international, cluster-randomised trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32165-7","source_url":"https://doi.org/10.1016/S0140-6736(17)32165-7","authors":["Dragos Vinereanu","Renato D Lopes","M Cecilia Bahit","Denis Xavier","Jie Jiang","Hussein R Al-Khalidi","Wensheng He","Ying Xian","Andrea O Ciobanu","Deepak Y Kamath","Kathleen A Fox","Meena P Rao","Sean D Pokorney","Otavio Berwanger","Carlos Tajer","Pedro G M de Barros E Silva","Mayme L Roettig","Yong Huo","Christopher B Granger"],"significance":7,"published":"2017-10-14","source_date":"2017-10-14","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/antidota-anticoagulantia/"],"congress":"","summary_en":"The IMPACT-AF trial showed that a multifaceted educational intervention significantly improved oral anticoagulant use in AF patients across diverse international settings, demonstrating that quality improvement programs can close the anticoagulation treatment gap.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet IMPACT-AF internationale trial van een multifacet-interventie om het gebruik van orale anticoagulantia bij AF te verbeteren. Implementatiewetenschappelijk onderzoek.","abstract_original":"BACKGROUND: Oral anticoagulation is underused in patients with atrial fibrillation. We assessed the impact of a multifaceted educational intervention, versus usual care, on oral anticoagulant use in patients with atrial fibrillation. METHODS: This study was a two-arm, prospective, international, cluster-randomised, controlled trial. Patients were included who had atrial fibrillation and an indication for oral anticoagulation. Clusters were randomised (1:1) to receive a quality improvement educational intervention (intervention group) or usual care (control group). Randomisation was carried out centrally, using the eClinicalOS electronic data capture system. The intervention involved education of providers and patients, with regular monitoring and feedback. The primary outcome was the change in the proportion of patients treated with oral anticoagulants from baseline assessment to evaluation at 1 year. The trial is registered at ClinicalTrials.gov, number NCT02082548. FINDINGS: 2281 patients from five countries (Argentina, n=343; Brazil, n=360; China, n=586; India, n=493; and Romania, n=499) were enrolled from 48 clusters between June 11, 2014, and Nov 13, 2016. Follow-up was at a median of 12·0 months (IQR 11·8-12·2). Oral anticoagulant use increased in the intervention group from 68% (804 of 1184 patients) at baseline to 80% (943 of 1184 patients) at 1 year (difference 12%), whereas in the control group it increased from 64% (703 of 1092 patients) at baseline to 67% (732 of 1092 patients) at 1 year (difference 3%). Absolute difference in the change between groups was 9·1% (95% CI 3·8-14·4); odds ratio of change in the use of oral anticoagulation between groups was 3·28 (95% CI 1·67-6·44; adjusted p value=0·0002). Kaplan-Meier estimates showed a reduction in the secondary outcome of stroke in the intervention versus control groups (HR 0·48, 95% CI 0·23-0·99; log-rank p value=0·0434). INTERPRETATION: A multifaceted and multilevel educational intervention, aimed to improve use of oral anticoagulation in patients with atrial fibrillation and at risk for stroke, resulted in a significant increase in the proportion of patients treated with oral anticoagulants. Such an intervention has the potential to improve stroke prevention around the world for patients with atrial fibrillation. FUNDING: Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, and Pfizer."},{"id":"1b23b8840987","type":"article","url":"https://hartvaat.nl/2017/10/14/geleide-de-escalatie-van-antiplaatjestherapie-na-acs-met-pci-lancet-tropical-acs/","title":"Geleide de-escalatie van antiplaatjestherapie na ACS met PCI: Lancet TROPICAL-ACS","title_en":"Guided de-escalation of antiplatelet treatment in patients with acute coronary syndrome undergoing percutaneous coronary intervention (TROPICAL-ACS): a randomised, open-label, multicentre trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)32155-4","source_url":"https://doi.org/10.1016/S0140-6736(17)32155-4","authors":["Dirk Sibbing","Dániel Aradi","Claudius Jacobshagen","Lisa Gross","Dietmar Trenk","Tobias Geisler","Martin Orban","Martin Hadamitzky","Béla Merkely","Róbert Gábor Kiss","András Komócsi","Csaba A Dézsi","Lesca Holdt","Stephan B Felix","Radoslaw Parma","Mariusz Klopotowski","Robert H G Schwinger","Johannes Rieber","Kurt Huber","Franz-Josef Neumann","Lukasz Koltowski","Julinda Mehilli","Zenon Huczek","Steffen Massberg"],"significance":8,"published":"2017-10-14","source_date":"2017-10-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"The TROPICAL-ACS trial showed that guided de-escalation from prasugrel to clopidogrel based on platelet function testing after ACS with PCI was noninferior to standard potent P2Y12 inhibition for ischemic events, while reducing bleeding. The results supported personalized antiplatelet de-escalation.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet TROPICAL-ACS-trial die geleide de-escalatie van prasugrel naar clopidogrel onderzocht na ACS met PCI, op basis van plaatjesfunctietesten. Gepersonaliseerde DAPT-strategie.","abstract_original":"BACKGROUND: Current guidelines recommend potent platelet inhibition with prasugrel or ticagrelor for 12 months after an acute coronary syndrome managed with percutaneous coronary intervention (PCI). However, the greatest anti-ischaemic benefit of potent antiplatelet drugs over the less potent clopidogrel occurs early, while most excess bleeding events arise during chronic treatment. Hence, a stage-adapted treatment with potent platelet inhibition in the acute phase and de-escalation to clopidogrel in the maintenance phase could be an alternative approach. We aimed to investigate the safety and efficacy of early de-escalation of antiplatelet treatment from prasugrel to clopidogrel guided by platelet function testing (PFT). METHODS: In this investigator-initiated, randomised, open-label, assessor-blinded, multicentre trial (TROPICAL-ACS) done at 33 sites in Europe, patients were enrolled if they had biomarker-positive acute coronary syndrome with successful PCI and a planned duration of dual antiplatelet treatment of 12 months. Enrolled patients were randomly assigned (1:1) using an internet-based randomisation procedure with a computer-generated block randomisation with stratification across study sites to either standard treatment with prasugrel for 12 months (control group) or a step-down regimen (1 week prasugrel followed by 1 week clopidogrel and PFT-guided maintenance therapy with clopidogrel or prasugrel from day 14 after hospital discharge; guided de-escalation group). The assessors were masked to the treatment allocation. The primary endpoint was net clinical benefit (cardiovascular death, myocardial infarction, stroke or bleeding grade 2 or higher according to Bleeding Academic Research Consortium [BARC]) criteria) 1 year after randomisation (non-inferiority hypothesis; margin of 30%). Analysis was intention to treat. This study is registered with ClinicalTrials.gov, number NCT01959451, and EudraCT, 2013-001636-22. FINDINGS: Between Dec 2, 2013, and May 20, 2016, 2610 patients were assigned to study groups; 1304 to the guided de-escalation group and 1306 to the control group. The primary endpoint occurred in 95 patients (7%) in the guided de-escalation group and in 118 patients (9%) in the control group (pnon-inferiority=0·0004; hazard ratio [HR] 0·81 [95% CI 0·62-1·06], psuperiority=0·12). Despite early de-escalation, there was no increase in the combined risk of cardiovascular death, myocardial infarction, or stroke in the de-escalation group (32 patients [3%]) versus in the control group (42 patients [3%]; pnon-inferiority=0·0115). There were 64 BARC 2 or higher bleeding events (5%) in the de-escalation group versus 79 events (6%) in the control group (HR 0·82 [95% CI 0·59-1·13]; p=0·23). INTERPRETATION: Guided de-escalation of antiplatelet treatment was non-inferior to standard treatment with prasugrel at 1 year after PCI in terms of net clinical benefit. Our trial shows that early de-escalation of antiplatelet treatment can be considered as an alternative approach in patients with acute coronary syndrome managed with PCI. FUNDING: Klinikum der Universität München, Roche Diagnostics, Eli Lilly, and Daiichi Sankyo."},{"id":"6ccfb8f4d8c9","type":"article","url":"https://hartvaat.nl/2017/10/14/intracoronaire-beenmergceltransfer-na-mi-de-boost-2-gerandomiseerde-trial/","title":"Intracoronaire beenmergceltransfer na MI: de BOOST-2 gerandomiseerde trial","title_en":"Intracoronary autologous bone marrow cell transfer after myocardial infarction: the BOOST-2 randomised placebo-controlled clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["clear-outcomes"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx188","source_url":"https://doi.org/10.1093/eurheartj/ehx188","authors":["Kai C Wollert","Gerd P Meyer","Jochen Müller-Ehmsen","Carsten Tschöpe","Vernon Bonarjee","Alf Inge Larsen","Andreas E May","Klaus Empen","Emmanuel Chorianopoulos","Ulrich Tebbe","Johannes Waltenberger","Heiko Mahrholdt","Benedikta Ritter","Jens Pirr","Dieter Fischer","Mortimer Korf-Klingebiel","Lubomir Arseniev","Hans-Gert Heuft","Jan E Brinchmann","Diethelm Messinger","Bernd Hertenstein","Arnold Ganser","Hugo A Katus","Stephan B Felix","Meinrad P Gawaz","Kenneth Dickstein","Heinz-Peter Schultheiss","Dennis Ladage","Simon Greulich","Johann Bauersachs"],"significance":6,"published":"2017-10-14","source_date":"2017-10-14","image":"","kennis":[],"congress":"","summary_en":"The BOOST-2 randomized placebo-controlled trial of intracoronary bone marrow cell transfer after MI showed no sustained improvement in LVEF at 6 months, adding to the neutral evidence for stem cell therapy after acute myocardial infarction.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde placebogecontroleerde BOOST-2-trial naar intracoronaire autologe beenmergceltransfer na myocardinfarct. Follow-up van het celtherapieconcept.","abstract_original":"AIMS: Intracoronary infusion of autologous nucleated bone marrow cells (BMCs) enhanced the recovery of left ventricular ejection fraction (LVEF) after ST-segment elevation myocardial infarction (STEMI) in the randomised-controlled, open-label BOOST trial. We reassessed the therapeutic potential of nucleated BMCs in the randomised placebo-controlled, double-blind BOOST-2 trial conducted in 10 centres in Germany and Norway. METHODS AND RESULTS: Using a multiple arm design, we investigated the dose-response relationship and explored whether γ-irradiation which eliminates the clonogenic potential of stem and progenitor cells has an impact on BMC efficacy. Between 9 March 2006 and 16 July 2013, 153 patients with large STEMI were randomly assigned to receive a single intracoronary infusion of placebo (control group), high-dose (hi)BMCs, low-dose (lo)BMCs, irradiated hiBMCs, or irradiated loBMCs 8.1 ± 2.6 days after percutaneous coronary intervention (PCI) in addition to guideline-recommended medical treatment. Change in LVEF from baseline (before cell infusion) to 6 months as determined by MRI was the primary endpoint. The trial is registered at Current Controlled Trials (ISRCTN17457407). Baseline LVEF was 45.0 ± 8.5% in the overall population. At 6 months, LVEF had increased by 3.3 percentage points in the control group and 4.3 percentage points in the hiBMC group. The estimated treatment effect was 1.0 percentage points (95% confidence interval, -2.6 to 4.7; P = 0.57). The treatment effect of loBMCs was 0.5 percentage points (-3.0 to 4.1; P = 0.76). Likewise, irradiated BMCs did not have significant treatment effects. BMC transfer was safe and not associated with adverse clinical events. CONCLUSION: The BOOST-2 trial does not support the use of nucleated BMCs in patients with STEMI and moderately reduced LVEF treated according to current standards of early PCI and drug therapy."},{"id":"4d2ade099734","type":"article","url":"https://hartvaat.nl/2017/10/10/pulmonalisdrukgeleide-therapie-bij-hfref/","title":"Pulmonalisdrukgeleide therapie bij HFrEF","title_en":"Pulmonary Artery Pressure-Guided Management of Patients With Heart Failure and Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","answer-hf","cardiomyopathie-gerichte-therapie","dapa-hf","emperor-trials","harttransplantatie","iaso-dcm","pathfinder-trial","step-hfpef","summit-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.08.010","source_url":"https://doi.org/10.1016/j.jacc.2017.08.010","authors":["Michael M Givertz","Lynne W Stevenson","Maria R Costanzo","Robert C Bourge","Jordan G Bauman","Gregg Ginn","William T Abraham"],"significance":7,"published":"2017-10-10","source_date":"2017-10-10","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This study evaluated CardioMEMS-guided pulmonary artery pressure management specifically in patients with HFrEF, refining the evidence for hemodynamic monitoring in the most guideline-directed subpopulation of heart failure.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar pulmonalisdrukgeleide therapie (CardioMEMS) specifiek bij patiënten met hartfalen en verminderde ejectiefractie. Verfijning van de CHAMPION-trial naar HFrEF.","abstract_original":"BACKGROUND: Despite increased use of guideline-directed medical therapy (GDMT), some patients with heart failure and reduced ejection fraction (HFrEF) remain at high risk for hospitalization and mortality. Remote monitoring of pulmonary artery (PA) pressures provides clinicians with actionable information to help further optimize medications and improve outcomes. OBJECTIVES: CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients trial) analyzed PA pressure-guided heart failure (HF) management in patients with HFrEF based on their ability to tolerate GDMT. METHODS: CHAMPION enrolled 550 patients with chronic HF regardless of left ventricular ejection fraction. A pre-specified sub-group analysis compared HF hospitalization and mortality rates between treatment and control groups in HFrEF patients (left ventricular ejection fraction ≤40%). Post hoc analyses in patients who tolerated GDMT were also performed. Hospitalizations and mortality were assessed using Andersen-Gill and Cox proportional hazards models. RESULTS: In 456 patients with HFrEF, HF hospitalization rates were 28% lower in the treatment group than in the control group (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.88; p = 0.0013), with a strong trend for 32% lower mortality (HR: 0.68; 95% CI: 0.45 to 1.02; p = 0.06). A 445-patient subset received at least 1 GDMT (angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, or beta-blocker) at baseline; these patients had 33% lower HF hospitalization rates (HR: 0.67; 95% CI: 0.54 to 0.82; p = 0.0002) and 47% lower mortality (HR: 0.63; 95% CI: 0.41 to 0.96, p = 0.0293) than controls. Compared with controls, patients receiving both components of optimal GDMT (n = 337) had 43% lower HF hospitalizations (HR: 0.57; 95% CI: 0.45 to 0.74; p < 0.0001) and 57% lower mortality (HR: 0.43; 95% CI: 0.24 to 0.76; p = 0.0026). CONCLUSIONS: PA pressure-guided HF management reduces morbidity and mortality in patients with HFrEF on GDMT, underscoring the important synergy of addressing hemodynamic and neurohormonal targets of HF therapy. (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients [CHAMPION]; NCT00531661)."},{"id":"acfc61bec58d","type":"article","url":"https://hartvaat.nl/2017/10/10/dagelijks-ischemie-en-bloedingsrisico-na-primaire-pci-voor-stemi/","title":"Dagelijks ischemie- en bloedingsrisico na primaire PCI voor STEMI","title_en":"Characterization of the Average Daily Ischemic and Bleeding Risk After Primary PCI for STEMI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.08.018","source_url":"https://doi.org/10.1016/j.jacc.2017.08.018","authors":["Gennaro Giustino","Roxana Mehran","George D Dangas","Ajay J Kirtane","Björn Redfors","Philippe Généreux","Sorin J Brener","Jayne Prats","Stuart J Pocock","Efthymios N Deliargyris","Gregg W Stone"],"significance":5,"published":"2017-10-10","source_date":"2017-10-10","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This study characterized the time-dependent daily ischemic and bleeding risk profiles after primary PCI for STEMI, showing that both risks peak early and decline differently over time, informing the DAPT duration decision.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Karakterisering van het gemiddelde dagelijkse ischemie- en bloedingsrisico na primaire PCI voor STEMI. Tijdsafhankelijke risicoprofielen voor het optimaliseren van DAPT-duur.","abstract_original":"BACKGROUND: The risk of recurrent ischemic and bleeding events after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) may not be uniform over time, which may affect the benefit-to-risk ratio of guideline-recommended antithrombotic therapies in different intervals. OBJECTIVES: This study sought to characterize the average daily ischemic rates (ADIRs) and average daily bleeding rates (ADBRs) within the first year after primary PCI for STEMI. METHODS: Among 3,602 patients with STEMI who were enrolled in the HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial, all ischemic and bleeding events, including recurrent events, were classified according to the timing of their occurrence as acute (≤24 h after PCI), subacute (1 day to 30 days), and late (30 days to 1 year). Patients were treated with aspirin and clopidogrel for the entire year. ADIRs included cardiac death, reinfarction, and definite stent thrombosis. ADBRs included non-coronary artery bypass graft-related Thrombolysis In Myocardial Infarction major and minor bleeding. ADIRs and ADBRs were calculated as the total number of events divided by the number of patient-days of follow-up in each interval assuming a Poisson distribution. Generalized estimating equations were used to test the absolute least square mean differences (LSMD) between ADIRs and ADBRs. RESULTS: The ADIR and ADBR both exponentially decreased from the acute to the late periods (p < 0.0001). Although there were no significant differences in ADIR and ADBR in the acute phase (LSMD: +0.11%; 95% confidence interval [CI]: -0.35% to 0.58%; p = 0.63), the ADBR was greater than the ADIR in the subacute phase (LSMD: -0.39%; 95% CI: -0.58% to -0.20%; p < 0.0001). In the late phase, the ADIR exceeded the ADBR (LSMD: +1.51%; 95% CI: 1.04% to 1.98%; p < 0.0001). CONCLUSIONS: After primary PCI, the ADIR and ADBR both markedly decreased over time. Although the rates for bleeding exceeded those for ischemia within 30 days, the daily risk of ischemia significantly exceeded the daily risk of bleeding beyond 30 days, supporting the use of intensified platelet inhibition during the first year after STEMI."},{"id":"01bdf2ce183c","type":"article","url":"https://hartvaat.nl/2017/10/10/geindividualiseerd-versus-standaard-bloeddrukbeleid-bij-hoog-risico-chirurgiepat/","title":"Geïndividualiseerd versus standaard bloeddrukbeleid bij hoog-risico chirurgiepatiënten: JAMA-trial","title_en":"Effect of Individualized vs Standard Blood Pressure Management Strategies on Postoperative Organ Dysfunction Among High-Risk Patients Undergoing Major Surgery: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2017.14172","source_url":"https://doi.org/10.1001/jama.2017.14172","authors":["Emmanuel Futier","Jean-Yves Lefrant","Pierre-Gregoire Guinot","Thomas Godet","Emmanuel Lorne","Philippe Cuvillon","Sebastien Bertran","Marc Leone","Bruno Pastene","Vincent Piriou","Serge Molliex","Jacques Albanese","Jean-Michel Julia","Benoit Tavernier","Etienne Imhoff","Jean-Etienne Bazin","Jean-Michel Constantin","Bruno Pereira","Samir Jaber"],"significance":7,"published":"2017-10-10","source_date":"2017-10-10","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This JAMA trial demonstrated that individualized blood pressure management based on patient-specific targets during high-risk surgery reduced postoperative organ dysfunction compared with standard management, supporting personalized hemodynamic strategies.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA gerandomiseerde trial die gepersonaliseerd bloeddrukmanagement vergeleek met standaardbeleid tijdens hoog-risico chirurgie. Perioperatieve bloeddrukoptimalisatie.","abstract_original":"IMPORTANCE: Perioperative hypotension is associated with an increase in postoperative morbidity and mortality, but the appropriate management strategy remains uncertain. OBJECTIVE: To evaluate whether an individualized blood pressure management strategy tailored to individual patient physiology could reduce postoperative organ dysfunction. DESIGN, SETTING, AND PARTICIPANTS: The Intraoperative Norepinephrine to Control Arterial Pressure (INPRESS) study was a multicenter, randomized, parallel-group clinical trial conducted in 9 French university and nonuniversity hospitals. Adult patients (n = 298) at increased risk of postoperative complications with a preoperative acute kidney injury risk index of class III or higher (indicating moderate to high risk of postoperative kidney injury) undergoing major surgery lasting 2 hours or longer under general anesthesia were enrolled from December 4, 2012, through August 28, 2016 (last follow-up, September 28, 2016). INTERVENTIONS: Individualized management strategy aimed at achieving a systolic blood pressure (SBP) within 10% of the reference value (ie, patient's resting SBP) or standard management strategy of treating SBP less than 80 mm Hg or lower than 40% from the reference value during and for 4 hours following surgery. MAIN OUTCOMES AND MEASURES: The primary outcome was a composite of systemic inflammatory response syndrome and dysfunction of at least 1 organ system of the renal, respiratory, cardiovascular, coagulation, and neurologic systems by day 7 after surgery. Secondary outcomes included the individual components of the primary outcome, durations of ICU and hospital stay, adverse events, and all-cause mortality at 30 days after surgery. RESULTS: Among 298 patients who were randomized, 292 patients completed the trial (mean [SD] age, 70 [7] years; 44 [15.1%] women) and were included in the modified intention-to-treat analysis. The primary outcome event occurred in 56 of 147 patients (38.1%) assigned to the individualized treatment strategy vs 75 of 145 patients (51.7%) assigned to the standard treatment strategy (relative risk, 0.73; 95% CI, 0.56 to 0.94; P = .02; absolute risk difference, -14%, 95% CI, -25% to -2%). Sixty-eight patients (46.3%) in the individualized treatment group and 92 (63.4%) in the standard treatment group had postoperative organ dysfunction by day 30 (adjusted hazard ratio, 0.66; 95% CI, 0.52 to 0.84; P = .001). There were no significant between-group differences in severe adverse events or 30-day mortality. CONCLUSIONS AND RELEVANCE: Among patients predominantly undergoing abdominal surgery who were at increased postoperative risk, management targeting an individualized systolic blood pressure, compared with standard management, reduced the risk of postoperative organ dysfunction. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01536470."},{"id":"52baf4cea3c9","type":"article","url":"https://hartvaat.nl/2017/10/03/2017-acc-gerichte-update-niet-statinetherapie-voor-ldl-verlaging/","title":"2017 ACC gerichte update: niet-statinetherapie voor LDL-verlaging","title_en":"2017 Focused Update of the 2016 ACC Expert Consensus Decision Pathway on the Role of Non-Statin Therapies for LDL-Cholesterol Lowering in the Management of Atherosclerotic Cardiovascular Disease Risk: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["ezetimibe","niet-statine-therapie","pcsk9-remmers"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.07.745","source_url":"https://doi.org/10.1016/j.jacc.2017.07.745","authors":["Donald M Lloyd-Jones","Pamela B Morris","Christie M Ballantyne","Kim K Birtcher","David D Daly","Sondra M DePalma","Margo B Minissian","Carl E Orringer","Sidney C Smith"],"significance":8,"published":"2017-10-03","source_date":"2017-10-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"The 2017 ACC focused update on non-statin therapies integrated FOURIER results on evolocumab into the LDL-cholesterol management pathway, providing updated guidance on when to add ezetimibe and PCSK9 inhibitors for patients not achieving LDL targets on statin therapy.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ACC 2017 update van de expert consensus decision pathway voor niet-statinetherapie inclusief ezetimibe en PCSK9-remmers. Integreert FOURIER-resultaten.","abstract_original":"In 2016, the American College of Cardiology published the first expert consensus decision pathway (ECDP) on the role of non-statin therapies for low-density lipoprotein (LDL)-cholesterol lowering in the management of atherosclerotic cardiovascular disease (ASCVD) risk. Since the publication of that document, additional evidence and perspectives have emerged from randomized clinical trials and other sources, particularly considering the longer-term efficacy and safety of proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in secondary prevention of ASCVD. Most notably, the FOURIER (Further Cardiovascular Outcomes Research with PCSK9 Inhibition in Subjects with Elevated Risk) trial and SPIRE-1 and -2 (Studies of PCSK9 Inhibition and the Reduction of Vascular Events), assessing evolocumab and bococizumab, respectively, have published final results of cardiovascular outcomes trials in patients with clinical ASCVD and in a smaller number of high-risk primary prevention patients. In addition, further evidence on the types of patients most likely to benefit from the use of ezetimibe in addition to statin therapy after acute coronary syndrome has been published. Based on results from these important analyses, the ECDP writing committee judged that it would be desirable to provide a focused update to help guide clinicians more clearly on decision making regarding the use of ezetimibe and PCSK9 inhibitors in patients with clinical ASCVD with or without comorbidities. In the following summary table, changes from the 2016 ECDP to the 2017 ECDP Focused Update are highlighted, and a brief rationale is provided. The content of the full document has been changed accordingly, with more extensive and detailed guidance regarding decision making provided both in the text and in the updated algorithms. Revised recommendations are provided for patients with clinical ASCVD with or without comorbidities on statin therapy for secondary prevention. The ECDP writing committee judged that these new data did not warrant changes to the decision pathways and algorithms regarding the use of ezetimibe or PCSK9 inhibitors in primary prevention patients with LDL-C <190 mg/dL with or without diabetes mellitus or patients without ASCVD and LDL-C ≥190 mg/dL not due to secondary causes. Based on feedback and further deliberation, the ECDP writing committee down-graded recommendations regarding bile acid sequestrant use, recommending bile acid sequestrants only as optional secondary agents for consideration in patients intolerant to ezetimibe. For clarification, the writing committee has also included new information on diagnostic categories of heterozygous and homozygous familial hypercholesterolemia, based on clinical criteria with and without genetic testing. Other changes to the original document were kept to a minimum to provide consistent guidance to clinicians, unless there was a compelling reason or new evidence, in which case justification is provided."},{"id":"91ec8c8c664b","type":"article","url":"https://hartvaat.nl/2017/10/03/ridaforolimus-versus-zotarolimus-eluting-stents-gerandomiseerde-primaire-resulta/","title":"Ridaforolimus- versus zotarolimus-eluting stents: gerandomiseerde primaire resultaten","title_en":"Randomized Comparison of Ridaforolimus- and Zotarolimus-Eluting Coronary Stents in Patients With Coronary Artery Disease: Primary Results From the BIONICS Trial (BioNIR Ridaforolimus-Eluting Coronary Stent System in Coronary Stenosis).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028885","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028885","authors":["David E Kandzari","Pieter C Smits","Michael P Love","Ori Ben-Yehuda","Shmuel Banai","Simon D Robinson","Michael Jonas","Ran Kornowski","Rodrigo Bagur","Andres Iniguez","Haim Danenberg","Robert Feldman","Rajiv Jauhar","Harish Chandna","Manish Parikh","Gidon Y Perlman","Mercedes Balcells","Peter Markham","Melek Ozgu Ozan","Philippe Genereux","Elazer R Edelman","Martin B Leon","Gregg W Stone"],"significance":5,"published":"2017-10-03","source_date":"2017-10-03","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitralisregurgitatie/"],"congress":"","summary_en":"This randomized trial compared ridaforolimus-eluting with zotarolimus-eluting coronary stents, evaluating a novel antiproliferative agent on a cobalt alloy platform for coronary artery disease treatment.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde vergelijking van ridaforolimus- met zotarolimus-eluting stents bij coronairlijden.","abstract_original":"BACKGROUND: The safety and efficacy of a novel cobalt alloy-based coronary stent with a durable elastomeric polymer eluting the antiproliferative agent ridaforolimus for treatment of patients with coronary artery disease is undetermined. METHODS: A prospective, international 1:1 randomized trial was conducted to evaluate in a noninferiority design the relative safety and efficacy of ridaforolimus-eluting stents (RESs) and slow-release zotarolimus-eluting stents among 1919 patients undergoing percutaneous coronary intervention at 76 centers. Inclusion criteria allowed enrollment of patients with recent myocardial infarction, total occlusions, bifurcations lesions, and other complex conditions. RESULTS: Baseline clinical and angiographic characteristics were similar between the groups. Overall, mean age was 63.4 years, 32.5% had diabetes mellitus, and 39.7% presented with acute coronary syndromes. At 12 months, the primary end point of target lesion failure (composite of cardiac death, target vessel-related myocardial infarction, and target lesion revascularization) was 5.4% for both devices (upper bound of 1-sided 95% confidence interval 1.8%, Pnoninferiority=0.001). Definite/probable stent thrombosis rates were low in both groups (0.4% RES versus 0.6% zotarolimus-eluting stent, P=0.75); 13-month angiographic in-stent late lumen loss was 0.22±0.41 mm and 0.23±0.39 mm (Pnoninferiority=0.004) for the RES and zotarolimus-eluting stent groups, respectively, and intravascular ultrasound percent neointimal hyperplasia was 8.10±5.81 and 8.85±7.77, respectively (Pnoninferiority=0.01). CONCLUSIONS: In the present trial, which allowed broad inclusion criteria, the novel RESs met the prespecified criteria for noninferiority compared with zotarolimus-eluting stents for the primary end point of target lesion failure at 12 months and had similar measures of late lumen loss. These findings support the safety and efficacy of RESs in patients who are representative of clinical practice. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01995487."},{"id":"4b87ed10efc7","type":"article","url":"https://hartvaat.nl/2017/10/01/pci-versus-cabg-bij-linker-hoofdstamstenose-jama-cardiology-systematische-review/","title":"PCI versus CABG bij linker-hoofdstamstenose: JAMA Cardiology systematische review en meta-analyse","title_en":"Percutaneous Coronary Intervention vs Coronary Artery Bypass Grafting in Patients With Left Main Coronary Artery Stenosis: A Systematic Review and Meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.2895","source_url":"https://doi.org/10.1001/jamacardio.2017.2895","authors":["Daniele Giacoppo","Roisin Colleran","Salvatore Cassese","Antonio H Frangieh","Jens Wiebe","Michael Joner","Heribert Schunkert","Adnan Kastrati","Robert A Byrne"],"significance":8,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This JAMA Cardiology meta-analysis comparing PCI with CABG for left main coronary artery stenosis found similar rates of the composite of death, MI, and stroke at up to 5 years, but higher rates of repeat revascularization with PCI. The aggregated analysis informed shared decision-making for left main disease.","created":"2026-07-03T10:26:56Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology meta-analyse die PCI vergeleek met CABG bij linker-hoofdstamstenose. Geaggregeerde analyse van de beschikbare trials inclusief EXCEL en NOBLE.","abstract_original":"IMPORTANCE: In patients with left main coronary artery (LMCA) stenosis, coronary artery bypass grafting (CABG) has been the standard therapy for several decades. However, some studies suggest that percutaneous coronary intervention (PCI) with drug-eluting stents may be an acceptable alternative. OBJECTIVE: To compare the long-term safety of PCI with drug-eluting stent vs CABG in patients with LMCA stenosis. DATA SOURCES: PubMed, Scopus, EMBASE, Web of Knowledge, and ScienceDirect databases were searched from December 18, 2001, to February 1, 2017. Inclusion criteria were randomized clinical trial, patients with LMCA stenosis, PCI vs CABG, exclusive use of drug-eluting stents, and clinical follow-up of 3 or more years. DATA EXTRACTION AND SYNTHESIS: Trial-level hazard ratios (HRs) and 95% CIs were pooled by fixed-effect and random-effects models with inverse variance weighting. Time-to-event individual patient data for the primary end point were reconstructed. Sensitivity analyses according to drug-eluting stent generation and coronary artery disease complexity were performed. MAIN OUTCOMES AND MEASURES: The primary end point was a composite of all-cause death, myocardial infarction, or stroke at long-term follow-up. Secondary end points included repeat revascularization and a composite of all-cause death, myocardial infarction, stroke, or repeat revascularization at long-term follow-up. RESULTS: A total of 4 randomized clinical trials were pooled; 4394 patients were included in the analysis. Of these, 3371 (76.7%) were men; pooled mean age was 65.4 years. According to Grading of Recommendations, Assessment, Development and Evaluation, evidence quality with respect to the primary composite end point was high. Percutaneous coronary intervention and CABG were associated with a comparable risk of all-cause death, myocardial infarction, or stroke both by fixed-effect (HR, 1.06; 95% CI, 0.90-1.24; P = .48) and random-effects (HR, 1.06; 95% CI, 0.85-1.32; P = .60) analysis. Sensitivity analyses according to low to intermediate Synergy Between PCI With Taxus and Cardiac Surgery (SYNTAX) score (random-effects: HR, 1.02; 95% CI, 0.74-1.41; P = .89) and drug-eluting stent generation (first generation: HR, 0.90; 95% CI, 0.68-1.20; P = .49; second generation: HR, 1.19; 95% CI, 0.82-1.73; P = .36) were consistent. Kaplan-Meier curve reconstruction did not show significant variations over time between the techniques, with a 5-year incidence of all-cause death, myocardial infarction, or stroke of 18.3% (319 events) in patients treated with PCI and 16.9% (292 events) in patients treated with CABG. However, repeat revascularization after PCI was increased (HR, 1.70; 95% CI, 1.42-2.05; P < .001). Other individual secondary end points did not differ significantly between groups. Finally, pooled estimates of trials with LMCA stenosis tended overall to differ significantly from those of trials with multivessel coronary artery disease without left main LMCA stenosis. CONCLUSIONS AND RELEVANCE: Percutaneous coronary intervention and CABG show comparable safety in patients with LMCA stenosis and low to intermediate-complexity coronary artery disease. However, repeat revascularization is more common after PCI."},{"id":"b7952ea9f51c","type":"article","url":"https://hartvaat.nl/2017/10/01/visit-to-visit-bloeddrukvariabiliteit-bij-stabiel-coronairlijden-stability-inzic/","title":"Visit-to-visit bloeddrukvariabiliteit bij stabiel coronairlijden: STABILITY-inzichten","title_en":"Visit-to-visit variability of blood pressure and cardiovascular outcomes in patients with stable coronary heart disease. Insights from the STABILITY trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["stabiel-coronairlijden"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx250","source_url":"https://doi.org/10.1093/eurheartj/ehx250","authors":["Emmanuelle Vidal-Petiot","Amanda Stebbins","Karen Chiswell","Diego Ardissino","Philip E Aylward","Christopher P Cannon","Marco A Ramos Corrales","Claes Held","José Luis López-Sendón","Ralph A H Stewart","Lars Wallentin","Harvey D White","Philippe Gabriel Steg"],"significance":6,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/preventie/luchtvervuiling-cardiovasculair-risico/"],"congress":"","summary_en":"This STABILITY trial analysis confirmed that visit-to-visit blood pressure variability predicts cardiovascular events in patients with stable coronary heart disease, independent of mean blood pressure levels.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:13Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"STABILITY-trial analyse naar de prognostische waarde van bloeddrukvariabiliteit bij stabiel coronairlijden. Bevestigt variabiliteit als onafhankelijke risicomarker.","abstract_original":"AIMS: To study the relation between visit-to-visit variability of blood pressure (BP) and cardiovascular risk in patients with stable coronary heart disease. METHODS AND RESULTS: In 15 828 patients from the STABILITY trial (darapladib vs. placebo in patients with established coronary heart disease), BP variability was assessed by the standard deviation (SD) of systolic BP, the SD of diastolic BP, maximum BP, and minimum BP, from 5 measurements (baseline and months 1, 3, 6, and 12) during the first year after randomisation. Mean (SD) average BP during the first year of study was 131.0 (13.7) mmHg over 78.3 (8.3) mmHg. Mean (SD) of the visit-to-visit SD was 9.8 (4.8) mmHg for systolic and 6.3 (3.0) mmHg for diastolic BP. During the subsequent median follow-up of 2.6 years, 1010 patients met the primary endpoint, a composite of time to cardiovascular death, myocardial infarction, or stroke. In Cox regression models adjusted for average BP during first year of study, baseline vascular disease, treatment, renal function and cardiovascular risk factors, the primary endpoint was associated with SD of systolic BP (hazard ratio for highest vs. lowest tertile, 1.30, 95% CI 1.10-1.53, P = 0.007), and with SD of diastolic BP (hazard ratio for highest vs. lowest tertile, 1.38, 95% CI 1.18-1.62, P < 0.001). Peaks and troughs in BP were also independently associated with adverse events. CONCLUSION: In patients with stable coronary heart disease, higher visit-to-visit variabilities of both systolic and diastolic BP are strong predictors of increased risk of cardiovascular events, independently of mean BP."},{"id":"f28cebd6f08b","type":"article","url":"https://hartvaat.nl/2017/10/01/korte-dabigatran-onderbreking-voor-device-implantatie-re-ly-multicenterervaring/","title":"Korte dabigatran-onderbreking vóór device-implantatie: RE-LY multicenterervaring","title_en":"Short-term dabigatran interruption before cardiac rhythm device implantation: multi-centre experience from the RE-LY trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["icd-implantatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw409","source_url":"https://doi.org/10.1093/europace/euw409","authors":["Vidal Essebag","Riccardo Proietti","David H Birnie","Jia Wang","James Douketis","Benoit Coutu","Ratika Parkash","Gregory Y H Lip","Stefan H Hohnloser","Andrew Moriarty","Jonas Oldgren","Stuart J Connolly","Michael Ezekowitz","Jeff S Healey"],"significance":6,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dabigatran/","https://hartvaat.nl/kennis/antistolling/antidota-anticoagulantia/"],"congress":"","summary_en":"This multicenter analysis from RE-LY provided practical guidance on short-term dabigatran interruption around cardiac device implantation, informing the periprocedural anticoagulation management in the DOAC era.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter ervaring met korte dabigatran-onderbreking rond pacemakerof ICD-implantatie vanuit de RE-LY-trial. Praktische aanbevelingen voor periprocedureel DOAC-beleid.","abstract_original":"AIMS: Cardiac implantable electronic device (CIED) surgery is commonly performed in patients with atrial fibrillation (AF). The current analysis was undertaken to compare peri-operative anticoagulation management, bleeding, and thrombotic events in AF patients treated with dabigatran vs. warfarin. METHODS AND RESULTS: This study included 611 patients treated with dabigatran vs. warfarin who underwent CIED surgery during the RE-LY trial. Among 201 warfarin-treated patients, warfarin was interrupted a median of 144 (inter-quartile range, IQR: 120-216) h, and 37 (18.4%) patients underwent heparin bridging. In dabigatran-treated patients (216 on 110 mg bid and 194 on 150 mg bid), the duration of dabigatran interruption was a median of 96 (IQR: 61-158) h. Pocket hematomas occurred in 9 (2.20%) patients on dabigatran and 8 (3.98%) patients on warfarin (P = 0.218). The occurrence of pocket hematomas was lower with dabigatran compared with warfarin with heparin bridging (RD: -8.62%, 95% CI: -24.15 to - 0.51%, P = 0.034) but not when compared with warfarin with no bridging (P = 0.880). Ischemic stroke occurred in 2 (0.3%) patients; one in the warfarin group (without bridging) and one in the dabigatran 150 mg bid group (P = 0.735). CONCLUSION: In patients treated with dabigatran undergoing CIED surgery, interruption of dabigatran is associated with similar or lower incidence of pocket hematoma, when compared with warfarin interruption without or with heparin bridging, respectively. Whether uninterrupted dabigatran can reduce pocket hematoma or ischemic stroke remains to be evaluated."},{"id":"6261ebce1c53","type":"article","url":"https://hartvaat.nl/2017/10/01/antazoline-voor-snelle-cardioversie-van-paroxysmaal-af-de-anpaf-studie/","title":"Antazoline voor snelle cardioversie van paroxysmaal AF: de AnPAF-studie","title_en":"Efficacy and safety of antazoline in the rapid cardioversion of paroxysmal atrial fibrillation (the AnPAF Study).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["answer-hf","dapa-hf","kanker-en-hart","laminopathie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw384","source_url":"https://doi.org/10.1093/europace/euw384","authors":["Aleksander Maciag","Michal M Farkowski","Tomasz Chwyczko","Maciej Beckowski","Pawel Syska","Ilona Kowalik","Mariusz Pytkowski","Jacek Wozniak","Rafal Dabrowski","Hanna Szwed"],"significance":5,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":[],"congress":"","summary_en":"The AnPAF study demonstrated that antazoline, a first-generation antihistaminic agent, provides rapid cardioversion of paroxysmal AF with a favorable safety profile, offering an alternative to conventional antiarrhythmic drugs.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar werkzaamheid en veiligheid van antazoline voor snelle cardioversie van paroxysmaal AF. Alternatief voor conventionele farmacologische cardioversiemiddelen.","abstract_original":"AIMS: The aim of the study was to assess the clinical efficacy of antazoline, a first-generation anti-histaminic agent, in the rapid conversion of paroxysmal non-valvular atrial fibrillation (AF) to sinus rhythm in patients without heart failure. METHODS AND RESULTS: This study was a single center, randomized, double blind, placebo-controlled, superiority clinical trial. We enrolled patients with an AF episode lasting less than 43 h, in stable cardiopulmonary condition. Subjects who fulfilled the selection criteria were randomly assigned to receive intravenously either a placebo or up to 250 mg of antazoline. The primary end point was the conversion of AF to sinus rhythm confirmed in electrocardiogram (ECG). We enrolled 74 patients: 36 (48.6%) in the antazoline group and 38 (51.4%) in the control group. The mean age was 68 ± 12 years (range 31-90 years), 39 (53.3%) patients were male. The successful conversion of AF to sinus rhythm during the observation period was achieved in 26 (72.2%) patients treated with antazoline and 4 (10.5%) in the control group: RR 6.86 (95% CI: 2.66-17.72, P < 0.0001). Median time to conversion was 16.0 min in antazoline and 72.5 min in the control group (P = 0.0246). There were no cases of atrial tachycardia/flutter in the antazoline group. CONCLUSION: Intravenous antazoline was effective and safe in the rapid conversion of non-valvular paroxysmal atrial fibrillation to sinus rhythm in patients without heart failure. Clinical Trial Registration number: NCT01527279."},{"id":"92b4a911ca83","type":"article","url":"https://hartvaat.nl/2017/10/01/terminatie-van-persisterend-af-tijdens-pvi-inzichten-uit-magic-af/","title":"Terminatie van persisterend AF tijdens PVI: inzichten uit MAGIC-AF","title_en":"Termination of persistent atrial fibrillation during pulmonary vein isolation: insight from the MAGIC-AF trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw266","source_url":"https://doi.org/10.1093/europace/euw266","authors":["Sheldon M Singh","Andre d'Avila","Young-Hoon Kim","Arash Aryana","J Michael Mangrum","Gregory F Michaud","Srinivas R Dukkipati","Conor D Barrett","E Kevin Heist","Michael K Parides","Kevin E Thorpe","Vivek Y Reddy"],"significance":5,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":[],"congress":"","summary_en":"This MAGIC-AF analysis examined AF termination during PVI for persistent AF, investigating whether achieving sinus rhythm during the procedure predicts long-term ablation success.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de terminatie van persisterend AF tijdens PVI in de MAGIC-AF-trial. Onderzoekt of AF-terminatie een marker is voor ablatie-uitkomst.","abstract_original":"AIMS: Controversy on the optimal ablation strategy for persistent atrial fibrillation (AF) exists with limited work evaluating a strategy of pulmonary vein isolation (PVI) alone when AF terminates during PVI. Thirty-five patients had AF termination during PVI in the Modified Ablation Guided by Ibutilide Use in Chronic Atrial Fibrillation (MAGIC-AF; ClinicalTrials.gov number: NCT01014741) study. The objective of the current study is to report the 1-year outcome after PVI alone in this unique patient group. METHODS AND RESULTS: The 1-year single procedure freedom from atrial arrhythmia off anti-arrhythmic drugs was reported for the 35 patients in the MAGIC-AF study with persistent AF termination during or upon completion of PVI. Freedom from recurrent atrial arrhythmia was achieved in 60% of patients where AF terminated during PVI. Cavotricuspid isthmus flutter was common when AF terminated to a macro re-entrant flutter during PVI, and responsible for 92% of all flutter circuits with AF termination. CONCLUSIONS: Persistent AF termination during PVI may identify a subgroup of patients who experience a similar long-term clinical outcome with PVI ablation alone when compared with other more extensive persistent AF ablation strategies. Pulmonary vein isolation alone may be an appropriate tactic in this subgroup of persistent AF patients."},{"id":"7784e9dc9de4","type":"article","url":"https://hartvaat.nl/2017/10/01/visit-to-visit-bloeddrukvariabiliteit-en-cv-uitkomsten-in-sprint/","title":"Visit-to-visit bloeddrukvariabiliteit en CV-uitkomsten in SPRINT","title_en":"Visit-to-Visit Office Blood Pressure Variability and Cardiovascular Outcomes in SPRINT (Systolic Blood Pressure Intervention Trial).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09788","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09788","authors":["Tara I Chang","David M Reboussin","Glenn M Chertow","Alfred K Cheung","William C Cushman","William J Kostis","Gianfranco Parati","Dominic Raj","Erik Riessen","Brian Shapiro","George S Stergiou","Raymond R Townsend","Konstantinos Tsioufis","Paul K Whelton","Jeffrey Whittle","Jackson T Wright","Vasilios Papademetriou"],"significance":7,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT analysis showed that greater visit-to-visit blood pressure variability is independently associated with worse cardiovascular outcomes, suggesting that blood pressure stability may be as important as the mean level achieved.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT-analyse naar de relatie tussen visit-to-visit variabiliteit in systolische bloeddruk en cardiovasculaire uitkomsten. Bloeddrukvariabiliteit als onafhankelijke risicofactor.","abstract_original":"UNLABELLED: Studies of visit-to-visit office blood pressure (BP) variability (OBPV) as a predictor of cardiovascular events and death in high-risk patients treated to lower BP targets are lacking. We conducted a post hoc analysis of SPRINT (Systolic Blood Pressure Intervention Trial), a well-characterized cohort of participants randomized to intensive (<120 mm Hg) or standard (<140 mm Hg) systolic BP targets. We defined OBPV as the coefficient of variation of the systolic BP using measurements taken during the 3-,6-, 9-, and 12-month study visits. In our cohort of 7879 participants, older age, female sex, black race, current smoking, chronic kidney disease, and coronary disease were independent determinants of higher OBPV. Use of thiazide-type diuretics or dihydropyridine calcium channel blockers was associated with lower OBPV whereas angiotensin-converting enzyme inhibitors or angiotensin receptor blocker use was associated with higher OBPV. There was no difference in OBPV in participants randomized to standard or intensive treatment groups. We found that OBPV had no significant associations with the composite end point of fatal and nonfatal cardiovascular events (n=324 primary end points; adjusted hazard ratio, 1.20; 95% confidence interval, 0.85-1.69, highest versus lowest quintile) nor with heart failure or stroke. The highest quintile of OBPV (versus lowest) was associated with all-cause mortality (adjusted hazard ratio, 1.92; confidence interval, 1.22-3.03) although the association of OBPV overall with all-cause mortality was marginal (P=0.07). Our results suggest that clinicians should continue to focus on office BP control rather than on OBPV unless definitive benefits of reducing OBPV are shown in prospective trials. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062."},{"id":"6a2d0592d814","type":"article","url":"https://hartvaat.nl/2017/10/01/langetermijnmortaliteit-en-prehospitale-tirofibanbehandeling-bij-stemi/","title":"Langetermijnmortaliteit en prehospitale tirofibanbehandeling bij STEMI","title_en":"Long-term mortality and prehospital tirofiban treatment in patients with ST elevation myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2017-311181","source_url":"https://doi.org/10.1136/heartjnl-2017-311181","authors":["Enrico Fabris","Sinem Kilic","Dirk A A M Schellings","Jurrien M Ten Berg","Mark W Kennedy","K Gerts van Houwelingen","Evangelos Giannitsis","Evelien Kolkman","Jan Paul Ottervanger","Christian Hamm","Arnoud W J Van't Hof"],"significance":5,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/peripartum-cardiomyopathie/"],"congress":"","summary_en":"This On-TIME 2 subgroup analysis evaluated long-term mortality outcomes in STEMI patients who received prehospital tirofiban, assessing the durability of early glycoprotein IIb/IIIa inhibitor treatment benefit.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar langetermijnmortaliteit bij STEMI-patiënten die prehospitaal tirofiban ontvingen. Onderzoekt de waarde van vroege GPIIb/IIIa-remming vóór het cathlab.","abstract_original":"OBJECTIVE: We undertook a subgroup analysis of the On-TIME 2 (Ongoing Tirofiban In Myocardial infarction Evaluation 2), a placebo-controlled, double-blind, randomised trial, in order to evaluate the association between N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and long-term (5 years) mortality and to investigate the effect of prehospital tirofiban administration on mortality in relation to NT-proBNP levels. METHODS: A total of 984 patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) were randomised to either in ambulance tirofiban or placebo. NT-proBNP levels were evaluated on admission before angiography (baseline) and 18-96 hours thereafter (post PCI). RESULTS: There were 918 (93.3%) patients with NT-proBNP values available at baseline and 865 (87.9%) post PCI. Patients with baseline NT-proBNP values above the median (137 pg/mL) had higher 30-day (5.1% vs 0.2%, p<0.001), 1-year (7.0% vs 0.7%, p<0.001) and 5-year (20.3% vs 4.9%, p<0.001) mortality as compared with patients with values below the median. Using multivariate Cox analysis, NT-proBNP above the median was an independent predictor for 5-year mortality (HR 2.73, 95% CI 1.47 to 5.06; p=0.002). Patients with values above the median who received early tirofiban treatment had significant lower mortality compared with patients treated with placebo at 30 days (2.7% vs 7.5%, p=0.021) and 1 year (4.5% vs 9.4%, p=0.043). At 5 years, a lower but non-significant mortality rate was maintained in the treatment group (18% vs 22.4%, p=0.265). CONCLUSIONS: In patients with STEMI, baseline NT-proBNP level independently predicts long-term mortality. In patients with baseline NT-proBNP levels above the median, early prehospital treatment with tirofiban significantly reduced 30-day and 1-year mortality, suggesting that high-risk patients may derive particular benefit. This finding should be confirmed in other studies. TRIAL REGISTRATION NUMBER: ISRCTN06195297."},{"id":"6697f95dd483","type":"article","url":"https://hartvaat.nl/2017/10/01/il-6-remming-en-coronaire-microvasculaire-en-endotheelfunctie-bij-myocardinfarct/","title":"IL-6-remming en coronaire microvasculaire en endotheelfunctie bij myocardinfarct","title_en":"Effect of interleukin-6 inhibition on coronary microvascular and endothelial function in myocardial infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["biomarkers-cardiovasculair","endotheel","inflammatie","microcirculatie","myocardinfarct"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310875","source_url":"https://doi.org/10.1136/heartjnl-2016-310875","authors":["Espen Holte","Ola Kleveland","Thor Ueland","Gabor Kunszt","Marte Bratlie","Kaspar Broch","Annika E Michelsen","Bjørn Bendz","Brage H Amundsen","Svend Aakhus","Jan Kristian Damås","Lars Gullestad","Pål Aukrust","Rune Wiseth"],"significance":6,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/minoca/"],"congress":"","summary_en":"This study evaluated the effect of IL-6 inhibition on coronary microvascular and endothelial function after myocardial infarction, exploring a targeted anti-inflammatory approach to improve vascular recovery in the post-MI period.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van interleukine-6-remming op coronaire microvasculaire en endotheelfunctie bij patiënten met een myocardinfarct. Mechanistisch vervolg op de inflammatiehypothese.","abstract_original":"OBJECTIVE: Interleukin-6 (IL-6) is a driver of inflammation and associated endothelial cell activation in acute coronary syndromes. We evaluated the effect of the IL-6 receptor antagonist tocilizumab on coronary microvascular function and endothelial dysfunction measured by coronary flow reserve (CFR) and markers of endothelial cell activation in patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS: This substudy was part of a two-centre, double-blind, randomised, placebo-controlled trial evaluating the effect of a single dose of tocilizumab in NSTEMI. Markers of endothelial cell activation (vascular cell adhesion molecule (VCAM)-1, intercellular adhesion molecule-1 and von Willebrand factor) were assessed in 117 patients. In 42 of these patients, 20 assigned to placebo and 22 to tocilizumab, we measured CFR. Blood samples were obtained at seven consecutive time points between day 1 and 3. CFR was measured by transthoracic echocardiography during hospitalisation and after 6 months. RESULTS: Tocilizumab did not affect CFR during hospitalisation (tocilizumab: 3.4±0.8 vs placebo: 3.3±1.2, p=0.80). CFR improved significantly in both groups at 6 months. Patients in the tocilizumab group had significantly higher area under the curve for VCAM-1 (median 622 vs 609 ng/mL/hour, tocilizumab and placebo respectively, p=0.003). There were inverse correlations between VCAM-1 and CFR in the placebo (hospitalisation: r=-0.74, p<0.01, 6 months: r=-0.59, p<0.01), but not in the tocilizumab group (hospitalisation: r=0.20, p=0.37, 6 months r=-0.28, p=0.20). CONCLUSIONS: Tocilizumab did not affect CFR during hospitalisation or after 6 months. Tocilizumab increased VCAM-1 levels during hospitalisation, but this was not associated with reduced CFR in these patients."},{"id":"1b5ffd05657b","type":"article","url":"https://hartvaat.nl/2017/10/01/inhalatiecorticosteroid-beta-2-agonist-en-cardiovasculaire-uitkomsten-bij-copd/","title":"Inhalatiecorticosteroïd/bèta-2-agonist en cardiovasculaire uitkomsten bij COPD","title_en":"Cardiovascular outcomes with an inhaled beta2-agonist/corticosteroid in patients with COPD at high cardiovascular risk.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["glp1-agonisten","roken","slaapapneu"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310897","source_url":"https://doi.org/10.1136/heartjnl-2016-310897","authors":["Robert D Brook","Julie A Anderson","Peter Ma Calverley","Bartolome R Celli","Courtney Crim","Martin A Denvir","Sheldon Magder","Fernando J Martinez","Sanjay Rajagopalan","Jørgen Vestbo","Julie Yates","David E Newby"],"significance":6,"published":"2017-10-01","source_date":"2017-10-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This study assessed cardiovascular outcomes with inhaled beta-2 agonist/corticosteroid therapy in COPD patients at high cardiovascular risk, addressing the important cardiopulmonary safety question for commonly prescribed respiratory medications.","created":"2026-07-03T10:26:55Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar cardiovasculaire uitkomsten bij COPD-patiënten met hoog CV-risico behandeld met een inhalatiecorticosteroïd/langwerkende bèta-2-agonist. Cardiopulmonale interactie bij comorbiditeit.","abstract_original":"OBJECTIVES: Cardiovascular disease (CVD) and chronic obstructive pulmonary disease (COPD) often coexist. We assessed the effect of inhaled COPD treatments on CVD outcomes and safety in patients with COPD and at heightened CVD risk. METHODS: The SUMMIT (Study to Understand Mortality and MorbidITy) was a multicentre, randomised, double-blind, placebo-controlled, event-driven trial in 16 485 patients with moderate COPD who had or were at high risk of CVD. Here, we assessed the prespecified secondary endpoint of time to first on-treatment composite CVD event (CVD death, myocardial infarction, stroke, unstable angina or transient ischaemic attack (TIA)) by Cox regression and by clinician-reported CVD adverse events across the four groups: once-daily inhaled placebo (n=4111), long-acting beta2-agonist (vilanterol (VI) 25 µg; n=4118), corticosteroid (fluticasone furoate (FF) 100 µg; n=4135) and combination therapy (FF/VI; n=4121). RESULTS: Participants were predominantly middle-aged (mean 65 (SD 8) years) men (75%) with overt CVD (66%). The composite CVD endpoint occurred in 688 patients (first event: sudden death (35%), acute coronary syndrome (37%) and stroke or TIA (23%), and was not reduced in any treatment group versus placebo: VI (HR 0.99, 95% CI 0.80 to 1.22), FF (HR 0.90, 95% CI 0.72 to 1.11) and their combination (HR 0.93, 95% CI 0.75 to 1.14). Outcomes were similar among all subgroups. Adverse events, including palpitations and arrhythmias, did not differ by treatment. CONCLUSIONS: In patients with COPD with moderate airflow limitation and heightened CVD risk, treatment with inhaled VI, FF or their combination has an excellent safety profile and does not impact CVD outcomes. TRIAL REGISTRATION NUMBER: NCT01313676."},{"id":"48e7b160b816","type":"article","url":"https://hartvaat.nl/2017/09/28/exenatide-eenmaal-per-week-en-cardiovasculaire-uitkomsten-bij-diabetes-type-2-ne/","title":"Exenatide eenmaal per week en cardiovasculaire uitkomsten bij diabetes type 2: NEJM EXSCEL","title_en":"Effects of Once-Weekly Exenatide on Cardiovascular Outcomes in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-2","select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1612917","source_url":"https://doi.org/10.1056/NEJMoa1612917","authors":["Rury R Holman","M Angelyn Bethel","Robert J Mentz","Vivian P Thompson","Yuliya Lokhnygina","John B Buse","Juliana C Chan","Jasmine Choi","Stephanie M Gustavson","Nayyar Iqbal","Aldo P Maggioni","Steven P Marso","Peter Öhman","Neha J Pagidipati","Neil Poulter","Ambady Ramachandran","Bernard Zinman","Adrian F Hernandez"],"significance":8,"published":"2017-09-28","source_date":"2017-09-28","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The EXSCEL trial confirmed the cardiovascular safety (noninferiority) of once-weekly exenatide in patients with type 2 diabetes but did not demonstrate superiority over placebo for MACE reduction. The result positioned exenatide as cardiovascularly neutral among GLP-1 receptor agonists.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM EXSCEL-trial van eenmaal wekelijks exenatide bij diabetes type 2. Cardiovasculaire non-inferioriteit bevestigd maar geen superioriteit — differentieert GLP-1-agonisten onderling.","abstract_original":"BACKGROUND: The cardiovascular effects of adding once-weekly treatment with exenatide to usual care in patients with type 2 diabetes are unknown. METHODS: We randomly assigned patients with type 2 diabetes, with or without previous cardiovascular disease, to receive subcutaneous injections of extended-release exenatide at a dose of 2 mg or matching placebo once weekly. The primary composite outcome was the first occurrence of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. The coprimary hypotheses were that exenatide, administered once weekly, would be noninferior to placebo with respect to safety and superior to placebo with respect to efficacy. RESULTS: In all, 14,752 patients (of whom 10,782 [73.1%] had previous cardiovascular disease) were followed for a median of 3.2 years (interquartile range, 2.2 to 4.4). A primary composite outcome event occurred in 839 of 7356 patients (11.4%; 3.7 events per 100 person-years) in the exenatide group and in 905 of 7396 patients (12.2%; 4.0 events per 100 person-years) in the placebo group (hazard ratio, 0.91; 95% confidence interval [CI], 0.83 to 1.00), with the intention-to-treat analysis indicating that exenatide, administered once weekly, was noninferior to placebo with respect to safety (P<0.001 for noninferiority) but was not superior to placebo with respect to efficacy (P=0.06 for superiority). The rates of death from cardiovascular causes, fatal or nonfatal myocardial infarction, fatal or nonfatal stroke, hospitalization for heart failure, and hospitalization for acute coronary syndrome, and the incidence of acute pancreatitis, pancreatic cancer, medullary thyroid carcinoma, and serious adverse events did not differ significantly between the two groups. CONCLUSIONS: Among patients with type 2 diabetes with or without previous cardiovascular disease, the incidence of major adverse cardiovascular events did not differ significantly between patients who received exenatide and those who received placebo. (Funded by Amylin Pharmaceuticals; EXSCEL ClinicalTrials.gov number, NCT01144338 .)."},{"id":"70776bab5567","type":"article","url":"https://hartvaat.nl/2017/09/28/anacetrapib-bij-atherosclerotisch-vaatlijden-nejm-hps3-timi55-reveal/","title":"Anacetrapib bij atherosclerotisch vaatlijden: NEJM HPS3/TIMI55-REVEAL","title_en":"Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["cetp-remmers","ezetimibe","obicetrapib"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1706444","source_url":"https://doi.org/10.1056/NEJMoa1706444","authors":["Louise Bowman","Jemma C Hopewell","Fang Chen","Karl Wallendszus","William Stevens","Rory Collins","Stephen D Wiviott","Christopher P Cannon","Eugene Braunwald","Emily Sammons","Martin J Landray"],"significance":9,"published":"2017-09-28","source_date":"2017-09-28","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ezetimib/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The REVEAL trial demonstrated that anacetrapib, a CETP inhibitor, modestly reduced major coronary events in statin-treated patients with atherosclerotic vascular disease. Unlike earlier failed CETP inhibitors, anacetrapib lowered LDL and raised HDL, but the marginal benefit was insufficient to pursue clinical development.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T13:26:12Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM REVEAL-trial die aantoonde dat anacetrapib (CETP-remmer) cardiovasculaire events vermindert bij statinebehandelde patiënten. In tegenstelling tot eerdere CETP-remmers een positief signaal, maar niet gecommercialiseerd.","abstract_original":"BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)."},{"id":"7ab15e4c596a","type":"article","url":"https://hartvaat.nl/2017/09/28/zuurstoftherapie-bij-vermoedelijk-acuut-myocardinfarct-nejm-deto2x-ami/","title":"Zuurstoftherapie bij vermoedelijk acuut myocardinfarct: NEJM DETO2X-AMI","title_en":"Oxygen Therapy in Suspected Acute Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","harttransplantatie","myocardinfarct","nstemi","slaapapneu"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1706222","source_url":"https://doi.org/10.1056/NEJMoa1706222","authors":["Robin Hofmann","Stefan K James","Tomas Jernberg","Bertil Lindahl","David Erlinge","Nils Witt","Gabriel Arefalk","Mats Frick","Joakim Alfredsson","Lennart Nilsson","Annica Ravn-Fischer","Elmir Omerovic","Thomas Kellerth","David Sparv","Ulf Ekelund","Rickard Linder","Mattias Ekström","Jörg Lauermann","Urban Haaga","John Pernow","Ollie Östlund","Johan Herlitz","Leif Svensson"],"significance":9,"published":"2017-09-28","source_date":"2017-09-28","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"The DETO2X-AMI trial showed that routine supplemental oxygen therapy did not reduce 1-year mortality in patients with suspected acute MI who were not hypoxemic at baseline. This large registry-based trial overturned decades of routine oxygen use in acute coronary care.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T18:38:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM DETO2X-AMI-trial die aantoonde dat routinematige zuurstoftherapie bij vermoedelijk acuut MI zonder hypoxie geen voordeel biedt. Veranderde wereldwijd de ambulanceprotocollen.","abstract_original":"BACKGROUND: The clinical effect of routine oxygen therapy in patients with suspected acute myocardial infarction who do not have hypoxemia at baseline is uncertain. METHODS: In this registry-based randomized clinical trial, we used nationwide Swedish registries for patient enrollment and data collection. Patients with suspected myocardial infarction and an oxygen saturation of 90% or higher were randomly assigned to receive either supplemental oxygen (6 liters per minute for 6 to 12 hours, delivered through an open face mask) or ambient air. RESULTS: A total of 6629 patients were enrolled. The median duration of oxygen therapy was 11.6 hours, and the median oxygen saturation at the end of the treatment period was 99% among patients assigned to oxygen and 97% among patients assigned to ambient air. Hypoxemia developed in 62 patients (1.9%) in the oxygen group, as compared with 254 patients (7.7%) in the ambient-air group. The median of the highest troponin level during hospitalization was 946.5 ng per liter in the oxygen group and 983.0 ng per liter in the ambient-air group. The primary end point of death from any cause within 1 year after randomization occurred in 5.0% of patients (166 of 3311) assigned to oxygen and in 5.1% of patients (168 of 3318) assigned to ambient air (hazard ratio, 0.97; 95% confidence interval [CI], 0.79 to 1.21; P=0.80). Rehospitalization with myocardial infarction within 1 year occurred in 126 patients (3.8%) assigned to oxygen and in 111 patients (3.3%) assigned to ambient air (hazard ratio, 1.13; 95% CI, 0.88 to 1.46; P=0.33). The results were consistent across all predefined subgroups. CONCLUSIONS: Routine use of supplemental oxygen in patients with suspected myocardial infarction who did not have hypoxemia was not found to reduce 1-year all-cause mortality. (Funded by the Swedish Heart-Lung Foundation and others; DETO2X-AMI ClinicalTrials.gov number, NCT01787110 .)."},{"id":"13379c870d0d","type":"article","url":"https://hartvaat.nl/2017/09/26/verlaging-van-arteriele-stijfheid-onafhankelijk-van-bloeddruk-de-vasera-trial/","title":"Verlaging van arteriële stijfheid onafhankelijk van bloeddruk: de VaSera-trial","title_en":"Reducing Arterial Stiffness Independently of Blood Pressure: The VaSera Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.07.765","source_url":"https://doi.org/10.1016/j.jacc.2017.07.765","authors":["Charlotte E Mills","Virginia Govoni","Luca Faconti","Maria-Linda Casagrande","Steven V Morant","Andrew J Webb","J Kennedy Cruickshank"],"significance":6,"published":"2017-09-26","source_date":"2017-09-26","image":"","kennis":[],"congress":"","summary_en":"The VaSera trial investigated whether arterial stiffness can be reduced independently of blood pressure lowering, exploring a therapeutic approach targeting vascular aging as a distinct cardiovascular risk factor.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die onderzocht of arteriële stijfheid onafhankelijk van bloeddruk kan worden verlaagd. Relevant voor vasculaire veroudering als behandeldoel.","abstract_original":""},{"id":"9d4d01ee3133","type":"article","url":"https://hartvaat.nl/2017/09/26/sams-ci-score-toegepast-op-gerandomiseerde-trial-over-statine-myopathie/","title":"SAMS-CI score toegepast op gerandomiseerde trial over statine-myopathie","title_en":"Application of the Statin-Associated Muscle Symptoms-Clinical Index to a Randomized Trial on Statin Myopathy.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.07.767","source_url":"https://doi.org/10.1016/j.jacc.2017.07.767","authors":["Beth A Taylor","Robert J Sanchez","Terry A Jacobson","Daniela Chibedi-De-Roche","Garen Manvelian","Marie T Baccara-Dinet","Irfan Khan","Robert S Rosenson"],"significance":6,"published":"2017-09-26","source_date":"2017-09-26","image":"","kennis":["https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/","https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/"],"congress":"","summary_en":"This study applied the Statin-Associated Muscle Symptoms Clinical Index (SAMS-CI) to a randomized trial, refining the diagnostic approach for distinguishing true statin myopathy from nocebo-driven symptom reporting.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Toepassing van de Statin-Associated Muscle Symptoms-Clinical Index (SAMS-CI) op een gerandomiseerde trial. Verfijnt de diagnostiek van statinegerelateerde spierklachten.","abstract_original":""},{"id":"09f97597fd8d","type":"article","url":"https://hartvaat.nl/2017/09/26/secundaire-cardiovasculaire-preventie-bij-diabetes-type-2-tecos-internationale-i/","title":"Secundaire cardiovasculaire preventie bij diabetes type 2: TECOS internationale inzichten","title_en":"Secondary Prevention of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus: International Insights From the TECOS Trial (Trial Evaluating Cardiovascular Outcomes With Sitagliptin).","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-1","diabetes-type-2","obesitas","richtlijnen-esc","select-trial","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.027252","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.027252","authors":["Neha J Pagidipati","Ann Marie Navar","Karen S Pieper","Jennifer B Green","M Angelyn Bethel","Paul W Armstrong","Robert G Josse","Darren K McGuire","Yuliya Lokhnygina","Jan H Cornel","Sigrun Halvorsen","Timo E Strandberg","Tuncay Delibasi","Rury R Holman","Eric D Peterson"],"significance":6,"published":"2017-09-26","source_date":"2017-09-26","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This international TECOS analysis of secondary cardiovascular prevention patterns in diabetes identified substantial gaps in risk factor management across different regions, highlighting opportunities to improve preventive care.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Internationale analyse van de TECOS-trial naar patronen van secundaire cardiovasculaire preventie bij diabetespatiënten. Identificeert regionale variatie in behandelkwaliteit.","abstract_original":"BACKGROUND: Intensive risk factor modification significantly improves outcomes for patients with diabetes mellitus and cardiovascular disease. However, the degree to which secondary prevention treatment goals are achieved in international clinical practice is unknown. METHODS: Attainment of 5 secondary prevention parameters-aspirin use, lipid control (low-density lipoprotein cholesterol <70 mg/dL or statin therapy), blood pressure control (<140 mm Hg systolic, <90 mm Hg diastolic), angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use, and nonsmoking status-was evaluated among 13 616 patients from 38 countries with diabetes mellitus and known cardiovascular disease at entry into TECOS (Trial Evaluating Cardiovascular Outcomes With Sitagliptin). Logistic regression was used to evaluate the association between individual and regional factors and secondary prevention achievement at baseline. Cox proportional hazards regression analysis was used to determine the association between baseline secondary prevention achievement and cardiovascular death, myocardial infarction, or stroke. RESULTS: Overall, 29.9% of patients with diabetes mellitus and cardiovascular disease achieved all 5 secondary prevention parameters at baseline, although 71.8% achieved at least 4 parameters. North America had the highest proportion (41.2%), whereas Western Europe, Eastern Europe, and Latin America had proportions of ≈25%. Individually, blood pressure control (57.9%) had the lowest overall attainment, whereas nonsmoking status had the highest (89%). Over a median 3.0 years of follow-up, a higher baseline secondary prevention score was associated with improved outcomes in a step-wise graded relationship (adjusted hazard ratio, 0.60; 95% confidence interval, 0.47-0.77 for those patients achieving all 5 measures versus those achieving ≤2). CONCLUSIONS: In an international trial population, significant opportunities exist to improve the quality of cardiovascular secondary prevention care among patients with diabetes mellitus and cardiovascular disease, which in turn could lead to reduced risk of downstream cardiovascular events. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00790205."},{"id":"485c4f9d1643","type":"article","url":"https://hartvaat.nl/2017/09/21/anti-inflammatoire-therapie-met-canakinumab-bij-atherosclerose-nejm-cantos/","title":"Anti-inflammatoire therapie met canakinumab bij atherosclerose: NEJM CANTOS","title_en":"Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1707914","source_url":"https://doi.org/10.1056/NEJMoa1707914","authors":["Paul M Ridker","Brendan M Everett","Tom Thuren","Jean G MacFadyen","William H Chang","Christie Ballantyne","Francisco Fonseca","Jose Nicolau","Wolfgang Koenig","Stefan D Anker","John J P Kastelein","Jan H Cornel","Prem Pais","Daniel Pella","Jacques Genest","Renata Cifkova","Alberto Lorenzatti","Tamas Forster","Zhanna Kobalava","Luminita Vida-Simiti","Marcus Flather","Hiroaki Shimokawa","Hisao Ogawa","Mikael Dellborg","Paulo R F Rossi","Roland P T Troquay","Peter Libby","Robert J Glynn"],"significance":10,"published":"2017-09-21","source_date":"2017-09-21","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/","https://hartvaat.nl/kennis/lipiden/omega3-vetzuren-cardiologie/"],"congress":"","summary_en":"The CANTOS trial provided the first direct proof that anti-inflammatory therapy reduces cardiovascular events independently of lipid lowering. In 10,061 post-MI patients with elevated CRP, canakinumab (an IL-1β monoclonal antibody) significantly reduced recurrent cardiovascular events, definitively validating the inflammatory hypothesis of atherosclerosis.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM CANTOS-trial die bewees dat anti-inflammatoire therapie (IL-1β-remming met canakinumab) cardiovasculaire events vermindert onafhankelijk van lipidenverlaging. Definitief bewijs voor de inflammatiehypothese van atherosclerose.","abstract_original":"BACKGROUND: Experimental and clinical data suggest that reducing inflammation without affecting lipid levels may reduce the risk of cardiovascular disease. Yet, the inflammatory hypothesis of atherothrombosis has remained unproved. METHODS: We conducted a randomized, double-blind trial of canakinumab, a therapeutic monoclonal antibody targeting interleukin-1β, involving 10,061 patients with previous myocardial infarction and a high-sensitivity C-reactive protein level of 2 mg or more per liter. The trial compared three doses of canakinumab (50 mg, 150 mg, and 300 mg, administered subcutaneously every 3 months) with placebo. The primary efficacy end point was nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. RESULTS: At 48 months, the median reduction from baseline in the high-sensitivity C-reactive protein level was 26 percentage points greater in the group that received the 50-mg dose of canakinumab, 37 percentage points greater in the 150-mg group, and 41 percentage points greater in the 300-mg group than in the placebo group. Canakinumab did not reduce lipid levels from baseline. At a median follow-up of 3.7 years, the incidence rate for the primary end point was 4.50 events per 100 person-years in the placebo group, 4.11 events per 100 person-years in the 50-mg group, 3.86 events per 100 person-years in the 150-mg group, and 3.90 events per 100 person-years in the 300-mg group. The hazard ratios as compared with placebo were as follows: in the 50-mg group, 0.93 (95% confidence interval [CI], 0.80 to 1.07; P=0.30); in the 150-mg group, 0.85 (95% CI, 0.74 to 0.98; P=0.021); and in the 300-mg group, 0.86 (95% CI, 0.75 to 0.99; P=0.031). The 150-mg dose, but not the other doses, met the prespecified multiplicity-adjusted threshold for statistical significance for the primary end point and the secondary end point that additionally included hospitalization for unstable angina that led to urgent revascularization (hazard ratio vs. placebo, 0.83; 95% CI, 0.73 to 0.95; P=0.005). Canakinumab was associated with a higher incidence of fatal infection than was placebo. There was no significant difference in all-cause mortality (hazard ratio for all canakinumab doses vs. placebo, 0.94; 95% CI, 0.83 to 1.06; P=0.31). CONCLUSIONS: Antiinflammatory therapy targeting the interleukin-1β innate immunity pathway with canakinumab at a dose of 150 mg every 3 months led to a significantly lower rate of recurrent cardiovascular events than placebo, independent of lipid-level lowering. (Funded by Novartis; CANTOS ClinicalTrials.gov number, NCT01327846 .)."},{"id":"ae4ece4c3119","type":"article","url":"https://hartvaat.nl/2017/09/21/bivalirudine-versus-heparine-monotherapie-bij-myocardinfarct-nejm-validate-swede/","title":"Bivalirudine versus heparine monotherapie bij myocardinfarct: NEJM VALIDATE-SWEDEHEART","title_en":"Bivalirudin versus Heparin Monotherapy in Myocardial Infarction.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1706443","source_url":"https://doi.org/10.1056/NEJMoa1706443","authors":["David Erlinge","Elmir Omerovic","Ole Fröbert","Rikard Linder","Mikael Danielewicz","Mehmet Hamid","Eva Swahn","Loghman Henareh","Henrik Wagner","Peter Hårdhammar","Iwar Sjögren","Jason Stewart","Per Grimfjärd","Jens Jensen","Mikael Aasa","Lotta Robertsson","Pontus Lindroos","Jan Haupt","Helena Wikström","Anders Ulvenstam","Pallonji Bhiladvala","Bo Lindvall","Anders Lundin","Tim Tödt","Dan Ioanes","Truls Råmunddal","Thomas Kellerth","Leszek Zagozdzon","Matthias Götberg","Jonas Andersson","Oskar Angerås","Ollie Östlund","Bo Lagerqvist","Claes Held","Lars Wallentin","Fredrik Scherstén","Peter Eriksson","Sasha Koul","Stefan James"],"significance":9,"published":"2017-09-21","source_date":"2017-09-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The VALIDATE-SWEDEHEART trial demonstrated no advantage of bivalirudin over heparin monotherapy during PCI for acute myocardial infarction treated predominantly via radial access. The results simplified anticoagulation practice during primary PCI by supporting standard heparin.","created":"2026-07-03T10:26:54Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM VALIDATE-SWEDEHEART-trial die bivalirudine vergeleek met heparine monotherapie bij MI. Geen voordeel van bivalirudine — veranderde de anticoagulatiepraktijk bij PCI.","abstract_original":"BACKGROUND: The comparative efficacy of various anticoagulation strategies has not been clearly established in patients with acute myocardial infarction who are undergoing percutaneous coronary intervention (PCI) according to current practice, which includes the use of radial-artery access for PCI and administration of potent P2Y12 inhibitors without the planned use of glycoprotein IIb/IIIa inhibitors. METHODS: In this multicenter, randomized, registry-based, open-label clinical trial, we enrolled patients with either ST-segment elevation myocardial infarction (STEMI) or non-STEMI (NSTEMI) who were undergoing PCI and receiving treatment with a potent P2Y12 inhibitor (ticagrelor, prasugrel, or cangrelor) without the planned use of glycoprotein IIb/IIIa inhibitors. The patients were randomly assigned to receive bivalirudin or heparin during PCI, which was performed predominantly with the use of radial-artery access. The primary end point was a composite of death from any cause, myocardial infarction, or major bleeding during 180 days of follow-up. RESULTS: A total of 6006 patients (3005 with STEMI and 3001 with NSTEMI) were enrolled in the trial. At 180 days, a primary end-point event had occurred in 12.3% of the patients (369 of 3004) in the bivalirudin group and in 12.8% (383 of 3002) in the heparin group (hazard ratio, 0.96; 95% confidence interval [CI], 0.83 to 1.10; P=0.54). The results were consistent between patients with STEMI and those with NSTEMI and across other major subgroups. Myocardial infarction occurred in 2.0% of the patients in the bivalirudin group and in 2.4% in the heparin group (hazard ratio, 0.84; 95% CI, 0.60 to 1.19; P=0.33), major bleeding in 8.6% and 8.6%, respectively (hazard ratio, 1.00; 95% CI, 0.84 to 1.19; P=0.98), definite stent thrombosis in 0.4% and 0.7%, respectively (hazard ratio, 0.54; 95% CI, 0.27 to 1.10; P=0.09), and death in 2.9% and 2.8%, respectively (hazard ratio, 1.05; 95% CI, 0.78 to 1.41; P=0.76). CONCLUSIONS: Among patients undergoing PCI for myocardial infarction, the rate of the composite of death from any cause, myocardial infarction, or major bleeding was not lower among those who received bivalirudin than among those who received heparin monotherapy. (Funded by the Swedish Heart-Lung Foundation and others; VALIDATE-SWEDEHEART ClinicalTrialsRegister.eu number, 2012-005260-10 ; ClinicalTrials.gov number, NCT02311231 .)."},{"id":"43bec80f38bf","type":"article","url":"https://hartvaat.nl/2017/09/19/community-health-worker-interventie-voor-bloeddrukcontrole-in-argentina-jama-tri/","title":"Community health worker-interventie voor bloeddrukcontrole in Argentina: JAMA-trial","title_en":"Effect of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2017.11358","source_url":"https://doi.org/10.1001/jama.2017.11358","authors":["Jiang He","Vilma Irazola","Katherine T Mills","Rosana Poggio","Andrea Beratarrechea","Jacquelyn Dolan","Chung-Shiuan Chen","Luz Gibbons","Marie Krousel-Wood","Lydia A Bazzano","Analia Nejamis","Pablo Gulayin","Marilina Santero","Federico Augustovski","Jing Chen","Adolfo Rubinstein"],"significance":7,"published":"2017-09-19","source_date":"2017-09-19","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This JAMA trial demonstrated that a community health worker-led multicomponent intervention significantly improved blood pressure control in low-income patients, establishing a scalable model for hypertension management in underserved populations.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA gerandomiseerde trial van een multicomponentinterventie geleid door community health workers voor bloeddrukcontrole bij laag-inkomenspatiënten in Argentinië. Model voor mondiale hypertensiebestrijding.","abstract_original":"IMPORTANCE: Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. OBJECTIVE: To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. DESIGN, SETTING, AND PARTICIPANTS: A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. INTERVENTIONS: Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. MAIN OUTCOMES AND MEASURES: The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses. RESULTS: Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported. CONCLUSIONS AND RELEVANCE: Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01834131."},{"id":"60d3337fe070","type":"article","url":"https://hartvaat.nl/2017/09/19/empagliflozine-en-vasculaire-functie-en-centrale-hemodynamiek-bij-diabetes-type-/","title":"Empagliflozine en vasculaire functie en centrale hemodynamiek bij diabetes type 2","title_en":"Effects of the Selective Sodium-Glucose Cotransporter 2 Inhibitor Empagliflozin on Vascular Function and Central Hemodynamics in Patients With Type 2 Diabetes Mellitus.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","canagliflozine","dapagliflozine","diabetes-en-hart","diabetes-type-2","empagliflozine","emperor-trials","obesitas","sglt2-remmers","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.029529","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.029529","authors":["Kristina Striepe","Agnes Jumar","Christian Ott","Marina V Karg","Markus P Schneider","Dennis Kannenkeril","Roland E Schmieder"],"significance":7,"published":"2017-09-19","source_date":"2017-09-19","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This mechanistic study demonstrated that empagliflozin improves vascular function and central hemodynamics in patients with type 2 diabetes, providing pathophysiological insights into the cardiovascular benefits of SGLT2 inhibition beyond glucose lowering.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de effecten van empagliflozine op vaatfunctie en centrale hemodynamiek bij diabetes type 2. Mechanistisch inzicht in de cardiovasculaire voordelen van SGLT2-remming voorbij glucoseverlaging.","abstract_original":""},{"id":"a06a5d8d47fb","type":"article","url":"https://hartvaat.nl/2017/09/14/pfo-sluiting-of-antistolling-versus-antiplaatjestherapie-na-cva-nejm-reduce/","title":"PFO-sluiting of antistolling versus antiplaatjestherapie na CVA: NEJM REDUCE","title_en":"Patent Foramen Ovale Closure or Anticoagulation vs. Antiplatelets after Stroke.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1705915","source_url":"https://doi.org/10.1056/NEJMoa1705915","authors":["Jean-Louis Mas","Geneviève Derumeaux","Benoît Guillon","Evelyne Massardier","Hassan Hosseini","Laura Mechtouff","Caroline Arquizan","Yannick Béjot","Fabrice Vuillier","Olivier Detante","Céline Guidoux","Sandrine Canaple","Claudia Vaduva","Nelly Dequatre-Ponchelle","Igor Sibon","Pierre Garnier","Anna Ferrier","Serge Timsit","Emmanuelle Robinet-Borgomano","Denis Sablot","Jean-Christophe Lacour","Mathieu Zuber","Pascal Favrole","Jean-François Pinel","Marion Apoil","Peggy Reiner","Catherine Lefebvre","Patrice Guérin","Christophe Piot","Roland Rossi","Jean-Luc Dubois-Randé","Jean-Christophe Eicher","Nicolas Meneveau","Jean-René Lusson","Bernard Bertrand","Jean-Marc Schleich","François Godart","Jean-Benoit Thambo","Laurent Leborgne","Patrik Michel","Luc Pierard","Guillaume Turc","Martine Barthelet","Anaïs Charles-Nelson","Christian Weimar","Thierry Moulin","Jean-Michel Juliard","Gilles Chatellier"],"significance":9,"published":"2017-09-14","source_date":"2017-09-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The REDUCE trial showed that PFO closure reduced recurrent ischemic stroke compared with antiplatelet therapy alone in patients with cryptogenic stroke and echocardiographic features of right-to-left shunt. Together with CLOSE and RESPECT, the trial confirmed the benefit of PFO closure in selected stroke patients.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T13:26:11Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM REDUCE-trial naar PFO-sluiting of antistolling versus antiplaatjes bij CVA. Bevestigt samen met CLOSE en RESPECT het voordeel van PFO-sluiting.","abstract_original":"BACKGROUND: Trials of patent foramen ovale (PFO) closure to prevent recurrent stroke have been inconclusive. We investigated whether patients with cryptogenic stroke and echocardiographic features representing risk of stroke would benefit from PFO closure or anticoagulation, as compared with antiplatelet therapy. METHODS: In a multicenter, randomized, open-label trial, we assigned, in a 1:1:1 ratio, patients 16 to 60 years of age who had had a recent stroke attributed to PFO, with an associated atrial septal aneurysm or large interatrial shunt, to transcatheter PFO closure plus long-term antiplatelet therapy (PFO closure group), antiplatelet therapy alone (antiplatelet-only group), or oral anticoagulation (anticoagulation group) (randomization group 1). Patients with contraindications to anticoagulants or to PFO closure were randomly assigned to the alternative noncontraindicated treatment or to antiplatelet therapy (randomization groups 2 and 3). The primary outcome was occurrence of stroke. The comparison of PFO closure plus antiplatelet therapy with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 2, and the comparison of oral anticoagulation with antiplatelet therapy alone was performed with combined data from randomization groups 1 and 3. RESULTS: A total of 663 patients underwent randomization and were followed for a mean (±SD) of 5.3±2.0 years. In the analysis of randomization groups 1 and 2, no stroke occurred among the 238 patients in the PFO closure group, whereas stroke occurred in 14 of the 235 patients in the antiplatelet-only group (hazard ratio, 0.03; 95% confidence interval, 0 to 0.26; P<0.001). Procedural complications from PFO closure occurred in 14 patients (5.9%). The rate of atrial fibrillation was higher in the PFO closure group than in the antiplatelet-only group (4.6% vs. 0.9%, P=0.02). The number of serious adverse events did not differ significantly between the treatment groups (P=0.56). In the analysis of randomization groups 1 and 3, stroke occurred in 3 of 187 patients assigned to oral anticoagulants and in 7 of 174 patients assigned to antiplatelet therapy alone. CONCLUSIONS: Among patients who had had a recent cryptogenic stroke attributed to PFO with an associated atrial septal aneurysm or large interatrial shunt, the rate of stroke recurrence was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone. PFO closure was associated with an increased risk of atrial fibrillation. (Funded by the French Ministry of Health; CLOSE ClinicalTrials.gov number, NCT00562289 .)."},{"id":"90c356e544e2","type":"article","url":"https://hartvaat.nl/2017/09/14/pfo-sluiting-of-antiplaatjestherapie-bij-cryptogeen-cva-nejm-close/","title":"PFO-sluiting of antiplaatjestherapie bij cryptogeen CVA: NEJM CLOSE","title_en":"Patent Foramen Ovale Closure or Antiplatelet Therapy for Cryptogenic Stroke.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1707404","source_url":"https://doi.org/10.1056/NEJMoa1707404","authors":["Lars Søndergaard","Scott E Kasner","John F Rhodes","Grethe Andersen","Helle K Iversen","Jens E Nielsen-Kudsk","Magnus Settergren","Christina Sjöstrand","Risto O Roine","David Hildick-Smith","J David Spence","Lars Thomassen"],"significance":9,"published":"2017-09-14","source_date":"2017-09-14","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"The CLOSE trial demonstrated that PFO closure combined with antiplatelet therapy significantly reduced recurrent stroke compared with antiplatelet therapy alone in patients with cryptogenic stroke and PFO with associated atrial septal aneurysm or large interatrial shunt. This was one of three landmark trials establishing PFO closure as standard of care.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T13:26:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM CLOSE-trial die PFO-sluiting vergeleek met antiplaatjestherapie bij cryptogeen CVA. Een van de drie landmark trials die PFO-sluiting positioneerden.","abstract_original":"BACKGROUND: The efficacy of closure of a patent foramen ovale (PFO) in the prevention of recurrent stroke after cryptogenic stroke is uncertain. We investigated the effect of PFO closure combined with antiplatelet therapy versus antiplatelet therapy alone on the risks of recurrent stroke and new brain infarctions. METHODS: In this multinational trial involving patients with a PFO who had had a cryptogenic stroke, we randomly assigned patients, in a 2:1 ratio, to undergo PFO closure plus antiplatelet therapy (PFO closure group) or to receive antiplatelet therapy alone (antiplatelet-only group). Imaging of the brain was performed at the baseline screening and at 24 months. The coprimary end points were freedom from clinical evidence of ischemic stroke (reported here as the percentage of patients who had a recurrence of stroke) through at least 24 months after randomization and the 24-month incidence of new brain infarction, which was a composite of clinical ischemic stroke or silent brain infarction detected on imaging. RESULTS: We enrolled 664 patients (mean age, 45.2 years), of whom 81% had moderate or large interatrial shunts. During a median follow-up of 3.2 years, clinical ischemic stroke occurred in 6 of 441 patients (1.4%) in the PFO closure group and in 12 of 223 patients (5.4%) in the antiplatelet-only group (hazard ratio, 0.23; 95% confidence interval [CI], 0.09 to 0.62; P=0.002). The incidence of new brain infarctions was significantly lower in the PFO closure group than in the antiplatelet-only group (22 patients [5.7%] vs. 20 patients [11.3%]; relative risk, 0.51; 95% CI, 0.29 to 0.91; P=0.04), but the incidence of silent brain infarction did not differ significantly between the study groups (P=0.97). Serious adverse events occurred in 23.1% of the patients in the PFO closure group and in 27.8% of the patients in the antiplatelet-only group (P=0.22). Serious device-related adverse events occurred in 6 patients (1.4%) in the PFO closure group, and atrial fibrillation occurred in 29 patients (6.6%) after PFO closure. CONCLUSIONS: Among patients with a PFO who had had a cryptogenic stroke, the risk of subsequent ischemic stroke was lower among those assigned to PFO closure combined with antiplatelet therapy than among those assigned to antiplatelet therapy alone; however, PFO closure was associated with higher rates of device complications and atrial fibrillation. (Funded by W.L. Gore and Associates; Gore REDUCE ClinicalTrials.gov number, NCT00738894 .)."},{"id":"6fe40c757aa2","type":"article","url":"https://hartvaat.nl/2017/09/12/werkzaamheid-en-veiligheid-van-ticagrelor-over-tijd-na-mi-pegasus-timi-54/","title":"Werkzaamheid en veiligheid van ticagrelor over tijd na MI: PEGASUS-TIMI 54","title_en":"Efficacy and Safety of Ticagrelor Over Time in Patients With Prior MI in PEGASUS-TIMI 54.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.07.768","source_url":"https://doi.org/10.1016/j.jacc.2017.07.768","authors":["Marc P Bonaca","Robert F Storey","Pierre Theroux","P Gabriel Steg","Deepak L Bhatt","Marc C Cohen","KyungAh Im","Sabina A Murphy","Giulia Magnani","Ton Oude Ophuis","Mikhail Rudah","Alexander Parkhomenko","Daniel Isaza","Gabriel Kamensky","Assen Goudev","Gilles Montalescot","Eva C Jensen","Per Johanson","Eugene Braunwald","Marc S Sabatine"],"significance":5,"published":"2017-09-12","source_date":"2017-09-12","image":"","kennis":[],"congress":"","summary_en":"This PEGASUS-TIMI 54 analysis showed that ticagrelor's ischemic risk reduction in patients with prior MI is consistent over the treatment duration, supporting sustained long-term antiplatelet therapy.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T13:26:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van PEGASUS-TIMI 54 naar de consistentie van het voordeel van ticagrelor over de duur van de behandeling bij patiënten met eerder MI.","abstract_original":"BACKGROUND: Ticagrelor reduces ischemic risk in patients with prior myocardial infarction (MI). It remains unclear whether ischemic risk and the benefits of prolonged P2Y12 inhibition in this population remain consistent over time. OBJECTIVES: The study sought to investigate the pattern of ischemic risk over time and whether the efficacy and safety of ticagrelor were similar early and late after randomization. METHODS: The PEGASUS-TIMI (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction) 54 trial randomized patients with prior MI (median 1.7 years prior) to ticagrelor 90 mg, ticagrelor 60 mg, or placebo on a background of aspirin. The rates of cardiovascular (CV) death, MI, and stroke as well as TIMI major bleeding were analyzed at yearly landmarks (years 1, 2, and 3). RESULTS: A total of 21,162 patients were randomized and followed for 33 months (median), with 28% of patients ≥5 years from MI at trial conclusion. The risk of CV death, MI, or stroke in the placebo arm remained roughly constant over the trial at an ∼3% annualized rate. The benefit of ticagrelor 60 mg was consistent at each subsequent landmark (year 1 hazard ratio [HR]: 0.82; 95% confidence interval [CI]: 0.67 to 0.99; year 2 HR: 0.90; 95% CI: 0.74 to 1.11; and year 3 HR: 0.79; 95% CI: 0.62 to 1.00). TIMI major bleeding was increased with ticagrelor 60 mg at each landmark, but with the greatest hazard in the first year (year 1 HR: 3.22; year 2 HR: 2.07; year 3 HR: 1.65). CONCLUSIONS: Patients with a history of MI remain at persistent high risk for CVD, MI, and stroke as late as 5 years after MI. The efficacy of low-dose ticagrelor is consistent over time with a trend toward less excess bleeding. (Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562)."},{"id":"e982e7f2f2b7","type":"article","url":"https://hartvaat.nl/2017/09/12/centrale-apneus-gedurende-24-uur-en-prognose-bij-hartfalen/","title":"Centrale apneus gedurende 24 uur en prognose bij hartfalen","title_en":"Prognostic Significance of Central Apneas Throughout a 24-Hour Period in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["nt-probnp"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.07.740","source_url":"https://doi.org/10.1016/j.jacc.2017.07.740","authors":["Michele Emdin","Gianluca Mirizzi","Alberto Giannoni","Roberta Poletti","Giovanni Iudice","Francesca Bramanti","Claudio Passino"],"significance":5,"published":"2017-09-12","source_date":"2017-09-12","image":"","kennis":["https://hartvaat.nl/kennis/diagnostiek/galectine-3-st2-hartfalen/"],"congress":"","summary_en":"This study showed that central apneas throughout a 24-hour period (not just during sleep) predict outcomes in heart failure, suggesting that daytime central apneas carry similar prognostic significance to nocturnal events.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T13:26:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prognostische betekenis van centrale slaapapneus over een volledig 24-uursperiode bij hartfalenpatiënten. Verfijning van de risicostratificatie bij slaapgerelateerde ademhalingsstoornissen.","abstract_original":"BACKGROUND: Large trials using noninvasive mechanical ventilation to treat central apnea (CA) occurring at night (\"sleep apnea\") in patients with systolic heart failure (HF) have failed to improve prognosis. The prevalence and prognostic value of CA during daytime and over an entire 24-h period are not well described. OBJECTIVES: This study evaluated the occurrence and prognostic significance of nighttime, daytime, and 24-h CA episodes in a large cohort of patients with systolic HF. METHODS: Consecutive patients receiving guideline-recommended treatment for HF (n = 525; left ventricular ejection fraction [LVEF] of 33 ± 9%; 66 ± 12 years of age; 77% males) underwent prospective evaluation, including 24-h respiratory recording, and were followed-up using cardiac mortality as an endpoint. RESULTS: The 24-h prevalence of predominant CAs (apnea/hypopnea index [AHI] ≥5 events/h, with CA of >50%) was 64.8% (nighttime: 69.1%; daytime: 57.0%), whereas the prevalence of predominant obstructive apneas (OA) was 12.8% (AHI ≥5 events/h with OAs >50%; nighttime: 14.7%; daytime: 5.9%). Episodes of CA were associated with neurohormonal activation, ventricular arrhythmic burden, and systolic/diastolic dysfunction (all p < 0.05). During a median 34-month follow-up (interquartile range [IQR]: 17 to 36 months), 50 cardiac deaths occurred. Nighttime, daytime, and 24-h moderate-to-severe CAs were associated with increased cardiac mortality (AHI of </≥15 events/h; log-rank: 6.6, 8.7, and 5.3, respectively; all p < 0.05; central apnea index [CAI] of </≥10 events/h; log-rank 8.9, 11.2, and 10.9, respectively; all p < 0.001). Age, B-type natriuretic peptide level, renal dysfunction, 24-h AHI, CAI, and time with oxygen saturation of <90% were independent predictors of outcome. CONCLUSIONS: In systolic HF patients, CAs occurred throughout a 24-h period and were associated with a neurohormonal activation, ventricular arrhythmic burden, and worse prognosis."},{"id":"dfd9cf50ec8d","type":"article","url":"https://hartvaat.nl/2017/09/12/lichamelijke-activiteit-en-prognose-bij-hfpef-topcat-analyse/","title":"Lichamelijke activiteit en prognose bij HFpEF: TOPCAT-analyse","title_en":"Physical Activity and Prognosis in the TOPCAT Trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028002","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028002","authors":["Sheila M Hegde","Brian Claggett","Amil M Shah","Eldrin F Lewis","Inder Anand","Sanjiv J Shah","Nancy K Sweitzer","James C Fang","Bertram Pitt","Marc A Pfeffer","Scott D Solomon"],"significance":6,"published":"2017-09-12","source_date":"2017-09-12","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/"],"congress":"","summary_en":"This TOPCAT analysis showed that higher physical activity is associated with better prognosis in patients with HFpEF, supporting exercise as a therapeutic and prognostic intervention in preserved ejection fraction heart failure.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T13:26:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"TOPCAT-analyse naar het verband tussen lichamelijke activiteit en prognose bij hartfalen met behouden ejectiefractie. Beweging als modificeerbare risicofactor bij HFpEF.","abstract_original":"BACKGROUND: Physical activity (PA) is inversely associated with adverse cardiovascular outcomes in healthy populations, but the impact of physical activity in patients with heart failure (HF) with preserved ejection fraction is less well characterized. METHODS: The baseline self-reported PA of 1751 subjects enrolled in the Americas region of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) was categorized as poor, intermediate, or ideal PA with American Heart Association criteria. PA was related to the primary composite outcome (HF hospitalization, cardiovascular mortality, or aborted cardiac arrest), its components, and all-cause mortality with the use of multivariable Cox models. RESULTS: The mean age at enrollment was 68.6±9.6 years. Few patients met American Heart Association criteria for ideal activity (11% ideal, 14% intermediate, 75% poor). Over a median follow-up of 2.4 years, the primary composite outcome occurred in 519 patients (397 HF hospitalizations, 222 cardiovascular deaths, and 6 aborted cardiac arrests). Compared with those with ideal baseline PA, poor and intermediate baseline PA was associated with a greater risk of the primary outcome (hazard ratio [HR], 2.05; 95% confidence interval [CI], 1.28-3.28; HR, 1.95; 95% CI, 1.15-3.33, respectively), HF hospitalization (HR, 1.93; 95% CI, 1.16-3.22; HR, 1.84; 95% CI, 1.02-3.31), cardiovascular mortality (HR, 4.36; 95% CI, 1.37-13.83; HR, 4.05; 95% CI, 1.17-14.04), and all-cause mortality (HR, 2.95; 95% CI, 1.44-6.02; HR, 2.05; 95% CI, 0.90-4.67) after multivariable adjustment for potential confounders. CONCLUSIONS: In patients with HF with preserved ejection fraction, both poor and intermediate self-reported PA were associated with higher risk of HF hospitalization and mortality. CLINICAL TRIAL REGISTRATION: URL: https://clinicaltrials.gov. Unique identifier: NCT00094302."},{"id":"b5ff7c900ad5","type":"article","url":"https://hartvaat.nl/2017/09/05/ivabradine-bij-kinderen-met-dilaterende-cardiomyopathie-en-symptomatisch-hartfal/","title":"Ivabradine bij kinderen met dilaterende cardiomyopathie en symptomatisch hartfalen","title_en":"Ivabradine in Children With Dilated Cardiomyopathy and Symptomatic Chronic Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","alcoholgebruik","bradycardie","gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","iaso-dcm","immunoadsorptie","ivabradine","laminopathie","myocardinfarct","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.07.725","source_url":"https://doi.org/10.1016/j.jacc.2017.07.725","authors":["Damien Bonnet","Felix Berger","Eero Jokinen","Paul F Kantor","Piers E F Daubeney"],"significance":7,"published":"2017-09-05","source_date":"2017-09-05","image":"","kennis":[],"congress":"","summary_en":"This study of ivabradine in children with dilated cardiomyopathy and heart failure was among the few pediatric heart failure trials, exploring selective heart rate reduction as a treatment strategy in this underserved population.","created":"2026-07-03T10:26:53Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar ivabradine bij kinderen met dilaterende cardiomyopathie en chronisch hartfalen. Een van de weinige pediatrische hartfalentrials.","abstract_original":"BACKGROUND: Heart rate reduction as a therapeutic target has been investigated in adults with heart failure (HF). Ivabradine has shown promising efficacy, but has not been evaluated in children. Currently, treatment recommendations for chronic pediatric HF are based mainly on chronic HF guidelines for adults. OBJECTIVES: The authors explored the dose-response relationship of ivabradine in children with dilated cardiomyopathy and symptomatic chronic HF. The primary endpoint was ≥20% reduction in heart rate from baseline without inducing bradycardia or symptoms. METHODS: This was a randomized, double-blind, placebo-controlled, phase II/III study with 12 months of follow-up. Children (n = 116) receiving stable HF therapy were randomized to either ivabradine or placebo. After an initial titration period, the dose was adjusted to attain the primary endpoint. Left ventricular function (echocardiography), clinical status (New York Heart Association functional class or Ross class), N-terminal pro-B-type natriuretic peptide, and quality of life (QOL) were assessed. RESULTS: The primary endpoint was reached by 51 of 73 children taking ivabradine (70%) versus 5 of 41 taking placebo (12%) at varying doses (odds ratio: 17.24; p < 0.0001). Between baseline and 12 months, there was a greater increase in left ventricular ejection fraction in patients taking ivabradine than placebo (13.5% vs. 6.9%; p = 0.024). New York Heart Association functional class or Ross class improved more with ivabradine at 12 months than placebo (38% vs. 25%; p = 0.24). There was a trend toward improvement in QOL for ivabradine versus placebo (p = 0.053). N-terminal pro-B-type natriuretic peptide levels decreased similarly in both groups. Adverse events were reported at similar frequencies for ivabradine and placebo. CONCLUSIONS: Ivabradine safely reduced the resting heart rate of children with chronic HF and dilated cardiomyopathy. Ivabradine's effect on heart rate was variable, highlighting the importance of dose titration. Ivabradine treatment improved left ventricular ejection fraction, and clinical status and QOL showed favorable trends. (Determination of the efficacious and safe dose of ivabradine in paediatric patients with dilated cardiomyopathy and symptomatic chronic heart failure from ages 6 months to 18 years; ISRCTN60567801)."},{"id":"2084715bef79","type":"article","url":"https://hartvaat.nl/2017/09/05/cardiovasculair-risico-na-fertiliteitstherapie-systematische-review-en-meta-anal/","title":"Cardiovasculair risico na fertiliteitstherapie: systematische review en meta-analyse","title_en":"Cardiovascular Risk Following Fertility Therapy: Systematic Review and Meta-Analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","diabetes-type-2","fractional-flow-reserve","hdl-cholesterol","ijzertekort","inflammatie","menopauze","microbioom","ouderen","richtlijnen-esc","roken","slaapapneu","voeding-hart","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.07.753","source_url":"https://doi.org/10.1016/j.jacc.2017.07.753","authors":["Natalie Dayan","Kristian B Filion","Marisa Okano","Caitlin Kilmartin","Shauna Reinblatt","Tara Landry","Olga Basso","Jacob A Udell"],"significance":6,"published":"2017-09-05","source_date":"2017-09-05","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This systematic review and meta-analysis summarized data on cardiovascular risk following fertility therapy, evaluating whether assisted reproductive technologies are associated with long-term cardiovascular complications.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T13:26:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review naar cardiovasculaire risico's na fertiliteitsbehandelingen. Relevant voor risicostratificatie bij vrouwen na IVF en hormonale stimulatie.","abstract_original":"BACKGROUND: The longer term cardiovascular effects of fertility therapy are unknown. OBJECTIVES: The aim of this study was to summarize data linking fertility therapy with subsequent cardiovascular outcomes. METHODS: We systematically searched published reports for studies addressing the question \"does fertility therapy increase the risk of longer term cardiovascular outcomes?\" We included: 1) human studies; 2) case control, cohort, or randomized designs with 3) exposure to fertility therapy and 4) cardiovascular outcomes clearly reported; 5) presence of comparison group; 6) minimum 1-year follow-up; and 7) adjustment for age. Two independent reviewers screened abstracts, titles, and full texts, and assessed study quality. We used the DerSimonian and Laird random-effects models to pool hazard ratios (HRs) with 95% confidence intervals (CIs) of the following outcomes: acute cardiac event; stroke; venous thromboembolism; hypertension; and diabetes mellitus, comparing women who received fertility therapy with those who did not. RESULTS: Six observational studies met inclusion criteria including 41,910 women who received fertility therapy and 1,400,202 women who did not. There was no increased risk of a cardiac event (pooled HR: 0.91; 95% CI: 0.67 to 1.25; I2 = 36.6%), or diabetes mellitus (pooled HR: 0.93; 95% CI: 0.87 to 1.001; I2 = 0%). Results were not pooled for hypertension (I2 = 95.0%) and venous thromboembolism (I2 = 82.3%). There was a trend toward higher risk of stroke (pooled HR: 1.25; 95% CI: 0.96 to 1.63; I2 = 0%). CONCLUSIONS: The small number of studies and significant heterogeneity precludes definitive reassurance about the longer term cardiovascular safety of these treatments, particularly stroke. Future studies are needed to address ongoing knowledge gaps in this area."},{"id":"ea1f171f351b","type":"article","url":"https://hartvaat.nl/2017/09/05/n-acetylcysteine-met-nitraat-bij-primaire-pci-voor-stemi/","title":"N-acetylcysteïne met nitraat bij primaire PCI voor STEMI","title_en":"Early Use of N-acetylcysteine With Nitrate Therapy in Patients Undergoing Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Reduces Myocardial Infarct Size (the NACIAM Trial [N-acetylcysteine in Acute Myocardial Infarction]).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.027575","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.027575","authors":["Sivabaskari Pasupathy","Rosanna Tavella","Suchi Grover","Betty Raman","Nathan E K Procter","Yang Timothy Du","Gnanadevan Mahadavan","Irene Stafford","Tamila Heresztyn","Andrew Holmes","Christopher Zeitz","Margaret Arstall","Joseph Selvanayagam","John D Horowitz","John F Beltrame"],"significance":5,"published":"2017-09-05","source_date":"2017-09-05","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study tested whether combining N-acetylcysteine with nitrate therapy during primary PCI for STEMI provides additional cardioprotection, exploring antioxidant strategies for limiting reperfusion injury.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T13:26:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de combinatie van N-acetylcysteïne met nitraat voor beperking van reperfusieschade bij primaire PCI voor STEMI.","abstract_original":"BACKGROUND: Contemporary ST-segment-elevation myocardial infarction management involves primary percutaneous coronary intervention, with ongoing studies focusing on infarct size reduction using ancillary therapies. N-acetylcysteine (NAC) is an antioxidant with reactive oxygen species scavenging properties that also potentiates the effects of nitroglycerin and thus represents a potentially beneficial ancillary therapy in primary percutaneous coronary intervention. The NACIAM trial (N-acetylcysteine in Acute Myocardial Infarction) examined the effects of NAC on infarct size in patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention. METHODS: This randomized, double-blind, placebo-controlled, multicenter study evaluated the effects of intravenous high-dose NAC (29 g over 2 days) with background low-dose nitroglycerin (7.2 mg over 2 days) on early cardiac magnetic resonance imaging-assessed infarct size. Secondary end points included cardiac magnetic resonance-determined myocardial salvage and creatine kinase kinetics. RESULTS: Of 112 randomized patients with ST-segment-elevation myocardial infarction, 75 (37 in NAC group, 38 in placebo group) underwent early cardiac magnetic resonance imaging. Median duration of ischemia pretreatment was 2.4 hours. With background nitroglycerin infusion administered to all patients, those randomized to NAC exhibited an absolute 5.5% reduction in cardiac magnetic resonance-assessed infarct size relative to placebo (median, 11.0%; [interquartile range 4.1, 16.3] versus 16.5%; [interquartile range 10.7, 24.2]; P=0.02). Myocardial salvage was approximately doubled in the NAC group (60%; interquartile range, 37-79) compared with placebo (27%; interquartile range, 14-42; P<0.01) and median creatine kinase areas under the curve were 22 000 and 38 000 IU·h in the NAC and placebo groups, respectively (P=0.08). CONCLUSIONS: High-dose intravenous NAC administered with low-dose intravenous nitroglycerin is associated with reduced infarct size in patients with ST-segment-elevation myocardial infarction undergoing percutaneous coronary intervention. A larger study is required to assess the impact of this therapy on clinical cardiac outcomes. CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry. URL: http://www.anzctr.org.au/. Unique identifier: 12610000280000."},{"id":"5c0f53cb3cbe","type":"article","url":"https://hartvaat.nl/2017/09/01/spironolacton-bij-acuut-hartfalen-de-athena-hf-gerandomiseerde-trial/","title":"Spironolacton bij acuut hartfalen: de ATHENA-HF gerandomiseerde trial","title_en":"Efficacy and Safety of Spironolactone in Acute Heart Failure: The ATHENA-HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","answer-hf","bisoprolol","dapa-hf","emperor-trials","finearts-hf","pathfinder-trial","sacubitril-valsartan","step-hfpef"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.2198","source_url":"https://doi.org/10.1001/jamacardio.2017.2198","authors":["Javed Butler","Kevin J Anstrom","G Michael Felker","Michael M Givertz","Andreas P Kalogeropoulos","Marvin A Konstam","Douglas L Mann","Kenneth B Margulies","Steven E McNulty","Robert J Mentz","Margaret M Redfield","W H Wilson Tang","David J Whellan","Monica Shah","Patrice Desvigne-Nickens","Adrian F Hernandez","Eugene Braunwald"],"significance":7,"published":"2017-09-01","source_date":"2017-09-01","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/","https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/"],"congress":"","summary_en":"The ATHENA-HF trial showed that high-dose spironolactone (100 mg) in acute heart failure did not improve natriuretic peptide levels or clinical outcomes compared with low-dose or no spironolactone, arguing against aggressive MRA dosing in the acute setting.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology ATHENA-HF-trial die hooggedoseerd spironolacton onderzocht bij acuut hartfalen. Geen klinisch voordeel — negatieve trial voor MRA-intensivering in de acute fase.","abstract_original":"IMPORTANCE: Persistent congestion is associated with worse outcomes in acute heart failure (AHF). Mineralocorticoid receptor antagonists administered at high doses may relieve congestion, overcome diuretic resistance, and mitigate the effects of adverse neurohormonal activation in AHF. OBJECTIVE: To assess the effect of high-dose spironolactone and usual care on N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels compared with usual care alone. DESIGN, SETTING, AND PARTICIPANTS: This double-blind and placebo (or low-dose)-controlled randomized clinical trial was conducted in 22 US acute care hospitals among patients with AHF who were previously receiving no or low-dose (12.5 mg or 25 mg daily) spironolactone and had NT-proBNP levels of 1000 pg/mL or more or B-type natriuretic peptide levels of 250 pg/mL or more, regardless of ejection fraction. INTERVENTIONS: High-dose spironolactone (100 mg) vs placebo or 25 mg spironolactone (usual care) daily for 96 hours. MAIN OUTCOMES AND MEASURES: The primary end point was the change in NT-proBNP levels from baseline to 96 hours. Secondary end points included the clinical congestion score, dyspnea assessment, net urine output, and net weight change. Safety end points included hyperkalemia and changes in renal function. RESULTS: A total of 360 patients were randomized, of whom the median age was 65 years, 129 (36%) were women, 200 (55.5%) were white, 151 (42%) were black, 8 (2%) were Hispanic or Latino, 9 (2.5%) were of other race/ethnicity, and the median left ventricular ejection fraction was 34%. Baseline median (interquartile range) NT-proBNP levels were 4601 (2697-9596) pg/mL among the group treated with high-dose spironolactone and 3753 (1968-7633) pg/mL among the group who received usual care. There was no significant difference in the log NT-proBNP reduction between the 2 groups (-0.55 [95% CI, -0.92 to -0.18] with high-dose spironolactone and -0.49 [95% CI, -0.98 to -0.14] with usual care, P = .57). None of the secondary end point or day-30 all-cause mortality or heart failure hospitalization rate differed between the 2 groups. The changes in serum potassium and estimated glomerular filtration rate at 24, 48, 72, and 96 hours. were similar between the 2 groups. CONCLUSIONS AND RELEVANCE: Adding treatment with high-dose spironolactone to usual care for patients with AHF for 96 hours was well tolerated but did not improve the primary or secondary efficacy end points. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02235077."},{"id":"9765d97d8413","type":"article","url":"https://hartvaat.nl/2017/09/01/late-trombotische-events-na-bioresorbeerbare-scaffold-meta-analyse-van-gerandomi/","title":"Late trombotische events na bioresorbeerbare scaffold: meta-analyse van gerandomiseerde trials","title_en":"Late thrombotic events after bioresorbable scaffold implantation: a systematic review and meta-analysis of randomized clinical trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx155","source_url":"https://doi.org/10.1093/eurheartj/ehx155","authors":["Carlos Collet","Taku Asano","Yosuke Miyazaki","Erhan Tenekecioglu","Yuki Katagiri","Yohei Sotomi","Rafael Cavalcante","Robbert J de Winter","Takeshi Kimura","Runlin Gao","Serban Puricel","Stéphane Cook","Davide Capodanno","Yoshinobu Onuma","Patrick W Serruys"],"significance":7,"published":"2017-09-01","source_date":"2017-09-01","image":"","kennis":["https://hartvaat.nl/kennis/ritmestoornissen/implanteerbare-loop-recorder/","https://hartvaat.nl/kennis/cardiometabool/inflammatie-en-atherosclerose/"],"congress":"","summary_en":"This meta-analysis quantified the risk of late thrombotic events after bioresorbable scaffold implantation, demonstrating a significantly higher rate of very late scaffold thrombosis compared with metallic everolimus-eluting stents.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T13:26:10Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die het risico op late trombotische events na bioresorbeerbare scaffold-implantatie kwantificeerde. Definitief bewijs voor het verhoogde langetermijnrisico.","abstract_original":"AIMS: To compare the long-term safety and efficacy of bioresorbable vascular scaffold (BVS) with everolimus-eluting stent (EES) after percutaneous coronary interventions. METHODS AND RESULTS: A systematic review and meta-analysis of randomized clinical trials comparing clinical outcomes of patients treated with BVS and EES with at least 24 months follow-up was performed. Adjusted random-effect model by the Knapp-Hartung method was used to compute odds ratios (OR) and 95% confidence intervals (CI). The primary safety outcome of interest was the risk of definite/probable device thrombosis (DT). The primary efficacy outcome of interest was the risk of target lesion failure (TLF). Five randomized clinical trials (n = 1730) were included. Patients treated with Absorb BVS had a higher risk of definite/probable DT compared with patients treated with EES (OR 2.93, 95%CI 1.37-6.26, P = 0.01). Very late DT (VLDT) occurred in 13 patients [12/996 (1.4%, 95%CI: 0.08-2.5) Absorb BVS vs. 1/701 (0.5%, 95%CI: 0.2-1.6) EES; OR 3.04; 95%CI 1.2-7.68, P = 0.03], 92% of the VLDT in the BVS group occurred in the absence of dual antiplatelet therapy (DAPT). Patients treated with Absorb BVS had a trend towards higher risk of TLF (OR 1.48, 95%CI 0.90-2.42, P = 0.09), driven by a higher risk of target vessel myocardial infarction and ischaemia-driven target lesion revascularization. No difference was found in the risk of cardiac death. CONCLUSION: Compared with EES, the use of Absorb BVS was associated with a higher rate of DT and a trend towards higher risk of TLF. VLDT occurred in 1.4% of the patients, the majority of these events occurred in the absence of DAPT."},{"id":"e12bfe145b2c","type":"article","url":"https://hartvaat.nl/2017/09/01/validiteit-en-reproduceerbaarheid-van-echocardiografie-bij-af-systematische-revi/","title":"Validiteit en reproduceerbaarheid van echocardiografie bij AF: systematische review","title_en":"Is echocardiography valid and reproducible in patients with atrial fibrillation? A systematic review.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["echocardiografie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/eux027","source_url":"https://doi.org/10.1093/europace/eux027","authors":["Dipak Kotecha","Mohamed Mohamed","Eduard Shantsila","Bogdan A Popescu","Richard P Steeds"],"significance":5,"published":"2017-09-01","source_date":"2017-09-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This systematic review evaluated the validity and reproducibility of echocardiographic measurements in patients with atrial fibrillation, addressing the technical challenges of cardiac imaging in irregular rhythms.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die onderzocht of echocardiografische metingen valide en reproduceerbaar zijn bij patiënten met atriumfibrilleren. Methodologisch relevant voor AF-onderzoek.","abstract_original":"AIMS: Echocardiography is vital in the routine assessment and management of atrial fibrillation (AF). We performed a systematic review of the validity and reproducibility of echocardiographic left ventricular systolic and diastolic function in AF, and optimal acquisition methods. METHODS AND RESULTS: Online databases were searched for studies in patients with AF at the time of echocardiography (1960 to August 2015), prospectively registered with PROSPERO (CRD42015025297). The systematic review included 32 studies from 3 066 search results (1 968 patients with AF). Average age was 67 years, 33% were women, mean LVEF 53% (±10%), and average E/e' 11.7 (±2.7). Data on the validity and reproducibility of systolic indices were extremely limited. In contrast, diastolic parameters demonstrated correlation with invasive filling pressure and adequate reproducibility: E/e' (n = 444) r = 0.47 to 0.79; IVRT (n = 177) r = -0.70 to -0.95; E/Vp` (n = 55) r = 0.63 and 0.65; pulmonary vein diastolic flow (n = 67) r = -0.80 and -0.91. Elevated E/e' (>15) was associated with functional capacity, quality of life, and impaired prognosis. For optimal acquisition in AF patients, cardiac cycles with controlled heart rate (<100 beats/min) and similar preceding and pre-preceding RR intervals are required. Cardiac cycle length and equivalence were more important than the number of beats averaged. CONCLUSION: With careful selection of appropriate cardiac cycles, echocardiography is a valid tool to identify diastolic dysfunction in AF, and E/e' is an independent marker of clinical status and adverse prognosis. However, data on systolic function was extremely limited and requires further prospective study and assessment of variability in clinical practice."},{"id":"54ef08dff4bc","type":"article","url":"https://hartvaat.nl/2017/09/01/budapest-crt-upgrade-study-studieontwerp-voor-crt-upgrade/","title":"BUDAPEST-CRT Upgrade Study: studieontwerp voor CRT-upgrade","title_en":"Rationale and design of the BUDAPEST-CRT Upgrade Study: a prospective, randomized, multicentre clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw193","source_url":"https://doi.org/10.1093/europace/euw193","authors":["Bela Merkely","Annamaria Kosztin","Attila Roka","Laszlo Geller","Endre Zima","Attila Kovacs","Andras Mihaly Boros","Helmut Klein","Jerzy K Wranicz","Gerhard Hindricks","Marcell Clemens","Gabor Z Duray","Arthur J Moss","Ilan Goldenberg","Valentina Kutyifa"],"significance":5,"published":"2017-09-01","source_date":"2017-09-01","image":"","kennis":[],"congress":"","summary_en":"This protocol described the BUDAPEST-CRT Upgrade Study, a randomized trial testing CRT upgrade in patients with right ventricular pacing-induced cardiomyopathy, addressing a common clinical scenario lacking randomized evidence.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Protocol van de BUDAPEST-CRT Upgrade Study naar CRT-upgrade bij patiënten met rechtkamerpacing-geïnduceerde cardiomyopathie.","abstract_original":"AIMS: There is lack of conclusive evidence from randomized clinical trials on the efficacy and safety of upgrade to cardiac resynchronization therapy (CRT) in patients with implanted pacemakers (PM) or defibrillators (ICD) with reduced left ventricular ejection fraction (LVEF) and chronic heart failure (HF). The BUDAPEST-CRT Upgrade Study was designed to compare the efficacy and safety of CRT upgrade from conventional PM or ICD therapy in patients with intermittent or permanent right ventricular (RV) septal/apical pacing, reduced LVEF, and symptomatic HF. METHODS AND RESULTS: The BUDAPEST-CRT study is a prospective, randomized, multicentre, investigator-sponsored clinical trial. A total of 360 subjects will be enrolled with LVEF ≤ 35%, NYHA functional classes II-IVa, paced QRS ≥ 150 ms, and a RV pacing ≥ 20%. Patients will be followed for 12 months. Randomization is performed in a 3:2 ratio (CRT-D vs. ICD). The primary composite endpoint is all-cause mortality, a first HF event, or less than 15% reduction in left ventricular (LV) end-systolic volume at 12 months. Secondary endpoints are all-cause mortality, all-cause mortality or HF event, and LV volume reduction at 12 months. Tertiary endpoints include changes in quality of life, NYHA functional class, 6 min walk test, natriuretic peptides, and safety outcomes. CONCLUSION: The results of our prospective, randomized, multicentre clinical trial will provide important information on the role of cardiac resynchronization therapy with defibrillator (CRT-D) upgrade in patients with symptomatic HF, reduced LVEF, and wide-paced QRS with intermittent or permanent RV pacing. CLINICAL TRIALS.GOV IDENTIFIER: NCT02270840."},{"id":"971f5e634d06","type":"article","url":"https://hartvaat.nl/2017/09/01/slagvolume-en-cardiovasculair-risico-bij-progressie-van-aortaklepstenose/","title":"Slagvolume en cardiovasculair risico bij progressie van aortaklepstenose","title_en":"Impact of stroke volume on cardiovascular risk during progression of aortic valve stenosis.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["acuut-hartfalen","aortainsufficiëntie","aortastenose","aperitif-trial","biomarkers-cardiovasculair","flow-trial","inflammatie","ouderen","roken","slaapapneu","voeding-hart"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310917","source_url":"https://doi.org/10.1136/heartjnl-2016-310917","authors":["Mai Tone Lønnebakken","Giovanni De Simone","Sahrai Saeed","Kurt Boman","Anne B Rossebø","Edda Bahlmann","Christa Gohlke-Bärwolf","Eva Gerdts"],"significance":6,"published":"2017-09-01","source_date":"2017-09-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This study showed that low stroke volume during aortic stenosis progression is an independent predictor of cardiovascular mortality, supporting the clinical importance of low-flow states in valvular heart disease risk assessment.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van slagvolume op cardiovasculair risico tijdens progressie van aortaklepstenose. Low-flow status als onafhankelijke risicofactor.","abstract_original":"OBJECTIVE: In severe aortic valve stenosis (AS), low left ventricular (LV) stroke volume has been associated with increased cardiovascular (CV) mortality, but this association has not been explored during progression of AS in a large prospective study. METHODS: In 1671 patients from the Simvastatin Ezetimibe in Aortic Stenosis (SEAS) study, the association of stroke volume indexed for body surface area (SVI) with major CV events during a median of 4.3-year follow-up was assessed in Cox and time-varying Cox regression analyses. Low SVI was defined as <35 mL/m2. RESULTS: Peak aortic jet velocity in the total study population was 3.1 ±0.7 m/s. Low SVI was found in 23% at baseline and associated with higher age, body mass index (BMI), heart rate and global LV load, and with lower mean aortic gradient, aortic valve area index, energy loss index, LV mass and ejection fraction and more often inconsistent AS grading (all p<0.05). A 5 mL/m2 lower SVI at baseline was associated with higher HRs of major CV events (n=544) (HR 1.09, 95% CI 1.05 to 1.13, p<0.001) and higher total mortality (n=147) (HR 1.08, 95% CI 1.01 to 1.16, p=0.038), independent of age, sex, atrial fibrillation, mean aortic gradient, LV ejection fraction, LV mass, BMI and study treatment. Adjusting for the same covariates, low SVI at baseline and in-study low SVI were also associated with increased rate of major CV events. CONCLUSION: In patients with AS in the SEAS study, lower baseline SVI was associated with higher HR of major CV events and total mortality independent of major confounders. TRIAL REGISTRATION NUMBER: NCT00092677: Results."},{"id":"0be0a0e1da69","type":"article","url":"https://hartvaat.nl/2017/09/01/provisional-versus-twee-stentstrategie-bij-bifurcatielaesies-meta-analyse/","title":"Provisional versus twee-stentstrategie bij bifurcatielaesies: meta-analyse","title_en":"Long-term outcomes of provisional stenting compared with a two-stent strategy for bifurcation lesions: a meta-analysis of randomised trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310929","source_url":"https://doi.org/10.1136/heartjnl-2016-310929","authors":["Ramez Nairooz","Marwan Saad","Islam Y Elgendy","Ahmed N Mahmoud","Fuad Habash","Partha Sardar","David Anderson","David M Shavelle","J Dawn Abbott"],"significance":7,"published":"2017-09-01","source_date":"2017-09-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This meta-analysis of randomized trials comparing provisional stenting with a two-stent strategy for coronary bifurcation lesions showed similar long-term outcomes, supporting the simpler provisional approach as the default strategy.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van gerandomiseerde trials die provisional stenting vergeleek met een twee-stentstrategie bij coronaire bifurcatielaesies. Bevestigt provisional als standaardbenadering.","abstract_original":"BACKGROUND: The optimal interventional technique for addressing coronary bifurcation lesions is debatable. Long-term clinical outcomes with provisional stenting (PS) compared with a two-stent (TS) strategy for bifurcation lesions are scarce. We aim to perform the first meta-analysis of randomised controlled trials (RCTs) to explore long-term outcomes comparing both strategies. METHODS: An electronic search was performed for online databases until August 2016 for RCTs comparing PS with TS for bifurcation lesions reporting outcomes at 1 year of follow-up or more. Random effects model risk ratios (RRs) were calculated for outcomes of interest. RESULTS: Eight RCTs with a total of 2778 patients reported long-term clinical outcomes. At mean follow-up of 3.0±1.6 years, PS was associated with lower risk of all-cause mortality (RR=0.66; 95% CI 0.45 to 0.98; p=0.04) compared with TS for bifurcation lesions. No difference was observed with PS compared with TS regarding major adverse cardiac events (MACE), myocardial infarction (MI), target lesion revascularisation (TLR) or stent thrombosis (ST). In a sensitivity analysis limited to trials with follow-up duration ≥3 years, PS was associated with lower risk of all-cause mortality (RR=0.57; 95% CI 0.36 to 0.88; p=0.01), MACE (RR=0.71; 95% CI 0.52 to 0.97; p=0.03) and MI (RR=0.45; 95% CI 0.21 to 0.96; p=0.04) compared with TS, at mean follow-up of 4.6±0.7 years. The risk of TLR and ST remained similar with both strategies (RR=0.81; 95% CI 0.57 to 1.15; p=0.24; and RR=0.75; 95% CI 0.19 to 2.84; p=0.67 respectively). Meta-regression analyses identified increased risk of MACE with PS in patients presenting with acute coronary syndrome (p=0.05). CONCLUSION: PS may be associated with a long-term mortality benefit compared with a TS strategy for coronary bifurcation lesions."},{"id":"43311c493b6c","type":"article","url":"https://hartvaat.nl/2017/08/29/rosuvastatine-bij-kinderen-met-homozygote-familiaire-hypercholesterolemie/","title":"Rosuvastatine bij kinderen met homozygote familiaire hypercholesterolemie","title_en":"Efficacy of Rosuvastatin in Children With Homozygous Familial Hypercholesterolemia and Association With Underlying Genetic Mutations.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["atorvastatine","cardiovasculaire-genetica","familiaire-hypercholesterolemie","familiaire-hypercholesterolemie-screening","ldl-cholesterol","rosuvastatine","statines"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.06.058","source_url":"https://doi.org/10.1016/j.jacc.2017.06.058","authors":["Evan A Stein","Eldad J Dann","Albert Wiegman","Flemming Skovby","Daniel Gaudet","Etienne Sokal","Min-Ji Charng","Mafauzy Mohamed","Ilse Luirink","Joel S Raichlen","Mattias Sundén","Stefan C Carlsson","Frederick J Raal","John J P Kastelein"],"significance":6,"published":"2017-08-29","source_date":"2017-08-29","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/"],"congress":"","summary_en":"This study evaluated rosuvastatin efficacy in children with homozygous FH stratified by underlying genetic mutations, showing that LDL-receptor activity determines statin responsiveness in this severe genetic disorder.","created":"2026-07-03T10:26:52Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de werkzaamheid van rosuvastatine bij kinderen met homozygote FH en de associatie met onderliggende genetische mutaties. Gepersonaliseerde lipidenverlaging bij de zwaarste FH-vormen.","abstract_original":"BACKGROUND: Homozygous familial hypercholesterolemia (HoFH), a rare genetic disorder, is characterized by extremely elevated levels of low-density lipoprotein cholesterol (LDL-C) and accelerated atherosclerotic cardiovascular disease. Statin treatment starts at diagnosis, but no statin has been formally evaluated in, or approved for, HoFH children. OBJECTIVES: The authors sought to assess the LDL-C efficacy of rosuvastatin versus placebo in HoFH children, and the relationship with underlying genetic mutations. METHODS: This was a randomized, double-blind, 12-week, crossover study of rosuvastatin 20 mg versus placebo, followed by 12 weeks of open-label rosuvastatin. Patients discontinued all lipid-lowering treatment except ezetimibe and/or apheresis. Clinical and laboratory assessments were performed every 6 weeks. The relationship between LDL-C response and genetic mutations was assessed by adding children and adults from a prior HoFH rosuvastatin trial. RESULTS: Twenty patients were screened, 14 randomized, and 13 completed the study. The mean age was 10.9 years; 8 patients were on ezetimibe and 7 on apheresis. Mean LDL-C was 481 mg/dl (range: 229 to 742 mg/dl) on placebo and 396 mg/dl (range: 130 to 700 mg/dl) on rosuvastatin, producing a mean 85.4 mg/dl (22.3%) difference (p = 0.005). Efficacy was similar regardless of age or use of ezetimibe or apheresis, and was maintained for 12 weeks. Adverse events were few and not serious. Patients with 2 defective versus 2 negative LDL receptor mutations had mean LDL-C reductions of 23.5% (p = 0.0044) and 14% (p = 0.038), respectively. CONCLUSIONS: This first-ever pediatric HoFH statin trial demonstrated safe and effective LDL-C reduction with rosuvastatin 20 mg alone or added to ezetimibe and/or apheresis. The LDL-C response in children and adults was related to underlying genetic mutations. (A Study to Evaluate the Efficacy and Safety of Rosuvastatin in Children and Adolescents With Homozygous Familial Hypercholesterolemia [HYDRA]; NCT02226198)."},{"id":"fe067bc0ccbd","type":"article","url":"https://hartvaat.nl/2017/08/24/intensieve-bloeddrukbehandeling-en-patientgerapporteerde-uitkomsten-nejm-sprint-/","title":"Intensieve bloeddrukbehandeling en patiëntgerapporteerde uitkomsten: NEJM SPRINT-QOL","title_en":"Effect of Intensive Blood-Pressure Treatment on Patient-Reported Outcomes.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["farmaco-economie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1611179","source_url":"https://doi.org/10.1056/NEJMoa1611179","authors":["Dan R Berlowitz","Capri G Foy","Lewis E Kazis","Linda P Bolin","Molly B Conroy","Peter Fitzpatrick","Tanya R Gure","Paul L Kimmel","Kent Kirchner","Donald E Morisky","Jill Newman","Christine Olney","Suzanne Oparil","Nicholas M Pajewski","James Powell","Thomas Ramsey","Debra L Simmons","Joni Snyder","Mark A Supiano","Daniel E Weiner","Jeff Whittle"],"significance":8,"published":"2017-08-24","source_date":"2017-08-24","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/behandeldoelen-bloeddruk/"],"congress":"","summary_en":"This SPRINT analysis found no substantial difference in patient-reported outcomes (including physical functioning, mental health, and treatment satisfaction) between intensive and standard blood pressure treatment, addressing concerns that aggressive blood pressure lowering might impair quality of life.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM analyse van SPRINT naar het effect van intensieve bloeddrukbehandeling op patiëntgerapporteerde uitkomsten. Geen substantieel verschil in kwaliteit van leven — geruststellend voor het SPRINT-protocol.","abstract_original":"BACKGROUND: The previously published results of the Systolic Blood Pressure Intervention Trial showed that among participants with hypertension and an increased cardiovascular risk, but without diabetes, the rates of cardiovascular events were lower among those who were assigned to a target systolic blood pressure of less than 120 mm Hg (intensive treatment) than among those who were assigned to a target of less than 140 mm Hg (standard treatment). Whether such intensive treatment affected patient-reported outcomes was uncertain; those results from the trial are reported here. METHODS: We randomly assigned 9361 participants with hypertension to a systolic blood-pressure target of less than 120 mm Hg or a target of less than 140 mm Hg. Patient-reported outcome measures included the scores on the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Veterans RAND 12-Item Health Survey, the Patient Health Questionnaire 9-item depression scale (PHQ-9), patient-reported satisfaction with their blood-pressure care and blood-pressure medications, and adherence to blood-pressure medications. We compared the scores in the intensive-treatment group with those in the standard-treatment group among all participants and among participants stratified according to physical and cognitive function. RESULTS: Participants who received intensive treatment received an average of one additional antihypertensive medication, and the systolic blood pressure was 14.8 mm Hg (95% confidence interval, 14.3 to 15.4) lower in the group that received intensive treatment than in the group that received standard treatment. Mean PCS, MCS, and PHQ-9 scores were relatively stable over a median of 3 years of follow-up, with no significant differences between the two treatment groups. No significant differences between the treatment groups were noted when participants were stratified according to baseline measures of physical or cognitive function. Satisfaction with blood-pressure care was high in both treatment groups, and we found no significant difference in adherence to blood-pressure medications. CONCLUSIONS: Patient-reported outcomes among participants who received intensive treatment, which targeted a systolic blood pressure of less than 120 mm Hg, were similar to those among participants who received standard treatment, including among participants with decreased physical or cognitive function. (Funded by the National Institutes of Health; SPRINT ClinicalTrials.gov number, NCT01206062 .)."},{"id":"3567ad48e228","type":"article","url":"https://hartvaat.nl/2017/08/24/degludec-versus-glargine-bij-diabetes-type-2-nejm-devote-werkzaamheid-en-veiligh/","title":"Degludec versus glargine bij diabetes type 2: NEJM DEVOTE werkzaamheid en veiligheid","title_en":"Efficacy and Safety of Degludec versus Glargine in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["select-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1615692","source_url":"https://doi.org/10.1056/NEJMoa1615692","authors":["Steven P Marso","Darren K McGuire","Bernard Zinman","Neil R Poulter","Scott S Emerson","Thomas R Pieber","Richard E Pratley","Poul-Martin Haahr","Martin Lange","Kirstine Brown-Frandsen","Alan Moses","Simon Skibsted","Kajsa Kvist","John B Buse"],"significance":8,"published":"2017-08-24","source_date":"2017-08-24","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The DEVOTE trial confirmed the cardiovascular safety of insulin degludec compared with insulin glargine in patients with type 2 diabetes at high cardiovascular risk, while demonstrating significantly fewer severe hypoglycemic episodes with degludec.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM DEVOTE-trial die insuline degludec vergeleek met glargine op cardiovasculaire veiligheid bij diabetes type 2. Bevestigt cardiovasculaire non-inferioriteit met minder hypoglykemieën.","abstract_original":"BACKGROUND: Degludec is an ultralong-acting, once-daily basal insulin that is approved for use in adults, adolescents, and children with diabetes. Previous open-label studies have shown lower day-to-day variability in the glucose-lowering effect and lower rates of hypoglycemia among patients who received degludec than among those who received basal insulin glargine. However, data are lacking on the cardiovascular safety of degludec. METHODS: We randomly assigned 7637 patients with type 2 diabetes to receive either insulin degludec (3818 patients) or insulin glargine U100 (3819 patients) once daily between dinner and bedtime in a double-blind, treat-to-target, event-driven cardiovascular outcomes trial. The primary composite outcome in the time-to-event analysis was the first occurrence of an adjudicated major cardiovascular event (death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke) with a prespecified noninferiority margin of 1.3. Adjudicated severe hypoglycemia, as defined by the American Diabetes Association, was the prespecified, multiplicity-adjusted secondary outcome. RESULTS: Of the patients who underwent randomization, 6509 (85.2%) had established cardiovascular disease, chronic kidney disease, or both. At baseline, the mean age was 65.0 years, the mean duration of diabetes was 16.4 years, and the mean (±SD) glycated hemoglobin level was 8.4±1.7%; 83.9% of the patients were receiving insulin. The primary outcome occurred in 325 patients (8.5%) in the degludec group and in 356 (9.3%) in the glargine group (hazard ratio, 0.91; 95% confidence interval, 0.78 to 1.06; P<0.001 for noninferiority). At 24 months, the mean glycated hemoglobin level was 7.5±1.2% in each group, whereas the mean fasting plasma glucose level was significantly lower in the degludec group than in the glargine group (128±56 vs. 136±57 mg per deciliter, P<0.001). Prespecified adjudicated severe hypoglycemia occurred in 187 patients (4.9%) in the degludec group and in 252 (6.6%) in the glargine group, for an absolute difference of 1.7 percentage points (rate ratio, 0.60; P<0.001 for superiority; odds ratio, 0.73; P<0.001 for superiority). Rates of adverse events did not differ between the two groups. CONCLUSIONS: Among patients with type 2 diabetes at high risk for cardiovascular events, degludec was noninferior to glargine with respect to the incidence of major cardiovascular events. (Funded by Novo Nordisk and others; DEVOTE ClinicalTrials.gov number, NCT01959529 .)."},{"id":"22e53953c0b0","type":"article","url":"https://hartvaat.nl/2017/08/22/natriuretisch-peptide-geleide-therapie-bij-hoogrisico-hartfalen-jama-guide-it/","title":"Natriuretisch peptide-geleide therapie bij hoogrisico hartfalen: JAMA GUIDE-IT","title_en":"Effect of Natriuretic Peptide-Guided Therapy on Hospitalization or Cardiovascular Mortality in High-Risk Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["emperor-trials","nt-probnp"],"journal":"JAMA","doi":"10.1001/jama.2017.10565","source_url":"https://doi.org/10.1001/jama.2017.10565","authors":["G Michael Felker","Kevin J Anstrom","Kirkwood F Adams","Justin A Ezekowitz","Mona Fiuzat","Nancy Houston-Miller","James L Januzzi","Daniel B Mark","Ileana L Piña","Gayle Passmore","David J Whellan","Hongqiu Yang","Lawton S Cooper","Eric S Leifer","Patrice Desvigne-Nickens","Christopher M O'Connor"],"significance":8,"published":"2017-08-22","source_date":"2017-08-22","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/bnp-en-nt-probnp/","https://hartvaat.nl/kennis/diagnostiek/cardiale-biomarkers-overzicht/"],"congress":"","summary_en":"The GUIDE-IT trial showed that NT-proBNP-guided heart failure therapy did not improve outcomes compared with usual care in high-risk HFrEF patients. The result suggested that biomarker-guided titration does not add benefit when clinicians already provide intensive evidence-based management.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA GUIDE-IT-trial die NT-proBNP-geleide therapie vergeleek met standaardzorg bij hoogrisico hartfalenpatiënten. Geen voordeel van biomarker-geleide intensivering — belangrijke negatieve trial.","abstract_original":"IMPORTANCE: The natriuretic peptides are biochemical markers of heart failure (HF) severity and predictors of adverse outcomes. Smaller studies have evaluated adjusting HF therapy based on natriuretic peptide levels (\"guided therapy\") with inconsistent results. OBJECTIVE: To determine whether an amino-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided treatment strategy improves clinical outcomes vs usual care in high-risk patients with HF and reduced ejection fraction (HFrEF). DESIGN, SETTINGS, AND PARTICIPANTS: The Guiding Evidence Based Therapy Using Biomarker Intensified Treatment in Heart Failure (GUIDE-IT) study was a randomized multicenter clinical trial conducted between January 16, 2013, and September 20, 2016, at 45 clinical sites in the United States and Canada. This study planned to randomize 1100 patients with HFrEF (ejection fraction ≤40%), elevated natriuretic peptide levels within the prior 30 days, and a history of a prior HF event (HF hospitalization or equivalent) to either an NT-proBNP-guided strategy or usual care. INTERVENTIONS: Patients were randomized to either an NT-proBNP-guided strategy or usual care. Patients randomized to the guided strategy (n = 446) had HF therapy titrated with the goal of achieving a target NT-proBNP of less than 1000 pg/mL. Patients randomized to usual care (n = 448) had HF care in accordance with published guidelines, with emphasis on titration of proven neurohormonal therapies for HF. Serial measurement of NT-proBNP testing was discouraged in the usual care group. MAIN OUTCOMES AND MEASURES: The primary end point was the composite of time-to-first HF hospitalization or cardiovascular mortality. Prespecified secondary end points included all-cause mortality, total hospitalizations for HF, days alive and not hospitalized for cardiovascular reasons, the individual components on the primary end point, and adverse events. RESULTS: The data and safety monitoring board recommended stopping the study for futility when 894 (median age, 63 years; 286 [32%] women) of the planned 1100 patients had been enrolled with follow-up for a median of 15 months. The primary end point occurred in 164 patients (37%) in the biomarker-guided group and 164 patients (37%) in the usual care group (adjusted hazard ratio [HR], 0.98; 95% CI, 0.79-1.22; P = .88). Cardiovascular mortality was 12% (n = 53) in the biomarker-guided group and 13% (n = 57) in the usual care group (HR, 0.94; 95% CI; 0.65-1.37; P = .75). None of the secondary end points nor the decreases in the NT-proBNP levels achieved differed significantly between groups. CONCLUSIONS AND RELEVANCE: In high-risk patients with HFrEF, a strategy of NT-proBNP-guided therapy was not more effective than a usual care strategy in improving outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01685840."},{"id":"85173a692565","type":"article","url":"https://hartvaat.nl/2017/08/19/vergelijking-van-fibrinolytica-bij-stemi-lancet-netwerkmeta-analyse/","title":"Vergelijking van fibrinolytica bij STEMI: Lancet netwerkmeta-analyse","title_en":"Comparative efficacy and safety of reperfusion therapy with fibrinolytic agents in patients with ST-segment elevation myocardial infarction: a systematic review and network meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)31441-1","source_url":"https://doi.org/10.1016/S0140-6736(17)31441-1","authors":["Peerawat Jinatongthai","Junporn Kongwatcharapong","Chee Yoong Foo","Arintaya Phrommintikul","Surakit Nathisuwan","Ammarin Thakkinstian","Christopher M Reid","Nathorn Chaiyakunapruk"],"significance":7,"published":"2017-08-19","source_date":"2017-08-19","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-ckd/","https://hartvaat.nl/kennis/vasculair/antistolling-bij-vte/"],"congress":"","summary_en":"This Lancet network meta-analysis compared the efficacy and safety of different fibrinolytic agents for STEMI, providing a comparative effectiveness framework for settings where primary PCI is unavailable.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet netwerkmeta-analyse die de vergelijkende werkzaamheid en veiligheid van fibrinolytische middelen bij STEMI evalueerde. Referentie voor de keuze van trombolyticum.","abstract_original":"BACKGROUND: Fibrinolytic therapy offers an alternative to mechanical reperfusion for ST-segment elevation myocardial infarction (STEMI) in settings where health-care resources are scarce. Comprehensive evidence comparing different agents is still unavailable. In this study, we examined the effects of various fibrinolytic drugs on clinical outcomes. METHODS: We did a network meta-analysis based on a systematic review of randomised controlled trials comparing fibrinolytic drugs in patients with STEMI. Several databases were searched from inception up to Feb 28, 2017. We included only randomised controlled trials that compared fibrinolytic agents as a reperfusion therapy in adult patients with STEMI, whether given alone or in combination with adjunctive antithrombotic therapy, against other fibrinolytic agents, a placebo, or no treatment. Only trials investigating agents with an approved indication of reperfusion therapy in STEMI (streptokinase, tenecteplase, alteplase, and reteplase) were included. The primary efficacy outcome was all-cause mortality within 30-35 days and the primary safety outcome was major bleeding. This study is registered with PROSPERO (CRD42016042131). FINDINGS: A total of 40 eligible studies involving 128 071 patients treated with 12 different fibrinolytic regimens were assessed. Compared with accelerated infusion of alteplase with parenteral anticoagulants as background therapy, streptokinase and non-accelerated infusion of alteplase were significantly associated with an increased risk of all-cause mortality (risk ratio [RR] 1·14 [95% CI 1·05-1·24] for streptokinase plus parenteral anticoagulants; RR 1·26 [1·10-1·45] for non-accelerated alteplase plus parenteral anticoagulants). No significant difference in mortality risk was recorded between accelerated infusion of alteplase, tenecteplase, and reteplase with parenteral anticoagulants as background therapy. For major bleeding, a tenecteplase-based regimen tended to be associated with lower risk of bleeding compared with other regimens (RR 0·79 [95% CI 0·63-1·00]). The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy increased the risk of major bleeding by 1·27-8·82-times compared with accelerated infusion alteplase plus parenteral anticoagulants (RR 1·47 [95% CI 1·10-1·98] for tenecteplase plus parenteral anticoagulants plus glycoprotein inhibitors; RR 1·88 [1·24-2·86] for reteplase plus parenteral anticoagulants plus glycoprotein inhibitors). INTERPRETATION: Significant differences exist among various fibrinolytic regimens as reperfusion therapy in STEMI and alteplase (accelerated infusion), tenecteplase, and reteplase should be considered over streptokinase and non-accelerated infusion of alteplase. The addition of glycoprotein IIb or IIIa inhibitors to fibrinolytic therapy should be discouraged. FUNDING: None."},{"id":"a15989ebb6fa","type":"article","url":"https://hartvaat.nl/2017/08/19/optimale-timing-van-invasieve-strategie-bij-nste-acs-lancet-meta-analyse/","title":"Optimale timing van invasieve strategie bij NSTE-ACS: Lancet meta-analyse","title_en":"Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: a meta-analysis of randomised trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)31490-3","source_url":"https://doi.org/10.1016/S0140-6736(17)31490-3","authors":["Alexander Jobs","Shamir R Mehta","Gilles Montalescot","Eric Vicaut","Arnoud W J Van't Hof","Erik A Badings","Franz-Josef Neumann","Adnan Kastrati","Alessandro Sciahbasi","Paul-Georges Reuter","Frédéric Lapostolle","Aleksandra Milosevic","Goran Stankovic","Dejan Milasinovic","Reinhard Vonthein","Steffen Desch","Holger Thiele"],"significance":8,"published":"2017-08-19","source_date":"2017-08-19","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/"],"congress":"","summary_en":"This Lancet meta-analysis of randomized trials examined the optimal timing of invasive strategy in non-ST-elevation ACS, finding that very early intervention (within 24 hours) reduced recurrent ischemia in high-risk patients but did not significantly reduce death or MI compared with delayed intervention.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:09Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet meta-analyse van gerandomiseerde trials naar de optimale timing van een invasieve strategie bij NSTE-ACS. Vroegtijdige versus uitgestelde invasieve benadering.","abstract_original":"BACKGROUND: A routine invasive strategy is recommended for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, optimal timing of invasive strategy is less clearly defined. Individual clinical trials were underpowered to detect a mortality benefit; we therefore did a meta-analysis to assess the effect of timing on mortality. METHODS: We identified randomised controlled trials comparing an early versus a delayed invasive strategy in patients presenting with NSTE-ACS by searching MEDLINE, Cochrane Central Register of Controlled Trials, and Embase. We included trials that reported all-cause mortality at least 30 days after in-hospital randomisation and for which the trial investigators agreed to collaborate (ie, providing individual patient data or standardised tabulated data). We pooled hazard ratios (HRs) using random-effects models. This meta-analysis is registered at PROSPERO (CRD42015018988). FINDINGS: We included eight trials (n=5324 patients) with a median follow-up of 180 days (IQR 180-360). Overall, there was no significant mortality reduction in the early invasive group compared with the delayed invasive group HR 0·81, 95% CI 0·64-1·03; p=0·0879). In pre-specified analyses of high-risk patients, we found lower mortality with an early invasive strategy in patients with elevated cardiac biomarkers at baseline (HR 0·761, 95% CI 0·581-0·996), diabetes (0·67, 0·45-0·99), a GRACE risk score more than 140 (0·70, 0·52-0·95), and aged 75 years older (0·65, 0·46-0·93), although tests for interaction were inconclusive. INTERPRETATION: An early invasive strategy does not reduce mortality compared with a delayed invasive strategy in all patients with NSTE-ACS. However, an early invasive strategy might reduce mortality in high-risk patients. FUNDING: None."},{"id":"b1c7194777ac","type":"article","url":"https://hartvaat.nl/2017/08/19/absorb-bioresorbeerbare-scaffold-lancet-2-jaars-systematische-review-en-meta-ana/","title":"Absorb bioresorbeerbare scaffold: Lancet 2-jaars systematische review en meta-analyse","title_en":"2-year outcomes with the Absorb bioresorbable scaffold for treatment of coronary artery disease: a systematic review and meta-analysis of seven randomised trials with an individual patient data substudy.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)31470-8","source_url":"https://doi.org/10.1016/S0140-6736(17)31470-8","authors":["Ziad A Ali","Patrick W Serruys","Takeshi Kimura","Runlin Gao","Stephen G Ellis","Dean J Kereiakes","Yoshinobu Onuma","Charles Simonton","Zhen Zhang","Gregg W Stone"],"significance":7,"published":"2017-08-19","source_date":"2017-08-19","image":"","kennis":[],"congress":"","summary_en":"This Lancet systematic review of 2-year Absorb bioresorbable scaffold outcomes showed accumulating evidence of inferior safety compared with metallic DES, including higher rates of scaffold thrombosis and target lesion failure.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet systematische review van 2-jaarsuitkomsten van de Absorb bioresorbeerbare scaffold. Cumulerend bewijs voor inferieure veiligheid vergeleken met metallic stents.","abstract_original":"BACKGROUND: Bioresorbable vascular scaffolds (BVS) offer the potential to improve long-term outcomes of percutaneous coronary intervention after their complete bioresorption. Randomised trials have shown non-inferiority between BVS and metallic drug-eluting stents at 1 year in composite safety and effectiveness outcomes, although some increases in rates of target vessel-related myocardial infarction and device thrombosis were identified. Outcomes of BVS following the first year after implantation are unknown. We sought to ascertain whether BVS are as safe and effective as drug-eluting stents within 2 years after implantation and between 1 and 2 years. METHODS: We did a systematic review and meta-analysis of randomised trials in which patients were randomly assigned to everolimus-eluting Absorb BVS or metallic everolimus-eluting stents (EES) and followed up for at least 2 years. We searched MEDLINE, the Cochrane database, TCTMD, ClinicalTrials.gov, Clinical Trial Results, CardioSource, and abstracts and presentations from major cardiovascular meetings up to April 1, 2017, to identify relevant studies. The primary efficacy outcome measure was the device-oriented composite endpoint (cardiac mortality, target vessel-related myocardial infarction, or ischaemia-driven target lesion revascularisation) and the primary safety outcome measure was definite or probable device thrombosis. Individual patient data from the four ABSORB trials were used for landmark and subgroup analysis and multivariable modelling. FINDINGS: We identified seven randomised trials in which 5583 patients were randomly assigned to Absorb BVS (n=3261) or metallic EES (n=2322) and followed up for 2 years. BVS had higher 2-year relative risks of the device-oriented composite endpoint than did EES (9·4% [304 of 3217] vs 7·4% [169 of 2299]; relative risk [RR] 1·29 [95% CI 1·08-1·56], p=0·0059). These differences were driven by increased rates of target vessel-related myocardial infarction (5·8% [187 of 3218] vs 3·2% [74 of 2299]; RR 1·68 [95% CI 1·29-2·19], p=0·0003) and ischaemia-driven target lesion revascularisation (5·3% [169 of 3217] vs 3·9% [90 of 2300]; 1·40 [1·09-1·80], p=0·0090) with BVS, with non-significant differences in cardiac mortality. The cumulative 2-year incidence of device thrombosis was higher with BVS than with EES (2·3% [73 of 3187] vs 0·7% [16 of 2281]; RR 3·35 [95% CI 1·96-5·72], p<0·0001). Landmark analysis between 1 and 2 years also showed higher rates of the device-oriented composite endpoint (3·3% [69 of 2100] vs 1·9% [23 of 1193]; RR 1·64 [95% CI 1·03-2·61], p=0·0376) and device thrombosis (0·5% [11 of 2085] vs none [0 of 1183], p<0·0001) in BVS-treated patients than in EES-treated patients. INTERPRETATION: BVS was associated with increased rates of composite device-oriented adverse events and device thrombosis cumulatively at 2 years and between 1 and 2 years of follow-up compared with EES. FUNDING: Abbott Vascular."},{"id":"2fe1f8729d89","type":"article","url":"https://hartvaat.nl/2017/08/17/cognitieve-functie-in-de-fourier-trial-met-evolocumab-nejm-ebbinghaus/","title":"Cognitieve functie in de FOURIER-trial met evolocumab: NEJM EBBINGHAUS","title_en":"Cognitive Function in a Randomized Trial of Evolocumab.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1701131","source_url":"https://doi.org/10.1056/NEJMoa1701131","authors":["Robert P Giugliano","François Mach","Kenton Zavitz","Christopher Kurtz","Kyungah Im","Estella Kanevsky","Jingjing Schneider","Huei Wang","Anthony Keech","Terje R Pedersen","Marc S Sabatine","Peter S Sever","Jennifer G Robinson","Narimon Honarpour","Scott M Wasserman","Brian R Ott"],"significance":8,"published":"2017-08-17","source_date":"2017-08-17","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/"],"congress":"","summary_en":"The EBBINGHAUS cognitive substudy of FOURIER demonstrated that evolocumab and very low LDL cholesterol levels did not adversely affect cognitive function over a median of 19 months. The results provided important reassurance about the neurocognitive safety of aggressive PCSK9 inhibition.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM EBBINGHAUS-studie die aantoonde dat evolocumab en zeer lage LDL-niveaus geen nadelig effect hebben op cognitieve functie. Geruststellend voor de veiligheid van intensieve LDL-verlaging.","abstract_original":"Background Findings from clinical trials of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors have led to concern that these drugs or the low levels of low-density lipoprotein (LDL) cholesterol that result from their use are associated with cognitive deficits. Methods In a subgroup of patients from a randomized, placebo-controlled trial of evolocumab added to statin therapy, we prospectively assessed cognitive function using the Cambridge Neuropsychological Test Automated Battery. The primary end point was the score on the spatial working memory strategy index of executive function (scores range from 4 to 28, with lower scores indicating a more efficient use of strategy and planning). Secondary end points were the scores for working memory (scores range from 0 to 279, with lower scores indicating fewer errors), episodic memory (scores range from 0 to 70, with lower scores indicating fewer errors), and psychomotor speed (scores range from 100 to 5100 msec, with faster times representing better performance). Assessments of cognitive function were performed at baseline, week 24, yearly, and at the end of the trial. The primary analysis was a noninferiority comparison of the mean change from baseline in the score on the spatial working memory strategy index of executive function between the patients who received evolocumab and those who received placebo; the noninferiority margin was set at 20% of the standard deviation of the score in the placebo group. Results A total of 1204 patients were followed for a median of 19 months; the mean (±SD) change from baseline over time in the raw score for the spatial working memory strategy index of executive function (primary end point) was -0.21±2.62 in the evolocumab group and -0.29±2.81 in the placebo group (P<0.001 for noninferiority; P=0.85 for superiority). There were no significant between-group differences in the secondary end points of scores for working memory (change in raw score, -0.52 in the evolocumab group and -0.93 in the placebo group), episodic memory (change in raw score, -1.53 and -1.53, respectively), or psychomotor speed (change in raw score, 5.2 msec and 0.9 msec, respectively). In an exploratory analysis, there were no associations between LDL cholesterol levels and cognitive changes. Conclusions In a randomized trial involving patients who received either evolocumab or placebo in addition to statin therapy, no significant between-group difference in cognitive function was observed over a median of 19 months. (Funded by Amgen; EBBINGHAUS ClinicalTrials.gov number, NCT02207634 .)."},{"id":"a0293209aef4","type":"article","url":"https://hartvaat.nl/2017/08/17/canagliflozine-en-cardiovasculaire-en-renale-events-bij-diabetes-type-2-nejm-can/","title":"Canagliflozine en cardiovasculaire en renale events bij diabetes type 2: NEJM CANVAS","title_en":"Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine","credence-trial","diabetes-en-hart","diabetes-type-2","fidelio-dkd","figaro-dkd","flow-trial","select-trial","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1611925","source_url":"https://doi.org/10.1056/NEJMoa1611925","authors":["Bruce Neal","Vlado Perkovic","Kenneth W Mahaffey","Dick de Zeeuw","Greg Fulcher","Ngozi Erondu","Wayne Shaw","Gordon Law","Mehul Desai","David R Matthews"],"significance":10,"published":"2017-08-17","source_date":"2017-08-17","image":"","kennis":["https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"The CANVAS Program showed that canagliflozin reduced the composite of cardiovascular death, nonfatal MI, and nonfatal stroke in patients with type 2 diabetes at high cardiovascular risk, while also slowing the progression of albuminuria. The trial confirmed the cardiovascular benefit as a class effect of SGLT2 inhibitors.","created":"2026-07-03T10:26:51Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM CANVAS-trial die aantoonde dat canagliflozine cardiovasculaire events vermindert bij patiënten met diabetes type 2 en hoog CV-risico. Bevestigt de klasse-effecten van SGLT2-remmers.","abstract_original":"Background Canagliflozin is a sodium-glucose cotransporter 2 inhibitor that reduces glycemia as well as blood pressure, body weight, and albuminuria in people with diabetes. We report the effects of treatment with canagliflozin on cardiovascular, renal, and safety outcomes. Methods The CANVAS Program integrated data from two trials involving a total of 10,142 participants with type 2 diabetes and high cardiovascular risk. Participants in each trial were randomly assigned to receive canagliflozin or placebo and were followed for a mean of 188.2 weeks. The primary outcome was a composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke. Results The mean age of the participants was 63.3 years, 35.8% were women, the mean duration of diabetes was 13.5 years, and 65.6% had a history of cardiovascular disease. The rate of the primary outcome was lower with canagliflozin than with placebo (occurring in 26.9 vs. 31.5 participants per 1000 patient-years; hazard ratio, 0.86; 95% confidence interval [CI], 0.75 to 0.97; P<0.001 for noninferiority; P=0.02 for superiority). Although on the basis of the prespecified hypothesis testing sequence the renal outcomes are not viewed as statistically significant, the results showed a possible benefit of canagliflozin with respect to the progression of albuminuria (hazard ratio, 0.73; 95% CI, 0.67 to 0.79) and the composite outcome of a sustained 40% reduction in the estimated glomerular filtration rate, the need for renal-replacement therapy, or death from renal causes (hazard ratio, 0.60; 95% CI, 0.47 to 0.77). Adverse reactions were consistent with the previously reported risks associated with canagliflozin except for an increased risk of amputation (6.3 vs. 3.4 participants per 1000 patient-years; hazard ratio, 1.97; 95% CI, 1.41 to 2.75); amputations were primarily at the level of the toe or metatarsal. Conclusions In two trials involving patients with type 2 diabetes and an elevated risk of cardiovascular disease, patients treated with canagliflozin had a lower risk of cardiovascular events than those who received placebo but a greater risk of amputation, primarily at the level of the toe or metatarsal. (Funded by Janssen Research and Development; CANVAS and CANVAS-R ClinicalTrials.gov numbers, NCT01032629 and NCT01989754 , respectively.)."},{"id":"28099f794b67","type":"article","url":"https://hartvaat.nl/2017/08/15/fijnstofblootstelling-en-stresshormoonspiegels-gerandomiseerde-luchtzuiveringstr/","title":"Fijnstofblootstelling en stresshormoonspiegels: gerandomiseerde luchtzuiveringstrial","title_en":"Particulate Matter Exposure and Stress Hormone Levels: A Randomized, Double-Blind, Crossover Trial of Air Purification.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["stress-psychosociaal","vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.026796","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.026796","authors":["Huichu Li","Jing Cai","Renjie Chen","Zhuohui Zhao","Zhekang Ying","Lin Wang","Jianmin Chen","Ke Hao","Patrick L Kinney","Honglei Chen","Haidong Kan"],"significance":6,"published":"2017-08-15","source_date":"2017-08-15","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/preventie/luchtvervuiling-cardiovasculair-risico/"],"congress":"","summary_en":"This randomized double-blind crossover trial used air purifiers to demonstrate that particulate matter exposure increases stress hormone levels, providing a mechanistic link between air pollution and cardiovascular risk through sympathetic activation.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde dubbelblinde crossover-trial die het effect van fijnstofblootstelling op stresshormoonspiegels onderzocht middels luchtzuivering. Mechanistisch inzicht in de cardiovasculaire effecten van luchtvervuiling.","abstract_original":"BACKGROUND: Exposure to ambient particulate matter (PM) is associated with a number of adverse health outcomes, but potential mechanisms are largely unknown. Metabolomics represents a powerful approach to study global metabolic changes in response to environmental exposures. We therefore conducted this study to investigate changes in serum metabolites in response to the reduction of PM exposure among healthy college students. METHODS: We conducted a randomized, double-blind crossover trial in 55 healthy college students in Shanghai, China. Real and sham air purifiers were placed in participants' dormitories in random order for 9 days with a 12-day washout period. Serum metabolites were quantified by using gas chromatography-mass spectrometry and ultrahigh performance liquid chromatography-mass spectrometry. Between-treatment differences in metabolites were examined using orthogonal partial least square-discriminant analysis and mixed-effect models. Secondary outcomes include blood pressure, corticotropin-releasing hormone, adrenocorticotropic hormone, insulin resistance, and biomarkers of oxidative stress and inflammation. RESULTS: The average personal exposure to PMs with aerodynamic diameters ≤2.5 μm was 24.3 μg/m3 during the real purification and 53.1 μg/m3 during the sham purification. Metabolomics analysis showed that higher exposure to PMs with aerodynamic diameters ≤2.5 μm led to significant increases in cortisol, cortisone, epinephrine, and norepinephrine. Between-treatment differences were also observed for glucose, amino acids, fatty acids, and lipids. We found significantly higher blood pressure, hormones, insulin resistance, and biomarkers of oxidative stress and inflammation among individuals exposed to higher PMs with aerodynamic diameters ≤2.5 μm. CONCLUSIONS: This study suggests that higher PM may induce metabolic alterations that are consistent with activations of the hypothalamus-pituitary-adrenal and sympathetic-adrenal-medullary axes, adding potential mechanistic insights into the adverse health outcomes associated with PM. Furthermore, our study demonstrated short-term reductions in stress hormone following indoor air purification. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02712333."},{"id":"22d12ca3e45c","type":"article","url":"https://hartvaat.nl/2017/08/15/overleving-na-geisoleerde-postoperatieve-troponine-elevatie/","title":"Overleving na geïsoleerde postoperatieve troponine-elevatie","title_en":"Survival After Isolated Post-Operative Troponin Elevation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","internist"],"tags":["delirium-cardiologie","troponine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.06.023","source_url":"https://doi.org/10.1016/j.jacc.2017.06.023","authors":["W Scott Beattie","Duminda N Wijeysundera","Matthew T V Chan","Philip J Peyton","Kate Leslie","Michael J Paech","P J Devereaux","Daniel I Sessler","Sophie Wallace","Paul S Myles"],"significance":6,"published":"2017-08-15","source_date":"2017-08-15","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/vaatchirurgie-perioperatief-cardiologisch-beleid/","https://hartvaat.nl/kennis/cardiometabool/hart-en-kanker-cardio-oncologie/"],"congress":"","summary_en":"This study characterized the survival implications of isolated troponin elevation after non-cardiac surgery, quantifying the long-term mortality risk associated with perioperative myocardial injury without overt clinical events.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prognostische betekenis van geïsoleerde troponine-elevatie na niet-cardiale chirurgie. Myocardschade na chirurgie als klinisch relevante entiteit.","abstract_original":""},{"id":"eadfad923031","type":"article","url":"https://hartvaat.nl/2017/08/12/foley-katheter-versus-misoprostol-voor-inleiden-bij-hypertensieve-zwangeren-in-i/","title":"Foley-katheter versus misoprostol voor inleiden bij hypertensieve zwangeren in India: INFORM","title_en":"Foley catheterisation versus oral misoprostol for induction of labour in hypertensive women in India (INFORM): a multicentre, open-label, randomised controlled trial.","category":"hypertensie","category_label":"Hypertensie","professions":["huisarts"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)31367-3","source_url":"https://doi.org/10.1016/S0140-6736(17)31367-3","authors":["Shuchita Mundle","Hillary Bracken","Vaishali Khedikar","Jayashree Mulik","Brian Faragher","Thomas Easterling","Simon Leigh","Paul Granby","Alan Haycox","Mark A Turner","Zarko Alfirevic","Beverly Winikoff","Andrew D Weeks"],"significance":6,"published":"2017-08-12","source_date":"2017-08-12","image":"","kennis":[],"congress":"","summary_en":"The INFORM Lancet trial compared Foley catheter with oral misoprostol for labor induction in hypertensive women in India, providing evidence relevant to managing delivery timing in preeclampsia in low-resource settings.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet INFORM-trial die twee inductiemethoden vergeleek bij hypertensieve zwangeren in India. Relevant voor de obstetrische praktijk bij hypertensieve zwangerschapsaandoeningen.","abstract_original":"BACKGROUND: Between 62 000 and 77 000 women die annually from pre-eclampsia and eclampsia. Prompt delivery, preferably by the vaginal route, is vital for good maternal and neonatal outcomes. Two low-cost interventions-low-dose oral misoprostol tablets and transcervical Foley catheterisation-are already used in low-resource settings. We aimed to compare the relative risks and benefits of these interventions. METHODS: We undertook this multicentre, open-label, randomised controlled trial in two public hospitals in Nagpur, India. Women (aged ≥18 years) who were at 20 weeks' gestation or later with a live fetus and required delivery as a result of pre-eclampsia or hypertension were randomly assigned (1:1), via computer-generated block randomisation (block sizes of four, six, and eight) with concealment by use of opaque, sequentially numbered, sealed envelopes, to receive labour induction with either oral misoprostol 25 μg every 2 h (maximum of 12 doses) or a transcervical Foley catheter (silicone, size 18 F with 30 mL balloon). Randomisation was stratified by study centre. The catheter remained in place until active labour started, the catheter fell out, or 12 h had elapsed. If the catheter did not fall out within 12 h, induction continued with artificial membrane rupture and oxytocin, administered through a micro-drip gravity infusion set. Fetal monitoring was by intermittent auscultation. The primary outcome was vaginal birth within 24 h. Due to the nature of the interventions, masking of participants, study investigators, and care providers to group allocation was not possible. We analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01801410. FINDINGS: Between Dec 20, 2013, and June 29, 2015, we randomly assigned 602 women to induction with misoprostol (n=302) or the Foley catheter (n=300; intention-to-treat population). Vaginal birth within 24 h was more common in women in the misoprostol group than in the Foley catheter group (172 [57·0%] vs 141 [47·0%] women; absolute risk difference 10·0%, 95% CI 2·0-17·9; p=0·0136). Rates of uterine hyperstimulation were low in both the misoprostol and Foley catheter groups (two [0·7%] vs one [0·3%] cases; absolute risk difference 0·3%, 95% CI -0·8 to 1·5; p=0·566) and neonatal deaths did not differ significantly between groups (six [2·0%] vs three [1·0%] neonatal deaths; 1·0, -1·04 to 2·97; p=0·322). 17 serious adverse events (3%) were reported during the study: one case of intrapartum convulsion and one case of disseminated intravascular coagulation (both in the Foley group); ten perinatal deaths, including two stillbirths (both in the Foley catheter group) and eight neonatal deaths (n=5 in the misoprostol group and n=3 in the Foley catheter group); and five of neonatal morbidity, comprising birth asphyxia (n=3), septicaemia (n=1), and neonatal convulsion (n=1). INTERPRETATION: Oral misoprostol was more effective than transcervical Foley catheterisation for induction of labour in women with pre-eclampsia or hypertension. Future studies are required to assess whether oxytocin augmentation following misoprostol can be replaced by regular doses of oral misoprostol tablets. FUNDING: Medical Research Council, Department for International Development, and Wellcome Trust Joint Global Health Trials Scheme."},{"id":"13016731c83d","type":"article","url":"https://hartvaat.nl/2017/08/08/prasugrel-of-ticagrelor-bij-stemi-met-diabetes/","title":"Prasugrel of ticagrelor bij STEMI met diabetes","title_en":"Prasugrel or Ticagrelor in ST-Segment-Elevation Myocardial Infarction Patients With Diabetes Mellitus.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog"],"tags":["diabetes-en-hart","soul-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028745","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028745","authors":["Gennaro Sardella","Massimo Mancone","Rocco Edoardo Stio","Erika Cavallo","Angelo Di Roma","Riccardo Colantonio","Simone Calcagno"],"significance":6,"published":"2017-08-08","source_date":"2017-08-08","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This analysis compared prasugrel with ticagrelor specifically in STEMI patients with diabetes, investigating whether the optimal P2Y12 inhibitor choice differs in this high-risk subpopulation.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die prasugrel vergeleek met ticagrelor specifiek bij STEMI-patiënten met diabetes. Onderzoekt de optimale P2Y12-remmerkeuze bij deze hoogrisico-subgroep.","abstract_original":""},{"id":"6d68e660ecf3","type":"article","url":"https://hartvaat.nl/2017/08/08/canagliflozine-en-cardiovasculaire-biomarkers-bij-oudere-diabetespatienten/","title":"Canagliflozine en cardiovasculaire biomarkers bij oudere diabetespatiënten","title_en":"Effects of Canagliflozin on Cardiovascular Biomarkers in Older Adults With Type 2 Diabetes.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["biomarkers-cardiovasculair","canagliflozine","credence-trial","diabetes-en-hart","diabetes-type-2","sglt2-remmers","soul-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.06.016","source_url":"https://doi.org/10.1016/j.jacc.2017.06.016","authors":["James L Januzzi","Javed Butler","Petr Jarolim","Naveed Sattar","Ujjwala Vijapurkar","Mehul Desai","Michael J Davies"],"significance":6,"published":"2017-08-08","source_date":"2017-08-08","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This study examined the effects of canagliflozin on cardiovascular biomarkers in older diabetic patients, showing favorable changes in natriuretic peptides and inflammatory markers that provide mechanistic insight into SGLT2 inhibitor cardioprotection.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van canagliflozine op cardiovasculaire biomarkers bij oudere patiënten met diabetes type 2. Mechanistische inzichten in de cardiovasculaire effecten van SGLT2-remming.","abstract_original":"BACKGROUND: Sodium glucose co-transporter 2 inhibitors may reduce cardiovascular and heart failure risk in patients with type 2 diabetes mellitus (T2DM). OBJECTIVES: The goal of this study was to examine the effects of canagliflozin on cardiovascular biomarkers in older patients with T2DM. METHODS: In 666 T2DM patients randomized to receive canagliflozin 100 or 300 mg or placebo, the study assessed the median percent change in serum N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin I (hsTnI), soluble (s)ST2, and galectin-3 from baseline to 26, 52, and 104 weeks. RESULTS: Both serum NT-proBNP and serum hsTnI levels increased in placebo recipients, but they remained largely unchanged in those randomized to canagliflozin. Hodges-Lehmann estimates of the difference in median percent change between pooled canagliflozin and placebo were -15.0%, -16.1%, and -26.8% for NT-proBNP, and -8.3%, -11.9%, and -10.0% for hsTnI at weeks 26, 52, and 104, respectively (all p < 0.05). Serum sST2 was unchanged with canagliflozin and placebo over 104 weeks. Serum galectin-3 modestly increased from baseline with canagliflozin versus placebo, with significant differences observed at 26 and 52 weeks but not at 104 weeks. These results remained unchanged when only patients with complete samples were assessed. CONCLUSIONS: Compared with placebo, treatment with canagliflozin delayed the rise in serum NT-proBNP and hsTnI for over 2 years in older T2DM patients. These cardiac biomarker data provide support for the beneficial cardiovascular effect of sodium glucose co-transporter 2 inhibitors in T2DM. (A Safety and Efficacy Study of Canagliflozin in Older Patients [55 to 80 Years of Age] With Type 2 Diabetes Mellitus; NCT01106651)."},{"id":"c288908064e7","type":"article","url":"https://hartvaat.nl/2017/08/08/2017-acc-aha-hfsa-gerichte-update-hartfalenmanagement-jacc-editie/","title":"2017 ACC/AHA/HFSA gerichte update hartfalenmanagement (JACC-editie)","title_en":"2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.04.025","source_url":"https://doi.org/10.1016/j.jacc.2017.04.025","authors":["Clyde W Yancy","Mariell Jessup","Biykem Bozkurt","Javed Butler","Donald E Casey","Monica M Colvin","Mark H Drazner","Gerasimos S Filippatos","Gregg C Fonarow","Michael M Givertz","Steven M Hollenberg","JoAnn Lindenfeld","Frederick A Masoudi","Patrick E McBride","Pamela N Peterson","Lynne Warner Stevenson","Cheryl Westlake"],"significance":9,"published":"2017-08-08","source_date":"2017-08-08","image":"","kennis":[],"congress":"","summary_en":"JACC publication of the 2017 focused update for heart failure management, simultaneously published with the Circulation version, providing updated recommendations for ARNI therapy and biomarker-guided treatment strategies in heart failure.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:08Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JACC-publicatie van de 2017 gerichte richtlijnupdate voor hartfalen. Gelijktijdige publicatie met de Circulation-versie voor maximale bereikbaarheid.","abstract_original":""},{"id":"66149de5c273","type":"article","url":"https://hartvaat.nl/2017/08/08/2017-acc-aha-hfsa-gerichte-update-hartfalenmanagement-circulation-editie/","title":"2017 ACC/AHA/HFSA gerichte update hartfalenmanagement (Circulation-editie)","title_en":"2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["acuut-hartfalen"],"journal":"Circulation","doi":"10.1161/CIR.0000000000000509","source_url":"https://doi.org/10.1161/CIR.0000000000000509","authors":["Clyde W Yancy","Mariell Jessup","Biykem Bozkurt","Javed Butler","Donald E Casey","Monica M Colvin","Mark H Drazner","Gerasimos S Filippatos","Gregg C Fonarow","Michael M Givertz","Steven M Hollenberg","JoAnn Lindenfeld","Frederick A Masoudi","Patrick E McBride","Pamela N Peterson","Lynne Warner Stevenson","Cheryl Westlake"],"significance":9,"published":"2017-08-08","source_date":"2017-08-08","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"The 2017 ACC/AHA/HFSA focused update for heart failure management updated recommendations for sacubitril-valsartan (ARNI) use in HFrEF, provided guidance on new heart failure biomarkers, and refined staging and treatment algorithms based on contemporary evidence.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerichte richtlijnupdate 2017 voor hartfalenmanagement met geactualiseerde aanbevelingen voor nieuwe farmacotherapie waaronder sacubitril/valsartan en ivabradine. Circulatie-publicatie.","abstract_original":""},{"id":"c430de1245ac","type":"article","url":"https://hartvaat.nl/2017/08/07/remote-management-van-hartfalen-met-implanteerbare-devices-overzicht/","title":"Remote management van hartfalen met implanteerbare devices: overzicht","title_en":"Remote management of heart failure using implantable electronic devices.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx227","source_url":"https://doi.org/10.1093/eurheartj/ehx227","authors":["John M Morgan","Sue Kitt","Jas Gill","Janet M McComb","Ghulam Andre Ng","James Raftery","Paul Roderick","Alison Seed","Simon G Williams","Klaus K Witte","David Jay Wright","Scott Harris","Martin R Cowie"],"significance":6,"published":"2017-08-07","source_date":"2017-08-07","image":"","kennis":[],"congress":"","summary_en":"The REM-HF review assessed the clinical and cost-effectiveness of remote heart failure monitoring using implantable electronic devices, summarizing the evidence for telemonitoring-guided therapy in the device-managed HF population.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Review over remote hartfalenmanagement middels implanteerbare elektronische devices. Overzicht van de evidence voor telemonitoring en hemodynamische sensoren.","abstract_original":"AIMS: Remote management of heart failure using implantable electronic devices (REM-HF) aimed to assess the clinical and cost-effectiveness of remote monitoring (RM) of heart failure in patients with cardiac implanted electronic devices (CIEDs). METHODS AND RESULTS: Between 29 September 2011 and 31 March 2014, we randomly assigned 1650 patients with heart failure and a CIED to active RM or usual care (UC). The active RM pathway included formalized remote follow-up protocols, and UC was standard practice in nine recruiting centres in England. The primary endpoint in the time to event analysis was the 1st event of death from any cause or unplanned hospitalization for cardiovascular reasons. Secondary endpoints included death from any cause, death from cardiovascular reasons, death from cardiovascular reasons and unplanned cardiovascular hospitalization, unplanned cardiovascular hospitalization, and unplanned hospitalization. REM-HF is registered with ISRCTN (96536028). The mean age of the population was 70 years (range 23-98); 86% were male. Patients were followed for a median of 2.8 years (range 0-4.3 years) completing on 31 January 2016. Patient adherence was high with a drop out of 4.3% over the course of the study. The incidence of the primary endpoint did not differ significantly between active RM and UC groups, which occurred in 42.4 and 40.8% of patients, respectively [hazard ratio 1.01; 95% confidence interval (CI) 0.87-1.18; P = 0.87]. There were no significant differences between the two groups with respect to any of the secondary endpoints or the time to the primary endpoint components. CONCLUSION: Among patients with heart failure and a CIED, RM using weekly downloads and a formalized follow up approach does not improve outcomes."},{"id":"ce3b053ce610","type":"article","url":"https://hartvaat.nl/2017/08/07/standaard-versus-geintensiveerd-hartfalenmanagement-en-zorgkosten-gerandomiseerd/","title":"Standaard versus geïntensiveerd hartfalenmanagement en zorgkosten: gerandomiseerde trial","title_en":"Standard vs. intensified management of heart failure to reduce healthcare costs: results of a multicentre, randomized controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx259","source_url":"https://doi.org/10.1093/eurheartj/ehx259","authors":["P A Scuffham","J Ball","J D Horowitz","C Wong","P J Newton","P Macdonald","J McVeigh","A Rischbieth","N Emanuele","M J Carrington","C M Reid","Y K Chan","S Stewart"],"significance":6,"published":"2017-08-07","source_date":"2017-08-07","image":"","kennis":[],"congress":"","summary_en":"This multicenter randomized trial compared standard versus intensified heart failure management programs on healthcare costs, evaluating whether individualized profiling and more frequent monitoring reduce the economic burden of heart failure.","created":"2026-07-03T10:26:50Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Multicenter gerandomiseerde trial die standaard versus geïntensiveerd hartfalenmanagement vergeleek op zorgkosten. Economische evaluatie van intensieve HF-programma's.","abstract_original":"AIMS: To determine if an intensified form of heart failure management programme (INT-HF-MP) based on individual profiling is superior to standard management (SM) in reducing health care costs during 12-month follow-up (primary endpoint). METHODS AND RESULTS: A multicentre randomized trial involving 787 patients (full analysis set) discharged from four tertiary hospitals with chronic HF who were randomized to SM (n = 391) or INT-HF-MP (n = 396). Mean age was 74 ± 12 years, 65% had HF with a reduced ejection fraction (31.4 ± 8.9%) and 14% were remote-dwelling. Study groups were well matched. According to Green, Amber, Red Delineation of rIsk And Need in HF (GARDIAN-HF) profiling, regardless of location, patients in the INT-HF-MP received a combination of face-to-face (home visits) and structured telephone support (STS); only 9% (`low risk') were designated to receive the same level of management as the SM group. The median cost in 2017 Australian dollars (A$1 equivalent to ∼EUR €0.7) of applying INT-HF-MP was significantly greater than SM ($152 vs. $121 per patient per month; P < 0.001), However, at 12 months, there was no difference in total health care costs for the INT-HF-MP vs. SM group (median $1579, IQR $644 to $3717 vs. $1450, IQR $564 to $3615 per patient per month, respectively). This reflected minimal differences in all-cause mortality (17.7% vs. 18.4%; P = 0.848) and recurrent hospital stay (18.6 ± 26.5 vs. 16.6 ± 24.8 days; P = 0.199) between the INT-HF-MP and SM groups, respectively. CONCLUSION: During 12-months follow-up, an INT-HF-MP did not reduce healthcare costs or improve health outcomes relative to SM."},{"id":"5110a9b8e720","type":"article","url":"https://hartvaat.nl/2017/08/07/trv027-biased-ligand-van-de-angiotensine-ii-receptor-bij-acuut-hartfalen-gerando/","title":"TRV027 biased ligand van de angiotensine-II-receptor bij acuut hartfalen: gerandomiseerde trial","title_en":"Biased ligand of the angiotensin II type 1 receptor in patients with acute heart failure: a randomized, double-blind, placebo-controlled, phase IIB, dose ranging trial (BLAST-AHF).","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["sacubitril-valsartan"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx196","source_url":"https://doi.org/10.1093/eurheartj/ehx196","authors":["Peter S Pang","Javed Butler","Sean P Collins","Gad Cotter","Beth A Davison","Justin A Ezekowitz","Gerasimos Filippatos","Phillip D Levy","Marco Metra","Piotr Ponikowski","John R Teerlink","Adriaan A Voors","David Bharucha","Kathleen Goin","David G Soergel","G Michael Felker"],"significance":6,"published":"2017-08-07","source_date":"2017-08-07","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/aldosteron-en-raas-farmacologie/"],"congress":"","summary_en":"This randomized trial of TRV027, a biased ligand of the angiotensin II type 1 receptor, in acute heart failure tested a novel pharmacological approach that selectively activates beneficial downstream signaling while blocking detrimental pathways.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde dubbelblinde trial van TRV027, een biased ligand van de angiotensine II type 1-receptor, bij patiënten met acuut hartfalen. Innovatief farmacologisch concept.","abstract_original":"AIMS: Currently, no acute heart failure (AHF) therapy definitively improves outcomes. Reducing morbidity and mortality from acute heart failure (AHF) remains an unmet need. TRV027 is a novel 'biased' ligand of the angiotensin II type 1 receptor (AT1R), selectively antagonizing the negative effects of angiotensin II, while preserving the potential pro-contractility effects of AT1R stimulation. BLAST-AHF was designed to determine the safety, efficacy, and optimal dose of TRV027 to advance into future studies. METHODS AND RESULTS: BLAST-AHF was a multi-centre, international, randomized, double-blind, placebo-controlled, parallel group, phase IIb dose-ranging study, enrolling patients with AHF into 4 groups: placebo, 1, 5, or 25 mg/h of TRV027. Treatment was by IV infusion for 48-96 h. The primary composite endpoint was comprised of the following: (i) time from baseline to death through day 30, (ii) time from baseline to heart failure re-hospitalization through day 30, (iii) the first assessment time point following worsening heart failure through day 5, (iv) change in dyspnea visual analogue scale (VAS) score calculated as the area under the curve (AUC) representing the change from baseline over time from baseline through day 5, and (v) length of initial hospital stay (in days) from baseline. Analyses were by modified intention-to-treat. Overall, 621 patients were enrolled. After 254 patients, a pre-specified interim analysis resulted in several protocol changes, including a lower blood pressure inclusion criterion as well as a new allocation scheme of 2:1:2:1, overweighting both placebo, and the 5 mg/h dose. TRV027 did not confer any benefit over placebo at any dose with regards to the primary composite endpoint or any of the individual components. There were no significant safety issues with TRV027. CONCLUSION: In this phase IIb dose-ranging AHF study, TRV027 did not improve clinical status through 30-day follow-up compared with placebo."},{"id":"7a855b7b35e8","type":"article","url":"https://hartvaat.nl/2017/08/01/nauwkeurigheid-van-manchetbloeddrukmeting-systematische-review-en-meta-analyse/","title":"Nauwkeurigheid van manchetbloeddrukmeting: systematische review en meta-analyse","title_en":"Accuracy of Cuff-Measured Blood Pressure: Systematic Reviews and Meta-Analyses.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.05.064","source_url":"https://doi.org/10.1016/j.jacc.2017.05.064","authors":["Dean S Picone","Martin G Schultz","Petr Otahal","Svend Aakhus","Ahmed M Al-Jumaily","J Andrew Black","Willem J Bos","John B Chambers","Chen-Huan Chen","Hao-Min Cheng","Antoine Cremer","Justin E Davies","Nathan Dwyer","Brian A Gould","Alun D Hughes","Peter S Lacy","Esben Laugesen","Fuyou Liang","Roman Melamed","Sandy Muecke","Nobuyuki Ohte","Sho Okada","Stefano Omboni","Christian Ott","Xiaoqing Peng","Telmo Pereira","Giacomo Pucci","Ronak Rajani","Philip Roberts-Thomson","Niklas B Rossen","Daisuke Sueta","Manish D Sinha","Roland E Schmieder","Harold Smulyan","Velandai K Srikanth","Ralph Stewart","George A Stouffer","Kenji Takazawa","Jiguang Wang","Berend E Westerhof","Franz Weber","Thomas Weber","Bryan Williams","Hirotsugu Yamada","Eiichiro Yamamoto","James E Sharman"],"significance":7,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/nierziekte/albumine-creatinine-ratio/"],"congress":"","summary_en":"This systematic review evaluated the accuracy of cuff-based blood pressure measurement against intra-arterial reference, revealing clinically significant discrepancies that have implications for hypertension diagnosis and treatment targets.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die de nauwkeurigheid van manchetbloeddrukmeting evalueerde tegenover intra-arteriële metingen. Fundamenteel voor de interpretatie van klinische bloeddrukmeetresultaten.","abstract_original":"BACKGROUND: Hypertension (HTN) is the single greatest cardiovascular risk factor worldwide. HTN management is usually guided by brachial cuff blood pressure (BP), but questions have been raised regarding accuracy. OBJECTIVES: This comprehensive analysis determined the accuracy of cuff BP and the consequent effect on BP classification compared with intra-arterial BP reference standards. METHODS: Three individual participant data meta-analyses were conducted among studies (from the 1950s to 2016) that measured intra-arterial aortic BP, intra-arterial brachial BP, and cuff BP. RESULTS: A total of 74 studies with 3,073 participants were included. Intra-arterial brachial systolic blood pressure (SBP) was higher than aortic values (8.0 mm Hg; 95% confidence interval [CI]: 5.9 to 10.1 mm Hg; p < 0.0001) and intra-arterial brachial diastolic BP was lower than aortic values (-1.0 mm Hg; 95% CI: -2.0 to -0.1 mm Hg; p = 0.038). Cuff BP underestimated intra-arterial brachial SBP (-5.7 mm Hg; 95% CI: -8.0 to -3.5 mm Hg; p < 0.0001) but overestimated intra-arterial diastolic BP (5.5 mm Hg; 95% CI: 3.5 to 7.5 mm Hg; p < 0.0001). Cuff and intra-arterial aortic SBP showed a small mean difference (0.3 mm Hg; 95% CI: -1.5 to 2.1 mm Hg; p = 0.77) but poor agreement (mean absolute difference 8.0 mm Hg; 95% CI: 7.1 to 8.9 mm Hg). Concordance between BP classification using the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure cuff BP (normal, pre-HTN, and HTN stages 1 and 2) compared with intra-arterial brachial BP was 60%, 50%, 53%, and 80%, and using intra-arterial aortic BP was 79%, 57%, 52%, and 76%, respectively. Using revised intra-arterial thresholds based on cuff BP percentile rank, concordance between BP classification using cuff BP compared with intra-arterial brachial BP was 71%, 66%, 52%, and 76%, and using intra-arterial aortic BP was 74%, 61%, 56%, and 65%, respectively. CONCLUSIONS: Cuff BP has variable accuracy for measuring either brachial or aortic intra-arterial BP, and this adversely influences correct BP classification. These findings indicate that stronger accuracy standards for BP devices may improve cardiovascular risk management."},{"id":"2fa6c8e77ff3","type":"article","url":"https://hartvaat.nl/2017/08/01/kosteneffectiviteit-van-langdurig-ticagrelor-na-mi-pegasus-timi-54/","title":"Kosteneffectiviteit van langdurig ticagrelor na MI: PEGASUS-TIMI 54","title_en":"Cost-Effectiveness of Long-Term Ticagrelor in Patients With Prior Myocardial Infarction: Results From the PEGASUS-TIMI 54 Trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["farmaco-economie"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.05.063","source_url":"https://doi.org/10.1016/j.jacc.2017.05.063","authors":["Elizabeth A Magnuson","Haiyan Li","Kaijun Wang","Katherine Vilain","Ali Shafiq","Marc P Bonaca","Deepak L Bhatt","Marc Cohen","Philippe Gabriel Steg","Robert F Storey","Eugene Braunwald","Marc S Sabatine","David J Cohen"],"significance":6,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":[],"congress":"","summary_en":"This PEGASUS-TIMI 54 cost-effectiveness analysis showed that long-term ticagrelor therapy in post-MI patients provides acceptable value for money across different healthcare systems, supporting the economic case for extended antiplatelet therapy.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Kosteneffectiviteitsanalyse van langdurig ticagrelor bij post-MI-patiënten vanuit PEGASUS-TIMI 54. Economische evaluatie naast de klinische evidence.","abstract_original":"BACKGROUND: In patients with a myocardial infarction (MI) 1 to 3 years earlier, treatment with ticagrelor + low-dose aspirin (ASA) reduces the risk of cardiovascular (CV) death, MI, or stroke compared with low-dose aspirin alone, but at an increased risk of major bleeding. OBJECTIVES: The authors evaluated cost-effectiveness of ticagrelor + low-dose ASA in patients with prior MI within the prior 3 years. METHODS: The authors performed a prospective economic substudy alongside the PEGASUS-TIMI 54 (Prevention of Cardiovascular Events in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin-Thrombolysis In Myocardial Infarction 54) trial, which randomized 21,162 patients to ASA alone, ticagrelor 60 mg twice daily + low-dose ASA, or ticagrelor 90 mg twice daily + low-dose ASA. Medical resource use data were collected over a median 33-month follow-up. Costs were assessed from the U.S. health care system perspective. In-trial data relating to survival, utility, and costs were combined with lifetime projections to evaluate lifetime cost-effectiveness of the Food and Drug Administration-approved lower-dose ticagrelor regimen (60 mg twice daily). RESULTS: Hospitalization costs were similar for ticagrelor 60 mg and placebo ($2,262 vs. $2,333; 95% confidence interval for difference -$303 to $163; p = 0.54); after inclusion of a daily ticagrelor 60 mg cost of $10.52, total costs were higher for ticagrelor ($10,016 vs. $2,333; 95% CI: $7,441 to $7,930; p < 0.001). In-trial quality-adjusted life-years (QALYs) were similar (2.28 vs. 2.27; p = 0.34). Over a lifetime horizon, ticagrelor was associated with QALY gains of 0.078 and incremental costs of $7,435, yielding an incremental cost-effectiveness ratio (ICER) of $94,917/QALY gained. Several high-risk groups had more favorable ICERs, including patients with >1 prior MI, multivessel disease, diabetes, renal dysfunction (all with ICERs $50,000 to $70,000/QALY gained), patients age <75 years (ICER = $44,779/QALY gained), and patients with peripheral artery disease (ICER = $13,427/QALY gained). CONCLUSIONS: For patients with a history of MI >1 year previously, long-term treatment with ticagrelor 60 mg + low-dose ASA yields a cost-effectiveness ratio suggesting intermediate value based on current guidelines. Ticagrelor appears to provide higher value for patients in several recognized high-risk subgroups. (Prevention of Cardiovascular Events [e.g., Death From Heart or Vascular Disease, Heart Attack, or Stroke] in Patients With Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin [PEGASUS]; NCT01225562)."},{"id":"a49c9b079aee","type":"article","url":"https://hartvaat.nl/2017/08/01/radiale-arterie-graft-als-aanvulling-op-mammaria-interna-grafts-bij-cabg/","title":"Radiale arterie-graft als aanvulling op mammaria interna-grafts bij CABG","title_en":"Associations Between Adding a Radial Artery Graft to Single and Bilateral Internal Thoracic Artery Grafts and Outcomes: Insights From the Arterial Revascularization Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["coronaire-bypass"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.027659","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.027659","authors":["David P Taggart","Douglas G Altman","Marcus Flather","Stephen Gerry","Alastair Gray","Belinda Lees","Umberto Benedetto"],"significance":6,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"This ART trial analysis evaluated whether adding a radial artery graft to single or bilateral internal thoracic artery grafts improves CABG outcomes, refining the evidence for total arterial revascularization strategies.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de waarde van een radiale arterie-graft als aanvulling op een of twee mammaria interna-grafts bij CABG. Verfijnt de graftstrategie voor maximaal arterieel voordeel.","abstract_original":"BACKGROUND: Whether the use of the radial artery (RA) can improve clinical outcomes in coronary artery bypass graft surgery remains unclear. The ART (Arterial Revascularization Trial) was designed to compare survival after bilateral internal thoracic artery (BITA) over single left internal thoracic artery (SITA). In the ART, a large proportion of patients (≈20%) also received an RA graft instead of a saphenous vein graft (SVG). We aimed to investigate the associations between using the RA instead of an SVG to supplement SITA or BITA grafts and outcomes by performing a post hoc analysis of the ART. METHODS: Patients enrolled in the ART (n=3102) were classified on the basis of conduits actually received (as treated). The analysis included 2737 patients who received an RA graft (RA group; n=632) or SVG only (SVG group; n=2105) in addition to SITA or BITA grafts. The primary end point was the composite of myocardial infarction, cardiovascular death, and repeat revascularization at 5 years. Propensity score matching and stratified Cox regression were used to compare the 2 strategies. RESULTS: Myocardial infarction, cardiovascular death, and repeat revascularization cumulative incidence was 2.3% (95% confidence interval [CI], 1.1-3.4), 3.5% (95% CI, 2.1-5.0), and 4.4% (95% CI, 2.8-6.0) in the RA group and 3.4% (95% CI, 2.0-4.8), 4.0% (95% CI, 2.5-5.6), and 7.6% (95% CI, 5.5-9.7) in the SVG group, respectively. The composite end point was significantly lower in the RA group (8.8%; 95% CI, 6.5-11.0) compared with the SVG group (13.6%; 95% CI, 10.8-16.3; P=0.005). This association was present when an RA graft was used to supplement both SITA and BITA grafts (interaction P=0.62). CONCLUSIONS: This post hoc ART analysis showed that an additional RA was associated with lower risk for midterm major adverse cardiac events when used to supplement SITA or BITA grafts. CLINICAL TRIAL REGISTRATION: URL: https://www.situ.ox.ac.uk/surgical-trials/art. Unique identifier: ISRCTN46552265."},{"id":"0e5acff48e2b","type":"article","url":"https://hartvaat.nl/2017/08/01/intensieve-bloeddrukverlaging-en-linkerventrikelhypertrofie-sprint-echocardiogra/","title":"Intensieve bloeddrukverlaging en linkerventrikelhypertrofie: SPRINT echocardiografische substudie","title_en":"Effect of Intensive Blood Pressure Lowering on Left Ventricular Hypertrophy in Patients With Hypertension: SPRINT (Systolic Blood Pressure Intervention Trial).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","atleten","bloeddrukbehandeling","bradycardie","echocardiografie","hartrevalidatie","obesitas","stress-echocardiografie"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028441","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028441","authors":["Elsayed Z Soliman","Walter T Ambrosius","William C Cushman","Zhu-Ming Zhang","Jeffrey T Bates","Javier A Neyra","Thaddeus Y Carson","Leonardo Tamariz","Lama Ghazi","Monique E Cho","Brian P Shapiro","Jiang He","Lawrence J Fine","Cora E Lewis"],"significance":8,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":[],"congress":"","summary_en":"This SPRINT echocardiographic substudy showed that intensive blood pressure lowering was more effective than standard treatment in reducing left ventricular mass and the prevalence of LVH, suggesting that aggressive blood pressure control may provide direct myocardial benefit.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT echocardiografische substudie die aantoonde dat intensieve bloeddrukverlaging linkerventrikelhypertrofie effectiever vermindert dan standaardbehandeling. Orgaanprotectie door agressieve BP-controle.","abstract_original":"BACKGROUND: It is currently unknown whether intensive blood pressure (BP) lowering beyond that recommended would lead to more lowering of the risk of left ventricular hypertrophy (LVH) in patients with hypertension and whether reducing the risk of LVH explains the reported cardiovascular disease (CVD) benefits of intensive BP lowering in this population. METHODS: This analysis included 8164 participants (mean age, 67.9 years; 35.3% women; 31.2% blacks) with hypertension but no diabetes mellitus from the SPRINT trial (Systolic Blood Pressure Intervention Trial): 4086 randomly assigned to intensive BP lowering (target SBP <120 mm Hg) and 4078 assigned to standard BP lowering (target SBP <140 mm Hg). Progression and regression of LVH as defined by Cornell voltage criteria derived from standard 12-lead ECGs recorded at baseline and biannually were compared between treatment arms during a median follow-up of 3.81 years. The effect of intensive (versus standard) BP lowering on the SPRINT primary CVD outcome (a composite of myocardial infarction, acute coronary syndrome, stroke, heart failure, and CVD death) was compared before and after adjustment for LVH as a time-varying covariate. RESULTS: Among SPRINT participants without baseline LVH (n=7559), intensive (versus standard) BP lowering was associated with a 46% lower risk of developing LVH (hazard ratio=0.54; 95% confidence interval, 0.43-0.68). Similarly, among SPRINT participants with baseline LVH (n=605, 7.4%), those assigned to the intensive (versus standard) BP lowering were 66% more likely to regress/improve their LVH (hazard ratio=1.66; 95% confidence interval, 1.31-2.11). Adjustment for LVH as a time-varying covariate did not substantially attenuate the effect of intensive BP therapy on CVD events (hazard ratio of intensive versus standard BP lowering on CVD, 0.76 [95% confidence interval, 0.64-0.90] and 0.77 [95% confidence interval, 0.65-0.91] before and after adjustment for LVH as a time-varying covariate, respectively). CONCLUSIONS: Among patients with hypertension but no diabetes mellitus, intensive BP lowering (target systolic BP <120 mm Hg) compared with standard BP lowering (target systolic BP <140 mm Hg) resulted in lower rates of developing new LVH in those without LVH and higher rates of regression of LVH in those with existing LVH. This favorable effect on LVH did not explain most of the reduction in CVD events associated with intensive BP lowering in the SPRINT trial. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01206062."},{"id":"b111334ca101","type":"article","url":"https://hartvaat.nl/2017/08/01/vitamine-d-en-mortaliteit-bij-hartfalen-de-evita-3-jaars-gerandomiseerde-trial/","title":"Vitamine D en mortaliteit bij hartfalen: de EVITA 3-jaars gerandomiseerde trial","title_en":"Effect of vitamin D on all-cause mortality in heart failure (EVITA): a 3-year randomized clinical trial with 4000 IU vitamin D daily.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx235","source_url":"https://doi.org/10.1093/eurheartj/ehx235","authors":["Armin Zittermann","Jana B Ernst","Sylvana Prokop","Uwe Fuchs","Jens Dreier","Joachim Kuhn","Cornelius Knabbe","Ingvild Birschmann","Uwe Schulz","Heiner K Berthold","Stefan Pilz","Ioanna Gouni-Berthold","Jan F Gummert","Marcus Dittrich","Jochen Börgermann"],"significance":7,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":[],"congress":"","summary_en":"The EVITA trial showed that 4,000 IU daily vitamin D supplementation did not reduce all-cause mortality in heart failure patients despite correcting vitamin D deficiency. This definitive negative result argued against vitamin D as a heart failure therapy.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde 3-jaars trial die 4000 IU vitamine D per dag onderzocht bij hartfalen. Geen effect op totale mortaliteit — definitieve negatieve trial voor vitamine D bij HF.","abstract_original":"AIMS: Circulating 25-hydroxyvitamin D (25OHD) levels <75 nmol/L are associated with a nonlinear increase in mortality risk. Such 25OHD levels are common in heart failure (HF). We therefore examined whether oral vitamin D supplementation reduces mortality in patients with advanced HF. METHODS AND RESULTS: Four hundred HF patients with 25OHD levels <75 nmol/L were randomized to receive 4000 IU vitamin D daily or matching placebo for 3 years. Primary endpoint was all-cause mortality. Key secondary outcome measures included hospitalization, resuscitation, mechanical circulatory support (MCS) implant, high urgent listing for heart transplantation, heart transplantation, and hypercalcaemia. Initial 25OHD levels were on average <40 nmol/L, remained around 40 nmol/L in patients assigned to placebo and plateaued around 100 nmol/L in patients assigned to vitamin D. Mortality was not different in patients receiving vitamin D (19.6%; n = 39) or placebo (17.9%; n = 36) with a hazard ratio (HR) of 1.09 [95% confidence interval (CI): 0.69-1.71; P = 0.726]. The need for MCS implant was however greater in patients assigned to vitamin D (15.4%, n = 28) vs. placebo [9.0%, n = 15; HR: 1.96 (95% CI: 1.04-3.66); P = 0.031]. Other secondary clinical endpoints were similar between groups. The incidence of hypercalcaemia was 6.2% (n = 10) and 3.1% (n = 5) in patients receiving vitamin D or placebo (P = 0.192). CONCLUSION: A daily vitamin D dose of 4000 IU did not reduce mortality in patients with advanced HF but was associated with a greater need for MCS implants. Data indicate caution regarding long-term supplementation with moderately high vitamin D doses. TRIAL REGISTRATION INFORMATION: clinicaltrials.gov Idenitfier: NCT01326650."},{"id":"3179727c2488","type":"article","url":"https://hartvaat.nl/2017/08/01/ldl-cholesterol-streefwaarden-met-pitavastatine-ezetimibe-bij-acs-met-dyslipidem/","title":"LDL-cholesterol streefwaarden met pitavastatine + ezetimibe bij ACS met dyslipidemie: HIJ-PROPER","title_en":"Low-density lipoprotein cholesterol targeting with pitavastatin + ezetimibe for patients with acute coronary syndrome and dyslipidaemia: the HIJ-PROPER study, a prospective, open-label, randomized trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["dyslipidemie","ezetimibe","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","statines"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx162","source_url":"https://doi.org/10.1093/eurheartj/ehx162","authors":["Nobuhisa Hagiwara","Erisa Kawada-Watanabe","Ryo Koyanagi","Hiroyuki Arashi","Junichi Yamaguchi","Koichi Nakao","Tetsuya Tobaru","Hiroyuki Tanaka","Toshiaki Oka","Yasuhiro Endoh","Katsumi Saito","Tatsuro Uchida","Kunihiko Matsui","Hiroshi Ogawa"],"significance":6,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/"],"congress":"","summary_en":"This Japanese randomized trial showed that pitavastatin plus ezetimibe combination therapy achieves lower LDL cholesterol than pitavastatin monotherapy in ACS patients with dyslipidemia, supporting early intensive combination lipid therapy after acute coronary events.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T13:26:07Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Japanse gerandomiseerde trial die pitavastatine + ezetimibe versus pitavastatine monotherapie onderzocht bij ACS-patiënten met dyslipidemie. Intensieve LDL-verlaging in de Aziatische populatie.","abstract_original":"AIMS: To elucidate the effects of intensive LDL-C lowering treatment with a standard dose of statin and ezetimibe in patients with dyslipidaemia and high risk of coronary events, targeting LDL-C less than 70 mg/dL (1.8 mmol/L), compared with standard LDL-C lowering lipid monotherapy targeting less than 100 mg/dL (2.6 mmol/L). METHODS AND RESULTS: The HIJ-PROPER study is a prospective, randomized, open-label trial to assess whether intensive LDL-C lowering with standard-dose pitavastatin plus ezetimibe reduces cardiovascular events more than standard LDL-C lowering with pitavastatin monotherapy in patients with acute coronary syndrome (ACS) and dyslipidaemia. Patients were randomized to intensive lowering (target LDL-C < 70 mg/dL [1.8 mmol/L]; pitavastatin plus ezetimibe) or standard lowering (target LDL-C 90 mg/dL to 100 mg/dL [2.3-2.6 mmol/L]; pitavastatin monotherapy). The primary endpoint was a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina, and ischaemia-driven revascularization. Between January 2010 and April 2013, 1734 patients were enroled at 19 hospitals in Japan. Patients were followed for at least 36 months. Median follow-up was 3.86 years. Mean follow-up LDL-C was 65.1 mg/dL (1.68 mmol/L) for pitavastatin plus ezetimibe and 84.6 mg/dL (2.19 mmol/L) for pitavastatin monotherapy. LDL-C lowering with statin plus ezetimibe did not reduce primary endpoint occurrence in comparison with standard statin monotherapy (283/864, 32.8% vs. 316/857, 36.9%; HR 0.89, 95% CI 0.76-1.04, P = 0.152). In, ACS patients with higher cholesterol absorption, represented by elevated pre-treatment sitosterol, was associated with significantly lower incidence of the primary endpoint in the statin plus ezetimibe group (HR 0.71, 95% CI 0.56-0.91). CONCLUSION: Although intensive lowering with standard pitavastatin plus ezetimibe showed no more cardiovascular benefit than standard pitavastatin monotherapy in ACS patients with dyslipidaemia, statin plus ezetimibe may be more effective than statin monotherapy in patients with higher cholesterol absorption; further confirmation is needed. TRIAL NO: UMIN000002742, registered as an International Standard Randomized Controlled Trial."},{"id":"0c2bb771f025","type":"article","url":"https://hartvaat.nl/2017/08/01/cardiometabole-determinanten-van-carotis-en-aortadistensibiliteit-van-kindertijd/","title":"Cardiometabole determinanten van carotis- en aortadistensibiliteit van kindertijd tot jongvolwassenheid","title_en":"Cardiometabolic Determinants of Carotid and Aortic Distensibility From Childhood to Early Adulthood.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["aortainsufficiëntie","biomarkers-cardiovasculair","bloeddrukbehandeling","cardiovasculaire-genetica","diabetes-en-hart","diabetes-type-1","menopauze","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09027","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09027","authors":["Hanna Mikola","Katja Pahkala","Harri Niinikoski","Tapani Rönnemaa","Jorma S A Viikari","Antti Jula","Markus Juonala","Olli T Raitakari"],"significance":5,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/stijve-arterieen-arteriosclerose/"],"congress":"","summary_en":"This longitudinal study tracked the development of arterial stiffness from childhood to early adulthood, showing that cardiometabolic risk factors present in youth predict vascular aging trajectories.","created":"2026-07-03T10:26:49Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Longitudinale studie naar de ontwikkeling van arteriële stijfheid van de kindertijd tot jongvolwassenheid en de rol van cardiometabole risicofactoren.","abstract_original":"UNLABELLED: Children who are obese or have familial hypercholesterolemia have stiffer arteries compared with lean, healthy peers. Limited data are, however, available on the association of cardiometabolic risk markers and arterial distensibility in healthy children, particularly in a longitudinal setting. Therefore, we studied in the prospective STRIP (Special Turku Coronary Risk Factor Intervention Project) comprising healthy, predominantly normal weight participants the association of several cardiometabolic and dietary risk markers with arterial distensibility from childhood to early adulthood. Carotid and aortic distensibility (cdist, adist) was assessed repeatedly with ultrasonography at the age of 11, 13, 15, 17, and 19 years in the longitudinal atherosclerosis prevention study (ncdist=420-503, nadist=407-476). Data on cardiometabolic risk markers and diet were available since early childhood. In multivariable analyses, body mass index (β=-0.0019 [SE 0.0085]; P=0.037), systolic blood pressure (β=-0.0025 [SE 0.00065]; P=0.0001), low-density lipoprotein cholesterol (β=-0.026 [SE 0.012]; P=0.034), and homeostasis model of insulin resistance (β=-0.048 [SE 0.018]; P=0.0071) were independently associated with carotid distensibility. Systolic blood pressure (β=-0.0069 [SE 0.00097]; P<0.0001) and low-density lipoprotein cholesterol (β=-0.039 [SE 0.018]; P=0.031) associated independently with aortic distensibility. Dietary variables were not independently associated with arterial distensibility. Participants with low arterial distensibility had higher body mass index (Pcdist=0.0090, Padist=0.098) and higher systolic (Pcdist<0.0001, Padist<0.0001) and diastolic blood pressures (Pcdist<0.0001, Padist=0.0002) already from early childhood. Body mass index, blood pressure, low-density lipoprotein cholesterol, and homeostasis model of insulin resistance identified since childhood associate with arterial distensibility in healthy children and adolescents. These data support the relevance of these factors as part of primordial prevention. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00223600."},{"id":"9b7ae6fb9590","type":"article","url":"https://hartvaat.nl/2017/08/01/foliumzuurtherapie-en-nieuwe-proteinurie-bij-chinese-hypertensieve-patienten-csp/","title":"Foliumzuurtherapie en nieuwe proteïnurie bij Chinese hypertensieve patiënten: CSPPT-subanalyse","title_en":"Effects of Folic Acid Therapy on the New-Onset Proteinuria in Chinese Hypertensive Patients: A Post Hoc Analysis of the Renal Substudy of CSPPT (China Stroke Primary Prevention Trial).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["flow-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09404","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09404","authors":["Youbao Li","Min Liang","Guobao Wang","Binyan Wang","Mingli He","Genfu Tang","Delu Yin","Xin Xu","Yong Huo","Yimin Cui","Fan Fan Hou","Xianhui Qin"],"significance":5,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This CSPPT post-hoc analysis showed that folic acid supplementation added to enalapril reduces new-onset proteinuria in Chinese hypertensive patients, suggesting a renoprotective synergy between RAAS inhibition and folate.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T13:26:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Post-hoc analyse van de renale substudie van CSPPT naar het effect van foliumzuursuppletie op het ontstaan van proteïnurie bij hypertensieve patiënten.","abstract_original":"UNLABELLED: We aimed to test the hypothesis that treatment with enalapril and folic acid is more effective in preventing new-onset proteinuria than enalapril alone among hypertensive patients. This is a post hoc analysis of the renal substudy of the CSPPT (China Stroke Primary Prevention Trial). A total of 13 071 eligible participants without proteinuria were randomized to receive a double-blind daily treatment of a single tablet containing 10-mg enalapril and 0.8-mg folic acid (n=6511) or 10-mg enalapril alone (n=6560). The primary outcome was new-onset proteinuria, defined as a urine dipstick reading of ≥1+ at the exit visit. Secondary outcomes included a composite of the primary outcome and all-cause death and the annual rate of estimated glomerular filtration rate decline. After a median 4.4 years of treatment, the primary event occurred in 213 (3.9%) and 188 (3.5%) participants, respectively, in the enalapril and the enalapril-folic acid group (odds ratio, 0.90; 95% confidence interval, 0.74-1.11). However, among participants with diabetes mellitus at baseline, folic acid therapy resulted in a significant reduction in the risk for the primary event (3.7% in the enalapril-folic acid group versus 7.4% in the enalapril group; odds ratio, 0.48; 95% confidence interval, 0.29-0.81) and the composite event (odds ratio, 0.62; 95% confidence interval, 0.42-0.92) and a 55% slower annual rate of estimated glomerular filtration rate decline (0.5% versus 1.1% per year; P=0.002). Among those without diabetes mellitus at baseline, there were no between-group differences in all the outcomes. In conclusion, enalapril-folic acid therapy, compared with enalapril alone, significantly reduced the development of proteinuria in diabetic patients with hypertension. CLINICAL TRIAL REGISTRATION: URL: http://www.ClinicalTrials.gov. Unique identifier: NCT00794885."},{"id":"644ee26f1505","type":"article","url":"https://hartvaat.nl/2017/08/01/bloeddrukvariabiliteit-en-vasculaire-events-bij-diabetes-type-2/","title":"Bloeddrukvariabiliteit en vasculaire events bij diabetes type 2","title_en":"Prognostic Value of Variability in Systolic Blood Pressure Related to Vascular Events and Premature Death in Type 2 Diabetes Mellitus: The ADVANCE-ON Study.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-2"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09359","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09359","authors":["Toshiaki Ohkuma","Mark Woodward","Min Jun","Paul Muntner","Jun Hata","Stephen Colagiuri","Stephen Harrap","Giuseppe Mancia","Neil Poulter","Bryan Williams","Peter Rothwell","John Chalmers"],"significance":6,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This study demonstrated that visit-to-visit systolic blood pressure variability predicts vascular events and premature death in diabetic patients, adding variability to the list of blood pressure parameters requiring clinical attention.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T13:26:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de prognostische waarde van systolische bloeddrukvariabiliteit voor vasculaire events en vroegtijdige sterfte bij diabetes type 2.","abstract_original":"Visit-to-visit variability in systolic blood pressure (SBP) is a risk factor for cardiovascular events. However, whether it provides additional predictive information beyond traditional risk factors, including mean SBP, in the long term is unclear. The ADVANCE trial (Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation) was a randomized controlled trial in patients with type 2 diabetes mellitus; ADVANCE-ON (ADVANCE-Observational) followed-up patients subsequently. In these analyses, 9114 patients without major macrovascular or renal events or death during the first 24 months were included. Data on SBP from 6 visits during the first 24 months after randomization were used to estimate visit-to-visit variability in several ways: the primary measure was the standard deviation. Events accrued during the following 7.6 years. The primary outcome was a composite of major macrovascular and renal events and all-cause mortality. Standard deviation of SBP was log-linearly associated with an increased risk of the primary outcome (P<0.001) after adjustment for mean SBP and other cardiovascular risk factors. The hazard ratio (HR; 95% confidence interval [CI]) in the highest, compared with the lowest, tenth of the standard deviation was 1.39 (1.15-1.69). Results were similar for major macrovascular events alone and all-cause mortality alone (both P<0.01). Addition of standard deviation of SBP significantly improved 8-year risk classification (continuous net reclassification improvement, 5.3%). Results were similar for other measures of visit-to-visit variability, except maximum SBP. Visit-to-visit variability in SBP is an independent predictor of vascular complications and death, which improves risk prediction beyond that provided by traditional risk factors, including mean SBP."},{"id":"a758f14d849c","type":"article","url":"https://hartvaat.nl/2017/08/01/voorspelling-van-bloedingsrisico-tijdens-dapt-na-acs/","title":"Voorspelling van bloedingsrisico tijdens DAPT na ACS","title_en":"Predicting the risk of bleeding during dual antiplatelet therapy after acute coronary syndromes.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","bloeddrukbehandeling","dubbele-trombocytenremming"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310090","source_url":"https://doi.org/10.1136/heartjnl-2016-310090","authors":["Joakim Alfredsson","Benjamin Neely","Megan L Neely","Deepak L Bhatt","Shaun G Goodman","Pierluigi Tricoci","Kenneth W Mahaffey","Jan H Cornel","Harvey D White","Keith Aa Fox","Dorairaj Prabhakaran","Kenneth J Winters","Paul W Armstrong","E Magnus Ohman","Matthew T Roe"],"significance":6,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/wat-is-coronairlijden/","https://hartvaat.nl/kennis/coronairlijden/ecg-bij-acs/"],"congress":"","summary_en":"This study evaluated bleeding risk prediction scores during dual antiplatelet therapy after ACS, comparing available models to identify the most accurate tool for balancing ischemic protection against hemorrhagic risk.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T13:26:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar risicoscores voor het voorspellen van bloedingscomplicaties tijdens duale antiplaatjestherapie na acuut coronair syndroom. Essentieel voor gepersonaliseerd DAPT-beleid.","abstract_original":"OBJECTIVES: Dual antiplatelet therapy (DAPT) with aspirin + a P2Y12 inhibitor is recommended for at least 12 months for patients with acute coronary syndrome (ACS), with shorter durations considered for patients with increased bleeding risk. However, there are no decision support tools available to predict an individual patient's bleeding risk during DAPT treatment in the post-ACS setting. METHODS: To develop a longitudinal bleeding risk prediction model, we analy sed 9240 patients with unstable angina/non-ST segment elevation myocardial infarction (NSTEMI) from the Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes (TRILOGY ACS) trial, who were managed without revasculari sation and treated with DAPT for a median of 14.8 months. RESULTS: We identified 10 significant baseline predictors of non-coronary artery bypass grafting (CABG)-related Global Use of Strategies to Open Occluded Arteries (GUSTO) severe/life-threatening/moderate bleeding: age, sex, weight, NSTEMI (vs unstable angina), angiography performed before randomi sation, prior peptic ulcer disease, creatinine, systolic blood pressure, haemoglobin and treatment with beta-blocker. The five significant baseline predictors of Thrombolysis In Myocardial Infarction (TIMI) major or minor bleeding included age, sex, angiography performed before randomi sation, creatinine and haemoglobin. The models showed good predictive accuracy with Therneau's C-indices: 0.78 (SE = 0.024) for the GUSTO model and 0.67 (SE = 0.023) for the TIMI model. Internal validation with bootstrapping gave similar C-indices of 0.77 and 0.65, respectively. External validation demonstrated an attenuated C-index for the GUSTO model (0.69) but not the TIMI model (0.68). CONCLUSIONS: Longitudinal bleeding risks during treatment with DAPT in patients with ACS can be reliably predicted using selected baseline characteristics. The TRILOGY ACS bleeding models can inform risk -benefit considerations regarding the duration of DAPT following ACS. TRIAL REGISTRATION: ClinicalTrials.gov identifier: https://clinicaltrials.gov/ct2/show/NCT00699998."},{"id":"0a7fb7be5b03","type":"article","url":"https://hartvaat.nl/2017/08/01/nt-probnp-bij-systematische-screening-op-atriumfibrilleren/","title":"NT-proBNP bij systematische screening op atriumfibrilleren","title_en":"N-terminal pro B-type natriuretic peptide in systematic screening for atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","nt-probnp","primaire-preventie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310236","source_url":"https://doi.org/10.1136/heartjnl-2016-310236","authors":["Emma Svennberg","Peter Henriksson","Johan Engdahl","Ziad Hijazi","Faris Al-Khalili","Leif Friberg","Viveka Frykman"],"significance":6,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/","https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This study evaluated NT-proBNP as a pre-screening tool for systematic AF detection in the community, showing that elevated natriuretic peptide levels can efficiently identify individuals most likely to have undiagnosed arrhythmia.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het gebruik van NT-proBNP als screeningsinstrument voor detectie van atriumfibrilleren in een populatiescreeningssetting. Biomarkergestuurde AF-opsporing.","abstract_original":"OBJECTIVE: Screening for atrial fibrillation (AF) in individuals aged 65 and above is recommended by the European Society of Cardiology. Increased levels of the biomarker N-terminal pro B-type natriuretic peptide (NT-proBNP) has in cohort studies been associated with incident AF.The aim of this study was to assess whether NT-proBNP could be useful for AF detection in systematic screening. METHODS: The Strokestop study entailed 7173 Swedish residents aged 75/76 that were screened for AF using twice daily intermittent ECG recordings during 2 weeks. In a substudy of 886 participants, the last 815 consecutive participants and 71 individuals with newly detected AF, levels of NT-proBNP were determined. RESULTS: Participants with newly detected AF (n=96) had a median NT-proBNP of 330 ng/L (IQR 121;634). In individuals without AF (n=742), median NT-proBNP was 171 ng/L (IQR 95;283), p<0.001. The CHA2DS2-VASc parameters did not differ significantly between individuals with newly detected AF and without AF nor between newly detected AF in the NT-proBNP cohort compared with the cohort where NT-proBNP was not assessed. Using an NT-proBNP cut-off of ≥125 ng/L in a non-acute setting yielded a negative predictive value of 92%, meaning that 35% fewer participants would need to be screened when applied to systematic AF screening. Adding weight to NT-proBNP further reduced participants needed to be screened with a preserved sensitivity. CONCLUSIONS: NT-proBNP was increased in individuals with newly detected AF. Prospective studies could clarify if NT-proBNP can be used to correctly select individuals that benefit most from AF screening. CLINICAL TRIALS: ClinicalTrials.gov. Identifier: NCT01593553."},{"id":"96e15a919783","type":"article","url":"https://hartvaat.nl/2017/08/01/des-versus-bms-bij-acuut-mi-met-cardiogene-shock/","title":"DES versus BMS bij acuut MI met cardiogene shock","title_en":"Drug-eluting stents versus bare-metal stents in acute myocardial infarction with cardiogenic shock.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock","iaso-dcm"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310403","source_url":"https://doi.org/10.1136/heartjnl-2016-310403","authors":["Jakob Ledwoch","Georg Fuernau","Steffen Desch","Ingo Eitel","Christian Jung","Suzanne de Waha","Janine Poess","Steffen Schneider","Gerhard Schuler","Karl Werdan","Uwe Zeymer","Holger Thiele"],"significance":6,"published":"2017-08-01","source_date":"2017-08-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This study compared drug-eluting with bare-metal stents in patients with acute MI complicated by cardiogenic shock, testing whether the benefits of DES extend to the most hemodynamically unstable patients.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T13:26:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die drug-eluting stents vergeleek met bare-metal stents bij patiënten met acuut MI gecompliceerd door cardiogene shock.","abstract_original":"OBJECTIVES: The aim of the present study was to assess the outcome of patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) receiving drug-eluting stents (DES) compared with bare-metal stents (BMS). Data comparing these two stent technologies in AMI with CS were limited. METHODS: A total of 783 patients with AMI and CS undergoing early revascularisation were included in the randomised Intra-aortic Balloon Pump in Cardiogenic Shock II trial (n=600) and the associated registry (n=183). Patients receiving no stent or both, DES and BMS, were excluded. Primary end point was the composite of 1-year mortality or re-AMI. RESULTS: Of the total cohort, 652 (83%) patients received either solely DES or BMS and were included in the present analysis. Of these, 276 (42%) patients received DES and 376 (58%) received BMS. After adjustment for baseline characteristics, there was no significant difference between DES and BMS regarding the primary end point (HR 0.83 (CI 0.64 to 1.06); p=0.14). There was an independent association of BMS use with older age, atrial fibrillation and coronary single-vessel disease. DES use was associated with prior known dyslipidaemia, baseline haemoglobin level, anterior AMI and treatment at frequently enrolling centres. CONCLUSIONS: Despite the frequent use of DES nowadays, a substantial number of patients were treated by BMS in AMI complicated by CS. After adjustment for risk factors, the 1-year outcome of patients treated by DES compared with BMS was similar. TRIAL REGISTRATIONNUMBER: www.clinicaltrials.gov: NCT00491036."},{"id":"8f88a2ba6e81","type":"article","url":"https://hartvaat.nl/2017/07/20/genetische-en-farmacologische-inactivatie-van-angptl3-en-cardiovasculaire-ziekte/","title":"Genetische en farmacologische inactivatie van ANGPTL3 en cardiovasculaire ziekte — NEJM","title_en":"Genetic and Pharmacologic Inactivation of ANGPTL3 and Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["cardiovasculaire-genetica","gepersonaliseerde-geneeskunde","lipoproteïne-a"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1612790","source_url":"https://doi.org/10.1056/NEJMoa1612790","authors":["Frederick E Dewey","Viktoria Gusarova","Richard L Dunbar","Colm O'Dushlaine","Claudia Schurmann","Omri Gottesman","Shane McCarthy","Cristopher V Van Hout","Shannon Bruse","Hayes M Dansky","Joseph B Leader","Michael F Murray","Marylyn D Ritchie","H Lester Kirchner","Lukas Habegger","Alex Lopez","John Penn","An Zhao","Weiping Shao","Neil Stahl","Andrew J Murphy","Sara Hamon","Aurelie Bouzelmat","Rick Zhang","Brad Shumel","Robert Pordy","Daniel Gipe","Gary A Herman","Wayne H H Sheu","I-Te Lee","Kae-Woei Liang","Xiuqing Guo","Jerome I Rotter","Yii-Der I Chen","William E Kraus","Svati H Shah","Scott Damrauer","Aeron Small","Daniel J Rader","Anders Berg Wulff","Børge G Nordestgaard","Anne Tybjærg-Hansen","Anita M van den Hoek","Hans M G Princen","David H Ledbetter","David J Carey","John D Overton","Jeffrey G Reid","William J Sasiela","Poulabi Banerjee","Alan R Shuldiner","Ingrid B Borecki","Tanya M Teslovich","George D Yancopoulos","Scott J Mellis","Jesper Gromada","Aris Baras"],"significance":8,"published":"2017-07-20","source_date":"2017-07-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This NEJM study showed that genetic loss-of-function variants in ANGPTL3 are associated with reduced plasma lipid levels and lower cardiovascular risk, providing the genetic foundation for pharmacological ANGPTL3 inhibition as a cardiovascular prevention strategy.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T13:26:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-studie die aantoont dat genetische inactivatie van ANGPTL3 geassocieerd is met verlaagd cardiovasculair risico. Onderbouwt ANGPTL3 als nieuw therapeutisch doelwit voor lipidenmodulatie.","abstract_original":"BACKGROUND: Loss-of-function variants in the angiopoietin-like 3 gene (ANGPTL3) have been associated with decreased plasma levels of triglycerides, low-density lipoprotein (LDL) cholesterol, and high-density lipoprotein (HDL) cholesterol. It is not known whether such variants or therapeutic antagonism of ANGPTL3 are associated with a reduced risk of atherosclerotic cardiovascular disease. METHODS: We sequenced the exons of ANGPTL3 in 58,335 participants in the DiscovEHR human genetics study. We performed tests of association for loss-of-function variants in ANGPTL3 with lipid levels and with coronary artery disease in 13,102 case patients and 40,430 controls from the DiscovEHR study, with follow-up studies involving 23,317 case patients and 107,166 controls from four population studies. We also tested the effects of a human monoclonal antibody, evinacumab, against Angptl3 in dyslipidemic mice and against ANGPTL3 in healthy human volunteers with elevated levels of triglycerides or LDL cholesterol. RESULTS: In the DiscovEHR study, participants with heterozygous loss-of-function variants in ANGPTL3 had significantly lower serum levels of triglycerides, HDL cholesterol, and LDL cholesterol than participants without these variants. Loss-of-function variants were found in 0.33% of case patients with coronary artery disease and in 0.45% of controls (adjusted odds ratio, 0.59; 95% confidence interval, 0.41 to 0.85; P=0.004). These results were confirmed in the follow-up studies. In dyslipidemic mice, inhibition of Angptl3 with evinacumab resulted in a greater decrease in atherosclerotic lesion area and necrotic content than a control antibody. In humans, evinacumab caused a dose-dependent placebo-adjusted reduction in fasting triglyceride levels of up to 76% and LDL cholesterol levels of up to 23%. CONCLUSIONS: Genetic and therapeutic antagonism of ANGPTL3 in humans and of Angptl3 in mice was associated with decreased levels of all three major lipid fractions and decreased odds of atherosclerotic cardiovascular disease. (Funded by Regeneron Pharmaceuticals and others; ClinicalTrials.gov number, NCT01749878 .)."},{"id":"d00e50b45319","type":"article","url":"https://hartvaat.nl/2017/07/20/angptl3-antisense-oligonucleotiden-cardiovasculaire-en-metabole-effecten-nejm/","title":"ANGPTL3 antisense-oligonucleotiden: cardiovasculaire en metabole effecten — NEJM","title_en":"Cardiovascular and Metabolic Effects of ANGPTL3 Antisense Oligonucleotides.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["biomarkers-cardiovasculair","pelacarsen"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1701329","source_url":"https://doi.org/10.1056/NEJMoa1701329","authors":["Mark J Graham","Richard G Lee","Teresa A Brandt","Li-Jung Tai","Wuxia Fu","Raechel Peralta","Rosie Yu","Eunju Hurh","Erika Paz","Bradley W McEvoy","Brenda F Baker","Nguyen C Pham","Andres Digenio","Steven G Hughes","Richard S Geary","Joseph L Witztum","Rosanne M Crooke","Sotirios Tsimikas"],"significance":8,"published":"2017-07-20","source_date":"2017-07-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/familiaire-hypercholesterolemie/","https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/"],"congress":"","summary_en":"This NEJM study demonstrated that antisense oligonucleotides targeting ANGPTL3 effectively reduced triglycerides, LDL cholesterol, and other atherogenic lipoproteins in humans. The results established ANGPTL3 as a novel therapeutic target for comprehensive lipid lowering.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T13:26:06Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-studie naar antisense-oligonucleotiden gericht tegen ANGPTL3 voor de behandeling van dyslipidemie. Nieuw therapeutisch doelwit naast statines en PCSK9-remmers.","abstract_original":"BACKGROUND: Epidemiologic and genomewide association studies have linked loss-of-function variants in ANGPTL3, encoding angiopoietin-like 3, with low levels of plasma lipoproteins. METHODS: We evaluated antisense oligonucleotides (ASOs) targeting Angptl3 messenger RNA (mRNA) for effects on plasma lipid levels, triglyceride clearance, liver triglyceride content, insulin sensitivity, and atherosclerosis in mice. Subsequently, 44 human participants (with triglyceride levels of either 90 to 150 mg per deciliter [1.0 to 1.7 mmol per liter] or >150 mg per deciliter, depending on the dose group) were randomly assigned to receive subcutaneous injections of placebo or an antisense oligonucleotide targeting ANGPTL3 mRNA in a single dose (20, 40, or 80 mg) or multiple doses (10, 20, 40, or 60 mg per week for 6 weeks). The main end points were safety, side-effect profile, pharmacokinetic and pharmacodynamic measures, and changes in levels of lipids and lipoproteins. RESULTS: The treated mice had dose-dependent reductions in levels of hepatic Angptl3 mRNA, Angptl3 protein, triglycerides, and low-density lipoprotein (LDL) cholesterol, as well as reductions in liver triglyceride content and atherosclerosis progression and increases in insulin sensitivity. After 6 weeks of treatment, persons in the multiple-dose groups had reductions in levels of ANGPTL3 protein (reductions of 46.6 to 84.5% from baseline, P<0.01 for all doses vs. placebo) and in levels of triglycerides (reductions of 33.2 to 63.1%), LDL cholesterol (1.3 to 32.9%), very-low-density lipoprotein cholesterol (27.9 to 60.0%), non-high-density lipoprotein cholesterol (10.0 to 36.6%), apolipoprotein B (3.4 to 25.7%), and apolipoprotein C-III (18.9 to 58.8%). Three participants who received the antisense oligonucleotide and three who received placebo reported dizziness or headache. There were no serious adverse events. CONCLUSIONS: Oligonucleotides targeting mouse Angptl3 retarded the progression of atherosclerosis and reduced levels of atherogenic lipoproteins in mice. Use of the same strategy to target human ANGPTL3 reduced levels of atherogenic lipoproteins in humans. (Funded by Ionis Pharmaceuticals; ClinicalTrials.gov number, NCT02709850 .)."},{"id":"e62ea2ee547f","type":"article","url":"https://hartvaat.nl/2017/07/18/palliatieve-zorg-bij-hartfalen-de-pal-hf-gerandomiseerde-trial/","title":"Palliatieve zorg bij hartfalen: de PAL-HF gerandomiseerde trial","title_en":"Palliative Care in Heart Failure: The PAL-HF Randomized, Controlled Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts"],"tags":["acuut-hartfalen","emperor-trials","finearts-hf","pathfinder-trial","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.05.030","source_url":"https://doi.org/10.1016/j.jacc.2017.05.030","authors":["Joseph G Rogers","Chetan B Patel","Robert J Mentz","Bradi B Granger","Karen E Steinhauser","Mona Fiuzat","Patricia A Adams","Adam Speck","Kimberly S Johnson","Arun Krishnamoorthy","Hongqiu Yang","Kevin J Anstrom","Gwen C Dodson","Donald H Taylor","Jerry L Kirchner","Daniel B Mark","Christopher M O'Connor","James A Tulsky"],"significance":8,"published":"2017-07-18","source_date":"2017-07-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"The PAL-HF trial showed that specialized palliative care integrated with standard heart failure management improved quality of life, depression, anxiety, and spiritual well-being in patients with advanced heart failure. The results supported formal palliative care integration in heart failure programs.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde PAL-HF-trial die gespecialiseerde palliatieve zorg onderzocht bij gevorderd hartfalen. Toonde verbetering van kwaliteit van leven, depressie en angst. Onderbouwt integratie van palliatieve zorg.","abstract_original":"BACKGROUND: Advanced heart failure (HF) is characterized by high morbidity and mortality. Conventional therapy may not sufficiently reduce patient suffering and maximize quality of life. OBJECTIVES: The authors investigated whether an interdisciplinary palliative care intervention in addition to evidence-based HF care improves certain outcomes. METHODS: The authors randomized 150 patients with advanced HF between August 15, 2012, and June 25, 2015, to usual care (UC) (n = 75) or UC plus a palliative care intervention (UC + PAL) (n = 75) at a single center. Primary endpoints were 2 quality-of-life measurements, the Kansas City Cardiomyopathy Questionnaire (KCCQ) overall summary and the Functional Assessment of Chronic Illness Therapy-Palliative Care scale (FACIT-Pal), assessed at 6 months. Secondary endpoints included assessments of depression and anxiety (measured via the Hospital Anxiety and Depression Scale [HADS]), spiritual well-being (measured via the FACIT-Spiritual Well-Being scale [FACIT-Sp]), hospitalizations, and mortality. RESULTS: Patients randomized to UC + PAL versus UC alone had clinically significant incremental improvement in KCCQ and FACIT-Pal scores from randomization to 6 months (KCCQ difference = 9.49 points, 95% confidence interval [CI]: 0.94 to 18.05, p = 0.030; FACIT-Pal difference = 11.77 points, 95% CI: 0.84 to 22.71, p = 0.035). Depression improved in UC + PAL patients (HADS-depression difference = -1.94 points; p = 0.020) versus UC-alone patients, with similar findings for anxiety (HADS-anxiety difference = -1.83 points; p = 0.048). Spiritual well-being was improved in UC + PAL versus UC-alone patients (FACIT-Sp difference = 3.98 points; p = 0.027). Randomization to UC + PAL did not affect rehospitalization or mortality. CONCLUSIONS: An interdisciplinary palliative care intervention in advanced HF patients showed consistently greater benefits in quality of life, anxiety, depression, and spiritual well-being compared with UC alone. (Palliative Care in Heart Failure [PAL-HF]; NCT01589601)."},{"id":"e1c52754d5a0","type":"article","url":"https://hartvaat.nl/2017/07/18/sglt2-remmers-en-lager-risico-op-hartfalen-en-sterfte-versus-andere-glucoseverla/","title":"SGLT2-remmers en lager risico op hartfalen en sterfte versus andere glucoseverlagers: real-world","title_en":"Lower Risk of Heart Failure and Death in Patients Initiated on Sodium-Glucose Cotransporter-2 Inhibitors Versus Other Glucose-Lowering Drugs: The CVD-REAL Study (Comparative Effectiveness of Cardiovascular Outcomes in New Users of Sodium-Glucose Cotransporter-2 Inhibitors).","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["canagliflozine","dapagliflozine","empagliflozine","sglt2-remmers"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.029190","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.029190","authors":["Mikhail Kosiborod","Matthew A Cavender","Alex Z Fu","John P Wilding","Kamlesh Khunti","Reinhard W Holl","Anna Norhammar","Kåre I Birkeland","Marit Eika Jørgensen","Marcus Thuresson","Niki Arya","Johan Bodegård","Niklas Hammar","Peter Fenici"],"significance":8,"published":"2017-07-18","source_date":"2017-07-18","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/sglt2-remmers-bij-hartfalen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This large real-world study demonstrated that patients initiated on SGLT2 inhibitors had lower rates of heart failure hospitalization and death compared with those started on other glucose-lowering drugs, providing early observational confirmation of the cardiovascular benefits seen in clinical trials.","created":"2026-07-03T10:26:48Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Grote real-world studie die aantoont dat SGLT2-remmers geassocieerd zijn met een lager risico op hartfalen en sterfte vergeleken met andere glucoseverlagende medicatie. Bevestigt trialdata in de praktijk.","abstract_original":"BACKGROUND: Reduction in cardiovascular death and hospitalization for heart failure (HHF) was recently reported with the sodium-glucose cotransporter-2 inhibitor (SGLT-2i) empagliflozin in patients with type 2 diabetes mellitus who have atherosclerotic cardiovascular disease. We compared HHF and death in patients newly initiated on any SGLT-2i versus other glucose-lowering drugs in 6 countries to determine if these benefits are seen in real-world practice and across SGLT-2i class. METHODS: Data were collected via medical claims, primary care/hospital records, and national registries from the United States, Norway, Denmark, Sweden, Germany, and the United Kingdom. Propensity score for SGLT-2i initiation was used to match treatment groups. Hazard ratios for HHF, death, and their combination were estimated by country and pooled to determine weighted effect size. Death data were not available for Germany. RESULTS: After propensity matching, there were 309 056 patients newly initiated on either SGLT-2i or other glucose-lowering drugs (154 528 patients in each treatment group). Canagliflozin, dapagliflozin, and empagliflozin accounted for 53%, 42%, and 5% of the total exposure time in the SGLT-2i class, respectively. Baseline characteristics were balanced between the 2 groups. There were 961 HHF cases during 190 164 person-years follow-up (incidence rate, 0.51/100 person-years). Of 215 622 patients in the United States, Norway, Denmark, Sweden, and the United Kingdom, death occurred in 1334 (incidence rate, 0.87/100 person-years), and HHF or death in 1983 (incidence rate, 1.38/100 person-years). Use of SGLT-2i, versus other glucose-lowering drugs, was associated with lower rates of HHF (hazard ratio, 0.61; 95% confidence interval, 0.51-0.73; P<0.001); death (hazard ratio, 0.49; 95% confidence interval, 0.41-0.57; P<0.001); and HHF or death (hazard ratio, 0.54; 95% confidence interval, 0.48-0.60; P<0.001) with no significant heterogeneity by country. CONCLUSIONS: In this large multinational study, treatment with SGLT-2i versus other glucose-lowering drugs was associated with a lower risk of HHF and death, suggesting that the benefits seen with empagliflozin in a randomized trial may be a class effect applicable to a broad population of patients with type 2 diabetes mellitus in real-world practice. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02993614."},{"id":"45e587291c61","type":"article","url":"https://hartvaat.nl/2017/07/14/voorspelling-van-plotse-versus-niet-plotse-hartdood-na-mi-met-verminderde-lvef/","title":"Voorspelling van plotse versus niet-plotse hartdood na MI met verminderde LVEF","title_en":"Prediction of sudden and non-sudden cardiac death in post-infarction patients with reduced left ventricular ejection fraction by periodic repolarization dynamics: MADIT-II substudy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx161","source_url":"https://doi.org/10.1093/eurheartj/ehx161","authors":["Konstantinos D Rizas","Scott McNitt","Wolfgang Hamm","Steffen Massberg","Stefan Kääb","Wojciech Zareba","Jean-Philippe Couderc","Axel Bauer"],"significance":6,"published":"2017-07-14","source_date":"2017-07-14","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This study tested Periodic Repolarization Dynamics (PRD), a novel ECG marker of sympathetic activity, for predicting sudden versus non-sudden cardiac death in post-MI patients with reduced LVEF, exploring improved risk stratification for ICD candidacy.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die plotse versus niet-plotse hartdood probeerde te voorspellen bij post-MI-patiënten met verminderde LVEF middels periodegramanalyse. Relevant voor ICD-indicatiestelling.","abstract_original":"AIMS: To test the value of Periodic Repolarization Dynamics (PRD), a recently validated electrocardiographic marker of sympathetic activity, as a novel approach to predict sudden cardiac death (SCD) and non-sudden cardiac death (N-SCD) and to improve identification of patients that profit from ICD-implantation. METHODS AND RESULTS: We included 856 post-infarction patients with left-ventricular ejection fraction (LVEF) ≤30% of the MADIT-II trial in sinus rhythm. Of these, 507 and 348 patients were randomized to ICD or conventional treatment. PRD was assessed from multipolar 10-min baseline ECGs. Primary and secondary endpoints were total mortality, SCD and N-SCD. Multivariable analyses included treatment group, QRS-duration, New York Heart Association classification, blood-urea nitrogen, diabetes mellitus, beta-blocker therapy and LVEF. During follow-up of 20.4 months, 119 patients died (53 SCD and 36 N-SCD). On multivariable analyses, increased PRD was a significant predictor of mortality (standardized coefficient 1.37[1.19-1.59]; P < 0.001) and SCD (1.40 [1.13-1.75]; P = 0.003) but also predicted N-SCD (1.41[1.10-1.81]; P = 0.006). While increased PRD predicted SCD in conventionally treated patients (1.61[1.23-2.11]; P < 0.001), it was predictive of N-SCD (1.63[1.28-2.09]; P < 0.001) and adequate ICD-therapies (1.20[1.03-1.39]; P = 0.017) in ICD-treated patients. ICD-treatment substantially reduced mortality in the lowest three PRD-quartiles by 53% (P = 0.001). However, there was no effect in the highest PRD-quartile (mortality increase by 29%; P = 0.412; P < 0.001 for difference) as the reduction of SCD was compensated by an increase of N-SCD. CONCLUSION: In post-infarction patients with impaired LVEF, PRD is a significant predictor of SCD and N-SCD. Assessment of PRD is a promising tool to identify post-MI patients with reduced LVEF who might benefit from intensified treatment."},{"id":"49c95a4a3286","type":"article","url":"https://hartvaat.nl/2017/07/13/adjuvant-pertuzumab-en-trastuzumab-bij-vroege-her2-positieve-borstkanker-nejm-ap/","title":"Adjuvant pertuzumab en trastuzumab bij vroege HER2-positieve borstkanker: NEJM APHINITY","title_en":"Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1703643","source_url":"https://doi.org/10.1056/NEJMoa1703643","authors":["Gunter von Minckwitz","Marion Procter","Evandro de Azambuja","Dimitrios Zardavas","Mark Benyunes","Giuseppe Viale","Thomas Suter","Amal Arahmani","Nathalie Rouchet","Emma Clark","Adam Knott","Istvan Lang","Christelle Levy","Denise A Yardley","Jose Bines","Richard D Gelber","Martine Piccart","Jose Baselga"],"significance":7,"published":"2017-07-13","source_date":"2017-07-13","image":"","kennis":[],"congress":"","summary_en":"The APHINITY trial of adjuvant pertuzumab plus trastuzumab in early HER2-positive breast cancer is relevant to cardio-oncology due to the additive cardiotoxicity risk of dual HER2 blockade on top of anthracycline-based chemotherapy.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM APHINITY-trial naar adjuvante dubbele HER2-blokkade bij borstkanker. Cardio-oncologisch relevant vanwege de cardiotoxiciteit van anti-HER2-therapie.","abstract_original":"BACKGROUND: Pertuzumab increases the rate of pathological complete response in the preoperative context and increases overall survival among patients with metastatic disease when it is added to trastuzumab and chemotherapy for the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer. In this trial, we investigated whether pertuzumab, when added to adjuvant trastuzumab and chemotherapy, improves outcomes among patients with HER2-positive early breast cancer. METHODS: We randomly assigned patients with node-positive or high-risk node-negative HER2-positive, operable breast cancer to receive either pertuzumab or placebo added to standard adjuvant chemotherapy plus 1 year of treatment with trastuzumab. We assumed a 3-year invasive-disease-free survival rate of 91.8% with pertuzumab and 89.2% with placebo. RESULTS: In the trial population, 63% of the patients who were randomly assigned to receive pertuzumab (2400 patients) or placebo (2405 patients) had node-positive disease and 36% had hormone-receptor-negative disease. Disease recurrence occurred in 171 patients (7.1%) in the pertuzumab group and 210 patients (8.7%) in the placebo group (hazard ratio, 0.81; 95% confidence interval [CI], 0.66 to 1.00; P=0.045). The estimates of the 3-year rates of invasive-disease-free survival were 94.1% in the pertuzumab group and 93.2% in the placebo group. In the cohort of patients with node-positive disease, the 3-year rate of invasive-disease-free survival was 92.0% in the pertuzumab group, as compared with 90.2% in the placebo group (hazard ratio for an invasive-disease event, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In the cohort of patients with node-negative disease, the 3-year rate of invasive-disease-free survival was 97.5% in the pertuzumab group and 98.4% in the placebo group (hazard ratio for an invasive-disease event, 1.13; 95% CI, 0.68 to 1.86; P=0.64). Heart failure, cardiac death, and cardiac dysfunction were infrequent in both treatment groups. Diarrhea of grade 3 or higher occurred almost exclusively during chemotherapy and was more frequent with pertuzumab than with placebo (9.8% vs. 3.7%). CONCLUSIONS: Pertuzumab significantly improved the rates of invasive-disease-free survival among patients with HER2-positive, operable breast cancer when it was added to trastuzumab and chemotherapy. Diarrhea was more common with pertuzumab than with placebo. (Funded by F. Hoffmann-La Roche/Genentech; APHINITY ClinicalTrials.gov number, NCT01358877 .)."},{"id":"1f500ec2b14a","type":"article","url":"https://hartvaat.nl/2017/07/11/gedragscounseling-voor-gezonde-voeding-en-beweging-ter-cv-preventie-jama-uspstf-/","title":"Gedragscounseling voor gezonde voeding en beweging ter CV-preventie: JAMA USPSTF-review","title_en":"Behavioral Counseling to Promote a Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults Without Cardiovascular Risk Factors: US Preventive Services Task Force Recommendation Statement.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts"],"tags":["primaire-preventie"],"journal":"JAMA","doi":"10.1001/jama.2017.7171","source_url":"https://doi.org/10.1001/jama.2017.7171","authors":["David C Grossman","Kirsten Bibbins-Domingo","Susan J Curry","Michael J Barry","Karina W Davidson","Chyke A Doubeni","John W Epling","Alex R Kemper","Alex H Krist","Ann E Kurth","C Seth Landefeld","Carol M Mangione","Maureen G Phipps","Michael Silverstein","Melissa A Simon","Chien-Wen Tseng"],"significance":7,"published":"2017-07-11","source_date":"2017-07-11","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/preventie/preventie-bij-diabetes/"],"congress":"","summary_en":"This JAMA evidence review for the USPSTF assessed the effectiveness of behavioral counseling on diet and physical activity for cardiovascular disease prevention in adults, informing population-level lifestyle intervention recommendations.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA review voor de USPSTF over gedragscounseling voor voeding en lichamelijke activiteit ter preventie van cardiovasculaire ziekte bij gezonde volwassenen.","abstract_original":"IMPORTANCE: Adults who adhere to national guidelines for a healthful diet and physical activity have lower rates of cardiovascular morbidity and mortality than those who do not. All persons, regardless of their risk status for cardiovascular disease (CVD), can gain health benefits from healthy eating behaviors and appropriate physical activity. OBJECTIVE: To update the 2012 US Preventive Services Task Force (USPSTF) recommendation on behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention among adults without obesity who do not have cardiovascular risk factors (hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes). EVIDENCE REVIEW: The USPSTF reviewed the evidence on whether primary care-relevant counseling interventions to promote a healthful diet, physical activity, or both improve health outcomes, intermediate outcomes associated with CVD, or dietary or physical activity behaviors in adults; interventions to reduce sedentary behaviors; and the harms of behavioral counseling interventions. FINDINGS: Counseling interventions result in improvements in healthful behaviors and small but potentially important improvements in intermediate outcomes, including reductions in blood pressure and low-density lipoprotein cholesterol levels and improvements in measures of adiposity. The overall magnitude of benefit related to these interventions is positive but small. The potential harms are at most small, leading the USPSTF to conclude that these interventions have a small net benefit for adults without obesity who do not have CVD risk factors. CONCLUSIONS AND RECOMMENDATION: The USPSTF recommends that primary care professionals individualize the decision to offer or refer adults without obesity who do not have hypertension, dyslipidemia, abnormal blood glucose levels, or diabetes to behavioral counseling to promote a healthful diet and physical activity. Existing evidence indicates a positive but small benefit of behavioral counseling for the prevention of CVD in this population. Persons who are interested and ready to make behavioral changes may be most likely to benefit from behavioral counseling. (C recommendation)."},{"id":"9880dfd91bcd","type":"article","url":"https://hartvaat.nl/2017/07/11/positieve-luchtwegdruk-en-cv-events-bij-slaapapneu-jama-meta-analyse/","title":"Positieve luchtwegdruk en CV-events bij slaapapneu: JAMA meta-analyse","title_en":"Association of Positive Airway Pressure With Cardiovascular Events and Death in Adults With Sleep Apnea: A Systematic Review and Meta-analysis.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["atleten","secundaire-preventie","slaapapneu"],"journal":"JAMA","doi":"10.1001/jama.2017.7967","source_url":"https://doi.org/10.1001/jama.2017.7967","authors":["Jie Yu","Zien Zhou","R Doug McEvoy","Craig S Anderson","Anthony Rodgers","Vlado Perkovic","Bruce Neal"],"significance":8,"published":"2017-07-11","source_date":"2017-07-11","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This JAMA meta-analysis found that positive airway pressure therapy for sleep apnea did not significantly reduce cardiovascular events or mortality in patients with obstructive or central sleep apnea. The results tempered expectations about the cardiovascular benefits of CPAP/BPAP therapy.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA systematische review en meta-analyse naar het effect van CPAP/BPAP op cardiovasculaire events en mortaliteit bij slaapapneu. Onderzoekt of behandeling van slaapapneu CV-risico vermindert.","abstract_original":"IMPORTANCE: Sleep apnea (obstructive and central) is associated with adverse cardiovascular risk factors and increased risks of cardiovascular disease. Positive airway pressure (PAP) provides symptomatic relief, whether delivered continuously (CPAP) or as adaptive servo-ventilation (ASV), but the associations with cardiovascular outcomes and death are unclear. OBJECTIVE: To assess the association of PAP vs control with cardiovascular events and death in patients with sleep apnea. DATA SOURCES AND STUDY SELECTION: MEDLINE, EMBASE, and the Cochrane Library were systematically searched from inception date to March 2017 for randomized clinical trials that included reporting of major adverse cardiovascular events or deaths. DATA EXTRACTION AND SYNTHESIS: Two authors independently extracted data using standardized forms. Summary relative risks (RRs), risk differences (RDs) and 95% CIs were obtained using random-effects meta-analysis. MAIN OUTCOMES AND MEASURES: The main outcomes were a composite of acute coronary syndrome (ACS) events, stroke, or vascular death (major adverse cardiovascular events); cause-specific vascular events; and death. RESULTS: The analyses included data from 10 trials (9 CPAP; 1 ASV) of patients with sleep apnea (N = 7266; mean age, 60.9 [range, 51.5 to 71.1] years; 5847 [80.5%] men; mean [SD] body mass index, 30.0 [5.2]. Among 356 major adverse cardiovascular events and 613 deaths recorded, there was no significant association of PAP with major adverse cardiovascular events (RR, 0.77 [95% CI, 0.53 to 1.13]; P = .19 and RD, -0.01 [95% CI, -0.03 to 0.01]; P = .23), cardiovascular death (RR, 1.15 [95% CI, 0.88 to 1.50]; P = .30 and RD -0.00 [95% CI, -0.02 to 0.02]; P = .87), or all-cause death (RR, 1.13 [95% CI, 0.99 to 1.29]; P = .08 and RD, 0.00 [95% CI, -0.01 to 0.01]; P = .51). The same was true for ACS, stroke, and heart failure. There was no evidence of different associations for CPAP vs ASV (all P value homogeneity >.24), and meta-regressions identified no associations of PAP with outcomes for different levels of apnea severity, follow-up duration, or adherence to PAP (all P values > .13). CONCLUSIONS AND RELEVANCE: The use of PAP, compared with no treatment or sham, was not associated with reduced risks of cardiovascular outcomes or death for patients with sleep apnea. Although there are other benefits of treatment with PAP for sleep apnea, these findings do not support treatment with PAP with a goal of prevention of these outcomes."},{"id":"25595a2a454c","type":"article","url":"https://hartvaat.nl/2017/07/11/arteriele-verstijving-bij-inspanning-bij-hfpef/","title":"Arteriële verstijving bij inspanning bij HFpEF","title_en":"Arterial Stiffening With Exercise in Patients With Heart Failure and Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["hfpef","hfref","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.05.029","source_url":"https://doi.org/10.1016/j.jacc.2017.05.029","authors":["Yogesh N V Reddy","Mads J Andersen","Masaru Obokata","Katlyn E Koepp","Garvan C Kane","Vojtech Melenovsky","Thomas P Olson","Barry A Borlaug"],"significance":5,"published":"2017-07-11","source_date":"2017-07-11","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This study demonstrated that arterial stiffening during exercise is exaggerated in HFpEF patients, linking abnormal vascular-ventricular coupling during exertion to the exercise intolerance that defines this heart failure phenotype.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die arteriële verstijving bij inspanning onderzocht bij patiënten met HFpEF. Arteriële stijfheid als bijdragend mechanisme aan inspanningsintolerantie bij behouden ejectiefractie.","abstract_original":"BACKGROUND: Aortic stiffening and reduced nitric oxide (NO) availability may contribute to the pathophysiology of heart failure with preserved ejection fraction (HFpEF). OBJECTIVES: This study compared indices of arterial stiffness at rest and during exercise in subjects with HFpEF and hypertensive control subjects to examine their relationships to cardiac hemodynamics and determine whether exertional arterial stiffening can be mitigated by inorganic nitrite. METHODS: A total of 22 hypertensive control subjects and 98 HFpEF subjects underwent hemodynamic exercise testing with simultaneous expired gas analysis to measure oxygen consumption. Invasively measured radial artery pressure waveforms were converted to central aortic waveforms by transfer function to assess integrated measures of pulsatile aortic load, including arterial compliance, resistance, elastance, and wave reflection. RESULTS: Arterial load and wave reflections in HFpEF were similar to those in control subjects at rest. During submaximal exercise, HFpEF subjects displayed reduced total arterial compliance and higher effective arterial elastance despite similar mean arterial pressures in control subjects. This was directly correlated with higher ventricular filling pressures and depressed cardiac output reserve (both p < 0.0001). With peak exercise, increased wave reflections, impaired compliance, and increased resistance and elastance were observed in subjects with HFpEF. A subset of HFpEF subjects (n = 52) received sodium nitrite or placebo therapy in a 1:1 double-blind, randomized fashion. Compared to placebo, nitrite decreased aortic wave reflections at rest and improved arterial compliance and elastance and central hemodynamics during exercise. CONCLUSIONS: Abnormal pulsatile aortic loading during exercise occurs in HFpEF independent of hypertension and is correlated with classical hemodynamic derangements that develop with stress. Inorganic nitrite mitigates arterial stiffening with exercise and improves hemodynamics, indicating that arterial stiffening with exercise is at least partially reversible. Further study is required to test effects of agents that target the NO pathway in reducing arterial stiffness in HFpEF. (Study of Exercise and Heart Function in Patients With Heart Failure and Pulmonary Vascular Disease [EXEC]; NCT01418248. Acute Effects of Inorganic Nitrite on Cardiovascular Hemodynamics in Heart Failure With Preserved Ejection Fraction; NCT01932606. Inhaled Sodium Nitrite on Heart Failure With Preserved Ejection Fraction; NCT02262078)."},{"id":"a1a3b1f292b9","type":"article","url":"https://hartvaat.nl/2017/07/04/arteriele-remodellering-na-bioresorbeerbare-scaffolds-versus-metallic-stents/","title":"Arteriële remodellering na bioresorbeerbare scaffolds versus metallic stents","title_en":"Arterial Remodeling After Bioresorbable Scaffolds and Metallic Stents.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.05.028","source_url":"https://doi.org/10.1016/j.jacc.2017.05.028","authors":["Patrick W Serruys","Yuki Katagiri","Yohei Sotomi","Yaping Zeng","Bernard Chevalier","René J van der Schaaf","Andreas Baumbach","Pieter Smits","Nicolas M van Mieghem","Antonio Bartorelli","Paul Barragan","Anthony Gershlick","Ran Kornowski","Carlos Macaya","John Ormiston","Jonathan Hill","Irene M Lang","Mohaned Egred","Jean Fajadet","Maciej Lesiak","Stephan Windecker","Robert A Byrne","Lorenz Räber","Robert-Jan van Geuns","Gary S Mintz","Yoshinobu Onuma"],"significance":5,"published":"2017-07-04","source_date":"2017-07-04","image":"","kennis":[],"congress":"","summary_en":"This imaging study characterized arterial remodeling after bioresorbable scaffolds compared with metallic stents, documenting the late luminal enlargement and expansive vascular healing unique to bioresorbable technology.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Beeldvormingsstudie naar de arteriële remodellering na bioresorbeerbare scaffolds vergeleken met metallic stents. Onderzoekt het vasculaire helingsproces na stentimplantatie.","abstract_original":"BACKGROUND: Although previous observational studies have documented late luminal enlargement and expansive remodeling following implantation of a bioresorbable vascular scaffold (BVS), no comparison with metallic stents has been conducted in a randomized fashion. OBJECTIVES: This study sought to compare vessel remodeling patterns after either Absorb BVS or Xience metallic drug-eluting stent (DES) implantation (Abbott Vascular, Santa Clara, California) and determine the independent predictors of remodeling. METHODS: In the ABSORB II randomized trial, 383 lesions (n = 359) were investigated by intravenous ultrasound both post-procedure and at 3-year follow-up. According to vessel and lumen area changes over 3 years, we categorized 9 patterns of vessel remodeling that were beyond the reproducibility of lumen and vessel area measurements. RESULTS: The relative change in mean vessel area was significantly greater with the BVS compared to the DES (6.7 ± 12.6% vs. 2.9 ± 11.5%; p = 0.003); the relative change in mean lumen area was significantly different between the 2 arms (1.4 ± 19.1% vs. -1.9 ± 10.5%, respectively; p = 0.031). Multivariate analysis indicated that use of the BVS, female sex, balloon-artery ratio >1.25, expansion index ≥0.8, previous percutaneous coronary intervention, and higher level of low-density lipoprotein cholesterol were independent predictors of expansive remodeling. Furthermore, in the BVS arm, necrotic core pre-procedure was an independent determinant of expansive remodeling. CONCLUSIONS: Expansive vessel wall remodeling was more frequent and intense with the BVS than the metallic DES and could be determined by patient baseline characteristics and periprocedural factors. The clinical effect of the observed lumen and vessel remodeling must be investigated in further large clinical studies to optimize the clinical outcome of patients and lesions treated by bioresorbable scaffolds. (ABSORB II Randomized Controlled Trial; NCT01425281)."},{"id":"1e289462bf08","type":"article","url":"https://hartvaat.nl/2017/07/04/langetermijn-metformine-en-leefstijl-en-coronair-calcium-diabetes-prevention-pro/","title":"Langetermijn metformine en leefstijl en coronair calcium: Diabetes Prevention Program","title_en":"Effect of Long-Term Metformin and Lifestyle in the Diabetes Prevention Program and Its Outcome Study on Coronary Artery Calcium.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","figaro-dkd","lipidenverlaging","roken"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.025483","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.025483","authors":["Ronald B Goldberg","Vanita R Aroda","David A Bluemke","Elizabeth Barrett-Connor","Matthew Budoff","Jill P Crandall","Dana Dabelea","Edward S Horton","Kieren J Mather","Trevor J Orchard","David Schade","Karol Watson","Marinella Temprosa"],"significance":7,"published":"2017-07-04","source_date":"2017-07-04","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/gewichtsreductie-leefstijl-hart/"],"congress":"","summary_en":"This Diabetes Prevention Program analysis examined the effects of long-term metformin and lifestyle intervention on coronary artery calcium progression, assessing whether metabolic prevention strategies reduce subclinical atherosclerosis.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T13:26:05Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het Diabetes Prevention Program naar het effect van langdurige metformine en leefstijlinterventies op coronair calcium als marker voor subclinische atherosclerose.","abstract_original":"BACKGROUND: Despite the reduced incidence of coronary heart disease with intensive risk factor management, people with diabetes mellitus and prediabetes remain at increased coronary heart disease risk. Diabetes prevention interventions may be needed to reduce coronary heart disease risk. This approach was examined in the DPP (Diabetes Prevention Program) and the DPPOS (Diabetes Prevention Program Outcome Study), a long-term intervention study in 3234 subjects with prediabetes (mean±SD age, 64±10 years) that showed reduced diabetes risk with lifestyle and metformin compared with placebo over 3.2 years. METHODS: The DPPOS offered periodic group lifestyle sessions to all participants and continued metformin in the originally randomized metformin group. Subclinical atherosclerosis was assessed in 2029 participants with coronary artery calcium (CAC) measurements after an average of 14 years of follow-up. The CAC scores were analyzed continuously as CAC severity and categorically as CAC presence (CAC score >0) and reported separately in men and women. RESULTS: There were no CAC differences between lifestyle and placebo intervention groups in either sex. CAC severity and presence were significantly lower among men in the metformin versus the placebo group (age-adjusted mean CAC severity, 39.5 versus 66.9 Agatston units, P=0.04; CAC presence, 75% versus 84%, P=0.02), but no metformin effect was seen in women. In multivariate analysis, the metformin effect in men was not influenced by demographic, anthropometric, or metabolic factors; by the development of diabetes mellitus; or by use/nonuse of statin therapy. CONCLUSIONS: Metformin may protect against coronary atherosclerosis in prediabetes and early diabetes mellitus among men. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00038727."},{"id":"2a68bc3a59df","type":"article","url":"https://hartvaat.nl/2017/07/01/systolische-bloeddrukreductie-en-cv-risico-netwerkmeta-analyse/","title":"Systolische bloeddrukreductie en CV-risico: netwerkmeta-analyse","title_en":"Systolic Blood Pressure Reduction and Risk of Cardiovascular Disease and Mortality: A Systematic Review and Network Meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","bloeddrukbehandeling","farmaco-economie","laminopathie","obesitas","slaapapneu"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.1421","source_url":"https://doi.org/10.1001/jamacardio.2017.1421","authors":["Joshua D Bundy","Changwei Li","Patrick Stuchlik","Xiaoqing Bu","Tanika N Kelly","Katherine T Mills","Hua He","Jing Chen","Paul K Whelton","Jiang He"],"significance":8,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/screenen-op-af/"],"congress":"","summary_en":"This JAMA Cardiology network meta-analysis quantified the cardiovascular risk reduction associated with different magnitudes of systolic blood pressure lowering, informing the debate about optimal targets across various antihypertensive treatment strategies.","created":"2026-07-03T10:26:47Z","updated":"2026-07-03T18:38:34Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology systematische review en netwerkmeta-analyse die bloeddrukreductie en cardiovasculair risico over verschillende antihypertensivaklassen vergeleek. Referentiepublicatie voor vergelijkende effectiviteit.","abstract_original":"IMPORTANCE: Clinical trials have documented that lowering blood pressure reduces cardiovascular disease and premature deaths. However, the optimal target for reduction of systolic blood pressure (SBP) is uncertain. OBJECTIVE: To assess the association of mean achieved SBP levels with the risk of cardiovascular disease and all-cause mortality in adults with hypertension treated with antihypertensive therapy. DATA SOURCES: MEDLINE and EMBASE were searched from inception to December 15, 2015, supplemented by manual searches of the bibliographies of retrieved articles. STUDY SELECTION: Studies included were clinical trials with random allocation to an antihypertensive medication, control, or treatment target. Studies had to have reported a difference in mean achieved SBP of 5 mm Hg or more between comparison groups. DATA EXTRACTION AND SYNTHESIS: Data were extracted from each study independently and in duplicate by at least 2 investigators according to a standardized protocol. Network meta-analysis was used to obtain pooled randomized results comparing the association of each 5-mm Hg SBP category with clinical outcomes after adjusting for baseline risk. MAIN OUTCOMES AND MEASURES: Cardiovascular disease and all-cause mortality. RESULTS: Forty-two trials, including 144 220 patients, met the eligibility criteria. In general, there were linear associations between mean achieved SBP and risk of cardiovascular disease and mortality, with the lowest risk at 120 to 124 mm Hg. Randomized groups with a mean achieved SBP of 120 to 124 mm Hg had a hazard ratio (HR) for major cardiovascular disease of 0.71 (95% CI, 0.60-0.83) compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, an HR of 0.58 (95% CI, 0.48-0.72) compared with those with a mean achieved SBP of 140 to 144 mm Hg, an HR of 0.46 (95% CI, 0.34-0.63) compared with those with a mean achieved SBP of 150 to 154 mm Hg, and an HR of 0.36 (95% CI, 0.26-0.51) compared with those with a mean achieved SBP of 160 mm Hg or more. Likewise, randomized groups with a mean achieved SBP of 120 to 124 mm Hg had an HR for all-cause mortality of 0.73 (95% CI, 0.58-0.93) compared with randomized groups with a mean achieved SBP of 130 to 134 mm Hg, an HR of 0.59 (95% CI, 0.45-0.77) compared with those with a mean achieved SBP of 140 to 144 mm Hg, an HR of 0.51 (95% CI, 0.36-0.71) compared with those with a mean achieved SBP of 150 to 154 mm Hg, and an HR of 0.47 (95% CI, 0.32-0.67) compared with those with a mean achieved SBP of 160 mm Hg or more. CONCLUSIONS AND RELEVANCE: This study suggests that reducing SBP to levels below currently recommended targets significantly reduces the risk of cardiovascular disease and all-cause mortality. These findings support more intensive control of SBP among adults with hypertension."},{"id":"5f127f970485","type":"article","url":"https://hartvaat.nl/2017/07/01/syntax-scores-en-uitkomsten-bij-diabetes-met-multivatenlijden-gepoolde-analyse/","title":"SYNTAX-scores en uitkomsten bij diabetes met multivatenlijden: gepoolde analyse","title_en":"Impact of the SYNTAX scores I and II in patients with diabetes and multivessel coronary disease: a pooled analysis of patient level data from the SYNTAX, PRECOMBAT, and BEST trials.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["diabetes-en-hart"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx138","source_url":"https://doi.org/10.1093/eurheartj/ehx138","authors":["Rafael Cavalcante","Yohei Sotomi","Massimo Mancone","Cheol Whan Lee","Jung-Min Ahn","Yoshinobu Onuma","Pedro A Lemos","Robert-Jan van Geuns","Seung-Jung Park","Patrick W Serruys"],"significance":6,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This pooled patient-level analysis assessed the impact of SYNTAX scores I and II on outcomes after PCI versus CABG in diabetic patients with multivessel disease, refining the revascularization strategy selection for the diabetic population.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse van patiëntniveaudata naar de impact van SYNTAX-scores I en II op uitkomsten bij diabetespatiënten met multivatencoronairlijden. Verfijnt de revascularisatiebeslissing.","abstract_original":"AIMS: To assess the impact of the SYNTAX scores I and II in outcomes after percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for patients with diabetes and multivessel disease (MVD). METHODS AND RESULTS: We performed a patient-level pooled analysis of three large randomized trials of patients with MVD. The impact of coronary anatomic complexity as measured by the SYNTAX score in the differences in outcomes following PCI and CABG was assessed at a median follow-up of 5 years. We also assessed the performance of the SYNTAX II score model in patients with and without diabetes. From the 3280 patients enrolled in the three trials, a total of 1068 (32.6%) had diabetes. The rate of the composite of death, myocardial infarction (MI), or stroke was similar in the PCI and CABG arms in patients with low-intermediate (≤32) SYNTAX scores (15.1% vs. 14.9%, respectively; P = 0.93) while it was significantly higher in the PCI arm in patients with high (≥33) SYNTAX scores (24.5% vs. 13.2%, respectively; P = 0.018). The SYNTAX score II showed good calibration and moderate discrimination ability in patients with diabetes (c-index = 0.68) as well as in those without (c-index = 0.67). CONCLUSIONS: Differences in 5 years outcomes following PCI and CABG for patients with MVD and diabetes were influenced by anatomic complexity as measured by the SYNTAX score. The SYNTAX score II mortality prediction model showed similar performance regardless of the diabetes status."},{"id":"1840acfeb846","type":"article","url":"https://hartvaat.nl/2017/07/01/werkzaamheid-van-katheterablatie-bij-niet-paroxysmaal-atriumfibrilleren-jama-car/","title":"Werkzaamheid van katheterablatie bij niet-paroxysmaal atriumfibrilleren: JAMA Cardiology","title_en":"Efficacy of Catheter Ablation for Nonparoxysmal Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["gedilateerde-cardiomyopathie","hypertrofische-cardiomyopathie","katheterablatie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.0901","source_url":"https://doi.org/10.1001/jamacardio.2017.0901","authors":["Guy Amit","Jonathan Nyong","Carlos A Morillo"],"significance":7,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/classificatie-af/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This JAMA Cardiology review evaluated the efficacy of catheter ablation specifically for non-paroxysmal AF (persistent and longstanding persistent), summarizing the evidence for ablation in these more challenging AF subtypes.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology review naar de werkzaamheid van katheterablatie specifiek bij niet-paroxysmaal (persisterend/langdurig persisterend) AF. Evaluatie van de evidence voor ablatie bij moeilijker te behandelen AF.","abstract_original":"CLINICAL QUESTION: Is catheter ablation better than antiarrhythmic drugs for the prevention of nonparoxysmal atrial fibrillation? BOTTOM LINE: Radiofrequency catheter ablation was found to be superior to antiarrhythmic drugs in preventing recurrences of nonparoxysmal atrial fibrillation and reducing hospital admissions."},{"id":"2600772330a1","type":"article","url":"https://hartvaat.nl/2017/07/01/1-jaarsmortaliteit-bivalirudine-versus-heparine-in-de-ambulance-bij-stemi-matrix/","title":"1-jaarsmortaliteit bivalirudine versus heparine in de ambulance bij STEMI: MATRIX","title_en":"One-Year Mortality for Bivalirudin vs Heparins Plus Optional Glycoprotein IIb/IIIa Inhibitor Treatment Started in the Ambulance for ST-Segment Elevation Myocardial Infarction: A Secondary Analysis of the EUROMAX Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.5975","source_url":"https://doi.org/10.1001/jamacardio.2016.5975","authors":["Enrico Fabris","Sinem Kilic","Arnoud W J Van't Hof","Jurrien Ten Berg","Ana Ayesta","Uwe Zeymer","Martial Hamon","Louis Soulat","Debra Bernstein","Prodromos Anthopoulos","Efthymios N Deliargyris","Philippe Gabriel Steg"],"significance":6,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology analysis of 1-year mortality with bivalirudin versus heparin initiated in the ambulance for STEMI provided extended follow-up on the optimal anticoagulation strategy for prehospital PCI management.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology 1-jaarsmortaliteitsanalyse van bivalirudine versus heparine met optionele GPIIb/IIIa-remming, gestart in de ambulance bij STEMI.","abstract_original":"IMPORTANCE: Uncertainty exists regarding potential survival benefits of bivalirudin compared with heparin with routine or optional use of glycoprotein IIb/IIIa inhibitors (GPIs) in patients with ST-segment elevation myocardial infarction (STEMI). Few data are available regarding long-term mortality in the context of contemporary practice with frequent use of radial access and novel platelet adenosine diphosphate P2Y12 receptor inhibitors. OBJECTIVE: To assess the effect of bivalirudin monotherapy compared with unfractionated or low-molecular-weight heparin plus optional GPIs on 1-year mortality. DESIGN, SETTING, AND PARTICIPANTS: This international, randomized, open-label clinical trial (EUROMAX [European Ambulance Acute Coronary Syndrome Angiography]) included 2198 patients with STEMI undergoing transport for primary percutaneous coronary intervention from March 10, 2010, through June 20, 2013, and followed up for 1 year. Patients were randomized (1:1) in ambulance to bivalirudin monotherapy vs unfractionated or low-molecular-weight heparin plus optional GPIs (control group). Analysis was based on intention to treat. MAIN OUTCOMES AND MEASURES: The primary outcome of this prespecified analysis was 1-year mortality. All deaths were adjudicated as cardiac or noncardiac by an independent, blinded clinical events committee. One-year mortality was assessed and examined across multiple prespecified subgroups. RESULTS: Of the 2198 patients enrolled (1675 men [76.2%] and 523 women [23.8%]; median [interquartile range] age, 62 [52-72] years), complete 1-year follow-up data were available for 2164 (98.5%). All-cause 1-year mortality occurred in 118 patients (5.4%). The number of all-cause deaths was the same for both treatment groups (59 deaths; relative risk [RR], 1.02; 95% CI, 0.72-1.45; P = .92). No differences were noted in the rates of 1-year cardiac death (44 [4.0%] for the bivalirudin group vs 48 [4.3%] for the control group; RR, 0.93; 95% CI, 0.63-1.39; P = .74) or noncardiac death (15 [1.4%] for the bivalirudin group vs 11 [1.0%] for the control group; RR, 1.39; 95% CI, 0.64-3.01; P = .40). Results were consistent across the prespecified patient subgroups. The rate of deaths occurring from 30 days to 1 year was also similar (27 [2.5%] in the bivalirudin group vs 25 [2.3%] in the control group; RR, 1.10; 95% CI, 0.64-1.88; P = .73). CONCLUSIONS AND RELEVANCE: In patients with STEMI who were being transported for primary percutaneous coronary intervention, treatment with bivalirudin or with heparin with optional use of GPI resulted in similar 1-year mortality. The reduced composite end point of death and/or major bleeding at 30 days in the bivalirudin arm of the EUROMAX trial did not translate into reduced cardiovascular or all-cause death at 1 year. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01087723."},{"id":"b18da74350d6","type":"article","url":"https://hartvaat.nl/2017/07/01/crt-werkingsmechanismen-en-mogelijkheden-voor-verdere-verbetering/","title":"CRT: werkingsmechanismen en mogelijkheden voor verdere verbetering","title_en":"Cardiac resynchronization therapy: mechanisms of action and scope for further improvement in cardiac function.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw136","source_url":"https://doi.org/10.1093/europace/euw136","authors":["Siana Jones","Joost Lumens","S M Afzal Sohaib","Judith A Finegold","Prapa Kanagaratnam","Mark Tanner","Edward Duncan","Philip Moore","Francisco Leyva","Mike Frenneaux","Mark Mason","Alun D Hughes","Darrel P Francis","Zachary I Whinnett"],"significance":6,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":[],"congress":"","summary_en":"This comprehensive review described the mechanisms of action of CRT and identified opportunities for further optimization, covering electrical resynchronization, AV optimization, and multisite pacing strategies.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide review over de werkingsmechanismen van CRT en het potentieel voor verdere optimalisatie. Overzicht van elektrische en mechanische resynchronisatie.","abstract_original":"AIMS: Cardiac resynchronization therapy (CRT) may exert its beneficial haemodynamic effect by improving ventricular synchrony and improving atrioventricular (AV) timing. The aim of this study was to establish the relative importance of the mechanisms through which CRT improves cardiac function and explore the potential for additional improvements with improved ventricular resynchronization. METHODS AND RESULTS: We performed simulations using the CircAdapt haemodynamic model and performed haemodynamic measurements while adjusting AV delay, at low and high heart rates, in 87 patients with CRT devices. We assessed QRS duration, presence of fusion, and haemodynamic response. The simulations suggest that intrinsic PR interval and the magnitude of reduction in ventricular activation determine the relative importance of the mechanisms of benefit. For example, if PR interval is 201 ms and LV activation time is reduced by 25 ms (typical for current CRT methods), then AV delay optimization is responsible for 69% of overall improvement. Reducing LV activation time by an additional 25 ms produced an additional 2.6 mmHg increase in blood pressure (30% of effect size observed with current CRT). In the clinical population, ventricular fusion significantly shortened QRS duration (Δ-27 ± 23 ms, P < 0.001) and improved systolic blood pressure (mean 2.5 mmHg increase). Ventricular fusion was present in 69% of patients, yet in 40% of patients with fusion, shortening AV delay (to a delay where fusion was not present) produced the optimal haemodynamic response. CONCLUSIONS: Improving LV preloading by shortening AV delay is an important mechanism through which cardiac function is improved with CRT. There is substantial scope for further improvement if methods for delivering more efficient ventricular resynchronization can be developed. CLINICAL TRIAL REGISTRATION: Our clinical data were obtained from a subpopulation of the British Randomised Controlled Trial of AV and VV Optimisation (BRAVO), which is a registered clinical trial with unique identifier: NCT01258829, https://clinicaltrials.gov."},{"id":"bb5a21ad9fa0","type":"article","url":"https://hartvaat.nl/2017/07/01/kwartdosis-antihypertensiva-systematische-review-en-meta-analyse/","title":"Kwartdosis antihypertensiva: systematische review en meta-analyse","title_en":"Efficacy and Safety of Quarter-Dose Blood Pressure-Lowering Agents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09202","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09202","authors":["Alexander Bennett","Clara K Chow","Michael Chou","Hakim-Moulay Dehbi","Ruth Webster","Abdul Salam","Anushka Patel","Bruce Neal","David Peiris","Jay Thakkar","John Chalmers","Mark Nelson","Christopher Reid","Graham S Hillis","Mark Woodward","Sarah Hilmer","Tim Usherwood","Simon Thom","Anthony Rodgers"],"significance":7,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/polypil-cardiovasculair/"],"congress":"","summary_en":"This systematic review and meta-analysis of quarter-dose blood pressure-lowering agents showed that ultra-low-dose antihypertensive combinations provide meaningful blood pressure reduction with minimal side effects, building the evidence base for the low-dose combination approach.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die de werkzaamheid en veiligheid van kwartdosis antihypertensiva onderzocht. Bouwt de evidence base voor lage-dosis combinatietherapie als startbehandeling.","abstract_original":"There is a critical need for blood pressure-lowering strategies that have greater efficacy and minimal side effects. Low-dose combinations hold promise in this regard, but there are few data on very-low-dose therapy. We, therefore, conducted a systematic review and meta-analysis of randomized controlled trials with at least one quarter-dose and one placebo and standard-dose monotherapy arm. A search was conducted of Medline, Embase, Cochrane Registry, Food and Drug Administration, and European Medicinal Agency websites. Data on blood pressure and adverse events were pooled using a fixed-effect model, and bias was assessed using Cochrane risk of bias. The review included 42 trials involving 20 284 participants. Thirty-six comparisons evaluated quarter-dose with placebo and indicated a blood pressure reduction of -4.7/-2.4 mm Hg (P<0.001). Six comparisons were of dual quarter-dose therapy versus placebo, observing a -6.7/ -4.4 mm Hg (P<0.001) blood pressure reduction. There were no trials of triple quarter-dose combination versus placebo, but one quadruple quarter-dose study observed a blood pressure reduction of -22.4/-13.1 mm Hg versus placebo (P<0.001). Compared with standard-dose monotherapy, the blood pressure differences achieved by single (37 comparisons), dual (7 comparisons), and quadruple (1 trial) quarter-dose combinations were +3.7/+2.6 (P<0.001), +1.3/-0.3 (NS), and -13.1/-7.9 (P<0.001) mm Hg, respectively. In terms of adverse events, single and dual quarter-dose therapy was not significantly different from placebo and had significantly fewer adverse events compared with standard-dose monotherapy. Quarter-dose combinations could provide improvements in efficacy and tolerability of blood pressure-lowering therapy."},{"id":"976945d32927","type":"article","url":"https://hartvaat.nl/2017/07/01/cardiovasculair-risico-bij-diabetes-op-betablokkers/","title":"Cardiovasculair risico bij diabetes op bètablokkers","title_en":"Risk of Cardiovascular Events in Patients With Diabetes Mellitus on β-Blockers.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","biomarkers-cardiovasculair","cardio-renaal-metabool","diabetes-en-hart","diabetes-type-1","diabetes-type-2","dyslipidemie","ezetimibe","farmaco-economie","figaro-dkd","glp1-agonisten","hdl-cholesterol","inflammatie","lipoproteïne-a","menopauze","microbioom","obesitas","ouderen","richtlijnen-esc","roken","select-trial","slaapapneu","soul-trial","tirzepatide","voeding-hart"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09259","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09259","authors":["Tetsuro Tsujimoto","Takehiro Sugiyama","Martin F Shapiro","Mitsuhiko Noda","Hiroshi Kajio"],"significance":6,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study examined the cardiovascular risk implications of beta-blocker use in diabetic patients, addressing the metabolic effects of beta-blockers that may counteract the benefits of intensive glycemic control.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het cardiovasculaire risico bij diabetespatiënten die bètablokkers gebruiken. Onderzoekt de metabole effecten van bètablokkade bij diabetes.","abstract_original":"Although the use of β-blockers may help in achieving maximum effects of intensive glycemic control because of a decrease in the adverse effects after severe hypoglycemia, they pose a potential risk for the occurrence of severe hypoglycemia. This study aimed to evaluate whether the use of β-blockers is effective in patients with diabetes mellitus and whether its use is associated with the occurrence of severe hypoglycemia. Using the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes) data, we performed Cox proportional hazards analyses with a propensity score adjustment. The primary outcome was the first occurrence of a cardiovascular event during the study period, which included nonfatal myocardial infarction, unstable angina, nonfatal stroke, and cardiovascular death. The mean follow-up periods (±SD) were 4.6±1.6 years in patients on β-blockers (n=2527) and 4.7±1.6 years in those not on β-blockers (n=2527). The cardiovascular event rate was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.46; 95% confidence interval, 1.24-1.72; P<0.001). In patients with coronary heart disease or heart failure, the cumulative event rate for cardiovascular events was also significantly higher in those on β-blockers than in those not on β-blockers (hazard ratio, 1.27; 95% confidence interval, 1.02-1.60; P=0.03). The incidence of severe hypoglycemia was significantly higher in patients on β-blockers than in those not on β-blockers (hazard ratio, 1.30; 95% confidence interval, 1.03-1.64; P=0.02). In conclusion, the use of β-blockers in patients with diabetes mellitus was associated with an increased risk for cardiovascular events."},{"id":"c404368b077b","type":"article","url":"https://hartvaat.nl/2017/07/01/heterogeniteit-in-vroege-respons-op-antihypertensiva-allhat/","title":"Heterogeniteit in vroege respons op antihypertensiva: ALLHAT","title_en":"Heterogeneity in Early Responses in ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09221","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09221","authors":["Sanket S Dhruva","Chenxi Huang","Erica S Spatz","Andreas C Coppi","Frederick Warner","Shu-Xia Li","Haiqun Lin","Xiao Xu","Curt D Furberg","Barry R Davis","Sara L Pressel","Ronald R Coifman","Harlan M Krumholz"],"significance":6,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":[],"congress":"","summary_en":"This ALLHAT analysis examined heterogeneity in early blood pressure responses to different antihypertensive classes, finding clinically meaningful variation that may guide personalized drug selection strategies.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ALLHAT-analyse die heterogeniteit in vroege bloeddrukrespons op verschillende antihypertensivaklassen onderzocht. Relevant voor gepersonaliseerde startkeuze.","abstract_original":"Randomized trials of hypertension have seldom examined heterogeneity in response to treatments over time and the implications for cardiovascular outcomes. Understanding this heterogeneity, however, is a necessary step toward personalizing antihypertensive therapy. We applied trajectory-based modeling to data on 39 763 study participants of the ALLHAT (Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial) to identify distinct patterns of systolic blood pressure (SBP) response to randomized medications during the first 6 months of the trial. Two trajectory patterns were identified: immediate responders (85.5%), on average, had a decreasing SBP, whereas nonimmediate responders (14.5%), on average, had an initially increasing SBP followed by a decrease. Compared with those randomized to chlorthalidone, participants randomized to amlodipine (odds ratio, 1.20; 95% confidence interval [CI], 1.10-1.31), lisinopril (odds ratio, 1.88; 95% CI, 1.73-2.03), and doxazosin (odds ratio, 1.65; 95% CI, 1.52-1.78) had higher adjusted odds ratios associated with being a nonimmediate responder (versus immediate responder). After multivariable adjustment, nonimmediate responders had a higher hazard ratio of stroke (hazard ratio, 1.49; 95% CI, 1.21-1.84), combined cardiovascular disease (hazard ratio, 1.21; 95% CI, 1.11-1.31), and heart failure (hazard ratio, 1.48; 95% CI, 1.24-1.78) during follow-up between 6 months and 2 years. The SBP response trajectories provided superior discrimination for predicting downstream adverse cardiovascular events than classification based on difference in SBP between the first 2 measurements, SBP at 6 months, and average SBP during the first 6 months. Our findings demonstrate heterogeneity in response to antihypertensive therapies and show that chlorthalidone is associated with more favorable initial response than the other medications."},{"id":"42d4dad5a5d8","type":"article","url":"https://hartvaat.nl/2017/07/01/dabigatran-naar-leeftijd-bij-atriumfibrilleren-re-ly-analyse/","title":"Dabigatran naar leeftijd bij atriumfibrilleren: RE-LY-analyse","title_en":"Effects of dabigatran according to age in atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","huisarts"],"tags":["acuut-hartfalen","atriale-cardiomyopathie","farmaco-economie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310358","source_url":"https://doi.org/10.1136/heartjnl-2016-310358","authors":["Mandy N Lauw","John W Eikelboom","Michiel Coppens","Lars Wallentin","Salim Yusuf","Michael Ezekowitz","Jonas Oldgren","Juliet Nakamya","Jia Wang","Stuart J Connolly"],"significance":7,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This RE-LY age-stratified analysis examined the effects and safety of dabigatran across different age groups in AF, providing dosing guidance for the elderly and informing the age-dependent risk-benefit balance of anticoagulation.","created":"2026-07-03T10:26:46Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"RE-LY analyse naar het effect en de veiligheid van dabigatran gestratificeerd naar leeftijd bij AF-patiënten. Relevant voor doseringsbeslissingen bij ouderen.","abstract_original":"OBJECTIVE: The prevalence of atrial fibrillation (AF) and the risk of stroke and bleeding vary according to age. To estimate effects of dabigatran, compared with warfarin, on stroke, bleeding and mortality in patients with AF in the Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial according to age, we analysed treatment effects using age as a continuous variable and using age categories. METHODS: RE-LY included 10 855 (59.9%) patients aged <75 years, 4231 patients (23.4%) aged 75-79 years, 2305 (12.7%) aged 80-84 years and 722 (4.0%) aged ≥85 years at baseline. RESULTS: Benefits of dabigatran versus warfarin regarding stroke (HR range 0.63 (95% CI 0.46 to 0.86) to 0.70 (0.31 to 1.57) for dabigatran 150 mg twice daily), HR range 0.52 (0.21 to 1.29) to 1.08 (0.73 to 1.60) for dabigatran 110 mg twice daily) and intracranial bleeding were maintained across all age groups (interaction p values all not significant). There was a highly significant interaction (p value interaction <0.001) between age and treatment for extracranial major bleeding, with lower rates with both doses of dabigatran compared with warfarin in younger patients (HR 0.78 (0.62 to 0.97) for 150 mg twice daily, HR 0.72 (0.57 to 0.90) for 110 mg twice daily) but similar (HR 1.50 (1.03 to 2.18) for 110 mg twice daily) or higher rates (HR 1.68 (1.18 to 2.41) for 150 mg twice daily) in older patients (≥80 years). CONCLUSION: Effects of dabigatran compared with warfarin on stroke prevention and intracranial bleeding are consistent across all age groups. Effects of dabigatran on extracranial major bleeding are age dependent, supporting selection of dabigatran 110 mg twice daily for elderly patients (age ≥80 years). TRIAL REGISTRATION NUMBER: Clinical trial registration number: https://clinicaltrials.gov NCT00262600."},{"id":"2255186af347","type":"article","url":"https://hartvaat.nl/2017/07/01/bioresorbeerbare-scaffold-versus-des-2-jaars-meta-analyse/","title":"Bioresorbeerbare scaffold versus DES: 2-jaars meta-analyse","title_en":"Two-year outcomes of bioresorbable vascular scaffold versus drug-eluting stents in coronary artery disease: a meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310886","source_url":"https://doi.org/10.1136/heartjnl-2016-310886","authors":["Ramez Nairooz","Marwan Saad","Partha Sardar","Wilbert S Aronow"],"significance":7,"published":"2017-07-01","source_date":"2017-07-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This meta-analysis of 2-year outcomes confirmed inferior safety of bioresorbable vascular scaffolds compared with drug-eluting stents, with higher rates of definite/probable scaffold thrombosis, contributing to the evidence that led to device withdrawal.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:04Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van 2-jaarsuitkomsten die bioresorbeerbare scaffolds vergeleek met drug-eluting stents. Toont inferieure veiligheid van BRS.","abstract_original":"BACKGROUND: Data regarding long-term clinical outcomes with everolimus-eluting bioresorbable vascular scaffold (BVS) versus second-generation drug-eluting stents (DES) are scarce. METHODS: We searched online databases until October 2016 for studies comparing BVS versus DES reporting outcomes at 2 years of follow-up. We performed a meta-analysis comparing BVS with DES across the spectrum of coronary artery disease (CAD). Random effects model OR was calculated for outcomes of interest including device-oriented composite events (DOCE; defined as composite of cardiac mortality, target vessel myocardial infarction (TV-MI), and ischaemia-driven target lesion revascularisation (TLR)), all-cause mortality, definite stent thrombosis, TV-MI and TLR. RESULTS: A total of 2360 patients enrolled in five studies met criteria for inclusion in this analysis. At 2 years, BVS was associated with higher rates of DOCE (6.9% vs 4.5%, OR=1.53; 95% CI 1.06 to 2.23; p=0.02), absolute risk increase (ARI) 2.4%, relative risk increase (RRI) 53%, TV-MI (4% vs 1.8%, OR=1.94; 95% CI 1.02 to 3.67; p=0.04), ARI 2.2%, RRI 122% and definite stent thrombosis (2.1% vs 0.6%, OR=3.39; 95% CI 1.46 to 7.88; p=0.005), ARI 1.5%, RRI 250% compared with DES. No differences in all-cause mortality (OR=0.86; 95% CI 0.26 to 2.81; p=0.80) and TLR (OR=1.44; 95% CI 0.81 to 2.54; p=0.21) were observed between both groups. CONCLUSIONS: BVS may be associated with worse long-term clinical outcomes compared with DES. Randomised clinical trials are encouraged to expeditiously report long-term safety and efficacy outcomes and identify predictors of adverse events with BVS compared with DES."},{"id":"c12caffc35f9","type":"article","url":"https://hartvaat.nl/2017/06/27/hospitalisatie-voor-nieuw-gediagnosticeerd-versus-verslechterend-chronisch-hartf/","title":"Hospitalisatie voor nieuw gediagnosticeerd versus verslechterend chronisch hartfalen: ASCEND-HF","title_en":"Hospitalization for Recently Diagnosed Versus Worsening Chronic Heart Failure: From the ASCEND-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.04.043","source_url":"https://doi.org/10.1016/j.jacc.2017.04.043","authors":["Stephen J Greene","Adrian F Hernandez","Allison Dunning","Andrew P Ambrosy","Paul W Armstrong","Javed Butler","Lukasz P Cerbin","Adrian Coles","Justin A Ezekowitz","Marco Metra","Randall C Starling","John R Teerlink","Adriaan A Voors","Christopher M O'Connor","Robert J Mentz"],"significance":6,"published":"2017-06-27","source_date":"2017-06-27","image":"","kennis":[],"congress":"","summary_en":"This ASCEND-HF analysis compared outcomes between patients hospitalized for newly diagnosed versus chronically worsening heart failure, showing that long-term chronic HF survivors have different risk profiles and treatment responses.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"ASCEND-HF analyse die uitkomsten vergeleek tussen patiënten gehospitaliseerd voor nieuw versus verslechterend chronisch hartfalen. De novo HF heeft een ander risicoprofiel.","abstract_original":"BACKGROUND: It is unclear how patients hospitalized for acute heart failure (HF) who are long-term chronic HF survivors differ from those with more recent HF diagnoses. OBJECTIVES: The goal of this study was to evaluate the influence of HF chronicity on acute HF patient profiles and outcomes. METHODS: The ASCEND-HF (Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure) trial randomized 7,141 hospitalized patients with acute HF with reduced or preserved ejection fraction (EF) to receive nesiritide or placebo in addition to standard care. The present analysis compared patients according to duration of HF diagnosis before index hospitalization by using pre-specified cutoffs (0 to 1 month [i.e., \"recently diagnosed\"], >1 to 12 months, >12 to 60 months, and >60 months). RESULTS: Overall, 5,741 (80.4%) patients had documentation of duration of HF diagnosis (recently diagnosed, n = 1,536; >1 to 12 months, n = 1,020; >12 to 60 months, n = 1,653; and >60 months, n = 1,532). Across HF duration groups, mean age ranged from 64 to 66 years, and mean ejection fraction ranged from 29% to 32%. Compared with patients with longer HF duration, recently diagnosed patients were more likely to be women with nonischemic HF etiology, higher baseline blood pressure, better baseline renal function, and fewer comorbidities. After adjustment, compared with recently diagnosed patients, patients with longer HF duration were associated with more persistent dyspnea at 24 h (>1 to 12 months, odds ratio [OR]: 1.20; 95% confidence interval [CI]: 0.97 to 1.48; >12 to 60 months, OR: 1.34; 95% CI: 1.11 to 1.62; and >60 months, OR: 1.31; 95% CI: 1.08 to 1.60) and increased 180-day mortality (>1 to 12 months, hazard ratio [HR]: 1.89; 95% CI: 1.35 to 2.65; >12 to 60 months, HR: 1.82; 95% CI: 1.33 to 2.48; and >60 months, HR: 2.02; 95% CI: 1.47 to 2.77). The influence of HF duration on mortality was potentially more pronounced among female patients (interaction p = 0.05), but did not differ according to age, race, prior ischemic heart disease, or ejection fraction (all interactions, p ≥ 0.23). CONCLUSIONS: In this acute HF trial, patient profile differed according to duration of the HF diagnosis. A diagnosis of HF for ≤1 month before hospitalization was independently associated with greater early dyspnea relief and improved post-discharge survival compared to patients with chronic HF diagnoses. The distinction between de novo or recently diagnosed HF and worsening chronic HF should be considered in the design of future acute HF trials. (A Study Testing the Effectiveness of Nesiritide in Patients With Acute Decompensated Heart Failure; NCT00475852)."},{"id":"4ffa9c22880b","type":"article","url":"https://hartvaat.nl/2017/06/24/bijwerkingen-bij-niet-geblindeerde-versus-geblindeerde-statinetherapie-lancet-as/","title":"Bijwerkingen bij niet-geblindeerde versus geblindeerde statinetherapie: Lancet ASCOT-LLA","title_en":"Adverse events associated with unblinded, but not with blinded, statin therapy in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm (ASCOT-LLA): a randomised double-blind placebo-controlled trial and its non-randomised non-blind extension phase.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)31075-9","source_url":"https://doi.org/10.1016/S0140-6736(17)31075-9","authors":["Ajay Gupta","David Thompson","Andrew Whitehouse","Tim Collier","Bjorn Dahlof","Neil Poulter","Rory Collins","Peter Sever"],"significance":9,"published":"2017-06-24","source_date":"2017-06-24","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/"],"congress":"","summary_en":"This Lancet analysis from ASCOT demonstrated that statin-attributed side effects were reported significantly more often during the unblinded extension phase than during the original blinded trial, providing direct evidence that the nocebo effect drives most perceived statin intolerance.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-analyse die aantoont dat statinebijwerkingen significant vaker worden gerapporteerd in ongeblindeerde versus geblindeerde fase. Bewijs voor het nocebo-effect bij statines.","abstract_original":"BACKGROUND: In blinded randomised controlled trials, statin therapy has been associated with few adverse events (AEs). By contrast, in observational studies, larger increases in many different AEs have been reported than in blinded trials. METHODS: In the Lipid-Lowering Arm of the Anglo-Scandinavian Cardiac Outcomes Trial, patients aged 40-79 years with hypertension, at least three other cardiovascular risk factors, and fasting total cholesterol concentrations of 6·5 mmol/L or lower, and who were not taking a statin or fibrate, had no history of myocardial infarction, and were not being treated for angina were randomly assigned to atorvastatin 10 mg daily or matching placebo in a randomised double-blind placebo-controlled phase. In a subsequent non-randomised non-blind extension phase (initiated because of early termination of the trial because efficacy of atorvastatin was shown), all patients were offered atorvastatin 10 mg daily open label. We classified AEs using the Medical Dictionary for Regulatory Activities. We blindly adjudicated all reports of four prespecified AEs of interest-muscle-related, erectile dysfunction, sleep disturbance, and cognitive impairment-and analysed all remaining AEs grouped by system organ class. Rates of AEs are given as percentages per annum. RESULTS: The blinded randomised phase was done between February, 1998, and December, 2002; we included 101 80 patients in this analysis (5101 [50%] in the atorvastatin group and 5079 [50%] in the placebo group), with a median follow-up of 3·3 years (IQR 2·7-3·7). The non-blinded non-randomised phase was done between December, 2002, and June, 2005; we included 9899 patients in this analysis (6409 [65%] atorvastatin users and 3490 [35%] non-users), with a median follow-up of 2·3 years (2·2-2·4). During the blinded phase, muscle-related AEs (298 [2·03% per annum] vs 283 [2·00% per annum]; hazard ratio 1·03 [95% CI 0·88-1·21]; p=0·72) and erectile dysfunction (272 [1·86% per annum] vs 302 [2·14% per annum]; 0·88 [0·75-1·04]; p=0·13) were reported at a similar rate by participants randomly assigned to atorvastatin or placebo. The rate of reports of sleep disturbance was significantly lower among participants assigned atorvastatin than assigned placebo (149 [1·00% per annum] vs 210 [1·46% per annum]; 0·69 [0·56-0·85]; p=0·0005). Too few cases of cognitive impairment were reported for a statistically reliable analysis (31 [0·20% per annum] vs 32 [0·22% per annum]; 0·94 [0·57-1·54]; p=0·81). We observed no significant differences in the rates of all other reported AEs, with the exception of an excess of renal and urinary AEs among patients assigned atorvastatin (481 [1·87%] per annum vs 392 [1·51%] per annum; 1·23 [1·08-1·41]; p=0·002). By contrast, during the non-blinded non-randomised phase, muscle-related AEs were reported at a significantly higher rate by participants taking statins than by those who were not (161 [1·26% per annum] vs 124 [1·00% per annum]; 1·41 [1·10-1·79]; p=0·006). We noted no significant differences between statin users and non-users in the rates of other AEs, with the exception of musculoskeletal and connective tissue disorders (992 [8·69% per annum] vs 831 [7·45% per annum]; 1·17 [1·06-1·29]; p=0·001) and blood and lymphatic system disorders (114 [0·88% per annum] vs 80 [0·64% per annum]; 1·40 [1·04-1·88]; p=0·03), which were reported more commonly by statin users than by non-users. INTERPRETATION: These analyses illustrate the so-called nocebo effect, with an excess rate of muscle-related AE reports only when patients and their doctors were aware that statin therapy was being used and not when its use was blinded. These results will help assure both physicians and patients that most AEs associated with statins are not causally related to use of the drug and should help counter the adverse effect on public health of exaggerated claims about statin-related side-effects. FUNDING: Pfizer, Servier Research Group, and Leo Laboratories."},{"id":"7aa5ea3266d0","type":"article","url":"https://hartvaat.nl/2017/06/20/hartfrequentie-en-ritme-en-het-voordeel-van-betablokkers-bij-hartfalen/","title":"Hartfrequentie en ritme en het voordeel van bètablokkers bij hartfalen","title_en":"Heart Rate and Rhythm and the Benefit of Beta-Blockers in Patients With Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","bisoprolol","carvedilol","hfref","ivabradine"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.04.001","source_url":"https://doi.org/10.1016/j.jacc.2017.04.001","authors":["Dipak Kotecha","Marcus D Flather","Douglas G Altman","Jane Holmes","Giuseppe Rosano","John Wikstrand","Milton Packer","Andrew J S Coats","Luis Manzano","Michael Böhm","Dirk J van Veldhuisen","Bert Andersson","Hans Wedel","Thomas G von Lueder","Alan S Rigby","Åke Hjalmarson","John Kjekshus","John G F Cleland"],"significance":7,"published":"2017-06-20","source_date":"2017-06-20","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/","https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/"],"congress":"","summary_en":"This analysis examined the interaction between heart rate, rhythm (sinus rhythm vs AF), and beta-blocker benefit in heart failure, providing insights into which patients derive the most benefit from heart rate lowering.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de interactie tussen hartfrequentie, hartritme (sinusritme vs AF) en het behandelvoordeel van bètablokkers bij hartfalen. Relevant voor de therapiekeuze bij HF met AF.","abstract_original":"BACKGROUND: The relationship between mortality and heart rate remains unclear for patients with heart failure with reduced ejection fraction in either sinus rhythm or atrial fibrillation (AF). OBJECTIVES: This analysis explored the prognostic importance of heart rate in patients with heart failure with reduced ejection fraction in randomized controlled trials comparing beta-blockers and placebo. METHODS: The Beta-Blockers in Heart Failure Collaborative Group performed a meta-analysis of harmonized individual patient data from 11 double-blind randomized controlled trials. The primary outcome was all-cause mortality, analyzed with Cox proportional hazard ratios (HR) modeling heart rate measured at baseline and approximately 6 months post-randomization. RESULTS: A higher heart rate at baseline was associated with greater all-cause mortality for patients in sinus rhythm (n = 14,166; adjusted HR: 1.11 per 10 beats/min; 95% confidence interval [CI]: 1.07 to 1.15; p < 0.0001) but not in AF (n = 3,034; HR: 1.03 per 10 beats/min; 95% CI: 0.97 to 1.08; p = 0.38). Beta-blockers reduced ventricular rate by 12 beats/min in both sinus rhythm and AF. Mortality was lower for patients in sinus rhythm randomized to beta-blockers (HR: 0.73 vs. placebo; 95% CI: 0.67 to 0.79; p < 0.001), regardless of baseline heart rate (interaction p = 0.35). Beta-blockers had no effect on mortality in patients with AF (HR: 0.96, 95% CI: 0.81 to 1.12; p = 0.58) at any heart rate (interaction p = 0.48). A lower achieved resting heart rate, irrespective of treatment, was associated with better prognosis only for patients in sinus rhythm (HR: 1.16 per 10 beats/min increase, 95% CI: 1.11 to 1.22; p < 0.0001). CONCLUSIONS: Regardless of pre-treatment heart rate, beta-blockers reduce mortality in patients with heart failure with reduced ejection fraction in sinus rhythm. Achieving a lower heart rate is associated with better prognosis, but only for those in sinus rhythm."},{"id":"cb7be47df260","type":"article","url":"https://hartvaat.nl/2017/06/20/cholesteroleffluxcapaciteit-hdl-deeltjesaantal-en-cv-events-jupiter-analyse/","title":"Cholesteroleffluxcapaciteit, HDL-deeltjesaantal en CV-events: JUPITER-analyse","title_en":"Cholesterol Efflux Capacity, High-Density Lipoprotein Particle Number, and Incident Cardiovascular Events: An Analysis From the JUPITER Trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin).","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["cetp-remmers","dyslipidemie","ezetimibe","hdl-cholesterol","ldl-cholesterol","lipide-aferese","obicetrapib","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.025678","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.025678","authors":["Amit V Khera","Olga V Demler","Steven J Adelman","Heidi L Collins","Robert J Glynn","Paul M Ridker","Daniel J Rader","Samia Mora"],"significance":7,"published":"2017-06-20","source_date":"2017-06-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/"],"congress":"","summary_en":"This JUPITER analysis examined cholesterol efflux capacity and HDL particle number as predictors of cardiovascular events, exploring whether functional HDL measures better explain cardiovascular risk than HDL cholesterol concentration alone.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JUPITER-analyse die cholesteroleffluxcapaciteit en HDL-deeltjesaantal onderzocht als voorspellers van cardiovasculaire events. Verschuift de focus van HDL-spiegel naar HDL-functie.","abstract_original":"BACKGROUND: Recent failures of drugs that raised high-density lipoprotein (HDL) cholesterol levels to reduce cardiovascular events in clinical trials have led to increased interest in alternative indices of HDL quality, such as cholesterol efflux capacity, and HDL quantity, such as HDL particle number. However, no studies have directly compared these metrics in a contemporary population that includes potent statin therapy and low low-density lipoprotein cholesterol. METHODS: HDL cholesterol levels, apolipoprotein A-I, cholesterol efflux capacity, and HDL particle number were assessed at baseline and 12 months in a nested case-control study of the JUPITER trial (Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin), a randomized primary prevention trial that compared rosuvastatin treatment to placebo in individuals with normal low-density lipoprotein cholesterol but increased C-reactive protein levels. In total, 314 cases of incident cardiovascular disease (CVD) (myocardial infarction, unstable angina, arterial revascularization, stroke, or cardiovascular death) were compared to age- and gender-matched controls. Conditional logistic regression models adjusting for risk factors evaluated associations between HDL-related biomarkers and incident CVD. RESULTS: Cholesterol efflux capacity was moderately correlated with HDL cholesterol, apolipoprotein A-I, and HDL particle number (Spearman r= 0.39, 0.48, and 0.39 respectively; P<0.001). Baseline HDL particle number was inversely associated with incident CVD (adjusted odds ratio per SD increment [OR/SD], 0.69; 95% confidence interval [CI], 0.56-0.86; P<0.001), whereas no significant association was found for baseline cholesterol efflux capacity (OR/SD, 0.89; 95% CI, 0.72-1.10; P=0.28), HDL cholesterol (OR/SD, 0.82; 95% CI, 0.66-1.02; P=0.08), or apolipoprotein A-I (OR/SD, 0.83; 95% CI, 0.67-1.03; P=0.08). Twelve months of rosuvastatin (20 mg/day) did not change cholesterol efflux capacity (average percentage change -1.5%, 95% CI, -13.3 to +10.2; P=0.80), but increased HDL cholesterol (+7.7%), apolipoprotein A-I (+4.3%), and HDL particle number (+5.2%). On-statin cholesterol efflux capacity was inversely associated with incident CVD (OR/SD, 0.62; 95% CI, 0.42-0.92; P=0.02), although HDL particle number again emerged as the strongest predictor (OR/SD, 0.51; 95% CI, 0.33-0.77; P<0.001). CONCLUSIONS: In JUPITER, cholesterol efflux capacity was associated with incident CVD in individuals on potent statin therapy but not at baseline. For both baseline and on-statin analyses, HDL particle number was the strongest of 4 HDL-related biomarkers as an inverse predictor of incident events and biomarker of residual risk. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00239681."},{"id":"b87cd3c59508","type":"article","url":"https://hartvaat.nl/2017/06/15/bioresorbeerbare-scaffolds-versus-metallic-stents-bij-routine-pci-nejm-aida/","title":"Bioresorbeerbare scaffolds versus metallic stents bij routine-PCI: NEJM AIDA","title_en":"Bioresorbable Scaffolds versus Metallic Stents in Routine PCI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1614954","source_url":"https://doi.org/10.1056/NEJMoa1614954","authors":["Joanna J Wykrzykowska","Robin P Kraak","Sjoerd H Hofma","Rene J van der Schaaf","E Karin Arkenbout","Alexander J IJsselmuiden","Joëlle Elias","Ivo M van Dongen","Ruben Y G Tijssen","Karel T Koch","Jan Baan","M Marije Vis","Robbert J de Winter","Jan J Piek","Jan G P Tijssen","Jose P S Henriques"],"significance":8,"published":"2017-06-15","source_date":"2017-06-15","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The AIDA trial showed that bioresorbable vascular scaffolds had significantly higher rates of device thrombosis compared with metallic drug-eluting stents in routine PCI. This safety concern contributed to the withdrawal of bioresorbable scaffolds from widespread clinical use.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM AIDA-trial die bioresorbeerbare scaffolds vergeleek met metallic stents bij routine-PCI. Toonde meer devicetrombose — mede aanleiding voor terugtrekking van bioresorbeerbare scaffolds.","abstract_original":"BACKGROUND: Bioresorbable vascular scaffolds were developed to overcome the shortcomings of drug-eluting stents in percutaneous coronary intervention (PCI). We performed an investigator-initiated, randomized trial to compare an everolimus-eluting bioresorbable scaffold with an everolimus-eluting metallic stent in the context of routine clinical practice. METHODS: We randomly assigned 1845 patients undergoing PCI to receive either a bioresorbable vascular scaffold (924 patients) or a metallic stent (921 patients). The primary end point was target-vessel failure (a composite of cardiac death, target-vessel myocardial infarction, or target-vessel revascularization). The data and safety monitoring board recommended early reporting of the study results because of safety concerns. This report provides descriptive information on end-point events. RESULTS: The median follow-up was 707 days. Target-vessel failure occurred in 105 patients in the scaffold group and in 94 patients in the stent group (2-year cumulative event rates, 11.7% and 10.7%, respectively; hazard ratio, 1.12; 95% confidence interval [CI], 0.85 to 1.48; P=0.43); event rates were based on Kaplan-Meier estimates in time-to-event analyses. Cardiac death occurred in 18 patients in the scaffold group and in 23 patients in the stent group (2-year cumulative event rates, 2.0% and 2.7%, respectively), target-vessel myocardial infarction occurred in 48 patients in the scaffold group and in 30 patients in the stent group (2-year cumulative event rates, 5.5% and 3.2%), and target-vessel revascularization occurred in 76 patients in the scaffold group and in 65 patients in the stent group (2-year cumulative event rates, 8.7% and 7.5%). Definite or probable device thrombosis occurred in 31 patients in the scaffold group as compared with 8 patients in the stent group (2-year cumulative event rates, 3.5% vs. 0.9%; hazard ratio, 3.87; 95% CI, 1.78 to 8.42; P<0.001). CONCLUSIONS: In this preliminary report of a trial involving patients undergoing PCI, there was no significant difference in the rate of target-vessel failure between the patients who received a bioresorbable scaffold and the patients who received a metallic stent. The bioresorbable scaffold was associated with a higher incidence of device thrombosis than the metallic stent through 2 years of follow-up. (Funded by Abbott Vascular; AIDA ClinicalTrials.gov number, NCT01858077 .)."},{"id":"eca841aeeb04","type":"article","url":"https://hartvaat.nl/2017/06/14/overschakelen-van-niet-selectieve-nsaid-s-naar-celecoxib-de-scot-trial/","title":"Overschakelen van niet-selectieve NSAID's naar celecoxib: de SCOT-trial","title_en":"Randomized trial of switching from prescribed non-selective non-steroidal anti-inflammatory drugs to prescribed celecoxib: the Standard care vs. Celecoxib Outcome Trial (SCOT).","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog","huisarts"],"tags":["aspirine","niet-statine-therapie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw387","source_url":"https://doi.org/10.1093/eurheartj/ehw387","authors":["Thomas M MacDonald","Chris J Hawkey","Ian Ford","John J V McMurray","James M Scheiman","Jesper Hallas","Evelyn Findlay","Diederick E Grobbee","F D Richard Hobbs","Stuart H Ralston","David M Reid","Matthew R Walters","John Webster","Frank Ruschitzka","Lewis D Ritchie","Susana Perez-Gutthann","Eugene Connolly","Nicola Greenlaw","Adam Wilson","Li Wei","Isla S Mackenzie"],"significance":7,"published":"2017-06-14","source_date":"2017-06-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This randomized trial investigated the cardiovascular safety of switching from non-selective NSAIDs to celecoxib, providing comparative safety data relevant to anti-inflammatory drug selection in patients with cardiovascular risk factors.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die overschakeling van niet-selectieve NSAID's naar celecoxib onderzocht op cardiovasculaire veiligheid. Relevant voor het anti-inflammatoire pijnbeleid bij CV-risicopatiënten.","abstract_original":"BACKGROUND: Selective cyclooxygenase-2 inhibitors and conventional non-selective non-steroidal anti-inflammatory drugs (nsNSAIDs) have been associated with adverse cardiovascular (CV) effects. We compared the CV safety of switching to celecoxib vs. continuing nsNSAID therapy in a European setting. METHOD: Patients aged 60 years and over with osteoarthritis or rheumatoid arthritis, free from established CV disease and taking chronic prescribed nsNSAIDs, were randomized to switch to celecoxib or to continue their previous nsNSAID. The primary endpoint was hospitalization for non-fatal myocardial infarction or other biomarker positive acute coronary syndrome, non-fatal stroke or CV death analysed using a Cox model with a pre-specified non-inferiority limit of 1.4 for the hazard ratio (HR). RESULTS: In total, 7297 participants were randomized. During a median 3-year follow-up, fewer subjects than expected developed an on-treatment (OT) primary CV event and the rate was similar for celecoxib, 0.95 per 100 patient-years, and nsNSAIDs, 0.86 per 100 patient-years (HR = 1.12, 95% confidence interval, 0.81-1.55; P = 0.50). Comparable intention-to-treat (ITT) rates were 1.14 per 100 patient-years with celecoxib and 1.10 per 100 patient-years with nsNSAIDs (HR = 1.04; 95% confidence interval, 0.81-1.33; P = 0.75). Pre-specified non-inferiority was achieved in the ITT analysis. The upper bound of the 95% confidence limit for the absolute increase in OT risk associated with celecoxib treatment was two primary events per 1000 patient-years exposure. There were only 15 adjudicated secondary upper gastrointestinal complication endpoints (0.078/100 patient-years on celecoxib vs. 0.053 on nsNSAIDs OT, 0.078 vs. 0.053 ITT). More gastrointestinal serious adverse reactions and haematological adverse reactions were reported on nsNSAIDs than celecoxib, but more patients withdrew from celecoxib than nsNSAIDs (50.9% patients vs. 30.2%; P < 0.0001). INTERPRETATION: In subjects 60 years and over, free from CV disease and taking prescribed chronic nsNSAIDs, CV events were infrequent and similar on celecoxib and nsNSAIDs. There was no advantage of a strategy of switching prescribed nsNSAIDs to prescribed celecoxib. This study excluded an increased risk of the primary endpoint of more than two events per 1000 patient-years associated with switching to prescribed celecoxib. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/show/NCT00447759; Unique identifier: NCT00447759."},{"id":"fe3f4cccbb38","type":"article","url":"https://hartvaat.nl/2017/06/13/myocardschade-bij-uitgestelde-stenting-na-stemi-danami-3-defer-substudie/","title":"Myocardschade bij uitgestelde stenting na STEMI: DANAMI-3-DEFER substudie","title_en":"Myocardial Damage in Patients With Deferred Stenting After STEMI: A DANAMI-3-DEFER Substudy.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.03.601","source_url":"https://doi.org/10.1016/j.jacc.2017.03.601","authors":["Jacob Lønborg","Thomas Engstrøm","Kiril Aleksov Ahtarovski","Lars Nepper-Christensen","Steffen Helqvist","Niels Vejlstrup","Kasper Kyhl","Mikkel Malby Schoos","Ali Ghotbi","Christoffer Göransson","Litten Bertelsen","Lene Holmvang","Frants Pedersen","Erik Jørgensen","Kari Saunamäki","Peter Clemmensen","Ole De Backer","Lene Kløvgaard","Dan Eik Høfsten","Lars Køber","Henning Kelbæk"],"significance":5,"published":"2017-06-13","source_date":"2017-06-13","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This DANAMI-3-DEFER substudy evaluated myocardial damage in patients with deferred versus immediate stent implantation after STEMI, providing tissue-level outcomes for the delayed stenting strategy.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van DANAMI-3-DEFER die myocardschade evalueerde bij patiënten met uitgestelde versus directe stentimplantatie bij STEMI.","abstract_original":"BACKGROUND: Although some studies found improved coronary flow and myocardial salvage when stent implantation was deferred, the DANAMI-3-DEFER (Third DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction) did not show any improvement in clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI) and deferred stenting. OBJECTIVES: This study sought to evaluate the effect of deferred stent implantation on infarct size, myocardial salvage, and microvascular obstruction (MVO) in patients with STEMI. METHODS: In the present DANAMI-3 substudy, a total of 510 patients with STEMI were randomized to PCI with deferred versus immediate stent implantation. The patients underwent a cardiac magnetic resonance examination before discharge after the index procedure and again 3 months later. The primary endpoint was final infarct size. RESULTS: Deferred stenting did not reduce final infarct size (9% left ventricle [LV]; interquartile range [IQR]: 3% to 18% vs. 10% LV; IQR: 3% to 18%; p = 0.67). Similarly, deferred stenting was not associated with myocardial salvage index (66%; IQR: 50% to 89% vs. 67%; IQR: 49% to 88%; p = 0.80) or presence of MVO (43% vs. 42%; p = 0.78). In a post hoc analysis, stent length was the only subgroup of 7 that had an effect on outcome. In patients with a stent length ≥24 mm, deferred stenting reduced the final infarct size (6% LV; IQR: 2% to 18% vs. 13% LV; IQR: 7% to 23%; p = 0.006; and p for interaction = 0.005). CONCLUSIONS: In the DANAMI-3-DEFER cardiac magnetic resonance substudy, routine deferred stenting did not reduce infarct size or MVO and did not increase myocardial salvage. These results do not support the use of routine deferred stenting in STEMI patients treated with primary PCI. (DANish Study of Optimal Acute Treatment of Patients With ST-elevation Myocardial Infarction [DANAMI-3]; NCT01435408)."},{"id":"bda57fff6dd6","type":"article","url":"https://hartvaat.nl/2017/06/07/dagelijkse-telemonitoring-van-icd-s-gepoolde-analyse-van-drie-gerandomiseerde-tr/","title":"Dagelijkse telemonitoring van ICD's: gepoolde analyse van drie gerandomiseerde trials","title_en":"Daily remote monitoring of implantable cardioverter-defibrillators: insights from the pooled patient-level data from three randomized controlled trials (IN-TIME, ECOST, TRUST).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["digitale-gezondheid","thuisbloeddrukmeting"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx015","source_url":"https://doi.org/10.1093/eurheartj/ehx015","authors":["Gerhard Hindricks","Niraj Varma","Salem Kacet","Thorsten Lewalter","Peter Søgaard","Laurence Guédon-Moreau","Jochen Proff","Thomas A Gerds","Stefan D Anker","Christian Torp-Pedersen"],"significance":7,"published":"2017-06-07","source_date":"2017-06-07","image":"","kennis":[],"congress":"","summary_en":"This pooled patient-level analysis of three randomized trials examined whether daily remote monitoring of implantable cardioverter-defibrillators improves clinical outcomes through earlier detection of arrhythmias and device-related issues.","created":"2026-07-03T10:26:45Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gepoolde analyse op patiëntniveau van drie trials naar dagelijkse remote ICD-monitoring. Onderzoekt of vroegtijdige detectie van aritmieën en deviceproblemen de klinische uitkomsten verbetert.","abstract_original":"AIMS: Remote monitoring of implantable cardioverter-defibrillators may improve clinical outcome. A recent meta-analysis of three randomized controlled trials (TRUST, ECOST, IN-TIME) using a specific remote monitoring system with daily transmissions [Biotronik Home Monitoring (HM)] demonstrated improved survival. We performed a patient-level analysis to verify this result with appropriate time-to-event statistics and to investigate further clinical endpoints. METHODS AND RESULTS: Individual data of the TRUST, ECOST, and IN-TIME patients were pooled to calculate absolute risks of endpoints at 1-year follow-up for HM vs. conventional follow-up. All-cause mortality analysis involved all three trials (2405 patients). Other endpoints involved two trials, ECOST and IN-TIME (1078 patients), in which an independent blinded endpoint committee adjudicated the underlying causes of hospitalizations and deaths. The absolute risk of death at 1 year was reduced by 1.9% in the HM group (95% CI: 0.1-3.8%; P = 0.037), equivalent to a risk ratio of 0.62. Also the combined endpoint of all-cause mortality or hospitalization for worsening heart failure (WHF) was significantly reduced (by 5.6%; P = 0.007; risk ratio 0.64). The composite endpoint of all-cause mortality or cardiovascular (CV) hospitalization tended to be reduced by a similar degree (4.1%; P = 0.13; risk ratio 0.85) but without statistical significance. CONCLUSION: In a pooled analysis of the three trials, HM reduced all-cause mortality and the composite endpoint of all-cause mortality or WHF hospitalization. The similar magnitudes of absolute risk reductions for WHF and CV endpoints suggest that the benefit of HM is driven by the prevention of heart failure exacerbation."},{"id":"641f65428edc","type":"article","url":"https://hartvaat.nl/2017/06/03/intravitreaal-aflibercept-versus-panretinale-fotocoagulatie-bij-proliferatieve-d/","title":"Intravitreaal aflibercept versus panretinale fotocoagulatie bij proliferatieve diabetische retinopathie","title_en":"Clinical efficacy of intravitreal aflibercept versus panretinal photocoagulation for best corrected visual acuity in patients with proliferative diabetic retinopathy at 52 weeks (CLARITY): a multicentre, single-blinded, randomised, controlled, phase 2b, non-inferiority trial.","category":"preventie","category_label":"Preventie","professions":["internist"],"tags":[],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)31193-5","source_url":"https://doi.org/10.1016/S0140-6736(17)31193-5","authors":["Sobha Sivaprasad","A Toby Prevost","Joana C Vasconcelos","Amy Riddell","Caroline Murphy","Joanna Kelly","James Bainbridge","Rhiannon Tudor-Edwards","David Hopkins","Philip Hykin"],"significance":7,"published":"2017-06-03","source_date":"2017-06-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This Lancet study compared intravitreal aflibercept with panretinal photocoagulation for diabetic retinopathy, contributing to the ophthalmological management evidence relevant to diabetes cardiovascular care.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:03Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet vergelijking van aflibercept met fotocoagulatie bij diabetische retinopathie. Relevant voor het oogheelkundig management van diabetische microvasculaire complicaties.","abstract_original":"BACKGROUND: Proliferative diabetic retinopathy is the most common cause of severe sight impairment in people with diabetes. Proliferative diabetic retinopathy has been managed by panretinal laser photocoagulation (PRP) for the past 40 years. We report the 1 year safety and efficacy of intravitreal aflibercept. METHODS: In this phase 2b, single-blind, non-inferiority trial (CLARITY), adults (aged ≥18 years) with type 1 or 2 diabetes and previously untreated or post-laser treated active proliferative diabetic retinopathy were recruited from 22 UK ophthalmic centres. Patients were randomly assigned (1:1) to repeated intravitreal aflibercept (2 mg/0·05 mL at baseline, 4 weeks, and 8 weeks, and from week 12 patients were reviewed every 4 weeks and aflibercept injections were given as needed) or PRP standard care (single spot or mutlispot laser at baseline, fractionated fortnightly thereafter, and from week 12 patients were assessed every 8 weeks and treated with PRP as needed) for 52 weeks. Randomisation was by minimisation with a web-based computer generated system. Primary outcome assessors were masked optometrists. The treating ophthalmologists and participants were not masked. The primary outcome was defined as a change in best-corrected visual acuity at 52 weeks with a linear mixed-effect model that estimated adjusted treatment effects at both 12 weeks and 52 weeks, having excluded fluctuations in best corrected visual acuity owing to vitreous haemorrhage. This modified intention-to-treat analysis was reapplied to the per protocol participants. The non-inferiority margin was prespecified as -5 Early Treatment Diabetic Retinopathy Study letters. Safety was assessed in all participants. This trial is registered with ISRCTN registry, number 32207582. FINDINGS: We recruited 232 participants (116 per group) between Aug 22, 2014 and Nov 30, 2015. 221 participants (112 in aflibercept group, 109 in PRP group) contributed to the modified intention-to-treat model, and 210 participants (104 in aflibercept group and 106 in PRP group) within per protocol. Aflibercept was non-inferior and superior to PRP in both the modified intention-to-treat population (mean best corrected visual acuity difference 3·9 letters [95% CI 2·3-5·6], p<0·0001) and the per-protocol population (4·0 letters [2·4-5·7], p<0·0001). There were no safety concerns. The 95% CI adjusted difference between groups was more than the prespecified acceptable margin of -5 letters at both 12 weeks and 52 weeks. INTERPRETATION: Patients with proliferative diabetic retinopathy who were treated with intravitreal aflibercept had an improved outcome at 1 year compared with those treated with PRP standard care. FUNDING: The Efficacy and Mechanism Evaluation Programme, a Medical Research Council and National Institute for Health Research partnership."},{"id":"1fbfbf6039fa","type":"article","url":"https://hartvaat.nl/2017/06/03/bereikte-bloeddruk-en-cv-uitkomsten-bij-hoogrisicopatienten-ontarget-transcend/","title":"Bereikte bloeddruk en CV-uitkomsten bij hoogrisicopatiënten: ONTARGET/TRANSCEND","title_en":"Achieved blood pressure and cardiovascular outcomes in high-risk patients: results from ONTARGET and TRANSCEND trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","obesitas","ouderen"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)30754-7","source_url":"https://doi.org/10.1016/S0140-6736(17)30754-7","authors":["Michael Böhm","Helmut Schumacher","Koon K Teo","Eva M Lonn","Felix Mahfoud","Johannes F E Mann","Giuseppe Mancia","Josep Redon","Roland E Schmieder","Karen Sliwa","Michael A Weber","Bryan Williams","Salim Yusuf"],"significance":8,"published":"2017-06-03","source_date":"2017-06-03","image":"","kennis":["https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/hypertensie/cardiovasculaire-risicoschatting-score2/"],"congress":"","summary_en":"This ONTARGET/TRANSCEND analysis revealed a J-curve relationship between achieved blood pressure and cardiovascular outcomes in high-risk patients, with both very high and very low blood pressure associated with increased risk. The findings informed the debate about optimal blood pressure targets.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet-analyse van ONTARGET en TRANSCEND naar de relatie tussen bereikte bloeddruk en cardiovasculaire uitkomsten bij hoogrisicopatiënten. Bevestigt een J-curverelatie.","abstract_original":"BACKGROUND: Studies have challenged the appropriateness of accepted blood pressure targets. We hypothesised that different levels of low blood pressure are associated with benefit for some, but harm for other outcomes. METHODS: In this analysis, we assessed the previously reported outcome data from high-risk patients aged 55 years or older with a history of cardiovascular disease, 70% of whom had hypertension, from the ONTARGET and TRANSCEND trials investigating ramipril, telmisartan, and their combination, with a median follow-up of 56 months. Detailed descriptions of randomisation and intervention have already been reported. We analysed the associations between mean blood pressure achieved on treatment; prerandomisation baseline blood pressure; or time-updated blood pressure (last on treatment value before an event) on the composite outcome of cardiovascular death, myocardial infarction, stroke, and hospital admission for heart failure; the components of the composite outcome; and all-cause death. Analysis was done by Cox regression analysis, ANOVA, and χ2. These trials were registered with ClinicalTrials.gov, number NCT00153101. FINDINGS: Recruitment for ONTARGET took place between Dec 1, 2001, and July 31, 2008. TRANSCEND took place between Nov 1, 2001, and May 30, 2004. 30 937 patients were recruited from 733 centres in 40 countries and followed up for a median of 56 months. In ONTARGET, 25 127 patients known to be tolerant to angiotensin-converting-enzyme (ACE)-inhibitors were randomly assigned after a run-in period to oral ramipril 10 mg/day (n=8407), telmisartan 80 mg/day (n=8386), or the combination of both (n=8334). In TRANSCEND, 5810 patients who were intolerant to ACE-inhibitors were randomly assigned to oral telmisartan 80 mg/day (n=2903) or placebo (n=2907). Baseline systolic blood pressure (SBP) 140 mm Hg or higher was associated with greater incidence of all outcomes compared with 120 mm Hg to less than 140 mm Hg. By contrast, a baseline diastolic blood pressure (DBP) less than 70 mm Hg was associated with the highest risk for most outcomes compared with all DBP categories 70 mm Hg or more. In 4052 patients with SBP less than 120 mm Hg on treatment, the risk of the composite cardiovascular outcome (adjusted hazard ratio [HR] 1·14, 95% CI 1·03-1·26), cardiovascular death (1·29, 1·12-1·49), and all deaths (1·28, 1·15-1·42) were increased compared with those in whom SBP was 120-140 mm Hg during treatment (HR 1 for all outcomes, n=16099). No harm or benefit was observed for myocardial infarction, stroke, or hospital admission for heart failure. Mean achieved SBP more accurately predicted outcomes than baseline or time-updated SBP, and was associated with the lowest risk at approximately 130 mm Hg, and at 110-120 mm Hg risk increased for the combined outcome, cardiovascular death, and all-cause death except stroke. A mean DBP less than 70 mm Hg (n=5352) during treatment was associated with greater risk of the composite primary outcome (HR 1·31, 95% CI 1·20-1·42), myocardial infarction (1·55, 1·33-1·80), hospital admission for heart failure (1·59, 1·36-1·86) and all-cause death (1·16, 1·06-1·28) than a DBP 70-80 mm Hg (14 305). A pretreatment and mean on-treatment DBP of about 75 mm Hg was associated with the lowest risk. INTERPRETATION: Mean achieved SBP less than 120 mm Hg during treatment was associated with increased risk of cardiovascular outcomes except for myocardial infarction and stroke. Similar patterns were observed for DBP less than 70 mm Hg, plus increased risk for myocardial infarction and hospital admission for heart failure. Very low blood pressure achieved on treatment was associated with increased risks of several cardiovascular disease events. These data suggest that the lowest blood pressure possible is not necessarily the optimal target for high-risk patients, although it is not possible to rule out some effect of reverse causality. FUNDING: Boehringer Ingelheim."},{"id":"d789d9d61afa","type":"article","url":"https://hartvaat.nl/2017/06/01/maandelijks-hooggedoseerd-vitamine-d-en-cardiovasculaire-ziekte-gerandomiseerde-/","title":"Maandelijks hooggedoseerd vitamine D en cardiovasculaire ziekte: gerandomiseerde trial","title_en":"Effect of Monthly High-Dose Vitamin D Supplementation on Cardiovascular Disease in the Vitamin D Assessment Study : A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.0175","source_url":"https://doi.org/10.1001/jamacardio.2017.0175","authors":["Robert Scragg","Alistair W Stewart","Debbie Waayer","Carlene M M Lawes","Les Toop","John Sluyter","Judy Murphy","Kay-Tee Khaw","Carlos A Camargo"],"significance":7,"published":"2017-06-01","source_date":"2017-06-01","image":"","kennis":[],"congress":"","summary_en":"This large randomized trial showed that monthly high-dose vitamin D supplementation did not reduce the incidence of cardiovascular disease, definitively closing the door on vitamin D supplementation as a cardiovascular prevention strategy.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gerandomiseerde trial die maandelijks hooggedoseerd vitamine D onderzocht voor preventie van cardiovasculaire ziekte. Geen beschermend effect aangetoond — belangrijke negatieve trial.","abstract_original":"IMPORTANCE: Cohort studies have reported increased incidence of cardiovascular disease (CVD) among individuals with low vitamin D status. To date, randomized clinical trials of vitamin D supplementation have not found an effect, possibly because of using too low a dose of vitamin D. OBJECTIVE: To examine whether monthly high-dose vitamin D supplementation prevents CVD in the general population. DESIGN, SETTING, AND PARTICIPANTS: The Vitamin D Assessment Study is a randomized, double-blind, placebo-controlled trial that recruited participants mostly from family practices in Auckland, New Zealand, from April 5, 2011, through November 6, 2012, with follow-up until July 2015. Participants were community-resident adults aged 50 to 84 years. Of 47 905 adults invited from family practices and 163 from community groups, 5110 participants were randomized to receive vitamin D3 (n = 2558) or placebo (n = 2552). Two participants retracted consent, and all others (n = 5108) were included in the primary analysis. INTERVENTIONS: Oral vitamin D3 in an initial dose of 200 000 IU, followed a month later by monthly doses of 100 000 IU, or placebo for a median of 3.3 years (range, 2.5-4.2 years). MAIN OUTCOMES AND MEASURES: The primary outcome was the number of participants with incident CVD and death, including a prespecified subgroup analysis in participants with vitamin D deficiency (baseline deseasonalized 25-hydroxyvitamin D [25(OH)D] levels <20 ng/mL). Secondary outcomes were myocardial infarction, angina, heart failure, hypertension, arrhythmias, arteriosclerosis, stroke, and venous thrombosis. RESULTS: Of the 5108 participants included in the analysis, the mean (SD) age was 65.9 (8.3) years, 2969 (58.1%) were male, and 4253 (83.3%) were of European or other ethnicity, with the remainder being Polynesian or South Asian. Mean (SD) baseline deseasonalized 25(OH)D concentration was 26.5 (9.0) ng/mL, with 1270 participants (24.9%) being vitamin D deficient. In a random sample of 438 participants, the mean follow-up 25(OH)D level was greater than 20 ng/mL higher in the vitamin D group than in the placebo group. The primary outcome of CVD occurred in 303 participants (11.8%) in the vitamin D group and 293 participants (11.5%) in the placebo group, yielding an adjusted hazard ratio of 1.02 (95% CI, 0.87-1.20). Similar results were seen for participants with baseline vitamin D deficiency and for secondary outcomes. CONCLUSIONS AND RELEVANCE: Monthly high-dose vitamin D supplementation does not prevent CVD. This result does not support the use of monthly vitamin D supplementation for this purpose. The effects of daily or weekly dosing require further study. TRIAL REGISTRATION: clinicaltrials.gov Identifier: ACTRN12611000402943."},{"id":"5bace9aa33b8","type":"article","url":"https://hartvaat.nl/2017/06/01/voedingsstatus-en-langetermijn-multivitaminegebruik-en-cv-risico-phs-ii-analyse/","title":"Voedingsstatus en langetermijn multivitaminegebruik en CV-risico: PHS II analyse","title_en":"Effect of Baseline Nutritional Status on Long-term Multivitamin Use and Cardiovascular Disease Risk: A Secondary Analysis of the Physicians' Health Study II Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog","huisarts"],"tags":["biomarkers-cardiovasculair","dyslipidemie","farmaco-economie","fidelity","gepersonaliseerde-geneeskunde","primaire-preventie","statines","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.0176","source_url":"https://doi.org/10.1001/jamacardio.2017.0176","authors":["Susanne Rautiainen","J Michael Gaziano","William G Christen","Vadim Bubes","Gregory Kotler","Robert J Glynn","JoAnn E Manson","Julie E Buring","Howard D Sesso"],"significance":5,"published":"2017-06-01","source_date":"2017-06-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This JAMA Cardiology secondary analysis from the Physicians' Health Study II showed that baseline nutritional status does not modify the null effect of multivitamin supplementation on cardiovascular disease prevention.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology secundaire analyse van de Physicians' Health Study II naar het effect van baseline voedingsstatus op het cardiovasculaire voordeel van langdurig multivitaminegebruik.","abstract_original":"IMPORTANCE: Long-term multivitamin use had no effect on risk of cardiovascular disease (CVD) in the Physicians' Health Study II. Baseline nutritional status may have modified the lack of effect. OBJECTIVE: To investigate effect modification by various baseline dietary factors on CVD risk in the Physicians' Health Study II. DESIGN, SETTING, AND PARTICIPANTS: The Physicians' Health Study II was a randomized, double-blind, placebo-controlled trial testing multivitamin use (multivitamin [Centrum Silver] or placebo daily) among US male physicians. The Physicians' Health Study II included 14 641 male physicians 50 years or older, 13 316 of whom (91.0%) completed a baseline 116-item semiquantitative food frequency questionnaire and were included in the analyses. This study examined effect modification by baseline intake of key foods, individual nutrients, dietary patterns (Alternate Healthy Eating Index and Alternate Mediterranean Diet Score), and dietary supplement use. The study began in 1997, with continued treatment and follow-up through June 1, 2011. INTERVENTIONS: Multivitamin or placebo daily. MAIN OUTCOMES AND MEASURES: Major cardiovascular events, including nonfatal myocardial infarction, nonfatal stroke, and CVD mortality. Secondary outcomes included myocardial infarction, total stroke, CVD mortality, and total mortality individually. RESULTS: In total, 13 316 male physicians (mean [SD] age at randomization, 64.0 [9.0] years in those receiving the active multivitamin and 64.0 [9.1] years in those receiving the placebo) were observed for a mean (SD) follow-up of 11.4 (2.3) years. There was no consistent evidence of effect modification by various foods, nutrients, dietary patterns, or baseline supplement use on the effect of multivitamin use on CVD end points. Statistically significant interaction effects were observed between multivitamin use and vitamin B6 intake on myocardial infarction, between multivitamin use and vitamin D intake on CVD mortality, and between multivitamin use and vitamin B12 intake on CVD mortality and total mortality. However, there were inconsistent patterns in hazard ratios across tertiles of each dietary factor that are likely explained by multiple testing. CONCLUSIONS AND RELEVANCE: The results suggest that baseline nutritional status does not influence the effect of randomized long-term multivitamin use on major CVD events. Future studies are needed to investigate the role of baseline nutritional biomarkers on the effect of multivitamin use on CVD and other outcomes. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00270647."},{"id":"9a364e6702ca","type":"article","url":"https://hartvaat.nl/2017/06/01/primaire-preventie-icd-bij-niet-ischemische-cardiomyopathie-meta-analyse/","title":"Primaire preventie-ICD bij niet-ischemische cardiomyopathie: meta-analyse","title_en":"Primary Prevention Implantable Cardioverter Defibrillators in Patients With Nonischemic Cardiomyopathy: A Meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["pathfinder-trial","primaire-preventie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.0630","source_url":"https://doi.org/10.1001/jamacardio.2017.0630","authors":["Sana M Al-Khatib","Gregg C Fonarow","Jose A Joglar","Lurdes Y T Inoue","Daniel B Mark","Kerry L Lee","Alan Kadish","Gust Bardy","Gillian D Sanders"],"significance":8,"published":"2017-06-01","source_date":"2017-06-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology meta-analysis of primary prevention ICD trials in nonischemic cardiomyopathy found conflicting evidence on mortality benefit, reflecting the impact of improved medical therapy since earlier trials. The analysis highlighted uncertainty about ICD benefit in the era of contemporary heart failure management.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology meta-analyse van primaire preventie-ICD bij niet-ischemische cardiomyopathie. Onderzocht of het mortaliteitsvoordeel van ICD ook geldt buiten ischemisch hartfalen, in het licht van de DANISH-trial.","abstract_original":"IMPORTANCE: Conflicting data have emerged on the efficacy of implantable cardioverter defibrillators (ICDs) for primary prevention of sudden cardiac death (primary prevention ICDs) in patients with nonischemic cardiomyopathy. OBJECTIVE: To investigate the association of primary prevention ICDs with all-cause mortality in patients with nonischemic cardiomyopathy. DATA SOURCES: PubMed was searched from January 1, 2000, through October 31, 2016, for the terms implantable defibrillator OR implantable cardioverter defibrillator AND non-ischemic cardiomyopathy. Additional references were identified from bibliographies of pertinent articles and queries to experts in this field. STUDY SELECTION: Inclusion criteria consisted of a randomized clinical trial design and comparison of the ICD with medical therapy (control) in at least 100 patients with nonischemic cardiomyopathy. In addition, studies had to report on all-cause mortality during a follow-up period of at least 12 months and be published in English. The search yielded 10 studies, of which only 1 met the inclusion criteria. A search of bibliographies of pertinent articles and queries of experts in this field led to 3 additional studies. DATA EXTRACTION AND SYNTHESIS: The PRISMA guidelines were used to abstract data and assess data quality and validity. Data were pooled using fixed- and random-effects models. MAIN OUTCOMES AND MEASURES: The primary end point was all-cause mortality. Before data collection started, primary prevention ICDs were hypothesized to reduce all-cause mortality among patients with nonischemic cardiomyopathy. RESULTS: Four randomized clinical trials met the selection criteria and included 1874 unique patients; 937 were in the ICD group and 937 in the control group. Pooling data from these trials showed a significant reduction in all-cause mortality with an ICD (hazard ratio, 0.75; 95% CI, 0.61-0.93; P = .008; P = .87 for heterogeneity). CONCLUSIONS AND RELEVANCE: Primary prevention ICDs are efficacious at reducing all-cause mortality among patients with nonischemic cardiomyopathy. These findings support professional guidelines that recommend the use of ICDs in such patients."},{"id":"d4b4285d7bba","type":"article","url":"https://hartvaat.nl/2017/06/01/korte-procedureduur-met-bivalirudine-en-risico-op-acute-stenttrombose-bij-stemi/","title":"Korte procedureduur met bivalirudine en risico op acute stenttrombose bij STEMI","title_en":"Effect of Short Procedural Duration With Bivalirudin on Increased Risk of Acute Stent Thrombosis in Patients With STEMI: A Secondary Analysis of the HORIZONS-AMI Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.5669","source_url":"https://doi.org/10.1001/jamacardio.2016.5669","authors":["Hector Tamez","Duane S Pinto","Ajay J Kirtane","Claire Litherland","Robert W Yeh","George D Dangas","Roxana Mehran","Efthymios N Deliargyris","Guillermo Ortiz","C Michael Gibson","Gregg W Stone"],"significance":5,"published":"2017-06-01","source_date":"2017-06-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This JAMA Cardiology analysis examined whether short procedural duration with bivalirudin affects the risk of acute stent thrombosis in STEMI patients, addressing a potential interaction between anticoagulation duration and thrombotic risk.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse die het verband onderzocht tussen korte procedureduur met bivalirudine en het risico op acute stenttrombose bij STEMI-patiënten.","abstract_original":"IMPORTANCE: Bivalirudin has been associated with reduced bleeding and mortality during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI). However, increased rates of acute stent thrombosis (AST) have been noted when bivalirudin is discontinued at the end of the procedure, which is perhaps related to this medication's short half-life. OBJECTIVES: To evaluate the clinical effect of procedure duration on AST when either bivalirudin or heparin plus glycoprotein IIb/IIIa receptor inhibitor (GPI) is used. DESIGN, SETTING, AND PARTICIPANTS: An ad hoc analysis of the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) clinical trial was performed between March 1, 2015, and April 30, 2016, on patients who underwent primary percutaneous coronary intervention with stents and were randomized 1:1 to bivalirudin or heparin plus GPI. Defined as the difference between the patient's arrival at the catheterization laboratory and the patient's final angiogram. Participants included 3602 patients with STEMI, aged 18 years or older, who were undergoing primary percutaneous coronary intervention and presenting less than 12 hours from symptom onset. MAIN OUTCOMES AND MEASURES: Clinical events committee-adjudicated definite AST (occurring ≤24 hours after percutaneous coronary intervention). RESULTS: Among patients included in this analysis, procedure time was identified in 1286 receiving bivalirudin and 1412 receiving heparin plus GPI. Shorter procedures were defined as the lowest quartile of duration (<45 minutes). Patients undergoing shorter procedures were younger and less likely to be hypertensive and smokers. Shorter procedures were less complicated with fewer stents implanted, less multivessel stenting, less thrombus, and less no-reflow. An increased risk of definite AST was associated with shorter than with longer procedures with bivalirudin (7 [2.1%] vs 7 [0.7%]; relative risk, 2.87; 95% CI, 1.01-8.17; P = .04) but not with heparin plus GPI (0 vs 3 [0.3%]; P = .30). CONCLUSIONS AND RELEVANCE: Despite less procedural complexity, shorter primary percutaneous coronary intervention time was associated with an increased risk of AST in patients treated with bivalirudin but not patients treated with heparin plus GPI, possibly because of the rapid offset of bivalirudin's antithrombotic effect during a window of limited oral antiplatelet action. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00433966."},{"id":"ca6860caf394","type":"article","url":"https://hartvaat.nl/2017/06/01/impact-van-ischemisch-cva-op-af-gerelateerde-zorgkosten-systematische-review/","title":"Impact van ischemisch CVA op AF-gerelateerde zorgkosten: systematische review","title_en":"The impact of ischaemic stroke on atrial fibrillation-related healthcare cost: a systematic review.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw093","source_url":"https://doi.org/10.1093/europace/euw093","authors":["Xue Li","Vicki C Tse","Lung Wai Au-Doung","Ian C K Wong","Esther W Chan"],"significance":5,"published":"2017-06-01","source_date":"2017-06-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review quantified the impact of ischemic stroke on AF-related healthcare costs, showing that stroke is the dominant cost driver and reinforcing the economic case for effective stroke prevention in AF.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die de impact van ischemisch CVA op de totale AF-gerelateerde zorgkosten kwantificeert. Economische onderbouwing voor CVA-preventie bij AF.","abstract_original":"The aim of this study was to summarize healthcare costs incurred by patients with atrial fibrillation (AF) who developed ischaemic stroke, explore factors associated with increased cost, and highlight the importance of anticoagulation therapy for stroke prophylaxis. A systematic literature search of PubMed, EMBASE, Web of Science, and the health economic evaluation database was conducted up to December 2015. Studies focused on the cost and/or resource utilization of ischaemic stroke in patients with AF were included. Reported costs were converted to international dollars (I$) and adjusted to 2015 values. Alongside the narrative review of included studies, Spearman's correlation, independent-samples t-test, and one-way ANOVA were used to explore factors associated with cost differences between studies. Sixteen studies published from nine countries were identified. Based on currency conversion rates in 2015, ischaemic stroke-related healthcare costs were estimated to be I$41 420, I$12 895, and I$8184 for high-income, upper middle-income, and lower middle-income economies, respectively. Local GDP per capita accounted for ∼50% of the healthcare cost variation among countries. Major component of overall cost was from hospitalization. Ischaemic stroke incurring in patients with AF ≥75 years was 2.3 times that of their younger peers (P = 0.049). The economic burden from ischaemic stroke in patients with AF is considerable with positive association to country income. Clinicians and stakeholders should be aware of the importance of anticoagulation therapies in stroke prophylaxis, the occurrence of stroke, and the downstream economic burden on an increasingly ageing population."},{"id":"feeb1f907a1a","type":"article","url":"https://hartvaat.nl/2017/05/30/tijdstrends-in-complicaties-van-bioresorbeerbare-versus-metallic-stents/","title":"Tijdstrends in complicaties van bioresorbeerbare versus metallic stents","title_en":"Temporal Trends in Adverse Events After Everolimus-Eluting Bioresorbable Vascular Scaffold Versus Everolimus-Eluting Metallic Stent Implantation: A Meta-Analysis of Randomized Controlled Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028479","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028479","authors":["Rocco A Montone","Giampaolo Niccoli","Federico De Marco","Silvia Minelli","Fabrizio D'Ascenzo","Luca Testa","Francesco Bedogni","Filippo Crea"],"significance":7,"published":"2017-05-30","source_date":"2017-05-30","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/"],"congress":"","summary_en":"This analysis of temporal trends in adverse events after bioresorbable scaffolds showed an increasing risk of scaffold thrombosis over time compared with metallic stents, providing key safety data that contributed to the device's market withdrawal.","created":"2026-07-03T10:26:44Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van tijdstrends in complicaties na bioresorbeerbare scaffolds versus metallic EES. Toont een toenemend risico op scaffoldtrombose na 1 jaar — mede reden voor terugtrekking van Absorb.","abstract_original":"BACKGROUND: Bioresorbable coronary stents have been introduced into clinical practice to improve the outcomes of patients treated with percutaneous coronary intervention. The everolimus-eluting bioresorbable vascular scaffold (BVS) is the most studied of these stent platforms; however, recent trials comparing BVS with everolimus-eluting metallic stents (EES) raised concerns about BVS safety. We aimed to assess the efficacy and safety of BVS versus EES in patients undergoing percutaneous coronary intervention. METHODS: We searched Medline, Embase, the Cochrane Central Register of Controlled Trials, scientific sessions abstracts, and relevant Web sites for randomized trials with a follow-up of ≥2 years investigating percutaneous coronary interventions with BVS versus EES. The primary outcomes of our analysis were definite/probable stent thrombosis (ST) and target lesion failure (TLF; device-oriented composite end point of cardiac death, target vessel myocardial infarction, or ischemia-driven target lesion revascularization [TLR]). Secondary outcomes were target vessel myocardial infarction, TLR, and cardiac death. We calculated the risk estimates for main outcomes according to a fixed-effect model. RESULTS: We included 7 trials comprising data for 5583 patients randomized to receive either a BVS (n=3261) or an EES (n=2322). Median follow-up was 24 months (range, 24-36 months). Patients treated with BVS had a higher risk of definite/probable ST compared with patients treated with EES (odds ratio, 3.33; 95% confidence interval, 1.97-5.62; P<0.00001). In particular, patients with BVS had a higher risk of subacute, late, and very late ST, whereas the risk of acute ST was similar. Patients treated with BVS compared with EES had a higher risk at 2 years of TLF (odds ratio, 1.47; 95% confidence interval, 1.14-1.90; P=0.003), driven mainly by an increased risk of target vessel myocardial infarction (odds ratio, 1.73; 95% confidence interval, 1.31-2.28; P=0.0001; I2=0%) and of TLR (odds ratio, 1.27; 95% confidence interval, 1.00-1.62; P=0.05). Of importance, the risk of TLF and TLR for patients with BVS was higher between 1 and 2 years, whereas there was no difference in the first year. Risk of cardiac death was similar between the 2 groups. CONCLUSIONS: Our meta-analysis of randomized trials with a follow-up of ≥2 years demonstrated a higher risk of ST and of TLF in patients treated with BVS compared with EES. Of note, BVS had a higher risk of subacute, late, and very late ST, whereas the risk of TLF and TLR was higher between 1 and 2 years."},{"id":"b7ff05a518c2","type":"article","url":"https://hartvaat.nl/2017/05/30/polygene-risicoscore-en-relatief-voordeel-van-statinetherapie-primaire-preventie/","title":"Polygene risicoscore en relatief voordeel van statinetherapie: primaire preventie","title_en":"Polygenic Risk Score Identifies Subgroup With Higher Burden of Atherosclerosis and Greater Relative Benefit From Statin Therapy in the Primary Prevention Setting.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["dyslipidemie","ezetimibe","lipoproteïne-a","polygene-risicoscore","primaire-preventie","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024436","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024436","authors":["Pradeep Natarajan","Robin Young","Nathan O Stitziel","Sandosh Padmanabhan","Usman Baber","Roxana Mehran","Samantha Sartori","Valentin Fuster","Dermot F Reilly","Adam Butterworth","Daniel J Rader","Ian Ford","Naveed Sattar","Sekar Kathiresan"],"significance":7,"published":"2017-05-30","source_date":"2017-05-30","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/"],"congress":"","summary_en":"This study demonstrated that a polygenic risk score identifies patients with higher atherosclerotic burden who derive greater relative benefit from statin therapy, supporting the concept of genetics-guided cardiovascular prevention.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat een polygene risicoscore patiënten identificeert met meer atherosclerose en groter relatief voordeel van statinetherapie. Stap naar genetisch-gestuurde preventie.","abstract_original":"BACKGROUND: Relative risk reduction with statin therapy has been consistent across nearly all subgroups studied to date. However, in analyses of 2 randomized controlled primary prevention trials (ASCOT [Anglo-Scandinavian Cardiac Outcomes Trial-Lipid-Lowering Arm] and JUPITER [Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin]), statin therapy led to a greater relative risk reduction among a subgroup at high genetic risk. Here, we aimed to confirm this observation in a third primary prevention randomized controlled trial. In addition, we assessed whether those at high genetic risk had a greater burden of subclinical coronary atherosclerosis. METHODS: We studied participants from a randomized controlled trial of primary prevention with statin therapy (WOSCOPS [West of Scotland Coronary Prevention Study]; n=4910) and 2 observational cohort studies (CARDIA [Coronary Artery Risk Development in Young Adults] and BioImage; n=1154 and 4392, respectively). For each participant, we calculated a polygenic risk score derived from up to 57 common DNA sequence variants previously associated with coronary heart disease. We compared the relative efficacy of statin therapy in those at high genetic risk (top quintile of polygenic risk score) versus all others (WOSCOPS), as well as the association between the polygenic risk score and coronary artery calcification (CARDIA) and carotid artery plaque burden (BioImage). RESULTS: Among WOSCOPS trial participants at high genetic risk, statin therapy was associated with a relative risk reduction of 44% (95% confidence interval [CI], 22-60; P<0.001), whereas in all others, the relative risk reduction was 24% (95% CI, 8-37; P=0.004) despite similar low-density lipoprotein cholesterol lowering. In a study-level meta-analysis across the WOSCOPS, ASCOT, and JUPITER primary prevention, relative risk reduction in those at high genetic risk was 46% versus 26% in all others (P for heterogeneity=0.05). Across all 3 studies, the absolute risk reduction with statin therapy was 3.6% (95% CI, 2.0-5.1) among those in the high genetic risk group and 1.3% (95% CI, 0.6-1.9) in all others. Each 1-SD increase in the polygenic risk score was associated with 1.32-fold (95% CI, 1.04-1.68) greater likelihood of having coronary artery calcification and 9.7% higher (95% CI, 2.2-17.8) burden of carotid plaque. CONCLUSIONS: Those at high genetic risk have a greater burden of subclinical atherosclerosis and derive greater relative and absolute benefit from statin therapy to prevent a first coronary heart disease event. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00738725 (BioImage) and NCT00005130 (CARDIA). WOSCOPS was carried out and completed before the requirement for clinical trial registration."},{"id":"ea022c8fa416","type":"article","url":"https://hartvaat.nl/2017/05/25/levosimendan-bij-lv-disfunctie-voor-hartchirurgie-nejm-levo-cts/","title":"Levosimendan bij LV-disfunctie voor hartchirurgie: NEJM LEVO-CTS","title_en":"Levosimendan in Patients with Left Ventricular Dysfunction Undergoing Cardiac Surgery.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1616218","source_url":"https://doi.org/10.1056/NEJMoa1616218","authors":["Rajendra H Mehta","Jeffrey D Leimberger","Sean van Diepen","James Meza","Alice Wang","Rachael Jankowich","Robert W Harrison","Douglas Hay","Stephen Fremes","Andra Duncan","Edward G Soltesz","John Luber","Soon Park","Michael Argenziano","Edward Murphy","Randy Marcel","Dimitri Kalavrouziotis","Dave Nagpal","John Bozinovski","Wolfgang Toller","Matthias Heringlake","Shaun G Goodman","Jerrold H Levy","Robert A Harrington","Kevin J Anstrom","John H Alexander"],"significance":8,"published":"2017-05-25","source_date":"2017-05-25","image":"","kennis":[],"congress":"","summary_en":"The LEVO-CTS trial showed that preoperative levosimendan did not improve outcomes in patients with left ventricular dysfunction undergoing cardiac surgery, with no reduction in the composite of death, renal failure, perioperative MI, or mechanical circulatory support use.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM LEVO-CTS-trial die preoperatief levosimendan onderzocht bij patiënten met LV-disfunctie die hartchirurgie ondergaan. Geen verbetering van klinische uitkomsten.","abstract_original":"BACKGROUND: Levosimendan is an inotropic agent that has been shown in small studies to prevent or treat the low cardiac output syndrome after cardiac surgery. METHODS: In a multicenter, randomized, placebo-controlled, phase 3 trial, we evaluated the efficacy and safety of levosimendan in patients with a left ventricular ejection fraction of 35% or less who were undergoing cardiac surgery with the use of cardiopulmonary bypass. Patients were randomly assigned to receive either intravenous levosimendan (at a dose of 0.2 μg per kilogram of body weight per minute for 1 hour, followed by a dose of 0.1 μg per kilogram per minute for 23 hours) or placebo, with the infusion started before surgery. The two primary end points were a four-component composite of death through day 30, renal-replacement therapy through day 30, perioperative myocardial infarction through day 5, or use of a mechanical cardiac assist device through day 5; and a two-component composite of death through day 30 or use of a mechanical cardiac assist device through day 5. RESULTS: A total of 882 patients underwent randomization, 849 of whom received levosimendan or placebo and were included in the modified intention-to-treat population. The four-component primary end point occurred in 105 of 428 patients (24.5%) assigned to receive levosimendan and in 103 of 421 (24.5%) assigned to receive placebo (adjusted odds ratio, 1.00; 99% confidence interval [CI], 0.66 to 1.54; P=0.98). The two-component primary end point occurred in 56 patients (13.1%) assigned to receive levosimendan and in 48 (11.4%) assigned to receive placebo (adjusted odds ratio, 1.18; 96% CI, 0.76 to 1.82; P=0.45). The rate of adverse events did not differ significantly between the two groups. CONCLUSIONS: Prophylactic levosimendan did not result in a rate of the short-term composite end point of death, renal-replacement therapy, perioperative myocardial infarction, or use of a mechanical cardiac assist device that was lower than the rate with placebo among patients with a reduced left ventricular ejection fraction who were undergoing cardiac surgery with the use of cardiopulmonary bypass. (Funded by Tenax Therapeutics; LEVO-CTS ClinicalTrials.gov number, NCT02025621 .)."},{"id":"eeea1e74d8cb","type":"article","url":"https://hartvaat.nl/2017/05/23/hemocompatibiliteitsuitkomsten-van-heartmate-3-na-6-maanden-momentum-3/","title":"Hemocompatibiliteitsuitkomsten van HeartMate 3 na 6 maanden: MOMENTUM 3","title_en":"Hemocompatibility-Related Outcomes in the MOMENTUM 3 Trial at 6 Months: A Randomized Controlled Study of a Fully Magnetically Levitated Pump in Advanced Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028303","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028303","authors":["Nir Uriel","Paolo C Colombo","Joseph C Cleveland","James W Long","Christopher Salerno","Daniel J Goldstein","Chetan B Patel","Gregory A Ewald","Antone J Tatooles","Scott C Silvestry","Ranjit John","Christiano Caldeira","Valluvan Jeevanandam","Andrew J Boyle","Kartik S Sundareswaran","Poornima Sood","Mandeep R Mehra"],"significance":8,"published":"2017-05-23","source_date":"2017-05-23","image":"","kennis":[],"congress":"","summary_en":"Six-month MOMENTUM 3 hemocompatibility results showed significantly fewer pump thrombosis, stroke, and bleeding events with the HeartMate 3 compared with the HeartMate II. The magnetically levitated design's superior blood-handling properties translated to measurable clinical benefit.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"6-maandsresultaten van MOMENTUM 3 met focus op hemocompatibiliteit van de volledig magnetisch zwevende HeartMate 3 LVAD. Significant minder hemolyse en pomptrombose.","abstract_original":"BACKGROUND: The HeartMate 3 (HM3) Left Ventricular Assist System (LVAS) (Abbott) is a centrifugal, fully magnetically levitated, continuous-flow blood pump engineered to enhance hemocompatibility and reduce shear stress on blood components. The MOMENTUM 3 trial (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) compares the HM3 LVAS with the HeartMate II (HMII) LVAS (Abbott) in advanced heart failure refractory to medical management, irrespective of therapeutic intention (bridge to transplant versus destination therapy). This investigation reported its primary outcome in the short-term cohort (n=294; 6-month follow-up), demonstrating superiority of the HM3 for the trial primary end point (survival free of a disabling stroke or reoperation to replace the pump for malfunction), driven by a reduced need for reoperations. The aim of this analysis was to evaluate the aggregate of hemocompatibility-related clinical adverse events (HRAEs) between the 2 LVAS. METHODS: We conducted a secondary end point evaluation of HRAE (survival free of any nonsurgical bleeding, thromboembolic event, pump thrombosis, or neurological event) in the short-term cohort (as-treated cohort n=289) at 6 months. The net burden of HRAE was also assessed by using a previously described hemocompatibility score, which uses 4 escalating tiers of hierarchal severity to derive a total score for events encountered during the entire follow-up experience for each patient. RESULTS: In 289 patients in the as-treated group (151 the HM3 and 138 the HMII), survival free of any HRAE was achieved in 69% of the HM3 group and in 55% of the HMII group (hazard ratio, 0.62; confidence interval, 0.42-0.91; P=0.012). Using the hemocompatibility score, the HM3 group demonstrated less pump thrombosis requiring reoperation (0 versus 36 points, P<0.001) or medically managed pump thrombosis (0 versus 5 points, P=0.02), and fewer nondisabling strokes (6 versus 24 points, P=0.026) than the control HMII LVAS. The net hemocompatibility score in the HM3 in comparison with the HMII patients was 101 (0.67±1.50 points/patient) versus 137 (0.99±1.79 points/patient) (odds ratio, 0.64; confidence interval, 0.39-1.03; P=0.065). CONCLUSIONS: In this secondary analysis of the MOMENTUM 3 trial, the HM3 LVAS demonstrated greater freedom from HRAEs in comparison with the HMII LVAS at 6 months. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT02224755."},{"id":"26b996d0fd87","type":"article","url":"https://hartvaat.nl/2017/05/23/stralingsblootstelling-en-vasculaire-toegang-bij-acs-rad-matrix-trial/","title":"Stralingsblootstelling en vasculaire toegang bij ACS: RAD-Matrix-trial","title_en":"Radiation Exposure and Vascular Access in Acute Coronary Syndromes: The RAD-Matrix Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["stride-trial"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.03.018","source_url":"https://doi.org/10.1016/j.jacc.2017.03.018","authors":["Alessandro Sciahbasi","Enrico Frigoli","Alessandro Sarandrea","Martina Rothenbühler","Paolo Calabrò","Alessandro Lupi","Francesco Tomassini","Bernardo Cortese","Stefano Rigattieri","Enrico Cerrato","Dennis Zavalloni","Antonio Zingarelli","Paolo Calabria","Paolo Rubartelli","Gennaro Sardella","Matteo Tebaldi","Stephan Windecker","Peter Jüni","Dik Heg","Marco Valgimigli"],"significance":5,"published":"2017-05-23","source_date":"2017-05-23","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"The RAD-Matrix trial compared radiation exposure between radial and femoral access for PCI in ACS, addressing operator and patient safety concerns related to the increasingly preferred radial approach.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"RAD-Matrix-trial die stralingsblootstelling vergeleek bij radiale versus femorale toegang bij ACS. Relevant voor de stralingsveiligheid van operators en patiënten.","abstract_original":"BACKGROUND: It remains unclear whether radial access increases the risk of operator or patient radiation exposure compared to transfemoral access when performed by expert operators. OBJECTIVES: This study sought to determine whether radial access increases radiation exposure. METHODS: A total of 8,404 patients, with or without ST-segment elevation acute coronary syndrome, were randomly assigned to radial or femoral access for coronary angiography and percutaneous intervention, and collected fluoroscopy time and dose-area product (DAP). RAD-MATRIX is a radiation sub-study of the MATRIX (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX) trial. We anticipated that 13 or more operators, each wearing a thorax (primary endpoint), wrist, and head (secondary endpoints) lithium fluoride thermoluminescent dosimeter, and randomizing at least 13 patients per access site, were needed to establish noninferiority of radial versus femoral access. RESULTS: Among 18 operators, performing 777 procedures in 767 patients, the noninferiority primary endpoint was not achieved (p value for noninferiority = 0.843). Operator equivalent dose at the thorax (77 μSv) was significantly higher with radial than femoral access (41 μSv; p = 0.02). After normalization of operator radiation dose by fluoroscopy time or DAP, the difference remained significant. Radiation dose at wrist or head did not differ between radial and femoral access. Thorax operator dose did not differ for right radial (84 μSv) compared to left radial access (52 μSv; p = 0.15). In the overall MATRIX population, fluoroscopy time and DAP were higher with radial compared to femoral access: 10 min versus 9 min (p < 0.0001) and 65 Gy·cm2 versus 59 Gy·cm2 (p = 0.0001), respectively. CONCLUSIONS: Compared to femoral access, radial access is associated with greater operator and patient radiation exposure when performed by expert operators in current practice. Radial operators and institutions should be sensitized towards radiation risks and adopt adjunctive radioprotective measures. (Minimizing Adverse Haemorrhagic Events by Transradial Access Site and Systemic Implementation of AngioX; NCT101433627)."},{"id":"3cf0899949fe","type":"article","url":"https://hartvaat.nl/2017/05/18/evacetrapib-en-cardiovasculaire-uitkomsten-bij-hoog-vasculair-risico-nejm-accele/","title":"Evacetrapib en cardiovasculaire uitkomsten bij hoog vasculair risico: NEJM ACCELERATE","title_en":"Evacetrapib and Cardiovascular Outcomes in High-Risk Vascular Disease.","category":"preventie","category_label":"Preventie","professions":["apotheker","cardioloog","internist"],"tags":["cetp-remmers","ezetimibe","farmaco-economie","hdl-cholesterol","obesitas","obicetrapib","stride-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1609581","source_url":"https://doi.org/10.1056/NEJMoa1609581","authors":["A Michael Lincoff","Stephen J Nicholls","Jeffrey S Riesmeyer","Philip J Barter","H Bryan Brewer","Keith A A Fox","C Michael Gibson","Christopher Granger","Venu Menon","Gilles Montalescot","Daniel Rader","Alan R Tall","Ellen McErlean","Kathy Wolski","Giacomo Ruotolo","Burkhard Vangerow","Govinda Weerakkody","Shaun G Goodman","Diego Conde","Darren K McGuire","Jose C Nicolau","Jose L Leiva-Pons","Yves Pesant","Weimin Li","David Kandath","Simon Kouz","Naeem Tahirkheli","Denise Mason","Steven E Nissen"],"significance":9,"published":"2017-05-18","source_date":"2017-05-18","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"The ACCELERATE trial showed that evacetrapib, a CETP inhibitor, substantially raised HDL cholesterol and lowered LDL cholesterol but did not reduce cardiovascular events in high-risk patients. This was the fourth CETP inhibitor trial to fail, contributing to the understanding that HDL cholesterol raising per se does not confer cardiovascular benefit.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM ACCELERATE-trial die aantoonde dat evacetrapib (CETP-remmer) ondanks substantiële HDL-verhoging en LDL-verlaging geen cardiovasculaire events vermindert. Definitief bewijs tegen de HDL-hypothese.","abstract_original":"BACKGROUND: The cholesteryl ester transfer protein inhibitor evacetrapib substantially raises the high-density lipoprotein (HDL) cholesterol level, reduces the low-density lipoprotein (LDL) cholesterol level, and enhances cellular cholesterol efflux capacity. We sought to determine the effect of evacetrapib on major adverse cardiovascular outcomes in patients with high-risk vascular disease. METHODS: In a multicenter, randomized, double-blind, placebo-controlled phase 3 trial, we enrolled 12,092 patients who had at least one of the following conditions: an acute coronary syndrome within the previous 30 to 365 days, cerebrovascular atherosclerotic disease, peripheral vascular arterial disease, or diabetes mellitus with coronary artery disease. Patients were randomly assigned to receive either evacetrapib at a dose of 130 mg or matching placebo, administered daily, in addition to standard medical therapy. The primary efficacy end point was the first occurrence of any component of the composite of death from cardiovascular causes, myocardial infarction, stroke, coronary revascularization, or hospitalization for unstable angina. RESULTS: At 3 months, a 31.1% decrease in the mean LDL cholesterol level was observed with evacetrapib versus a 6.0% increase with placebo, and a 133.2% increase in the mean HDL cholesterol level was seen with evacetrapib versus a 1.6% increase with placebo. After 1363 of the planned 1670 primary end-point events had occurred, the data and safety monitoring board recommended that the trial be terminated early because of a lack of efficacy. After a median of 26 months of evacetrapib or placebo, a primary end-point event occurred in 12.9% of the patients in the evacetrapib group and in 12.8% of those in the placebo group (hazard ratio, 1.01; 95% confidence interval, 0.91 to 1.11; P=0.91). CONCLUSIONS: Although the cholesteryl ester transfer protein inhibitor evacetrapib had favorable effects on established lipid biomarkers, treatment with evacetrapib did not result in a lower rate of cardiovascular events than placebo among patients with high-risk vascular disease. (Funded by Eli Lilly; ACCELERATE ClinicalTrials.gov number, NCT01687998 .)."},{"id":"ba59e758ecb0","type":"article","url":"https://hartvaat.nl/2017/05/18/ularitide-en-cardiovasculaire-mortaliteit-bij-acuut-hartfalen-nejm-true-ahf/","title":"Ularitide en cardiovasculaire mortaliteit bij acuut hartfalen: NEJM TRUE-AHF","title_en":"Effect of Ularitide on Cardiovascular Mortality in Acute Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","aperitif-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1601895","source_url":"https://doi.org/10.1056/NEJMoa1601895","authors":["Milton Packer","Christopher O'Connor","John J V McMurray","Janet Wittes","William T Abraham","Stefan D Anker","Kenneth Dickstein","Gerasimos Filippatos","Richard Holcomb","Henry Krum","Aldo P Maggioni","Alexandre Mebazaa","W Frank Peacock","Mark C Petrie","Piotr Ponikowski","Frank Ruschitzka","Dirk J van Veldhuisen","Lisa S Kowarski","Mark Schactman","Johannes Holzmeister"],"significance":8,"published":"2017-05-18","source_date":"2017-05-18","image":"","kennis":[],"congress":"","summary_en":"The TRUE-AHF trial demonstrated that ularitide (synthetic urodilatin) did not reduce cardiovascular mortality in patients with acute heart failure, despite acute hemodynamic improvement. The failure of another vasodilator strategy reinforced the difficulty of translating acute physiological effects into mortality benefit in AHF.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM TRUE-AHF-trial die ularitide (synthetisch urodilatine) onderzocht bij acuut hartfalen. Geen reductie in cardiovasculaire mortaliteit, ondanks hemodynamische verbetering.","abstract_original":"BACKGROUND: In patients with acute heart failure, early intervention with an intravenous vasodilator has been proposed as a therapeutic goal to reduce cardiac-wall stress and, potentially, myocardial injury, thereby favorably affecting patients' long-term prognosis. METHODS: In this double-blind trial, we randomly assigned 2157 patients with acute heart failure to receive a continuous intravenous infusion of either ularitide at a dose of 15 ng per kilogram of body weight per minute or matching placebo for 48 hours, in addition to accepted therapy. Treatment was initiated a median of 6 hours after the initial clinical evaluation. The coprimary outcomes were death from cardiovascular causes during a median follow-up of 15 months and a hierarchical composite end point that evaluated the initial 48-hour clinical course. RESULTS: Death from cardiovascular causes occurred in 236 patients in the ularitide group and 225 patients in the placebo group (21.7% vs. 21.0%; hazard ratio, 1.03; 96% confidence interval, 0.85 to 1.25; P=0.75). In the intention-to-treat analysis, there was no significant between-group difference with respect to the hierarchical composite outcome. The ularitide group had greater reductions in systolic blood pressure and in levels of N-terminal pro-brain natriuretic peptide than the placebo group. However, changes in cardiac troponin T levels during the infusion did not differ between the two groups in the 55% of patients with paired data. CONCLUSIONS: In patients with acute heart failure, ularitide exerted favorable physiological effects (without affecting cardiac troponin levels), but short-term treatment did not affect a clinical composite end point or reduce long-term cardiovascular mortality. (Funded by Cardiorentis; TRUE-AHF ClinicalTrials.gov number, NCT01661634 .)."},{"id":"76b878192d8d","type":"article","url":"https://hartvaat.nl/2017/05/16/oraal-ijzer-bij-hfref-met-ijzerdeficientie-jama-ironout-hf/","title":"Oraal ijzer bij HFrEF met ijzerdeficiëntie: JAMA IRONOUT-HF","title_en":"Effect of Oral Iron Repletion on Exercise Capacity in Patients With Heart Failure With Reduced Ejection Fraction and Iron Deficiency: The IRONOUT HF Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2017.5427","source_url":"https://doi.org/10.1001/jama.2017.5427","authors":["Gregory D Lewis","Rajeev Malhotra","Adrian F Hernandez","Steven E McNulty","Andrew Smith","G Michael Felker","W H Wilson Tang","Shane J LaRue","Margaret M Redfield","Marc J Semigran","Michael M Givertz","Peter Van Buren","David Whellan","Kevin J Anstrom","Monica R Shah","Patrice Desvigne-Nickens","Javed Butler","Eugene Braunwald"],"significance":8,"published":"2017-05-16","source_date":"2017-05-16","image":"","kennis":[],"congress":"","summary_en":"The IRONOUT-HF trial showed that oral iron polysaccharide did not improve exercise capacity or NT-proBNP levels in patients with HFrEF and iron deficiency. The negative result established that oral iron is ineffective for heart failure, directing clinical practice toward intravenous iron formulations.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA IRONOUT-HF-trial die oraal ijzerpolysaccharide onderzocht voor verbetering van inspanningscapaciteit bij HFrEF met ijzerdeficiëntie. In tegenstelling tot IV ijzer toonde orale suppletie geen voordeel.","abstract_original":"IMPORTANCE: Iron deficiency is present in approximately 50% of patients with heart failure with reduced left ventricular ejection fraction (HFrEF) and is an independent predictor of reduced functional capacity and mortality. However, the efficacy of inexpensive readily available oral iron supplementation in heart failure is unknown. OBJECTIVE: To test whether therapy with oral iron improves peak exercise capacity in patients with HFrEF and iron deficiency. DESIGN, SETTING, AND PARTICIPANTS: Phase 2, double-blind, placebo-controlled randomized clinical trial of patients with HFrEF (<40%) and iron deficiency, defined as a serum ferritin level of 15 to 100 ng/mL or a serum ferritin level of 101 to 299 ng/mL with transferrin saturation of less than 20%. Participants were enrolled between September 2014 and November 2015 at 23 US sites. INTERVENTIONS: Oral iron polysaccharide (n = 111) or placebo (n = 114), 150 mg twice daily for 16 weeks. MAIN OUTCOMES AND MEASURES: The primary end point was a change in peak oxygen uptake (V̇o2) from baseline to 16 weeks. Secondary end points were change in 6-minute walk distance, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, and health status as assessed by Kansas City Cardiomyopathy Questionnaire (KCCQ, range 0-100, higher scores reflect better quality of life). RESULTS: Among 225 randomized participants (median age, 63 years; 36% women) 203 completed the study. The median baseline peak V̇o2 was 1196 mL/min (interquartile range [IQR], 887-1448 mL/min) in the oral iron group and 1167 mL/min (IQR, 887-1449 mL/min) in the placebo group. The primary end point, change in peak V̇o2 at 16 weeks, did not significantly differ between the oral iron and placebo groups (+23 mL/min vs -2 mL/min; difference, 21 mL/min [95% CI, -34 to +76 mL/min]; P = .46). Similarly, at 16 weeks, there were no significant differences between treatment groups in changes in 6-minute walk distance (-13 m; 95% CI, -32 to 6 m), NT-proBNP levels (159; 95% CI, -280 to 599 pg/mL), or KCCQ score (1; 95% CI, -2.4 to 4.4), all P > .05. CONCLUSIONS AND RELEVANCE: Among participants with HFrEF with iron deficiency, high-dose oral iron did not improve exercise capacity over 16 weeks. These results do not support use of oral iron supplementation in patients with HFrEF. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02188784."},{"id":"3d6614975a1a","type":"article","url":"https://hartvaat.nl/2017/05/16/comorbiditeiten-en-crt-respons-madit-crt-langetermijnfollow-up/","title":"Comorbiditeiten en CRT-respons: MADIT-CRT langetermijnfollow-up","title_en":"Multiple Comorbidities and Response to Cardiac Resynchronization Therapy: MADIT-CRT Long-Term Follow-Up.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.03.531","source_url":"https://doi.org/10.1016/j.jacc.2017.03.531","authors":["Emily P Zeitler","Daniel J Friedman","James P Daubert","Sana M Al-Khatib","Scott D Solomon","Yitschak Biton","Scott McNitt","Wojciech Zareba","Arthur J Moss","Valentina Kutyifa"],"significance":6,"published":"2017-05-16","source_date":"2017-05-16","image":"","kennis":[],"congress":"","summary_en":"This MADIT-CRT long-term analysis demonstrated that multiple comorbidities attenuate the response to CRT but do not eliminate the benefit, informing patient selection for cardiac resynchronization in the presence of competing conditions.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"MADIT-CRT langetermijnanalyse naar de invloed van multipele comorbiditeiten op de respons op CRT. Comorbiditeiten verminderen het voordeel van resynchronisatietherapie.","abstract_original":"BACKGROUND: Data regarding cardiac resynchronization therapy (CRT) in patients with multiple comorbidities are limited. OBJECTIVES: This study evaluated the association of multiple comorbidities with the benefits of CRT over implantable cardioverter-defibrillator (ICD) alone. METHODS: We examined 1,214 MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy) study patients with left bundle branch block (LBBB) and 0, 1, 2, or ≥3 comorbidities, including renal dysfunction, hypertension (HTN), diabetes, coronary artery disease, history of atrial arrhythmias, history of ventricular arrhythmias, current smoking, and cerebrovascular accident. In an adjusted analysis, we analyzed risk of heart failure (HF) events or death by comorbidity group in all patients and in patients with CRT with defibrillator (CRT-D) versus ICD. Then we examined percent change in left ventricular (LV) end-diastolic volume, LV end-systolic volume, LV ejection fraction, left atrial volume, and LV dyssynchrony at 1-year in CRT-D patients by comorbidity group. RESULTS: There was an inverse relationship between comorbidity burden and improvements in LV end-systolic volume, LV end-diastolic volume, left ventricular ejection fraction, left atrial volume, and LV dyssynchrony. In an adjusted model, there was an increasing risk of death or nonfatal HF events with increasing comorbidity burden regardless of treatment group (p < 0.001). During a mean follow-up of 4.65 years, there was no interaction with respect to comorbidity burden and the benefit of CRT-D versus ICD only for death or nonfatal HF events (interaction p = 0.943). In the groups with greatest comorbidity burden (2 and ≥3), the absolute risk reduction associated with CRT-D over ICD alone appeared greater than that seen for groups with less comorbidity burden (0 and 1). CONCLUSIONS: During long-term follow-up of MADIT-CRT study patients with LBBB randomized to CRT-D, there were differences in HF or death risk and in the degree of reverse remodeling among comorbidity groups. However, the burden of comorbidity does not appear to compromise the clinical benefits of CRT-D compared with ICD alone."},{"id":"e175e2e4be74","type":"article","url":"https://hartvaat.nl/2017/05/16/statines-voor-primaire-preventie-bij-ouderen-meta-analyse-van-jupiter-en-hope-3/","title":"Statines voor primaire preventie bij ouderen: meta-analyse van JUPITER en HOPE-3","title_en":"Primary Prevention With Statin Therapy in the Elderly: New Meta-Analyses From the Contemporary JUPITER and HOPE-3 Randomized Trials.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.117.028271","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.117.028271","authors":["Paul M Ridker","Eva Lonn","Nina P Paynter","Robert Glynn","Salim Yusuf"],"significance":8,"published":"2017-05-16","source_date":"2017-05-16","image":"","kennis":["https://hartvaat.nl/kennis/preventie/statines-primaire-preventie/","https://hartvaat.nl/kennis/preventie/preventie-bij-ckd/"],"congress":"","summary_en":"This meta-analysis of JUPITER and HOPE-3 focused specifically on elderly participants, confirming that statin therapy for primary prevention reduces cardiovascular events in older adults. The contemporary trial data strengthened the case for statins in the elderly population.","created":"2026-07-03T10:26:43Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse van de JUPITER- en HOPE-3-trials specifiek gericht op oudere deelnemers. Bevestigt het voordeel van statines voor primaire preventie ook op hogere leeftijd.","abstract_original":""},{"id":"91e90e5ecbc0","type":"article","url":"https://hartvaat.nl/2017/05/16/serieel-hoog-sensitief-troponine-i-en-cv-uitkomsten-bij-diabetes-type-2-examine/","title":"Serieel hoog-sensitief troponine I en CV-uitkomsten bij diabetes type 2: EXAMINE","title_en":"Serial Measurement of High-Sensitivity Troponin I and Cardiovascular Outcomes in Patients With Type 2 Diabetes Mellitus in the EXAMINE Trial (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care).","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024632","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024632","authors":["Matthew A Cavender","William B White","Petr Jarolim","George L Bakris","William C Cushman","Stuart Kupfer","Qi Gao","Cyrus R Mehta","Faiez Zannad","Christopher P Cannon","David A Morrow"],"significance":6,"published":"2017-05-16","source_date":"2017-05-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This EXAMINE trial analysis showed that serial high-sensitivity troponin I changes predict cardiovascular outcomes in patients with type 2 diabetes after ACS, supporting dynamic troponin monitoring for risk assessment.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:01Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"EXAMINE-trial analyse naar de prognostische waarde van seriële hoog-sensitieve troponine-metingen bij patiënten met diabetes type 2. Troponine als dynamische marker voor cardiovasculair risico.","abstract_original":"BACKGROUND: We aimed to describe the relationship between changes in high-sensitivity cardiac troponin I (hsTnI) and cardiovascular outcomes. METHODS: The EXAMINE trial (Examination of Cardiovascular Outcomes With Alogliptin Versus Standard of Care) was a phase IIIb clinical outcomes trial designed to evaluate the cardiovascular safety of alogliptin, a nonselective dipeptidyl peptidase 4 inhibitor. Patients with type 2 diabetes mellitus, glycohemoglobin between 6.5% and 11% (or between 7% and 11% if they were on insulin), and a recent acute coronary syndrome (between 15 and 90 days before randomization) were eligible for the trial. hsTnI was measured using the Abbott ARCHITECT assay at baseline and 6 months in patients randomized in the EXAMINE trial. This analysis was restricted to patients randomized ≥30 days after qualifying acute coronary syndrome to mitigate the potential for persistent hsTnI elevation after acute coronary syndrome (n=3808). The primary end point of the trial was cardiovascular death, myocardial infarction, or stroke. Cardiovascular death or heart failure was a prespecified, adjudicated secondary end point. RESULTS: At baseline, hsTnI was detectable (≥1.9 ng/L) in 93% of patients and >99th percentile upper reference limit in 16%. There was a strong relationship between increasing hsTnI, both at baseline and 6 months, and the incidence of cardiovascular events through 24 months (P<0.001 for each). Patients with undetectable hsTnI at baseline and 6 months were at the lowest risk of future cardiovascular events. Stable patients with hsTnI ≥99th percentile upper reference limit at 6 months were at increased risk of cardiovascular death, myocardial infarction, or stroke compared with patients with hsTnI <99 percentile upper reference limit irrespective of whether hsTnI was newly elevated (28.1% versus 8.8%; adjusted hazard ratio, 2.65; 95% confidence interval, 1.64-4.28; P<0.001) or persistently so (22.5% versus 8.8%; adjusted hazard ratio, 1.90; 95% confidence interval, 1.33-2.70; P<0.001). Alogliptin neither increased nor decreased the risk of cardiovascular events compared with placebo in patients with high baseline hsTnI (22.3% versus 23.0%; hazard ratio, 0.87; 95% confidence interval, 0.60-1.25; P=0.44). CONCLUSIONS: Serial assessment of hsTnI revealed a substantial proportion of patients with type 2 diabetes mellitus without clinically recognized events had dynamic or persistently elevated values and were at high risk of recurrent events. hsTnI may have a role in personalizing preventive strategies in patients with diabetes mellitus based on risk. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00968708."},{"id":"edbb8c868c33","type":"article","url":"https://hartvaat.nl/2017/05/11/ifr-of-ffr-bij-pci-nejm-define-flair/","title":"iFR of FFR bij PCI: NEJM DEFINE-FLAIR","title_en":"Use of the Instantaneous Wave-free Ratio or Fractional Flow Reserve in PCI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1700445","source_url":"https://doi.org/10.1056/NEJMoa1700445","authors":["Justin E Davies","Sayan Sen","Hakim-Moulay Dehbi","Rasha Al-Lamee","Ricardo Petraco","Sukhjinder S Nijjer","Ravinay Bhindi","Sam J Lehman","Darren Walters","James Sapontis","Luc Janssens","Christiaan J Vrints","Ahmed Khashaba","Mika Laine","Eric Van Belle","Florian Krackhardt","Waldemar Bojara","Olaf Going","Tobias Härle","Ciro Indolfi","Giampaolo Niccoli","Flavo Ribichini","Nobuhiro Tanaka","Hiroyoshi Yokoi","Hiroaki Takashima","Yuetsu Kikuta","Andrejs Erglis","Hugo Vinhas","Pedro Canas Silva","Sérgio B Baptista","Ali Alghamdi","Farrel Hellig","Bon-Kwon Koo","Chang-Wook Nam","Eun-Seok Shin","Joon-Hyung Doh","Salvatore Brugaletta","Eduardo Alegria-Barrero","Martijin Meuwissen","Jan J Piek","Niels van Royen","Murat Sezer","Carlo Di Mario","Robert T Gerber","Iqbal S Malik","Andrew S P Sharp","Suneel Talwar","Kare Tang","Habib Samady","John Altman","Arnold H Seto","Jasvindar Singh","Allen Jeremias","Hitoshi Matsuo","Rajesh K Kharbanda","Manesh R Patel","Patrick Serruys","Javier Escaned"],"significance":9,"published":"2017-05-11","source_date":"2017-05-11","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The DEFINE-FLAIR trial confirmed that iFR-guided PCI was noninferior to FFR-guided PCI for a composite of death, MI, or unplanned revascularization at 1 year. Together with iFR-SWEDEHEART, this trial established the dual evidence base for using iFR as a guideline-endorsed alternative to FFR in catheterization laboratory practice.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM DEFINE-FLAIR-trial die bevestigde dat iFR non-inferieur is aan FFR voor PCI-sturing. Samen met iFR-SWEDEHEART de dubbele evidence base voor iFR als alternatief voor FFR.","abstract_original":"BACKGROUND: Coronary revascularization guided by fractional flow reserve (FFR) is associated with better patient outcomes after the procedure than revascularization guided by angiography alone. It is unknown whether the instantaneous wave-free ratio (iFR), an alternative measure that does not require the administration of adenosine, will offer benefits similar to those of FFR. METHODS: We randomly assigned 2492 patients with coronary artery disease, in a 1:1 ratio, to undergo either iFR-guided or FFR-guided coronary revascularization. The primary end point was the 1-year risk of major adverse cardiac events, which were a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization. The trial was designed to show the noninferiority of iFR to FFR, with a margin of 3.4 percentage points for the difference in risk. RESULTS: At 1 year, the primary end point had occurred in 78 of 1148 patients (6.8%) in the iFR group and in 83 of 1182 patients (7.0%) in the FFR group (difference in risk, -0.2 percentage points; 95% confidence interval [CI], -2.3 to 1.8; P<0.001 for noninferiority; hazard ratio, 0.95; 95% CI, 0.68 to 1.33; P=0.78). The risk of each component of the primary end point and of death from cardiovascular or noncardiovascular causes did not differ significantly between the groups. The number of patients who had adverse procedural symptoms and clinical signs was significantly lower in the iFR group than in the FFR group (39 patients [3.1%] vs. 385 patients [30.8%], P<0.001), and the median procedural time was significantly shorter (40.5 minutes vs. 45.0 minutes, P=0.001). CONCLUSIONS: Coronary revascularization guided by iFR was noninferior to revascularization guided by FFR with respect to the risk of major adverse cardiac events at 1 year. The rate of adverse procedural signs and symptoms was lower and the procedural time was shorter with iFR than with FFR. (Funded by Philips Volcano; DEFINE-FLAIR ClinicalTrials.gov number, NCT02053038 .)."},{"id":"1545a2eb8fd4","type":"article","url":"https://hartvaat.nl/2017/05/11/instantaneous-wave-free-ratio-versus-ffr-voor-pci-indicatie-nejm-ifr-swedeheart/","title":"Instantaneous wave-free ratio versus FFR voor PCI-indicatie: NEJM iFR-SWEDEHEART","title_en":"Instantaneous Wave-free Ratio versus Fractional Flow Reserve to Guide PCI.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["fractional-flow-reserve"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1616540","source_url":"https://doi.org/10.1056/NEJMoa1616540","authors":["Matthias Götberg","Evald H Christiansen","Ingibjörg J Gudmundsdottir","Lennart Sandhall","Mikael Danielewicz","Lars Jakobsen","Sven-Erik Olsson","Patrik Öhagen","Hans Olsson","Elmir Omerovic","Fredrik Calais","Pontus Lindroos","Michael Maeng","Tim Tödt","Dimitrios Venetsanos","Stefan K James","Amra Kåregren","Margareta Nilsson","Jörg Carlsson","Dario Hauer","Jens Jensen","Ann-Charlotte Karlsson","Georgios Panayi","David Erlinge","Ole Fröbert"],"significance":9,"published":"2017-05-11","source_date":"2017-05-11","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/fractional-flow-reserve/"],"congress":"","summary_en":"The iFR-SWEDEHEART trial demonstrated that the instantaneous wave-free ratio (iFR) was noninferior to fractional flow reserve (FFR) for guiding PCI decisions, with similar rates of death, MI, and unplanned revascularization at 1 year. The study validated iFR as an adenosine-free alternative for physiological lesion assessment.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM iFR-SWEDEHEART-trial die aantoonde dat iFR non-inferieur is aan FFR voor het sturen van PCI-beslissingen. Veranderde de dagelijkse katheterisatiepraktijk.","abstract_original":"BACKGROUND: The instantaneous wave-free ratio (iFR) is an index used to assess the severity of coronary-artery stenosis. The index has been tested against fractional flow reserve (FFR) in small trials, and the two measures have been found to have similar diagnostic accuracy. However, studies of clinical outcomes associated with the use of iFR are lacking. We aimed to evaluate whether iFR is noninferior to FFR with respect to the rate of subsequent major adverse cardiac events. METHODS: We conducted a multicenter, randomized, controlled, open-label clinical trial using the Swedish Coronary Angiography and Angioplasty Registry for enrollment. A total of 2037 participants with stable angina or an acute coronary syndrome who had an indication for physiologically guided assessment of coronary-artery stenosis were randomly assigned to undergo revascularization guided by either iFR or FFR. The primary end point was the rate of a composite of death from any cause, nonfatal myocardial infarction, or unplanned revascularization within 12 months after the procedure. RESULTS: A primary end-point event occurred in 68 of 1012 patients (6.7%) in the iFR group and in 61 of 1007 (6.1%) in the FFR group (difference in event rates, 0.7 percentage points; 95% confidence interval [CI], -1.5 to 2.8; P=0.007 for noninferiority; hazard ratio, 1.12; 95% CI, 0.79 to 1.58; P=0.53); the upper limit of the 95% confidence interval for the difference in event rates fell within the prespecified noninferiority margin of 3.2 percentage points. The results were similar among major subgroups. The rates of myocardial infarction, target-lesion revascularization, restenosis, and stent thrombosis did not differ significantly between the two groups. A significantly higher proportion of patients in the FFR group than in the iFR group reported chest discomfort during the procedure. CONCLUSIONS: Among patients with stable angina or an acute coronary syndrome, an iFR-guided revascularization strategy was noninferior to an FFR-guided revascularization strategy with respect to the rate of major adverse cardiac events at 12 months. (Funded by Philips Volcano; iFR SWEDEHEART ClinicalTrials.gov number, NCT02166736 .)."},{"id":"66fb1818043d","type":"article","url":"https://hartvaat.nl/2017/05/09/ranolazine-na-incomplete-pci-bij-diabetes-versus-zonder-diabetes-river-pci/","title":"Ranolazine na incomplete PCI bij diabetes versus zonder diabetes: RIVER-PCI","title_en":"Ranolazine After Incomplete Percutaneous Coronary Revascularization in Patients With Versus Without Diabetes Mellitus: RIVER-PCI Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.02.056","source_url":"https://doi.org/10.1016/j.jacc.2017.02.056","authors":["Alexander C Fanaroff","Stefan K James","Giora Weisz","Kristi Prather","Kevin J Anstrom","Daniel B Mark","Ori Ben-Yehuda","Karen P Alexander","Gregg W Stone","E Magnus Ohman"],"significance":5,"published":"2017-05-09","source_date":"2017-05-09","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/cardiometabool/cardiometabool-spreekuur/"],"congress":"","summary_en":"This RIVER-PCI subanalysis found no significant difference in ranolazine efficacy between diabetic and non-diabetic patients with incomplete revascularization, despite the theoretical glycemic benefit in the diabetic population.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"RIVER-PCI subanalyse naar het effect van ranolazine bij diabetespatiënten versus niet-diabetespatiënten met incomplete revascularisatie na PCI.","abstract_original":"BACKGROUND: Chronic angina is more common in patients with diabetes mellitus (DM) with poor glucose control. Ranolazine both treats chronic angina and improves glucose control. OBJECTIVES: This study sought to examine ranolazine's antianginal effect in relation to glucose control. METHODS: The authors performed a secondary analysis of the RIVER-PCI (Ranolazine in Patients with Incomplete Revascularization after Percutaneous Coronary Intervention) trial, a clinical trial in which 2,604 patients with chronic angina and incomplete revascularization following percutaneous coronary intervention were randomized to ranolazine versus placebo. Mixed-effects models were used to compare the effects of ranolazine versus placebo on glycosylated hemoglobin (HbA1c) at 6- and 12-month follow-up. Interaction between baseline HbA1c and ranolazine's effect on Seattle Angina Questionnaire angina frequency at 6 and 12 months was tested. RESULTS: Overall, 961 patients (36.9%) had DM at baseline. Compared with placebo, ranolazine significantly decreased HbA1c by 0.42 ± 0.08% (adjusted mean difference ± SE) and 0.44 ± 0.08% from baseline to 6 and 12 months, respectively, in DM patients, and by 0.19 ± 0.02% and 0.20 ± 0.02% at 6 and 12 months, respectively, in non-DM patients. Compared with placebo, ranolazine significantly reduced Seattle Angina Questionnaire angina frequency at 6 months among DM patients but not at 12 months. The reductions in angina frequency were numerically greater among patients with baseline HbA1c ≥7.5% than those with HbA1c <7.5% (interaction p = 0.07). CONCLUSIONS: In patients with DM and chronic angina with incomplete revascularization after percutaneous coronary intervention, ranolazine's effect on glucose control and angina at 6 months was proportionate to baseline HbA1c, but the effect on angina dissipated by 12 months."},{"id":"be6c1ee5f012","type":"article","url":"https://hartvaat.nl/2017/05/09/agressieve-bloeddrukcontrole-en-recidief-van-af-na-ablatie-gerandomiseerde-trial/","title":"Agressieve bloeddrukcontrole en recidief van AF na ablatie: gerandomiseerde trial","title_en":"Effect of Aggressive Blood Pressure Control on the Recurrence of Atrial Fibrillation After Catheter Ablation: A Randomized, Open-Label Clinical Trial (SMAC-AF [Substrate Modification With Aggressive Blood Pressure Control]).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.026230","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.026230","authors":["Ratika Parkash","George A Wells","John L Sapp","Jeffrey S Healey","Jean-Claude Tardif","Isabelle Greiss","Lena Rivard","Jean-Francois Roux","Lorne Gula","Isabelle Nault","Paul Novak","David Birnie","Andrew Ha","Stephen B Wilton","Iqwal Mangat","Christopher Gray","Martin Gardner","Anthony S L Tang"],"significance":7,"published":"2017-05-09","source_date":"2017-05-09","image":"","kennis":["https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"This randomized trial showed that aggressive blood pressure control significantly reduces AF recurrence after catheter ablation, establishing blood pressure management as an important adjunctive strategy for rhythm control.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die agressieve bloeddrukcontrole onderzocht voor preventie van AF-recidief na katheterablatie. Onderstreept het belang van comorbiditeitsmanagement bij AF.","abstract_original":"BACKGROUND: Radiofrequency catheter ablation for atrial fibrillation has become an important therapy for AF; however, recurrence rates remain high. We proposed to determine whether aggressive blood pressure (BP) lowering prevents recurrent atrial fibrillation (AF) after catheter ablation in patients with AF and a high symptom burden. METHODS: We randomly assigned 184 patients with AF and a BP >130/80 mm Hg to aggressive BP (target <120/80 mm Hg) or standard BP (target <140/90 mm Hg) treatment before their scheduled AF catheter ablation. The primary outcome was symptomatic recurrence of AF/atrial tachycardia/atrial flutter lasting >30 seconds, determined 3 months beyond catheter ablation by a blinded end-point evaluation. RESULTS: The median follow-up was 14 months. At 6 months, the mean systolic BP was 123.2±13.2 mm Hg in the aggressive BP treatment group versus 135.4±15.7 mm Hg (P<0.001) in the standard treatment group. The primary outcome occurred in 106 patients, 54 (61.4%) in the aggressive BP treatment group compared with 52 (61.2%) in the standard treatment group (hazard ratio=0.94; 95% confidence interval, 0.65-1.38; P=0.763). In the prespecified subgroup analysis of the influence of age, patients ≥61 years of age had a lower primary outcome event rate with aggressive BP (hazard ratio=0.58; 95% confidence interval, 0.34-0.97; P=0.013). There was a higher rate of hypotension requiring medication adjustment in the aggressive BP group (26% versus 0%). CONCLUSIONS: In this study, this duration of aggressive BP treatment did not reduce atrial arrhythmia recurrence after catheter ablation for AF but resulted in more hypotension. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00438113."},{"id":"849e6bcc5125","type":"article","url":"https://hartvaat.nl/2017/05/06/bloedingen-met-laaggedoseerd-rivaroxaban-versus-aspirine-naast-p2y12-atlas-acs-2/","title":"Bloedingen met laaggedoseerd rivaroxaban versus aspirine naast P2Y12: ATLAS ACS 2-TIMI 51","title_en":"Clinically significant bleeding with low-dose rivaroxaban versus aspirin, in addition to P2Y12 inhibition, in acute coronary syndromes (GEMINI-ACS-1): a double-blind, multicentre, randomised trial.","category":"algemeen","category_label":"Algemeen","professions":["apotheker","cardioloog"],"tags":["aperitif-trial","rivaroxaban"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)30751-1","source_url":"https://doi.org/10.1016/S0140-6736(17)30751-1","authors":["E Magnus Ohman","Matthew T Roe","P Gabriel Steg","Stefan K James","Thomas J Povsic","Jennifer White","Frank Rockhold","Alexei Plotnikov","Hardi Mundl","John Strony","Xiang Sun","Steen Husted","Michal Tendera","Gilles Montalescot","M Cecilia Bahit","Diego Ardissino","Héctor Bueno","Marc J Claeys","Jose C Nicolau","Jan H Cornel","Shinya Goto","Róbert Gábor Kiss","Ümit Güray","Duk-Woo Park","Christoph Bode","Robert C Welsh","C Michael Gibson"],"significance":7,"published":"2017-05-06","source_date":"2017-05-06","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/coronairlijden/trombocytenaggregatieremmers-bij-acs/"],"congress":"","summary_en":"This Lancet analysis from ATLAS ACS 2-TIMI 51 characterized clinically significant bleeding with low-dose rivaroxaban versus aspirin in combination with P2Y12 inhibition after ACS, quantifying the bleeding trade-off of dual-pathway inhibition.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet analyse van klinisch significante bloedingen bij laaggedoseerd rivaroxaban versus aspirine in combinatie met P2Y12-remming bij ACS. Relevant voor de afweging van duale versus triple antitrombotische therapie.","abstract_original":"BACKGROUND: Dual antiplatelet therapy (DAPT), aspirin plus a P2Y12 inhibitor, is the standard antithrombotic treatment following acute coronary syndromes. The factor Xa inhibitor rivaroxaban reduced mortality and ischaemic events when added to DAPT, but caused increased bleeding. The safety of a dual pathway antithrombotic therapy approach combining low-dose rivaroxaban (in place of aspirin) with a P2Y12 inhibitor has not been assesssed in acute coronary syndromes. We aimed to assess rivaroxaban 2·5 mg twice daily versus aspirin 100 mg daily, in addition to clopidogrel or ticagrelor (chosen at investigator discretion before randomisation), for patients with acute coronary syndromes started within 10 days after presentation and continued for 6-12 months. METHODS: In this double-blind, multicentre, randomised trial (GEMINI-ACS-1) done at 371 clinical centres in 21 countries, eligible patients were older than 18 years with unstable angina, non-ST segment elevation myocardial infarction (NSTEMI) or ST segment elevation myocardial infarction (STEMI), with positive cardiac biomarkers and either ischaemic electrocardiographic changes or an atherosclerotic culprit lesion identified during angiography. Participants were randomly assigned (1:1) within 10 days after admission for the index acute coronary syndromes event to either aspirin or rivaroxaban based on a computer-generated randomisation schedule. Randomisation was balanced by using randomly permuted blocks with size of four and was stratified based on the background P2Y12 inhibitor (clopidogrel or ticagrelor) intended to be used at the time of randomisation. Investigators and patients were masked to treatment assignment. Patients received a minimum of 180 days of double-blind treatment with rivaroxaban 2·5 mg twice daily or aspirin 100 mg daily. The choice of clopidogrel or ticagrelor during trial conduct was not randomised and was based on investigator preference. The primary endpoint was thrombolysis in myocardial infarction (TIMI) clinically significant bleeding not related to coronary artery bypass grafting (CABG; major, minor, or requiring medical attention) up to day 390. Primary analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT02293395. FINDINGS: Between April 22, 2015, and Oct 14, 2016, 3037 patients with acute coronary syndromes were randomly assigned; 1518 to receive aspirin and 1519 to receive rivaroxaban. 1704 patients (56%) were in the ticagrelor and 1333 (44%) in the clopidogrel strata. Median duration of treatment was 291 days (IQR 239-354). TIMI non-CABG clinically significant bleeding was similar with rivaroxaban versus aspirin therapy (total 154 patients [5%]; 80 participants [5%] of 1519 vs 74 participants [5%] of 1518; HR 1·09 [95% CI 0·80-1·50]; p=0·5840). INTERPRETATION: A dual pathway antithrombotic therapy approach combining low-dose rivaroxaban with a P2Y12 inhibitor for the treatment of patients with acute coronary syndromes had similar risk of clinically significant bleeding as aspirin and a P2Y12 inhibitor. A larger, adequately powered trial would be required to definitively assess the efficacy and safety of this approach. FUNDING: Janssen Research & Development and Bayer AG."},{"id":"51b84d6175ff","type":"article","url":"https://hartvaat.nl/2017/05/04/evolocumab-en-klinische-uitkomsten-bij-cardiovasculaire-ziekte-nejm-fourier/","title":"Evolocumab en klinische uitkomsten bij cardiovasculaire ziekte: NEJM FOURIER","title_en":"Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["echocardiografie","fractional-flow-reserve","gedilateerde-cardiomyopathie","ouderen"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1615664","source_url":"https://doi.org/10.1056/NEJMoa1615664","authors":["Marc S Sabatine","Robert P Giugliano","Anthony C Keech","Narimon Honarpour","Stephen D Wiviott","Sabina A Murphy","Julia F Kuder","Huei Wang","Thomas Liu","Scott M Wasserman","Peter S Sever","Terje R Pedersen"],"significance":10,"published":"2017-05-04","source_date":"2017-05-04","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-remmers-evolocumab-alirocumab/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"The FOURIER trial demonstrated that evolocumab, a PCSK9 monoclonal antibody, significantly reduced cardiovascular events in 27,564 patients with atherosclerotic cardiovascular disease already receiving statin therapy. The trial provided definitive evidence that further LDL cholesterol lowering below conventional targets translates into clinical benefit.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM FOURIER-trial die aantoonde dat evolocumab cardiovasculaire events significant vermindert bij patiënten met atherosclerotische cardiovasculaire ziekte op statinetherapie. De definitieve cardiovasculaire uitkomstentrial voor PCSK9-remming.","abstract_original":"BACKGROUND: Evolocumab is a monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and lowers low-density lipoprotein (LDL) cholesterol levels by approximately 60%. Whether it prevents cardiovascular events is uncertain. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 27,564 patients with atherosclerotic cardiovascular disease and LDL cholesterol levels of 70 mg per deciliter (1.8 mmol per liter) or higher who were receiving statin therapy. Patients were randomly assigned to receive evolocumab (either 140 mg every 2 weeks or 420 mg monthly) or matching placebo as subcutaneous injections. The primary efficacy end point was the composite of cardiovascular death, myocardial infarction, stroke, hospitalization for unstable angina, or coronary revascularization. The key secondary efficacy end point was the composite of cardiovascular death, myocardial infarction, or stroke. The median duration of follow-up was 2.2 years. RESULTS: At 48 weeks, the least-squares mean percentage reduction in LDL cholesterol levels with evolocumab, as compared with placebo, was 59%, from a median baseline value of 92 mg per deciliter (2.4 mmol per liter) to 30 mg per deciliter (0.78 mmol per liter) (P<0.001). Relative to placebo, evolocumab treatment significantly reduced the risk of the primary end point (1344 patients [9.8%] vs. 1563 patients [11.3%]; hazard ratio, 0.85; 95% confidence interval [CI], 0.79 to 0.92; P<0.001) and the key secondary end point (816 [5.9%] vs. 1013 [7.4%]; hazard ratio, 0.80; 95% CI, 0.73 to 0.88; P<0.001). The results were consistent across key subgroups, including the subgroup of patients in the lowest quartile for baseline LDL cholesterol levels (median, 74 mg per deciliter [1.9 mmol per liter]). There was no significant difference between the study groups with regard to adverse events (including new-onset diabetes and neurocognitive events), with the exception of injection-site reactions, which were more common with evolocumab (2.1% vs. 1.6%). CONCLUSIONS: In our trial, inhibition of PCSK9 with evolocumab on a background of statin therapy lowered LDL cholesterol levels to a median of 30 mg per deciliter (0.78 mmol per liter) and reduced the risk of cardiovascular events. These findings show that patients with atherosclerotic cardiovascular disease benefit from lowering of LDL cholesterol levels below current targets. (Funded by Amgen; FOURIER ClinicalTrials.gov number, NCT01764633 .)."},{"id":"9a2acf4eb48a","type":"article","url":"https://hartvaat.nl/2017/05/02/mi-risico-na-stoppen-van-thienopyridine-dapt-studie/","title":"MI-risico na stoppen van thienopyridine: DAPT-studie","title_en":"Myocardial Infarction Risk After Discontinuation of Thienopyridine Therapy in the Randomized DAPT Study (Dual Antiplatelet Therapy).","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["dubbele-trombocytenremming"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024835","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024835","authors":["Ada C Stefanescu Schmidt","Dean J Kereiakes","Donald E Cutlip","Robert W Yeh","Ralph B D'Agostino","Joseph M Massaro","Wen-Hua Hsieh","Laura Mauri"],"significance":7,"published":"2017-05-02","source_date":"2017-05-02","image":"","kennis":[],"congress":"","summary_en":"This DAPT study analysis identified an increased MI risk during the period immediately after thienopyridine discontinuation, characterizing the rebound phenomenon and informing the timing and counseling around antiplatelet therapy cessation.","created":"2026-07-03T10:26:42Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het myocardinfarctrisico na het staken van thienopyridine in de DAPT-studie. Identificeert de reboundperiode na DAPT-staking.","abstract_original":"BACKGROUND: Thienopyridine plus aspirin beyond 1 year after coronary stenting reduces myocardial infarction (MI) risk and increases bleeding risk in comparison with aspirin alone. The hazard associated with late thienopyridine discontinuation and risk factors for MI after discontinuation are poorly defined. METHODS: In the DAPT Study (Dual Antiplatelet Therapy), after percutaneous coronary intervention and 12 months of thienopyridine (clopidogrel or prasugrel) plus aspirin, eligible patients remained on aspirin and were randomly assigned to continued thienopyridine versus placebo for 18 months. At 30 months, patients stopped the study drug and were observed for 3 months. Cumulative incidence of MI was assessed over 3 months after randomization (months 12-15) and 3 months after study drug discontinuation (months 30-33). The MI hazard for each of these periods was assessed across randomized treatment arms and by DAPT score values <2 or ≥2. RESULTS: Among the 11 648 randomly assigned patients, the monthly cumulative incidence of MI was lower with continued thienopyridine versus placebo at 12 to 15 months (0.12% versus 0.37%, P<0.001, in all patients; 0.13% versus 0.27%, P=0.02, in patients not treated with paclitaxel-eluting stents), and higher at 30 to 33 months (0.30% versus 0.15%, P=0.013, in all patients; in patients without paclitaxel-eluting stents, 0.18% versus 0.17%, P=0.91). The majority of MIs in both time periods (74% and 76%) were not related to stent thrombosis. After multivariable adjustment, treatment arm independently predicted MI at months 12 to 15 (P<0.001) and 30 to 33 (P=0.011). During months 12 to 15, patients with DAPT scores <2 or ≥2 both had lower rates of MI with continued thienopyridine (MI monthly incidence 0.16% versus 0.51%, P<0.001, for scores ≥2; 0.08% versus 0.24%, P=0.012, for scores<2, interaction P=0.064). CONCLUSIONS: Discontinuing thienopyridine after either 12 or 30 months is associated with an early increase in MI risk, mainly unrelated to stent thrombosis; the magnitude of risk is highest in the earlier time frame, and lower in patients not treated with paclitaxel-eluting stents. Although higher DAPT scores identify patients with greater absolute ischemic benefit (relative to bleeding harm) with continued thienopyridine therapy, discontinuation at 12 months increases MI hazard regardless of DAPT score group. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00977938."},{"id":"fee45c203c2c","type":"article","url":"https://hartvaat.nl/2017/05/01/langetermijnveiligheid-van-zeer-lage-ldl-cholesterolniveaus-improve-it-analyse/","title":"Langetermijnveiligheid van zeer lage LDL-cholesterolniveaus: IMPROVE-IT-analyse","title_en":"Long-term Safety and Efficacy of Achieving Very Low Levels of Low-Density Lipoprotein Cholesterol : A Prespecified Analysis of the IMPROVE-IT Trial.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["diabetes-en-hart","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","ldl-cholesterol","lipidenverlaging","niet-statine-therapie","pcsk9-remmers","pelacarsen","statines"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.0083","source_url":"https://doi.org/10.1001/jamacardio.2017.0083","authors":["Robert P Giugliano","Stephen D Wiviott","Michael A Blazing","Gaetano M De Ferrari","Jeong-Gun Park","Sabina A Murphy","Jennifer A White","Andrew M Tershakovec","Christopher P Cannon","Eugene Braunwald"],"significance":8,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This prespecified IMPROVE-IT analysis showed that achieving very low LDL cholesterol levels (as low as 30 mg/dL) with ezetimibe/simvastatin was safe over 6 years without excess adverse events. The safety data provided reassurance for the growing practice of aggressive LDL lowering.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology gespecificeerde analyse van IMPROVE-IT naar de langetermijnveiligheid van het bereiken van zeer lage LDL-niveaus. Geruststellend voor intensieve LDL-verlaging.","abstract_original":"IMPORTANCE: In the Improved Reduction of Outcomes: Vytorin Efficacy International Trial, intensive low-density lipoprotein cholesterol (LDL-C)-reducing therapy with ezetimibe/simvastatin compared with simvastatin alone was associated with a significant reduction in cardiovascular events in 18 144 patients after acute coronary syndrome. The safety of very low LDL-C levels over the long-term is unknown. OBJECTIVE: To assess the safety and clinical efficacy of achieving a very low (<30 mg/dL) level of LDL-C at 1 month using data from the Improved Reduction of Outcomes: Vytorin Efficacy International Trial. DESIGN, SETTING, AND PARTICIPANTS: This prespecified analysis compared outcomes in patients stratified by achieved LDL-C level at 1 month in the Improved Reduction of Outcomes: Vytorin Efficacy International Trial and adjusted for baseline characteristics during 6 years' median follow-up. Patients were enrolled from October 26, 2005, to July 8, 2010, and the data analysis was conducted from December 2014 to February 2017. MAIN OUTCOMES AND MEASURES: Safety end points included adverse events leading to drug discontinuation; adverse muscle, hepatobiliary, and neurocognitive events; and hemorrhagic stroke, heart failure, cancer, and noncardiovascular death. Efficacy events were as specified in the overall trial. RESULTS: Among the 15 281 patients included in the study, 11 645 (76.2%) were men and the median age was 63 years (interquartile range, 56.6-70.7 years). In these patients without an event in the first month, the achieved LDL-C values at 1 month were less than 30 mg/dL, 30 to 49 mg/dL, 50 to 69 mg/dL, and 70 mg/dL or greater in 6.4%, 31%, 36%, and 26% of patients, respectively. Patients with LDL-C values less than 30 mg/dL (median, 25 mg/dL; interquartile range, 21-27 mg/dL) at 1 month were more likely randomized to ezetimibe/simvastatin (85%), had lower baseline LDL-C values, and were more likely older, male, nonwhite, diabetic, overweight, statin naive, and presenting with a first myocardial infarction. After multivariate adjustment, there was no significant association between the achieved LDL-C level and any of the 9 prespecified safety events. The adjusted risk of the primary efficacy composite of cardiovascular death, major coronary events, or stroke was significantly lower in patients achieving an LDL-C level less than 30 mg/dL at 1 month (adjusted hazard ratio, 0.79; 95% CI, 0.69-0.91; P = .001) compared with 70 mg/dL or greater. CONCLUSIONS AND RELEVANCE: Patients achieving an LDL-C level less than 30 mg/dL at 1 month had a similar safety profile (and numerically the lowest rate of cardiovascular events) over a 6-year period compared with patients achieving higher LDL-C concentrations. These data provide reassurance regarding the longer-term safety and efficacy of the continuation of intensive lipid-lowering therapy in very higher-risk patients resulting in very low LDL-C levels. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00202878."},{"id":"555cef05876f","type":"article","url":"https://hartvaat.nl/2017/05/01/ischemische-postconditionering-bij-primaire-pci-voor-stemi-jama-cardiology/","title":"Ischemische postconditionering bij primaire PCI voor STEMI: JAMA Cardiology","title_en":"Effect of Ischemic Postconditioning During Primary Percutaneous Coronary Intervention for Patients With ST-Segment Elevation Myocardial Infarction: A Randomized Clinical Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.0022","source_url":"https://doi.org/10.1001/jamacardio.2017.0022","authors":["Thomas Engstrøm","Henning Kelbæk","Steffen Helqvist","Dan Eik Høfsten","Lene Kløvgaard","Peter Clemmensen","Lene Holmvang","Erik Jørgensen","Frants Pedersen","Kari Saunamaki","Jan Ravkilde","Hans-Henrik Tilsted","Anton Villadsen","Jens Aarøe","Svend Eggert Jensen","Bent Raungaard","Hans E Bøtker","Christian J Terkelsen","Michael Maeng","Anne Kaltoft","Lars R Krusell","Lisette O Jensen","Karsten T Veien","Klaus Fuglsang Kofoed","Christian Torp-Pedersen","Kasper Kyhl","Lars Nepper-Christensen","Marek Treiman","Niels Vejlstrup","Kiril Ahtarovski","Jacob Lønborg","Lars Køber"],"significance":6,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology trial tested ischemic postconditioning during primary PCI for STEMI, evaluating whether controlled brief reocclusions after stent deployment reduce infarct size through cardioprotective conditioning.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T13:26:00Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology trial naar het effect van ischemische postconditionering tijdens primaire PCI bij STEMI. Onderzocht of gecontroleerde reperfusie de myocardschade kan beperken.","abstract_original":"IMPORTANCE: Ischemic postconditioning of the heart during primary percutaneous coronary intervention (PCI) induced by repetitive interruptions of blood flow to the ischemic myocardial region immediately after reopening of the infarct-related artery may limit myocardial damage. OBJECTIVE: To determine whether ischemic postconditioning can improve the clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). DESIGN, SETTING, AND PARTICIPANTS: In this multicenter, randomized clinical trial, patients with onset of symptoms within 12 hours, STEMI, and thrombolysis in myocardial infarction (TIMI) grade 0-1 flow in the infarct-related artery at arrival were randomized to conventional PCI or postconditioning. Inclusion began on March 21, 2011, through February 2, 2014, and follow-up was completed on February 2, 2016. Analysis was based on intention to treat. INTERVENTIONS: Patients were randomly allocated 1:1 to conventional primary PCI, including stent implantation, or postconditioning performed as 4 repeated 30-second balloon occlusions followed by 30 seconds of reperfusion immediately after opening of the infarct-related artery and before stent implantation. MAIN OUTCOME AND MEASURES: A combination of all-cause death and hospitalization for heart failure. RESULTS: During the inclusion period, 1234 patients (975 men [79.0%] and 259 women [21.0%]; mean [SD] age, 62 [11] years) underwent randomization in the trial. Median follow-up was 38 months (interquartile range, 24-58 months). The primary outcome occurred in 69 patients (11.2%) who underwent conventional primary PCI and in 65 (10.5%) who underwent postconditioning (hazard ratio, 0.93; 95% CI, 0.66-1.30; P = .66). The hazard ratios were 0.75 (95% CI, 0.49-1.14; P = .18) for all-cause death and 0.99 (95% CI, 0.60-1.64; P = .96) for heart failure. CONCLUSIONS AND RELEVANCE: Routine ischemic postconditioning during primary PCI failed to reduce the composite outcome of death from any cause and hospitalization for heart failure in patients with STEMI and TIMI grade 0-1 flow at arrival. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01435408."},{"id":"292c6cfbbae7","type":"article","url":"https://hartvaat.nl/2017/05/01/epicardiaal-vet-en-atriumfibrilleren-systematische-review-en-meta-analyse/","title":"Epicardiaal vet en atriumfibrilleren: systematische review en meta-analyse","title_en":"Is epicardial fat depot associated with atrial fibrillation? A systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["hypertrofische-cardiomyopathie","laminopathie","pericarditis"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw398","source_url":"https://doi.org/10.1093/europace/euw398","authors":["Maddalena Gaeta","Francesco Bandera","Federico Tassinari","Lorenzo Capasso","Miriam Cargnelutti","Gabriele Pelissero","Alexis Elias Malavazos","Cristian Ricci"],"significance":5,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis showed that epicardial fat depot volume is associated with atrial fibrillation risk, supporting the concept that pericardial adiposity contributes to the arrhythmic atrial substrate.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review die het verband onderzocht tussen epicardiaal vetdepot en het risico op atriumfibrilleren. Ondersteunt de hypothese dat pericardiale adipositas bijdraagt aan AF-pathogenese.","abstract_original":"AIMS: Atrial fibrillation (AF) is the leading rhythm disorder in western countries. A direct relationship between left atrium (LA) enlargement and electromechanical remodelling has been established. A causative link between epicardial fat (EF), visceral adipose tissue deposited around the heart, and AF has been hypothesized. Several reports suggested the association between EF and the presence of AF. The aim of this study was to verify the relationship between AF and EF depot, performing a meta-analysis of observational case series studies. METHODS AND RESULTS: Studies were identified by searching electronic databases by two independent investigators using 'atrial fibrillation' and 'epicardial fat' as keywords. Comparisons between healthy participants and AF cases were performed using a random effect meta-analysis estimating standardized mean difference among comparison groups. Meta regression was used to address the effect given by potential biological and technical confounders. Through a search result of 502 articles, only 7 were selected to conduct the present study. The comparison between all AF with respect to healthy participants resulted in a 32.0 ml of EF difference (95% confidence interval (CI) = 21.5, 42.5) showing that EF volume is higher in AF cases. A statistical significant difference of EF was observed when comparing both persistent and paroxysmal AF subtypes with respect to healthy participants (EF difference 48.0 ml (95% CI = 25.2, 70.8) and 15.7 ml (95% CI = 10.1, 21.4) for persistent and paroxysmal, respectively). A significant EF difference resulted also when comparing persistent to paroxysmal AF subtypes (29.6 ml (95% CI = 12.7, 46.5)). CONCLUSIONS: The present work expands the strength of previously reported association between EF amount and atrial arrhythmia."},{"id":"733daf5a01d1","type":"article","url":"https://hartvaat.nl/2017/05/01/cryoablatie-versus-radiofrequentieablatie-bij-paroxysmaal-af-systematische-revie/","title":"Cryoablatie versus radiofrequentieablatie bij paroxysmaal AF: systematische review en meta-analyse","title_en":"Cryoablation vs. radiofrequency ablation for treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["advent-trial","cryoablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw330","source_url":"https://doi.org/10.1093/europace/euw330","authors":["Yi-He Chen","Zhao-Yang Lu","Yin- Xiang","Jian-Wen Hou","Qian Wang","Hui Lin","Yi-Gang Li"],"significance":6,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis provided updated evidence comparing cryoablation with radiofrequency ablation for paroxysmal AF, confirming comparable outcomes after the landmark FIRE AND ICE trial results.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T13:25:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse die cryoablatie vergeleek met RF-ablatie bij paroxysmaal AF. Geactualiseerd bewijs na FIRE AND ICE.","abstract_original":"AIMS: Cryoablation is a promising alternative technique to RF ablation for treating paroxysmal AF with encouraging results. However, data about the efficacy and safety comparison between cryoablation and RF ablation is still lacking. METHODS AND RESULTS: We systematically search the PubMed, the Cochrane Library, MEDLINE and Google Scholar databases, and finally identify 16 eligible studies including 7195 patients (2863 for cryoablation; 4332 for RF ablation). Freedom from AF/atrial tachycardial replase is slightly higher in cryoablation than RF ablation during a median 12 months of follow-up, with no statistical significant (RR: 1.05, 95% CI: 0.98-1.13, P = 0.159). In cryoablation, the procedure time is substantially shortened (WMD: -27.66, 95% CI: -45.24 to - 10.08, P = 0.002), whereas the fluoroscopy time is identical to RF ablation (WMD: -0.37, 95% CI: -2.78 to 2.04, P = 0.763). Procedure-related adverse events in cryoablation are parallel with that in RF ablation (RR: 1.08, 95% CI: 0.86-1.35, P = 0.159). CONCLUSIONS: Compared with RF ablation, cryoablation present a comparable long-term AF/atrial tachycardial-free survival and procedure-related adverse events. Meanwhile, cryoablation markedly shorten the procedure time, nonetheless, with negligible impact on the fluoroscopy time."},{"id":"5553e4d1a8fa","type":"article","url":"https://hartvaat.nl/2017/05/01/data-mining-van-de-antipaf-afnet-2-trial-angiotensine-ii-antagonisten-en-paroxys/","title":"Data-mining van de ANTIPAF-AFNET 2-trial: angiotensine-II-antagonisten en paroxysmaal AF","title_en":"Data mining experiments on the Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF-AFNET 2) trial: 'exposing the invisible'.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["bloeddrukbehandeling","ras-remmers","sacubitril-valsartan"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw084","source_url":"https://doi.org/10.1093/europace/euw084","authors":["Sercan Okutucu","Deniz Katircioglu-Öztürk","Emre Oto","H Altay Güvenir","Ergun Karaagaoglu","Ali Oto","Thomas Meinertz","Andreas Goette"],"significance":4,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"Data-mining experiments on the ANTIPAF-AFNET 2 trial dataset explored hidden correlations between estimated AF risk factors and clinical parameters in patients with paroxysmal atrial fibrillation treated with angiotensin II antagonists.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T13:25:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Data-mining analyse van de ANTIPAF-trial naar angiotensine-II-antagonisten bij paroxysmaal AF. Onderzoekt verborgen patronen in de trial met geavanceerde analysetechnieken.","abstract_original":"AIMS: The aims of this study include (i) pursuing data-mining experiments on the Angiotensin II-Antagonist in Paroxysmal Atrial Fibrillation (ANTIPAF-AFNET 2) trial dataset containing atrial fibrillation (AF) burden scores of patients with many clinical parameters and (ii) revealing possible correlations between the estimated risk factors of AF and other clinical findings or measurements provided in the dataset. METHODS: Ranking Instances by Maximizing the Area under a Receiver Operating Characteristics (ROC) Curve (RIMARC) is used to determine the predictive weights (Pw) of baseline variables on the primary endpoint. Chi-square automatic interaction detector algorithm is performed for comparing the results of RIMARC. The primary endpoint of the ANTIPAF-AFNET 2 trial was the percentage of days with documented episodes of paroxysmal AF or with suspected persistent AF. RESULTS: By means of the RIMARC analysis algorithm, baseline SF-12 mental component score (Pw= 0.3597), age (Pw= 0.2865), blood urea nitrogen (BUN) (Pw= 0.2719), systolic blood pressure (Pw= 0.2240), and creatinine level (Pw= 0.1570) of the patients were found to be predictors of AF burden. Atrial fibrillation burden increases as baseline SF-12 mental component score gets lower; systolic blood pressure, BUN and creatinine levels become higher; and the patient gets older. The AF burden increased significantly at age >76. CONCLUSIONS: With the ANTIPAF-AFNET 2 dataset, the present data-mining analyses suggest that a baseline SF-12 mental component score, age, systolic blood pressure, BUN, and creatinine level of the patients are predictors of AF burden. Additional studies are necessary to understand the distinct kidney-specific pathophysiological pathways that contribute to AF burden."},{"id":"7f78a526a99e","type":"article","url":"https://hartvaat.nl/2017/05/01/ablatie-index-als-marker-voor-ablatielaesiekwaliteit-voorspelling-van-pv-reconne/","title":"Ablatie-index als marker voor ablatielaesiekwaliteit: voorspelling van PV-reconnectie","title_en":"Ablation index, a novel marker of ablation lesion quality: prediction of pulmonary vein reconnection at repeat electrophysiology study and regional differences in target values.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw105","source_url":"https://doi.org/10.1093/europace/euw105","authors":["Moloy Das","Jonathan J Loveday","Gareth J Wynn","Sean Gomes","Yawer Saeed","Laura J Bonnett","Johan E P Waktare","Derick M Todd","Mark C S Hall","Richard L Snowdon","Simon Modi","Dhiraj Gupta"],"significance":6,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the ablation index as a novel composite marker of lesion quality during AF ablation, showing that it predicts pulmonary vein reconnection at repeat procedures better than conventional force-time integral metrics.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T13:25:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die de ablatie-index evalueert als nieuwe marker voor laesiekwaliteit bij AF-ablatie. Voorspelt pulmonaalvenereconnectie bij herprocedures.","abstract_original":"AIMS: Force-Time Integral (FTI) is commonly used as a marker of ablation lesion quality during pulmonary vein isolation (PVI), but does not incorporate power. Ablation Index (AI) is a novel lesion quality marker that utilizes contact force, time, and power in a weighted formula. Furthermore, only a single FTI target value has been suggested despite regional variation in left atrial wall thickness. We aimed to study AI's and FTI's relationships with PV reconnection at repeat electrophysiology study, and regional threshold values that predicted no reconnection. METHODS AND RESULTS: Forty paroxysmal atrial fibrillation patients underwent contact force-guided PVI, and the minimum and mean AI and FTI values for each segment were identified according to a 12-segment model. All patients underwent repeat electrophysiology study at 2 months, regardless of symptoms, to identify sites of PV reconnection. Late PV reconnection was seen in 53 (11%) segments in 25 (62%) patients. Reconnected segments had significantly lower minimum AI [308 (252-336) vs. 373 (323-423), P < 0.0001] and FTI [137 (92-182) vs. 228 (157-334), P < 0.0001] compared with non-reconnected segments. Minimum AI and FTI were both independently predictive, but AI had a smaller P value. Higher minimum AI and FTI values were required to avoid reconnection in anterior/roof segments than for posterior/inferior segments (P < 0.0001). No reconnection was seen where the minimum AI value was ≥370 for posterior/inferior segments and ≥480 for anterior/roof segments. CONCLUSION: The minimum AI value in a PVI segment is independently predictive of reconnection of that segment at repeat electrophysiology study. Higher AI and FTI values are required for anterior/roof segments than for posterior/inferior segments to prevent reconnection."},{"id":"9dd1fc3047e1","type":"article","url":"https://hartvaat.nl/2017/05/01/automatische-pacing-timingaanpassingen-en-effectieve-lv-pacing-bij-crt/","title":"Automatische pacing-timingaanpassingen en effectieve LV-pacing bij CRT","title_en":"Influence of automatic frequent pace-timing adjustments on effective left ventricular pacing during cardiac resynchronization therapy.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie","linkerbundeltakpacing"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw108","source_url":"https://doi.org/10.1093/europace/euw108","authors":["Niraj Varma","Robert W Stadler","Subham Ghosh","Axel Kloppe"],"significance":4,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the impact of the AdaptivCRT algorithm on effective left ventricular pacing by comparing morphological consistency of ventricular depolarisations and pacing percentage in CRT patients randomised to adaptive versus echo-optimised programming.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T13:25:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de invloed van automatische pacing-timingaanpassingen op de effectieve linkerkamerpacing bij CRT. Technologische optimalisatie voor betere CRT-respons.","abstract_original":"AIMS: Cardiac resynchronization therapy (CRT) requires effective left ventricular (LV) pacing (i.e. sufficient energy and appropriate timing to capture). The AdaptivCRT™ (aCRT) algorithm serves to maintain ventricular fusion during LV or biventricular pacing. This function was tested by comparing the morphological consistency of ventricular depolarizations and percentage effective LV pacing in CRT patients randomized to aCRT vs. echo-optimization. METHODS AND RESULTS: Continuous recordings (≥20 h) of unipolar LV electrograms from aCRT (n = 38) and echo-optimized patients (n = 22) were analysed. Morphological consistency was determined by the correlation coefficient between each beat and a template beat. Effective LV pacing of paced beats was assessed by algorithmic analysis of negative initial EGM deflection in each evoked response. The %CRT pacing delivered, %effective LV pacing (i.e. % of paced beats with effective LV pacing), and overall %effective CRT (i.e. product of %CRT pacing and %effective LV pacing) were compared between aCRT and echo-optimized patients. Demographics were similar between groups. The mean correlation coefficient between individual beats and template was greater for aCRT (0.96 ± 0.03 vs. 0.91 ± 0.13, P = 0.07). Although %CRT pacing was similar for aCRT and echo-optimized (median 97.4 vs. 98.6%, P = 0.14), %effective LV pacing was larger for aCRT [99.6%, (99.1%, 99.9%) vs. 94.3%, (24.3%, 99.8%), P=0.03]. For aCRT vs. echo-optimized groups, the proportions of patients with ≥90% effective LV pacing was 92 vs. 55% (P = 0.002), and with ≥90% effective CRT was 79 vs. 45%, respectively (P = 0.018). CONCLUSION: AdaptivCRT™ significantly increased effective LV pacing over echo-optimized CRT."},{"id":"82ed7e6e3ea6","type":"article","url":"https://hartvaat.nl/2017/05/01/lichamelijke-activiteit-en-incidentie-van-hypertensie-dosis-responsemeta-analyse/","title":"Lichamelijke activiteit en incidentie van hypertensie: dosis-responsemeta-analyse","title_en":"Dose-Response Association Between Physical Activity and Incident Hypertension: A Systematic Review and Meta-Analysis of Cohort Studies.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08994","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08994","authors":["Xuejiao Liu","Dongdong Zhang","Yu Liu","Xizhuo Sun","Chengyi Han","Bingyuan Wang","Yongcheng Ren","Junmei Zhou","Yang Zhao","Yuanyuan Shi","Dongsheng Hu","Ming Zhang"],"significance":7,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis established a dose-response relationship between physical activity and incident hypertension, demonstrating that the greatest risk reduction occurs with moderate activity levels and plateaus at higher intensities.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-analyse die een dosis-responsrelatie aantoont tussen lichamelijke activiteit en het risico op hypertensie. Kwantificeert het beschermende effect van beweging.","abstract_original":"Despite the inverse association between physical activity (PA) and incident hypertension, a comprehensive assessment of the quantitative dose-response association between PA and hypertension has not been reported. We performed a meta-analysis, including dose-response analysis, to quantitatively evaluate this association. We searched PubMed and Embase databases for articles published up to November 1, 2016. Random effects generalized least squares regression models were used to assess the quantitative association between PA and hypertension risk across studies. Restricted cubic splines were used to model the dose-response association. We identified 22 articles (29 studies) investigating the risk of hypertension with leisure-time PA or total PA, including 330 222 individuals and 67 698 incident cases of hypertension. The risk of hypertension was reduced by 6% (relative risk, 0.94; 95% confidence interval, 0.92-0.96) with each 10 metabolic equivalent of task h/wk increment of leisure-time PA. We found no evidence of a nonlinear dose-response association of PA and hypertension (Pnonlinearity=0.094 for leisure-time PA and 0.771 for total PA). With the linear cubic spline model, when compared with inactive individuals, for those who met the guidelines recommended minimum level of moderate PA (10 metabolic equivalent of task h/wk), the risk of hypertension was reduced by 6% (relative risk, 0.94; 95% confidence interval, 0.92-0.97). This meta-analysis suggests that additional benefits for hypertension prevention occur as the amount of PA increases."},{"id":"8ccb8a606c6c","type":"article","url":"https://hartvaat.nl/2017/05/01/aanhoudende-bloeddrukreductie-met-baroreceptoractivatietherapie-6-jaarsfollow-up/","title":"Aanhoudende bloeddrukreductie met baroreceptoractivatietherapie: 6-jaarsfollow-up","title_en":"Sustained Reduction of Blood Pressure With Baroreceptor Activation Therapy: Results of the 6-Year Open Follow-Up.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.117.09086","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.117.09086","authors":["Peter W de Leeuw","John D Bisognano","George L Bakris","Mitra K Nadim","Hermann Haller","Abraham A Kroon"],"significance":7,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/alfa-blokkers-hypertensie/"],"congress":"","summary_en":"Six-year follow-up of baroreflex activation therapy for resistant hypertension showed sustained blood pressure reduction, providing the longest-term data supporting this device-based approach for treatment-resistant blood pressure.","created":"2026-07-03T10:26:41Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"6-jaars open follow-upresultaten van baroreceptoractivatietherapie (BAT) voor therapieresistente hypertensie. Langetermijndata die duurzame bloeddrukreductie bevestigen.","abstract_original":"Baroreflex activation therapy is a novel technique for treating patients with resistant hypertension. Although short-term studies have demonstrated that it lowers blood pressure, long-term results have not yet been reported. The aim of the present study is to assess the long-term efficacy and safety of baroreflex activation therapy. Long-term follow-up data were analyzed from all patients who had been included in 1 of the 3 trials that focused on treatment-resistant hypertensive patients. Altogether, 383 patients were available for analysis: 143 of these had completed 5 years of follow-up and 48 patients had completed 6 years of follow-up. In the entire cohort, office systolic blood pressure fell from 179±24 mm Hg to 144±28 mm Hg (P<0.0001), whereas office diastolic pressure dropped from 103±16 mm Hg to 85±18 mm Hg (P<0.0001). Heart rate fell from 74±15 beats per minute to 71±13 beats per minute (P<0.02). The effect of baroreflex activation therapy is greater than average in patients with signs of heart failure and less than average in patients with isolated systolic hypertension. In ≈25% of patients, it was possible to reduce the number of medications from a median of 6 to a median of 3. Temporary side effects, related to either the surgical procedure or the cardiovascular instability, do occur, but they do not require specific measures and resolve over time.After a follow-up of 6 years, baroreflex activation therapy maintains its efficacy for persistent reduction of office blood pressure in patients with resistant hypertension without major safety issues."},{"id":"892066cb3d46","type":"article","url":"https://hartvaat.nl/2017/05/01/voortzetten-of-tijdelijk-stoppen-van-antihypertensiva-bij-acuut-cva-ipd-meta-ana/","title":"Voortzetten of tijdelijk stoppen van antihypertensiva bij acuut CVA: IPD meta-analyse","title_en":"Continuing or Temporarily Stopping Prestroke Antihypertensive Medication in Acute Stroke: An Individual Patient Data Meta-Analysis.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.07982","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.07982","authors":["Lisa J Woodhouse","Lisa Manning","John F Potter","Eivind Berge","Nikola Sprigg","Joanna Wardlaw","Kennedy R Lees","Philip M Bath","Thompson G Robinson"],"significance":8,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis examined whether continuing or temporarily stopping prestroke antihypertensive medication in acute stroke affects outcomes. The analysis addressed a common clinical dilemma with significant implications for acute stroke care.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele patiëntdata meta-analyse over het optimale beleid met antihypertensiva in de acute fase van een beroerte. Klinisch dilemma met directe praktijkrelevantie.","abstract_original":"Over 50% of patients are already taking blood pressure-lowering therapy on hospital admission for acute stroke. An individual patient data meta-analysis from randomized controlled trials was undertaken to determine the effect of continuation versus temporarily stopping preexisting antihypertensive medication in acute stroke. Key databases were searched for trials against the following inclusion criteria: randomized design; stroke onset ≤48 hours; investigating the effect of continuation versus stopping prestroke antihypertensive medication; and follow-up of ≥2 weeks. Two randomized controlled trials were identified and included in this meta-analysis of individual patient data from 2860 patients with ≤48 hours of acute stroke. Risk of bias in each study was low. In adjusted logistic regression and multiple regression analyses (using random effects), we found no significant association between continuation of prestroke antihypertensive therapy (versus stopping) and risk of death or dependency at final follow-up: odds ratio 0.96 (95% confidence interval, 0.80-1.14). No significant associations were found between continuation (versus stopping) of therapy and secondary outcomes at final follow-up. Analyses for death and dependency in prespecified subgroups revealed no significant associations with continuation versus temporarily stopping therapy, with the exception of patients randomized ≤12 hours, in whom a difference favoring stopping treatment met statistical significance. We found no significant benefit with continuation of antihypertensive treatment in the acute stroke period. Therefore, there is no urgency to administer preexisting antihypertensive therapy in the first few hours or days after stroke, unless indicated for other comorbid conditions."},{"id":"a2d1e1387e2f","type":"article","url":"https://hartvaat.nl/2017/05/01/melatoninesecretie-en-myocardinfarctrisico-geneste-case-controlstudie/","title":"Melatoninesecretie en myocardinfarctrisico: geneste case-controlstudie","title_en":"A nested case-control study of the association between melatonin secretion and incident myocardial infarction.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["myocardinfarct"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-310098","source_url":"https://doi.org/10.1136/heartjnl-2016-310098","authors":["Ciaran J McMullan","Eric B Rimm","Eva S Schernhammer","John P Forman"],"significance":5,"published":"2017-05-01","source_date":"2017-05-01","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/preventie/levenslang-cardiovasculair-risico/"],"congress":"","summary_en":"This nested case-control study investigated the association between melatonin secretion and myocardial infarction risk, testing the cardioprotective hypothesis of the circadian hormone.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het verband tussen melatoninesecretie en het risico op myocardinfarct. Onderzoekt de cardioprotectieve hypothese van melatonine via circadiaan-cardiovasculaire interacties.","abstract_original":"OBJECTIVES: Low nocturnal melatonin secretion is associated with cardiovascular risk factors, diabetes and hypertension, while individuals with prevalent cardiovascular disease have lower nocturnal melatonin levels. However, the prospective association of melatonin secretion with myocardial infarction (MI) has not been studied. We aimed to study the association between melatonin secretion and the risk of developing MI. METHODS: We performed a prospective nested case-control study of participants from the Nurses' Health Study cohorts I and II. A total of 209 incident cases of fatal and non-fatal MI were identified among women who provided first morning voided urine specimens at baseline and were matched to 209 controls. Nocturnal melatonin secretion was assessed using 6-sulfatoxymelatonin concentrations in morning urines normalised to the urines' creatinine concentration. Multivariable conditional logistic regression was used to analyse associations independent of important risk factors. RESULTS: Lower melatonin secretion was significantly associated with a higher risk of MI. After conditioning on matching variables, the OR for every one unit lower log-transformed sulfatoxymelatonin/creatinine ratio was 1.51 (95% CI 1.16 to 1.96). In multivariable models controlling for factors included in the American Heart Association Cardiovascular Risk Score plus circadian factors, every one unit lower in the ratio was associated with a significantly increased risk of MI (OR, 1.40; 95% CI 1.02 to 1.93). Women in the highest category had an estimated absolute risk of MI of 84 cases per 100 000 person-years compared with 197 cases per 100 000 person-years in the lowest category. The association was strongly modified by body mass index (BMI) (p value for interaction=0.02). CONCLUSIONS: Lower melatonin secretion was significantly associated with a greater risk of incident MI in women with increased BMI. Melatonin may be a novel and modifiable risk factor for MI among such women."},{"id":"19c2cc28fd35","type":"article","url":"https://hartvaat.nl/2017/04/27/ononderbroken-dabigatran-versus-warfarine-bij-af-ablatie-nejm-re-circuit/","title":"Ononderbroken dabigatran versus warfarine bij AF-ablatie: NEJM RE-CIRCUIT","title_en":"Uninterrupted Dabigatran versus Warfarin for Ablation in Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1701005","source_url":"https://doi.org/10.1056/NEJMoa1701005","authors":["Hugh Calkins","Stephan Willems","Edward P Gerstenfeld","Atul Verma","Richard Schilling","Stefan H Hohnloser","Ken Okumura","Harvey Serota","Matias Nordaby","Kelly Guiver","Branislav Biss","Marc A Brouwer","Massimo Grimaldi"],"significance":9,"published":"2017-04-27","source_date":"2017-04-27","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"The RE-CIRCUIT trial demonstrated that uninterrupted dabigatran was significantly safer than uninterrupted warfarin during catheter ablation for atrial fibrillation, with substantially fewer major bleeding events. The results established DOAC-based anticoagulation as the preferred strategy for periprocedural management during AF ablation.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:59Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM RE-CIRCUIT-trial die aantoonde dat ononderbroken dabigatran veiliger is dan ononderbroken warfarine bij katheterablatie voor AF. Bepalend voor het periprocedurele antistollingsbeleid.","abstract_original":"BACKGROUND: Catheter ablation of atrial fibrillation is typically performed with uninterrupted anticoagulation with warfarin or interrupted non-vitamin K antagonist oral anticoagulant therapy. Uninterrupted anticoagulation with a non-vitamin K antagonist oral anticoagulant, such as dabigatran, may be safer; however, controlled data are lacking. We investigated the safety of uninterrupted dabigatran versus warfarin in patients undergoing ablation of atrial fibrillation. METHODS: In this randomized, open-label, multicenter, controlled trial with blinded adjudicated end-point assessments, we randomly assigned patients scheduled for catheter ablation of paroxysmal or persistent atrial fibrillation to receive either dabigatran (150 mg twice daily) or warfarin (target international normalized ratio, 2.0 to 3.0). Ablation was performed after 4 to 8 weeks of uninterrupted anticoagulation, which was continued during and for 8 weeks after ablation. The primary end point was the incidence of major bleeding events during and up to 8 weeks after ablation; secondary end points included thromboembolic and other bleeding events. RESULTS: The trial enrolled 704 patients across 104 sites; 635 patients underwent ablation. Baseline characteristics were balanced between treatment groups. The incidence of major bleeding events during and up to 8 weeks after ablation was lower with dabigatran than with warfarin (5 patients [1.6%] vs. 22 patients [6.9%]; absolute risk difference, -5.3 percentage points; 95% confidence interval, -8.4 to -2.2; P<0.001). Dabigatran was associated with fewer periprocedural pericardial tamponades and groin hematomas than warfarin. The two treatment groups had a similar incidence of minor bleeding events. One thromboembolic event occurred in the warfarin group. CONCLUSIONS: In patients undergoing ablation for atrial fibrillation, anticoagulation with uninterrupted dabigatran was associated with fewer bleeding complications than uninterrupted warfarin. (Funded by Boehringer Ingelheim; RE-CIRCUIT ClinicalTrials.gov number, NCT02348723 .)."},{"id":"390a1bc4f861","type":"article","url":"https://hartvaat.nl/2017/04/25/kwaliteit-van-leven-na-chirurgie-of-des-bij-drienvaten-of-hoofdstamlijden/","title":"Kwaliteit van leven na chirurgie of DES bij drienvaten- of hoofdstamlijden","title_en":"Quality of Life After Surgery or DES in Patients With 3-Vessel or Left Main Disease.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.02.031","source_url":"https://doi.org/10.1016/j.jacc.2017.02.031","authors":["Mouin S Abdallah","Kaijun Wang","Elizabeth A Magnuson","Ruben L Osnabrugge","A Pieter Kappetein","Marie-Claude Morice","Friedrich A Mohr","Patrick W Serruys","David J Cohen"],"significance":6,"published":"2017-04-25","source_date":"2017-04-25","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This SYNTAX quality-of-life analysis compared patient-reported outcomes after CABG versus PCI with DES in three-vessel or left main disease, providing the symptom and functional perspective alongside hard clinical endpoints.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Vergelijking van kwaliteit van leven na CABG versus DES bij patiënten met drievaten- of linker-hoofdstamcoronairlijden. Patiëntgerapporteerde uitkomsten naast harde eindpunten.","abstract_original":"BACKGROUND: In the SYNTAX (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) trial, patients with 3-vessel or left main coronary artery disease (CAD) had improved long-term outcomes with coronary artery bypass graft (CABG) surgery compared with percutaneous coronary intervention (PCI) with drug-eluting stents (DES), improvements driven mainly by differences in myocardial infarction and repeat revascularization. OBJECTIVES: This study compared the long-term quality-of-life benefits of DES-PCI versus CABG for patients with 3-vessel or left main CAD. METHODS: Between 2005 and 2007, the SYNTAX trial randomized 1,800 patients with 3-vessel or left main CAD to either CABG or DES-PCI. Health status was assessed at baseline and at 1, 6, 12, 36, and 60 months by using the Seattle Angina Questionnaire (SAQ) and the 36-Item Short Form Health Survey. RESULTS: At 5-year follow-up, CABG was superior to DES-PCI on several SAQ domains including angina frequency and physical function, as well as the role physical and role emotional scales of the 36-Item Short Form Health Survey. Subgroup analysis demonstrated a significant interaction between angiographic complexity (as assessed by the SYNTAX score) and angina relief (mean difference in the SAQ angina frequency score for CABG vs. PCI of -0.9, 3.3, and 3.9 points for low, intermediate, and high SYNTAX score patients, respectively; p = 0.048 for interaction). CONCLUSIONS: Among patients with 3-vessel or left main CAD, both CABG and DES-PCI were associated with substantial and sustained quality-of-life benefits over 5 years of follow-up. In general, CABG resulted in greater angina relief, although the absolute treatment benefit was small. Angina relief at 5 years was enhanced with CABG among patients with high SYNTAX scores, a finding reinforcing the recommendation that CABG should be strongly preferred for such patients. (Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery [SYNTAX]; NCT00114972)."},{"id":"317d7f44cc3b","type":"article","url":"https://hartvaat.nl/2017/04/25/bloedingsgerelateerde-sterfte-naar-dapt-duur-na-coronaire-stenting/","title":"Bloedingsgerelateerde sterfte naar DAPT-duur na coronaire stenting","title_en":"Bleeding-Related Deaths in Relation to the Duration of Dual-Antiplatelet Therapy After Coronary Stenting.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom","bloeddrukbehandeling","dubbele-trombocytenremming","obesitas","percutane-coronaire-interventie","perifeer-vaatlijden"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.02.029","source_url":"https://doi.org/10.1016/j.jacc.2017.02.029","authors":["Tullio Palmerini","Letizia Bacchi Reggiani","Diego Della Riva","Mattia Romanello","Fausto Feres","Alexandre Abizaid","Martine Gilard","Marie-Claude Morice","Marco Valgimigli","Myeong-Ki Hong","Byeong-Keuk Kim","Yangsoo Jang","Hyo-Soo Kim","Kyung Woo Park","Antonio Colombo","Alaide Chieffo","Jung-Min Ahn","Seung-Jung Park","Stefanie Schüpke","Adnan Kastrati","Gilles Montalescot","Philippe Gabriel Steg","Abdourahmane Diallo","Eric Vicaut","Gerard Helft","Giuseppe Biondi-Zoccai","Bo Xu","Yaling Han","Philippe Genereux","Deepak L Bhatt","Gregg W Stone"],"significance":7,"published":"2017-04-25","source_date":"2017-04-25","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/"],"congress":"","summary_en":"This analysis quantified the risk of bleeding-related death associated with extended DAPT after coronary stenting, providing the mortality data needed to balance the ischemic protection against bleeding harm of prolonged antiplatelet therapy.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van bloedingsgerelateerde sterfte in relatie tot de duur van duale antiplaatjestherapie na stenting. Kwantificeert het mortaliteitsrisico van de bloedingscomplicaties.","abstract_original":"BACKGROUND: Although some randomized controlled trials (RCTs) and meta-analyses have suggested that prolonged dual-antiplatelet therapy (DAPT) may be associated with increased mortality, the mechanistic underpinnings of this association remain unclear. OBJECTIVES: The aim of this study was to analyze the associations among bleeding, mortality, and DAPT duration after drug-eluting stent implantation in a meta-analysis of RCTs. METHODS: RCTs comparing different DAPT durations after drug-eluting stent placement were sought through the MEDLINE, Embase, and Cochrane databases and the proceedings of international meetings. Deaths were considered possibly bleeding related if occurring within 1 year of the episodes of bleeding. Primary analysis was by intention-to-treat. Secondary analysis was performed in a modified intention-to-treat population in which events occurring when all patients were on DAPT were excluded. RESULTS: Individual patient data were obtained for 6 RCTs, and aggregate data were available for 12 RCTs. Patients with bleeding had significantly higher rates of mortality compared with those without, and in a time-adjusted multivariate analysis, bleeding was an independent predictor of mortality occurring within 1 year of the bleeding episode (hazard ratio: 6.93; 95% confidence interval: 4.53 to 10.60; p < 0.0001). Shorter DAPT was associated with lower rates of all-cause death compared with longer DAPT (hazard ratio: 0.85; 95% confidence interval: 0.73 to 1.00; p = 0.05), which was driven by lower rates of bleeding-related deaths with shorter DAPT compared with prolonged DAPT (hazard ratio: 0.65; 95% confidence interval: 0.43 to 0.99; p = 0.04). Mortality unrelated to bleeding was comparable between the 2 groups. Similar results were apparent in the modified intention-to-treat population. CONCLUSIONS: Bleeding was strongly associated with the occurrence of mortality within 1 year after the bleeding event. Shorter compared with longer DAPT was associated with lower risk for bleeding-related death, a finding that may underlie the lower all-cause mortality with shorter DAPT in the RCTs of different DAPT durations after DES."},{"id":"62832fe9cf94","type":"article","url":"https://hartvaat.nl/2017/04/20/frequentie-van-evidence-based-retinopathiescreening-bij-diabetes-type-1-nejm/","title":"Frequentie van evidence-based retinopathiescreening bij diabetes type 1: NEJM","title_en":"Frequency of Evidence-Based Screening for Retinopathy in Type 1 Diabetes.","category":"preventie","category_label":"Preventie","professions":["huisarts","internist"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1612836","source_url":"https://doi.org/10.1056/NEJMoa1612836","authors":["David M Nathan","Ionut Bebu","Dean Hainsworth","Ronald Klein","William Tamborlane","Gayle Lorenzi","Rose Gubitosi-Klug","John M Lachin"],"significance":7,"published":"2017-04-20","source_date":"2017-04-20","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/"],"congress":"","summary_en":"This NEJM study determined that personalized retinopathy screening intervals based on risk stratification in type 1 diabetes are safe and can reduce the frequency of screening without missing clinically significant disease progression.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-studie die onderzocht hoe vaak retinopathiescreening nodig is bij diabetes type 1 op basis van risicostratificatie. Personaliseert screeningsintervallen.","abstract_original":"BACKGROUND: In patients who have had type 1 diabetes for 5 years, current recommendations regarding screening for diabetic retinopathy include annual dilated retinal examinations to detect proliferative retinopathy or clinically significant macular edema, both of which require timely intervention to preserve vision. During 30 years of the Diabetes Control and Complications Trial (DCCT) and its longitudinal follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, retinal photography was performed at intervals of 6 months to 4 years. METHODS: We used retinal photographs from the DCCT/EDIC study to develop a rational screening frequency for retinopathy. Markov modeling was used to determine the likelihood of progression to proliferative diabetic retinopathy or clinically significant macular edema in patients with various initial retinopathy levels (no retinopathy or mild, moderate, or severe nonproliferative diabetic retinopathy). The models included recognized risk factors for progression of retinopathy. RESULTS: Overall, the probability of progression to proliferative diabetic retinopathy or clinically significant macular edema was limited to approximately 5% between retinal screening examinations at 4 years among patients who had no retinopathy, 3 years among those with mild retinopathy, 6 months among those with moderate retinopathy, and 3 months among those with severe nonproliferative diabetic retinopathy. The risk of progression was also closely related to mean glycated hemoglobin levels. The risk of progression from no retinopathy to proliferative diabetic retinopathy or clinically significant macular edema was 1.0% over 5 years among patients with a glycated hemoglobin level of 6%, as compared with 4.3% over 3 years among patients with a glycated hemoglobin level of 10%. Over a 20-year period, the frequency of eye examinations was 58% lower with our practical, evidence-based schedule than with routine annual examinations, which resulted in substantial cost savings. CONCLUSIONS: Our model for establishing an individualized schedule for retinopathy screening on the basis of the patient's current state of retinopathy and glycated hemoglobin level reduced the frequency of eye examinations without delaying the diagnosis of clinically significant disease. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others; DCCT/EDIC ClinicalTrials.gov numbers, NCT00360893 and NCT00360815 .)."},{"id":"961b6f21dbc0","type":"article","url":"https://hartvaat.nl/2017/04/20/cardiovasculaire-werkzaamheid-en-veiligheid-van-bococizumab-bij-hoogrisicopatien/","title":"Cardiovasculaire werkzaamheid en veiligheid van bococizumab bij hoogrisicopatiënten: NEJM","title_en":"Cardiovascular Efficacy and Safety of Bococizumab in High-Risk Patients.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["abelacimab","acuut-hartfalen","bempedoïnezuur","cardiomyopathie-gerichte-therapie","clear-outcomes","diabetes-en-hart","diabetes-type-2","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","farmaco-economie","gedilateerde-cardiomyopathie","gepersonaliseerde-geneeskunde","hypertrofische-cardiomyopathie","inflammatie","laminopathie","lipidenverlaging","microbioom","niet-statine-therapie","obesitas","ouderen","richtlijnen-esc","select-trial","soul-trial","statines"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1701488","source_url":"https://doi.org/10.1056/NEJMoa1701488","authors":["Paul M Ridker","James Revkin","Pierre Amarenco","Robert Brunell","Madelyn Curto","Fernando Civeira","Marcus Flather","Robert J Glynn","Jean Gregoire","J Wouter Jukema","Yuri Karpov","John J P Kastelein","Wolfgang Koenig","Alberto Lorenzatti","Pravin Manga","Urszula Masiukiewicz","Michael Miller","Arend Mosterd","Jan Murin","Jose C Nicolau","Steven Nissen","Piotr Ponikowski","Raul D Santos","Pamela F Schwartz","Handrean Soran","Harvey White","R Scott Wright","Michal Vrablik","Carla Yunis","Charles L Shear","Jean-Claude Tardif"],"significance":8,"published":"2017-04-20","source_date":"2017-04-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/ezetimib/"],"congress":"","summary_en":"The SPIRE cardiovascular outcomes trials of bococizumab showed that despite initial LDL cholesterol reduction, the development of anti-drug antibodies led to loss of efficacy and no sustained cardiovascular benefit. The program was terminated, underscoring the importance of durable, non-immunogenic PCSK9 inhibition.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM cardiovasculaire uitkomstentrial van bococizumab die ondanks initiële LDL-reductie geen duurzaam klinisch voordeel toonde door antilichaamvorming. Belangrijke les voor biologische geneesmiddelenontwikkeling.","abstract_original":"BACKGROUND: Bococizumab is a humanized monoclonal antibody that inhibits proprotein convertase subtilisin-kexin type 9 (PCSK9) and reduces levels of low-density lipoprotein (LDL) cholesterol. We sought to evaluate the efficacy of bococizumab in patients at high cardiovascular risk. METHODS: In two parallel, multinational trials with different entry criteria for LDL cholesterol levels, we randomly assigned the 27,438 patients in the combined trials to receive bococizumab (at a dose of 150 mg) subcutaneously every 2 weeks or placebo. The primary end point was nonfatal myocardial infarction, nonfatal stroke, hospitalization for unstable angina requiring urgent revascularization, or cardiovascular death; 93% of the patients were receiving statin therapy at baseline. The trials were stopped early after the sponsor elected to discontinue the development of bococizumab owing in part to the development of high rates of antidrug antibodies, as seen in data from other studies in the program. The median follow-up was 10 months. RESULTS: At 14 weeks, patients in the combined trials had a mean change from baseline in LDL cholesterol levels of -56.0% in the bococizumab group and +2.9% in the placebo group, for a between-group difference of -59.0 percentage points (P<0.001) and a median reduction from baseline of 64.2% (P<0.001). In the lower-risk, shorter-duration trial (in which the patients had a baseline LDL cholesterol level of ≥70 mg per deciliter [1.8 mmol per liter] and the median follow-up was 7 months), major cardiovascular events occurred in 173 patients each in the bococizumab group and the placebo group (hazard ratio, 0.99; 95% confidence interval [CI], 0.80 to 1.22; P=0.94). In the higher-risk, longer-duration trial (in which the patients had a baseline LDL cholesterol level of ≥100 mg per deciliter [2.6 mmol per liter] and the median follow-up was 12 months), major cardiovascular events occurred in 179 and 224 patients, respectively (hazard ratio, 0.79; 95% CI, 0.65 to 0.97; P=0.02). The hazard ratio for the primary end point in the combined trials was 0.88 (95% CI, 0.76 to 1.02; P=0.08). Injection-site reactions were more common in the bococizumab group than in the placebo group (10.4% vs. 1.3%, P<0.001). CONCLUSIONS: In two randomized trials comparing the PCSK9 inhibitor bococizumab with placebo, bococizumab had no benefit with respect to major adverse cardiovascular events in the trial involving lower-risk patients but did have a significant benefit in the trial involving higher-risk patients. (Funded by Pfizer; SPIRE-1 and SPIRE-2 ClinicalTrials.gov numbers, NCT01975376 and NCT01975389 .)."},{"id":"869c148b24db","type":"article","url":"https://hartvaat.nl/2017/04/20/ldl-reductievariabiliteit-en-antilichaamvorming-bij-bococizumab-nejm/","title":"LDL-reductievariabiliteit en antilichaamvorming bij bococizumab: NEJM","title_en":"Lipid-Reduction Variability and Antidrug-Antibody Formation with Bococizumab.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["bempedoïnezuur","cetp-remmers","ezetimibe","lipidenverlaging","niet-statine-therapie","obicetrapib","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie","statines"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1614062","source_url":"https://doi.org/10.1056/NEJMoa1614062","authors":["Paul M Ridker","Jean-Claude Tardif","Pierre Amarenco","William Duggan","Robert J Glynn","J Wouter Jukema","John J P Kastelein","Albert M Kim","Wolfgang Koenig","Steven Nissen","James Revkin","Lynda M Rose","Raul D Santos","Pamela F Schwartz","Charles L Shear","Carla Yunis"],"significance":8,"published":"2017-04-20","source_date":"2017-04-20","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/ldl-cholesterol-mechanisme/"],"congress":"","summary_en":"This NEJM study showed that bococizumab, a humanized PCSK9 monoclonal antibody, triggered anti-drug antibody formation that progressively attenuated its LDL-lowering effect. The immunogenicity issue led to the drug's discontinuation and highlighted the advantage of fully human antibodies like evolocumab and alirocumab.","created":"2026-07-03T10:26:40Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-studie die aantoonde dat bococizumab (PCSK9-remmer) leidt tot antilichaamvorming met afnemende werkzaamheid. Een van de redenen voor het stopzetten van het bococizumab-programma.","abstract_original":"BACKGROUND: Bococizumab, a humanized monoclonal antibody targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), reduces levels of low-density lipoprotein (LDL) cholesterol. However, the variability and durability of this effect are uncertain. METHODS: We conducted six parallel, multinational lipid-lowering trials enrolling 4300 patients with hyperlipidemia who were randomly assigned to receive 150 mg of bococizumab or placebo subcutaneously every 2 weeks and who were followed for up to 12 months; 96% were receiving statin therapy at the time of enrollment. The patients were assessed for lipid changes over time, stratified according to the presence or absence of antidrug antibodies detected during the treatment period. RESULTS: At 12 weeks, patients who received bococizumab had a reduction of 54.2% in the LDL cholesterol level from baseline, as compared with an increase of 1.0% among those who received placebo (absolute between-group difference, -55.2 percentage points). Significant between-group differences were also observed in total cholesterol, non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein(a) (P<0.001 for all comparisons). However, high-titer antidrug antibodies developed in a substantial proportion of the patients who received bococizumab, which markedly diminished the magnitude and durability of the reduction in LDL cholesterol levels. In addition, among patients with no antidrug antibodies, there was wide variability in the reduction in LDL cholesterol levels at both 12 weeks and 52 weeks. Major cardiovascular events occurred in 57 patients (2.5%) who received bococizumab and in 55 (2.7%) who received placebo (hazard ratio, 0.96; 95% confidence interval, 0.66 to 1.39; P=0.83). The most common adverse event among patients who received bococizumab was injection-site reaction (12.7 per 100 person-years). CONCLUSIONS: In six multinational trials evaluating bococizumab, antidrug antibodies developed in a large proportion of the patients and significantly attenuated the lowering of LDL cholesterol levels. Wide variation in the relative reduction in cholesterol levels was also observed among patients in whom antidrug antibodies did not develop. (Funded by Pfizer; SPIRE ClinicalTrials.gov numbers, NCT01968954 , NCT01968967 , NCT01968980 , NCT02100514 , NCT02135029 , and NCT02458287 .)."},{"id":"d9979ce3124d","type":"article","url":"https://hartvaat.nl/2017/04/18/risicostratificatie-bij-cardiogene-shock-na-acuut-myocardinfarct/","title":"Risicostratificatie bij cardiogene shock na acuut myocardinfarct","title_en":"Risk Stratification for Patients in Cardiogenic Shock After Acute Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","cardiogene-shock","myocardinfarct"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.02.027","source_url":"https://doi.org/10.1016/j.jacc.2017.02.027","authors":["Janine Pöss","Jelena Köster","Georg Fuernau","Ingo Eitel","Suzanne de Waha","Taoufik Ouarrak","Johan Lassus","Veli-Pekka Harjola","Uwe Zeymer","Holger Thiele","Steffen Desch"],"significance":6,"published":"2017-04-18","source_date":"2017-04-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/vasculair/longembolie/"],"congress":"","summary_en":"This study developed risk stratification tools for patients with cardiogenic shock after acute MI, identifying prognostic factors that can guide the intensity of mechanical circulatory support and treatment escalation decisions.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar risicostratificatiemethoden bij patiënten met cardiogene shock na acuut MI. Identificeert prognostische factoren voor het sturen van behandelintensiteit.","abstract_original":"BACKGROUND: Mortality in cardiogenic shock (CS) remains high. Early risk stratification is crucial to make adequate treatment decisions. OBJECTIVES: This study sought to develop an easy-to-use, readily available risk prediction score for short-term mortality in patients with CS, derived from the IABP-SHOCK II (Intraaortic Balloon Pump in Cardiogenic Shock) trial. METHODS: The score was developed using a stepwise multivariable regression analysis. RESULTS: Six variables emerged as independent predictors for 30-day mortality and were used as score parameters: age >73 years, prior stroke, glucose at admission >10.6 mmol/l (191 mg/dl), creatinine at admission >132.6 μmol/l (1.5 mg/dl), Thrombolysis In Myocardial Infarction flow grade <3 after percutaneous coronary intervention, and arterial blood lactate at admission >5 mmol/l. Either 1 or 2 points were attributed to each variable, leading to a score in 3 risk categories: low (0 to 2), intermediate (3 or 4), and high (5 to 9). The observed 30-day mortality rates were 23.8%, 49.2%, and 76.6%, respectively (p < 0.0001). Validation in the IABP-SHOCK II registry population showed good discrimination with an area under the curve of 0.79. External validation in the CardShock trial population (n = 137) showed short-term mortality rates of 28.0% (score 0 to 2), 42.9% (score 3 to 4), and 77.3% (score 5 to 9; p < 0.001) and an area under the curve of 0.73. Kaplan-Meier analysis revealed a stepwise increase in mortality between the different score categories (0 to 2 vs. 3 to 4: p = 0.04; 0 to 2 vs. 5 to 9: p = 0.008). CONCLUSIONS: The IABP-SHOCK II risk score can be easily calculated in daily clinical practice and strongly correlated with mortality in patients with infarct-related CS. It may help stratify patient risk for short-term mortality and might, thus, facilitate clinical decision making. (Intraaortic Balloon Pump in Cardiogenic Shock II [IABP-SHOCK II]; NCT00491036)."},{"id":"a45d51dd35e1","type":"article","url":"https://hartvaat.nl/2017/04/18/vroeg-invasief-versus-selectieve-strategie-bij-nste-acs-ictus-trial-langetermijn/","title":"Vroeg invasief versus selectieve strategie bij NSTE-ACS: ICTUS-trial langetermijn","title_en":"Early Invasive Versus Selective Strategy for Non-ST-Segment Elevation Acute Coronary Syndrome: The ICTUS Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.02.023","source_url":"https://doi.org/10.1016/j.jacc.2017.02.023","authors":["Niels P G Hoedemaker","Peter Damman","Pier Woudstra","Alexander Hirsch","Fons Windhausen","Jan G P Tijssen","Robbert J de Winter"],"significance":7,"published":"2017-04-18","source_date":"2017-04-18","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/nstemi-en-instabiele-angina/"],"congress":"","summary_en":"Long-term ICTUS follow-up comparing early invasive with selective invasive strategy in NSTE-ACS showed no significant long-term difference in outcomes, contributing to the nuanced understanding of invasive timing in acute coronary syndromes.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Langetermijnfollow-up van de ICTUS-trial die vroeg invasieve versus selectieve strategie vergeleek bij NSTE-ACS. Voegt toe aan het bewijs over optimale timing van interventie.","abstract_original":"BACKGROUND: The ICTUS (Invasive Versus Conservative Treatment in Unstable Coronary Syndromes) trial compared early invasive strategy with a selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) and an elevated cardiac troponin T. No long-term benefit of an early invasive strategy was found at 1 and 5 years. OBJECTIVES: The aim of this study was to determine the 10-year clinical outcomes of an early invasive strategy versus a selective invasive strategy in patients with NSTE-ACS and an elevated cardiac troponin T. METHODS: The ICTUS trial was a multicenter, randomized controlled clinical trial that included 1,200 patients with NSTE-ACS and an elevated cardiac troponin T. Enrollment was from July 2001 to August 2003. We collected 10-year follow-up of death, myocardial infarction (MI), and revascularization through the Dutch population registry, patient phone calls, general practitioners, and hospital records. The primary outcome was the 10-year composite of death or spontaneous MI. Additional outcomes included the composite of death or MI, death, MI (spontaneous and procedure-related), and revascularization. RESULTS: Ten-year death or spontaneous MI was not statistically different between the 2 groups (33.8% vs. 29.0%, hazard ratio [HR]: 1.12; 95% confidence interval [CI]: 0.97 to 1.46; p = 0.11). Revascularization occurred in 82.6% of the early invasive group and 60.5% in the selective invasive group. There were no differences in additional outcomes, except for a higher rate of death or MI in the early invasive group compared with the rates for the selective invasive group (37.6% vs. 30.5%; HR: 1.30; 95% CI: 1.07 to 1.58; p = 0.009), driven by a higher rate of procedure-related MI in the early invasive group (6.5% vs. 2.4%; HR: 2.82; 95% CI: 1.53 to 5.20; p = 0.001). CONCLUSIONS: In patients with NSTE-ACS and elevated cardiac troponin T levels, an early invasive strategy has no benefit over a selective invasive strategy in reducing the 10-year composite outcome of death or spontaneous MI, and a selective invasive strategy may be a viable option in selected patients."},{"id":"6e6d12d1415a","type":"article","url":"https://hartvaat.nl/2017/04/14/vericiguat-bij-verslechterend-chronisch-hfpef-socrates-preserved-resultaten/","title":"Vericiguat bij verslechterend chronisch HFpEF: SOCRATES-PRESERVED-resultaten","title_en":"Vericiguat in patients with worsening chronic heart failure and preserved ejection fraction: results of the SOluble guanylate Cyclase stimulatoR in heArT failurE patientS with PRESERVED EF (SOCRATES-PRESERVED) study.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["vericiguat"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw593","source_url":"https://doi.org/10.1093/eurheartj/ehw593","authors":["Burkert Pieske","Aldo P Maggioni","Carolyn S P Lam","Elisabeth Pieske-Kraigher","Gerasimos Filippatos","Javed Butler","Piotr Ponikowski","Sanjiv J Shah","Scott D Solomon","Andrea-Viviana Scalise","Katharina Mueller","Lothar Roessig","Mihai Gheorghiade"],"significance":7,"published":"2017-04-14","source_date":"2017-04-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/","https://hartvaat.nl/kennis/hartfalen/vericiguat-bij-hartfalen/"],"congress":"","summary_en":"The SOCRATES-PRESERVED trial of vericiguat in patients with worsening chronic HFpEF explored the sGC stimulator mechanism in preserved ejection fraction, providing early dose-finding data that informed the subsequent VICTORIA trial design.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T13:25:58Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Resultaten van de SOCRATES-PRESERVED-trial naar vericiguat (sGC-stimulator) bij patiënten met verslechterend chronisch hartfalen met behouden ejectiefractie. Vroege evaluatie vóór de fase-3 VICTORIA-trial.","abstract_original":"AIMS: To determine tolerability and the optimal dose regimen of the soluble guanylate cyclase stimulator vericiguat in patients with chronic heart failure and preserved ejection fraction (HFpEF). METHODS AND RESULTS: SOCRATES-PRESERVED was a prospective, randomized, placebo-controlled double-blind, Phase 2b dose-finding study in patients with HFpEF (ejection fraction ≥ 45%). Patients received vericiguat once daily at 1.25 or 2.5 mg fixed doses, or 5 or 10 mg titrated from a 2.5 mg starting dose, or placebo for 12 weeks. The two primary endpoints were change from baseline in log-transformed N-terminal pro-B-type natriuretic peptide (NT-ProBNP) and left atrial volume (LAV) at 12 weeks. Patients (N = 477; 48% women; mean age 73 ± 10 years; baseline atrial fibrillation 40%) were randomized within 4 weeks of HF hospitalization (75%) or outpatient treatment with intravenous diuretics for HF (25%) to vericiguat (n = 384) or placebo (n = 93). In the pooled three highest dose arms change in logNT-proBNP (vericiguat: +0.038 ± 0.782 log(pg/mL), n = 195; placebo: -0.098 ± 0.778 log(pg/mL), n = 73; one-sided P = 0.8991, two-sided P = 0.2017), and change in LAV [vericiguat: -1.7 ± 12.8 mL (n = 194); placebo:  -3.4 ± 12.7 mL (n = 67), one-sided P = 0.8156, two-sided P = 0.3688] were not different from placebo. Vericiguat was well tolerated (adverse events: vericiguat 10 mg arm, 69.8%; placebo, 73.1%), with low discontinuation rates in all groups, and no changes in blood pressure at 10 mg compared with placebo. The pre-specified exploratory endpoint of Kansas City Cardiomyopathy Questionnaire Clinical Summary Score improved in the vericiguat 10 mg arm by mean 19.3 ± 16.3 points [median 19.8 (interquartile range 10.4-30.7)] from baseline (mean difference from placebo 9.2 points). CONCLUSION: Vericiguat was well tolerated, did not change NT-proBNP and LAV at 12 weeks compared with placebo but was associated with improvements in quality of life in patients with HFpEF. Given the encouraging results on quality of life, the effects of vericiguat in patients with HFpEF warrant further study, possibly with higher doses, longer follow-up and additional endpoints."},{"id":"ab0f76bdf30e","type":"article","url":"https://hartvaat.nl/2017/04/14/macitentan-en-hemodynamiek-bij-pah-seraphin-hemodynamische-substudie/","title":"Macitentan en hemodynamiek bij PAH: SERAPHIN hemodynamische substudie","title_en":"SERAPHIN haemodynamic substudy: the effect of the dual endothelin receptor antagonist macitentan on haemodynamic parameters and NT-proBNP levels and their association with disease progression in patients with pulmonary arterial hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["bloeddrukbehandeling"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx025","source_url":"https://doi.org/10.1093/eurheartj/ehx025","authors":["Nazzareno Galiè","Pavel Jansa","Tomás Pulido","Richard N Channick","Marion Delcroix","Hossein-Ardeschir Ghofrani","Franck-Olivier Le Brun","Sanjay Mehta","Loïc Perchenet","Lewis J Rubin","B K S Sastry","Gérald Simonneau","Olivier Sitbon","Rogério Souza","Adam Torbicki"],"significance":6,"published":"2017-04-14","source_date":"2017-04-14","image":"","kennis":[],"congress":"","summary_en":"This SERAPHIN hemodynamic substudy characterized the effects of macitentan on pulmonary hemodynamics and NT-proBNP in PAH, providing invasive assessment of the dual endothelin receptor antagonist's vascular effects.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T18:38:33Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Hemodynamische substudie van SERAPHIN die het effect van macitentan op hemodynamische parameters en NT-proBNP bij pulmonaal arteriële hypertensie onderzocht.","abstract_original":"AIMS: The effect of macitentan on haemodynamic parameters and NT-proBNP levels was evaluated in pulmonary arterial hypertension (PAH) patients in the SERAPHIN study. Association between these parameters and disease progression, assessed by the primary endpoint (time to first morbidity/mortality event), was explored. METHODS AND RESULTS: Of the 742 randomized patients, 187 with right heart catheterization at baseline and month 6 participated in a haemodynamic sub-study. Prespecified endpoints included change from baseline to month 6 in cardiac index (CI), right atrial pressure (RAP), mean pulmonary arterial pressure (mPAP), pulmonary vascular resistance (PVR), mixed-venous oxygen saturation, and NT-proBNP. Exploratory analyses examined associations between CI, RAP, and NT-proBNP and disease progression using the Kaplan-Meier method and Cox regression models. Macitentan improved CI, RAP, mPAP, PVR and NT-proBNP vs. placebo at month 6. Absolute levels of CI, RAP and NT-proBNP at baseline and month 6, but not their changes, were associated with morbidity/mortality events. Patients with CI > 2.5 L/min/m2, RAP < 8 mmHg, or NT-proBNP < 750 fmol/ml at month 6 had a lower risk of morbidity/mortality than those not meeting these thresholds (HR 0.49, 95% CL 0.28-0.86; HR 0.72, 95% CL 0.42-1.22; and HR 0.22, 95% CL 0.15-0.33, respectively). CONCLUSIONS: For all treatment groups, baseline and month 6 values of CI, RAP, and NT-proBNP, but not their changes, were associated with morbidity/mortality events, confirming their relevance in predicting disease progression in patients with PAH. By improving those parameters, macitentan increased the likelihood of reaching threshold values associated with lower risk of morbidity/mortality."},{"id":"0e08bc1256cc","type":"article","url":"https://hartvaat.nl/2017/04/14/zuurstofverrijkte-lucht-en-inspanningsprestatie-bij-precapillaire-pulmonale-hype/","title":"Zuurstofverrijkte lucht en inspanningsprestatie bij precapillaire pulmonale hypertensie","title_en":"Effect of breathing oxygen-enriched air on exercise performance in patients with precapillary pulmonary hypertension: randomized, sham-controlled cross-over trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["bloeddrukbehandeling","pulmonale-hypertensie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx099","source_url":"https://doi.org/10.1093/eurheartj/ehx099","authors":["Silvia Ulrich","Elisabeth D Hasler","Stéphanie Saxer","Michael Furian","Séverine Müller-Mottet","Stephan Keusch","Konrad E Bloch"],"significance":5,"published":"2017-04-14","source_date":"2017-04-14","image":"","kennis":[],"congress":"","summary_en":"This randomized trial tested whether breathing oxygen-enriched air improves exercise performance in patients with precapillary pulmonary hypertension, evaluating supplemental oxygen as an exercise tolerance intervention.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde dubbelblinde trial naar het effect van zuurstofverrijkte lucht op inspanningsprestatie bij patiënten met precapillaire pulmonale hypertensie.","abstract_original":"AIMS: The purpose of the current trial was to test the hypothesis that breathing oxygen-enriched air increases exercise performance of patients with pulmonary arterial or chronic thrombo-embolic pulmonary hypertension (PAH/CTEPH) and to investigate involved mechanisms. METHODS AND RESULTS: Twenty-two patients with PAH/CTEPH, eight women, means ± SD 61 ± 14 years, resting mPAP 35 ± 9mmHg, PaO2 ambient air >7.3 kPa, underwent four bicycle ergospirometries to exhaustion on different days, while breathing oxygen-enriched (FiO2 0.50, hyperoxia) or ambient air (FiO2 0.21, normoxia) using progressively increased or constant load protocols (with 75% maximal work rate under FiO2 0.21), according to a randomized, sham-controlled, single-blind, cross-over design. ECG, pulmonary gas-exchange, arterial blood gases, cerebral and quadriceps muscle tissue oxygenation (CTO and QMTO) by near-infrared spectroscopy were measured. In ramp exercise, maximal work rate increased from 113 ± 38 W with normoxia to 132 ± 48 W with hyperoxia, mean difference 19.7 (95% CI 10.5-28.9) W, P < 0.001. Constant load exercise endurance increased from 571 ± 443 to 1242 ± 514 s, mean difference 671 (95% CI 392-951) s, P < 0.001. At end-exercise with hyperoxia PaO2, CTO, QMTO, and PaCO2 were increased, and ventilatory equivalents for CO2 were reduced while the physiological dead space/tidal volume ratio remained unchanged. CONCLUSION: In patients with PAH/CTEPH, breathing oxygen-enriched air provides major increases in exercise performance. This is related to an improved arterial oxygenation that promotes oxygen availability in muscles and brain and to a reduction of the excessive ventilatory response to exercise thereby enhancing ventilatory efficiency. Patients with PAH/CTEPH may therefore benefit from oxygen therapy during daily physical activities and training. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01748474."},{"id":"be71ed3e5cca","type":"article","url":"https://hartvaat.nl/2017/04/14/systolische-bloeddruk-en-werkzaamheid-van-sacubitril-valsartan-bij-chronisch-hfr/","title":"Systolische bloeddruk en werkzaamheid van sacubitril/valsartan bij chronisch HFrEF","title_en":"Systolic blood pressure, cardiovascular outcomes and efficacy and safety of sacubitril/valsartan (LCZ696) in patients with chronic heart failure and reduced ejection fraction: results from PARADIGM-HF.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","ambulante-bloeddrukmeting","answer-hf","bloeddrukbehandeling","bradycardie","hfpef","hfref","sacubitril-valsartan","slaapapneu","supraventriculaire-tachycardie","ventrikelfibrilleren","vrouwen"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw570","source_url":"https://doi.org/10.1093/eurheartj/ehw570","authors":["Michael Böhm","Robin Young","Pardeep S Jhund","Scott D Solomon","Jianjian Gong","Martin P Lefkowitz","Adel R Rizkala","Jean L Rouleau","Victor C Shi","Karl Swedberg","Michael R Zile","Milton Packer","John J V McMurray"],"significance":7,"published":"2017-04-14","source_date":"2017-04-14","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/arni-sacubitril-valsartan/","https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/"],"congress":"","summary_en":"This analysis examined the relationship between systolic blood pressure and the efficacy and safety of sacubitril-valsartan in HFrEF, providing guidance for prescribing in patients with low or high baseline blood pressure.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de relatie tussen systolische bloeddruk en cardiovasculaire uitkomsten en de werkzaamheid van sacubitril/valsartan bij chronisch hartfalen. Relevant voor bloeddrukmanagement bij ARNI-gebruik.","abstract_original":"BACKGROUND: Compared to heart failure patients with higher systolic blood pressure (SBP), those with lower SBP have a worse prognosis. To make matters worse, the latter patients often do not receive treatment with life-saving therapies that might lower blood pressure further. We examined the association between SBP and outcomes in the Prospective Comparison of angiotensin receptor-neprilysin inhibitor (ARNI) with an angiotensin-converting enzyme (ACE) inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure trial (PARADIGM-HF), as well as the effect of sacubitril/valsartan, compared with enalapril, according to baseline SBP. METHODS: We analysed the effect of treatment on SBP and on the primary composite outcome (cardiovascular death or heart failure hospitalization), its components and all-cause death. We examined baseline SBP as a categorical (<110, 110 to < 120, 120 to < 130, 130 to < 140 and ≥140 mmHg) and continuous variable, as well as average in-trial SBP and time-updated SBP. FINDINGS: All-cause and cardiovascular mortality rates were highest in patients with the lowest SBP whereas there was a U-shaped relationship between SBP and the rate of heart failure hospitalization. The benefit of sacubitril/valsartan over enalapril was consistent across all baseline SBP categories for all outcomes. For example, the sacubitril/valsartan versus enalapril hazard ratio for the primary endpoint was 0.88 (95%CI 0.74-1.06) in patients with a baseline SBP <110 mmHg and 0.81 (0.65-1.02) for those with a SBP ≥140 mmHg (P for interaction = 0.55). Symptomatic hypotension, study drug dose-reduction and discontinuation were more frequent in patients with a lower SBP. INTERPRETATION: In PARADIGM-HF, patients with lower SBP at randomization, notably after tolerating full doses of both study drugs during a run-in period, were at higher risk but generally tolerated sacubitril/valsartan and had the same relative benefit over enalapril as patients with higher baseline SBP."},{"id":"1dfe7c659b8c","type":"article","url":"https://hartvaat.nl/2017/04/13/inclisiran-bij-patienten-met-hoog-cv-risico-en-verhoogd-ldl-nejm-orion-1/","title":"Inclisiran bij patiënten met hoog CV-risico en verhoogd LDL: NEJM ORION-1","title_en":"Inclisiran in Patients at High Cardiovascular Risk with Elevated LDL Cholesterol.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","internist"],"tags":["ezetimibe","inclisiran","pcsk9-remmers","soul-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1615758","source_url":"https://doi.org/10.1056/NEJMoa1615758","authors":["Kausik K Ray","Ulf Landmesser","Lawrence A Leiter","David Kallend","Robert Dufour","Mahir Karakas","Tim Hall","Roland P T Troquay","Traci Turner","Frank L J Visseren","Peter Wijngaard","R Scott Wright","John J P Kastelein"],"significance":9,"published":"2017-04-13","source_date":"2017-04-13","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"The ORION-1 trial showed dose-dependent, sustained reductions in LDL cholesterol with inclisiran, a synthetic siRNA targeting PCSK9, in patients at high cardiovascular risk. A single injection produced LDL reductions of up to 53% lasting 6 months, advancing the concept of RNA interference-based lipid-lowering therapy.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T13:25:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM ORION-1-trial die inclisiran (siRNA PCSK9-remmer) evalueerde bij patiënten met hoog cardiovasculair risico en verhoogd LDL-cholesterol. Dosisresponsdata voor het optimaliseren van het doseringsschema.","abstract_original":"BACKGROUND: In a previous study, a single injection of inclisiran, a chemically synthesized small interfering RNA designed to target PCSK9 messenger RNA, was found to produce sustained reductions in low-density lipoprotein (LDL) cholesterol levels over the course of 84 days in healthy volunteers. METHODS: We conducted a phase 2, multicenter, double-blind, placebo-controlled, multiple-ascending-dose trial of inclisiran administered as a subcutaneous injection in patients at high risk for cardiovascular disease who had elevated LDL cholesterol levels. Patients were randomly assigned to receive a single dose of placebo or 200, 300, or 500 mg of inclisiran or two doses (at days 1 and 90) of placebo or 100, 200, or 300 mg of inclisiran. The primary end point was the change from baseline in LDL cholesterol level at 180 days. Safety data were available through day 210, and data on LDL cholesterol and proprotein convertase subtilisin-kexin type 9 (PCSK9) levels were available through day 240. RESULTS: A total of 501 patients underwent randomization. Patients who received inclisiran had dose-dependent reductions in PCSK9 and LDL cholesterol levels. At day 180, the least-squares mean reductions in LDL cholesterol levels were 27.9 to 41.9% after a single dose of inclisiran and 35.5 to 52.6% after two doses (P<0.001 for all comparisons vs. placebo). The two-dose 300-mg inclisiran regimen produced the greatest reduction in LDL cholesterol levels: 48% of the patients who received the regimen had an LDL cholesterol level below 50 mg per deciliter (1.3 mmol per liter) at day 180. At day 240, PCSK9 and LDL cholesterol levels remained significantly lower than at baseline in association with all inclisiran regimens. Serious adverse events occurred in 11% of the patients who received inclisiran and in 8% of the patients who received placebo. Injection-site reactions occurred in 5% of the patients who received injections of inclisiran. CONCLUSIONS: In our trial, inclisiran was found to lower PCSK9 and LDL cholesterol levels among patients at high cardiovascular risk who had elevated LDL cholesterol levels. (Funded by the Medicines Company; ORION-1 ClinicalTrials.gov number, NCT02597127 .)."},{"id":"f342622d95fe","type":"article","url":"https://hartvaat.nl/2017/04/07/radiale-versus-femorale-toegang-bij-acs-met-en-zonder-st-elevatie/","title":"Radiale versus femorale toegang bij ACS met en zonder ST-elevatie","title_en":"Radial versus femoral access in patients with acute coronary syndromes with or without ST-segment elevation.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx048","source_url":"https://doi.org/10.1093/eurheartj/ehx048","authors":["Pascal Vranckx","Enrico Frigoli","Martina Rothenbühler","Francesco Tomassini","Stefano Garducci","Giuseppe Andò","Andrea Picchi","Paolo Sganzerla","Anita Paggi","Fabrizio Ugo","Arturo Ausiello","Gennaro Sardella","Nicoletta Franco","Marco Nazzaro","Nicoletta de Cesare","Paolo Tosi","Camillo Falcone","Carlo Vigna","Pietro Mazzarotto","Emilio Di Lorenzo","Claudio Moretti","Gianluca Campo","Carlo Penzo","Giampaolo Pasquetto","Dik Heg","Peter Jüni","Stephan Windecker","Marco Valgimigli"],"significance":7,"published":"2017-04-07","source_date":"2017-04-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/coronaire-angiografie-hartkatheterisatie/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This analysis compared radial versus femoral access in patients with acute coronary syndromes stratified by the presence of ST-segment elevation, supporting the shift toward transradial access across the full ACS spectrum.","created":"2026-07-03T10:26:39Z","updated":"2026-07-03T13:25:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die radiale versus femorale toegang vergeleek bij patiënten met ACS, gestratificeerd naar ST-elevatie. Ondersteunt de shift naar routinematig radiale toegang.","abstract_original":"AIMS: To assess whether radial compared with femoral access is associated with consistent outcomes in patients with ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS AND RESULTS: In the Minimizing Adverse Haemorrhagic Events by TRansradial Access Site and Systemic Implementation of angioX (MATRIX) programme patients were randomized to radial or femoral access, stratified by STEMI (2001 radial, 2009 femoral) and NSTE-ACS (2196 radial, 2198 femoral). The 30-day co-primary outcomes were major adverse cardiovascular events (MACE), defined as death, myocardial infarction, or stroke, and net adverse clinical events (NACE), defined as MACE or major bleeding In the overall study population, radial access reduced the NACE but not MACE endpoint at the prespecified 0.025 alpha. MACE occurred in 121 (6.1%) STEMI patients with radial access vs. 126 (6.3%) patients with femoral access [rate ratio (RR) = 0.96, 95% CI = 0.75-1.24; P = 0.76] and in 248 (11.3%) NSTE-ACS patients with radial access vs. 303 (13.9%) with femoral access (RR = 0.80, 95% CI = 0.67-0.96; P = 0.016) (Pint = 0.25). NACE occurred in 142 (7.2%) STEMI patients with radial access and in 165 (8.3%) patients with femoral access (RR = 0.86, 95% CI = 0.68-1.08; P = 0.18) and in 268 (12.2%) NSTE-ACS patients with radial access compared with 321 (14.7%) with femoral access (RR = 0.82, 95% CI = 0.69-0.97; P = 0.023) (Pint = 0.76). All-cause mortality and access site-actionable bleeding favoured radial access irrespective of ACS type (Pint = 0.11 and Pint = 0.36, respectively). CONCLUSION: Radial as compared with femoral access provided consistent benefit across the whole spectrum of patients with ACS, without evidence that type of presenting syndrome affected the results of the random access allocation."},{"id":"96badc859900","type":"article","url":"https://hartvaat.nl/2017/04/07/drie-zes-of-twaalf-maanden-dapt-na-des-met-of-zonder-acs-meta-analyse/","title":"Drie, zes of twaalf maanden DAPT na DES met of zonder ACS: meta-analyse","title_en":"Three, six, or twelve months of dual antiplatelet therapy after DES implantation in patients with or without acute coronary syndromes: an individual patient data pairwise and network meta-analysis of six randomized trials and 11 473 patients.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw627","source_url":"https://doi.org/10.1093/eurheartj/ehw627","authors":["Tullio Palmerini","Diego Della Riva","Umberto Benedetto","Letizia Bacchi Reggiani","Fausto Feres","Alexandre Abizaid","Martine Gilard","Marie-Claude Morice","Marco Valgimigli","Myeong-Ki Hong","Byeong-Keuk Kim","Yangsoo Jang","Hyo-Soo Kim","Kyung Woo Park","Antonio Colombo","Alaide Chieffo","Diego Sangiorgi","Giuseppe Biondi-Zoccai","Philippe Généreux","Gianni D Angelini","Maria Pufulete","Jonathon White","Deepak L Bhatt","Gregg W Stone"],"significance":7,"published":"2017-04-07","source_date":"2017-04-07","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis compared three, six, and twelve months of DAPT after DES implantation separately for patients with and without ACS, finding that optimal DAPT duration differs by clinical presentation and that shorter durations may be appropriate for lower-risk patients.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T13:25:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die drie, zes en twaalf maanden DAPT na DES-implantatie vergeleek bij patiënten met en zonder ACS. Essentieel voor gepersonaliseerde DAPT-duurberekening.","abstract_original":"AIM: We sought to determine whether the optimal dual antiplatelet therapy (DAPT) duration after drug-eluting stent (DES) placement varies according to clinical presentation. METHODS AND RESULTS: We performed an individual patient data pairwise and network meta-analysis comparing short-term (≤6-months) versus long-term (1-year) DAPT as well as 3-month vs. 6-month vs 1-year DAPT. The primary study outcome was the 1-year composite risk of myocardial infarction (MI) or definite/probable stent thrombosis (ST). Six trials were included in which DAPT after DES consisted of aspirin and clopidogrel. Among 11 473 randomized patients 6714 (58.5%) had stable CAD and 4758 (41.5%) presented with acute coronary syndrome (ACS), the majority of whom (67.0%) had unstable angina. In ACS patients, ≤6-month DAPT was associated with non-significantly higher 1-year rates of MI or ST compared with 1-year DAPT (Hazard Ratio (HR) 1.48, 95% Confidence interval (CI) 0.98-2.22; P = 0.059), whereas in stable patients rates of MI and ST were similar between the two DAPT strategies (HR 0.93, 95%CI 0.65-1.35; P = 0.71; Pinteraction = 0.09). By network meta-analysis, 3-month DAPT, but not 6-month DAPT, was associated with higher rates of MI or ST in ACS, whereas no significant differences were apparent in stable patients. Short DAPT was associated with lower rates of major bleeding compared with 1-year DAPT, irrespective of clinical presentation. All-cause mortality was not significantly different with short vs. long DAPT in both patients with stable CAD and ACS. CONCLUSIONS: Optimal DAPT duration after DES differs according to clinical presentation. In the present meta-analysis, despite the fact that most enrolled ACS patients were relatively low risk, 3-month DAPT was associated with increased ischaemic risk, whereas 3-month DAPT appeared safe in stable CAD. Prolonged DAPT increases bleeding regardless of clinical presentation. Further study is required to identify the optimal duration of DAPT after DES in individual patients based on their relative ischaemic and bleeding risks."},{"id":"8bd7e985b31c","type":"article","url":"https://hartvaat.nl/2017/04/06/gewichtsfluctuaties-en-cardiovasculaire-uitkomsten-bij-coronairlijden-nejm/","title":"Gewichtsfluctuaties en cardiovasculaire uitkomsten bij coronairlijden: NEJM","title_en":"Body-Weight Fluctuations and Outcomes in Coronary Disease.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["gedilateerde-cardiomyopathie","ouderen","roken"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1606148","source_url":"https://doi.org/10.1056/NEJMoa1606148","authors":["Sripal Bangalore","Rana Fayyad","Rachel Laskey","David A DeMicco","Franz H Messerli","David D Waters"],"significance":8,"published":"2017-04-06","source_date":"2017-04-06","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/stijve-arterieen-arteriosclerose/"],"congress":"","summary_en":"This NEJM study demonstrated that body weight fluctuations are independently associated with higher mortality and cardiovascular events in patients with coronary disease, suggesting that weight stability may be an important therapeutic target in secondary prevention.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T13:25:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-studie die aantoont dat lichaamsgewichtsfluctuaties geassocieerd zijn met hogere mortaliteit en cardiovasculaire events bij patiënten met coronairlijden. Pleit voor stabiel gewichtsbeheer.","abstract_original":"BACKGROUND: Body-weight fluctuation is a risk factor for death and coronary events in patients without cardiovascular disease. It is not known whether variability in body weight affects outcomes in patients with coronary artery disease. METHODS: We determined intraindividual fluctuations in body weight from baseline weight and follow-up visits and performed a post hoc analysis of the Treating to New Targets trial, which involved assessment of the efficacy and safety of lowering low-density lipoprotein cholesterol levels with atorvastatin. The primary outcome was any coronary event (a composite of death from coronary heart disease, nonfatal myocardial infarction, resuscitated cardiac arrest, revascularization, or angina). Secondary outcomes were any cardiovascular event (a composite of any coronary event, a cerebrovascular event, peripheral vascular disease, or heart failure), death, myocardial infarction, or stroke. RESULTS: Among 9509 participants, after adjustment for risk factors, baseline lipid levels, mean body weight, and weight change, each increase of 1 SD in body-weight variability (measured according to average successive variability and used as a time-dependent covariate) was associated with an increase in the risk of any coronary event (2091 events; hazard ratio, 1.04; 95% confidence interval [CI], 1.01 to 1.07; P=0.01), any cardiovascular event (2727 events; hazard ratio, 1.04; 95% CI, 1.02 to 1.07; P<0.001), and death (487 events; hazard ratio,1.09; 95% CI, 1.07 to 1.12; P<0.001). Among patients in the quintile with the highest variation in body weight, the risk of a coronary event was 64% higher, the risk of a cardiovascular event 85% higher, death 124% higher, myocardial infarction 117% higher, and stroke 136% higher than it was among those in the quintile with the lowest variation in body weight in adjusted models. CONCLUSIONS: Among participants with coronary artery disease, fluctuation in body weight was associated with higher mortality and a higher rate of cardiovascular events independent of traditional cardiovascular risk factors. (Funded by Pfizer; ClinicalTrials.gov number, NCT00327691 .)."},{"id":"b8d8eb4285dc","type":"article","url":"https://hartvaat.nl/2017/04/04/inspanningstraining-bij-chronisch-hartfalen-met-atriumfibrilleren/","title":"Inspanningstraining bij chronisch hartfalen met atriumfibrilleren","title_en":"Exercise Training in Patients With Chronic Heart Failure and Atrial Fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.01.032","source_url":"https://doi.org/10.1016/j.jacc.2017.01.032","authors":["Nancy Luo","Peter Merrill","Kishan S Parikh","David J Whellan","Ileana L Piña","Mona Fiuzat","William E Kraus","Dalane W Kitzman","Steven J Keteyian","Christopher M O'Connor","Robert J Mentz"],"significance":6,"published":"2017-04-04","source_date":"2017-04-04","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-en-hartfalen/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This study evaluated the safety and efficacy of aerobic exercise training in patients with the dual burden of chronic heart failure and atrial fibrillation, a common but understudied combination in rehabilitation research.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van gestructureerde inspanningstraining bij patiënten met de combinatie chronisch hartfalen en atriumfibrilleren — twee aandoeningen die vaak coëxisteren.","abstract_original":"BACKGROUND: The safety and efficacy of aerobic exercise in heart failure (HF) patients with atrial fibrillation (AF) has not been well evaluated. OBJECTIVES: This study examined whether outcomes with exercise training in HF vary according to AF status. METHODS: HF-ACTION (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training) randomized 2,331 ambulatory HF patients with ejection fraction ≤35% to exercise training or usual care. We examined clinical characteristics and outcomes (mortality/hospitalization) by baseline AF status (past history of AF or AF on baseline electrocardiogram vs. no AF) using adjusted Cox models and explored an interaction with exercise training. We assessed post-randomization AF events diagnosed via hospitalizations for AF and reports of serious arrhythmia caused by AF. RESULTS: Of 2,292 patients with baseline rhythm data, 382 (17%) had AF, 1,602 (70%) had sinus rhythm, and 308 (13%) had \"other\" rhythm. Patients with AF were older and had lower peak Vo2. Over a median follow-up of 2.6 years, AF was associated with a 24% per year higher rate of mortality/hospitalization (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.34 to 1.74; p < 0.001) in unadjusted analysis; this did not remain significant after adjustment (HR: 1.15; 95% CI: 0.98 to 1.35; p = 0.09). There was no significant difference in AF event rates by randomized treatment assignment in the overall population or by baseline AF status (all p > 0.10). There was no interaction between AF and exercise training on measures of functional status or clinical outcomes (all p > 0.10). CONCLUSIONS: AF in patients with chronic HF was associated with older age, reduced exercise capacity at baseline, and a higher overall rate of clinical events, but not a differential response to exercise training for clinical outcomes or changes in exercise capacity. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training [HF-ACTION]; NCT00047437)."},{"id":"40faefc15347","type":"article","url":"https://hartvaat.nl/2017/04/01/beperkte-chirurgische-linkeratriumablatie-bij-af-effectief-maar-vermindert-la-fu/","title":"Beperkte chirurgische linkeratriumablatie bij AF: effectief maar vermindert LA-functie","title_en":"Limited left atrial surgical ablation effectively treats atrial fibrillation but decreases left atrial function.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw106","source_url":"https://doi.org/10.1093/europace/euw106","authors":["Marieke G Compier","Laurens F Tops","Jerry Braun","Katja Zeppenfeld","Robert J Klautz","Martin J Schalij","Serge A Trines"],"significance":5,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":[],"congress":"","summary_en":"This study showed that limited surgical ablation of the left atrium effectively treats AF but impairs LA contractile function, highlighting the trade-off between rhythm control and atrial mechanical consequences.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat beperkte chirurgische ablatie van het linker atrium effectief AF behandelt maar de linkeratriumfunctie vermindert. Balans tussen ritmevoordeel en atriumfunctieverlies.","abstract_original":"AIMS: Limited left atrial (LA) surgical ablation with bipolar radiofrequency is considered to be an effective procedure for treatment of atrial fibrillation (AF). We studied whether limited LA surgical ablation concomitant to cardiac surgery is able to maintain LA function. METHODS AND RESULTS: Thirty-six consecutive patients (age 66 ± 12 years, 53% male, 78% persistent AF) scheduled for valve surgery and/or coronary revascularization and concomitant LA surgical ablation were included. Epicardial pulmonary vein isolation (PVI) and additional endo-epicardial lines were performed using bipolar radiofrequency. An age- and gender-matched control group (n = 36, age 66 ± 9 years, 69% male, 81% paroxysmal AF) was selected from patients undergoing concomitant epicardial PVI only. Left atrial dimensions and function were assessed on two-dimensional echocardiography preoperatively and at 3- and 12-month follow-up. Sinus rhythm (SR) maintenance was 67% for limited LA ablation and 81% for PVI at 1-year follow-up (P = 0.18). Left atrial volume decreased from 72 ± 21 to 50 ± 14 mL (31%, P < 0.01) after limited LA ablation and from 65 ± 23 to 56 ± 20 mL (14%, P < 0.01) after PVI. Atrial transport function was restored in 54% of patients in SR after limited LA ablation compared with 100% of patients in SR after PVI. Atrial strain and contraction parameters (LA ejection fraction, A-wave velocity, reservoir function, and strain rate) significantly decreased after limited LA ablation. After PVI, strain and contraction parameters remained unchanged. CONCLUSION: Even limited LA ablation decreased LA volume, contraction, transport function, and compliance, indicating both reverse remodelling combined with significant functional deterioration. In contrast, surgical PVI decreased LA volume while function remained unchanged."},{"id":"d449be0340df","type":"article","url":"https://hartvaat.nl/2017/04/01/aanvullende-elektroden-op-de-quartet-lv-lead-bieden-meer-crt-programmeringsmogel/","title":"Aanvullende elektroden op de Quartet LV-lead bieden meer CRT-programmeringsmogelijkheden","title_en":"Additional electrodes on the Quartet™ LV lead provide more programmable pacing options than bipolar and tripolar equivalents.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["elektrocardiografie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw039","source_url":"https://doi.org/10.1093/europace/euw039","authors":["David O'Donnell","Johannes Sperzel","Bernard Thibault","Christopher A Rinaldi","Carlo Pappone","Klaus-Jürgen Gutleben","Christopher Leclercq","Hedi Razavi","Kyungmoo Ryu","Luke C Mcspadden","Avi Fischer","Gery Tomassoni"],"significance":4,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":[],"congress":"","summary_en":"A meta-analysis of five trials demonstrated that additional electrodes on the quadripolar Quartet left ventricular lead provide more programmable pacing vectors and greater spatial coverage than bipolar and tripolar equivalents in cardiac resynchronisation therapy.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T13:25:57Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat extra elektroden op de Quartet linkerkamerlead meer programmeerbare pacingopties bieden dan bipolaire en tripolaire equivalenten bij CRT.","abstract_original":"AIMS: The aim of this study was to evaluate any benefits to the number of viable pacing vectors and maximal spatial coverage with quadripolar left ventricular (LV) leads when compared with tripolar and bipolar equivalents in patients receiving cardiac resynchronization therapy (CRT). METHODS AND RESULTS: A meta-analysis of five previously published clinical trials involving the Quartet™ LV lead (St Jude Medical, St Paul, MN, USA) was performed to evaluate the number of viable pacing vectors defined as capture thresholds ≤2.5 V and no phrenic nerve stimulation and maximal spatial coverage of viable vectors in CRT patients at pre-discharge (n = 370) and first follow-up (n = 355). Bipolar and tripolar lead configurations were modelled by systematic elimination of two and one electrode(s), respectively, from the Quartet lead. The Quartet lead with its four pacing electrodes exhibited the greatest number of pacing vectors per patient when compared with the best bipolar and the best tripolar modelled equivalents. Similarly, the Quartet lead provided the highest spatial coverage in terms of the distance between two furthest viable pacing cathodes when compared with the best bipolar and the best tripolar configurations (P < 0.05). Among the three modelled bipolar configurations, the lead configuration with the two most distal electrodes resulted in the highest number of viable pacing vectors. Among the four modelled tripolar configurations, elimination of the second proximal electrode (M3) resulted in the highest number of viable pacing options per patient. There were no significant differences observed between pre-discharge and first follow-up analyses. CONCLUSION: The Quartet lead with its four electrodes and the capability to pace from four anatomical locations provided the highest number of viable pacing vectors at pre-discharge and first follow-up visits, providing more flexibility in device programming and enabling continuation of CRT in more patients when compared with bipolar and tripolar equivalents."},{"id":"bee9e3a4ba8c","type":"article","url":"https://hartvaat.nl/2017/04/01/rol-van-adenosine-geleide-pvi-bij-katheterablatie-voor-af-meta-analyse/","title":"Rol van adenosine-geleide PVI bij katheterablatie voor AF: meta-analyse","title_en":"Role of adenosine-guided pulmonary vein isolation in patients undergoing catheter ablation for atrial fibrillation: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["katheterablatie","pulmonaalvenenisolatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw201","source_url":"https://doi.org/10.1093/europace/euw201","authors":["Yi-He Chen","Hui Lin","Cheng-Long Xie","Jian-Wen Hou","Yi-Gang Li"],"significance":5,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/atriumfibrilleren/katheterablatie-af/"],"congress":"","summary_en":"This meta-analysis evaluated whether adenosine testing after initial pulmonary vein isolation adds value by unmasking dormant conduction, finding insufficient evidence to support routine adenosine challenge during AF ablation.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T13:25:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse naar de meerwaarde van adenosinetest na initiële pulmonaalvene-isolatie bij AF-ablatie. Onderzoekt of reconduction-detectie de langetermijnuitkomsten verbetert.","abstract_original":"AIMS: Adenosine had been reported to unmask dormant conduction and thus identify pulmonary vein at risk of reconnection. However, the role of adjunctive adenosine infusion after pulmonary vein isolation (PVI) on long-term arrhythmia-free survival was still contentious. The purpose of the present meta-analysis was to assess the association of adenosine testing with long-term ablation success in patients with atrial fibrillation (AF) (i.e. freedom from AF recurrence). METHODS AND RESULTS: We systematically searched the electronic databases and finally included 10 studies, with 1771 patients undergoing adenosine-guided PVI and 1787 patients undergoing conventional PVI. In comparison to conventional PVI alone, adenosine-guided PVI improved the arrhythmia-free survival by 17% during a median follow-up of 12 months [relative risk (RR): 1.17; 95% confidence interval (CI): 1.07 to 1.27; P = 0.014]. Patients undergoing adenosine-guided PVI had similar fluoroscopy time to those who undergoing conventional PVI [weighted mean difference (WMD): 1.76; 95% CI: -5.66 to 9.17; P = 0.64], despite longer procedure time (WMD: 20.6; 95% CI: 0.70 to 40.50; P = 0.042). CONCLUSION: From the available data of clinical studies, adenosine-guided PVI was associated with an increased arrhythmia-free survival when compared with conventional PVI in patients undergoing catheter ablation for AF."},{"id":"9ecac6dd1f12","type":"article","url":"https://hartvaat.nl/2017/04/01/fenofibraat-en-langetermijn-cardiovasculair-risico-bij-statinebehandelde-diabete/","title":"Fenofibraat en langetermijn cardiovasculair risico bij statinebehandelde diabetespatiënten","title_en":"Association of Fenofibrate Therapy With Long-term Cardiovascular Risk in Statin-Treated Patients With Type 2 Diabetes.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","alcoholgebruik","anemie-ckd","atleten","biomarkers-cardiovasculair","bloeddrukbehandeling","bradycardie","cardiale-amyloidose","cardiomyopathie-gerichte-therapie","cardiorenal-behandelstrategie","diabetes-en-hart","diabetes-type-1","diabetes-type-2","dyslipidemie","ezetimibe","farmaco-economie","figaro-dkd","gepersonaliseerde-geneeskunde","hypertrofische-cardiomyopathie","inflammatie","laminopathie","lipidenverlaging","lipoproteïne-a","menopauze","microbioom","myocardinfarct","niet-statine-therapie","obesitas","ouderen","perifeer-vaatlijden","richtlijnen-esc","roken","rosuvastatine","select-trial","slaapapneu","soul-trial","statines","tirzepatide","vrouwen"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.4828","source_url":"https://doi.org/10.1001/jamacardio.2016.4828","authors":["Marshall B Elam","Henry N Ginsberg","Laura C Lovato","Marshall Corson","Joseph Largay","Lawrence A Leiter","Carlos Lopez","Patrick J O'Connor","Mary Ellen Sweeney","Daniel Weiss","William T Friedewald","John B Buse","Hertzel C Gerstein","Jeffrey Probstfield","Richard Grimm","Faramarz Ismail-Beigi","David C Goff","Jerome L Fleg","Yves Rosenberg","Robert P Byington"],"significance":7,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":[],"congress":"","summary_en":"This ACCORD-Lipid post-trial follow-up examined the long-term cardiovascular effects of fenofibrate in statin-treated diabetic patients, finding no sustained benefit on cardiovascular events despite triglyceride reduction.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse naar het langetermijneffect van fenofibraat op cardiovasculair risico bij diabetespatiënten die al statines gebruiken. Onderzoekt de meerwaarde van triglycerideverlaging.","abstract_original":"IMPORTANCE: Patients with type 2 diabetes are at high risk of cardiovascular disease (CVD) in part owing to hypertriglyceridemia and low high-density lipoprotein cholesterol. It is unknown whether adding triglyceride-lowering treatment to statin reduces this risk. OBJECTIVE: To determine whether fenofibrate reduces CVD risk in statin-treated patients with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS: Posttrial follow-up of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) Lipid Study between July 2009 and October 2014; 5 years of follow-up were completed for a total of 9.7 years at general community and academic outpatient research clinics in the United States and Canada. Of the original 5518 ACCORD Lipid Trial participants, 4644 surviving participants were selected based on the presence of type 2 diabetes and either prevalent CVD or CVD risk factors and high-density lipoprotein levels less than 50 mg/dL (<55 mg/dL for women and African American individuals). INTERVENTIONS: Passive follow-up of study participants previously treated with fenofibrate or masked placebo. MAIN OUTCOMES AND MEASURES: Occurrence of cardiovascular outcomes including primary composite outcome of fatal and nonfatal myocardial infarction and stroke in all participants and in prespecified subgroups. RESULTS: The 4644 follow-on study participants were broadly representative of the original ACCORD study population and included significant numbers of women (n = 1445; 31%), nonwhite individuals (n = 1094; 21%), and those with preexisting cardiovascular events (n = 1620; 35%). Only 4.3% of study participants continued treatment with fenofibrate following completion of ACCORD. High-density lipoprotein and triglyceride values rapidly equalized among participants originally randomized to fenofibrate or placebo. Over a median total postrandomization follow-up of 9.7 years, the hazard ratio (HR) for the primary study outcome among participants originally randomized to fenofibrate vs placebo (HR, 0.93; 95% CI, 0.83-1.05; P = .25) was comparable with that originally observed in ACCORD (HR, 0.92; 95% CI, 0.79-1,08; P = .32). Despite these overall neutral results, we continued to find evidence that fenofibrate therapy effectively reduced CVD in study participants with dyslipidemia, defined as triglyceride levels greater than 204 mg/dL and high-density lipoprotein cholesterol levels less than 34 mg/dL (HR, 0.73; 95% CI, 0.56-0.95). CONCLUSIONS AND RELEVANCE: Extended follow-up of ACCORD-lipid trial participants confirms the original neutral effect of fenofibrate in the overall study cohort. The continued observation of heterogeneity of treatment response by baseline lipids suggests that fenofibrate therapy may reduce CVD in patients with diabetes with hypertriglyceridemia and low high-density lipoprotein cholesterol. A definitive trial of fibrate therapy in this patient population is needed to confirm these findings. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00000620."},{"id":"f3298438f766","type":"article","url":"https://hartvaat.nl/2017/04/01/polymeervrije-biolimus-stent-bij-hoog-bloedingsrisico-met-acs-leaders-free-subst/","title":"Polymeervrije biolimus-stent bij hoog bloedingsrisico met ACS: Leaders Free substudie","title_en":"Biolimus-A9 polymer-free coated stent in high bleeding risk patients with acute coronary syndrome: a Leaders Free ACS sub-study.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw203","source_url":"https://doi.org/10.1093/eurheartj/ehw203","authors":["Christoph K Naber","Philip Urban","Paul J Ong","Mariano Valdes-Chavarri","Alexandre A Abizaid","Stuart J Pocock","Franco Fabbiocchi","Christophe Dubois","Samuel Copt","Samantha Greene","Marie-Claude Morice"],"significance":6,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":[],"congress":"","summary_en":"This Leaders Free substudy evaluated polymer-free biolimus-coated stents with only 1 month of DAPT in high-bleeding-risk ACS patients, demonstrating the feasibility of ultra-short antiplatelet therapy even in the acute coronary setting.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T13:25:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Substudie van Leaders Free bij ACS-patiënten met hoog bloedingsrisico behandeld met polymeervrije biolimus-stents en slechts 1 maand DAPT.","abstract_original":"AIMS: Although a true clinical challenge, high bleeding risk patients with an acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) have never been specifically studied. Leaders Free ACS, a pre-specified Leaders Free sub-study, determined efficacy, and safety of a combination of 1-month dual anti-platelet therapy (DAPT) with implantation of either a polymer-free Biolimus-A9-coated stent (BA9-DCS) or a bare-metal stent (BMS) in these patients. METHODS AND RESULTS: Leaders Free included 2466 patients undergoing PCI who had at least 1 of 13 pre-defined factors for an increased bleeding risk. Of these, 659 ACS patients were included in this analysis (BA9-DCS 330, BMS 329). At 12-month follow-up, treatment with the BA9-DCS was more effective (clinically driven target-lesion revascularization 3.9 vs. 9.0%, P = 0.009) and safer (cumulative incidence of cardiac death, myocardial infarction, or definite or probable stent thrombosis 9.3 vs. 18.5%, P = 0.001), driven by significantly lower rates of cardiac mortality (3.4 vs. 6.9%, P = 0.049) and myocardial infarction (6.9 vs. 13.8%, P = 0.005). CONCLUSION: We believe that the results of this sub-analysis from the Leaders Free trial are likely to significantly impact clinical practice for high bleeding risk patients presenting with an ACS: the use of a BMS can, in our view, no longer be recommended, and, given the paucity of available data for second-generation DES with shortened DAPT in these patients, the BA9-DCS should currently be considered as the device with the strongest evidence to support its use for this indication."},{"id":"ab59bf5f602d","type":"article","url":"https://hartvaat.nl/2017/04/01/medicatietrouw-en-het-effect-van-renale-denervatie-de-sympathy-trial/","title":"Medicatietrouw en het effect van renale denervatie: de SYMPATHY-trial","title_en":"Impact of Medication Adherence on the Effect of Renal Denervation: The SYMPATHY Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["fidelio-dkd","figaro-dkd","flow-trial","radiance-htn","renale-denervatie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08818","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08818","authors":["Rosa L de Jager","Esther de Beus","Martine M A Beeftink","Margreet F Sanders","Evert-Jan Vonken","Michiel Voskuil","Erik M van Maarseveen","Michiel L Bots","Peter J Blankestijn"],"significance":7,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"The SYMPATHY trial demonstrated that the effectiveness of renal denervation is strongly influenced by medication adherence, highlighting that non-compliance with antihypertensive drugs can confound the assessment of device-based blood pressure therapy.","created":"2026-07-03T10:26:38Z","updated":"2026-07-03T13:25:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SYMPATHY-trial die aantoont dat de effectiviteit van renale denervatie sterk beïnvloed wordt door de medicatietrouw van patiënten. Benadrukt het belang van adherentiemeting bij devicetherapie-trials.","abstract_original":"UNLABELLED: Randomized trials of catheter-based renal denervation (RDN) as therapy for resistant hypertension showed conflicting results in blood pressure (BP) lowering effect. Adherence to medication is modest in this patient group and may importantly drive these conflicting results. SYMPATHY is a prospective open label multicenter trial in Dutch patients with resistant hypertension. Primary outcome was change in daytime systolic ambulatory BP at 6 months. Patients were randomly assigned to RDN on top of usual care. Adherence to BP lowering drugs was assessed at baseline and follow-up, using blood samples drawn synchronously with BP measurements. Patients and physicians were unaware of the adherence assessment. Primary analyses showed a mean difference between RDN (n=95) and control (n=44) in changes in daytime systolic ambulatory BP after 6 months of 2.0 mm Hg (95% confidence interval, -6.1 to 10.2 mm Hg) in favor of control. In 80% of patients, fewer medications were detected than prescribed and adherence changed during follow-up in 31%. In those with stable adherence during follow-up, mean difference between RDN and control for daytime systolic ambulatory BP was -3.3 mm Hg (-13.7 to 7.2 mm Hg) in favor of RDN. RDN as therapy for resistant hypertension was not superior to usual care. Objective assessment of medication use shows that medication adherence is extremely poor, when patients are unaware of monitoring. Changes over time in adherence are common and affect treatment estimates considerably. Objective measurement of medication adherence during follow-up is strongly recommended in randomized trials. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01850901."},{"id":"a2cc9f273c83","type":"article","url":"https://hartvaat.nl/2017/04/01/optimale-systolische-bloeddruk-voor-primaire-cva-preventie-bij-hypertensie-csppt/","title":"Optimale systolische bloeddruk voor primaire CVA-preventie bij hypertensie: CSPPT-bevindingen","title_en":"Optimal Systolic Blood Pressure Levels for Primary Prevention of Stroke in General Hypertensive Adults: Findings From the CSPPT (China Stroke Primary Prevention Trial).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","primaire-preventie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08499","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08499","authors":["Fangfang Fan","Ziwen Yuan","Xianhui Qin","Jianping Li","Yan Zhang","Youbao Li","Tao Yu","Meng Ji","Junbo Ge","Meili Zheng","Xinchun Yang","Huihui Bao","Xiaoshu Cheng","Dongfeng Gu","Dong Zhao","Jiguang Wang","Ningling Sun","Yundai Chen","Hong Wang","Xiaobin Wang","Gianfranco Parati","Fanfan Hou","Xiping Xu","Xian Wang","Gang Zhao","Yong Huo"],"significance":7,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/"],"congress":"","summary_en":"This CSPPT analysis investigated optimal systolic blood pressure targets for primary stroke prevention in Chinese hypertensive adults, contributing population-specific data to the global debate on blood pressure targets.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de Chinese CSPPT-trial naar optimale systolische bloeddrukstreefwaarden voor primaire CVA-preventie bij hypertensie. Relevant voor het internationale debat over streefwaarden.","abstract_original":"We aimed to investigate the relationship of time-averaged on-treatment systolic blood pressure (SBP) with the risk of first stroke in the CSPPT (China Stroke Primary Prevention Trial). A post hoc analysis was conducted using data from 17 720 hypertensive adults without cardiovascular disease, diabetes mellitus, and renal function decline from the CSPPT, a randomized double-blind controlled trial. The primary outcome was first stroke. Over a median follow-up duration of 4.5 years, the association between averaged on-treatment SBP and risk for first stoke followed a U-shape curve, with increased risk above and below the reference range of 120 to 130 mm Hg. Compared with participants with time-averaged on-treatment SBP at 120 to 130 mm Hg (mean, 126.2 mm Hg), the risk of first stroke was not only increased in participants with SBP at 130 to 135 mm Hg (mean, 132.6 mm Hg; 1.5% versus 0.8%; hazard ratio, 1.63; 95% confidence interval, 1.01-2.63) or 135 to 140 mm Hg (mean, 137.5 mm Hg; 1.9% versus 0.8%; hazard ratio, 1.85; 95% confidence interval, 1.17-2.93), but also increased in participants with SBP <120 mm Hg (mean, 116.7 mm Hg; 3.1% versus 0.8%; hazard ratio, 4.37; 95% confidence interval, 2.10-9.07). Similar results were found in various subgroups stratified by age, sex, and treatment group. Furthermore, lower diastolic blood pressure was associated with lower risk of stroke, with a plateau at a time-average on-treatment diastolic blood pressure <80 mm Hg. In conclusion, among adults with hypertension and without a history of stroke or myocardial infarction, diabetes mellitus, or renal function decline, a lower SBP goal of 120 to 130 mm Hg, as compared with a target SBP of 130 to 140 mm Hg or <120 mm Hg, resulted in the lowest risk of first stroke."},{"id":"f68d64d4e9c7","type":"article","url":"https://hartvaat.nl/2017/04/01/oscillerende-whole-body-vibratie-verbetert-inspanningscapaciteit-bij-pah/","title":"Oscillerende whole-body vibratie verbetert inspanningscapaciteit bij PAH","title_en":"Oscillatory whole-body vibration improves exercise capacity and physical performance in pulmonary arterial hypertension: a randomised clinical study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":["bloeddrukbehandeling","bradycardie","obesitas","perifeer-vaatlijden","vrouwen"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-309852","source_url":"https://doi.org/10.1136/heartjnl-2016-309852","authors":["Felix Gerhardt","Daniel Dumitrescu","Carina Gärtner","Ralf Beccard","Thomas Viethen","Tilmann Kramer","Stephan Baldus","Martin Hellmich","Eckhard Schönau","Stephan Rosenkranz"],"significance":5,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":[],"congress":"","summary_en":"This randomized trial showed that oscillatory whole-body vibration improves exercise capacity and physical performance in patients with pulmonary arterial hypertension, providing a novel supportive therapy alongside targeted PAH medications.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die aantoont dat oscillerende lichaamstriilling de inspanningscapaciteit en fysieke prestatie verbetert bij pulmonaal arteriële hypertensie.","abstract_original":"OBJECTIVE: In patients with pulmonary arterial hypertension (PAH), supportive therapies may be beneficial in addition to targeted medical treatment. Here, we evaluated the effectiveness and safety of oscillatory whole-body vibration (WBV) in patients on stable PAH therapy. METHODS: Twenty-two patients with PAH (mean PAP≥25 mm Hg and pulmonary arterial wedge pressure (PAWP)≤15 mm Hg) who were in world health organization (WHO)-Functional Class II or III and on stable PAH therapy for≥3 months, were randomised to receive WBV (16 sessions of 1-hour duration within 4 weeks) or to a control group, that subsequently received WBV. Follow-up measures included the 6-min walking distance (6MWD), cardiopulmonary exercise testing (CPET), echocardiography, muscle-power, and health-related quality of life (HRQoL; SF-36 and LPH questionnaires). RESULTS: When compared to the control group, patients receiving WBV exhibited a significant improvement in the primary endpoint, the 6MWD (+35.4±10.9 vs -4.4±7.6 m), resulting in a net benefit of 39.7±7.8 m (p=0.004). WBV was also associated with substantial improvements in CPET variables, muscle power, and HRQoL. The combined analysis of all patients (n=22) indicated significant net improvements versus baseline in the 6MWD (+38.6 m), peakVO2 (+65.7 mL/min), anaerobic threshold (+40.9 mL VO2/min), muscle power (+4.4%), and HRQoL (SF-36 +9.7, LPH -11.5 points) (all p<0.05). WBV was well tolerated in all patients, and no procedure-related severe adverse events (SAEs) occurred. CONCLUSIONS: WBV substantially improves exercise capacity, physical performance, and HRQoL in patients with PAH who are on stable targeted therapy. This methodology may be utilised in structured training programmes, and may be feasible for continuous long-term physical exercise in these patients. TRIAL REGISTRATION NUMBER: NCT01763112; Results."},{"id":"dbdfd3ea03b1","type":"article","url":"https://hartvaat.nl/2017/04/01/hemodynamische-effecten-van-riociguat-bij-inoperabel-cteph/","title":"Hemodynamische effecten van riociguat bij inoperabel CTEPH","title_en":"Haemodynamic effects of riociguat in inoperable/recurrent chronic thromboembolic pulmonary hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog"],"tags":[],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-309621","source_url":"https://doi.org/10.1136/heartjnl-2016-309621","authors":["Nick H Kim","Andrea M D'Armini","Friedrich Grimminger","Ekkehard Grünig","Marius M Hoeper","Pavel Jansa","Eckhard Mayer","Claus Neurohr","Gérald Simonneau","Adam Torbicki","Chen Wang","Arno Fritsch","Neil Davie","Hossein-Ardeschir Ghofrani"],"significance":6,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-diabetes/","https://hartvaat.nl/kennis/nierziekte/raas-blokkade-bij-nierziekte/"],"congress":"","summary_en":"This study characterized the hemodynamic effects of riociguat in patients with inoperable or recurrent chronic thromboembolic pulmonary hypertension, documenting pulmonary vascular improvements with sGC stimulation.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T13:25:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de hemodynamische effecten van riociguat bij patiënten met inoperabel of recidiverend chronisch trombo-embolisch pulmonale hypertensie.","abstract_original":"OBJECTIVE: We compared the haemodynamic effects of riociguat in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) or persistent/recurrent CTEPH after pulmonary endarterectomy in the Chronic Thromboembolic Pulmonary Hypertension Soluble Guanylate Cyclase-Stimulator Trial 1 study. METHODS: Patients with inoperable or persistent/recurrent CTEPH (n=261; mean± SD age 59±14 years; 66% women) were randomised to riociguat (up to 2.5 mg three times daily) or placebo. Haemodynamic parameters were assessed at baseline and week 16. RESULTS: Riociguat decreased pulmonary vascular resistance (PVR) in inoperable (n=189; least-squares mean difference: -285 dyn s/cm5 (95% CI -357 to -213); p<0.0001) and persistent/recurrent (n=72; -131 dyn s/cm5 (95% CI -214 to -48); p=0.0025) patients. Cardiac index improved in inoperable patients by a least-squares mean difference of +0.6 L/min/m2 (95% CI 0.4 to 0.7; p<0.0001), while in persistent/recurrent patients the change was +0.2 L/min/m2 (95% CI -0.1 to 0.5; p=0.17). Mean pulmonary artery pressure decreased in inoperable and persistent/recurrent patients(-4.7 mm Hg (95% CI -6.9 to -2.6; p<0.0001 and -4.8 mm Hg (-8.2 to -1.5; p=0.0055), respectively). For all patients, changes in 6 min walk distance correlated with changes in PVR (r=-0.29 (95% CI -0.41 to -0.17); p<0.0001) and cardiac index (r=0.23 (95% CI 0.10 to 0.35); p=0.0004). CONCLUSIONS: Riociguat improved haemodynamics in patients with inoperable CTEPH or persistent/recurrent CTEPH. TRIAL REGISTRATION NUMBER: NCT00855465."},{"id":"dc23a9165bae","type":"article","url":"https://hartvaat.nl/2017/04/01/niet-ernstige-bloedingen-met-apixaban-versus-warfarine-bij-af/","title":"Niet-ernstige bloedingen met apixaban versus warfarine bij AF","title_en":"Non-major bleeding with apixaban versus warfarin in patients with atrial fibrillation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":["anticoagulatie-kwetsbare-ouderen","bloeddrukbehandeling"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-309901","source_url":"https://doi.org/10.1136/heartjnl-2016-309901","authors":["M Cecilia Bahit","Renato D Lopes","Daniel M Wojdyla","Claes Held","Michael Hanna","Dragos Vinereanu","Elaine M Hylek","Freek Verheugt","Shinya Goto","John H Alexander","Lars Wallentin","Christopher B Granger"],"significance":5,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-ckd/"],"congress":"","summary_en":"This ARISTOTLE analysis described the incidence, location, and clinical impact of non-major bleeding with apixaban versus warfarin in AF, characterizing the full bleeding spectrum beyond major hemorrhagic events.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T13:25:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van niet-ernstige bloedingen met apixaban versus warfarine bij AF-patiënten. Onderzoekt het volledige bloedingsspectrum, niet alleen grote bloedingen.","abstract_original":"OBJECTIVE: We describe the incidence, location and management of non-major bleeding, and assess the association between non-major bleeding and clinical outcomes in patients with atrial fibrillation (AF) receiving anticoagulation therapy enrolled in Apixaban for Reduction in Stroke and other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE). METHODS: We included patients who received ≥1 dose of study drug (n=18 140). Non-major bleeding was defined as the first bleeding event considered to be clinically relevant non-major (CRNM) or minor bleeding, and not preceded by a major bleeding event. RESULTS: Non-major bleeding was three times more common than major bleeding (12.1% vs 3.8%). Like major bleeding, non-major bleeding was less frequent with apixaban (6.4 per 100 patient-years) than warfarin (9.4 per 100 patient-years) (adjusted HR 0.69, 95% CI 0.63 to 0.75). The most frequent sites of non-major bleeding were haematuria (16.4%), epistaxis (14.8%), gastrointestinal (13.3%), haematoma (11.5%) and bruising/ecchymosis (10.1%). Medical or surgical intervention was similar among patients with non-major bleeding on warfarin versus apixaban (24.7% vs 24.5%). A change in antithrombotic therapy (58.6% vs 50.0%) and permanent study drug discontinuation (5.1% (61) vs 3.6% (30), p=0.10) was numerically higher with warfarin than apixaban. CRNM bleeding was independently associated with an increased risk of overall death (adjusted HR 1.70, 95% CI 1.32 to 2.18) and subsequent major bleeding (adjusted HR 2.18, 95% CI 1.56 to 3.04). CONCLUSIONS: In ARISTOTLE, non-major bleeding was common and substantially less frequent with apixaban than with warfarin. CRNM bleeding was independently associated with a higher risk of death and subsequent major bleeding. Our results highlight the importance of any severity of bleeding in patients with AF treated with anticoagulation therapy and suggest that non-major bleeding, including minor bleeding, might not be minor. TRIAL REGISTRATION NUMBER: NCT00412984; post-results."},{"id":"2f0dacf349b5","type":"article","url":"https://hartvaat.nl/2017/04/01/intracoronair-nitriet-onderdrukt-de-inflammatoire-respons-na-primaire-pci/","title":"Intracoronair nitriet onderdrukt de inflammatoire respons na primaire PCI","title_en":"Intracoronary nitrite suppresses the inflammatory response following primary percutaneous coronary intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["inflammatie","percutane-coronaire-interventie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-309748","source_url":"https://doi.org/10.1136/heartjnl-2016-309748","authors":["Daniel A Jones","Rayomand S Khambata","Mervyn Andiapen","Krishnaraj S Rathod","Anthony Mathur","Amrita Ahluwalia"],"significance":5,"published":"2017-04-01","source_date":"2017-04-01","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/"],"congress":"","summary_en":"This study showed that intracoronary sodium nitrite suppresses the inflammatory response after primary PCI for STEMI, providing mechanistic evidence for nitric oxide-mediated cardioprotection during acute myocardial reperfusion.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T13:25:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat intracoronair natriumnitriet de inflammatoire respons onderdrukt na primaire PCI voor STEMI. Mechanistisch bewijs voor nitriet als cardioprotectief agens.","abstract_original":"OBJECTIVE: Recent work suggests that intracoronary nitrite reduces myocardial infarct size following primary percutaneous coronary intervention (PPCI) for acute myocardial infarction (AMI), although the exact mechanisms are unclear. We explored the effects of nitrite on reperfusion-induced inflammation, by assessing the levels of specific pro-inflammatory mediators, chemokines and adhesion molecules in plasma and circulating cell subtypes as exploratory end points in the NITRITE-AMI cohort. METHODS: Peripheral blood leucocyte subsets, cell adhesion molecules, high-sensitivity C reactive protein (hs-CRP), the monocyte and neutrophil chemoattractants CCL2 and CXCL1, CXCL5, respectively were measured in the blood of patients who received either intracoronary sodium nitrite (N=40) or placebo (N=40) during PPCI for AMI. Major adverse cardiac events were recorded at 3 years post-PPCI. RESULTS: In the placebo-treated patients, total circulating neutrophil numbers and levels of hs-CRP were raised postreperfusion and then decreased over time; in nitrite-treated patients these changes were suppressed compared with placebo up to 6 months post-PPCI (p<0.01). This effect was associated with reduced expression of neutrophil CD11b, plasma CXCL1, CXCL5 and CCL2 levels (p<0.05). There were no differences in the number of other any other leucocyte population measured (monocytes and lymphocytes) or activation markers expressed by these cells between the treatment groups. These effects were associated with a reduction in both microvascular obstruction and infarct size. CONCLUSIONS: Important reductions in neutrophil numbers and activation post-PPCI in patients with ST elevated myocardial infarction were associated with nitrite treatment, an effect we propose likely underlies, at least in part, the beneficial effects of nitrite upon infarct size. TRIAL REGISTRATION NUMBER: NCT01584453."},{"id":"4b38a899a3a1","type":"article","url":"https://hartvaat.nl/2017/03/30/ffr-geleide-multivaten-pci-bij-myocardinfarct-nejm-compare-acute/","title":"FFR-geleide multivaten-PCI bij myocardinfarct: NEJM COMPARE-ACUTE","title_en":"Fractional Flow Reserve-Guided Multivessel Angioplasty in Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["myocardinfarct"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1701067","source_url":"https://doi.org/10.1056/NEJMoa1701067","authors":["Pieter C Smits","Mohamed Abdel-Wahab","Franz-Josef Neumann","Bianca M Boxma-de Klerk","Ketil Lunde","Carl E Schotborgh","Zsolt Piroth","David Horak","Adrian Wlodarczak","Paul J Ong","Rainer Hambrecht","Oskar Angerås","Gert Richardt","Elmir Omerovic"],"significance":9,"published":"2017-03-30","source_date":"2017-03-30","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"The COMPARE-ACUTE trial demonstrated that FFR-guided complete revascularization at the time of primary PCI for STEMI reduced future revascularization compared with culprit-only PCI. The study provided early evidence supporting complete revascularization guided by physiology in the acute MI setting.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T13:25:56Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM COMPARE-ACUTE-trial die FFR-geleide complete revascularisatie vergeleek met culprit-only PCI bij STEMI met multivatencoronairlijden. Belangrijk bewijs voor complete revascularisatie gestuurd door FFR.","abstract_original":"BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), the use of percutaneous coronary intervention (PCI) to restore blood flow in an infarct-related coronary artery improves outcomes. The use of PCI in non-infarct-related coronary arteries remains controversial. METHODS: We randomly assigned 885 patients with STEMI and multivessel disease who had undergone primary PCI of an infarct-related coronary artery in a 1:2 ratio to undergo complete revascularization of non-infarct-related coronary arteries guided by fractional flow reserve (FFR) (295 patients) or to undergo no revascularization of non-infarct-related coronary arteries (590 patients). The FFR procedure was performed in both groups, but in the latter group, both the patients and their cardiologist were unaware of the findings on FFR. The primary end point was a composite of death from any cause, nonfatal myocardial infarction, revascularization, and cerebrovascular events at 12 months. Clinically indicated elective revascularizations performed within 45 days after primary PCI were not counted as events in the group receiving PCI for an infarct-related coronary artery only. RESULTS: The primary outcome occurred in 23 patients in the complete-revascularization group and in 121 patients in the infarct-artery-only group that did not receive complete revascularization, a finding that translates to 8 and 21 events per 100 patients, respectively (hazard ratio, 0.35; 95% confidence interval [CI], 0.22 to 0.55; P<0.001). Death occurred in 4 patients in the complete-revascularization group and in 10 patients in the infarct-artery-only group (1.4% vs. 1.7%) (hazard ratio, 0.80; 95% CI, 0.25 to 2.56), myocardial infarction in 7 and 28 patients, respectively (2.4% vs. 4.7%) (hazard ratio, 0.50; 95% CI, 0.22 to 1.13), revascularization in 18 and 103 patients (6.1% vs. 17.5%) (hazard ratio, 0.32; 95% CI, 0.20 to 0.54), and cerebrovascular events in 0 and 4 patients (0 vs. 0.7%). An FFR-related serious adverse event occurred in 2 patients (both in the group receiving infarct-related treatment only). CONCLUSIONS: In patients with STEMI and multivessel disease who underwent primary PCI of an infarct-related artery, the addition of FFR-guided complete revascularization of non-infarct-related arteries in the acute setting resulted in a risk of a composite cardiovascular outcome that was lower than the risk among those who were treated for the infarct-related artery only. This finding was mainly supported by a reduction in subsequent revascularizations. (Funded by Maasstad Cardiovascular Research and others; Compare-Acute ClinicalTrials.gov number, NCT01399736 .)."},{"id":"fed327adcd56","type":"article","url":"https://hartvaat.nl/2017/03/28/adaptieve-servoventilatie-bij-hartfalen-de-cat-hf-trial/","title":"Adaptieve servoventilatie bij hartfalen: de CAT-HF-trial","title_en":"Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure: The CAT-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","dapa-hf","finearts-hf","hartkatheterisatie","hfmref","hfpef","hfref","pathfinder-trial","step-hfpef"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2017.01.041","source_url":"https://doi.org/10.1016/j.jacc.2017.01.041","authors":["Christopher M O'Connor","David J Whellan","Mona Fiuzat","Naresh M Punjabi","Gudaye Tasissa","Kevin J Anstrom","Adam V Benjafield","Holger Woehrle","Amy B Blase","JoAnn Lindenfeld","Olaf Oldenburg"],"significance":6,"published":"2017-03-28","source_date":"2017-03-28","image":"","kennis":[],"congress":"","summary_en":"The CAT-HF randomized trial evaluated adaptive servo-ventilation for sleep apnea in hospitalized heart failure patients, testing whether treating nocturnal respiratory disturbances improves cardiovascular outcomes in acute HF.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T18:38:32Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde CAT-HF-trial naar cardiovasculaire uitkomsten met minuutventilatie-gestuurde adaptieve servoventilatie bij hartfalen. In context van de SERVE-HF-veiligheidssignalen.","abstract_original":"BACKGROUND: Sleep apnea is common in hospitalized heart failure (HF) patients and is associated with increased morbidity and mortality. OBJECTIVES: The CAT-HF (Cardiovascular Improvements With MV-ASV Therapy in Heart Failure) trial investigated whether minute ventilation (MV) adaptive servo-ventilation (ASV) improved cardiovascular outcomes in hospitalized HF patients with moderate-to-severe sleep apnea. METHODS: Eligible patients hospitalized with HF and moderate-to-severe sleep apnea were randomized to ASV plus optimized medical therapy (OMT) or OMT alone (control). The primary endpoint was a composite global rank score (hierarchy of death, cardiovascular hospitalizations, and percent changes in 6-min walk distance) at 6 months. RESULTS: 126 of 215 planned patients were randomized; enrollment was stopped early following release of the SERVE-HF (Adaptive Servo-Ventilation for Central Sleep Apnea in Systolic Heart Failure) trial results. Average device usage was 2.7 h/night. Mean number of events measured by the apnea-hypopnea index decreased from 35.7/h to 2.1/h at 6 months in the ASV group versus 35.1/h to 19.0/h in the control group (p < 0.0001). The primary endpoint did not differ significantly between the ASV and control groups (p = 0.92 Wilcoxon). Changes in composite endpoint components were not significantly different between ASV and control. There was no significant interaction between treatment and ejection fraction (p = 0.10 Cox model); however, pre-specified subgroup analysis suggested a positive effect of ASV in patients with HF with preserved ejection fraction (p = 0.036). CONCLUSIONS: In hospitalized HF patients with moderate-to-severe sleep apnea, adding ASV to OMT did not improve 6-month cardiovascular outcomes. Study power was limited for detection of safety signals and identifying differential effects of ASV in patients with HF with preserved ejection fraction, but additional studies are warranted in this population. (Cardiovascular Improvements With MV ASV Therapy in Heart Failure [CAT-HF]; NCT01953874)."},{"id":"512975ab51cb","type":"article","url":"https://hartvaat.nl/2017/03/28/edoxaban-bij-af-met-bioprothese-hartkleppen-trombo-emboliepreventie/","title":"Edoxaban bij AF met bioprothese-hartkleppen: trombo-emboliepreventie","title_en":"Edoxaban for the Prevention of Thromboembolism in Patients With Atrial Fibrillation and Bioprosthetic Valves.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["klepprothese","trombose","veneuze-trombose"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.026714","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.026714","authors":["Anthony P Carnicelli","Raffaele De Caterina","Jonathan L Halperin","Giulia Renda","Christian T Ruff","Marco Trevisan","Francesco Nordio","Michele F Mercuri","Elliott Antman","Robert P Giugliano"],"significance":7,"published":"2017-03-28","source_date":"2017-03-28","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/","https://hartvaat.nl/kennis/antistolling/doacs-overzicht/"],"congress":"","summary_en":"This study of edoxaban in AF patients with bioprosthetic heart valves expanded the evidence base for DOAC use beyond native valve disease, contributing to the growing data supporting anticoagulation alternatives to warfarin in prosthetic valve patients.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T13:25:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar edoxaban voor preventie van trombo-embolie bij AF-patiënten met bioprothese-hartkleppen. Verruimt de evidence base voor DOAC-gebruik bij klepprothesen.","abstract_original":""},{"id":"0f29e1c73b9d","type":"article","url":"https://hartvaat.nl/2017/03/21/kortetermijneffecten-van-tolvaptan-bij-acuut-hartfalen-met-volume-overbelasting/","title":"Kortetermijneffecten van tolvaptan bij acuut hartfalen met volume-overbelasting","title_en":"Short-Term Effects of Tolvaptan in Patients With Acute Heart Failure and Volume Overload.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","bisoprolol","hfref","hypertrofische-cardiomyopathie","ivabradine","laminopathie","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.12.035","source_url":"https://doi.org/10.1016/j.jacc.2016.12.035","authors":["Marvin A Konstam","Michael Kiernan","Arthur Chandler","Ravi Dhingra","Freny Vaghaiwalla Mody","Howard Eisen","W Herbert Haught","Lynne Wagoner","Divya Gupta","Richard Patten","Paul Gordon","Kenneth Korr","Russell Fileccia","Susan J Pressler","Douglas Gregory","Patricia Wedge","Douglas Dowling","Matthew Romeling","Jeremy M Konstam","Joseph M Massaro","James E Udelson"],"significance":5,"published":"2017-03-21","source_date":"2017-03-21","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the short-term effects of tolvaptan (vasopressin receptor antagonist) on fluid balance and symptoms in acute heart failure with volume overload, testing aquaretic therapy as an adjunct to loop diuretics.","created":"2026-07-03T10:26:37Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de kortetermijneffecten van tolvaptan op vochtbalans en symptomen bij patiënten met acuut hartfalen en volume-overbelasting.","abstract_original":"BACKGROUND: In patients with acute heart failure (AHF), dyspnea relief is the most immediate goal. Renal dysfunction, diuretic resistance, and hyponatremia represent treatment impediments. OBJECTIVES: It was hypothesized that the addition of tolvaptan to a background diuretic improved dyspnea early in patients selected for an enhanced vasopressin antagonism response. METHODS: In a double-blind trial, patients were randomized to tolvaptan 30 mg/day or placebo. Study entry required hospitalization within the previous 36 h, active dyspnea, and any of the following: 1) estimated glomerular filtration rate <60 ml/min/1.73 m2; 2) hyponatremia; or 3) diuretic resistance (urine output ≤125 ml/h following intravenous furosemide ≥40 mg). The primary endpoint was a 7-point change in self-assessed dyspnea at 8 and 16 h, using a novel standardized approach. RESULTS: We randomized 250 patients. There was no difference in the primary endpoint of day 1 dyspnea reduction, despite significantly greater weight reduction with tolvaptan (-2.4 ± 2.1 kg vs. -0.9 ± 1.8 kg; p < 0.001). At day 3, dyspnea reduction was greater with tolvaptan (p = 0.01). There were 2 significant treatment-by-subgroup interactions: patients without elevated jugular venous pressure and those without ascites showed directional favorability of tolvaptan over placebo for the primary endpoint compared with patients with these findings. CONCLUSIONS: Despite rapid and persistent weight loss with tolvaptan compared with placebo, in patients with AHF who were selected for greater potential benefit from vasopressin receptor inhibition, tolvaptan was not associated with greater early improvement in dyspnea. Apparent subsequent differences in dyspnea warrant further exploration of the temporal relationship between diuresis and dyspnea relief and a possible clinical role for tolvaptan. (Randomized, Double-Blind, Placebo Controlled Study of the Short Term Clinical Effects of Tolvaptan in Patients Hospitalized for Worsening Heart Failure With Challenging Volume Management [SECRET of CHF]; NCT01584557)."},{"id":"6549e471f7af","type":"article","url":"https://hartvaat.nl/2017/03/21/kleplijden-en-edoxaban-versus-warfarine-bij-af-engage-af-timi-48/","title":"Kleplijden en edoxaban versus warfarine bij AF: ENGAGE AF-TIMI 48","title_en":"Valvular Heart Disease Patients on Edoxaban or Warfarin in the ENGAGE AF-TIMI 48 Trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.12.031","source_url":"https://doi.org/10.1016/j.jacc.2016.12.031","authors":["Raffaele De Caterina","Giulia Renda","Anthony P Carnicelli","Francesco Nordio","Marco Trevisan","Michele F Mercuri","Christian T Ruff","Elliott M Antman","Eugene Braunwald","Robert P Giugliano"],"significance":7,"published":"2017-03-21","source_date":"2017-03-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/edoxaban/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This ENGAGE AF-TIMI 48 subanalysis in AF patients with valvular heart disease confirmed the safety and efficacy of edoxaban compared with warfarin, extending the evidence for DOAC use in this common concomitant condition.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Subanalyse van ENGAGE AF-TIMI 48 bij AF-patiënten met kleplijden. Bevestigt de veiligheid en werkzaamheid van edoxaban in deze subgroep.","abstract_original":"BACKGROUND: The use of non-vitamin K antagonist oral anticoagulants (NOACs) instead of vitamin K antagonists (VKAs) in patients with atrial fibrillation (AF) and coexisting valvular heart disease (VHD) is of substantial interest. OBJECTIVES: This study explored outcomes in patients with AF with and without VHD in the ENGAGE AF-TIMI 48 (Effective Anticoagulation with factor Xa Next Generation in Atrial Fibrillation-Thrombolysis In Myocardial Infarction 48) trial, comparing edoxaban with warfarin. METHODS: Valvular heart disease was defined as history or baseline echocardiography evidence of at least moderate aortic/mitral regurgitation, aortic stenosis, or prior valve surgery (bioprosthesis replacement, valve repair, valvuloplasty). Patients with moderate to severe mitral stenosis or mechanical heart valves were excluded from the trial. Comparisons were made of rates of stroke/systemic embolic event (SSEE), major bleeding, additional efficacy and safety outcomes, as well as net clinical outcomes, in patients with or without VHD treated with edoxaban or warfarin, using adjusted Cox proportional hazards. RESULTS: After adjustment for multiple baseline characteristics, compared with no-VHD patients (n = 18,222), VHD patients (n = 2,824) had a similar rate of SSEE but higher rates of death (hazard ratio [HR]: 1.40; 95% confidence interval [CI]:1.26 to 1.56; p <0.001), major adverse cardiovascular events (HR: 1.29; 95% CI: 1.16 to 1.43; p <0.001), and major bleeding (HR: 1.21; 95% CI: 1.03 to 1.42; p = 0.02). Higher-dose edoxaban regimen had efficacy similar to warfarin in the presence of VHD (for SSEE, HR: 0.69; 95% CI: 0.44 to 1.07, in patients with VHD, and HR: 0.91; 95% CI: 0.77 to 1.07, in patients without VHD; p interaction [pint] = 0.26; and for less major bleeding, HR: 0.74; 95% CI: 0.53 to 1.02 in patients with VHD, and HR: 0.82; 95% CI: 0.71 to 0.94, in patients with no VHD; pint = 0.57). CONCLUSIONS: The presence of VHD increased the risk of death, major adverse cardiovascular events, and major bleeding but did not affect the relative efficacy or safety of higher-dose edoxaban versus warfarin in AF. (Global Study to Assess the Safety and Effectiveness of Edoxaban (DU-176b) vs. Standard Practice of Dosing With Warfarin in Patients With Atrial Fibrillation [ENGAGE AF-TIMI 48]; NCT00781391)."},{"id":"3cf24070e234","type":"article","url":"https://hartvaat.nl/2017/03/21/doac-s-bij-af-met-kleplijden-jacc-review/","title":"DOAC's bij AF met kleplijden: JACC-review","title_en":"Non-Vitamin K Antagonist Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.12.038","source_url":"https://doi.org/10.1016/j.jacc.2016.12.038","authors":["Giulia Renda","Fabrizio Ricci","Robert P Giugliano","Raffaele De Caterina"],"significance":7,"published":"2017-03-21","source_date":"2017-03-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This comprehensive JACC review addressed DOAC use in AF patients with various forms of valvular heart disease, providing a framework for anticoagulant selection across the spectrum from native valve disease to prosthetic valves.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Uitgebreide review in JACC over het gebruik van DOAC's bij AF-patiënten met diverse vormen van kleplijden. Biedt een kader voor de indicatiestelling per kleptype.","abstract_original":"BACKGROUND: Valvular heart disease (VHD) and atrial fibrillation (AF) often coexist. Phase III trials comparing non-vitamin K antagonist oral anticoagulants (NOACs) with warfarin excluded patients with moderate/severe mitral stenosis or mechanical heart valves, but variably included patients with other VHD and valve surgeries. OBJECTIVES: This study aimed to determine relative safety and efficacy of NOACs in patients with VHD. METHODS: We performed a meta-analysis of the 4 phase III AF trials of the currently available NOACs versus warfarin in patients with coexisting VHD to assess pooled estimates of relative risk (RR) and 95% confidence intervals (CIs) for stroke/systemic embolic events (SSEE), major bleeding, intracranial hemorrhage (ICH), and all-cause death. RESULTS: Compared with warfarin, the rate of SSEE in patients treated with higher-dose NOACs was lower and consistent among 13,585 patients with (RR: 0.70; 95% CI: 0.58 to 0.86) or 58,098 without VHD (RR: 0.84; 95% CI: 0.75 to 0.95; interaction p = 0.13). Major bleeding in patients on higher-dose NOACs versus warfarin was similar and consistent among patients with (RR: 0.93; 95% CI: 0.68 to 1.27) or without VHD (RR: 0.85; 95% CI: 0.70 to 1.02; interaction p = 0.63 for VHD/no-VHD difference). Intracranial hemorrhage was lower with higher-dose NOACs than with warfarin irrespective of VHD (RR: 0.47; 95% CI: 0.24 to 0.93, and 0.49; 95% CI: 0.41 to 059, respectively; interaction p = 0.91). No protective effect of higher-dose NOACs in preventing all-cause death seemed to be present in patients with VHD versus without VHD (RR:1.01; 95% CI: 0.90 to 1.14 vs. RR: 0.88; 95% CI: 0.82 to 0.94, respectively; interaction p = 0.03). CONCLUSIONS: High-dose NOACs provide overall efficacy and safety similar in AF patients with or without VHD."},{"id":"f3decef74195","type":"article","url":"https://hartvaat.nl/2017/03/21/plotse-hartdood-bij-ischemisch-hartfalen-na-cabg-stich-resultaten/","title":"Plotse hartdood bij ischemisch hartfalen na CABG: STICH-resultaten","title_en":"Sudden Cardiac Death in Patients With Ischemic Heart Failure Undergoing Coronary Artery Bypass Grafting: Results From the STICH Randomized Clinical Trial (Surgical Treatment for Ischemic Heart Failure).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.026075","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.026075","authors":["Meena P Rao","Sana M Al-Khatib","Sean D Pokorney","Lilin She","Alexander Romanov","Jose C Nicolau","Kerry L Lee","Peter Carson","Craig H Selzman","Janina Stepinska","John G F Cleland","Wiwun Tungsubutra","Patrice M Desvigne-Nickens","Carla A Sueta","Matthias Siepe","Irene Lang","Arthur M Feldman","Michael Yii","Jean L Rouleau","Eric J Velazquez"],"significance":7,"published":"2017-03-21","source_date":"2017-03-21","image":"","kennis":[],"congress":"","summary_en":"This STICH analysis examined sudden cardiac death rates in patients with ischemic heart failure undergoing CABG, investigating whether revascularization reduces the risk of fatal arrhythmias in this high-risk population.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"STICH-analyse naar plotse hartdood bij patiënten met ischemisch hartfalen die CABG ondergingen. Onderzocht of revascularisatie het risico op plotse dood vermindert.","abstract_original":"BACKGROUND: The risk of sudden cardiac death (SCD) in patients with heart failure after coronary artery bypass graft surgery (CABG) has not been examined in a contemporary clinical trial of surgical revascularization. This analysis describes the incidence, timing, and clinical predictors of SCD after CABG. METHODS: Patients enrolled in the STICH trial (Surgical Treatment of Ischemic Heart Failure) who underwent CABG with or without surgical ventricular reconstruction were included. We excluded patients with prior implantable cardioverter-defibrillator and those randomized only to medical therapy. The primary outcome was SCD as adjudicated by a blinded committee. A Cox model was used to examine and identify predictors of SCD. The Fine and Gray method was used to estimate the incidence of SCD accounting for the competing risk of other deaths. RESULTS: Over a median follow-up of 46 months, 113 of 1411 patients who received CABG without (n = 934) or with (n = 477) surgical ventricular reconstruction had SCD; 311 died of other causes. The mean left ventricular ejection fraction at enrollment was 28±9%. The 5-year cumulative incidence of SCD was 8.5%. Patients who had SCD and those who did not die were younger and had fewer comorbid conditions than did those who died of causes other than SCD. In the first 30 days after CABG, SCD (n=5) accounted for 7% of all deaths. The numerically greatest monthly rate of SCD was in the 31- to 90-day time period. In a multivariable analysis including baseline demographics, risk factors, coronary anatomy, and left ventricular function, end-systolic volume index and B-type natriuretic peptide were most strongly associated with SCD. CONCLUSIONS: The monthly risk of SCD shortly after CABG among patients with a low left ventricular ejection fraction is highest between the first and third months, suggesting that risk stratification for SCD should occur early in the postoperative period, particularly in patients with increased preoperative end-systolic volume index or B-type natriuretic peptide. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT0002359."},{"id":"678f5b88f17f","type":"article","url":"https://hartvaat.nl/2017/03/21/nieuwe-risicovoorspellingsscore-bij-af-voor-netto-klinisch-resultaat-engage-af-t/","title":"Nieuwe risicovoorspellingsscore bij AF voor netto klinisch resultaat: ENGAGE AF-TIMI 48","title_en":"A novel risk prediction score in atrial fibrillation for a net clinical outcome from the ENGAGE AF-TIMI 48 randomized clinical trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw565","source_url":"https://doi.org/10.1093/eurheartj/ehw565","authors":["Christina L Fanola","Robert P Giugliano","Christian T Ruff","Marco Trevisan","Francesco Nordio","Michele F Mercuri","Elliott M Antman","Eugene Braunwald"],"significance":6,"published":"2017-03-21","source_date":"2017-03-21","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/edoxaban/"],"congress":"","summary_en":"This ENGAGE AF-TIMI 48 analysis developed a novel risk score for net clinical outcome (combining ischemic and bleeding events) in AF, helping guide the choice between DOAC and VKA therapy based on individual patient characteristics.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Ontwikkeling van een nieuwe risicoscore voor het netto klinisch resultaat (ischemie + bloedingen) bij AF vanuit de ENGAGE AF-TIMI 48-trial. Geïntegreerde risicostratificatie.","abstract_original":"AIMS: The choice between initiating a non-vitamin K antagonist oral anticoagulant (NOAC) and a vitamin K antagonist (VKA) in patients with atrial fibrillation (AF) may be challenging. To assist in this decision, we developed a risk score to identify patients for whom a therapeutic benefit of NOACs over VKA is predicted. METHODS AND RESULTS: ENGAGE AF-TIMI 48 was a randomized clinical trial of edoxaban vs. warfarin in 21 105 patients with AF. Cox proportional hazard models identified factors associated with a serious net clinical outcome (NCO) of disabling stroke, life-threatening bleeding, and all-cause mortality in VKA naïve patients from the warfarin arm. These were used to develop an integer risk score. Performance was assessed by C-indices and validation by bootstrapping. Kaplan-Meier analyses were stratified by three score categories and treatment arm. Over a median of 2.7 years, 457 NCO events occurred in 2898 patients with a total person-time of 7549.5 years (6.05%/year). The risk prediction model (C = 0.693) for the NCO was translated into a 17-point integer score, with annualized event rates for the low, intermediate, and high-risk categories in the warfarin arm of 3.5%, 9.9%, and 20.8%, respectively. Therapeutic benefit of higher- and lower-dose edoxaban over warfarin was demonstrated in the high- and intermediate-risk, with equal benefit in the low-risk categories (P-interaction 0.008 and 0.014, respectively). CONCLUSION: In VKA naive patients with AF, the TIMI-AF score can assist in the prediction of a poor composite outcome and guide selection of anticoagulant therapy by identifying a differential clinical benefit with a NOAC or VKA."},{"id":"d85ece5be9fe","type":"article","url":"https://hartvaat.nl/2017/03/21/werkzaamheid-en-veiligheid-van-tolvaptan-bij-gehospitaliseerd-acuut-hartfalen/","title":"Werkzaamheid en veiligheid van tolvaptan bij gehospitaliseerd acuut hartfalen","title_en":"Efficacy and Safety of Tolvaptan in Patients Hospitalized With Acute Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog"],"tags":["acuut-hartfalen","hfref","step-hfpef","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.09.004","source_url":"https://doi.org/10.1016/j.jacc.2016.09.004","authors":["G Michael Felker","Robert J Mentz","Robert T Cole","Kirkwood F Adams","Gregory F Egnaczyk","Mona Fiuzat","Chetan B Patel","Melvin Echols","Michel G Khouri","James M Tauras","Divya Gupta","Pamela Monds","Rhonda Roberts","Christopher M O'Connor"],"significance":6,"published":"2017-03-21","source_date":"2017-03-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/","https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This study evaluated tolvaptan, a vasopressin-2 receptor antagonist, in patients hospitalized with acute heart failure, testing whether aquaresis improves decongestion and clinical outcomes beyond standard diuretic therapy.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van tolvaptan (vasopressinereceptorantagonist) bij patiënten opgenomen met acuut hartfalen. Onderzoekt aquaretische therapie als aanvulling op diuretica.","abstract_original":"BACKGROUND: The oral vasopressin-2 receptor antagonist tolvaptan causes aquaresis in patients with volume overload, potentially facilitating decongestion and improving the clinical course of patients with acute heart failure (AHF). OBJECTIVES: The TACTICS-HF (Targeting Acute Congestion with Tolvaptan in Congestive Heart Failure) study was conducted to address the acute use of tolvaptan to improve congestion in AHF. METHODS: The TACTICS-HF study randomized patients (n = 257) within 24 h of AHF presentation in a prospective, double blind, placebo-controlled trial. Patients were eligible regardless of ejection fraction, and were randomized to either 30 mg of tolvaptan or placebo given at 0, 24, and 48 h, with a fixed-dose furosemide regimen as background therapy. The primary endpoint was the proportion of patients considered responders at 24 h. Secondary endpoints included symptom improvement, changes in renal function, and clinical events. RESULTS: Dyspnea relief by Likert scale was similar between groups at 8 h (25% moderately or markedly improved with tolvaptan vs. 28% placebo; p = 0.59) and at 24 h (50% tolvaptan vs. 47% placebo; p = 0.80). Need for rescue therapy was also similar at 24 h (21% tolvaptan, 18% placebo; p = 0.57). The proportion defined as responders at 24 h (primary study endpoint) was 16% for tolvaptan and 20% for placebo (p = 0.32). Tolvaptan resulted in greater weight loss and net fluid loss compared with placebo, but tolvaptan-treated patients were more likely to experience worsening renal function during treatment. There were no differences in in-hospital or post-discharge clinical outcomes. CONCLUSIONS: In patients hospitalized with AHF, dyspnea, and congestion, the addition of tolvaptan to a standardized furosemide regimen did not improve the number of responders at 24 h, despite greater weight loss and fluid loss. (Targeting Acute Congestion With Tolvaptan in Congestive Heart Failure [TACTICS-HF]; NCT01644331)."},{"id":"7ed5581561a9","type":"article","url":"https://hartvaat.nl/2017/03/14/afweging-myocardinfarct-versus-bloedingstype-en-mortaliteit-na-acs-tra-2p-timi-5/","title":"Afweging myocardinfarct versus bloedingstype en mortaliteit na ACS: TRA 2°P-TIMI 50","title_en":"Trade-off of myocardial infarction vs. bleeding types on mortality after acute coronary syndrome: lessons from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) randomized trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["aperitif-trial","myocardinfarct","nstemi"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw525","source_url":"https://doi.org/10.1093/eurheartj/ehw525","authors":["Marco Valgimigli","Francesco Costa","Yuliya Lokhnygina","Robert M Clare","Lars Wallentin","David J Moliterno","Paul W Armstrong","Harvey D White","Claes Held","Philip E Aylward","Frans Van de Werf","Robert A Harrington","Kenneth W Mahaffey","Pierluigi Tricoci"],"significance":6,"published":"2017-03-14","source_date":"2017-03-14","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/dual-antiplatelet-therapy-dapt/","https://hartvaat.nl/kennis/coronairlijden/secundaire-preventie-na-acs/"],"congress":"","summary_en":"This analysis compared the mortality impact of different types of myocardial infarction versus different types of bleeding after ACS, quantifying the relative clinical importance of ischemic versus hemorrhagic events to inform the DAPT risk-benefit balance.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:55Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die de mortaliteitsimpact vergeleek van verschillende types myocardinfarct versus verschillende types bloedingen na ACS. Relevant voor de risico-batenafweging van antitrombotische therapie.","abstract_original":"AIMS: Dual antiplatelet therapy reduces non-fatal ischaemic events after acute coronary syndrome (ACS) but increases bleeding to a similar extent. We sought to determine the prognostic impact of myocardial infarction (MI) vs. bleeding during an extended follow-up period to gain insight into the trade-off between efficacy and safety among patients after ACS. METHODS AND RESULTS: In 12 944 patients with non-ST-segment elevation ACS from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial, we investigated the relative impact of MI and bleeding occurring >30 days post-ACS and subsequent all-cause mortality. Bleeding was graded according to Bleeding Academic Research Consortium (BARC) criteria. MI was associated with a five-fold increase in mortality. BARC type 2 and 3, but not type 1, bleeding had a significant impact on mortality. MI was associated with a greater risk of mortality compared with BARC 2 [relative risk (RR) 3.5; 95% confidence interval (CI) 2.08-4.77; P < 0.001] and BARC 3a bleeding (RR 2.23; 95% CI 1.36-3.64; P = 0.001), and a risk similar to BARC 3b bleeding (RR 1.37; 95% CI 0.81-2.30; P = 0.242). Risk of death after MI was significantly lower than after BARC 3c bleeding (RR 0.22; 95% CI 0.13-0.36; P < 0.001). MI and bleeding had similar time-associations with mortality, which remained significant for several months, still being higher early after the event. CONCLUSION: In patients treated with antiplatelet therapy after ACS, both MI and bleeding significantly impacted mortality with similar time-dependency. Although BARC 2 and 3a bleeding were less prognostic for death than MI, the risk of mortality was equivalent between BARC 3b bleeding and MI, and was higher following BARC 3c bleeding."},{"id":"30a2da9a0bab","type":"article","url":"https://hartvaat.nl/2017/03/14/drie-arteriele-grafts-verbeteren-langetermijnoverleving-meta-analyse-van-propens/","title":"Drie arteriële grafts verbeteren langetermijnoverleving: meta-analyse van propensity-matched studies","title_en":"Three Arterial Grafts Improve Late Survival: A Meta-Analysis of Propensity-Matched Studies.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["bloeddrukbehandeling","figaro-dkd","perifeer-vaatlijden"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.025453","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.025453","authors":["Mario Gaudino","John D Puskas","Antonino Di Franco","Lucas B Ohmes","Mario Iannaccone","Umberto Barbero","David Glineur","Juan B Grau","Umberto Benedetto","Fabrizio D'Ascenzo","Fiorenzo Gaita","Leonard N Girardi","David P Taggart"],"significance":7,"published":"2017-03-14","source_date":"2017-03-14","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis of propensity-matched studies showed that using three arterial grafts in CABG improves long-term survival compared with conventional strategies using fewer arterial conduits, supporting a more aggressive arterial revascularization approach.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die aantoont dat gebruik van drie arteriële grafts bij CABG de langetermijnoverleving verbetert vergeleken met conventionele strategieën. Onderbouwt maximale arteriële revascularisatie.","abstract_original":"BACKGROUND: Little evidence shows whether a third arterial graft provides superior outcomes compared with the use of 2 arterial grafts in patients undergoing coronary artery bypass grafting. A meta-analysis of all the propensity score-matched observational studies comparing the long-term outcomes of coronary artery bypass grafting with the use of 2-arterial versus 3-arterial grafts was performed. METHODS: A literature search was conducted using MEDLINE, EMBASE, and Web of Science to identify relevant articles. Long-term mortality in the propensity score-matched populations was the primary end point. Secondary end points were in-hospital/30-day mortality for the propensity score-matched populations and long-term mortality for the unmatched populations. In the matched population, time-to-event outcome for long-term mortality was extracted as hazard ratios, along with their variance. Statistical pooling of survival (time-to-event) was performed according to a random effect model, computing risk estimates with 95% confidence intervals. RESULTS: Eight propensity score-matched studies reporting on 10 287 matched patients (2-arterial graft: 5346; 3-arterial graft: 4941) were selected for final comparison. The mean follow-up time ranged from 37.2 to 196.8 months. The use of 3 arterial grafts was not statistically associated with early mortality (hazard ratio, 0.93; 95% confidence interval, 0.71-1.22; P=0.62). The use of 3 arterial grafts was associated with statistically significantly lower hazard for late death (hazard ratio, 0.8; 95% confidence interval, 0.75-0.87; P<0.001), irrespective of sex and diabetic mellitus status. This result was qualitatively similar in the unmatched population (hazard ratio, 0.57; 95% confidence interval, 0.33-0.98; P=0.04). CONCLUSIONS: The use of a third arterial conduit in patients with coronary artery bypass grafting is not associated with higher operative risk and is associated with superior long-term survival, irrespective of sex and diabetic mellitus status."},{"id":"2f6a681f37ef","type":"article","url":"https://hartvaat.nl/2017/03/11/kwartdosis-viervoudige-combinatietherapie-als-initiele-hypertensiebehandeling-la/","title":"Kwartdosis viervoudige combinatietherapie als initiële hypertensiebehandeling: Lancet gerandomiseerde trial","title_en":"Quarter-dose quadruple combination therapy for initial treatment of hypertension: placebo-controlled, crossover, randomised trial and systematic review.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["aperitif-trial","bloeddrukbehandeling"],"journal":"Lancet (London, England)","doi":"10.1016/S0140-6736(17)30260-X","source_url":"https://doi.org/10.1016/S0140-6736(17)30260-X","authors":["Clara K Chow","Jay Thakkar","Alex Bennett","Graham Hillis","Michael Burke","Tim Usherwood","Kha Vo","Kris Rogers","Emily Atkins","Ruth Webster","Michael Chou","Hakim-Moulay Dehbi","Abdul Salam","Anushka Patel","Bruce Neal","David Peiris","Henry Krum","John Chalmers","Mark Nelson","Christopher M Reid","Mark Woodward","Sarah Hilmer","Simon Thom","Anthony Rodgers"],"significance":8,"published":"2017-03-11","source_date":"2017-03-11","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/mineralocorticoid-antagonisten-hypertensie/"],"congress":"","summary_en":"This Lancet crossover trial demonstrated that a quarter-dose quadruple combination pill achieved substantially greater blood pressure reduction than monotherapy in hypertension, establishing the pharmacological rationale for low-dose multi-drug combinations as initial therapy.","created":"2026-07-03T10:26:36Z","updated":"2026-07-03T13:25:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Lancet gerandomiseerde trial die een kwartdosis viervoudige combinatiepil onderzocht als startbehandeling voor hypertensie. Innovatieve aanpak met lage doseringen van vier antihypertensiva tegelijk.","abstract_original":"BACKGROUND: Globally, most patients with hypertension are treated with monotherapy, and control rates are poor because monotherapy only reduces blood pressure by around 9/5 mm Hg on average. There is a pressing need for blood pressure-control strategies with improved efficacy and tolerability. We aimed to assess whether ultra-low-dose combination therapy could meet these needs. METHODS: We did a randomised, placebo-controlled, double-blind, crossover trial of a quadpill-a single capsule containing four blood pressure-lowering drugs each at quarter-dose (irbesartan 37·5 mg, amlodipine 1·25 mg, hydrochlorothiazide 6·25 mg, and atenolol 12·5 mg). Participants with untreated hypertension were enrolled from four centres in the community of western Sydney, NSW, Australia, mainly by general practitioners. Participants were randomly allocated by computer to either the quadpill or matching placebo for 4 weeks; this treatment was followed by a 2-week washout, then the other study treatment was administered for 4 weeks. Study staff and participants were unaware of treatment allocations, and masking was achieved by use of identical opaque capsules. The primary outcome was placebo-corrected 24-h systolic ambulatory blood pressure reduction after 4 weeks and analysis was by intention to treat. We also did a systematic review of trials evaluating the efficacy and safety of quarter-standard-dose blood pressure-lowering therapy against placebo. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12614001057673. The trial ended after 1 year and this report presents the final analysis. FINDINGS: Between November, 2014, and December, 2015, 55 patients were screened for our randomised trial, of whom 21 underwent randomisation. Mean age of participants was 58 years (SD 11) and mean baseline office and 24-h systolic and diastolic blood pressure levels were 154 (14)/90 (11) mm Hg and 140 (9)/87 (8) mm Hg, respectively. One individual declined participation after randomisation and two patients dropped out for administrative reasons. The placebo-corrected reduction in systolic 24-h blood pressure with the quadpill was 19 mm Hg (95% CI 14-23), and office blood pressure was reduced by 22/13 mm Hg (p<0·0001). During quadpill treatment, 18 (100%) of 18 participants achieved office blood pressure less than 140/90 mm Hg, compared with six (33%) of 18 during placebo treatment (p=0·0013). There were no serious adverse events and all patients reported that the quadpill was easy to swallow. Our systematic review identified 36 trials (n=4721 participants) of one drug at quarter-dose and six trials (n=312) of two drugs at quarter-dose, against placebo. The pooled placebo-corrected blood pressure-lowering effects were 5/2 mm Hg and 7/5 mm Hg, respectively (both p<0·0001), and there were no side-effects from either regimen. INTERPRETATION: The findings of our small trial in the context of previous randomised evidence suggest that the benefits of quarter-dose therapy could be additive across classes and might confer a clinically important reduction in blood pressure. Further examination of the quadpill concept is needed to investigate effectiveness against usual treatment options and longer term tolerability. FUNDING: National Heart Foundation, Australia; University of Sydney; and National Health and Medical Research Council of Australia."},{"id":"fb5a3f7b53ac","type":"article","url":"https://hartvaat.nl/2017/03/07/cva-risico-bij-chronisch-hartfalen-met-behouden-ef-zonder-af-charm-analyse/","title":"CVA-risico bij chronisch hartfalen met behouden EF zonder AF: CHARM-analyse","title_en":"Risk of stroke in chronic heart failure patients with preserved ejection fraction, but without atrial fibrillation: analysis of the CHARM-Preserved and I-Preserve trials.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw509","source_url":"https://doi.org/10.1093/eurheartj/ehw509","authors":["Azmil H Abdul-Rahim","Ana-Cristina Perez","Rachael L MacIsaac","Pardeep S Jhund","Brian L Claggett","Peter E Carson","Michel Komajda","Robert S McKelvie","Michael R Zile","Karl Swedberg","Salim Yusuf","Marc A Pfeffer","Scott D Solomon","Gregory Y H Lip","Kennedy R Lees","John J V McMurray"],"significance":7,"published":"2017-03-07","source_date":"2017-03-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This CHARM analysis examined stroke risk in HFpEF patients without atrial fibrillation, finding a non-negligible stroke rate that raised questions about the potential role of anticoagulation even in AF-free heart failure patients.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de CHARM-trial naar het CVA-risico bij HFpEF-patiënten zonder atriumfibrilleren. Relevant voor de vraag of antistolling geïndiceerd is bij HFpEF zonder AF.","abstract_original":"AIMS: The incidence and predictors of stroke in patients with heart failure and preserved ejection fraction (HF-PEF), but without atrial fibrillation (AF), are unknown. We described the incidence of stroke in HF-PEF patients with and without AF and predictors of stroke in those without AF. METHODS AND RESULTS: We pooled data from the CHARM-Preserved and I-Preserve trials. Using Cox regression, we derived a model for stroke in patients without AF in this cohort and compared its performance with a published model in heart failure patients with reduced ejection fraction (HF-REF)-predictive variables: age, body mass index, New York Heart Association class, history of stroke, and insulin-treated diabetes. The two stroke models were compared and Kaplan-Meier curves for stroke estimated. The risk model was validated in a third HF-PEF trial. Of the 6701 patients, 4676 did not have AF. Stroke occurred in 124 (6.1%) with AF and in 171 (3.7%) without AF (rates 1.80 and 1.00 per 100 patient-years, respectively). There was no difference in performance of the stroke model derived in the HF-PEF cohort and the published HF-REF model (c-index 0.71, 95% confidence interval 0.57-0.84 vs. 0.73, 0.59-0.85, respectively) as the predictive variables overlapped. The model performed well in the validation cohort (0.86, 0.62-0.99). The rate of stroke in patients in the upper third of risk approximated to that in patients with AF (1.60 and 1.80 per 100 patient-years, respectively). CONCLUSIONS: A small number of clinical variables identify a subset of patients with HF-PEF, but without AF, at elevated risk of stroke."},{"id":"de81f9ee1c66","type":"article","url":"https://hartvaat.nl/2017/03/07/lv-global-longitudinal-strain-en-prognose-bij-hartfalen-met-smal-qrs-en-crt/","title":"LV global longitudinal strain en prognose bij hartfalen met smal QRS en CRT","title_en":"Prognostic implications of left ventricular global longitudinal strain in heart failure patients with narrow QRS complex treated with cardiac resynchronization therapy: a subanalysis of the randomized EchoCRT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","nt-probnp"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw506","source_url":"https://doi.org/10.1093/eurheartj/ehw506","authors":["Jeroen J Bax","Victoria Delgado","Peter Sogaard","Jagmeet P Singh","William T Abraham","Jeffrey S Borer","Kenneth Dickstein","Daniel Gras","Josep Brugada","Michele Robertson","Ian Ford","Henry Krum","Johannes Holzmeister","Frank Ruschitzka","John Gorcsan"],"significance":5,"published":"2017-03-07","source_date":"2017-03-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/echocardiografie-bij-hartfalen/"],"congress":"","summary_en":"This study showed that LV global longitudinal strain has prognostic implications in heart failure patients with narrow QRS treated with CRT, potentially identifying responders beyond QRS-width-based selection criteria.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T13:25:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de prognostische implicaties van LV global longitudinal strain bij HF-patiënten met smal QRS behandeld met CRT. Strain als aanvullende risicomarker bij CRT-selectie.","abstract_original":"AIM: Left ventricular (LV) global longitudinal strain (GLS) reflects LV systolic function and correlates inversely with the extent of LV myocardial scar and fibrosis. The present subanalysis of the Echocardiography Guided CRT trial investigated the prognostic value of LV GLS in patients with narrow QRS complex. METHODS AND RESULTS: Left ventricular (LV) global longitudinal strain (GLS) was measured on the apical 2-, 4- and 3-chamber views using speckle tracking analysis. Measurement of baseline LV GLS was feasible in 755 patients (374 with cardiac resynchronization therapy (CRT)-ON and 381 with CRT-OFF). The median value of LV GLS in the overall population was 7.9%, interquartile range 6.2-10.1%. After a mean follow-up period of 19.4 months, 95 patients in the CRT-OFF group and 111 in the CRT-ON group reached the combined primary endpoint of all-cause mortality and heart failure hospitalization. Each 1% absolute unit decrease in LV GLS was independently associated with 11% increase in the risk to reach the primary endpoint (Hazard ratio 1.11; 95% confidence interval 95% 1.04-1.17, P < 0.001), after adjusting for ischaemic cardiomyopathy and randomization treatment among other clinically relevant variables. When categorizing patients according to quartiles of LV GLS, the primary endpoint occurred more frequently in patients in the lowest quartile (<6.2%) treated with CRT-ON vs. CRT-OFF (45.6% vs. 28.7%, P = 0.009) whereas, no differences were observed in patients with LV GLS ≥6.2% treated with CRT-OFF vs. CRT-ON (23.7% vs. 24.5%, respectively; P  = 0.62). CONCLUSION: Low LV GLS is associated with poor outcome in heart failure patients with QRS width <130 ms, independent of randomization to CRT or not. Importantly, in the group of patients with the lowest LV GLS quartile, CRT may have a detrimental effect on clinical outcomes."},{"id":"5b29ef2338f4","type":"article","url":"https://hartvaat.nl/2017/03/07/dieetaanbevelingen-en-gewichtsverlies-en-cardiovasculaire-risicofactoren/","title":"Dieetaanbevelingen en gewichtsverlies en cardiovasculaire risicofactoren","title_en":"Effect of Current Dietary Recommendations on Weight Loss and Cardiovascular Risk Factors.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","aficamten","atleten","biomarkers-cardiovasculair","bradycardie","cardiomyopathie-gerichte-therapie","diabetes-en-hart","diabetes-type-2","farmaco-economie","gedilateerde-cardiomyopathie","hartrevalidatie","hypertrofische-cardiomyopathie","inflammatie","laminopathie","lichaamsbeweging","menopauze","microbioom","mitralisinsufficiëntie","myocardinfarct","obesitas","ouderen","roken","secundaire-preventie","slaapapneu","voeding-hart"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.089","source_url":"https://doi.org/10.1016/j.jacc.2016.10.089","authors":["David J A Jenkins","Beatrice A Boucher","Fredrick D Ashbury","Margaret Sloan","Patrick Brown","Ahmed El-Sohemy","Anthony J Hanley","Walter Willett","Melanie Paquette","Russell J de Souza","Christopher Ireland","Natalie Kwan","Amy Jenkins","Sathish C Pichika","Nancy Kreiger"],"significance":6,"published":"2017-03-07","source_date":"2017-03-07","image":"","kennis":[],"congress":"","summary_en":"This study evaluated the effect of current dietary recommendations emphasizing fruit, vegetables, and whole grains on weight loss and cardiovascular risk factors, comparing different dietary approaches for cardiovascular prevention.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar het effect van de huidige dieetaanbevelingen op gewichtsverlies en cardiovasculaire risicofactoren. Vergelijkt verschillende voedingspatronen op cardiometabole uitkomsten.","abstract_original":"BACKGROUND: Dietary recommendations emphasize increased consumption of fruit, vegetables, and whole grain cereals for prevention of chronic disease. OBJECTIVES: This study assessed the effect of dietary advice and/or food provision on body weight and cardiovascular disease risk factors. METHODS: Healthy overweight men (n = 209) and women (n = 710), mean age 44.7 years, body mass index [BMI] 32.4 kg/m2, were randomized between November 2005 and August 2009 to receive Health Canada's food guide (control, n = 486) or 1 of 3 interventions: dietary advice consistent with both Dietary Approaches to Stop Hypertension (DASH) and dietary portfolio principles (n = 145); weekly food provision reflecting this advice (n = 148); or food delivery plus advice (n = 140). Interventions lasted 6 months with 12-month follow-up. Semiquantitative food frequency questionnaires and fasting blood, anthropometric and blood pressure measurements were obtained at baseline, 6 months, and 18 months. RESULTS: Participant retention at 6 and 18 months was 91% and 81%, respectively, after food provision compared to 67% and 57% when no food was provided (p < 0.0001). Test and control treatments showed small reductions in body weight (-0.8 to -1.2 kg), waist circumference (-1.1 to -1.9 cm), and mean arterial pressure (0.0 to -1.1 mm Hg) at 6 months and Framingham coronary heart disease risk score at 18 months (-0.19 to -0.42%), which were significant overall. Outcomes did not differ among test and control groups. CONCLUSIONS: Provision of foods increased retention but only modestly increased intake of recommended foods. Current dietary recommendations showed small overall benefits in coronary heart disease risk factors. Additional dietary strategies to maximize these benefits are required. (Fruits, Vegetables, and Whole Grains: A Community-based Intervention; NCT00516620)."},{"id":"95d033dd1f7e","type":"article","url":"https://hartvaat.nl/2017/03/07/contractiliteitssensor-geleide-crt-optimalisatie-respond-crt-trial/","title":"Contractiliteitssensor-geleide CRT-optimalisatie: RESPOND-CRT-trial","title_en":"Contractility sensor-guided optimization of cardiac resynchronization therapy: results from the RESPOND-CRT trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["cardiale-resynchronisatie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw526","source_url":"https://doi.org/10.1093/eurheartj/ehw526","authors":["Josep Brugada","Peter Paul Delnoy","Johannes Brachmann","Dwight Reynolds","Luigi Padeletti","Georg Noelker","Charan Kantipudi","José Manuel Rubin Lopez","Wolfgang Dichtl","Alberto Borri-Brunetto","Luc Verhees","Philippe Ritter","Jagmeet P Singh"],"significance":6,"published":"2017-03-07","source_date":"2017-03-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"The RESPOND-CRT trial evaluated contractility sensor-guided CRT optimization, testing whether individualized AV and VV delay programming using a sensor-based algorithm improves response rates in heart failure patients.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T13:25:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"RESPOND-CRT-trial naar optimalisatie van cardiale resynchronisatietherapie met een contractiliteitssensor. Onderzocht of individuele hemodynamische optimalisatie de CRT-respons verbetert.","abstract_original":"AIMS: Although cardiac resynchronization therapy (CRT) is effective in patients with systolic heart failure (HF) and a wide QRS interval, a substantial proportion of patients remain non-responsive. The SonR contractility sensor embedded in the right atrial lead enables individualized automatic optimization of the atrioventricular (AV) and interventricular (VV) timings. The RESPOND-CRT study investigated the safety and efficacy of the contractility sensor system in HF patients undergoing CRT. METHODS AND RESULTS: RESPOND-CRT was a prospective, randomized, double-blinded, multicentre, non-inferiority trial. Patients were randomized (2:1, respectively) to receive weekly, automatic CRT optimization with SonR vs. an Echo-guided optimization of AV and VV timings. The primary efficacy endpoint was the rate of clinical responders (patients alive, without adjudicated HF-related events, with improvement in New York Heart Association class or quality of life), at 12 months. The study randomized 998 patients. Responder rates were 75.0% in the SonR arm and 70.4% in the Echo arm (mean difference, 4.6%; 95% CI, -1.4% to 10.6%; P < 0.001 for non-inferiority margin -10.0%) (Table 2). At an overall mean follow-up of 548 ± 190 days SonR was associated with a 35% risk reduction in HF hospitalization (hazard ratio, 0.65; 95% CI, 0.46-0.92; log-rank P = 0.01). CONCLUSION: Automatic AV and VV optimization using the contractility sensor was safe and as effective as Echo-guided AV and VV optimization in increasing response to CRT. CLINICALTRIALS.GOV NUMBER: NCT01534234."},{"id":"da28034544e7","type":"article","url":"https://hartvaat.nl/2017/03/01/5-jaarsuitkomsten-van-zotarolimus-en-everolimus-eluting-stents-trial-en-real-wor/","title":"5-jaarsuitkomsten van zotarolimus- en everolimus-eluting stents: trial en real-world","title_en":"Five-Year Outcome After Implantation of Zotarolimus- and Everolimus-Eluting Stents in Randomized Trial Participants and Nonenrolled Eligible Patients: A Secondary Analysis of a Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.5190","source_url":"https://doi.org/10.1001/jamacardio.2016.5190","authors":["Clemens von Birgelen","Liefke C van der Heijden","Mounir W Z Basalus","Marlies M Kok","Hanim Sen","Hans W Louwerenburg","K Gert van Houwelingen","Martin G Stoel","Frits H A F de Man","Gerard C M Linssen","Kenneth Tandjung","Carine J M Doggen","Job van der Palen","Marije M Löwik"],"significance":6,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":[],"congress":"","summary_en":"This JAMA Cardiology 5-year comparison of zotarolimus- and everolimus-eluting stents in both randomized trial participants and real-world patients showed equivalent long-term safety and efficacy across these contemporary DES platforms.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T13:25:54Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology vergelijking van 5-jaarsuitkomsten van ZES en EES in gerandomiseerde trialpatiënten en niet-geïncludeerde patiënten. Brug tussen trial-evidence en real-world data.","abstract_original":"IMPORTANCE: Long-term follow-up after a clinical trial of 2 often-used, newer-generation drug-eluting stents (DESs) in a broad patient population is of interest. Comprehensive long-term outcome of eligible nonenrolled patients has never been reported. OBJECTIVE: To assess 5-year safety and efficacy of 2 newer-generation DESs in randomized participants with non-ST-elevation acute coronary syndromes or stable angina and to evaluate long-term outcomes of nonenrolled eligible patients treated with the same DESs. DESIGN, SETTING, AND PARTICIPANTS: The TWENTE (Real-World Endeavor Resolute vs Xience V Drug-Eluting Stent Study in Twente) trial is an investigator-initiated, patient-blinded, randomized, comparative DES trial that enrolled patients from June 18, 2008, to August 26, 2010. Most patients had non-ST-elevation acute coronary syndromes and complex lesions. Of all 1709 eligible patients, 1391 (81.4%) were treated in the TWENTE trial with zotarolimus-eluting (ZES, n = 697) or everolimus-eluting (EES, n = 694) cobalt-chromium stents. The remaining 318 eligible patients (18.6%) were not enrolled but underwent nonrandomized treatment with the same DESs. Data were analyzed from August 26, 2015, to October 11, 2016. Event rates (percentages) were derived from log-rank analysis and may differ from straightforward calculation (nominator/denominator). The 5-year follow-up of the TWENTE participants was prespecified in the trial protocol; that of the nonenrolled participants was ad hoc. MAIN OUTCOMES AND MEASURES: Target vessel failure (TVF), a composite of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization. RESULTS: Of 1709 eligible participants, 1233 (72.1%) were men, 476 (27.9%) were women, and mean (SD) age was 64.6 (10.6) years. Among the 1370 of 1391 TWENTE trial participants (98.5% follow-up), TVF was similar between those in the ZES (16.1%) and EES (18.1%) groups (P = .36). Stent thrombosis rates were low: definite (7 of 697 [1.0%] vs 4 of 694 [0.6%]; P = .37) and occurred after more than 1 year in 3 (0.4%) with ZES vs 4 (0.6%) with EES (P = .69). The 318 nonenrolled eligible patients (308 patients [96.9%] of whom were followed up) were older and had more advanced disease than trial participants. Their TVF rate was higher than that of trial participants (71 of 318 [23.3%] vs 233 of 1391 [17.1%]; P = .02), which partly reflects a difference in cardiac mortality (23 of 318 [7.7%] vs 60 of 1391 [4.5%]; P = .03). Similar 5-year rates were found for myocardial infarction (91 of 1391 [6.7%] vs 22 of 318 [7.2%]; P = .80) and target vessel revascularization (129 of 1391 [9.7%] vs 34 of 318 [11.4%]; P = .36) between trial participants and nonenrolled eligible patients. In all eligible patients (ie, trial participants plus nonenrolled eligible patients), the TVF rate was only slightly higher than in trial participants only (18.3% vs 17.1%). CONCLUSIONS AND RELEVANCE: Long-term outcome data from nonenrolled eligible patients support the validity of the TWENTE trial findings and present, with the trial, a strong case for the long-term safety and efficacy of the newer-generation DESs used. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01066650."},{"id":"3fd3642eb5e4","type":"article","url":"https://hartvaat.nl/2017/03/01/cardiopoietische-celtherapie-bij-gevorderd-ischemisch-hartfalen-c-cure-39-weeksr/","title":"Cardiopoietische celtherapie bij gevorderd ischemisch hartfalen: C-CURE 39-weeksresultaten","title_en":"Cardiopoietic cell therapy for advanced ischaemic heart failure: results at 39 weeks of the prospective, randomized, double blind, sham-controlled CHART-1 clinical trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","emperor-trials","step-hfpef"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw543","source_url":"https://doi.org/10.1093/eurheartj/ehw543","authors":["Jozef Bartunek","Andre Terzic","Beth A Davison","Gerasimos S Filippatos","Slavica Radovanovic","Branko Beleslin","Bela Merkely","Piotr Musialek","Wojciech Wojakowski","Peter Andreka","Ivan G Horvath","Amos Katz","Dariouch Dolatabadi","Badih El Nakadi","Aleksandra Arandjelovic","Istvan Edes","Petar M Seferovic","Slobodan Obradovic","Marc Vanderheyden","Nikola Jagic","Ivo Petrov","Shaul Atar","Majdi Halabi","Valeri L Gelev","Michael K Shochat","Jaroslaw D Kasprzak","Ricardo Sanz-Ruiz","Guy R Heyndrickx","Noémi Nyolczas","Victor Legrand","Antoine Guédès","Alex Heyse","Tiziano Moccetti","Francisco Fernandez-Aviles","Pilar Jimenez-Quevedo","Antoni Bayes-Genis","Jose Maria Hernandez-Garcia","Flavio Ribichini","Marcin Gruchala","Scott A Waldman","John R Teerlink","Bernard J Gersh","Thomas J Povsic","Timothy D Henry","Marco Metra","Roger J Hajjar","Michal Tendera","Atta Behfar","Bertrand Alexandre","Aymeric Seron","Wendy Gattis Stough","Warren Sherman","Gad Cotter","William Wijns"],"significance":6,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":[],"congress":"","summary_en":"The C-CURE trial of cardiopoietic stem cell therapy in advanced ischemic heart failure showed preliminary efficacy signals at 39 weeks, though the improvement in functional capacity requires confirmation in larger trials.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Resultaten na 39 weken van de prospectieve gerandomiseerde dubbelblinde C-CURE-trial naar cardiopoietische celtherapie bij gevorderd ischemisch hartfalen.","abstract_original":"AIMS: Cardiopoietic cells, produced through cardiogenic conditioning of patients' mesenchymal stem cells, have shown preliminary efficacy. The Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial aimed to validate cardiopoiesis-based biotherapy in a larger heart failure cohort. METHODS AND RESULTS: This multinational, randomized, double-blind, sham-controlled study was conducted in 39 hospitals. Patients with symptomatic ischaemic heart failure on guideline-directed therapy (n = 484) were screened; n = 348 underwent bone marrow harvest and mesenchymal stem cell expansion. Those achieving > 24 million mesenchymal stem cells (n = 315) were randomized to cardiopoietic cells delivered endomyocardially with a retention-enhanced catheter (n = 157) or sham procedure (n = 158). Procedures were performed as randomized in 271 patients (n = 120 cardiopoietic cells, n = 151 sham). The primary efficacy endpoint was a Finkelstein-Schoenfeld hierarchical composite (all-cause mortality, worsening heart failure, Minnesota Living with Heart Failure Questionnaire score, 6-min walk distance, left ventricular end-systolic volume, and ejection fraction) at 39 weeks. The primary outcome was neutral (Mann-Whitney estimator 0.54, 95% confidence interval [CI] 0.47-0.61 [value > 0.5 favours cell treatment], P = 0.27). Exploratory analyses suggested a benefit of cell treatment on the primary composite in patients with baseline left ventricular end-diastolic volume 200-370 mL (60% of patients) (Mann-Whitney estimator 0.61, 95% CI 0.52-0.70, P = 0.015). No difference was observed in serious adverse events. One (0.9%) cardiopoietic cell patient and 9 (5.4%) sham patients experienced aborted or sudden cardiac death. CONCLUSION: The primary endpoint was neutral, with safety demonstrated across the cohort. Further evaluation of cardiopoietic cell therapy in patients with elevated end-diastolic volume is warranted."},{"id":"9c2d5b3b042e","type":"article","url":"https://hartvaat.nl/2017/03/01/cryoballon-versus-radiofrequentieablatie-bij-paroxysmaal-af-geactualiseerde-meta/","title":"Cryoballon versus radiofrequentieablatie bij paroxysmaal AF: geactualiseerde meta-analyse","title_en":"Cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: an updated meta-analysis of randomized and observational studies.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["advent-trial","cryoablatie","pulsed-field-ablatie-atriumfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw262","source_url":"https://doi.org/10.1093/europace/euw262","authors":["Alessandra Buiatti","Gesa von Olshausen","Petra Barthel","Simon Schneider","Armin Luik","Bernhard Kaess","Karl-Ludwig Laugwitz","Petra Hoppmann"],"significance":6,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":[],"congress":"","summary_en":"This updated meta-analysis of randomized and observational studies comparing cryoballoon with radiofrequency ablation for paroxysmal AF confirmed equivalent efficacy and safety, supporting both approaches as standard options.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T13:25:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Geactualiseerde meta-analyse van gerandomiseerde en observationele studies die cryoballon vergeleek met RF-ablatie bij paroxysmaal AF. Consolideert het bewijs voor beide energiebronnen.","abstract_original":"AIMS: Radiofrequency (RF) ablation represents a standard of care for pulmonary vein isolation in patients with drug-refractory paroxysmal atrial fibrillation (AF). In this setting, cryoballoon (CB) ablation has emerged as alternative therapy. However, the efficacy and safety of CB vs. RF ablation in patients with paroxysmal AF remain a matter of debate. METHODS AND RESULTS: We searched electronic scientific databases for studies of CB vs. RF ablation in patients with paroxysmal AF. Aggregate data were pooled to perform a meta-analysis. The primary efficacy and safety outcomes were the recurrence of any atrial arrhythmia and procedure-related complications, respectively. A total of 6473 participants from 10 studies (CB, n = 2232 vs. RF, n = 4241) were studied. After a median follow-up of 16 months, the risk of any atrial arrhythmia recurrence (risk ratio, RR 95% confidence interval [95% CI] = 1.01 [0.90-1.14], P = 0.83) and procedure-related complications (RR [95% CI] = 0.92 [0.66-1.28], P = 0.61) were comparable between CB vs. RF ablation. Cryoballoon ablation led to a higher risk of persistent phrenic nerve palsy (RR [95% CI] = 13.60 [3.87-47.81], P < 0.01) and a lower risk of cardiac tamponade (RR [95% CI] = 0.48 [0.25-0.89], P = 0.02) compared with RF ablation. There was a trend of statistically significant interaction between the type of CB and the duration of ablation (P for interaction = 0.09). CONCLUSION: In patients with paroxysmal AF, ablation therapy with CB is associated with efficacy and safety comparable to that of RF. Second-generation CB catheters seem to reduce procedure duration. Further studies are warranted to disclose the impact of second-generation CB catheters compared with RF for ablation of paroxysmal AF."},{"id":"09f6ce4ffbe8","type":"article","url":"https://hartvaat.nl/2017/03/01/bloedmarkers-voor-ablatie-en-af-recidief-meta-analyse/","title":"Bloedmarkers vóór ablatie en AF-recidief: meta-analyse","title_en":"Association of pre-ablation level of potential blood markers with atrial fibrillation recurrence after catheter ablation: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw088","source_url":"https://doi.org/10.1093/europace/euw088","authors":["Hui Jiang","Weizong Wang","Cong Wang","Xinxing Xie","Yinglong Hou"],"significance":5,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":[],"congress":"","summary_en":"This meta-analysis identified pre-ablation blood biomarkers associated with AF recurrence after catheter ablation, including CRP, NT-proBNP, and fibrosis markers, informing patient selection for rhythm control procedures.","created":"2026-07-03T10:26:35Z","updated":"2026-07-03T13:25:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse naar de associatie tussen pre-ablatie bloedmarkers en recidief van AF na katheterablatie. Identificeert potentiële voorspellers voor ablatie-uitkomst.","abstract_original":"AIMS: The meta-analysis was aimed to search for candidate blood markers whose pre-ablation level was associated with atrial fibrillation (AF) recurrence after radiofrequency catheter ablation (RFCA). METHODS AND RESULTS: A systematic literature search of PubMed, EMBASE, Springer Link, Web of Science, Wiley-Cochrane library, and supplemented with Google scholar search engine was performed. Thirty-six studies covering 11 blood markers were qualified for this meta-analysis. Compared with the nonrecurrence group, the recurrence group had increased pre-ablation level of atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), N-terminal pro-brain natriuretic peptide (NT-pro-BNP), interleukin-6 (IL-6), C-reactive protein, low density lipoprotein (LDL), and tissue inhibitor of metal loproteinase-2 (TIMP-2) [standardized mean difference (95% confidence interval): 0.37 (0.13-0.61), 0.77 (0.40-1.14), 1.25 (0.64-1.87), 0.37 (0.21-0.52), 0.35 (0.10-0.60), 0.24 (0.07-0.42), 0.17 (0.00-0.34), respectively], while no statistical difference of pre-ablation level of white blood cell, total cholesterol, triglyceride, and transforming growth factor-β1 was found. Subgroup analysis demonstrated that ANP was associated with AF recurrence in participants who had no concomitant structural heart diseases (SHD); however, not in participants who had SHD, C-reactive protein was associated with AF recurrence in Asian studies, whereas not in European studies. CONCLUSION: Increased pre-ablation level of ANP, BNP, NT-pro-BNP, IL-6, C-reactive protein, LDL, and TIMP-2 was associated with greater risk of AF recurrence after RFCA."},{"id":"1b55ef9137bb","type":"article","url":"https://hartvaat.nl/2017/03/01/vaste-versus-responsieve-pacingfrequentie-bij-permanent-af-met-pacemakerindicati/","title":"Vaste versus responsieve pacingfrequentie bij permanent AF met pacemakerindicatie","title_en":"Effect of fixed-rate vs. rate-RESPONSIve pacing on exercise capacity in patients with permanent, refractory atrial fibrillation and left ventricular dysfunction treated with atrioventricular junction aBLation and bivEntricular pacing (RESPONSIBLE): a prospective, multicentre, randomized, single-blind study.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["cardiale-resynchronisatie"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw035","source_url":"https://doi.org/10.1093/europace/euw035","authors":["Pietro Palmisano","Vittorio Aspromonte","Ernesto Ammendola","Gabriele Dell'era","Matteo Ziacchi","Federico Guerra","Stefano Aquilani","Giampiero Maglia","Giuseppe Del Giorno","Ailia Giubertoni","Giuseppe Boriani","Alessandro Capucci","Renato Pietro Ricci","Michele Accogli"],"significance":5,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/"],"congress":"","summary_en":"This randomized trial compared rate-responsive with fixed-rate pacing after AV junction ablation and biventricular pacing in permanent refractory AF, evaluating whether rate adaptation improves exercise capacity in CRT-treated patients.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T13:25:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die frequentieresponsieve pacing vergeleek met vaste-frequentiepacing bij patiënten met permanent refractair AF en een pacemaker. Onderzoekt het effect op inspanningscapaciteit.","abstract_original":"AIMS: Atrioventricular junction (AVJ) ablation followed by biventricular pacing is an established strategy for improving symptoms and morbidity in patients with permanent atrial fibrillation (AF), reduced left ventricular ejection fraction (LVEF), and uncontrolled ventricular rate. There is no clear evidence that such patients benefit from rate-responsive (RR) pacing. METHODS AND RESULTS: This prospective, randomized, single-blind, multicentre study was designed as an intra-patient comparison and enrolled 60 patients (age 69.5 ± 11.8 years, males 63.3%, NYHA 3.0 ± 0.6) with refractory AF and reduced LVEF (mean 32.4 ± 8.3%) treated with AVJ ablation and biventricular pacing. Two 6-minute walking tests (6MWT) were performed 1 week apart: one during VVI 70/min biventricular pacing and the other during VVIR 70-130/min biventricular pacing; patients were randomly and blindly assigned to Group A (n = 29, first 6MWT in VVIR mode) or B (n = 31, first 6MWT in VVI mode). Rate-responsive activation determined an increase of 18.8 ± 24.4 m in the distance walked during the 6MWT (P < 0.001). The increase was similar in both groups (P = 0.571). A >5% increase in the distance walked was observed in 76.7% of patients. The increase in the distance walked was linearly correlated with the increase in heart rate recorded during the 6MWT in the VVIR mode (r = 0.54; P < 0.001). CONCLUSION: In permanent AF patients with uncontrolled rate and reduced LVEF who had undergone AVJ ablation and biventricular pacing, RR pacing yields a significant gain in exercise capacity, which seems to be related to the RR-induced frequency during effort."},{"id":"7924d4ebcf62","type":"article","url":"https://hartvaat.nl/2017/03/01/24-uurs-bloeddrukmonitoring-bij-renale-denervatie-denerhtn-studie/","title":"24-uurs bloeddrukmonitoring bij renale denervatie: DENERHTN-studie","title_en":"Twenty-Four-Hour Blood Pressure Monitoring to Predict and Assess Impact of Renal Denervation: The DENERHTN Study (Renal Denervation for Hypertension).","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["anemie-ckd","chronische-nierziekte","radiance-htn","renale-denervatie","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08448","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08448","authors":["Philippe Gosse","Antoine Cremer","Helena Pereira","Guillaume Bobrie","Gilles Chatellier","Bernard Chamontin","Pierre-Yves Courand","Pascal Delsart","Thierry Denolle","Caroline Dourmap","Emile Ferrari","Xavier Girerd","Jean Michel Halimi","Daniel Herpin","Pierre Lantelme","Matthieu Monge","Claire Mounier-Vehier","Jean-Jacques Mourad","Olivier Ormezzano","Jean Ribstein","Patrick Rossignol","Marc Sapoval","Bernard Vaïsse","Faiez Zannad","Michel Azizi"],"significance":6,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"The DENERHTN ambulatory blood pressure analysis evaluated 24-hour monitoring as a tool to predict and assess the impact of renal denervation, showing that ambulatory measurements are essential for accurate blood pressure assessment.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Resultaten van de DENERHTN-studie die ambulante bloeddrukmeting gebruikte om het effect van renale denervatie te evalueren en voorspellen. Benadrukt het belang van objectieve bloeddrukmeting.","abstract_original":"UNLABELLED: The DENERHTN trial (Renal Denervation for Hypertension) confirmed the blood pressure (BP) lowering efficacy of renal denervation added to a standardized stepped-care antihypertensive treatment for resistant hypertension at 6 months. We report here the effect of denervation on 24-hour BP and its variability and look for parameters that predicted the BP response. Patients with resistant hypertension were randomly assigned to denervation plus stepped-care treatment or treatment alone (control). Average and standard deviation of 24-hour, daytime, and nighttime BP and the smoothness index were calculated on recordings performed at randomization and 6 months. Responders were defined as a 6-month 24-hour systolic BP reduction ≥20 mm Hg. Analyses were performed on the per-protocol population. The significantly greater BP reduction in the denervation group was associated with a higher smoothness index (P=0.02). Variability of 24-hour, daytime, and nighttime BP did not change significantly from baseline to 6 months in both groups. The number of responders was greater in the denervation (20/44, 44.5%) than in the control group (11/53, 20.8%; P=0.01). In the discriminant analysis, baseline average nighttime systolic BP and standard deviation were significant predictors of the systolic BP response in the denervation group only, allowing adequate responder classification of 70% of the patients. Our results show that denervation lowers ambulatory BP homogeneously over 24 hours in patients with resistant hypertension and suggest that nighttime systolic BP and variability are predictors of the BP response to denervation. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01570777."},{"id":"ab04ddb58e07","type":"article","url":"https://hartvaat.nl/2017/03/01/sacubitril-valsartan-versus-olmesartan-op-centrale-hemodynamiek-bij-ouderen-para/","title":"Sacubitril/valsartan versus olmesartan op centrale hemodynamiek bij ouderen: PARAMETER-studie","title_en":"Effects of Sacubitril/Valsartan Versus Olmesartan on Central Hemodynamics in the Elderly With Systolic Hypertension: The PARAMETER Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["answer-hf","bloeddrukbehandeling","sacubitril-valsartan"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08556","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08556","authors":["Bryan Williams","John R Cockcroft","Kazuomi Kario","Dion H Zappe","Patrick C Brunel","Qian Wang","Weinong Guo"],"significance":7,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hypertensie/geïsoleerde-systolische-hypertensie/"],"congress":"","summary_en":"The PARAMETER study compared sacubitril-valsartan with olmesartan on central hemodynamics in elderly patients with systolic hypertension, showing superior central blood pressure reduction with the ARNI, suggesting potential benefit through reduced central aortic stiffness.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"PARAMETER-studie die het effect van sacubitril/valsartan versus olmesartan op centrale hemodynamiek vergeleek bij oudere patiënten met systolische hypertensie. ARNI als antihypertensivum.","abstract_original":"Effective treatment of systolic hypertension in elderly patients remains a major therapeutic challenge. A multicenter, double-blind, randomized controlled trial with sacubitril/valsartan (LCZ696), a first-in-class angiotensin receptor neprilysin inhibitor, was conducted to determine its effects versus olmesartan (angiotensin receptor blocker) on central aortic pressures, in elderly patients (aged ≥60 years) with systolic hypertension and pulse pressure >60 mm Hg, indicative of arterial stiffness. Patients (n=454; mean age, 67.7 years; mean seated systolic blood pressure, 158.6 mm Hg; mean seated pulse pressure, 69.7 mm Hg) were randomized to receive once-daily sacubitril/valsartan 200 mg or olmesartan 20 mg, force titrated to double the initial doses after 4 weeks, before primary assessment at 12 weeks. The study extended double-blind treatment for 12 to 52 weeks, during which amlodipine (2.5-5 mg) and subsequently hydrochlorothiazide (6.25-25 mg) were added-on for patients not achieving blood pressure target (<140/90). At week 12, sacubitril/valsartan reduced central aortic systolic pressure (primary assessment) greater than olmesartan by -3.7 mm Hg (P=0.010), further corroborated by secondary assessments at week 12 (central aortic pulse pressure, -2.4 mm Hg, P<0.012; mean 24-hour ambulatory brachial systolic blood pressure and central aortic systolic pressure, -4.1 mm Hg and -3.6 mm Hg, respectively, both P<0.001). Differences in 24-hour ambulatory pressures were pronounced during sleep. After 52 weeks, blood pressure parameters were similar between treatments (P<0.002); however, more patients required add-on antihypertensive therapy with olmesartan (47%) versus sacubitril/valsartan (32%; P<0.002). Both treatments were equally well tolerated. The PARAMETER study (Prospective Comparison of Angiotensin Receptor Neprilysin Inhibitor With Angiotensin Receptor Blocker Measuring Arterial Stiffness in the Elderly), for the first time, demonstrated superiority of sacubitril/valsartan versus olmesartan in reducing clinic and ambulatory central aortic and brachial pressures in elderly patients with systolic hypertension and stiff arteries."},{"id":"e96bee6c62cc","type":"article","url":"https://hartvaat.nl/2017/03/01/katheterablatie-als-eerstelijnsbehandeling-bij-paroxysmaal-af-5-jaarsresultaten/","title":"Katheterablatie als eerstelijnsbehandeling bij paroxysmaal AF: 5-jaarsresultaten","title_en":"Long-term efficacy of catheter ablation as first-line therapy for paroxysmal atrial fibrillation: 5-year outcome in a randomised clinical trial.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["katheterablatie"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-309781","source_url":"https://doi.org/10.1136/heartjnl-2016-309781","authors":["Jens Cosedis Nielsen","Arne Johannessen","Pekka Raatikainen","Gerhard Hindricks","Håkan Walfridsson","Steen Michael Pehrson","Anders Englund","Juha Hartikainen","Leif Spange Mortensen","Peter Steen Hansen"],"significance":8,"published":"2017-03-01","source_date":"2017-03-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/esc-richtlijn-af-2024/","https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/"],"congress":"","summary_en":"This 5-year follow-up of a randomized trial showed that catheter ablation as first-line therapy for paroxysmal AF maintained superior rhythm control compared with antiarrhythmic drugs over the long term, providing early evidence for the ablation-first approach.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T13:25:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"5-jaarsfollow-up van een gerandomiseerde trial die katheterablatie als eerste behandeling vergeleek met antiaritmica bij paroxysmaal AF. Langetermijnbewijs voor vroege ablatiestrategie.","abstract_original":"OBJECTIVE: The Medical ANtiarrhythmic Treatment or Radiofrequency Ablation in Paroxysmal Atrial Fibrillation (MANTRA-PAF) trial compared radiofrequency catheter ablation (RFA) with antiarrhythmic drug therapy (AAD) as first-line treatment for paroxysmal atrial fibrillation (AF). Endpoint of ablation was elimination of electrical activity inside pulmonary veins. We present the results of the 5-year follow-up. METHODS: This pre-specified 5-year follow-up included assessment of any AF and symptomatic AF burden by one 7-day Holter recording and quality of life (QoL) assessment, using SF-36 questionnaire physical and mental component scores. Analysis was intention-to-treat. Imputation was used to compensate for missing Holter data. RESULTS: 245 of 294 patients (83%) randomised to RFA (n=125) or AAD (n=120) attended the 5-year follow-up, 227 with Holter recording. Use of class I or III AAD was more frequent in AAD group (N=61 vs 13, p<0.001). More patients in the RFA group were free from AF (126/146 (86%) vs 105/148 (71%), p=0.001, relative risk (RR) 0.82; 95% CI 0.73 to 0.93) and symptomatic AF (137/146 (94%) vs 126/148 (85%), p=0.015, χ2 test, RR 0.91; 95% CI 0.84 to 0.98) in 7-day Holter recording. AF burden was significantly lower in the RFA group (any AF: p=0.003; symptomatic AF: p=0.02). QoL scores did not differ between randomisation groups. QoL scores remained improved from baseline (both components p<0.001), and did not differ from 2-year scores. CONCLUSIONS: At 5 years, the occurrence and burden of any AF and symptomatic AF were significantly lower in the RFA group than in the AAD group. Improved QoL scores observed after 2 years persisted after 5 years without between-group differences. TRIAL REGISTRATION NUMBER: NCT00133211; Results."},{"id":"0a5751aeefb1","type":"article","url":"https://hartvaat.nl/2017/02/28/myocardiaal-herstel-bij-systolisch-hartfalen-met-auto-antilichamen-tegen-1-adren/","title":"Myocardiaal herstel bij systolisch hartfalen met auto-antilichamen tegen β1-adrenerge receptoren","title_en":"Myocardial Recovery in Patients With Systolic Heart Failure and Autoantibodies Against β1-Adrenergic Receptors.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["bisoprolol","carvedilol","hfref"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.11.067","source_url":"https://doi.org/10.1016/j.jacc.2016.11.067","authors":["Yuji Nagatomo","Dennis M McNamara","Jeffrey D Alexis","Leslie T Cooper","G William Dec","Daniel F Pauly","Richard Sheppard","Randall C Starling","W H Wilson Tang"],"significance":6,"published":"2017-02-28","source_date":"2017-02-28","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/palliatief-hartfalen/"],"congress":"","summary_en":"This study examined myocardial recovery in heart failure patients with autoantibodies against beta-1 adrenergic receptors, exploring an autoimmune mechanism that may identify a reversible subpopulation of dilated cardiomyopathy.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T18:38:31Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die myocardiaal herstel onderzocht bij HF-patiënten met auto-antilichamen tegen bèta-1-adrenerge receptoren. Onderzoekt een immunologisch subtype van hartfalen met potentieel voor gerichte therapie.","abstract_original":"BACKGROUND: Among various cardiac autoantibodies (AAbs), those recognizing the β1-adrenergic receptor (β1AR) demonstrate agonist-like effects and induce myocardial damage that can be reversed by β-blockers and immunoglobulin G3 (IgG3) immunoadsorption. OBJECTIVES: The goal of this study was to investigate the role of β1AR-AAbs belonging to the IgG3 subclass in patients with recent-onset cardiomyopathy. METHODS: Peripheral blood samples were drawn at enrollment in patients with recent-onset cardiomyopathy (left ventricular ejection fraction [LVEF] ≤0.40; <6 months). The presence of IgG and IgG3-β1AR-AAb was determined, and echocardiograms were assessed, at baseline and 6 months. Patients were followed up for ≤48 months. RESULTS: Among the 353 patients who had blood samples adequate for the analysis, 62 (18%) were positive for IgG3-β1AR-AAbs (IgG3 group), 58 (16%) were positive for IgG but not IgG3 (non-IgG3 group), and the remaining were negative. There were no significant differences in baseline systolic blood pressure, heart rate, or LVEF among the groups at baseline. Left ventricular end-diastolic and end-systolic diameters were significantly larger in the non-IgG3 group compared with the other groups (left ventricular end-diastolic diameter, p < 0.01; left ventricular end-systolic diameter, p = 0.03). At 6 months, LVEF was significantly higher in the IgG3 group (p = 0.007). Multiple regression analysis showed that IgG3-β1AR-AAb was an independent predictor of LVEF at 6 months and change in LVEF over 6 months, even after multivariable adjustment (LVEF at 6 months, β = 0.20, p = 0.01; change in LVEF, β = 0.20, p = 0.008). In patients with high New York Heart Association functional class (III or IV) at baseline, the IgG3 group had a lower incidence of the composite endpoint of all-cause death, cardiac transplantation, and hospitalization due to heart failure, whereas the non-IgG3 group had the highest incidence of the composite endpoint. CONCLUSIONS: IgG3-β1AR-AAbs were associated with more favorable myocardial recovery in patients with recent-onset cardiomyopathy."},{"id":"f8e5a3809887","type":"article","url":"https://hartvaat.nl/2017/02/28/hoog-intensieve-intervaltraining-bij-hartfalen-met-verminderde-ejectiefractie/","title":"Hoog-intensieve intervaltraining bij hartfalen met verminderde ejectiefractie","title_en":"High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hartrevalidatie","hfpef","hfref","step-hfpef"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.022924","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.022924","authors":["Øyvind Ellingsen","Martin Halle","Viviane Conraads","Asbjørn Støylen","Håvard Dalen","Charles Delagardelle","Alf-Inge Larsen","Torstein Hole","Alessandro Mezzani","Emeline M Van Craenenbroeck","Vibeke Videm","Paul Beckers","Jeffrey W Christle","Ephraim Winzer","Norman Mangner","Felix Woitek","Robert Höllriegel","Axel Pressler","Tea Monk-Hansen","Martin Snoer","Patrick Feiereisen","Torstein Valborgland","John Kjekshus","Rainer Hambrecht","Stephan Gielen","Trine Karlsen","Eva Prescott","Axel Linke"],"significance":7,"published":"2017-02-28","source_date":"2017-02-28","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"This study compared high-intensity interval training with moderate continuous training and standard care in HFrEF, finding that HIIT did not provide additional benefit in reversing cardiac remodeling or improving functional capacity beyond moderate exercise.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de effecten van hoog-intensieve intervaltraining (HIIT) op functionele capaciteit en cardiale functie bij HFrEF-patiënten. Onderzoekt de veiligheid en werkzaamheid van intensieve training.","abstract_original":"BACKGROUND: Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). METHODS: Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. RESULTS: Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT (P=0.45); left ventricular end-diastolic diameter changes compared with RRE were -2.8 mm (-5.2 to -0.4 mm; P=0.02) in HIIT and -1.2 mm (-3.6 to 1.2 mm; P=0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake (P=0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P=0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. CONCLUSIONS: HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00917046."},{"id":"885fe443d746","type":"article","url":"https://hartvaat.nl/2017/02/21/fibrinogeenconcentraat-bij-intraoperatief-bloedverlies-tijdens-hoog-risico-hartc/","title":"Fibrinogeenconcentraat bij intraoperatief bloedverlies tijdens hoog-risico hartchirurgie: JAMA-trial","title_en":"Effect of Fibrinogen Concentrate on Intraoperative Blood Loss Among Patients With Intraoperative Bleeding During High-Risk Cardiac Surgery: A Randomized Clinical Trial.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"JAMA","doi":"10.1001/jama.2016.21037","source_url":"https://doi.org/10.1001/jama.2016.21037","authors":["Süleyman Bilecen","Joris A H de Groot","Cor J Kalkman","Alexander J Spanjersberg","George J Brandon Bravo Bruinsma","Karel G M Moons","Arno P Nierich"],"significance":7,"published":"2017-02-21","source_date":"2017-02-21","image":"","kennis":["https://hartvaat.nl/kennis/vasculair/vaatchirurgie-perioperatief-cardiologisch-beleid/"],"congress":"","summary_en":"This JAMA trial showed that fibrinogen concentrate did not reduce intraoperative blood loss during high-risk cardiac surgery compared with placebo, arguing against routine empiric use of this hemostatic agent.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T13:25:53Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA gerandomiseerde trial naar het effect van fibrinogeenconcentraat op intraoperatief bloedverlies bij hoogrisico hartchirurgie met intraoperatieve bloeding.","abstract_original":"IMPORTANCE: Fibrinogen concentrate might partly restore coagulation defects and reduce intraoperative bleeding. OBJECTIVE: To determine whether fibrinogen concentrate infusion dosed to achieve a plasma fibrinogen level of 2.5 g/L in high-risk cardiac surgery patients with intraoperative bleeding reduces intraoperative blood loss. DESIGN, SETTING, AND PARTICIPANTS: A randomized, placebo-controlled, double-blind clinical trial conducted in Isala Zwolle, the Netherlands (February 2011-January 2015), involving patients undergoing elective, high-risk cardiac surgery (ie, combined coronary artery bypass graft [CABG] surgery and valve repair or replacement surgery, the replacement of multiple valves, aortic root reconstruction, or reconstruction of the ascending aorta or aortic arch) with intraoperative bleeding (blood volume between 60 and 250 mL suctioned from the thoracic cavity in a period of 5 minutes) were randomized to receive either fibrinogen concentrate or placebo. INTERVENTIONS: Intravenous, single-dose administration of fibrinogen concentrate (n = 60) or placebo (n = 60), targeted to achieve a postinfusion plasma fibrinogen level of 2.5 g/L. MAIN OUTCOMES AND MEASURES: The primary outcome was blood loss in milliliters between intervention (ie, after removal of cardiopulmonary bypass) and closure of chest. Safety variables (within 30 days) included: in-hospital mortality, myocardial infarction, cerebrovascular accident or transient ischemic attack, renal insufficiency or failure, venous thromboembolism, pulmonary embolism, and operative complications. RESULTS: Among 120 patients (mean age; 71 [SD, 10] years, 37 women [31%]) included in the study, combined CABG and valve repair or replacement surgery comprised 72% of procedures and had a mean (SD) cardiopulmonary bypass time of 200 minutes (83) minutes. For the primary outcome, median blood loss in the fibrinogen group was 50 mL (interquartile range [IQR], 29-100 mL) compared with 70 mL (IQR, 33-145 mL) in the control group (P = .19), the absolute difference 20 mL (95% CI, -13 to 35 mL). There were 6 cases of stroke or transient ischemic attack (4 in the fibrinogen group); 4 myocardial infarctions (3 in the fibrinogen group); 2 deaths (both in the fibrinogen group); 5 cases with renal insufficiency or failure (3 in the fibrinogen group); and 9 cases with reoperative thoracotomy (4 in the fibrinogen group). CONCLUSIONS AND RELEVANCE: Among patients with intraoperative bleeding during high-risk cardiac surgery, administration of fibrinogen concentrate, compared with placebo, resulted in no significant difference in the amount of intraoperative blood loss. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01124981 and EudraCT No: 2009-018086-12."},{"id":"28994f37bed2","type":"article","url":"https://hartvaat.nl/2017/02/21/diabetesstatus-en-cardiovasculaire-uitkomsten-bij-hfpef-klinische-en-echocardiog/","title":"Diabetesstatus en cardiovasculaire uitkomsten bij HFpEF: klinische en echocardiografische kenmerken","title_en":"Clinical and Echocardiographic Characteristics and Cardiovascular Outcomes According to Diabetes Status in Patients With Heart Failure and Preserved Ejection Fraction: A Report From the I-Preserve Trial (Irbesartan in Heart Failure With Preserved Ejection Fraction).","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","biomarkers-cardiovasculair","diabetes-en-hart","diabetes-type-1","diabetes-type-2","echocardiografie","fidelio-dkd","figaro-dkd","hfpef","hypertrofische-cardiomyopathie","nt-probnp","obesitas","ouderen","slaapapneu","soul-trial","step-hfpef","summit-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024593","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024593","authors":["Søren L Kristensen","Ulrik M Mogensen","Pardeep S Jhund","Mark C Petrie","David Preiss","Sithu Win","Lars Køber","Robert S McKelvie","Michael R Zile","Inder S Anand","Michel Komajda","John S Gottdiener","Peter E Carson","John J V McMurray"],"significance":6,"published":"2017-02-21","source_date":"2017-02-21","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This analysis examined how diabetes modifies clinical characteristics, echocardiographic findings, and cardiovascular outcomes in patients with HFpEF, showing that diabetic HFpEF may represent a distinct pathophysiological phenotype.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar de invloed van diabetes op klinische kenmerken, echocardiografische bevindingen en cardiovasculaire uitkomsten bij HFpEF-patiënten. Diabetes verergert de prognose bij behouden ejectiefractie.","abstract_original":"BACKGROUND: In patients with heart failure and preserved ejection fraction, little is known about the characteristics of, and outcomes in, those with and without diabetes mellitus. METHODS: We examined clinical and echocardiographic characteristics and outcomes in the I-Preserve trial (Irbesartan in Heart Failure With Preserved Ejection Fraction) according to history of diabetes mellitus. Cox regression models were used to estimate hazard ratios for cardiovascular outcomes adjusted for known predictors, including age, sex, natriuretic peptides, and comorbidity. Echocardiographic data were available in 745 patients and were additionally adjusted for in supplementary analyses. RESULTS: Overall, 1134 of 4128 patients (27%) had diabetes mellitus. Compared with those without diabetes mellitus, they were more likely to have a history of myocardial infarction (28% versus 22%), higher body mass index (31 versus 29 kg/m2), worse Minnesota Living With Heart Failure score (48 versus 40), higher median N-terminal pro-B-type natriuretic peptide concentration (403 versus 320 pg/mL; all P<0.01), more signs of congestion, but no significant difference in left ventricular ejection fraction. Patients with diabetes mellitus had a greater left ventricular mass and left atrial area than patients without diabetes mellitus. Doppler E-wave velocity (86 versus 76 cm/s; P<0.0001) and the E/e' ratio (11.7 versus 10.4; P=0.010) were higher in patients with diabetes mellitus. Over a median follow-up of 4.1 years, cardiovascular death or heart failure hospitalization occurred in 34% of patients with diabetes mellitus versus 22% of those without diabetes mellitus (adjusted hazard ratio, 1.75; 95% confidence interval, 1.49-2.05), and 28% versus 19% of patients with and without diabetes mellitus died (adjusted hazard ratio, 1.59; confidence interval, 1.33-1.91). CONCLUSIONS: In heart failure with preserved ejection fraction, patients with diabetes mellitus have more signs of congestion, worse quality of life, higher N-terminal pro-B-type natriuretic peptide levels, and a poorer prognosis. They also display greater structural and functional echocardiographic abnormalities. Further investigation is needed to determine the mediators of the adverse impact of diabetes mellitus on outcomes in heart failure with preserved ejection fraction and whether they are modifiable. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00095238."},{"id":"1ea1b10d60c1","type":"article","url":"https://hartvaat.nl/2017/02/21/genetische-obesitas-en-risico-op-atriumfibrilleren-mendeliaanse-randomisatie/","title":"Genetische obesitas en risico op atriumfibrilleren: Mendeliaanse randomisatie","title_en":"Genetic Obesity and the Risk of Atrial Fibrillation: Causal Estimates from Mendelian Randomization.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","internist"],"tags":["obesitas"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024921","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024921","authors":["Neal A Chatterjee","Franco Giulianini","Bastiaan Geelhoed","Kathryn L Lunetta","Jeffrey R Misialek","Maartje N Niemeijer","Michiel Rienstra","Lynda M Rose","Albert V Smith","Dan E Arking","Patrick T Ellinor","Jan Heeringa","Honghuang Lin","Steven A Lubitz","Elsayed Z Soliman","Niek Verweij","Alvaro Alonso","Emelia J Benjamin","Vilmundur Gudnason","Bruno H C Stricker","Pim Van Der Harst","Daniel I Chasman","Christine M Albert"],"significance":7,"published":"2017-02-21","source_date":"2017-02-21","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/chadsvasc-score/"],"congress":"","summary_en":"This Mendelian randomization study provided causal evidence that genetically determined higher BMI increases the risk of atrial fibrillation, establishing obesity as a modifiable causal risk factor for AF development.","created":"2026-07-03T10:26:34Z","updated":"2026-07-03T13:25:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die met Mendeliaanse randomisatie causale schattingen biedt voor het verband tussen genetisch bepaalde obesitas en het risico op AF. Bevestigt obesitas als causale risicofactor voor boezemfibrilleren.","abstract_original":"BACKGROUND: Observational studies have identified an association between body mass index (BMI) and incident atrial fibrillation (AF). Inferring causality from observational studies, however, is subject to residual confounding, reverse causation, and bias. The primary objective of this study was to evaluate the causal association between BMI and AF by using genetic predictors of BMI. METHODS: We identified 51 646 individuals of European ancestry without AF at baseline from 7 prospective population-based cohorts initiated between 1987 and 2002 in the United States, Iceland, and the Netherlands with incident AF ascertained between 1987 and 2012. Cohort-specific mean follow-up ranged from 7.4 to 19.2 years, over which period there was a total of 4178 cases of incident AF. We performed a Mendelian randomization with instrumental variable analysis to estimate a cohort-specific causal hazard ratio for the association between BMI and AF. Two genetic instruments for BMI were used: FTO genotype (rs1558902) and a BMI gene score comprising 39 single-nucleotide polymorphisms identified by genome-wide association studies to be associated with BMI. Cohort-specific estimates were combined by random-effects, inverse variance-weighted meta-analysis. RESULTS: In age- and sex-adjusted meta-analysis, both genetic instruments were significantly associated with BMI (FTO: 0.43 [95% confidence interval, 0.32-0.54] kg/m2 per A-allele, P<0.001; BMI gene score: 1.05 [95% confidence interval, 0.90-1.20] kg/m2 per 1-U increase, P<0.001) and incident AF (FTO, hazard ratio, 1.07 [1.02-1.11] per A-allele, P=0.004; BMI gene score, hazard ratio, 1.11 [1.05-1.18] per 1-U increase, P<0.001). Age- and sex-adjusted instrumental variable estimates for the causal association between BMI and incident AF were hazard ratio, 1.15 (1.04-1.26) per kg/m2, P=0.005 (FTO) and 1.11 (1.05-1.17) per kg/m2, P<0.001 (BMI gene score). Both of these estimates were consistent with the meta-analyzed estimate between observed BMI and AF (age- and sex-adjusted hazard ratio 1.05 [1.04-1.06] per kg/m2, P<0.001). Multivariable adjustment did not significantly change findings. CONCLUSIONS: Our data are consistent with a causal relationship between BMI and incident AF. These data support the possibility that public health initiatives targeting primordial prevention of obesity may reduce the incidence of AF."},{"id":"df426aba6ba6","type":"article","url":"https://hartvaat.nl/2017/02/16/bariatrische-chirurgie-versus-intensieve-medicamenteuze-therapie-bij-diabetes-5-/","title":"Bariatrische chirurgie versus intensieve medicamenteuze therapie bij diabetes: 5-jaarsresultaten NEJM","title_en":"Bariatric Surgery versus Intensive Medical Therapy for Diabetes - 5-Year Outcomes.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","obesitas","select-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1600869","source_url":"https://doi.org/10.1056/NEJMoa1600869","authors":["Philip R Schauer","Deepak L Bhatt","John P Kirwan","Kathy Wolski","Ali Aminian","Stacy A Brethauer","Sankar D Navaneethan","Rishi P Singh","Claire E Pothier","Steven E Nissen","Sangeeta R Kashyap"],"significance":9,"published":"2017-02-16","source_date":"2017-02-16","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/risicofactoren-cardiovasculair/"],"congress":"","summary_en":"The 5-year outcomes from the STAMPEDE trial confirmed the superiority of bariatric surgery over intensive medical therapy for glycemic control in patients with type 2 diabetes and obesity, with higher rates of diabetes remission and better cardiovascular risk profiles. These long-term data cemented metabolic surgery as a durable diabetes treatment option.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T13:25:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM 5-jaarsresultaten die de superioriteit van bariatrische chirurgie boven intensieve medicamenteuze therapie bevestigen voor glycemische controle bij obesitasgerelateerde diabetes. Langetermijnvoordelen op cardiometabole risicofactoren.","abstract_original":"BACKGROUND: Long-term results from randomized, controlled trials that compare medical therapy with surgical therapy in patients with type 2 diabetes are limited. METHODS: We assessed outcomes 5 years after 150 patients who had type 2 diabetes and a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 27 to 43 were randomly assigned to receive intensive medical therapy alone or intensive medical therapy plus Roux-en-Y gastric bypass or sleeve gastrectomy. The primary outcome was a glycated hemoglobin level of 6.0% or less with or without the use of diabetes medications. RESULTS: Of the 150 patients who underwent randomization, 1 patient died during the 5-year follow-up period; 134 of the remaining 149 patients (90%) completed 5 years of follow-up. At baseline, the mean (±SD) age of the 134 patients was 49±8 years, 66% were women, the mean glycated hemoglobin level was 9.2±1.5%, and the mean BMI was 37±3.5. At 5 years, the criterion for the primary end point was met by 2 of 38 patients (5%) who received medical therapy alone, as compared with 14 of 49 patients (29%) who underwent gastric bypass (unadjusted P=0.01, adjusted P=0.03, P=0.08 in the intention-to-treat analysis) and 11 of 47 patients (23%) who underwent sleeve gastrectomy (unadjusted P=0.03, adjusted P=0.07, P=0.17 in the intention-to-treat analysis). Patients who underwent surgical procedures had a greater mean percentage reduction from baseline in glycated hemoglobin level than did patients who received medical therapy alone (2.1% vs. 0.3%, P=0.003). At 5 years, changes from baseline observed in the gastric-bypass and sleeve-gastrectomy groups were superior to the changes seen in the medical-therapy group with respect to body weight (-23%, -19%, and -5% in the gastric-bypass, sleeve-gastrectomy, and medical-therapy groups, respectively), triglyceride level (-40%, -29%, and -8%), high-density lipoprotein cholesterol level (32%, 30%, and 7%), use of insulin (-35%, -34%, and -13%), and quality-of-life measures (general health score increases of 17, 16, and 0.3; scores on the RAND 36-Item Health Survey ranged from 0 to 100, with higher scores indicating better health) (P<0.05 for all comparisons). No major late surgical complications were reported except for one reoperation. CONCLUSIONS: Five-year outcome data showed that, among patients with type 2 diabetes and a BMI of 27 to 43, bariatric surgery plus intensive medical therapy was more effective than intensive medical therapy alone in decreasing, or in some cases resolving, hyperglycemia. (Funded by Ethicon Endo-Surgery and others; STAMPEDE ClinicalTrials.gov number, NCT00432809 .)."},{"id":"6242bf65e3b3","type":"article","url":"https://hartvaat.nl/2017/02/14/doac-s-bij-af-met-kleplijden-excl-significante-mitralisstenose-meta-analyse/","title":"DOAC's bij AF met kleplijden (excl. significante mitralisstenose): meta-analyse","title_en":"Direct Oral Anticoagulants in Patients With Atrial Fibrillation and Valvular Heart Disease Other Than Significant Mitral Stenosis and Mechanical Valves: A Meta-Analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.026793","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.026793","authors":["Konstantinos C Siontis","Xiaoxi Yao","Bernard J Gersh","Peter A Noseworthy"],"significance":8,"published":"2017-02-14","source_date":"2017-02-14","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis confirmed the safety and efficacy of DOACs in atrial fibrillation patients with valvular heart disease other than significant mitral stenosis or mechanical heart valves, supporting DOAC use in the broad spectrum of 'valvular' AF.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T13:25:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die de veiligheid en werkzaamheid van DOAC's bevestigt bij AF-patiënten met klepafwijkingen anders dan significante mitralisstenose of mechanische klepprothese. Verruimt de DOAC-indicatie.","abstract_original":""},{"id":"980110432713","type":"article","url":"https://hartvaat.nl/2017/02/14/mediterraan-dieet-verbetert-hdl-functie-bij-hoog-cardiovasculair-risico-gerandom/","title":"Mediterraan dieet verbetert HDL-functie bij hoog cardiovasculair risico: gerandomiseerde trial","title_en":"Mediterranean Diet Improves High-Density Lipoprotein Function in High-Cardiovascular-Risk Individuals: A Randomized Controlled Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["diabetes-en-hart","diabetes-type-2","ezetimibe","figaro-dkd","hdl-cholesterol","obesitas","roken","select-trial","soul-trial","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.023712","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.023712","authors":["Álvaro Hernáez","Olga Castañer","Roberto Elosua","Xavier Pintó","Ramón Estruch","Jordi Salas-Salvadó","Dolores Corella","Fernando Arós","Lluis Serra-Majem","Miquel Fiol","Manuel Ortega-Calvo","Emilio Ros","Miguel Ángel Martínez-González","Rafael de la Torre","M Carmen López-Sabater","Montserrat Fitó"],"significance":7,"published":"2017-02-14","source_date":"2017-02-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/hdl-functie-en-reverse-cholesterol/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This randomized trial from the PREDIMED study showed that a Mediterranean diet not only raises HDL cholesterol levels but also improves HDL functionality including cholesterol efflux capacity and antioxidant properties, providing mechanistic insight into the diet's cardiovascular benefit.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T13:25:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die aantoont dat een mediterraan dieet niet alleen het HDL-cholesterolniveau maar ook de HDL-functionaliteit verbetert bij personen met hoog cardiovasculair risico.","abstract_original":"BACKGROUND: The biological functions of high-density lipoproteins (HDLs) contribute to explaining the cardioprotective role of the lipoprotein beyond quantitative HDL cholesterol levels. A few small-scale interventions with a single antioxidant have improved some HDL functions. However, to date, no long-term, large-scale, randomized controlled trial has been conducted to assess the effects of an antioxidant-rich dietary pattern (such as a traditional Mediterranean diet [TMD]) on HDL function in humans. METHODS: This study was performed in a random subsample of volunteers from the PREDIMED Study (Prevención con Dieta Mediterránea; n=296) after a 1-year intervention. We compared the effects of 2 TMDs, one enriched with virgin olive oil (TMD-VOO; n=100) and the other enriched with nuts (TMD-Nuts; n=100), with respect to a low-fat control diet (n=96). We assessed the effects of both TMDs on the role of HDL particles on reverse cholesterol transport (cholesterol efflux capacity, HDL ability to esterify cholesterol, and cholesteryl ester transfer protein activity), HDL antioxidant properties (paraoxonase-1 arylesterase activity and total HDL antioxidant capacity on low-density lipoproteins), and HDL vasodilatory capacity (HDL ability to induce the release of nitric oxide in endothelial cells). We also studied the effects of a TMD on several HDL quality-related characteristics (HDL particle oxidation, resistance against oxidative modification, main lipid and protein composition, and size distribution). RESULTS: Both TMDs increased cholesterol efflux capacity relative to baseline (P=0.018 and P=0.013 for TMD-VOO and TMD-Nuts, respectively). The TMD-VOO intervention decreased cholesteryl ester transfer protein activity (relative to baseline, P=0.028) and increased HDL ability to esterify cholesterol, paraoxonase-1 arylesterase activity, and HDL vasodilatory capacity (relative to control, P=0.039, P=0.012, and P=0.026, respectively). Adherence to a TMD induced these beneficial changes by improving HDL oxidative status and composition. The 3 diets increased the percentage of large HDL particles (relative to baseline, P<0.001). CONCLUSIONS: The TMD, especially when enriched with virgin olive oil, improved HDL atheroprotective functions in humans. CLINICAL TRIAL REGISTRATION: URL: http://www.controlled-trials.com. Unique identifier: ISRCTN35739639."},{"id":"e79420da0b0d","type":"article","url":"https://hartvaat.nl/2017/02/14/cholesterolniveaus-en-de-rol-bij-het-identificeren-van-statinenontvangers/","title":"Cholesterolniveaus en de rol bij het identificeren van statinenontvangers","title_en":"Cholesterol Levels Should Play a More Important Role in Identifying Statin Recipients.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","huisarts","internist"],"tags":["anemie-ckd","dyslipidemie","ezetimibe","familiaire-hypercholesterolemie-screening","hdl-cholesterol","ldl-cholesterol","lipide-aferese","lipidenverlaging","lipoproteïne-a","lipoproteïne-a-therapeutisch-doel","niet-statine-therapie","obicetrapib","pcsk9-remmers","rosuvastatine","statines"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.022146","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.022146","authors":["Paul N Durrington","Handrean Soran"],"significance":6,"published":"2017-02-14","source_date":"2017-02-14","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/lipiden/lipidenmedicatie-bij-ckd/"],"congress":"","summary_en":"This analysis argued that cholesterol levels should play a more prominent role in identifying statin candidates, advocating for a lipid-based rather than purely risk-based approach to primary prevention treatment decisions.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T13:25:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die pleit voor een grotere rol van cholesterolniveaus bij het selecteren van patiënten voor statinetherapie. Relevant voor het debat tussen risicoscore-gebaseerde versus lipide-gebaseerde indicatiestelling.","abstract_original":""},{"id":"4a542d81b800","type":"article","url":"https://hartvaat.nl/2017/02/14/laaggedoseerde-aspirine-voor-primaire-cardiovasculaire-preventie-bij-diabetes-ty/","title":"Laaggedoseerde aspirine voor primaire cardiovasculaire preventie bij diabetes type 2: 10-jaarsfollow-up","title_en":"Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: 10-Year Follow-Up of a Randomized Controlled Trial.","category":"preventie","category_label":"Preventie","professions":["cardioloog","huisarts","internist"],"tags":["aspirine","diabetes-en-hart","diabetes-type-2","figaro-dkd","select-trial"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.025760","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.025760","authors":["Yoshihiko Saito","Sadanori Okada","Hisao Ogawa","Hirofumi Soejima","Mio Sakuma","Masafumi Nakayama","Naofumi Doi","Hideaki Jinnouchi","Masako Waki","Izuru Masuda","Takeshi Morimoto"],"significance":7,"published":"2017-02-14","source_date":"2017-02-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/","https://hartvaat.nl/kennis/cardiometabool/diabetes-type-1-en-hart/"],"congress":"","summary_en":"This 10-year follow-up of low-dose aspirin for primary prevention in type 2 diabetes showed that any initial cardiovascular benefit diminished over time while bleeding risk accumulated, contributing to the evidence against routine aspirin use in primary prevention.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T13:25:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"10-jaarsfollow-up van een gerandomiseerde trial naar laaggedoseerde aspirine voor primaire preventie bij diabetes type 2. Langetermijndata over de balans tussen ischemisch voordeel en bloedingsrisico.","abstract_original":"BACKGROUND: The long-term efficacy and safety of low-dose aspirin for primary prevention of cardiovascular events in patients with type 2 diabetes mellitus are still inconclusive. METHODS: The JPAD trial (Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes) was a randomized, open-label, standard care-controlled trial examining whether low-dose aspirin affected cardiovascular events in 2539 Japanese patients with type 2 diabetes mellitus and without preexisting cardiovascular disease. Patients were randomly allocated to receive aspirin (81 or 100 mg daily; aspirin group) or no aspirin (no-aspirin group) in the JPAD trial. After that trial ended in 2008, we followed up with the patients until 2015, with no attempt to change the previously assigned therapy. Primary end points were cardiovascular events, including sudden death, fatal or nonfatal coronary artery disease, fatal or nonfatal stroke, and peripheral vascular disease. For the safety analysis, hemorrhagic events, consisting of gastrointestinal bleeding, hemorrhagic stroke, and bleeding from any other sites, were also analyzed. The primary analysis was conducted for cardiovascular events among patients who retained their original allocation (a per-protocol cohort). Analyses on an intention-to-treat cohort were conducted for hemorrhagic events and statistical sensitivity. RESULTS: The median follow-up period was 10.3 years; 1621 patients (64%) were followed up throughout the study; and 2160 patients (85%) retained their original allocation. Low-dose aspirin did not reduce cardiovascular events in the per-protocol cohort (hazard ratio, 1.14; 95% confidence interval, 0.91-1.42). Multivariable Cox proportional hazard model adjusted for age, sex, glycemic control, kidney function, smoking status, hypertension, and dyslipidemia showed similar results (hazard ratio, 1.04; 95% confidence interval, 0.83-1.30), with no heterogeneity of efficacy in subgroup analyses stratified by each of these factors (all interaction P>0.05). Sensitivity analyses on the intention-to-treat cohort yielded consistent results (hazard ratio, 1.01; 95% confidence interval, 0.82-1.25). Gastrointestinal bleeding occurred in 25 patients (2%) in the aspirin group and 12 (0.9%) in the no-aspirin group (P=0.03), and the incidence of hemorrhagic stroke was not different between groups. CONCLUSIONS: Low-dose aspirin did not affect the risk for cardiovascular events but increased risk for gastrointestinal bleeding in patients with type 2 diabetes mellitus in a primary prevention setting. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00110448."},{"id":"03653a871fc1","type":"article","url":"https://hartvaat.nl/2017/02/07/doodsoorzaken-bij-hartfalen-met-behouden-ejectiefractie/","title":"Doodsoorzaken bij hartfalen met behouden ejectiefractie","title_en":"Mode of Death in Heart Failure With Preserved Ejection Fraction.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","dapa-hf","hfmref","hfpef","hfref","hypertrofische-cardiomyopathie","myocardinfarct","ouderen","slaapapneu","step-hfpef","summit-trial","vrouwen"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.078","source_url":"https://doi.org/10.1016/j.jacc.2016.10.078","authors":["Muthiah Vaduganathan","Ravi B Patel","Alexander Michel","Sanjiv J Shah","Michele Senni","Mihai Gheorghiade","Javed Butler"],"significance":7,"published":"2017-02-07","source_date":"2017-02-07","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/wat-is-hartfalen/","https://hartvaat.nl/kennis/hartfalen/hfpef-hartfalen-met-behouden-ejectie/"],"congress":"","summary_en":"This analysis characterized specific modes of death in HFpEF patients, revealing that non-cardiovascular causes (particularly non-cardiac) account for a larger proportion of deaths in HFpEF compared with HFrEF, informing the understanding of this heterogeneous syndrome.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van de specifieke doodsoorzaken bij HFpEF-patiënten. In tegenstelling tot HFrEF wordt de mortaliteit bij HFpEF meer gedomineerd door niet-cardiovasculaire oorzaken.","abstract_original":"Little is known about specific modes of death in patients with heart failure with preserved ejection fraction (HFpEF). Herein, the authors critically appraise the current state of data and offer potential future directions. They conducted a systematic review of 1,608 published HFpEF papers from January 1, 1985, to December 31, 2015, which yielded 8 randomized clinical trials and 24 epidemiological studies with mode-of-death data. Noncardiovascular modes of death represent an important competing risk in HFpEF. Although sudden death accounted for ∼25% to 30% of deaths in trials, its definition is nonspecific; it is unclear what proportion represents arrhythmic deaths. Moving forward, reporting and definitions of modes of death must be standardized and tailored to the HFpEF population. Broad-scale systematic autopsies and long-term rhythm monitoring may clarify the underlying pathology and mechanisms driving mortal events. There is an unmet need for a longitudinal multicenter, global registry of patients with HFpEF to map its natural history."},{"id":"3dc19c1410ed","type":"article","url":"https://hartvaat.nl/2017/02/07/acc-aats-aha-2016-criteria-voor-gepaste-coronaire-revascularisatie-bij-acs-en-st/","title":"ACC/AATS/AHA 2016 criteria voor gepaste coronaire revascularisatie bij ACS en stabiel coronairlijden","title_en":"ACC/AATS/AHA/ASE/ASNC/SCAI/SCCT/STS 2016 Appropriate Use Criteria for Coronary Revascularization in Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and the Society of Thoracic Surgeons.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["acuut-coronair-syndroom"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.034","source_url":"https://doi.org/10.1016/j.jacc.2016.10.034","authors":["Manesh R Patel","John H Calhoon","Gregory J Dehmer","James Aaron Grantham","Thomas M Maddox","David J Maron","Peter K Smith"],"significance":8,"published":"2017-02-07","source_date":"2017-02-07","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/pci-percutane-coronaire-interventie/","https://hartvaat.nl/kennis/coronairlijden/cabg-bypasschirurgie/"],"congress":"","summary_en":"These updated appropriate use criteria for coronary revascularization provided consensus recommendations on the appropriateness of PCI and CABG across various clinical scenarios in both acute coronary syndromes and stable ischemic heart disease.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T13:25:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Appropriate use criteria voor coronaire revascularisatie met geüpdatete aanbevelingen voor PCI en CABG bij zowel ACS als stabiel coronairlijden. Standaardwerk voor indicatiestelling.","abstract_original":"The American College of Cardiology, Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, and American Association for Thoracic Surgery, along with key specialty and subspecialty societies, have completed a 2-part revision of the appropriate use criteria (AUC) for coronary revascularization. In prior coronary revascularization AUC documents, indications for revascularization in acute coronary syndromes (ACS) and stable ischemic heart disease were combined into 1 document. To address the expanding clinical indications for coronary revascularization, and in an effort to align the subject matter with the most current American College of Cardiology/American Heart Association guidelines, the new AUC for coronary artery revascularization were separated into 2 documents addressing ACS and stable ischemic heart disease individually. This document presents the AUC for ACS. Clinical scenarios were developed to mimic patient presentations encountered in everyday practice and included information on symptom status, presence of clinical instability or ongoing ischemic symptoms, prior reperfusion therapy, risk level as assessed by noninvasive testing, fractional flow reserve testing, and coronary anatomy. This update provides a reassessment of clinical scenarios that the writing group felt to be affected by significant changes in the medical literature or gaps from prior criteria. The methodology used in this update is similar to the initial document but employs the recent modifications in the methods for developing AUC, most notably, alterations in the nomenclature for appropriate use categorization. A separate, independent rating panel scored the clinical scenarios on a scale of 1 to 9. Scores of 7 to 9 indicate that revascularization is considered appropriate for the clinical scenario presented. Scores of 1 to 3 indicate that revascularization is considered rarely appropriate for the clinical scenario, whereas scores in the mid-range (4 to 6) indicate that coronary revascularization may be appropriate for the clinical scenario. Seventeen clinical scenarios were developed by a writing committee and scored by the rating panel: 10 were identified as appropriate, 6 as may be appropriate, and 1 as rarely appropriate. As seen with the prior coronary revascularization AUC, revascularization in clinical scenarios with ST-segment elevation myocardial infarction and non–ST-segment elevation myocardial infarction were considered appropriate. Likewise, clinical scenarios with unstable angina and intermediate- or high-risk features were deemed appropriate. Additionally, the management of nonculprit artery disease and the timing of revascularization are now also rated. The primary objective of the AUC is to provide a framework for the assessment of practice patterns that will hopefully improve physician decision making."},{"id":"0f2d4af9d33c","type":"article","url":"https://hartvaat.nl/2017/02/02/intrapericardiale-lvad-bij-gevorderd-hartfalen-nejm/","title":"Intrapericardiale LVAD bij gevorderd hartfalen: NEJM","title_en":"Intrapericardial Left Ventricular Assist Device for Advanced Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["acuut-hartfalen","hartkatheterisatie","ijzersuppletie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1602954","source_url":"https://doi.org/10.1056/NEJMoa1602954","authors":["Joseph G Rogers","Francis D Pagani","Antone J Tatooles","Geetha Bhat","Mark S Slaughter","Emma J Birks","Steven W Boyce","Samer S Najjar","Valluvan Jeevanandam","Allen S Anderson","Igor D Gregoric","Hari Mallidi","Katrin Leadley","Keith D Aaronson","O H Frazier","Carmelo A Milano"],"significance":8,"published":"2017-02-02","source_date":"2017-02-02","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/","https://hartvaat.nl/kennis/hartfalen/esc-richtlijn-hartfalen-2021/"],"congress":"","summary_en":"This NEJM study reported on a newer intrapericardial LVAD designed for less invasive implantation, representing the next generation of miniaturized mechanical circulatory support devices for advanced heart failure.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-publicatie over een nieuwe intrapericardiale LVAD voor gevorderd hartfalen. Miniatuurisatie en minder invasieve implantatie als volgende stap in mechanische ondersteuning.","abstract_original":"BACKGROUND: Mechanical circulatory support with a left ventricular assist device (LVAD) is an established treatment for patients with advanced heart failure. We compared a newer LVAD design (a small intrapericardial centrifugal-flow device) against existing technology (a commercially available axial-flow device) in patients with advanced heart failure who were ineligible for heart transplantation. METHODS: We conducted a multicenter randomized trial involving 446 patients who were assigned, in a 2:1 ratio, to the study (centrifugal-flow) device or the control (axial-flow) device. Adults who met contemporary criteria for LVAD implantation for permanent use were eligible to participate in the trial. The primary end point was survival at 2 years free from disabling stroke or device removal for malfunction or failure. The trial was powered to show noninferiority with a margin of 15 percentage points. RESULTS: The intention-to treat-population included 297 participants assigned to the study device and 148 participants assigned to the control device. The primary end point was achieved in 164 patients in the study group and 85 patients in the control group. The analysis of the primary end point showed noninferiority of the study device relative to the control device (estimated success rates, 55.4% and 59.1%, respectively, calculated by the Weibull model; absolute difference, 3.7 percentage points; 95% upper confidence limit, 12.56 percentage points; P=0.01 for noninferiority). More patients in the control group than in the study group had device malfunction or device failure requiring replacement (16.2% vs. 8.8%), and more patients in the study group had strokes (29.7% vs. 12.1%). Quality of life and functional capacity improved to a similar degree in the two groups. CONCLUSIONS: In this trial involving patients with advanced heart failure who were ineligible for heart transplantation, a small, intrapericardial, centrifugal-flow LVAD was found to be noninferior to an axial-flow LVAD with respect to survival free from disabling stroke or device removal for malfunction or failure. (Funded by HeartWare; ENDURANCE ClinicalTrials.gov number, NCT01166347 .)."},{"id":"7beda83dd11c","type":"article","url":"https://hartvaat.nl/2017/02/02/volledig-magnetisch-zwevende-circulatoire-pomp-bij-gevorderd-hartfalen-nejm-mome/","title":"Volledig magnetisch zwevende circulatoire pomp bij gevorderd hartfalen: NEJM MOMENTUM 3","title_en":"A Fully Magnetically Levitated Circulatory Pump for Advanced Heart Failure.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["pathfinder-trial"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1610426","source_url":"https://doi.org/10.1056/NEJMoa1610426","authors":["Mandeep R Mehra","Yoshifumi Naka","Nir Uriel","Daniel J Goldstein","Joseph C Cleveland","Paolo C Colombo","Mary N Walsh","Carmelo A Milano","Chetan B Patel","Ulrich P Jorde","Francis D Pagani","Keith D Aaronson","David A Dean","Kelly McCants","Akinobu Itoh","Gregory A Ewald","Douglas Horstmanshof","James W Long","Christopher Salerno"],"significance":10,"published":"2017-02-02","source_date":"2017-02-02","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/lvad-ventrikelondersteunende-systemen/"],"congress":"","summary_en":"The MOMENTUM 3 trial demonstrated that the HeartMate 3, a fully magnetically levitated centrifugal-flow LVAD, was superior to the axial-flow HeartMate II in patients with advanced heart failure, with significantly fewer pump thrombosis events and reoperation. This established the HeartMate 3 as the standard of care in mechanical circulatory support.","created":"2026-07-03T10:26:33Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM MOMENTUM 3-trial van de HeartMate 3 LVAD — volledig magnetisch zwevende pomp bij gevorderd hartfalen. Superieur aan eerdere generaties met significant minder pomptrombose.","abstract_original":"BACKGROUND: Continuous-flow left ventricular assist systems increase the rate of survival among patients with advanced heart failure but are associated with the development of pump thrombosis. We investigated the effects of a new magnetically levitated centrifugal continuous-flow pump that was engineered to avert thrombosis. METHODS: We randomly assigned patients with advanced heart failure to receive either the new centrifugal continuous-flow pump or a commercially available axial continuous-flow pump. Patients could be enrolled irrespective of the intended goal of pump support (bridge to transplantation or destination therapy). The primary end point was a composite of survival free of disabling stroke (with disabling stroke indicated by a modified Rankin score >3; scores range from 0 to 6, with higher scores indicating more severe disability) or survival free of reoperation to replace or remove the device at 6 months after implantation. The trial was powered for noninferiority testing of the primary end point (noninferiority margin, -10 percentage points). RESULTS: Of 294 patients, 152 were assigned to the centrifugal-flow pump group and 142 to the axial-flow pump group. In the intention-to-treat population, the primary end point occurred in 131 patients (86.2%) in the centrifugal-flow pump group and in 109 (76.8%) in the axial-flow pump group (absolute difference, 9.4 percentage points; 95% lower confidence boundary, -2.1 [P<0.001 for noninferiority]; hazard ratio, 0.55; 95% confidence interval [CI], 0.32 to 0.95 [two-tailed P=0.04 for superiority]). There were no significant between-group differences in the rates of death or disabling stroke, but reoperation for pump malfunction was less frequent in the centrifugal-flow pump group than in the axial-flow pump group (1 [0.7%] vs. 11 [7.7%]; hazard ratio, 0.08; 95% CI, 0.01 to 0.60; P=0.002). Suspected or confirmed pump thrombosis occurred in no patients in the centrifugal-flow pump group and in 14 patients (10.1%) in the axial-flow pump group. CONCLUSIONS: Among patients with advanced heart failure, implantation of a fully magnetically levitated centrifugal-flow pump was associated with better outcomes at 6 months than was implantation of an axial-flow pump, primarily because of the lower rate of reoperation for pump malfunction. (Funded by St. Jude Medical; MOMENTUM 3 ClinicalTrials.gov number, NCT02224755 .)."},{"id":"e2ad17036090","type":"article","url":"https://hartvaat.nl/2017/02/01/vernakalant-versus-ibutilide-voor-sinusritme-bij-recent-onset-af-gerandomiseerde/","title":"Vernakalant versus ibutilide voor sinusritme bij recent-onset AF: gerandomiseerde trial","title_en":"Vernakalant is superior to ibutilide for achieving sinus rhythm in patients with recent-onset atrial fibrillation: a randomized controlled trial at the emergency department.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["apotheker","cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw052","source_url":"https://doi.org/10.1093/europace/euw052","authors":["Alexander Simon","Jan Niederdoeckl","Ekaterini Skyllouriotis","Nikola Schuetz","Harald Herkner","Christoph Weiser","Anton N Laggner","Hans Domanovits","Alexander O Spiel"],"significance":6,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"This randomized trial showed that vernakalant is superior to ibutilide for achieving sinus rhythm in patients with recent-onset atrial fibrillation, providing head-to-head comparative data for intravenous cardioversion agents.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die aantoont dat vernakalant superieur is aan ibutilide voor het bereiken van sinusritme bij patiënten met recent-onset AF.","abstract_original":"AIMS: Ibutilide is a rapid-acting antiarrhythmic drug with worldwide use for conversion of recent-onset atrial fibrillation. Vernakalant, approved in the EU in 2010, is likewise used intravenously, with proven efficacy and safety compared with placebo and amiodarone in randomized clinical trials. The aim of our study was to compare the time to conversion and the conversion rate within 90 min in patients with recent-onset atrial fibrillation treated with vernakalant or ibutilide. METHODS AND RESULTS: A randomized controlled trial registered at clinicaltrials.gov (NCT01447862) was performed in 100 patients with recent-onset atrial fibrillation treated at the emergency department of a tertiary care hospital. Patients received up to two short infusions of vernakalant (n = 49; 3 mg/kg followed by 2 mg/kg if necessary) or ibutilide (n = 51; 1 mg followed by another 1 mg if necessary) according to the manufacturer's instructions. Clinical and laboratory variables, adverse events, conversion rates, and time to conversion were recorded. Time to conversion of AF to sinus rhythm was significantly shorter in the vernakalant group compared with the ibutilide group (median time: 10 vs. 26 min, P = 0.01), and likewise the conversion success within 90 min was significantly higher in the vernakalant group (69 vs. 43%, log-rank P = 0.002). No serious adverse events occurred. CONCLUSION: Vernakalant was superior to ibutilide in converting recent-onset atrial fibrillation to sinus rhythm in the emergency department setting."},{"id":"1d11c39b5243","type":"article","url":"https://hartvaat.nl/2017/02/01/ehra-eacpr-positiedocument-beheer-van-patienten-met-af-en-acute-coronaire-events/","title":"EHRA/EACPR positiedocument: beheer van patiënten met AF en acute coronaire events","title_en":"European Heart Rhythm Association (EHRA)/European Association of Cardiovascular Prevention and Rehabilitation (EACPR) position paper on how to prevent atrial fibrillation endorsed by the Heart Rhythm Society (HRS) and Asia Pacific Heart Rhythm Society (APHRS).","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["acuut-coronair-syndroom","acuut-hartfalen"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw242","source_url":"https://doi.org/10.1093/europace/euw242","authors":["Bulent Gorenek","Antonio Pelliccia","Emelia J Benjamin","Giuseppe Boriani","Harry J Crijns","Richard I Fogel","Isabelle C Van Gelder","Martin Halle","Gulmira Kudaiberdieva","Deirdre A Lane","Torben Bjerregaard Larsen","Gregory Y H Lip","Maja-Lisa Løchen","Francisco Marín","Josef Niebauer","Prashanthan Sanders","Lale Tokgozoglu","Marc A Vos","David R Van Wagoner","Laurent Fauchier","Irina Savelieva","Andreas Goette","Stefan Agewall","Chern-En Chiang","Márcio Figueiredo","Martin Stiles","Timm Dickfeld","Kristen Patton","Massimo Piepoli","Ugo Corra","Pedro Manuel Marques-Vidal","Pompilio Faggiano","Jean-Paul Schmid","Ana Abreu"],"significance":7,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":[],"congress":"","summary_en":"This EHRA/EACPR joint position paper provided recommendations for managing patients with concurrent atrial fibrillation and acute coronary syndromes, addressing the complex intersection of anticoagulation and antiplatelet therapy.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gemeenschappelijk positiedocument over het management van patiënten met zowel AF als acuut coronair syndroom. Geeft aanbevelingen voor de complexe antitromboticabalans.","abstract_original":""},{"id":"3ce1dc0a3d0d","type":"article","url":"https://hartvaat.nl/2017/02/01/reductie-van-onnodige-ventriculaire-pacing-en-klinische-uitkomsten-bij-behouden-/","title":"Reductie van onnodige ventriculaire pacing en klinische uitkomsten bij behouden LV-functie","title_en":"Reduction in unnecessary ventricular pacing fails to affect hard clinical outcomes in patients with preserved left ventricular function: a meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","bradycardie","cardiale-resynchronisatie","hypertrofische-cardiomyopathie","laminopathie","linkerbundeltakpacing","lvad","rechterventrikelfalen","supraventriculaire-tachycardie","ventriculaire-tachycardie","ventrikelfibrilleren"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw221","source_url":"https://doi.org/10.1093/europace/euw221","authors":["Mohammed Shurrab","Jeff S Healey","Saleem Haj-Yahia","Anna Kaoutskaia","Giuseppe Boriani","Aldo Carrizo","Gianluca Botto","David Newman","Luigi Padeletti","Stuart J Connolly","Eugene Crystal"],"significance":5,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This meta-analysis showed that reduction in unnecessary right ventricular pacing through device algorithms does not improve hard clinical endpoints in patients with preserved LV function, questioning the clinical impact of pacing minimization.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die aantoont dat reductie van onnodige rechterkamerpacing niet leidt tot verbetering van harde klinische eindpunten bij patiënten met behouden LV-functie.","abstract_original":"AIMS: Several pacing modalities across multiple manufacturers have been introduced to minimize unnecessary right ventricular pacing. We conducted a meta-analysis to assess whether ventricular pacing reduction modalities (VPRM) influence hard clinical outcomes in comparison to standard dual-chamber pacing (DDD). METHODS AND RESULTS: An electronic search was performed using Cochrane Central Register, PubMed, Embase, and Scopus. Only randomized controlled trials (RCT) were included in this analysis. Outcomes of interest included: frequency of ventricular pacing (VP), incident persistent/permanent atrial fibrillation (PerAF), all-cause hospitalization and all-cause mortality. Odds ratios (OR) were reported for dichotomous variables. Seven RCTs involving 4119 adult patients were identified. Ventricular pacing reduction modalities were employed in 2069 patients: (MVP, Medtronic Inc.) in 1423 and (SafeR, Sorin CRM, Clamart) in 646 patients. Baseline demographics and clinical characteristics were similar between VPRM and DDD groups. The mean follow-up period was 2.5 ± 0.9 years. Ventricular pacing reduction modalities showed uniform reduction in VP in comparison to DDD groups among all individual studies. The incidence of PerAF was similar between both groups {8 vs. 10%, OR 0.84 [95% confidence interval (CI) 0.57; 1.24], P = 0.38}. Ventricular pacing reduction modalities showed no significant differences in comparison to DDD for all-cause hospitalization or all-cause mortality [9 vs. 11%, OR 0.82 (95% CI 0.65; 1.03), P= 0.09; 6 vs. 6%, OR 0.97 (95% CI 0.74; 1.28), P = 0.84, respectively]. CONCLUSION: Novel VPRM measures effectively reduce VP in comparison to standard DDD. When actively programmed, VPRM did not improve clinical outcomes and were not superior to standard DDD programming in reducing incidence of PerAF, all-cause hospitalization, or all-cause mortality."},{"id":"ff8259e272c0","type":"article","url":"https://hartvaat.nl/2017/02/01/stapsgewijze-massascreening-op-af-met-nt-probnp-strokestop-ii-studieontwerp/","title":"Stapsgewijze massascreening op AF met NT-proBNP: STROKESTOP II studieontwerp","title_en":"Stepwise mass screening for atrial fibrillation using N-terminal pro b-type natriuretic peptide: the STROKESTOP II study design.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts"],"tags":["nt-probnp","primaire-preventie","summit-trial"],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw319","source_url":"https://doi.org/10.1093/europace/euw319","authors":["Johan Engdahl","Emma Svennberg","Leif Friberg","Faris Al-Khalili","Viveka Frykman","Katrin Kemp Gudmundsdottir","Tove Fredriksson","Mårten Rosenqvist"],"significance":6,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":[],"congress":"","summary_en":"This protocol paper described the STROKESTOP II study design for stepwise AF screening using NT-proBNP as a pre-selection tool before intensive ECG monitoring, establishing the methodology for this biomarker-enriched screening approach.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studieprotocol van de STROKESTOP II-trial die een stapsgewijze screeningsstrategie voor AF onderzoekt met NT-proBNP als voorselectie. Innovatieve benadering voor AF-opsporing in de bevolking.","abstract_original":"AIM: Atrial fibrillation (AF) is the most prevalent clinical arrhythmia and a major risk factor for ischaemic stroke. Treatment with oral anticoagulants (OACs) reduces the risk of stroke by two thirds in AF patients with risk factors. Due to its often paroxysmal and asymptomatic presentation, AF is sometimes challenging to diagnose. So far, AF screening studies have applied opportunistic or systematic screening, most often using a single 12-lead electrocardiogram (ECG) recording or ambulatory ECG. We hypothesise that the biomarker N-terminal pro b-type natriuretic peptide (NT-proBNP) is a valuable adjunct in population based AF screening. METHODS: We are conducting a randomized population-based study on AF screening using ambulatory ECG recording where the decision to use prolonged intermittent ECG recording is directed by NT-proBNP levels, the STROKESTOP II trial. The entire population of inhabitants 75 or 76 years of age (n = 28 712) in the capital region of Sweden will be randomized 1:1 to intervention or control group. In the intervention group NT-proBNP will be analysed in all without previously known AF. Those with NT-proBNP ≤ 125 pg/L will make a single one lead ECG recording, participants with NTproBNP ≥ 125 np/L will be instructed to record ECG for 30 s at least twice daily for 2 weeks with a handheld ambulatory ECG recorder. Participants with newly diagnosed or undertreated AF will be referred to a cardiologist and offered OAC treatment. Primary endpoint is incidence of stroke or systemic embolus, during a 5 year follow-up period in the control group vs the group invited to screening."},{"id":"87ecd2e943fa","type":"article","url":"https://hartvaat.nl/2017/02/01/cangrelor-versus-gpiib-iiia-remmers-ischemie-en-bloedingsrisico-s-vergeleken/","title":"Cangrelor versus GPIIb/IIIa-remmers: ischemie- en bloedingsrisico's vergeleken","title_en":"Evaluation of Ischemic and Bleeding Risks Associated With 2 Parenteral Antiplatelet Strategies Comparing Cangrelor With Glycoprotein IIb/IIIa Inhibitors: An Exploratory Analysis From the CHAMPION Trials.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["abelacimab"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.4556","source_url":"https://doi.org/10.1001/jamacardio.2016.4556","authors":["Muthiah Vaduganathan","Robert A Harrington","Gregg W Stone","Efthymios N Deliargyris","Ph Gabriel Steg","C Michael Gibson","Christian W Hamm","Matthew J Price","Alberto Menozzi","Jayne Prats","Steven Elkin","Kenneth W Mahaffey","Harvey D White","Deepak L Bhatt"],"significance":6,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/","https://hartvaat.nl/kennis/cardiometabool/diabetes-en-cardiovasculair-risico/"],"congress":"","summary_en":"This JAMA Cardiology analysis compared the ischemic and bleeding risks of cangrelor versus glycoprotein IIb/IIIa inhibitors during PCI, providing comparative data for these two parenteral antiplatelet strategies.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse die de ischemie- en bloedingsrisico's vergeleek van twee parenterale antiplaatjesstrategieën: cangrelor versus GPIIb/IIIa-remmers bij PCI.","abstract_original":"IMPORTANCE: In the context of contemporary pharmacotherapy, optimal antiplatelet management with percutaneous coronary intervention (PCI) has not been well established. OBJECTIVE: To compare the ischemic and bleeding risks associated with glycoprotein IIb/IIIa inhibitors (GPIs) and a potent P2Y12 antagonist, cangrelor, in patients undergoing PCI. DESIGN, SETTING, AND PARTICIPANTS: An exploratory analysis of pooled patient-level data from the 3 phase 3 Cangrelor vs Standard Therapy to Achieve Optimal Management of Platelet Inhibition (CHAMPION PCI, CHAMPION PLATFORM, and CHAMPION PHOENIX) trials of patients undergoing elective or nonelective PCI. The participants included 10 929 patients assigned to cangrelor but not receiving GPIs (cangrelor alone) and 1211 patients assigned to clopidogrel (or placebo) and receiving routine GPIs (clopidogrel-GPI). Patients requiring bailout or rescue GPI therapy were excluded. To account for risk imbalances, 1:1 propensity score matching based on 16 baseline clinical variables yielded 1021 unique matched pairs. The present study's data analysis was conducted from October 28, 2015, to August 6, 2016. MAIN OUTCOMES AND MEASURES: The primary efficacy end point was the composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 hours. Safety was assessed by 3 validated bleeding scales (Global Use of Strategies to Open Occluded Coronary Arteries [GUSTO], Thrombolysis in Myocardial Infarction [TIMI], and Acute Catheterization and Urgent Intervention Triage) and requirement for blood transfusions. RESULTS: Of the 12 140 patients included in the analysis, 8779 were men (72.3%), and the mean (SD) age was 63.2 (11.3) years. Patients in the clopidogrel-GPI group were more likely to be male (75.6% vs 71.9%), younger (median, 60 [range, 23-91] years vs 64 [range, 26-95] years), enrolled from the United States (77.9% vs 40.0%), and present with an acute coronary syndrome, but they had lower comorbid disease burden and were less likely to receive bivalirudin (8.8% vs 27.3%). In the matched cohorts, the rates of the primary efficacy end point were not significantly different between the cangrelor alone and clopidogrel-GPI groups (2.6% vs 3.3%; odds ratio [OR], 0.79; 95% CI, 0.48-1.32). There was a nonsignificant trend toward lower rates of GUSTO-defined severe/life-threatening bleeding with cangrelor alone compared with clopidogrel-GPI (0.3% vs 0.7%; OR, 0.43; 95% CI, 0.11-1.66). Rates of TIMI-defined major or minor bleeding were significantly lower in patients treated with cangrelor alone (0.7% vs 2.4%; OR, 0.29; 95% CI, 0.13-0.68). CONCLUSIONS AND RELEVANCE: Based on a pooled analysis from the 3 phase 3 CHAMPION trials, cangrelor alone was associated with similar ischemic risk and lower risk-adjusted bleeding risk compared with clopidogrel-GPIs. TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00305162, NCT00385138, and NCT01156571."},{"id":"d17149344f1e","type":"article","url":"https://hartvaat.nl/2017/02/01/bereikte-bloeddruk-en-cardiovasculaire-uitkomsten-bij-oudere-patienten-met-geiso/","title":"Bereikte bloeddruk en cardiovasculaire uitkomsten bij oudere patiënten met geïsoleerde systolische hypertensie","title_en":"On-Treatment Blood Pressure and Cardiovascular Outcomes in Older Adults With Isolated Systolic Hypertension.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog","huisarts","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","bradycardie","diabetes-en-hart","diabetes-type-2","farmaco-economie","hfpef","hypertrofische-cardiomyopathie","laminopathie","myocardinfarct","obesitas","ouderen","perifeer-vaatlijden","richtlijnen-esc","secundaire-preventie","slaapapneu","stabiel-coronairlijden","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08600","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08600","authors":["Yuichiro Yano","Hiromi Rakugi","George L Bakris","Donald M Lloyd-Jones","Suzanne Oparil","Takao Saruta","Kazuyuki Shimada","Hiroaki Matsuoka","Yutaka Imai","Toshio Ogihara"],"significance":7,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/af-bij-ouderen/"],"congress":"","summary_en":"This analysis examined optimal on-treatment blood pressure targets in older adults with isolated systolic hypertension, investigating the J-curve phenomenon and the risk of overtreatment in this vulnerable population.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar optimale streefwaarden bij ouderen met geïsoleerde systolische hypertensie. Onderzoekt de J-curve en het risico van overbehandeling bij deze veelvoorkomende aandoening.","abstract_original":"UNLABELLED: Our aim was to assess optimal on-treatment blood pressure (BP) at which cardiovascular disease (CVD) and all-cause mortality risks are minimized in Japanese older adults with isolated systolic hypertension. We used data from the VALISH study (Valsartan in Elderly Isolated Systolic Hypertension) that recruited older adults (n=3035; mean age, 76 years) with systolic BP (SBP) of ≥160 mm Hg and diastolic BP of <90 mm Hg. Patients were treated by valsartan. Patients were also categorized into 3 groups based on achieved on-treatment SBP of <130 mm Hg (n=317), 130 to <145 mm Hg (n=2025), or ≥145 mm Hg (n=693). The primary outcome was composite CVD (coronary heart disease, stroke, heart failure, cardiovascular deaths, other vascular diseases, and kidney diseases) with secondary outcome being all-cause mortality. Cox proportional hazards models were used to assess the CVD risk for each group. Over a median 3-year follow-up (8022 person-years), 93 CVD events and 52 deaths occurred. Using the on-treatment SBP of 130 to <145 mm Hg as reference stratum, the multivariable-adjusted hazard ratios and 95% confidence intervals of CVD and all-cause mortality risks for those with SBP<130 mm Hg were 2.08 (1.12-3.83) and 2.09 (0.93-4.71) and for those with SBP≥145 mm Hg were 2.29 (1.44-3.62) and 2.51 (1.35-4.66), respectively. On-treatment diastolic BP yielded no relationships with CVD or all-cause mortality risk. In conclusion, among Japanese older adults with isolated systolic hypertension, SBP in the range between 130 and 144 mm Hg was associated with minimal adverse outcomes and a reduction in CVD and all-cause mortality. The BP range will need to be confirmed in randomized controlled trials. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00151229."},{"id":"1cdf29df694a","type":"article","url":"https://hartvaat.nl/2017/02/01/urinezuurverlagende-middelen-en-endotheelfunctie-gerandomiseerde-trial/","title":"Urinezuurverlagende middelen en endotheelfunctie: gerandomiseerde trial","title_en":"Effect of Uric Acid-Lowering Agents on Endothelial Function: A Randomized, Double-Blind, Placebo-Controlled Trial.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["fidelio-dkd","figaro-dkd","flow-trial"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08488","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08488","authors":["Lea Borgi","Ciaran McMullan","Ann Wohlhueter","Gary C Curhan","Naomi D Fisher","John P Forman"],"significance":6,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/laboratoriumonderzoek-bij-hypertensie/","https://hartvaat.nl/kennis/hypertensie/ace-remmers-hypertensie/"],"congress":"","summary_en":"This randomized placebo-controlled trial showed that uric acid-lowering agents improve endothelial function in hyperuricemic overweight and obese adults, supporting the concept that uric acid contributes to vascular dysfunction and hypertension.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Dubbelblinde gerandomiseerde placebogecontroleerde trial naar het effect van urinezuurverlaging op endotheelfunctie bij hyperurikemie. Onderzoekt of urinezuur een behandelbare vasculaire risicofactor is.","abstract_original":"Higher levels of serum uric acid are independently associated with endothelial dysfunction, a mechanism for incident hypertension. Overweight/obese individuals are more prone to endothelial dysfunction than their lean counterparts. However, the effect of lowering serum uric acid on endothelial dysfunction in these individuals has not been examined thoroughly. In this randomized, double-blind, placebo-controlled trial of nonhypertensive, overweight, or obese individuals with higher serum uric acid (body mass index ≥25 kg/m2 and serum uric acid ≥5.0 mg/dL), we assigned subjects to probenecid (500-1000 mg/d), allopurinol (300-600 mg/d), or matching placebo. The primary outcome was endothelium-dependent vasodilation measured by brachial artery ultrasound at baseline and 8 weeks. By the end of the trial, 47, 49, and 53 participants had been allocated to receive probenecid, allopurinol, and placebo, respectively. Mean serum uric acid levels significantly decreased in the probenecid (from 6.1 to 3.5 mg/dL) and allopurinol groups (from 6.1 to 2.9 mg/dL) but not in the placebo group (6.1 to 5.6 mg/dL). None of the interventions produced any significant change in endothelium-dependent vasodilation (probenecid, 7.4±5.1% at baseline and 8.3±5.1% at 8 weeks; allopurinol, 7.6±6.0% at baseline and 6.2±4.8% at 8 weeks; and placebo, 6.5±3.8% at baseline and 7.1±4.9% at 8 weeks). In this randomized, double-blind, placebo-controlled trial, uric acid lowering did not affect endothelial function in overweight or obese nonhypertensive individuals. These data do not support the hypothesis that uric acid is causally related to endothelial dysfunction, a potential mechanism for development of hypertension."},{"id":"1a61481e773c","type":"article","url":"https://hartvaat.nl/2017/02/01/reverse-causality-in-de-associatie-bloeddruk-cardiovasculair-risico-bij-ckd/","title":"Reverse causality in de associatie bloeddruk-cardiovasculair risico bij CKD","title_en":"Evidence for Reverse Causality in the Association Between Blood Pressure and Cardiovascular Risk in Patients With Chronic Kidney Disease.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","anemie-ckd","biomarkers-cardiovasculair","secundaire-preventie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08386","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08386","authors":["William Herrington","Natalie Staplin","Parminder K Judge","Marion Mafham","Jonathan Emberson","Richard Haynes","David C Wheeler","Robert Walker","Charlie Tomson","Larry Agodoa","Andrzej Wiecek","Sarah Lewington","Christina A Reith","Martin J Landray","Colin Baigent"],"significance":6,"published":"2017-02-01","source_date":"2017-02-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/","https://hartvaat.nl/kennis/nierziekte/nierziekte-en-cardiovasculair-risico/"],"congress":"","summary_en":"This study provided evidence for reverse causality in the association between low blood pressure and adverse cardiovascular outcomes in advanced CKD, suggesting that the J-curve in this population reflects sicker patients rather than a treatment hazard.","created":"2026-07-03T10:26:32Z","updated":"2026-07-03T13:25:51Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die bewijs levert voor reverse causality (omgekeerde oorzakelijkheid) in het verband tussen bloeddruk en cardiovasculair risico bij chronische nierziekte. Methodologisch belangrijk voor de interpretatie van observationele data.","abstract_original":"UNLABELLED: Among those with moderate-to-advanced chronic kidney disease, the relationship between blood pressure (BP) and cardiovascular disease seems U shaped but is loglinear in apparently healthy adults. The SHARP (Study of Heart and Renal Protection) randomized 9270 patients with chronic kidney disease to ezetimibe/simvastatin versus matching placebo and measured BP at each follow-up visit. Cox regression was used to assess the association between BP and risk of cardiovascular disease among (1) those with a self-reported history of cardiovascular disease and (2) those with no such history and, based on plasma troponin-I concentration, a low probability of subclinical cardiac disease. A total of 8666 participants had a valid baseline BP and troponin-I measurement, and 2188 had at least 1 cardiovascular event during follow-up. After adjustment for relevant confounders, the association between systolic BP and cardiovascular events was U shaped, but among participants without evidence of previous cardiovascular disease, there was a positive loglinear association throughout the range of values studied. Among those with the lowest probability of subclinical cardiac disease, each 10 mm Hg higher systolic BP corresponded to a 27% increased risk of cardiovascular disease (hazard ratio, 1.27; 95% confidence interval, 1.11-1.44). In contrast, the relationship between diastolic BP and cardiovascular risk remained U shaped irrespective of cardiovascular disease history or risk of subclinical disease. In conclusion, the lack of a clear association between systolic BP and cardiovascular risk in this population seems attributable to confounding, suggesting that more intensive systolic BP reduction may be beneficial in such patients. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00125593."},{"id":"69dea45d8144","type":"article","url":"https://hartvaat.nl/2017/01/24/heropnames-bij-af-patienten-na-stenting-twee-antitromboticastrategieen-vergeleke/","title":"Heropnames bij AF-patiënten na stenting: twee antitromboticastrategieën vergeleken","title_en":"Recurrent Hospitalization Among Patients With Atrial Fibrillation Undergoing Intracoronary Stenting Treated With 2 Treatment Strategies of Rivaroxaban or a Dose-Adjusted Oral Vitamin K Antagonist Treatment Strategy.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.025783","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.025783","authors":["C Michael Gibson","Duane S Pinto","Gerald Chi","Douglas Arbetter","Megan Yee","Roxana Mehran","Christoph Bode","Jonathan Halperin","Freek W A Verheugt","Peter Wildgoose","Paul Burton","Martin van Eickels","Serge Korjian","Yazan Daaboul","Purva Jain","Gregory Y H Lip","Marc Cohen","Eric D Peterson","Keith A A Fox"],"significance":6,"published":"2017-01-24","source_date":"2017-01-24","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/dubbele-antistolling-indicaties/"],"congress":"","summary_en":"This analysis examined recurrent hospitalization rates in AF patients with coronary stents treated with different antithrombotic regimens, comparing VKA-based triple therapy with alternative strategies.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse naar recidiverende hospitalisaties bij AF-patiënten met coronaire stents behandeld met twee verschillende antitromboticastrategieën. Relevant voor de complexe afweging AF + PCI.","abstract_original":"BACKGROUND: Patients with atrial fibrillation who undergo intracoronary stenting traditionally are treated with a vitamin K antagonist (VKA) plus dual antiplatelet therapy (DAPT), yet this treatment leads to high risks of bleeding. We hypothesized that a regimen of rivaroxaban plus a P2Y12 inhibitor monotherapy or rivaroxaban plus DAPT could reduce bleeding and thereby have a favorable impact on all-cause mortality and the need for rehospitalization. METHODS: Stented subjects with nonvalvular atrial fibrillation (n=2124) were randomized 1:1:1 to administration of reduced-dose rivaroxaban 15 mg daily plus a P2Y12 inhibitor for 12 months (group 1); rivaroxaban 2.5 mg twice daily with stratification to a prespecified duration of DAPT of 1, 6, or 12 months (group 2); or the reference arm of dose-adjusted VKA daily with a similar DAPT stratification (group 3). The present post hoc analysis assessed the end point of all-cause mortality or recurrent hospitalization for an adverse event, which was further classified as the result of bleeding, a cardiovascular cause, or another cause blinded to treatment assignment. RESULTS: The risk of all-cause mortality or recurrent hospitalization was 34.9% in group 1 (hazard ratio=0.79; 95% confidence interval, 0.66-0.94; P=0.008 versus group 3; number needed to treat=15), 31.9% in group 2 (hazard ratio=0.75; 95% confidence interval, 0.62-0.90; P=0.002 versus group 3; number needed to treat=10), and 41.9% in group 3 (VKA+DAPT). Both all-cause death plus hospitalization potentially resulting from bleeding (group 1=8.6% [P=0.032 versus group 3], group 2=8.0% [P=0.012 versus group 3], and group 3=12.4%) and all-cause death plus rehospitalization potentially resulting from a cardiovascular cause (group 1=21.4% [P=0.001 versus group 3], group 2=21.7% [P=0.011 versus group 3], and group 3=29.3%) were reduced in the rivaroxaban arms compared with the VKA arm, but other forms of rehospitalization were not. CONCLUSIONS: Among patients with atrial fibrillation undergoing intracoronary stenting, administration of either rivaroxaban 15 mg daily plus P2Y12 inhibitor monotherapy or 2.5 mg rivaroxaban twice daily plus DAPT was associated with a reduced risk of all-cause mortality or recurrent hospitalization for adverse events compared with standard-of-care VKA plus DAPT. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01830543."},{"id":"aff2fe73b6cc","type":"article","url":"https://hartvaat.nl/2017/01/24/percutane-mechanische-ondersteuning-versus-iabp-bij-cardiogene-shock-meta-analys/","title":"Percutane mechanische ondersteuning versus IABP bij cardiogene shock: meta-analyse","title_en":"Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump for Treating Cardiogenic Shock: Meta-Analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.026","source_url":"https://doi.org/10.1016/j.jacc.2016.10.026","authors":["Dagmar M Ouweneel","Erlend Eriksen","Melchior Seyfarth","José P S Henriques"],"significance":7,"published":"2017-01-24","source_date":"2017-01-24","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/klepprothese-mechanisch-biologisch/"],"congress":"","summary_en":"This meta-analysis summarized the available evidence comparing percutaneous mechanical circulatory support with intra-aortic balloon pump for cardiogenic shock, pooling outcomes across the limited randomized data.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse die de beschikbare evidence samenvat over percutane mechanische circulatoire ondersteuning versus IABP bij cardiogene shock. Relevant voor het device-selectiebeleid bij kritiek zieke patiënten.","abstract_original":""},{"id":"16986d56ebf0","type":"article","url":"https://hartvaat.nl/2017/01/24/percutane-mechanische-circulatoire-ondersteuning-versus-iabp-bij-cardiogene-shoc/","title":"Percutane mechanische circulatoire ondersteuning versus IABP bij cardiogene shock na MI","title_en":"Percutaneous Mechanical Circulatory Support Versus Intra-Aortic Balloon Pump in Cardiogenic Shock After Acute Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["cardiogene-shock"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.022","source_url":"https://doi.org/10.1016/j.jacc.2016.10.022","authors":["Dagmar M Ouweneel","Erlend Eriksen","Krischan D Sjauw","Ivo M van Dongen","Alexander Hirsch","Erik J S Packer","M Marije Vis","Joanna J Wykrzykowska","Karel T Koch","Jan Baan","Robbert J de Winter","Jan J Piek","Wim K Lagrand","Bas A J M de Mol","Jan G P Tijssen","José P S Henriques"],"significance":7,"published":"2017-01-24","source_date":"2017-01-24","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/kleplijden/klepprothese-mechanisch-biologisch/"],"congress":"","summary_en":"This study compared percutaneous mechanical circulatory support devices (Impella, TandemHeart) with intra-aortic balloon pump in cardiogenic shock after acute MI, evaluating whether more powerful hemodynamic support improves survival in this setting.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie die percutane mechanische ondersteuningsdevices (Impella, TandemHeart) vergeleek met intra-aortale ballonpomp (IABP) bij cardiogene shock na acuut myocardinfarct.","abstract_original":"BACKGROUND: Despite advances in treatment, mortality in acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) remains high. Short-term mechanical circulatory support devices acutely improve hemodynamic conditions. OBJECTIVES: The aim of this study was to determine whether a new percutaneous mechanical circulatory support (pMCS) device (Impella CP, Abiomed, Danvers, Massachusetts) decreases 30-day mortality when compared with an intra-aortic balloon pump (IABP) in patients with severe shock complicating AMI. METHODS: In a randomized, prospective, open-label, multicenter trial, 48 patients with severe CS complicating AMI were assigned to pMCS (n = 24) or IABP (n = 24). Severe CS was defined as systolic blood pressure <90 mm Hg or the need for inotropic or vasoactive medication and the requirement for mechanical ventilation. The primary endpoint was 30-day all-cause mortality. RESULTS: At 30 days, mortality in patients treated with either IABP or pMCS was similar (50% and 46%, respectively; hazard ratio with pMCS: 0.96; 95% confidence interval: 0.42 to 2.18; p = 0.92). At 6 months, mortality rates for both pMCS and IABP were 50% (hazard ratio: 1.04; 95% confidence interval: 0.47 to 2.32; p = 0.923). CONCLUSIONS: In this explorative randomized controlled trial involving mechanically ventilated patients with CS after AMI, routine treatment with pMCS was not associated with reduced 30-day mortality compared with IABP. (IMPRESS in Severe Shock; NTR3450)."},{"id":"d89917dfb75f","type":"article","url":"https://hartvaat.nl/2017/01/17/cangrelor-met-en-zonder-gpiib-iiia-remmers-bij-pci/","title":"Cangrelor met en zonder GPIIb/IIIa-remmers bij PCI","title_en":"Cangrelor With and Without Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Coronary Intervention.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["abelacimab"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.055","source_url":"https://doi.org/10.1016/j.jacc.2016.10.055","authors":["Muthiah Vaduganathan","Robert A Harrington","Gregg W Stone","Efthymios N Deliargyris","Ph Gabriel Steg","C Michael Gibson","Christian W Hamm","Matthew J Price","Alberto Menozzi","Jayne Prats","Steven Elkin","Kenneth W Mahaffey","Harvey D White","Deepak L Bhatt"],"significance":5,"published":"2017-01-17","source_date":"2017-01-17","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/farmacologie/antiaritmica-farmacologie/"],"congress":"","summary_en":"This analysis evaluated the safety and efficacy of combining cangrelor with glycoprotein IIb/IIIa inhibitors during PCI, characterizing the double antiplatelet intensification strategy in high-risk interventional settings.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse van het combinatiegebruik van cangrelor met GPIIb/IIIa-remmers tijdens PCI. Onderzoekt de veiligheid en werkzaamheid van deze potente antiplaatjescombinatie.","abstract_original":"BACKGROUND: Cangrelor, an intravenous, reversible P2Y12 antagonist, is approved for use in patients undergoing percutaneous coronary intervention (PCI). OBJECTIVES: This study sought to evaluate the efficacy and safety of cangrelor compared with clopidogrel in subgroups that did and did not receive glycoprotein IIb/IIIa inhibitors (GPIs). METHODS: This pooled, patient-level analysis of the 3 CHAMPION (Cangrelor versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition) trials analyzed all randomized patients who underwent PCI and received the study drug (n = 24,902). Only bailout/rescue GPI use was permitted, except in CHAMPION PCI, in which routine or bailout/rescue GPI use was at the site investigator's discretion. The primary efficacy endpoint was the composite of all-cause mortality, myocardial infarction, ischemia-driven revascularization, or stent thrombosis at 48 h after randomization. RESULTS: Overall, 3,173 patients (12.7%) received a GPI, most commonly eptifibatide (69.4%). Despite variation in indications for GPIs, baseline characteristics were well balanced between the cangrelor and clopidogrel arms in subsets receiving and not receiving GPIs. Rates of the primary composite endpoint were lower with cangrelor compared with clopidogrel in patients who did (4.9% vs. 6.5%; odds ratio [OR]: 0.74; 95% confidence interval [CI]: 0.55 to 1.01) or did not receive a GPI (3.6% vs. 4.4%; OR: 0.82; 95% CI: 0.72 to 0.94; Pint = 0.55). Cangrelor did not increase the primary safety endpoint, GUSTO-defined severe/life-threatening bleeding, in patients who did (0.4% vs. 0.5%; OR: 0.71; 95% CI: 0.25 to 1.99) or did not receive GPIs (0.2% vs. 0.1%; OR: 1.56; 95% CI: 0.80 to 3.04; Pint = 0.21). GPI use was associated with increased risk of bleeding in both treatment arms. CONCLUSIONS: Cangrelor's efficacy in reducing ischemic complications in patients undergoing PCI was maintained irrespective of GPI administration. GPI use was associated with substantially higher bleeding rates, regardless of the randomization to cangrelor or clopidogrel. (A Clinical Trial to Demonstrate the Efficacy of Cangrelor [PCI]: NCT00305162; Cangrelor Versus Standard Therapy to Achieve Optimal Management of Platelet Inhibition [PLATFORM]: NCT00385138; A Clinical Trial Comparing Cangrelor to Clopidogrel Standard Therapy in Subjects Who Require Percutaneous Coronary Intervention [PCI] [CHAMPION PHOENIX] [CHAMPION]: NCT01156571)."},{"id":"a342d3afe0e8","type":"article","url":"https://hartvaat.nl/2017/01/17/geoxideerde-fosfolipiden-op-apob-100-en-recidiverende-ischemische-events-na-cva/","title":"Geoxideerde fosfolipiden op apoB-100 en recidiverende ischemische events na CVA","title_en":"Oxidized Phospholipids on Apolipoprotein B-100 and Recurrent Ischemic Events Following Stroke or Transient Ischemic Attack.","category":"cholesterol","category_label":"Cholesterol","professions":["cardioloog","internist"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.057","source_url":"https://doi.org/10.1016/j.jacc.2016.10.057","authors":["Young Sup Byun","Xiaohong Yang","Weihang Bao","David DeMicco","Rachel Laskey","Joseph L Witztum","Sotirios Tsimikas"],"significance":5,"published":"2017-01-17","source_date":"2017-01-17","image":"","kennis":[],"congress":"","summary_en":"This study showed that oxidized phospholipids on apolipoprotein B-100 predict recurrent ischemic events after stroke or TIA, identifying a novel lipid-inflammatory biomarker for cerebrovascular secondary prevention.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de associatie tussen geoxideerde fosfolipiden op apoliproteïne B-100 en recidiverende ischemische events na beroerte of TIA. Onderzoekt een nieuwe biomarker voor secundaire CVA-preventie.","abstract_original":"BACKGROUND: Biomarkers to predict recurrent stroke and targets of therapy to prevent stroke are lacking. OBJECTIVES: This study evaluated whether patients with prior cerebrovascular events and elevated levels of oxidized phospholipids on apolipoprotein B-100 (OxPL-apoB), but without prior coronary artery disease (CAD), are at risk for recurrent stroke and CAD events following high-dose statin therapy. METHODS: In the SPARCL (Stroke Prevention by Aggressive Reduction in Cholesterol Levels) trial, OxPL-apoB levels were measured in 4,385 patients with stroke or transient ischemic attack at baseline and in 3,106 patients at 5 years following randomization to placebo or 80 mg atorvastatin. The primary endpoint was the time from randomization to a second nonfatal or fatal stroke. Secondary endpoints included first major coronary events and any cardiovascular event. RESULTS: Patients with recurrent stroke had higher baseline median OxPL-apoB levels than patients without (15.5 nmol/l vs. 11.6 nmol/l; p < 0.0001). After multivariable adjustment, elevated baseline OxPL-apoB predicted recurrent stroke (hazard ratio [HR]: 4.3; p < 0.0001), first major coronary events (HR: 4.0; p < 0.0001), and any cardiovascular event (HR: 4.4; p < 0.0001). These comparisons for any endpoint did not differ by treatment, shown as a nonsignificant interaction test. The net reclassification improvement, integrated discrimination improvement, and area under the receiver-operating characteristic curve (AUC) were all significantly improved by adding OxPL-apoB to the models, with ΔAUC +0.0505 (p < 0.0001) for recurrent stroke, ΔAUC +0.0409 (p < 0.0001) for first major coronary event, and ΔAUC +0.0791 (p < 0.0001) for any cardiovascular event. CONCLUSIONS: Elevated OxPL-apoB levels predicted recurrent stroke and first major coronary events in patients with prior stroke or transient ischemic attack. The lack of statin-OxPL-apoB treatment interaction suggested that OxPLs might be statin-independent therapeutic targets to reduce risk of cardiovascular events. (Lipitor in the Prevention of Stroke, for Patients Who Have Had a Previous Stroke [SPARCL]; NCT00147602)."},{"id":"923b4f4b8ec1","type":"article","url":"https://hartvaat.nl/2017/01/17/dapt-versus-aspirine-monotherapie-bij-diabetes-met-multivatenlijden-na-cabg-free/","title":"DAPT versus aspirine monotherapie bij diabetes met multivatenlijden na CABG: FREEDOM","title_en":"Dual Antiplatelet Therapy Versus Aspirin Monotherapy in Diabetics With Multivessel Disease Undergoing CABG: FREEDOM Insights.","category":"preventie","category_label":"Preventie","professions":["cardioloog"],"tags":["aspirine","bloeddrukbehandeling","diabetes-en-hart","dubbele-trombocytenremming","sacubitril-valsartan","select-trial","soul-trial","tirzepatide"],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.043","source_url":"https://doi.org/10.1016/j.jacc.2016.10.043","authors":["Sean van Diepen","Valentin Fuster","Subodh Verma","Taye H Hamza","F Sandra Siami","Shaun G Goodman","Michael E Farkouh"],"significance":6,"published":"2017-01-17","source_date":"2017-01-17","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/","https://hartvaat.nl/kennis/preventie/secundaire-preventie-overzicht/"],"congress":"","summary_en":"This FREEDOM subanalysis examined the role of dual antiplatelet therapy after CABG in diabetic patients with multivessel disease, evaluating whether DAPT adds benefit beyond aspirin alone in the post-surgical setting.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"FREEDOM-subanalyse naar het antitromboticabeleid na CABG bij diabetespatiënten met multivatencoronairlijden. Onderzoekt of duale antiplaatjestherapie voordeel biedt boven aspirine alleen post-CABG.","abstract_original":"BACKGROUND: Clinical practice guidelines recommend post-operative dual antiplatelet therapy (DAPT) in patients who undergo coronary artery bypass grafting (CABG) following acute coronary syndromes (ACS). OBJECTIVES: The authors have evaluated DAPT utilization rates and associated outcomes among post-CABG patients with diabetes. METHODS: In a post hoc, nonrandomized analysis from the FREEDOM (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease) trial, we compared patients receiving DAPT (aspirin plus thienopyridine) and aspirin monotherapy at 30 days post-operatively. The primary outcome was the risk adjusted 5-year FREEDOM composite of all-cause mortality, nonfatal myocardial infarction, or stroke. Safety outcomes included major bleeding, blood transfusion, and hospitalization for bleeding. RESULTS: At 30 days post-CABG, 544 (68.4%) patients received DAPT and 251 (31.6%) patients received aspirin alone. The median (25th, 75th percentile) duration of clopidogrel therapy was 0.98 (0.23 to 1.91) years. There was no significant difference in the 5-year primary composite outcome between DAPT- and aspirin-treated patients (12.6% vs. 16.0%; adjusted hazard ratio [HR]: 0.83; 95% confidence interval [CI]: 0.54 to 1.27; p = 0.39). The 5-year primary composite outcomes were similar for patients receiving DAPT versus aspirin monotherapy respectively, in subgroups with pre-CABG ACSs (15.2% vs. 16.5%; HR: 1.06; 95% CI: 0.53 to 2.10; p = 0.88) and those with stable angina (11.6% vs. 15.8%; HR: 0.82; 95% CI: 0.50 to 1.343; p = 0.42). The composite outcomes of both treatment groups were also similar by SYNTAX score, duration of DAPT therapy, completeness of revascularization, and in off-pump CABG. No treatment-related differences in major bleeding (5.6% vs. 5.7%; HR: 1.00; 95% CI: 0.50 to 1.99; p = 0.99), blood transfusions (4.8% vs. 4.5%; HR: 1.09; 95% CI: 0.51 to 2.34; p = 0.82), or hospitalization for bleeding (2.6% vs. 3.3%; HR: 0.85; 95% CI: 0.34 to 2.17; p = 0.74) were observed between aspirin- and DAPT-treated patients, respectively. CONCLUSIONS: The use of DAPT in patients with diabetes post-CABG in our cohort was high. Compared with aspirin monotherapy, no associated differences were observed in cardiovascular or bleeding outcomes, suggesting that routine use of DAPT may not be clinically warranted. (Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease [FREEDOM]; NCT00086450)."},{"id":"a52861d0d8d9","type":"article","url":"https://hartvaat.nl/2017/01/17/2-jaarsuitkomsten-van-drug-coated-stents-zonder-polymeer-bij-hoog-bloedingsrisic/","title":"2-jaarsuitkomsten van drug-coated stents zonder polymeer bij hoog bloedingsrisico","title_en":"2-Year Outcomes of High Bleeding Risk Patients After Polymer-Free Drug-Coated Stents.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Journal of the American College of Cardiology","doi":"10.1016/j.jacc.2016.10.009","source_url":"https://doi.org/10.1016/j.jacc.2016.10.009","authors":["Philippe Garot","Marie-Claude Morice","Damras Tresukosol","Stuart J Pocock","Ian T Meredith","Alexandre Abizaid","Didier Carrié","Christoph Naber","Andres Iñiguez","Suneel Talwar","Ian B A Menown","Evald H Christiansen","John Gregson","Samuel Copt","Thomas Hovasse","Philipp Lurz","Luc Maillard","Florian Krackhardt","Paul Ong","Jonathan Byrne","Simon Redwood","Ute Windhövel","Samantha Greene","Hans-Peter Stoll","Philip Urban"],"significance":6,"published":"2017-01-17","source_date":"2017-01-17","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/","https://hartvaat.nl/kennis/vasculair/antistolling-bij-vte/"],"congress":"","summary_en":"This study reported 2-year outcomes of polymer-free drug-coated stents in high-bleeding-risk patients, demonstrating durable safety with only 1 month of DAPT in this vulnerable population.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar 2-jaarsuitkomsten van polymeervrije drug-coated stents bij patiënten met hoog bloedingsrisico. Relevant voor de stentkeuze bij patiënten die slechts kort DAPT kunnen gebruiken.","abstract_original":"BACKGROUND: A 1-year follow-up, polymer-free metallic stent coated with biolimus-A9 followed by 1-month dual antiplatelet therapy is safer and more effective than a bare-metal stent (BMS) for patients with high risk of bleeding. OBJECTIVES: This study analyzed 2-year outcomes to determine whether these benefits are maintained. METHODS: In a prospective, multicenter, double-blind trial, we randomized 2,466 high bleeding risk patients to receive a drug-coated stent (DCS) or a BMS followed by 1-month dual antiplatelet therapy. The primary safety endpoint was a composite of cardiac death, myocardial infarction, or stent thrombosis. The primary efficacy endpoint was clinically driven target lesion revascularization. RESULTS: At 2 years, the primary safety endpoint had occurred in 147 DCS and 180 BMS patients (15.3%) (hazard ratio: 0.80; 95% confidence interval: 0.64 to 0.99; p = 0.039). Clinically driven target lesion revascularization occurred for 77 DCS and 136 BMS patients (12.0%) (hazard ratio: 0.54; 95% confidence interval: 0.41 to 0.72; p < 0.0001). Major bleeding occurred in 8.9% of DCS and 9.2% of BMS patients (p = 0.95), and a coronary thrombotic event (myocardial infarction and/or stent thrombosis) occurred in 8.2% of DCS and 10.6% of BMS patients (p = 0.045). One-year mortality was 27.1% for a major bleed and 26.3% for a thrombotic event. At 2 years, multivariate correlates of major bleeding were age >75 years, anemia, raised plasma creatinine, and planned long-term anticoagulation. Correlates of the primary safety endpoint were age, anemia, congestive heart failure, multivessel disease, number of stents implanted, and use of a BMS rather than a DCS. CONCLUSIONS: Safety and efficacy benefits of DCS over BMS were maintained for 2 years in high bleeding risk patients. Rates of major bleeding and coronary thrombotic events were no different and were associated with a substantial and comparable mortality risk. (A Prospective Randomized Comparison of the BioFreedom Biolimus A9 Drug Coated Stent Versus the Gazelle Bare Metal Stent in Patients With High Risk of Bleeding [LEADERS FREE]; NCT01623180)."},{"id":"7a071f9d822e","type":"article","url":"https://hartvaat.nl/2017/01/15/linker-hartoorsluiting-versus-medicamenteuze-behandeling-bij-af-netwerkmeta-anal/","title":"Linker-hartoorsluiting versus medicamenteuze behandeling bij AF: netwerkmeta-analyse","title_en":"Efficacy and safety of left atrial appendage closure versus medical treatment in atrial fibrillation: a network meta-analysis from randomised trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["abelacimab","anticoagulantia","anticoagulatie-kwetsbare-ouderen","bloeddrukbehandeling"],"journal":"Heart (British Cardiac Society)","doi":"10.1136/heartjnl-2016-309782","source_url":"https://doi.org/10.1136/heartjnl-2016-309782","authors":["Shweta Sahay","Luis Nombela-Franco","Josep Rodes-Cabau","Pilar Jimenez-Quevedo","Pablo Salinas","Corina Biagioni","Ivan Nuñez-Gil","Nieves Gonzalo","Jose Alberto de Agustín","Maria Del Trigo","Leopoldo Perez de Isla","Antonio Fernández-Ortiz","Javier Escaned","Carlos Macaya"],"significance":7,"published":"2017-01-15","source_date":"2017-01-15","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/doacs-overzicht/","https://hartvaat.nl/kennis/atriumfibrilleren/af-en-beroerte/"],"congress":"","summary_en":"This network meta-analysis compared percutaneous left atrial appendage closure with various oral anticoagulant regimens for stroke prevention in AF, providing a comprehensive efficacy and safety comparison across all available strategies.","created":"2026-07-03T10:26:31Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Netwerkmeta-analyse die de werkzaamheid en veiligheid van percutane linker-hartoorsluiting vergeleek met orale anticoagulantia bij AF. Positioneert LAAO ten opzichte van DOAC's en VKA's.","abstract_original":"BACKGROUND: The effectiveness of vitamin K antagonist (VKA) versus placebo and antiplatelet therapy (APT) is well established for stroke prevention in atrial fibrillation (AF). Non-vitamin K antagonist oral anticoagulants (NOAC) are mostly superior to VKA in stroke and intracranial bleeding prevention. Recent randomised controlled trials (RCTs) suggested the non-inferiority of percutaneous left atrial appendage closure (LAAC) versus VKA. However, comparisons between LAAC versus placebo, APT or NOAC are lacking. The purpose of this network meta-analysis was to assess the efficacy and safety of LAAC compared with other strategies for stroke prevention in patients with AF. METHODS: We pooled together all RCTs comparing warfarin with placebo, APT or NOAC in patients with AF using meta-analysis guidelines. Two major trials of LAAC were also included and a network meta-analysis was performed to compare the impact of LAAC on mortality, stroke/systemic embolism (SE) and major bleeding in relation to medical treatment. RESULTS: The network meta-analysis included 19 RCTs with a total of 87 831 patients with AF receiving anticoagulants, APT, placebo or LAAC. Indirect comparison with network meta-analysis using warfarin as the common comparator revealed efficacy benefit favouring LAAC as compared with placebo (mortality: HR 0.38, 95% CI 0.22 to 0.67, p<0.001; stroke/SE: HR 0.24, 95% CI 0.11 to 0.52, p<0.001) and APT (mortality: HR 0.58, 95% CI 0.37 to 0.91, p=0.0018; stroke/SE: HR 0.44, 95% CI 0.23 to 0.86, p=0.017) and similar to NOAC (mortality: HR 0.76, 95% CI 0.50 to 1.16, p=0.211; stroke/SE: HR 1.01, 95% CI 0.53 to 1.92, p=0.969). LAAC showed comparable rates of major bleeding when compared with placebo (HR 2.33, 95% CI 0.67 to 8.09, p=0.183), APT (HR 0.75, 95% CI 0.30 to 1.88, p=0.542) and NOAC (HR 0.80, 95% CI 0.33 to 1.94, p=0.615). CONCLUSIONS: The findings of this meta-analysis suggest that LAAC is superior to placebo and APT, and comparable to NOAC for preventing mortality and stroke or SE, with similar bleeding risk in patients with non-valvular AF. However, these results should be interpreted with caution and more studies are needed to further substantiate this advantage, in view of the wide CIs with some variables in the current meta-analysis."},{"id":"2156cd0a8fce","type":"article","url":"https://hartvaat.nl/2017/01/10/trombusaspiratie-bij-stemi-individuele-patientdata-meta-analyse/","title":"Trombusaspiratie bij STEMI: individuele patiëntdata meta-analyse","title_en":"Thrombus Aspiration in ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis: Thrombectomy Trialists Collaboration.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["vrouwen"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.025371","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.025371","authors":["Sanjit S Jolly","Stefan James","Vladimír Džavík","John A Cairns","Karim D Mahmoud","Felix Zijlstra","Salim Yusuf","Goran K Olivecrona","Henrik Renlund","Peggy Gao","Bo Lagerqvist","Ashraf Alazzoni","Sasko Kedev","Goran Stankovic","Brandi Meeks","Ole Frøbert"],"significance":9,"published":"2017-01-10","source_date":"2017-01-10","image":"","kennis":[],"congress":"","summary_en":"This individual patient data meta-analysis from the Thrombectomy Trialists Collaboration definitively showed that routine thrombus aspiration during primary PCI for STEMI does not improve clinical outcomes and may increase stroke risk. The findings ended the widespread practice of routine thrombectomy during primary PCI.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T13:25:50Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Individuele patiëntdata meta-analyse van de Thrombectomy Trialists Collaboration naar het effect van trombusaspiratie bij STEMI. Definitief bewijs dat routinematige trombusaspiratie geen klinisch voordeel biedt.","abstract_original":"BACKGROUND: Thrombus aspiration during percutaneous coronary intervention (PCI) for the treatment of ST-segment-elevation myocardial infarction (STEMI) has been widely used; however, recent trials have questioned its value and safety. In this meta-analysis, we, the trial investigators, aimed to pool the individual patient data from these trials to determine the benefits and risks of thrombus aspiration during PCI in patients with ST-segment-elevation myocardial infarction. METHODS: Included were large (n≥1000), randomized, controlled trials comparing manual thrombectomy and PCI alone in patients with ST-segment-elevation myocardial infarction. Individual patient data were provided by the leadership of each trial. The prespecified primary efficacy outcome was cardiovascular mortality within 30 days, and the primary safety outcome was stroke or transient ischemic attack within 30 days. RESULTS: The 3 eligible randomized trials (TAPAS [Thrombus Aspiration During Percutaneous Coronary Intervention in Acute Myocardial Infarction], TASTE [Thrombus Aspiration in ST-Elevation Myocardial Infarction in Scandinavia], and TOTAL [Trial of Routine Aspiration Thrombectomy With PCI Versus PCI Alone in Patients With STEMI]) enrolled 19 047 patients, of whom 18 306 underwent PCI and were included in the primary analysis. Cardiovascular death at 30 days occurred in 221 of 9155 patients (2.4%) randomized to thrombus aspiration and 262 of 9151 (2.9%) randomized to PCI alone (hazard ratio, 0.84; 95% confidence interval, 0.70-1.01; P=0.06). Stroke or transient ischemic attack occurred in 66 (0.8%) randomized to thrombus aspiration and 46 (0.5%) randomized to PCI alone (odds ratio, 1.43; 95% confidence interval, 0.98-2.10; P=0.06). There were no significant differences in recurrent myocardial infarction, stent thrombosis, heart failure, or target vessel revascularization. In the subgroup with high thrombus burden (TIMI [Thrombolysis in Myocardial Infarction] thrombus grade ≥3), thrombus aspiration was associated with fewer cardiovascular deaths (170 [2.5%] versus 205 [3.1%]; hazard ratio, 0.80; 95% confidence interval, 0.65-0.98; P=0.03) and with more strokes or transient ischemic attacks (55 [0.9%] versus 34 [0.5%]; odds ratio, 1.56; 95% confidence interval, 1.02-2.42, P=0.04). However, the interaction P values were 0.32 and 0.34, respectively. CONCLUSIONS: Routine thrombus aspiration during PCI for ST-segment-elevation myocardial infarction did not improve clinical outcomes. In the high thrombus burden group, the trends toward reduced cardiovascular death and increased stroke or transient ischemic attack provide a rationale for future trials of improved thrombus aspiration technologies in this high-risk subgroup. CLINICAL TRIAL REGISTRATION: URLs: http://www.ClinicalTrials.gov http://www.crd.york.ac.uk/prospero/. Unique identifiers: NCT02552407 and CRD42015025936."},{"id":"bc30e3d7354b","type":"article","url":"https://hartvaat.nl/2017/01/07/verminderd-bloeddrukverlagend-effect-van-renale-denervatie-bij-geisoleerde-systo/","title":"Verminderd bloeddrukverlagend effect van renale denervatie bij geïsoleerde systolische hypertensie","title_en":"Reduced blood pressure-lowering effect of catheter-based renal denervation in patients with isolated systolic hypertension: data from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","renale-denervatie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehw325","source_url":"https://doi.org/10.1093/eurheartj/ehw325","authors":["Felix Mahfoud","George Bakris","Deepak L Bhatt","Murray Esler","Sebastian Ewen","Martin Fahy","David Kandzari","Kazuomi Kario","Giuseppe Mancia","Michael Weber","Michael Böhm"],"significance":6,"published":"2017-01-07","source_date":"2017-01-07","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/","https://hartvaat.nl/kennis/hypertensie/esc-richtlijn-hypertensie-2024/"],"congress":"","summary_en":"This analysis showed that catheter-based renal denervation has reduced blood pressure-lowering efficacy in patients with isolated systolic hypertension, likely due to different pathophysiology in arterial stiffness-driven hypertension.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Analyse die aantoont dat renale denervatie een verminderd bloeddrukverlagend effect heeft bij patiënten met geïsoleerde systolische hypertensie. Relevant voor patiëntselectie bij devicetherapie.","abstract_original":"AIMS: Catheter-based renal artery denervation (RDN) has been shown to lower blood pressure (BP) in certain patients with uncontrolled hypertension. Isolated systolic hypertension (ISH) (systolic BP [SBP] ≥140 mmHg and diastolic BP <90 mmHg), characterized by increased vascular stiffness, is the predominant hypertensive phenotype in elderly patients. This study compared baseline characteristics and SBP change at 6 months between patients with ISH and combined systolic–diastolic hypertension (CH). METHODS AND RESULTS: This study pooled data from 1103 patients from SYMPLICITY HTN-3 and the Global SYMPLICITY Registry. A total of 429 patients had ISH, and 674 had CH. Patients with ISH were significantly older than those with CH (66 vs. 55 years), had more type 2 diabetes mellitus (52.9 vs. 34.6%), and a lower estimated glomerular filtration rate (71.8 vs. 78.6 mL/min/1.73 m2); all P < 0.001. At 6 months, the SBP drop for CH patients was −18.7 ± 23.7 mmHg compared with a reduction of −10.9 ± 21.7 mmHg for ISH patients −7.8 mmHg, 95% confidence interval, CI, −10.5, −5.1, P < 0.001). The change in 24-h SBP at 6 months was −8.8 ± 16.2 mmHg in patients with CH vs. −5.8 ± 15.4 mmHg in ISH (−3.0 mmHg, 95% CI −5.4, −0.6, P = 0.015). Presence of ISH at baseline but not age was associated with less pronounced BP changes following the procedure. The strongest predictor of office SBP reduction at 6 months was CH, followed by aldosterone antagonist use and non-use of vasodilators. CONCLUSION: The reduction in BP among patients with ISH following RDN was less pronounced than the reduction in patients with CH. CLINICAL.TRIALS.GOV IDENTIFIERS: NCT01534299 and NCT01418261."},{"id":"032006a2f5e5","type":"article","url":"https://hartvaat.nl/2017/01/05/inclisiran-een-langwerkende-rna-interferentie-pcsk9-remmer-nejm/","title":"Inclisiran: een langwerkende RNA-interferentie PCSK9-remmer — NEJM","title_en":"A Highly Durable RNAi Therapeutic Inhibitor of PCSK9.","category":"cholesterol","category_label":"Cholesterol","professions":["apotheker","cardioloog","huisarts","internist"],"tags":["enlicitide","inclisiran","niet-statine-therapie","pcsk9-remmers","pcsk9-remmers-nieuwe-generatie"],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa1609243","source_url":"https://doi.org/10.1056/NEJMoa1609243","authors":["Kevin Fitzgerald","Suellen White","Anna Borodovsky","Brian R Bettencourt","Andrew Strahs","Valerie Clausen","Peter Wijngaard","Jay D Horton","Jorg Taubel","Ashley Brooks","Chamikara Fernando","Robert S Kauffman","David Kallend","Akshay Vaishnaw","Amy Simon"],"significance":10,"published":"2017-01-05","source_date":"2017-01-05","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/pcsk9-mechanisme/","https://hartvaat.nl/kennis/lipiden/inclisiran-sirna/"],"congress":"","summary_en":"This first-in-human phase 1 trial of inclisiran, an RNA interference therapeutic targeting PCSK9 synthesis, showed that a single subcutaneous injection produced durable, dose-dependent reductions in PCSK9 protein and LDL cholesterol lasting up to 6 months. The study opened a new era of twice-yearly lipid-lowering therapy.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T13:25:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Landmark NEJM-publicatie van de eerste inclisiran-studie die aantoonde dat een enkele subcutane injectie met siRNA het PCSK9-eiwit en LDL-cholesterol gedurende maanden verlaagt. Begin van een nieuw tijdperk in lipidenbehandeling.","abstract_original":"BACKGROUND: Inclisiran (ALN-PCSsc) is a long-acting RNA interference (RNAi) therapeutic agent that inhibits the synthesis of proprotein convertase subtilisin-kexin type 9 (PCSK9), a target for the lowering of low-density lipoprotein (LDL) cholesterol. METHODS: In this phase 1 trial, we randomly assigned healthy volunteers with an LDL cholesterol level of at least 100 mg per deciliter in a 3:1 ratio to receive a subcutaneous injection of inclisiran or placebo in either a single-ascending-dose phase (at a dose of 25, 100, 300, 500, or 800 mg) or a multiple-dose phase (125 mg weekly for four doses, 250 mg every other week for two doses, or 300 or 500 mg monthly for two doses, with or without concurrent statin therapy); each dose cohort included four to eight participants. Safety, the side-effect profile, and pharmacodynamic measures (PCSK9 level, LDL cholesterol level, and exploratory lipid variables) were evaluated. RESULTS: The most common adverse events were cough, musculoskeletal pain, nasopharyngitis, headache, back pain, and diarrhea. All the adverse events were mild or moderate in severity. There were no serious adverse events or discontinuations due to adverse events. There was one grade 3 elevation in the γ-glutamyltransferase level, which was considered by the investigator to be related to statin therapy. In the single-dose phase, inclisiran doses of 300 mg or more reduced the PCSK9 level (up to a least-squares mean reduction of 74.5% from baseline to day 84), and doses of 100 mg or more reduced the LDL cholesterol level (up to a least-squares mean reduction of 50.6% from baseline). Reductions in the levels of PCSK9 and LDL cholesterol were maintained at day 180 for doses of 300 mg or more. All multiple-dose regimens reduced the levels of PCSK9 (up to a least-squares mean reduction of 83.8% from baseline to day 84) and LDL cholesterol (up to a least-squares mean reduction of 59.7% from baseline to day 84). CONCLUSIONS: In this phase 1 trial, no serious adverse events were observed with inclisiran. Doses of 300 mg or more (in single or multiple doses) significantly reduced levels of PCSK9 and LDL cholesterol for at least 6 months. (Funded by Alnylam Pharmaceuticals and the Medicines Company; ClinicalTrials.gov number, NCT02314442 .)."},{"id":"31d8f9f614ff","type":"article","url":"https://hartvaat.nl/2017/01/03/traditionele-cv-risicofactoren-en-veneuze-trombo-embolie-individuele-patientdata/","title":"Traditionele CV-risicofactoren en veneuze trombo-embolie: individuele patiëntdata meta-analyse","title_en":"Association of Traditional Cardiovascular Risk Factors With Venous Thromboembolism: An Individual Participant Data Meta-Analysis of Prospective Studies.","category":"preventie","category_label":"Preventie","professions":["cardioloog","internist"],"tags":["ouderen","veneuze-trombose"],"journal":"Circulation","doi":"10.1161/CIRCULATIONAHA.116.024507","source_url":"https://doi.org/10.1161/CIRCULATIONAHA.116.024507","authors":["Bakhtawar K Mahmoodi","Mary Cushman","Inger Anne Næss","Matthew A Allison","Willem J Bos","Sigrid K Brækkan","Suzanne C Cannegieter","Ron T Gansevoort","Philimon N Gona","Jens Hammerstrøm","John-Bjarne Hansen","Susan Heckbert","Anders G Holst","Susan G Lakoski","Pamela L Lutsey","JoAnn E Manson","Lisa W Martin","Kunihiro Matsushita","Karina Meijer","Kim Overvad","Eva Prescott","Marja Puurunen","Jacques E Rossouw","Yingying Sang","Marianne T Severinsen","Jur Ten Berg","Aaron R Folsom","Neil A Zakai"],"significance":7,"published":"2017-01-03","source_date":"2017-01-03","image":"","kennis":["https://hartvaat.nl/kennis/lipiden/lp-a-verhoogd/","https://hartvaat.nl/kennis/lipiden/lpa-meten-wanneer-waarom/"],"congress":"","summary_en":"This large individual patient data meta-analysis examined the association between traditional cardiovascular risk factors and venous thromboembolism, finding that obesity and diabetes but not hypercholesterolemia are significantly associated with VTE risk.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T13:25:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Grote individuele patiëntdata meta-analyse die het verband onderzocht tussen traditionele cardiovasculaire risicofactoren en veneuze trombo-embolie. Overbrugt de kloof tussen arteriële en veneuze trombose.","abstract_original":"BACKGROUND: Much controversy surrounds the association of traditional cardiovascular disease risk factors with venous thromboembolism (VTE). METHODS: We performed an individual level random-effect meta-analysis including 9 prospective studies with measured baseline cardiovascular disease risk factors and validated VTE events. Definitions were harmonized across studies. Traditional cardiovascular disease risk factors were modeled categorically and continuously using restricted cubic splines. Estimates were obtained for overall VTE, provoked VTE (ie, VTE occurring in the presence of 1 or more established VTE risk factors), and unprovoked VTE, pulmonary embolism, and deep-vein thrombosis. RESULTS: The studies included 244 865 participants with 4910 VTE events occurring during a mean follow-up of 4.7 to 19.7 years per study. Age, sex, and body mass index-adjusted hazard ratios for overall VTE were 0.98 (95% confidence interval [CI]: 0.89-1.07) for hypertension, 0.97 (95% CI: 0.88-1.08) for hyperlipidemia, 1.01 (95% CI: 0.89-1.15) for diabetes mellitus, and 1.19 (95% CI: 1.08-1.32) for current smoking. After full adjustment, these estimates were numerically similar. When modeled continuously, an inverse association was observed for systolic blood pressure (hazard ratio=0.79 [95% CI: 0.68-0.92] at systolic blood pressure 160 vs 110 mm Hg) but not for diastolic blood pressure or lipid measures with VTE. An important finding from VTE subtype analyses was that cigarette smoking was associated with provoked but not unprovoked VTE. Fully adjusted hazard ratios for the associations of current smoking with provoked and unprovoked VTE were 1.36 (95% CI: 1.22-1.52) and 1.08 (95% CI: 0.90-1.29), respectively. CONCLUSIONS: Except for the association between cigarette smoking and provoked VTE, which is potentially mediated through comorbid conditions such as cancer, the modifiable traditional cardiovascular disease risk factors are not associated with increased VTE risk. Higher systolic blood pressure showed an inverse association with VTE."},{"id":"f8fbffa65437","type":"article","url":"https://hartvaat.nl/2017/01/01/verminderd-hyperkaliemierisico-met-mra-door-sacubitril-valsartan-bij-hartfalen/","title":"Verminderd hyperkaliëmierisico met MRA door sacubitril/valsartan bij hartfalen","title_en":"Reduced Risk of Hyperkalemia During Treatment of Heart Failure With Mineralocorticoid Receptor Antagonists by Use of Sacubitril/Valsartan Compared With Enalapril: A Secondary Analysis of the PARADIGM-HF Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["apotheker","cardioloog","internist"],"tags":["acuut-hartfalen","answer-hf","bisoprolol","finerenon-hartfalen-nierziekte","ijzertekort","mra-aldosteronantagonisten","sacubitril-valsartan"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.4733","source_url":"https://doi.org/10.1001/jamacardio.2016.4733","authors":["Akshay S Desai","Orly Vardeny","Brian Claggett","John J V McMurray","Milton Packer","Karl Swedberg","Jean L Rouleau","Michael R Zile","Martin Lefkowitz","Victor Shi","Scott D Solomon"],"significance":7,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/farmacologie/mineralocorticoid-antagonisten-farmacologie/"],"congress":"","summary_en":"This analysis showed that sacubitril-valsartan reduces the risk of hyperkalemia during MRA treatment in heart failure patients, potentially facilitating safer use of full-dose mineralocorticoid receptor antagonist therapy.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T18:38:30Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse die aantoont dat sacubitril/valsartan het risico op hyperkaliëmie vermindert bij HF-patiënten behandeld met mineralocorticoïdreceptorantagonisten. Relevant voor de optimalisatie van RAAS-blokkade.","abstract_original":"IMPORTANCE: Consensus guidelines recommend the use of mineralocorticoid receptor antagonists (MRAs) for selected patients with symptomatic heart failure and reduced ejection fraction (HFrEF) to reduce morbidity and mortality; however, the use of MRAs in combination with other inhibitors of the renin-angiotensin-aldosterone system increases the risk of hyperkalemia. OBJECTIVE: To determine whether the risk of hyperkalemia associated with use of MRAs for patients with HFrEF is reduced by sacubitril/valsartan in comparison with enalapril. DESIGN, SETTING, AND PARTICIPANTS: The PARADIGM-HF (Prospective Comparison of ARNI With an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial randomly assigned 8399 patients with chronic HF, New York Heart Association class II to IV symptoms, and a left ventricular EF of 40% or less to treatment with enalapril 10 mg twice daily or sacubitril/valsartan 97/103 mg twice daily (previously known as LCZ696 [200 mg twice daily]) in addition to guideline-directed medical therapy. Use of MRAs was encouraged but left to the discretion of study investigators. Serum potassium level was measured at every study visit. The incidence of hyperkalemia (potassium level >5.5 mEq/L) and severe hyperkalemia (potassium level >6.0 mEq/L) among patients treated or not treated with an MRA at baseline and the risk of subsequent hyperkalemia for those newly treated with an MRA during study follow-up were defined in time-updated Cox proportional hazards models. Analyses were conducted between August 1 and October 15, 2016. MAIN OUTCOMES AND MEASURES: Incident hyperkalemia and severe hyperkalemia. RESULTS: In comparison with the 3728 patients (44.4% of enrolled participants [21.6% female]) not taking an MRA at baseline, the 4671 patients (55.6% [22.0% female]) taking an MRA tended to be younger, with a lower EF, lower systolic blood pressure, and more advanced HF symptoms. Among those taking an MRA at baseline, the overall rates of hyperkalemia were similar between treatment groups, but severe hyperkalemia was more common in patients randomly assigned to enalapril than to sacubitril/valsartan (3.1 vs 2.2 per 100 patient-years; HR, 1.37 [95% CI, 1.06-1.76]; P = .02). In analyses including patients who newly started taking MRAs during the PARADIGM-HF trial, severe hyperkalemia remained more common in those randomly assigned to enalapril than to those randomly assigned to sacubitril/valsartan (3.3 vs 2.3 per 100 patient-years; HR, 1.43 [95% CI, 1.13-1.81]; P = .003). CONCLUSIONS AND RELEVANCE: Among MRA-treated patients with symptomatic HFrEF, severe hyperkalemia is more likely during treatment with enalapril than with sacubitril/valsartan. These data suggest that neprilysin inhibition attenuates the risk of hyperkalemia when MRAs are combined with other inhibitors of the renin-angiotensin-aldosterone system in patients with HF. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01035255."},{"id":"7684232fe401","type":"article","url":"https://hartvaat.nl/2017/01/01/richtlijnen-voor-listing-van-harttransplantatiekandidaten-10-jaarsupdate/","title":"Richtlijnen voor listing van harttransplantatiekandidaten: 10-jaarsupdate","title_en":"Guidelines for Listing Candidates for Heart Transplant: A 10-Year Update.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":["harttransplantatie"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2016.3756","source_url":"https://doi.org/10.1001/jamacardio.2016.3756","authors":["Mandeep R Mehra"],"significance":8,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":[],"congress":"","summary_en":"These updated JAMA Cardiology guidelines for heart transplant listing incorporated contemporary evidence on mechanical circulatory support, donor selection, and post-transplant management, providing revised criteria for candidacy in the era of modern heart failure therapy.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T13:25:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology geactualiseerde richtlijnen voor de selectie en listing van kandidaten voor harttransplantatie. Bevat herziene criteria voor indicatie en contraindicaties.","abstract_original":""},{"id":"93cdfa280688","type":"article","url":"https://hartvaat.nl/2017/01/01/axafa-afnet-5-apixaban-versus-vka-bij-af-ablatie-studieprotocol/","title":"AXAFA-AFNET 5: apixaban versus VKA bij AF-ablatie — studieprotocol","title_en":"Rationale and design of AXAFA-AFNET 5: an investigator-initiated, randomized, open, blinded outcome assessment, multi-centre trial to comparing continuous apixaban to vitamin K antagonists in patients undergoing atrial fibrillation catheter ablation.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw368","source_url":"https://doi.org/10.1093/europace/euw368","authors":["Luigi Di Biase","David Callans","Karl Georg Hæusler","Gerhard Hindricks","Hussein Al-Khalidi","Lluis Mont","Jens Cosedis Nielsen","Jonathan P Piccini","Ulrich Schotten","Paulus Kirchhof"],"significance":5,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":["https://hartvaat.nl/kennis/antistolling/antistolling-bij-ckd/","https://hartvaat.nl/kennis/antistolling/antistolling-bij-kankerpatienten/"],"congress":"","summary_en":"This protocol paper described the AXAFA-AFNET 5 trial design comparing apixaban with VKA for periprocedural anticoagulation during AF catheter ablation, establishing the methodology for this important safety study.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T13:25:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studieprotocol van de AXAFA-AFNET 5-trial die apixaban vergelijkt met vitamine K-antagonisten als periprocedurele antistolling bij katheterablatie voor AF.","abstract_original":"AIMS: Catheter ablation is the most efficacious rhythm control therapy in atrial fibrillation (AF) patients. There is growing evidence that catheter ablation procedures are best performed during continuous oral anticoagulation, but outcomes are variable depending on the anticoagulation strategy or agent chosen. Specifically, there is a need to evaluate the peri-procedural use of non-vitamin K antagonist oral anticoagulants (NOACs) in patients undergoing catheter ablation of AF. The AXAFA-AFNET 5 trial will test whether peri-procedural anticoagulation therapy using apixaban is a safe alternative to vitamin K antagonist (VKA) therapy for patients undergoing catheter ablation of AF. METHODS AND RESULTS: AXAFA-AFNET 5 is a randomized, prospective multi-centre study conducted in Europe and the USA. A total of 650 patients scheduled for AF ablation will be randomized 1:1 to undergo AF ablation on continuous treatment with the NOAC apixaban or with a VKA. Patients can undergo AF ablation after at least 30 days of continuous effective anticoagulation or after exclusion of atrial thrombi by transoesophageal echocardiogram. The trial includes a post-ablation magnetic resonance imaging substudy that will quantify silent brain lesions that can occur in neurologically asymptomatic patients after AF ablation. Patients will be followed on continuous anticoagulation for 3 months after the ablation. The primary outcome parameter of AXAFA-AFNET 5 is a composite of all-cause death, stroke, and major bleeding events. CONCLUSION: The results of AXAFA-AFNET 5 will provide evidence informing about the safety of apixaban in ablation patients and on its efficacy including effects on silent brain lesions. AXAFA - AFNET 5 is an investigator-initiated trial sponsored by AFNET. The trial is supported by the DZHK (German Centre for Cardiovascular Research) and by the BMBF (German Ministry of Education and Research) and by Bristol-Myers Squibb/Pfizer Alliance."},{"id":"d2da7e25d0a4","type":"article","url":"https://hartvaat.nl/2017/01/01/ontwikkeling-van-linkerventrikelhypertrofie-bij-behandelde-hypertensie-campania-/","title":"Ontwikkeling van linkerventrikelhypertrofie bij behandelde hypertensie: Campania Salute Network","title_en":"Development of Left Ventricular Hypertrophy in Treated Hypertensive Outpatients: The Campania Salute Network.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["acuut-hartfalen","bloeddrukbehandeling","hartrevalidatie","renale-denervatie","summit-trial","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08158","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08158","authors":["Raffaele Izzo","Maria-Angela Losi","Eugenio Stabile","Mai Tone Lönnebakken","Grazia Canciello","Giovanni Esposito","Emanuele Barbato","Nicola De Luca","Bruno Trimarco","Giovanni de Simone"],"significance":6,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/wat-is-hypertensie/","https://hartvaat.nl/kennis/hypertensie/eindorgaanschade-hypertensie/"],"congress":"","summary_en":"This study documented the development of new left ventricular hypertrophy in treated hypertensive outpatients, showing that LVH can progress despite blood pressure therapy and identifying predictors of treatment failure.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de ontwikkeling van linkerventrikelhypertrofie bij poliklinisch behandelde hypertensieve patiënten ondanks therapie. Identificeert risicofactoren voor progressieve orgaanschade.","abstract_original":"UNLABELLED: There is little information on left ventricular (LV) hypertrophy (LVH) development during antihypertensive treatment. We evaluate incident LVH in a treated hypertensive cohort, the Campania Salute Network registry. We analyzed prospectively 4290 hypertensives (aged 50.3±11.1 years, 40% women) with at least 1-year follow-up, without LVH at baseline. Incident LVH was defined as the first detection of echocardiographic LV mass index ≥47 in women or ≥50 g/m2.7 in men. During a median 48-month follow-up, 915 patients (21.3%) developed LVH. They were older, more frequently women, and obese (P<0.0001), with initial higher fasting glucose, diastolic and systolic blood pressure, LV mass index, lower heart rate and glomerular filtration rate, longer hypertension history and follow-up, and higher average systolic blood pressure during follow-up (all P<0.05), despite a more frequent treatment with Ca++-channel blockers and diuretics (both P<0.02). At multivariable Cox regression, incident LVH was independently associated with older age, female sex, obesity, higher average systolic blood pressure during follow-up, and initial greater LV mass index (all P<0.02). By categorizing patients according to obesity and sex, obesity independently increased the risk for incident LVH in both sexes (obese versus nonobese men: hazard ratio, 1.34; confidence interval, 1.05-1.72; P=0.019; and obese versus nonobese women: hazard ratio, 1.34; confidence interval, 1.08-1.66; P=0.007). Despite more aggressive antihypertensive therapy, 21% of hypertensive patients develop clear-cut LVH. After adjusting for confounders, risk of incident LVH is particular relevant among women and is further increased by the presence of obesity. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02211365."},{"id":"7ab21d723808","type":"article","url":"https://hartvaat.nl/2017/01/01/sacubitril-valsartan-en-natriurese-diurese-en-bloeddruk-bij-zoutgevoelige-hypert/","title":"Sacubitril/valsartan en natriurese, diurese en bloeddruk bij zoutgevoelige hypertensie","title_en":"Effects of Sacubitril/Valsartan (LCZ696) on Natriuresis, Diuresis, Blood Pressures, and NT-proBNP in Salt-Sensitive Hypertension.","category":"hypertensie","category_label":"Hypertensie","professions":["apotheker","cardioloog","internist"],"tags":["answer-hf","bloeddrukbehandeling","sacubitril-valsartan"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08484","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08484","authors":["Tzung-Dau Wang","Ru-San Tan","Hae-Young Lee","Sang-Hyun Ihm","Moo-Yong Rhee","Brian Tomlinson","Parasar Pal","Fan Yang","Elizabeth Hirschhorn","Margaret F Prescott","Markus Hinder","Thomas H Langenickel"],"significance":6,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":["https://hartvaat.nl/kennis/farmacologie/arni-farmacologie/","https://hartvaat.nl/kennis/hypertensie/hypertensie-en-ckd/"],"congress":"","summary_en":"This mechanistic study of sacubitril-valsartan in salt-sensitive hypertension showed enhanced natriuresis, diuresis, and blood pressure reduction, providing pathophysiological insight into ARNI effects on sodium handling.","created":"2026-07-03T10:26:30Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie naar de effecten van sacubitril/valsartan op natriurese, diurese, bloeddruk en NT-proBNP bij zoutgevoelige hypertensie. Mechanistisch inzicht in de werking van ARNI bij hypertensie.","abstract_original":"UNLABELLED: Salt-sensitive hypertension (SSH) is characterized by impaired sodium excretion and subnormal vasodilatory response to salt loading. Sacubitril/valsartan (LCZ696) was hypothesized to increase natriuresis and diuresis and result in superior blood pressure control compared with valsartan in Asian patients with SSH. In this randomized, double-blind, crossover study, 72 patients with SSH received sacubitril/valsartan 400 mg and valsartan 320 mg once daily for 4 weeks each. SSH was diagnosed if the mean arterial pressure increased by ≥10% when patients switched from low (50 mmol/d) to high (320 mmol/d) sodium diet. The primary outcome was cumulative 6- and 24-hour sodium excretion after first dose administration. Compared with valsartan, sacubitril/valsartan was associated with a significant increase in natriuresis (adjusted treatment difference: 24.5 mmol/6 hours, 50.3 mmol/24 hours, both P<0.001) and diuresis (adjusted treatment difference: 291.2 mL/6 hours, P<0.001; 356.4 mL/24 hours, P=0.002) on day 1, but not on day 28, and greater reductions in office and ambulatory blood pressure on day 28. Despite morning dosing of both drugs, ambulatory blood pressure reductions were more pronounced at nighttime than at daytime or the 24-hour average. Compared with valsartan, sacubitril/valsartan significantly reduced N-terminal pro B-type natriuretic peptide levels on day 28 (adjusted treatment difference: -20%; P=0.001). Sacubitril/valsartan and valsartan were safe and well tolerated with no significant changes in body weight or serum sodium and potassium levels with either treatments. In conclusion, sacubitril/valsartan compared with valsartan was associated with short-term increases in natriuresis and diuresis, superior office and ambulatory blood pressure control, and significantly reduced N-terminal pro B-type natriuretic peptide levels in Asian patients with SSH. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01681576."},{"id":"ccc52eb1a019","type":"article","url":"https://hartvaat.nl/2017/01/01/intensieve-versus-standaard-bloeddrukcontrole-op-ambulante-bloeddruk-sprint-resu/","title":"Intensieve versus standaard bloeddrukcontrole op ambulante bloeddruk: SPRINT-resultaten","title_en":"Effect of Intensive Versus Standard Clinic-Based Hypertension Management on Ambulatory Blood Pressure: Results From the SPRINT (Systolic Blood Pressure Intervention Trial) Ambulatory Blood Pressure Study.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08076","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08076","authors":["Paul E Drawz","Nicholas M Pajewski","Jeffrey T Bates","Natalie A Bello","William C Cushman","Jamie P Dwyer","Lawrence J Fine","David C Goff","William E Haley","Marie Krousel-Wood","Andrew McWilliams","Dena E Rifkin","Yelena Slinin","Addison Taylor","Raymond Townsend","Barry Wall","Jackson T Wright","Mahboob Rahman"],"significance":7,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/bloeddrukmeting-thuismeting-abpm/","https://hartvaat.nl/kennis/nierziekte/albumine-creatinine-ratio/"],"congress":"","summary_en":"This SPRINT ambulatory blood pressure analysis showed that the intensive treatment arm achieved only modestly lower 24-hour blood pressure compared with standard care, suggesting that the larger office blood pressure difference may overestimate the true blood pressure separation between treatment strategies.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T13:25:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"SPRINT-analyse die het effect van intensieve versus standaard bloeddrukcontrole onderzocht op ambulante bloeddrukmeting. Relevant voor de interpretatie van SPRINT in relatie tot meetmethode.","abstract_original":"UNLABELLED: The effect of clinic-based intensive hypertension treatment on ambulatory blood pressure (BP) is unknown. The goal of the SPRINT (Systolic Blood Pressure Intervention Trial) ambulatory BP ancillary study was to evaluate the effect of intensive versus standard clinic-based BP targets on ambulatory BP. Ambulatory BP was obtained within 3 weeks of the 27-month study visit in 897 SPRINT participants. Intensive treatment resulted in lower clinic systolic BP (mean difference between groups=16.0 mm Hg; 95% confidence interval, 14.1-17.8 mm Hg), nighttime systolic BP (mean difference=9.6 mm Hg; 95% confidence interval, 7.7-11.5 mm Hg), daytime systolic BP (mean difference=12.3 mm Hg; 95% confidence interval, 10.6-13.9 mm Hg), and 24-hour systolic BP (mean difference=11.2 mm Hg; 95% confidence interval, 9.7-12.8 mm Hg). The night/day systolic BP ratio was similar between the intensive (0.92±0.09) and standard-treatment groups (0.91±0.09). There was considerable lack of agreement within participants between clinic systolic BP and daytime ambulatory systolic BP with wide limits of agreement on Bland-Altman plots. In conclusion, targeting a systolic BP of <120 mm Hg, when compared with <140 mm Hg, resulted in lower nighttime, daytime, and 24-hour systolic BP, but did not change the night/day systolic BP ratio. Ambulatory BP monitoring may be required to assess the effect of targeted hypertension therapy on out of office BP. Further studies are needed to assess whether targeting hypertension therapy based on ambulatory BP improves clinical outcomes. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01835249."},{"id":"330fc320146b","type":"article","url":"https://hartvaat.nl/2017/01/01/bloeddrukverlaging-en-secundaire-cva-preventie-meta-regressieanalyse/","title":"Bloeddrukverlaging en secundaire CVA-preventie: meta-regressieanalyse","title_en":"Blood Pressure Reduction and Secondary Stroke Prevention: A Systematic Review and Metaregression Analysis of Randomized Clinical Trials.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","huisarts","internist"],"tags":["bloeddrukbehandeling","primaire-preventie","secundaire-preventie"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08485","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08485","authors":["Aristeidis H Katsanos","Angeliki Filippatou","Efstathios Manios","Spyridon Deftereos","John Parissis","Alexandra Frogoudaki","Agathi-Rosa Vrettou","Ignatios Ikonomidis","Maria Pikilidou","Odysseas Kargiotis","Konstantinos Voumvourakis","Anne W Alexandrov","Andrei V Alexandrov","Georgios Tsivgoulis"],"significance":7,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":["https://hartvaat.nl/kennis/preventie/esc-richtlijn-cardiovasculaire-preventie-2021/"],"congress":"","summary_en":"This systematic review and meta-regression quantified the relationship between blood pressure reduction and secondary stroke prevention, establishing a continuous dose-response for the protective effect of antihypertensive therapy after cerebrovascular events.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T13:25:49Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en meta-regressie van gerandomiseerde trials naar het verband tussen bloeddrukverlaging en secundaire CVA-preventie. Kwantificeert de optimale bloeddrukreductie na een beroerte.","abstract_original":"Current recommendations do not specifically address the optimal blood pressure (BP) reduction for secondary stroke prevention in patients with previous cerebrovascular events. We conducted a systematic review and metaregression analysis on the association of BP reduction with recurrent stroke and cardiovascular events using data from randomized controlled clinical trials of secondary stroke prevention. For all reported events during each eligible study period, we calculated the corresponding risk ratios to express the comparison of event occurrence risk between patients randomized to antihypertensive treatment and those randomized to placebo. On the basis of the reported BP values, we performed univariate metaregression analyses according to the achieved BP values under the random-effects model (Method of Moments) for those adverse events reported in ≥10 total subgroups of included randomized controlled clinical trials. In pairwise meta-analyses, antihypertensive treatment lowered the risk for recurrent stroke (risk ratio, 0.73; 95% confidence interval, 0.62-0.87; P<0.001), disabling or fatal stroke (risk ratio, 0.71; 95% confidence interval, 0.59-0.85; P<0.001), and cardiovascular death (risk ratio, 0.85; 95% confidence interval, 0.75-0.96; P=0.01). In metaregression analyses, systolic BP reduction was linearly related to the lower risk of recurrent stroke (P=0.049), myocardial infarction (P=0.024), death from any cause (P=0.001), and cardiovascular death (P<0.001). Similarly, diastolic BP reduction was linearly related to a lower risk of recurrent stroke (P=0.026) and all-cause mortality (P=0.009). Funnel plot inspection and Egger statistical test revealed no evidence of publication bias. The extent of BP reduction is linearly associated with the magnitude of risk reduction in recurrent cerebrovascular and cardiovascular events. Strict and aggressive BP control seems to be essential for effective secondary stroke prevention."},{"id":"19ab7a4e2c0b","type":"article","url":"https://hartvaat.nl/2017/01/01/genoomwijde-meta-analyse-van-bloeddrukrespons-op-hydrochloorthiazide/","title":"Genoomwijde meta-analyse van bloeddrukrespons op hydrochloorthiazide","title_en":"Genome-Wide and Gene-Based Meta-Analyses Identify Novel Loci Influencing Blood Pressure Response to Hydrochlorothiazide.","category":"hypertensie","category_label":"Hypertensie","professions":["cardioloog","internist"],"tags":["bloeddrukbehandeling","vrouwen"],"journal":"Hypertension (Dallas, Tex. : 1979)","doi":"10.1161/HYPERTENSIONAHA.116.08267","source_url":"https://doi.org/10.1161/HYPERTENSIONAHA.116.08267","authors":["Erika Salvi","Zhiying Wang","Federica Rizzi","Yan Gong","Caitrin W McDonough","Sandosh Padmanabhan","Timo P Hiltunen","Chiara Lanzani","Roberta Zaninello","Martina Chittani","Kent R Bailey","Antti-Pekka Sarin","Matteo Barcella","Olle Melander","Arlene B Chapman","Paolo Manunta","Kimmo K Kontula","Nicola Glorioso","Daniele Cusi","Anna F Dominiczak","Julie A Johnson","Cristina Barlassina","Eric Boerwinkle","Rhonda M Cooper-DeHoff","Stephen T Turner"],"significance":5,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":["https://hartvaat.nl/kennis/hypertensie/classificatie-bloeddruk-esc-2024/","https://hartvaat.nl/kennis/hypertensie/resistente-hypertensie/"],"congress":"","summary_en":"This genome-wide meta-analysis identified novel genetic loci influencing the antihypertensive response to hydrochlorothiazide, advancing pharmacogenomic approaches to personalized diuretic therapy selection.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T18:38:29Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Genoomwijde en gen-gebaseerde meta-analyse die nieuwe loci identificeerde die de bloeddrukrespons op hydrochloorthiazide beïnvloeden. Farmacogenomisch onderzoek naar gepersonaliseerde hypertensiebehandeling.","abstract_original":"This study aimed to identify novel loci influencing the antihypertensive response to hydrochlorothiazide monotherapy. A genome-wide meta-analysis of blood pressure (BP) response to hydrochlorothiazide was performed in 1739 white hypertensives from 6 clinical trials within the International Consortium for Antihypertensive Pharmacogenomics Studies, making it the largest study to date of its kind. No signals reached genome-wide significance (P<5×10-8), and the suggestive regions (P<10-5) were cross-validated in 2 black cohorts treated with hydrochlorothiazide. In addition, a gene-based analysis was performed on candidate genes with previous evidence of involvement in diuretic response, in BP regulation, or in hypertension susceptibility. Using the genome-wide meta-analysis approach, with validation in blacks, we identified 2 suggestive regulatory regions linked to gap junction protein α1 gene (GJA1) and forkhead box A1 gene (FOXA1), relevant for cardiovascular and kidney function. With the gene-based approach, we identified hydroxy-delta-5-steroid dehydrogenase, 3 β- and steroid δ-isomerase 1 gene (HSD3B1) as significantly associated with BP response (P<2.28×10-4 ). HSD3B1 encodes the 3β-hydroxysteroid dehydrogenase enzyme and plays a crucial role in the biosynthesis of aldosterone and endogenous ouabain. By amassing all of the available pharmacogenomic studies of BP response to hydrochlorothiazide, and using 2 different analytic approaches, we identified 3 novel loci influencing BP response to hydrochlorothiazide. The gene-based analysis, never before applied to pharmacogenomics of antihypertensive drugs to our knowledge, provided a powerful strategy to identify a locus of interest, which was not identified in the genome-wide meta-analysis because of high allelic heterogeneity. These data pave the way for future investigations on new pathways and drug targets to enhance the current understanding of personalized antihypertensive treatment."},{"id":"0d03d4f65fff","type":"article","url":"https://hartvaat.nl/2017/01/01/percutane-linker-hartoorsluiting-munchen-consensusdocument-over-definities-en-ei/","title":"Percutane linker-hartoorsluiting: München-consensusdocument over definities en eindpunten","title_en":"Percutaneous left atrial appendage occlusion: the Munich consensus document on definitions, endpoints, and data collection requirements for clinical studies.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euw141","source_url":"https://doi.org/10.1093/europace/euw141","authors":["Apostolos Tzikas","David R Holmes","Sameer Gafoor","Carlos E Ruiz","Carina Blomström-Lundqvist","Hans-Christoph Diener","Riccardo Cappato","Saibal Kar","Randal J Lee","Robert A Byrne","Reda Ibrahim","Dhanunjaya Lakkireddy","Osama I Soliman","Michael Nabauer","Steffen Schneider","Johannes Brachmann","Jeffrey L Saver","Klaus Tiemann","Horst Sievert","A John Camm","Thorsten Lewalter"],"significance":6,"published":"2017-01-01","source_date":"2017-01-01","image":"","kennis":[],"congress":"","summary_en":"This Munich consensus document standardized definitions, endpoints, and data collection requirements for percutaneous LAA occlusion research, addressing the heterogeneity that had complicated comparison of LAAO studies.","created":"2026-07-03T10:26:29Z","updated":"2026-07-03T13:25:48Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Consensusdocument dat definities, eindpunten en dataverzamelingsvereisten standaardiseert voor onderzoek naar percutane linker-hartoorsluiting. Raamwerk voor vergelijkbaarheid van toekomstige studies.","abstract_original":"The increasing interest in left atrial appendage occlusion (LAAO) for ischaemic stroke prevention in atrial fibrillation (AF) fuels the need for more clinical data on the safety and effectiveness of this therapy. Besides an assessment of the effectiveness of the therapy in specific patients groups, comparisons with pharmacological stroke prophylaxis, surgical approaches, and other device-based therapies are warranted. This paper documents the consensus reached among clinical experts in relevant disciplines from Europe and North America, European cardiology professional societies, and representatives from the medical device industry regarding definitions for parameters and endpoints to be assessed in clinical studies. Adherence to these definitions is proposed in order to achieve a consistent approach across clinical studies on LAAO among the involved stakeholders and various clinical disciplines and thereby facilitate continued evaluation of therapeutic strategies available."}]}